DoN: An Opportunity to Advance Health Community-Based Health Initiative Planning Guideline Health Priorities Guideline Community Engagement Guideline January 11, 2017
Retooling DoN for Today’s Health Care Market Development of Revised CHI Guidelines The revised CHI framework reflects multiple levels of input, review, and analysis, including: • Recommendations and information gathered during DPH’s Community Health Initiative Health Impact Assessment conducted in 2014 with significant provider and community input. • A comprehensive national literature and best practices review of over 100 peer- reviewed articles and dozens of grey-literature best practice websites, including: o o County Health Rankings: Roadmaps to Health CDC Community Health Improvement Navigator Quality Forum’s Improving Population Health by o Community Toolbox o Working with Communities: Action Guide 3.0 o Mobilizing For Action through Planning and Partnerships (MAPP) • A statewide review of Community Health Needs Assessments • Stakeholder and expert interviews • A DPH-wide survey of content experts to assess current and future evidence-based programmatic opportunities at the community level • Four (4) statewide public listening sessions held in October 2016 2
Retooling DoN for Today’s Health Care Market How do we build a bridge between health care and public health through DoN? CHI Today: CHI Tomorrow: No coordinated disbursement of the more than Standardized, coordinated CHI investments with $170M in CHI investments committed between enhanced accountability and reporting, ensuring FY06 through FY16; critical dollars are contributing to the improvement of community health; No standardized documentation or evaluation to Strong community involvement with funds ensure spending directly contributes to increased disbursed through a transparent process from health outcomes and lowered THCE; provider organizations with final DPH approval; Not publicly planned or competitively procured with Clear community engagement expectations that unclear DPH role; set “gold standard” for community -based planning; Flexible community engagement standards; Larger and/or coordinated approaches to CHI investments that ensures targeted investments Often small, uncoordinated investments across with high-value returns across a community; many issue areas; Establishes a public health framework that will Does not fully leverage DPH’s ability to build allow DPH to support a social determinant of population health expertise across health care health and health equity approach to community system, failing to incentivize providers’ adoption of health investments. This approach will balance population health strategies both at the patient investments in both state “Health Priorities” as well panel level and community level needed to as targeting resources towards responding to successfully take on desired risk. individual Community Health Needs Assessments and identified local health disparities. 3
Retooling DoN for Today’s Health Care Market Objectives of Community Health Initiative (CHI) Revision Four primary goals : Corresponding Guideline Achieving Robust Community Engagement Community Engagement Guideline Achieving Transparency in Decision-making CHI Planning Guideline Achieving Accountability Health Priorities Guideline Achieving Community Health Impact 4
Retooling DoN for Today’s Health Care Market Current CHI: Encourages (but does not require) alignment of CHI planning with AGO and federally mandated community health improvement planning (CHIP) processes Federally Mandated Community Health Lack of Synergy Improvement Planning Current DoN/CHI (3 year cycle) Planning • Many similar health needs 1. Assess & prioritize local 1. Assess & prioritize local assessments are occurring health needs health needs with no alignment 2. Engage community and 2. Engage community and • The same stakeholders are key local stakeholders to key local stakeholders to being approached identify evidence based separately for the CHIP vs identify evidence based interventions DoN processes interventions OUTPUT • Separate health priorities are OUTPUT • List of priority community identified • List of priority community • Separate evidence based health needs health needs interventions are proposed • List of selected interventions • List of selected interventions and selected 5
Retooling DoN for Today’s Health Care Market CHI from a System Transformation Approach: Collaboration and true alignment between ongoing AGO and federally mandated CHIP processes and DoN will: Federally Mandated Community Health New Synergies Improvement Planning Future DoN/CHI (3 year cycle) Planning • Provide opportunities to 1. Assess & prioritize local 1. Assess & prioritize local leverage existing community health needs health needs needs assessments 2. Engage community and • Minimize duplication of 2. Engage community and key local stakeholders to stakeholder engagement key local stakeholders to identify evidence based efforts identify evidence based interventions • Standardize definitions, interventions approaches, and evaluation of community engagement • Identify potential alignment OUTPUT OUTPUT of priority health needs • List of priority community • List of priority community • Select similar, or health needs health needs complimentary interventions • List of selected interventions • List of selected interventions • Leverage joint resources for larger community impact 6
Retooling DoN for Today’s Health Care Market CHI from a System Transformation Approach New Synergies and Bigger Impact • Community Benefits and CHI alignment • State defined minimum standards • Locally led and local decision- making 7
CHI Program Components
Retooling DoN for Today’s Health Care Market Community Engagement: Spectrum of Public Participation Throughout the CHNA/CHIP and CHI process, levels of engagement vary. Based on the International Associations Public Participation’s spectrum of engagement and DPH minimum standards, each applicant will use this tool to identify levels of community engagement in their CHNA/CHIP and CHI processes. Inform Consult Involve Collaborate Delegate Community Driven / -led To provide the To obtain To work directly with To partner with the To place the To support the Participation Goal community with community community throughout community in each decision- actions of balanced & feedback on the process to ensure aspect of the decision making in the community Community objective analysis, their concerns and including the hands of the initiated, driven information to alternatives, aspirations are development of community and/or led assist them in and/or solutions consistently understood alternatives and processes understanding the and considered identification of the problem, preferred solution alternatives, opportunities and/or solutions We will keep you We will keep you We will work with you to We will look to you for We will We will provide informed informed, listen to ensure that your advice & innovation in implement what support to see your Promise to the and acknowledge concerns & aspirations formulating solutions you decide, or ideas succeed community concerns, are directly reflected in and incorporate your follow your lead aspirations, and the alternatives advice and generally on the provide feedback developed and provide recommendations into way forward on how feedback on how that the decisions to the community input input influenced maximum extent influenced decisions possible decisions •Fact sheets •Public comments •Workshops •Advisory groups •Advisor groups • Community-based Examples •Web sites •Focus groups • Deliberative polling •Consensus building • Volunteers/ processes •Open Houses •Surveys •Advisory groups •Participatory decision •Stipended roles stipended •Community •Ballots making for community •Delegated • Advisory groups meetings decision 9 *Spectrum adapted from http://c.ymcdn.com/sites/www.iap2.org/resource/resmgr/imported/IAP2%20Spectrum_vertical.pdf
Retooling DoN for Today’s Health Care Market Operationalizing Community Engagement Leveraging existing national standards and guidelines, DPH is asking the applicants to meet the goals of transparency and authentic, robust community engagement. DPH has developed three tools to operationalize the standards: 1. Community 2. Applicant Self 3. Community Engagement Plan Assessment of Engagement Stakeholder Community Engagement Assessment If required, this form is Required of all Applicants, used by the Applicant to Required of all Applicants, these forms are used to describe community this form is used to provide ensure that community engagement activities that the department with an stakeholders have an will take place to comply accurate picture of the level opportunity to describe their with DPH community of community engagement perceptions and engagement requirements used in the Applicants experiences with the CHNA/CHIP Applicants community engagement process 10
DoN Health Priorities and Strategy Selection
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