Health Assessment, Improvement Planning and Strategic Planning 101

1
Health Assessment, Improvement Planning and
Strategic Planning 101
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• Jessica Solomon Fisher, NACCHO
• Jim Pearsol, ASTHO
• May 8, 2012

2
Objectives

• Discuss the current landscape of health
  improvement planning
• Detail key components of accreditation
  prerequisites (health assessment, health
  improvement plan, agency strategic plan)
• Describe Community Benefit requirements and
  opportunities to partner

3
Current Landscape

• Demands are increasing while funds are decreasing
• Economic recession means increased need in
  population
• Categorical funding
• Fragile and underfunded infrastructure
• Aging workforce in need of training
• Sustainable funding
• Efforts to repeal ACA uncertainty
• Federal budgets uncertainty cuts
• State and local budgets cuts

4
Challenges in Public Health

• Over 15,000 state health agency (SHA) and 39,000
  local health agency (LHA) jobs lost
• 20 of the workforce
• Over a third of SHAs have imposed furloughs
• Almost 120,000 furlough days
• Equivalent to another 500 workers
• Over 18,000 Jobs in LHAs affected by hours
  reduced or mandatory furlough

5
Opportunities

• Accreditation
• Community Benefit
• Foundation and federal investments
• NPHII
• COPPHI
• Natl partner TA

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PHAB Prerequisites
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Why are the prerequisites, prerequisites?
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Accreditation

• Why Prerequisites?
• Identifies community and health department needs
  and assets
• Good measure of capacity to address identified
  health needs
• Foundation for other documentation
• Springboard to the future

9
Definition Community/State/Tribal Health
Assessment

• What does this mean in your community?

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Definition Community Health Assessment
A community health assessment is a process that
uses quantitative and qualitative methods to
systematically collect and analyze health status
data within a specific community. The process
should involve active community engagement.
Health status data include information on risk
factors, quality of life, mortality, morbidity,
community assets, and other information that
illustrates why health issues exist in a
community. Community health assessment data
inform community decision-making, the
prioritization of health problems, and the
development and implementation of community
health improvement plans. (Issel 2004, Cibula et
al 2003, Dever 1997)
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State Health Assessment

• Common, core function of state health agencies
• Review existing assessment
• Connect SHA and CHA where possible
• Collect new data, as appropriate

12
Common Community Health Improvement Process
Models/Frameworks

• PRECEDE-PROCEED (1970s)
• Planned Approach to Community Health (PATCH)
  (1983)
• Healthy Communities (1980s)
• Assessment Protocol for Excellence in Public
  Health (APEX PH) (1991)
• Protocol for Assessing Community Excellence in
  Environmental Health (PACE EH) (2000)
• Mobilizing for Action through Planning and
  Partnerships (MAPP) (2001)
• Association for Community Health Improvement
  (ACHI) Toolkit
• State-specific models/frameworks

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Common Elements in Health Improvement Process
Models

• Prepare and plan
• Engage the community
• Develop a goal or vision
• Conduct community health assessment(s)
• Prioritize health issues
• Develop community health improvement plan
• Implement community health improvement plan
• Evaluate and monitor outcomes
• Not a PHAB requirement

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Common Steps in Conducting a Health Assessment

• Develop an assessment plan
• Engage the community and local public health
  system partners
• Define the population
• Identify community health indicators that align
  with your Communitys vision or goals for the
  assessment
• Collect data on identified indicators
• Analyze data
• Summarize key findings
• Report results back to community and partners
• not a PHAB requirement and in some cases
  visioning may come before the CHA
• conduct

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PHAB CHA Standards and Measures Version 1.0

• Standard 1.1 PARTICIPATE IN OR CONDUCT A
  COLLABORATIVE PROCESS RESULTING IN A
• COMPREHENSIVE COMMUNITY HEALTH ASSESSMENT.
• Measure 1.1.1 S Participate in or conduct a
  state partnership that develops a comprehensive
  community health assessment of the population of
  the state
• Measure 1.1.2 S Complete a state level
  community health assessment
• Measure 1.1.1T/L Participate in or conduct a
  local partnership for the development of a
• comprehensive community health assessment
• Measure 1.1.2T/L Complete a local community
  health assessment
• Measure 1.1.3 A Ensure that the community health
  assessment is accessible to agencies,
• organizations and the general public

