UCHealth hospitals eye community health, choose their targets

Mandated Community Health Needs Assessment implementation plans are in. Access to care, behavioral health care, cardiovascular disease prevention and cancer care are the top focus areas
January 25th, 2017

UCHealth’s hospitals identified the key health care needs of the communities they serve in early 2016. Now, having done the hard work of figuring out how to best meet those needs, they’re setting out to address them.

UCHealth’s formal, increasingly integrated community health efforts were triggered by Affordable Care Act (ACA) regulatory processes rolled out in 2013. The act instructs all nonprofit hospitals to show they’re deserving of nonprofit tax status by identifying the biggest health needs of their communities and taking concrete steps to address them. Hospitals must do this every three years.

The 2016 community health needs assessment (CHNA) effort wrapped up in June. The road was smoother for UCHealth Northern Colorado hospitals – Poudre Valley Hospital and Medical Center of the Rockies – than for University of Colorado Hospital in Aurora (UCHealth Metro Denver) and Memorial Hospital in Colorado Springs (UCHealth Colorado Springs). That’s because the northern Colorado institutions have had experience with the reporting process, or something close to it: since 2009, when the Internal Revenue Service required Schedule H (for hospital) as an addendum to its Form 990, the northern Colorado hospitals have been formally cataloging their community programs.

For UCH, an academic medical center the formal community needs assessment process wasn’t required until 2013. For Memorial, Hospital, formerly a city-owned institution, process became a requirement in 2014.  This time, the process was more ingrained into system-wide planning, thanks to big assists from the Community Benefit team at UCHealth Northern Colorado. The three regions’ CHNAs are linked here.

The same, but different

The ACA says CHNAs should be done in concert with local health care experts and others. These teams should independently identify the top health care needs in those communities, with an emphasis on those which the hospital in question can do the most to help. Interestingly, all three of UCHealth’s CHNA efforts independently settled upon two health problems among their top three or four targets. They were improving access to care and cardiovascular disease prevention and control.

In addition to supporting the various endeavors of its regional hubs, UCHealth plans to harness its power as a unified system through new task forces dedicated to addressing these two top community health needs.

The rest diverged somewhat by region. The UCHealth Northern Colorado hospitals as well as UCHealth Metro Denver identified improving mental and behavioral health services as a third option. UCHealth Northern Colorado added transportation between health care facilities as a fourth pressing community need. At UCHealth Colorado Springs, the early detection and prevention of cancer rounded out the principal community needs.

A closer looks shows divergence even among the shared conclusions. The UCHealth Northern Colorado “access to care” needs focused on those of older-adult, underinsured and minority populations. UCHealth Metro Denver pointed to improving access to specialists of the sort more common at a major academic medical center. UCHealth Colorado Springs’ access needs focused on primary and behavioral health care, with an emphasis on suicide prevention.

The top needs at UCH and other UCHealth hospitals bubbled up through an analysis of the scope and severity of the health need, the economic feasibility of addressing it and the hospitals’ potential to impact it, and alignment with the UCHealth system’s overall service strategies. Also, the needs assessments looked beyond the third- or fourth-line item. As an example, 109 respondents to a survey of medical providers in University of Colorado Hospital’s service area also listed alcohol and substance use disorders, obesity, and diabetes as top community health issues.

Memorial Hospital as well as UCHealth’’s University of Colorado Hospital and Poudre Valley Hospital/Medical Center of the Rockies, released their three-year Community Health Needs Assessments in June. Now they’’re rolling out programs to address those community needs.

With the needs now defined, the next step is to address them. Teams across UCHealth have developed their own implementation plans to tackle the key community needs identified in the CHNA. The plans of UCHealth Colorado Springs and UCHealth Northern Colorado have already been approved by their respective hospital boards; UCHealth Metro Denver’s goes before the University of Colorado Hospital board on Nov. 15.

The health system has an expansive view of community that goes beyond programs aimed at narrow geographic regions and demographics. For UCHealth Northern Colorado, it’s everyone in Larimer and Weld counties, nearly 600,000 people. For UCHealth Metro Denver, it’s more than 2 million people in Denver, Adams, Arapahoe, and Douglas counties. UCHealth Colorado Springs’ community encompasses El Paso County’s population of 700,000. Taken together, that’s about two-thirds of the state’s population.

Here’s the plan

The programs to address these communities’ needs are diverse. UCH Northern Colorado’s implementation plans outline nine programs dedicated to improving access to care alone, ranging from free postpartum nurse home visits for newborn health assessments and lactation counseling to the Healthy Harbors program, which provides patient-centered medical homes for at-risk patients. Another seven programs and services address cardiovascular disease prevention and control, from diabetes prevention to the Healthy Hearts school-based education and heart disease risk-factor screening program. For mental and behavioral health, UCH Northern Colorado offers six programs, including a major initiative in new suicide prevention community coalitions in Larimer and Weld counties.

At UCHealth Metro Denver, the focus of improving specialty care will be on enhancing and growing UCH’s e-consult and telehealth capabilities. For cardiovascular disease, the emphasis will be on smoking cessation and education. And with mental and behavioral health, it’s going to be about improving and expanding relationships with community-based programs and developing a business case for a specialized patient treatment area in the UCH Emergency Department, says Keith Peterson, UCH’s director of Community Relations.

UCHealth Colorado Springs’ implementation plans include 11 programs to improve access to care. They include the long-running HealthLink nurse advice line, a new partnership to connect low-income residents to donated health services, and the fostering of local physician recruitment and development through a new medical-residency program. The seven cardiovascular disease prevention and control programs range from an online cardiovascular risk assessment tool to tobacco-cessation and diabetes-prevention classes. For early detection and prevention of cancer, UCHealth Colorado Springs will provide six initiatives that include 3D mammography at no extra cost, online lung cancer risk screening, and annual free skin cancer screening events, among the six initiatives listed.

“We take this CHNA process, priority determination, and implementation very seriously,” said Jeff Thompson, UCHealth’s vice president for government and corporate relations, in an email. “We absolutely see this as a vehicle to significantly address strategies that will seek to improve health conditions of the community populations we serve.”