Are you looking to integrate the CHNA into your strategy? Then you don’t want to miss this webinar. All hospitals are required to conduct these assessments, so learn how best to connect and streamline your strategic planning and marketing activities to maximize your brand’s impact. In this webinar, originally presented December 6, 2016, Lee Ann Lambdin, Stratasan’s SVP of Healthcare Strategy, and Jon Headlee, President of Ten Adams, discuss how to extend your Community Health Needs Assessment to create effective wellness initiatives from the inside out.

1. INTEGRATING YOUR
COMMUNITY HEALTH NEEDS
ASSESSMENT INTO YOUR
STRATEGIC GAME PLAN
Strategic Planning + Marketing Insights for Hospitals:
A Three-Part Webinar Series

2. J O N H E A D L E E ,
P R E S I D E N T

3. L E E A N N L A M B D I N
S V P
H E A L T H C A R E S T R A T E G Y

4. OBJECTIVES
• Refresh on the required components of a CHNA
• Learn the similarities between a CHNA process and
strategic planning process
• Learn how to use the information gathered in the CHNA
for the strategic plan
• Share how healthcare organizations used a wellness and
a brand strategy to improve the health of their population.

5. REQUIRED
COMPONENTS
OF A CHNA

6. REQUIREMENTS
§ The Affordable Care Act includes a requirement that all 501(c)(3)
hospitals conduct a community health needs assessment in order to
maintain their tax-exempt status. This requirement is in effect for the
taxable year of each hospital beginning after March 23, 2012.
§ Investor-owned hospitals are exempt
§ Final Rules released December 31, 2014 (Happy New Year!)

7. IRS FORM 990
SCHEDULE H
REQUIREMENTS

8. DON’T JUST CHECK THE BOX
Open letter to Hospital CEOs,
The Accountable Care Act requires hospitals to
perform community health needs assessments
(CHNA).
The CHNA can be a valuable strategic planning
tool and source of information. Many CEOs are
assigning responsibility for the CHNA to others in the
organization who have no idea the strategic value of
a CHNA.
Some organizations are “checking the box”
performing the CHNA to meet the IRS requirement
and do not appear to be using the information for
meaningful strategic planning. Please don’t do this!
Sincerely,
Stratasan

9. THE STRATASAN
CHNA PROCESS

10. FIVE STAGE PROCESS
STAGE 1 – Market Research Analysis
Service area definition, market share, utilization
STAGE 2 – Community Health Needs Assessment and Evaluation
Secondary Research
STAGE 4 – Community Engagement Summit
Community involvement – sharing the information, prioritization and brainstorming solutions
STAGE 5 – Final Report
Written report/presentation suitable for website
STAGE 3 – Validate Findings
Primary Research: Survey ≈400 consumers, online survey associates and medical staff,
interviews, focus group(s)

11. STAGE 1
– MARKET RESEARCH ANALYSIS
§ Map hospital patient data to block group level – IP, OP, ED
§ Service area analysis
§ Analyze utilization – IP, OP, ED top diagnoses
§ Map Psychographics and demographics of area
§ Business and industry analysis, Commuter profiles (daytime versus
nighttime population)
§ Market Share by ZIP Code, service line, In/Out Migration (either
State data or Medicare)

12. STAGE 2
– SECONDARY RESEARCH AND EVALUATION
§ Determine health needs and determinants
§ Socioeconomics and demographics
§ Public health data analysis
§ Access to healthcare issues
§ Hot Spot analysis
§ Evaluation of medically underserved, low-income and minority populations
§ Asset Inventory - document all other healthcare and non-profit groups in the
community
§ Evaluation of the impact of actions that were taken since the preceding CHNA

13. POPULATION BY CENSUS TRACT
Source(s): Stratasan (2016); Esri (2015)
Yellow is positive up to the TX growth
Green is greater than the TX growth
Dark green is twice the TX growth rate
POPULATION GROWTH RATE