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PHAB CHA Process (Standard 1.1 Measure 1.1.1 T/L)

• Participation of representatives of various
  sectors of local community
• The collaboration could include hospitals and
  healthcare providers, academic institutions,
  local schools, other departments of government,
  community non-profits, and the state health
  department.
• Regular Meetings
• Description of the process used to identify
  health issues and assets
• Provide documentation of the collaborative
  process to identify and collect data and
  information, identify health issues, and identify
  existing state assets and resources to address
  health issues.
• The process used may be an accepted state or
  national model a model from the public, private,
  or business sector or other participatory
  process model.

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PHAB SHA Components (Standard 1.1 Measure 1.1.1 S)

• Participation of representatives of various
  state-level sectors
• The collaboration could include hospitals and
  healthcare associations, provider associations,
  academic institutions, other departments of state
  government, state-wide non-profits, and local
  health department representation.
• Regular Meetings
• Description of the process used to identify
  health issues and assets
• Provide documentation of the collaborative
  process to identify and collect data and
  information, identify health issues, and identify
  existing state assets and resources to address
  health issues.
• The process used may be an accepted state or
  national model a model from the public, private,
  or business sector or other participatory
  process model.

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PHAB CHA Components (Standard 1.1 Measure 1.1.2
T/L)

• Dated within the last five years
• Documentation that data and information from
  various sources contributed to the CHA and how
  data were obtained
• Must include primary and secondary data
• Description of the demographics of the population
  of the jurisdiction served
• General description of health issues and specific
  descriptions of population groups with particular
  health issues
• Narrative description of health issues and
  distribution of health issues
• Should include health issues of the uninsured/low
  income and minority populations
• Description of contributing causes of community
  health issues
• Including behavioral risk factors, environmental,
  socio-economic factors, morbidity/mortality,
  injury, maternal and child health, communicable
  and chronic disease, and other unique
  characteristics
• Must include health status disparities, health
  equity and high health-risk populations
• Description of existing community assets or
  resources to address health issues
• Documentation that the local community at large
  has had an opportunity to review and contribute
  to the assessment

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PHAB SHA Components (Standard 1.1 Measure 1.1.2 S)

• Dated within the last five years
• Documentation that data and information from
  various sources contributed to the SHA and how
  data were obtained
• Must include primary and secondary data
• Description of the demographics of the population
  of the jurisdiction served
• General description of health issues and specific
  descriptions of population groups with particular
  health issues
• Narrative description of health issues and
  distribution of health issues
• Should include health issues of the uninsured/low
  income and minority populations
• Description of contributing causes of health
  issues
• Including behavioral risk factors, environmental,
  socio-economic factors, morbidity/mortality,
  injury, maternal and child health, communicable
  and chronic disease, and other unique
  characteristics
• Must include health status disparities, health
  equity and high health-risk populations
• Description of existing state assets or resources
  to address health issues
• Documentation that the public at large has had an
  opportunity to review and contribute to the
  assessment

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PHAB CHA Components (Standard 1.1 Measure 1.1.3A)

• Documentation that the community health
  assessment has been distributed to partner
  organizations
• Must provide two examples
• Documentation that the community health
  assessment and/or its findings have been made
  available to the population of the jurisdiction
  served by the health department
• Must provide two examples

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Definition Health Improvement Plan

• What does this mean in your community?

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Definition Health Improvement Plan

• A long-term systematic effort to address issues
  identified by the assessment and community health
  improvement process
• Is broader than the health department and should
  include partners
• Considered current by PHAB if developed or
  updated within a 5 year time period prior to
  application
• Based on community health assessment
• Relates directly to Domain 5

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PHAB HIP Standards and Measures Version 1.0

