Are Nonprofit Hospitals Addressing the Most Critical Community Health Needs That They Identify in Their Community Health Needs Assessments?

Abstract

Context: Virtually all nonprofit hospitals are in compliance with the Affordable Care Act's new Community Health Needs Assessments requirements. Objective: To assess what needs have emerged in the Community Health Needs Assessments hospitals complete nationally, the degree to which identified needs reflect the most pressing community health issues, and the extent to which hospitals address identified needs. Design: Using both bivariate and logistic regressions, we analyzed the Community Health Needs Assessments and implementation strategies of nonprofit hospitals to determine whether identified needs overlapped with county health-ranking indicators of need and whether institutional or community-level factors predicted hospital willingness to address identified needs. Participants: We included a 20% random sample of US nonprofit hospitals (n = 496). Main Outcome Measures: Our main outcome measures were whether nonprofit hospitals addressed each of the most common needs. Results: Mental health, access to care, obesity, substance abuse, diabetes, cancer, and the social determinants of health were the most commonly identified needs across the sample. The rate at which hospitals chose to address each of these needs in their implementation strategies, however, varied considerably, ranging from 56% (cancer) to 85% (obesity). We found that several institutional and community characteristics predicted hospital willingness to address each need; whether the community ranked a need as number 1 was a better predictor of hospital investment than the severity of the need, as measured by county health-rankings data. Conclusions: These findings may help inform local, state, and federal policy makers as they consider interventions aimed at encouraging hospitals to invest in improving the health of their communities.

Population health partnerships and social capital: Facilitating hospital-community partnerships

“…These efforts have also been bolstered by new community benefit requirements included in the Affordable Care Act (ACA). The ACA requires nonprofit hospitals, nearly two-thirds of hospitals in the US, to regularly assess and report on pressing community health needs ( Franz, Cronin, & Singh, 2019 ; Pennel, McLeroy, Burdine, Matarrita-Cascante, & Wang, 2016 ). More specifically, nonprofit hospitals must complete a Community Health Needs Assessment (CHNA) every three years and propose specific interventions to improve community health in a corresponding implementation strategy in exchange for tax exemption ( James, 2016 ).…”

Are Children's Hospitals Unique in the Community Benefits They Provide? Exploring Decisions to Prioritize Community Health Needs Among U.S. Children's and General Hospitals

“…We interpret these findings to mean that many hospitals, and children's hospitals in particular, may be including health needs that are broader than the immediate county or reflect other priorities, such as needs that are considered highly relevant by local residents or by the hospital. One previous study found a high level of overlap between county health indicators and the prioritization of needs in CHNAs among general hospitals (32). With children's hospitals included, our findings may reflect a broader focus on regional, rather than county-level, health needs.…”

“…Our findings provide important insight into the decisions that hospitals make to include health needs as top priorities in their CHNAs. A past study found that hospitals that ranked needs at the top of their list of prioritized needs are more likely to have accompanying strategies to address these needs in their implementation strategies (32). As such, hospital decisions to prioritize a need in their CHNA are likely related to the presence of actionable strategies in the corresponding implementation strategy.…”

The Importance of Individual-Site and System-Wide Community Health Needs Assessments

“…These results indicate that there are both substantial overlaps within communities but also strengthen the idea that needs assessment should be done at the local level and not just across the system to identify needs that might exist within smaller pockets of a system's service area and might be best served by an individual hospital site rather than leveraging system resources. A combination of local level data collection [especially considering the need to link local population health data and rankings to the needs selected by individual hospitals (18)] and CHNA reports and a system-wide reporting and implementation planning mechanism would be a strong combination for healthcare systems looking to have an impact on large-scale population health. These findings reiterate findings in the literature speaking to the importance of regional planning for community benefit (16).…”