14. MEDIAN AGE MEDIAN INCOME

15. SMOKE 9+ PACKS OF CIGARETTES PER WEEK BY CENSUS TRACT
Source(s): Stratasan (2016); Esri (2015)

16. CONTIGUOUS COUNTY HEALTH RAKINGS + MEASUREMENTS
Source(s): Stratasan (2016); County Health Rankings (2015); Bureau of Labor
Statistics (2015)
TX county rankings
based on 241
counties.
Kerr Bandera Kendall Edwards Gillespie Kimble Real
Overall Rank 72 33 6 132 16 78 179
Health Outcomes 123 31 10 150 27 82 239
Length of Life 138 20 13 119 39 64 240
Quality of Life 123 77 14 179 33 142 170
Health Factors 21 36 2 114 6 74 119
Health Behaviors 18 21 5 23 14 19 104
Clinical Care 9 73 2 234 6 216 164
Social & Economic Factors 107 71 4 163 16 121 160
Physical Environment 110 152 137 1 21 4 5
Low Birth Weight 9.0% 9.3% 7.5% 9.4% 7.4% 9.7% 9.1%
Adult Smoking 14% 14% 13% 13% 13% 14% 15%
Adult Obesity 25% 28% 27% 29% 31% 30% 30%
Physical Inactivity 30% 28% 22% 28% 28% 27% 29%
Teen Birth Rate
(per 1,000 female pop 15-19)
53 30 22 72 43 45 50
Diabetes 13% 12% 10% 16% 13% 13% 15%
Uninsured 26% 25% 21% 35% 28% 32% 31%
Pop per Primary Care
Physicians
1,189:1 4,120:1 1,399:1 1,884:1 768:1 1,494:1 NA
HS Graduation 90% 92% 99% NA 96% NA NA
Unemployment 4% 4% 3% 5% 3% 4% 6%
Excessive Drinking 15% 16% 18% 14% 15% 15% 14%
Long Commute 16% 59% 45% 26% 20% 19% 23%
• Health Outcomes: how long people live and how healthy people feel and low birth
weight babies.
• Health Factors: health behaviors, clinical care, social and economic, and the physical
environment.

17. KERR COUNTY, TX HEALTH RANKINGS
Community safety
Education – HS graduation,
some college
Family & social support
Employment
Housing and commuting
Environmental quality
Income
STDs & Teen births
Alcohol use (Excessive drinking)
Obesity, Diet & exercise
Adult Smoking
Uninsured, PCPs, Dentists,
Mental Health providers
Preventable hospital stays,
diabetic and mammo screening
Physical environment
(10%)
Rank #110 out of 241
Social & economic
factors (40%)
Rank #107 out of 241
Health behaviors (30%)
Rank #18 out of 241
Clinical care (20%)
Rank #9 out of 241
Health Factors
Rank #21 out of 241
Programs and
Policies
Length of Life: 50% Rank #138 out of 241 (Premature death)
Quality of Life: 50% Rank #123 out of 241 (poor or fair health, poor
physical and mental health days, low birthweight)
Source(s): Stratasan (2016); County Health Rankings (2015)
Health Outcomes
Rank #123 out of
241

18. STAGE 3
– VALIDATE FINDINGS/PRIMARY RESEARCH
§ Stakeholder identification
§ Telephone and/or on-line community survey n=400
§ 10 -12 question on-line survey for associates and physicians
§ Input through focus group(s) and/or interviews

19. STAGE 4
– COMMUNITY INPUT AND ENGAGEMENT
§ Invite members of the community, stakeholders, leaders, public health,
government, schools, clergy, law enforcement, non-profit agencies,
United Way, Colleges, medical staff, underserved populations or
representatives, minority populations, all ages, representative of whole
community.
§ Leadership Forum (approx. 10 people) – leaders, secure commitment
§ Community Health Summit (approx. 100 people)

20. COMMUNITY HEALTH SUMMIT

21. STAGE 5
– FINAL REPORT
§ Community Health
Report suitable for
website, newspaper,
display at hospital
summarizing the
process, data and the
summit.