• Standard 5.2 CONDUCT A COMPREHENSIVE PLANNING
  PROCESS RESULTING IN A TRIBAL/STATE/COMMUNITY
  HEALTH IMPROVEMENT PLAN
• Measure 5.2.1 S Conduct a process to develop a
  state health improvement plan
• Measure 5.2.2 S Produce a state health
  improvement plan as a result of the health
  improvement planning process
• Measure 5.2.1 L Conduct a process to develop a
  community health improvement plan
• Measure 5.2.2 L Produce a community health
  improvement plan as a result of the community
  health improvement process
• Measure 5.2.1 T Conduct a process to develop a
  Tribal community health improvement plan
• Measure 5.2.2 T Produce a Tribal community
  health improvement plan as a result of the health
  improvement process
• Measure 5.2.3 A Implement elements and
  strategies of the health improvement plan, in
  partnership with others
• Measure 5.2.4 A Monitor progress on
  implementation of strategies in the community
  health improvement plan in collaboration with
  broad participation from stakeholders and partners

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PHAB HIP Process (Standard 5.2 Measure 5.2.1 S,
L, T)

1. Broad participation of public health
   system/community partners
2. Information from the SHA/CHAs
3. Issues and themes identified by stakeholders
4. Identification of state/local/Tribal assets and
   resources
5. A process to set state/local/Tribal health
   priorities

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PHAB HIP Components (Standard 5.2 Measure 5.2.2
S, L, T)

1. Dated within last five years
2. Health priorities, measurable objectives,
   improvement strategies, and performance measures
   with measurable and time-framed targets
3. Policy changes needed to accomplish health
   objectives
4. Individuals and organizations that have accepted
   responsibility for implementing strategies
5. Measurable health outcomes or indicators to
   monitor progress
6. Alignment between state/local/national/Tribal
   priorities

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5.2.3A Implement elements and strategies of the
health improvement plan, in partnership with
others

• The health department must provide
• Reports of actions taken related to implementing
  strategies to improve health
• Examples of how the plan was implemented

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5.2.4A Monitor progress on implementation of
strategies in the HIP collaboration with broad
participation from stakeholders and partners

• Evaluation reports on progress made in
• implementing SHIP strategies must show
• Monitoring of performance measures
• Progress related to health improvement indicators
• The health department must show that the health
  improvement plan has been revised based on the
  evaluation

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Common Steps in Developing a HIP

1. Ongoing engagement of community and public health
   system partners
2. Review findings of HA
3. Determine health priorities based on HA findings
   and community and partner input and how these
   were chosen
4. HIP implementation plan/ work plan develop
   goals, measurable objectives, strategies,
   timeline, and organization/persons responsible
   to address each identified health priority not
   limited to HD responsibility-refer to PHAB CHIP
   standard/measure language.
5. Devise process for monitoring progress on work
   plan implementation and meeting goals and
   objectives
6. Distribute HIP throughout the community/state
7. Action and monitoring action

29
Affordable Care Act Community Benefit
Requirements

• CHNA every three years
• Community engagement
• Incorporation of public health expertise
• Implementation strategy
• Accessible to the community

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Opportunity IRS Community Benefit Requirement

• Community Benefit

• Community Need

• Program or activities that provide treatment or
  promote health as a response to community needs
  and meet at least one community benefit
  objective
• Improve access to health services
• Enhance public health
• Advance knowledge
• Relieve government burden

• Community need can be demonstrated through
• Community health needs assessments
• Request from public agency or community group
• Partnership with government or other tax-exempt
  organizations

Source PPACA, Sec. 9007 and AHAs April 19, 2010
Detailed Summary of the legislation.
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Reasons to Consider Partnering with Hospitals

• By and large, they serve the population you serve
• They are/will be conducting CHNAs in any case
• Lots of valuable data (and knowledge)
  complementary to public healths own
• Potential economies of scale on assessment costs
  effort
• Potential voluntary coordination on
  priority-setting
• Potential voluntary coordination on plans and
  actions

32
Opportunities to Partner Points in the Process

• Discussion of opportunities
• to engage with hospitals at
• each step along the way.
• Tailor your approach to
• meet each partys needs
• in your case.

Note Six step process is from ACHI Community
Health Assessment Toolkit.
33
Definition Strategic Plan

• What does this mean in your agency?

