Originally posted on September 29, 2016
By Joanne Conroy, MD, and Susan Dentzer
In a recent post on WBUR’s CommonHealth, two doctoral students pleaded with Boston-area hospitals to collaborate on a joint community health needs assessment, as each is required to do every three years under the Affordable Care Act. As the CEOs of two organizations deeply engaged in health and health care, we couldn’t agree more.
In fact, we propose upping the ante. We want to persuade all hospitals in the greater Boston area to partner with state and local government, community health centers, regional planning agencies, community development corporations and others on such an assessment, known as a CHNA, and to help create a joint community health improvement plan to truly drive change in the region.
NEHI, the Network for Excellence in Health Innovation, recently conducted an analysis of 26 different CHNAs carried out by hospitals in Greater Boston. All of these assessments identified common health needs across all communities: chronic illness, lack of access to care for many populations, substance abuse, mental and behavioral health, and obesity; and were carried out amid considerable effort and expense by hospitals. However, the community health improvement plans that the hospitals put forward to address the needs varied greatly depending on hospital resources and capacity.
There are many reasons to dispense with the duplication of effort, collaborate on a joint assessment, and focus collective action on the common goal of improving health. There is plenty of excellent work, and substantial investment already underway, to build upon.
The Conference of Boston Teaching Hospitals (COBTH), a coalition of 14 Boston-area teaching hospitals of which Lahey Hospital & Medical Center is a member, provided more than $140 million in fiscal year 2015 in direct community benefits—the philanthropic investments required of hospitals that are federally tax-exempt. These hospitals partnered with more than 400 agencies to develop and deliver these programs and services. They include nutritional education and exercise programs aimed at low-income youth; a food pantry where people can fill “prescriptions” for healthy food; and programs to help seniors stay active and lose weight. Imagine what could happen if such programs were scaled up, and targeted even better to the communities most in need?
What’s more, as John Erwin and John Quinlan noted in their recent post, the COBTH hospitals have already begun to collaborate on their CHNAs. They are conducting joint focus groups to ask community members about health needs, collecting common data elements, and coordinating requests for data from state agencies.
All of these measures could lay the foundation for a true regional health needs assessment—carried out with state and local agencies, employers, and health insurers—that could draw on the best and broadest data to delineate the greatest needs. For example, data collected in 2014 through a large national survey show that Suffolk, Essex, and Middlesex counties fared worse than the national average in depression and preventable hospitalization in older adults, as well as in cancer diagnoses and, in some cases, cancer deaths. But even more useful analyses would collect even more data: for example, emergency calls to 911, or claims submitted to Medicare and Medicaid. The data and analysis could go down to the neighborhood—or even block—level, to show who’s most at risk, and target interventions accordingly.
The experience of other communities that have undertaken joint needs assessments shows that they can not only lead to targeted interventions, but can also help shape public policy to improve health. The county of Santa Cruz, California, has been collecting and analyzing local health and related data for more than two decades through the Community Assessment Project. Drawing on the project’s findings, community leaders have targeted priorities for action—in one instance, pointing to alcohol abuse rates to alter plans for one downtown entertainment district, and in another, setting a goal of cutting obesity rates in the county by 10 percent by 2020.
Can Greater Boston do as well, or even better? Collaborating across multiple sectors and communities to produce a joint assessment would hardly be a natural act. It may be necessary to delegate the task of coordinating it to a state agency or a third-party organization. And once a regional health improvement plan were adopted to address identified needs, it would be critical to track its implementation and assess its progress over time.
The good news is that the region has unmatched expertise in research, data collection and analysis, public health, prevention, and clinical care. We can work together on a far better regional health needs assessment, and commit to making a far more dramatic impact on the major drivers of poor health.
Joanne Conroy, MD, is CEO of Lahey Hospital & Medical Center, a physician-led, nonprofit group practice with more than 500 physicians, 5,000 nurses, therapists and support staff, and hospitals in Burlington and Peabody. She blogs at joanneconroymd.com. Follow her on Twitter @joanneconroymd.
Susan Dentzer is President and CEO of NEHI, the Network for Excellence in Health Innovation, a nonprofit think tank based in Cambridge, whose supporting members span the spectrum of health and health care.