22. IMPLEMENTATION
§ After the assessment and prioritization of the top health issues, a
hospital must create an implementation plan:
§ Community-benefit
§ Community- building
§ IRS encouraged joint CHNA implementation strategies
§ Based on the results of this CHNA, Peterson selected three of the
identified significant health needs to address:
§ Mental Health/Substance Abuse
§ Chronic Diseases
§ Access to Healthcare

23. EVALUATION OF IMPACT
§ The hospital must include an evaluation plan of the impact of
activities in the implementation plan.
§ Measurement and Monitoring

24. AFTER THE ASSESSMENT…
IMPLEMENTATION AND EVALUATION
Plan
§ Engage Stakeholders
§ Describe the program
§ Focus evaluation design
Implement
§ Gather credible evidence
Analyze and use findings
§ Justify conclusions
§ Ensure use and share lessons learned
Source: http://www.cdc.gov/eval/framework

25. PRIORITY ISSUES, GOALS
AND MONITORING IMPACT
Health Issue Goal Statement
Washington
Co Pre-CHNA
Score
Current
(2016) Score
Washington
Co Goal
National
Median/Avg
or Rate
Best
Practice/
National
Benchmark HP 2020 Goal
Access to Care
Population to primary care
physician ratio Increase access to primary care physicians by 10% 1,601:1
2,112:1*
measure
modified in 1,067:1 1,067:1 NA
Primary care physicians per 100,000
pop Increase access to primary care physicians by 10% 123.9 120.3 132.3 119.9 175 NA
Obesity
Adult Obesity Decrease adult obesity by 5% 29.0% 33.0% 31.4% 27.8% 25% 10% decrease
Chronic Disease
% of adult population with
diabetes
Decrease the number of the adult population with
diabetes by 2% 9.0% 10.0% 9.8% 9.7% 6.0% Decrease by 10%
Diabetic Screening
Increase diabetic screening for Medicare
population to 90% 86.0% 88.0% 90.0% 90.0% NA
Heart disease
Reduce incidence of heart disease by 10% in 5
years
183.6 deaths
per 100,000 180
Mammography screening
Increase diabetic screening for Medicare
population to 70% 69.0% 64.0% 70.0% 74.0%
Cancer Death Rate Decrease the death rate by 10% by 2020 221.1 181.9 163.7 176.4 160.6
160.6; 10%
improvement
Cancer Incidence Decrease the incidence of cancer by 10% by 2020 453.0 436.3 392.7 453.7
333.2
(Calhoun Co,
Smoking/Drinking/Drug Abuse
% of adults smoking Decrease smoking by 10% 18% 18% 16.2% 19.6% 13% 12%

26. CHNA AS A STRATEGIC
PLANNING TOOL
§ Listening beyond the CHNA integrating into the strategic plan and customer service
initiative
§ Determining the health needs of the community is key to product line development
§ Uncovering access issues assists with the physician/provider recruitment strategies
§ Relationship building with the community
§ Partnering with other resources in the community is key for population health
§ A telephone or on-line survey can be expanded to not only include community health
issues, but also access and image questions.
§ The implementation plan of a CHNA should be a category within the facility’s
strategic and implementation plan
§ Coordinate the timing of the CHNA prior to the beginning of the strategic planning
process

27. Sharp Healthcare added
community as have many other
systems and hospitals.
PILLARS OF EXCELLENCE

28. § Baldrige Criteria 3, “Customer” includes “Voice of the Customer”
and “Customer Engagement”
§ Process for listening to your patients and customers
§ Customer relationship strategies
§ Engagement as strategic action
BALDRIGE CRITERIA

29. S T R AT E G Y

30. CHNA as strategic planning
tools also known as…
“Why investor-owned
hospitals perform a CHNA”

31. § Politically and socially adept investor-owned hospitals are performing
CHNAs
§ Why? See previous slides…
INVESTOR-OWNED HOSPITALS
PERFORMING CHNAs

32. WELLNESS STRATEGY

33. I N S I D E - O U T
– H O S P I TA L E M P L O Y E E S C O M PA R E D
T O U . S . W O R K F O R C E
Higher burden of illness and higher healthcare costs
Higher
percentage of
chronic
conditions by
risk group
Compliance
with common
preventive
measures is
consistently
lower

34. § Improved access
§ Convenience
§ Reduced absenteeism
§ Improved productivity
§ Improved health outcomes
§ Strong employee retention
and morale
§ Reduced healthcare costs
I N S I D E - O U T
– C O M M O N E M P L O Y E R G O A L S

35. 3 Hospital System – 323 beds
- Tanner Medical Center – Carrollton
- Tanner Medical Center – Villa Ricca
- Higgins General Hospital
2,800 employees
150,000 residents

36. • Access to Care
• Social Determinants to Health
• Chronic Disease Issues
• Obesity
• Heart Disease
• Diabetes
• Cancer
• Mental Health
CHNA RESULTS