34
Department Strategic Plan

• A strategic plan results from a deliberate
  decision-making process and defines where an
  organization is going. The plan sets the
  direction for the organization and, through a
  common understanding of the mission, vision,
  goals and objectives, provides a template for all
  employees and stakeholders to make decisions that
  move the organization forward.
• Internal to the health department
• Sets what the health department plans to achieve
  and how it will do that
• Guide to
• Making decisions
• Allocating resources
• Taking action

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Agency Strategic Plan

• Domain 5 Develop public health policies and
  plans
• Standard 5.3 Develop and implement a health
  department organizational strategic plan.
• Measure 5.3.1 A Conduct a department strategic
  planning process
• Measure 5.3.2 A Adopt a department strategic
  plan
• Measure 5.3.3 A Implement the department
  strategic plan

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PHAB Required Components for a Strategic Plan

• Mission, vision and guiding principles/values for
  the health department
• Strategic priorities
• Goals and objectives with measurable and
  time-framed targets
• Identification of external trends, events, or
  other factors that may impact community health or
  the health department
• Analysis of the HDs weaknesses and strengths
• Linkages with the HIP and QI plan
• Members of the Governing Body involved in the
  process

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What is the difference?
38
Putting it all Together
Health Assessment
39
Prerequisites
CHA
CHIP
SP
Domains 1, 2, 3, 4, 5, 6, 7, 8, 9, 10
Essential Service 1, 2, 3, 4, 5, 6, 7, 8, 9 10
Essential service system performance measured
using the NPHPSP instrument can inform health
department PHAB domain performance. MAPP and
NPHPSP can be deliberately designed to meet
standards in domains 1, 3, 4, 5, 7, and 10.
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NACCHO Resources
Strategic Planning Resources

• Strategic Planning

• CHA/CHIP and MAPP

Accreditation/QI

• Example strategic plans and guidance materials
• Strategic planning webinar, May 16th, 3 430
  PM ET
• Developing a LHD Strategic Plan a How-To Guide
• Pre-conference training at NACCHO Annual, July
  11, 2012
• Virtual TA

• Example CHA/CHIPs
• CHA/CHIP Resource Center
• MAPP Clearinghouse http//www.naccho.org/topics/in
  frastructure/mapp/framework/clearinghouse/
• Virtual TA
• MAPP Network

• Accred Coordinators Learning Community
• QI Roadmap
• Webinar series
• Documentation repository and staff review
• Virtual TA
• accreditNATION e-newsletter

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NACCHO Websites

• Strategic Planning
• http//www.naccho.org/topics/infrastructure/accred
  itation/strategic-plan.cfm
• CHA/CHIP
• www.naccho.org/chachipgeneral
• MAPP
• www.naccho.org/mapp
• Accreditation/QI
• www.naccho.org/accreditation

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ASTHO Resources
Strategic Planning Resources

• Strategic Planning, SHA, and SHIP

• Example strategic plans, SHAs and SHIPs and
  guidance materials
• Accreditation and Performance Improvement Guide
• Onsite and Virtual TA
• PHAB prerequisites http//www.astho.org/Programs/A
  ccreditation-and-Performance/Accreditation/Prepari
  ng-for-Accreditation/

• SHA Accreditation Coordinators Network
• SHIP guidance and resources
• http//www.astho.org/Display/AssetDisplay.aspx?id
  6597

43
ASTHO Resources

• Custom-designed, hands on technical assistance
• Staff, Peer to Peer connections, SME expertise,
  funding partners
• On-site, teleconference, webinar, and/or email
• State health agency workgroups, planning
  resources, templates, tools , slide
  presentations, state examples
• ASTHO Accreditation Performance Website,
  Webinars (archived webinars)
• ASTHO Quality Connection newsletter
• ASTHO, CDC, RWJF, and partner web pages and
  newsletters
• Readiness assessment for PHAB prerequisites and
  across domains (gap analysis and self-assessment)
  
• Road mapping to accreditation
• Quality Improvement Tools, Techniques and
  Strategies
• http//www.astho.org/Programs/Accreditation-and-Pe
  rformance/

44

• Jessica Solomon Fisher
  Jim Pearsol
• jfisher_at_naccho.org
  jpearsol_at_astho.org
• 202.507.4265 202.371.9090

For more information