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Advancing the State of the Art in Community Benefit: Honoring the Trust


Eileen Barsi, Director Community Benefit, CHW. Maya Dunne, VP of Community Outreach, SJHS ... Anchors for Planning. Emphasize disproportionate unmet health needs. ... – PowerPoint PPT presentation

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Title: Advancing the State of the Art in Community Benefit: Honoring the Trust

Advancing the State of the Art in Community
Benefit Honoring the Trust
  • Catholic Health Association
  • February 6, 2007
  • Eileen Barsi, Director Community Benefit, CHW
  • Maya Dunne, VP of Community Outreach, SJHS

Getting Acquainted
  • Who are we?
  • What we do / what weve done

Learning Objectives
  • How can we together move our Catholic health
    systems to a point of distinction?
  • How can we foster a transforming environment that
    achieves measurable change in community health
  • How can we best honor the covenant we have with
    our communities to improve the quality of life?

Presentation Overview
  • Impetus for ASACB
  • ASACB Core Principles
  • Institutional Policy Measures
  • Uniform Programmatic Measures
  • Uniform Reporting Standards
  • Update on System Implementation
  • Challenges / Successes
  • ASACB Vision

Community Benefit Defined
  • IRS definition - The promotion of health for
    class of beneficiaries sufficiently large enough
    to constitute benefit for the community as a
  • Reference to a defined community suggests a
    population health orientation.
  • Determining the minimum size for the class of
    beneficiaries needed in order to produce a
    benefit for the larger defined community suggests
    accountability to achieve a measurable impact.
  • IRS Ruling 69-545
    (1969) and IRS Ruling 83-157 (1983)

Community Benefits Defined
  • a planned, managed, organized, and measured
    approach to. . . meeting identified community
    health needs.

Recent Trends - National
  • Billing and collection practices
  • Public reports (e.g., Yale-New Haven Hospital)
  • Scruggs class actions (50 suits 370)
  • Provena Covenant tax exemption challenge
  • Nonprofit hospital functions and roles
  • Led by Rep. Thomas and Sen. Grassley
  • Hearings started in 2004
  • Issues include compensation, contracting, B of D
    functions, transparency
  • IRS audit to determine hospital spending on CB

Communities of Concern
  • Hospitals Downward pressure on reimbursement
    increasing costs, and growing number of uninsured
    threatens financial viability.
  • Community/Consumer Advocates Anger about the
    impact of poor access and collection practices.
  • Policymakers Focus on charity care is a
    convenient (if ineffective) strategy to address a
    systemic problem.
  • Public Health Financial pressures and safety
    net obligations impede efforts to engage
    hospitals in substantive population health
  • Sponsors- Movement to Laity Leadership- Opening
    the door to revisit our continual call to our

Purpose of ASACB
  • To develop and implement a national model for
    community benefit programming to
  • Increase program effectiveness and sustainability
  • Ensure access for diverse communities
  • Increase institution-wide alignment and
    accountability to our nonprofit status
  • Deepen hospital engagement in local communities

Major Outcomes
  • Improve Health Status and Reduce Health
  • Through targeted investment and design of program
    activities to address disproportionate unmet
    health-related needs.
  • Reduce Health Care Costs
  • Proactive investment to reduce the demand for
    high cost charity medical care to treat
    preventable conditions.

A New Vision for Hospitals
  • The hospital of the 21st century should be fully
    engaged as a partner with diverse community
    stakeholders to address both the symptoms and
    underlying causes of persistent health problems,
    and to advocate for public policy strategies that
    address the systemic problem of access for
    uninsured people.

Five Core PrinciplesAnchors for Planning
  • Emphasize disproportionate unmet health needs.
  • Emphasize primary prevention.
  • Build a seamless continuum of care.
  • Build community capacity.
  • Emphasize collaborative governance.

Advancing the State of the Art in Community
Benefit, PHI. Nov. 2004
ASACB Partners
  • St. Joseph Health System
  • 9 facilities in CA, 5 facilities in TX
  • Catholic Healthcare West
  • 36 facilities in CA, 3 in AZ, and 4 in NV
  • Lucile Packard Childrens Hospital at Stanford
    (Palo Alto, CA)
  • Presbyterian Intercommunity Hospital (Whittier,
  • Texas Health Resources
  • 13 facilities in Northern TX

Phase I
  • Following a baseline assessment of our community
    benefit programs, we collaborated with CHA / VHA
    in a comprehensive review and revision of content
    categories. We also developed guidelines for the
    calculation of community benefit expenses.

Phase II
  • Pilot sites field tested a set of tools designed
    to facilitate comprehensive review and
    enhancement or discontinuation of existing
    community benefit programs to ensure their
    alignment with five core principles.
  • Phase III
  • Systemwide implementation

Quick Check-in
  • Where are you as an organization in terms of
    organizational frameworks to support community
  • What ways can you strengthen your partnership and
    response to the community?
  • How can you further build communities of healing
    and hope?

Community Benefit in your settingwhats in place
  • Exercise A
  • Community Benefit Quick Assessment

ASACB Uniform Standards
  • 1 - Institutional Policy Measures
  • Governance, management, and operations aligned
    for accountability on an institution-wide basis
  • 2 - Detailed Content Categories
  • All activities documented in the same way
  • 3 - Programmatic Measures
  • Measures aligned with ASACB Core Principles
  • 4 - Accounting Methods
  • All activities counted in the same way

Institutional Policy Measures
  • Purpose
  • To ensure optimal quality and sustainability of
    community benefit programs through alignment of
    governance, management, and operations with the
    charitable mission of the organization.
  • Address three levels of organizational function
    governance, management, and operations, with a
    focus on
  • Transparency
  • Competence
  • Quality
  • Sustainability
  • Refer to Handout

14 Institutional Policy Measures
  • Governance policies approved by the
    organizational board of trustees.
  • Management and Operations policies approved by
    senior management and adopted at the departmental
  • Institutional Policies compiled as a formal
    policy manual for the community benefit
    department to support continuity in function and
    facilitate easy access by external stakeholders.