37. • Prevent + Reduce Tobacco Use
• Prevent + Reduce Obesity
• Increase Physical Activity
• Improve Nutrition
• Increase Access to + Demand for High Impact Quality
Preventative Services
• Improve Community Environment to Support Health
A R E A O F F O C U S F O R
M A R K E T I N G & C O M M U N I C AT I O N

39. • Prevent + Reduce Tobacco Use
• Diabetes Education, Prevention + Management
• Childhood Obesity Task Force
• Healthy Child Care Centers
• Healthy + Safe Communities

40. • Improve Nutrition
• Regional Food Systems Collaborative
• Cooking Matters Series
• Farmers Markets
• Local Food + Restaurant Challenges
• Community Gardens
• Nutrition Training in Schools

41. • Increase Physical Activity
• Weight Loss Challenges
• Healthy Life Classes
• Group Exercise Classes
• Youth Wellness Classes
• Faith Based Wellness
• Business + Industry Wellness
• Take 10 Training Classes – School Program

42. WALKING TRAILS

43. FITNESS TRACKERS

44. FITNESS TRACKERS

45. RESULTS
• Combined Employee Miles -- 192,000
• Average HDL (Good) – Improved 5.5 points
• Average LDL (Bad) -- Decreased 14.2 points

46. CAMPAIGN LAUNCH

52. 52

53. 53

58. Prevent + Reduce Tobacco Use
• Quitline
Free counseling, resources + referral
service for smokers
• Business + Industry
Implemented tobacco free policies
• Speakers Bureau
Available health benefit information

59. Diabetes
• 17 Lifestyle Coaches
• 74 Registered -- Each has
lost an average of 10.8 pounds – 529 Total Pounds!
• 70% achieved measurable improvements

60. Improve Nutrition
Cooking Matters – Classes to
provide nutrition + education and
cooking instruction led by 46
Volunteer Instructors
Sponsored monthly cooking tips
at local farmers markets
Introduced SNAP benefits

61. Improve Nutrition
Exploring future partnerships
for a Regional Food Systems
Collaborative – including
farmers, business, restaurant
owners, chefs, school nutrition
directors + master gardeners.

62. Community Gardens
• Created 46 new gardens
• Benefited residents +
food banks
• Grew Knowledge for Life

63. GARDEN
CLUBS
BOYS &
GIRLS CLUB
FAITH-BASED
GROUPS
Educated Community Groups for Sustainability
4-H GROUPS
SCHOOLS
UNIVERSITY
STUDENTS
COMMUNITY
MEMBERS

64. Weight Loss Challenge
• Log your exercise
• Keep a food diary
• Track your weight loss
• Calculate your BMI (body mass index)
• Participate in local and regional exercise
challenges
• Connect with friends or coworkers
• Create your own group challenges
• Share healthy recipes or encouraging
messages

65. Increase Physical Activity
• 233 Participants
• Lost more than 2,400 Pounds
• Local Businesses provided
financial support
• Provided Exercise and Nutrition Classes
-- Over 500 Attended

66. Physical Activity for Kids
“Take 10 Program”
• 148 - 1st Grade Teachers Trained
• 10 min. bursts of activity
• 3,000 area students added an
additional 30 minutes of physical
activity to their school day
• Tanner Designed Play about Nutrition – reached 4,000
students K-3rd

67. COMMUNITY +
BRAND STRATEGY

68. 124 Bed Hospital
900+ Employees
Approx. 50,000 in County

69. 69
I N T E R N A L T H E M E S

97. • Be Prepared
- Know the Required Components of the CHNA
• Be Smart
- Align your strategic planning with the CHNA process to save
time and resources
• Be a Leader
- Develop compelling messages that will educate and inform your
community about the services offered from your organization.
• Be Accountable
- Build measurements into your planning so you can celebrate
your successes
WRAP UP

99. L E E A N N L A M B D I N
S T R A T A S A N
8 6 6 . 6 2 8 . 5 0 5 1 X 7 0 6
l e e a n n @ s t r a t a s a n . c o m
J O N H E A D L E E
T E N A D A M S
8 1 2 . 2 5 3 . 6 3 0 0
j h e a d l e e @ t e n a d a m s . c o m
WANT TO TALK?

100. THANK YOU!