Three Tips for a Great CHNA

We do Population Health Consulting.

We've helped large and small health systems and community organizations better understand the causes, conditions and solutions to population health issues.

Since the passage of the Affordable Care Act in 2010, Community Health Needs Assessments (CHNAs) have become a standard part of the strategy and planning process for non-profit health systems.  Since most systems have been through 2 or 3 CHNAs, the process and practice of assessing community health has been standardized.

But we hear from many health-systems that they are looking for new approaches and data to make their next CHNA more relevant and impactful.  Here are three things we've seen though-leading health systems do in their CHNA that are applicable for everyone.

1. Use frameworks to focus on issues and improve understanding

There is more data than people know what to do with. We typically use about 160 different indicators to provide a comprehensive picture of community health across a number of different outcomes.  This can be overwhelming, especially to people who don't have a deep background in population health data.  

Frameworks are a great way to synthesize data into an easy-to-understand set of takeaway numbers.  For example, there are a number of different emerging frameworks focused on community well-being that go beyond the typical disease burden focus most health-systems are familiar with. These frameworks can be really helpful in reframing the same set of indicators into terms that community partners are more comfortable with.

Anther opportunity that frameworks present is highlighting and clarifying strategic issues and challenges faced by a community.  For example, the Institute for People, Place and Possibility has released an opioid misuse framework that highlights the upstream causes and downstream impacts of the opioid epidemic on communities.  

For more information about how frameworks are developed and can be used, see our blog post here.

2. Add context with relevant benchmarks

Another important tool for meaningful CHNAs is benchmarking.  Benchmarking is essentially finding meaningful comparisons that put the measures of your community's health in context. The most effective CHNAs are able to answer not just the 'what' but the 'how' and 'why': how is our community doing compared to others that look similar, and why have things changed over time?  Common benchmarks that people use are comparing values to state and national averages. 

As more data becomes available, it is possible to create more interesting and relevant comparison benchmarks.  For example, as part of our work with New York City Health and Hospitals, it became clear that environmental indicators were only meaningfully compared with other highly dense urban environments, so we created an urban cities benchmark that calculated the average indicator values for the top 50 cities in the US by population.  This helped NYC to see that they actually scored very well in transportation and environment measures, when compared to their peers.

3. Go local with new data estimation techniques

Most source data used in a CHNA will come from national sources and is reported at the state and county level.  However, most health systems usually operate within a few counties at most - finding relevant, local data can be a challenge.  In 2017, CDC launched the 500 cities data set, an ambitious new modeling effort to generate tract level estimates of the BRFSS data for the 500 most populous cities in the US. 

This model estimation technique proved the concept for how to augment national sources with local estimates.  This means you can now view tract-level data where it wasn't avaialble before with a high level of confidence.  This improves decision making and relevance of data, enabling hotspot detection of crtiical health needs.