Institutional Policy Measures
  • Governance (Examples)
  • We had been doing some wonderful work to involve
    the Board but had never written this downIf I
    left I didnt know if it would continue.
  • A Board committee with specific roles and
    responsibilities clearly documented.
  • Explicit criteria for governing body recruitment
    that address ASACB Core Principles.
  • Criteria and process to select priority program
    areas of focus.
  • Community benefit planning and organizational
    strategic planning integrated.

Institutional Policy Measures
  • Management (Examples)
  • I have a staff member doing community benefit
    but I never identified the necessary competencies
    to do this work
  • Formal policies to ensure that senior
    leaders/community benefit managers have
    appropriate competencies and support the
    application of ASACB Core Principles (eg.
    competencies in public health/community health
    competencies in building partnerships).
  • Formal policies to give CB managers
    responsibility to evaluate program activities and
    make necessary design changes.

Institutional Policy Measures
  • Operations (Examples)
  • Develop formal community benefit plans that
    outline strategies to be implemented.
  • Engage outside stakeholders as partners in the
    community benefit monitoring and evaluation
  • Formal policy to solicit input and disseminate
    community benefit information to diverse
    community stakeholders.

Uniform Content Categories
  • Purpose
  • Increase internal accountability Clear listing
    of activities by specific content reinforces
    identified links to program priorities, and
    minimizes loss of data, double counting, other
  • Increase external accountability Consistency
    provides a basis for comparative analysis of
    hospital behavior by outside stakeholders.
  • CHA / VHA guidelines published

Cartoon. Modern Healthcare. 5 June 2006
Uniform Accounting Methods
  • Issues Addressed
  • Indirect Costs
  • Eliminate padding of costs by excluding broader
    organizational administrative costs.
  • Paid Staff Time
  • Limit financial accounting to paid activities by
    staff with explicit focus on efforts to address
  • Use of Hospital Space by Outside Groups
  • Limit counting to space and purchased materials
    space calculated with formula from Medicare Cost

Five Core PrinciplesAnchors for Planning
  • Emphasize disproportionate unmet health needs.
  • Emphasize primary prevention.
  • Build a seamless continuum of care.
  • Build community capacity.
  • Emphasize collaborative governance.

Why Evaluation?
  • What will you measure to judge success?
  • How will you know you are using resources
    effectively and efficiently?
  • of people reached
  • of services delivered
  • Change in health behavior
  • Change in health status
  • Change in health care
  • delivery system

Easier to collect
More meaningful
Community Benefit Planning
  • Establishing Goals and Objectives
  • Identify and dedicate resources up front.
  • Consider hiring evaluation, epidemiology or
    related skills.
  • Meaningful measure what indicates true community
  • Manageable select only a few indicators.
  • Practical measure only what you will use.

ASACB Uniform Assessment Tools
  • Preliminary Review Template (PRT)
  • Target population, cost of program, persons
    served, identified need being met
  • Comprehensive Review Template (CRT)
  • Using the Five Core Principles to assess program
  • Program Enhancement Template (PET)
  • What is needed to bring this program into
    alignment with the Five Core Principles
    intervention strategies
  • Program Enhancement Monitoring Template (PEMT)
  • Roles, responsibilities, and timeframes

Comprehensive Review Template
  • Exercise B
  • Comprehensive Review Template

  • Increases organizational leadership and
    accountability for community benefit.
  • Increases the quality of program planning,
    implementation, and evaluation.
  • Enhances the sustainability of community benefit

Advancing the State of the Art in Community
Benefit, PHI. Nov. 2004.
Honoring the Trust
  • Do we have support from the leadership of our
    organization/hospital for community benefit?
  • Do we have adequate staff with the competencies
    needed to do this work?
  • Do we have board members with an understanding of
    and a willingness to address the unmet
    health-related needs in our community?
  • How do we enhance existing staff and board to
    become more aligned to the principles?

Implementation Challenges and Successes
  • St. Bernardine Medical Center
  • St. Joseph Health System, Sonoma County
  • California Hospital Medical Center

Summary of ASACB Vision
Implementing the ASACB vision requires a
transformation in governance, management, and
Focus on on high cost, ER-based charity care to
treat illnesses that could have been prevented.
Comprehensive strategies to address the
underlying causes of health problems.
Proprietary approaches to planning
and implementation.
Collaborative approaches that mobilize and build
upon existing community assets.
Summary of ASACB Vision, contd.
Health improvement with a private
patient/enrollee focus.
Health improvement with a population health
Broad scattering of ad-hoc services. (RAK)
Coordinated and carefully targeted programming.
Evaluation based upon the volume of inputs
(i.e., of people served).
Evaluation based upon impact upon health status
and quality of life.
Summary of ASACB Vision, contd.
Executive decision making based upon
institutional priorities.
Collaborative decision making based upon
an objective assessment of community needs.
Institutional view of community benefit as
an unwelcome legal obligation..
Institutional view of community benefit as
a responsibility to return optimal value of
charitable assets to public investors.
Contact Us
  • Eileen Barsi
  • Director, Community Benefit
  • Catholic Healthcare West
  • Maya Dunne
  • Vice President, Community Outreach
  • St. Joseph Health System
  • Kevin Barnett
  • Advancing the State of the Art
  • in Community Benefit

Community Benefit Planning Resources
  • Advancing the State of the Art in Community
  • Association for Community Health Improvement
    Community Benefit http//
  • Catholic Health Association Community Benefits
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