Community Health Assessments (CHAs) and Community Health Improvement Plans (CHIPs)
Coordinated Care Organizations (CCOs), local public health authorities (LPHAs), non-profit hospitals, and tribal health departments are important partners in health improvement at the local level. CCOs, LPHAs and non-profit hospitals are required to develop and implement CHAs and CHIPs. CCOs must also invite tribal health departments to this process if they have a CHA or are in the process of developing a CHA.. CHIPs serve a similar purpose as the SHIP, but at a county or regional level.
Many CHIPS are in alignment with the priorities and strategies of the SHIP. CCOs are required to incorporate at least two of the SHIP health priorities and strategies. To illustrate this alignment with the SHIP and alignment across CHA/CHIP partners by county, the OHSU Office of Rural Health, in partnership with OHA, developed this
matrix of community health priorities by agency and region.
Additional information about community health improvement plans, community benefit investment and reporting requirements is detailed below.
CCOs are required, per Oregon Revised Statue, Oregon Administrative Rule and CCO contract, to complete a CHIP, based on a CHA, at least every five years. CCOs are now required to have a shared CHA/CHIP with local public health authorities, hospitals and other CCOs, and also invite tribes that share service areas to be equal shared partners. CCO Guidance: Community Health Assessments and Community Health Improvement Plans provides guidance to CCOs regarding how OHA defines a "shared" CHA/CHIP and when the next CHA/CHIP deliverable is due.
Reports
Community investment
CCOs are able to invest in the social determinants of health and equity (SDOH-E) through Health-Related Services (HRS) Community Benefit Initiatives (CBIs). Additionally, CCOs are required to invest a portion of their net income or reserves in SDOH-E through the Supporting Health for All through Reinvestment (SHARE) Initiative. For CCO spending on HRS CBIs and SHARE Initiative, there must be alignment with their CHIP health priorities.
Health Related Services
HRS are offered are non-covered services that are offered as a supplement to covered benefits under Oregon’s Medicaid State Plan. The purpose of HRS are to improve care delivery and overall member and community health and well-being. Health-related services include:
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Flexible services are cost effective services offered to an individual member to supplement covered benefits.
- Community benefit initiatives are community-level interventions focused on improving population health and health care quality. These initiatives include members, but are not necessarily limited to members.
More information about HRS, including eligible expenses and reports about how CCOs are using HRS can be found here.
SHARE Initiative
The SHARE Initiative comes from a legislative requirement for coordinated care organizations (CCOs) to invest some of their profits back into their communities. After meeting minimum financial standards, CCOs must spend a portion of their net income or reserves on services to address health inequities and the SDOH-E. SHARE investments are made within four areas:
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Economic stability
- Neighborhood and built environment
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Education
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Social and community health.
More information about the SHARE initiative can be found here.
Nonprofit hospitals are required, by requirements of the Internal Revenue Service (IRS), to develop and implement a Community Health Needs Assessment and Implementation Strategy as part of their non-profit tax status. The CHNA must be completed at least every three years. Hospitals are also required to support community benefit investment and report this information annually. Hospital community benefits are initiatives and activities undertaken by nonprofit hospitals to improve health in the communities they serve.
While not required, most LPHAs develop and implement CHAs and CHIPs as a requirement of Public Health Accreditation. CHAs and CHIPs completed to meet accreditation standards must be completed at least every 5 years. Links to CHIPS produced by LPHAs can be found here.
Here are a few of our favorite CHA, CHIP and health equity related resources and tools.
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Change Lab Solutions is a national organization that advances equitable laws and policies to ensure healthy lives for all. Website provides tools for numerous cross-sector partners.
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Collective Impact is a common and useful framework for CHAs/CHIPs.
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Community Tool Box is a free, online resource for those working to build healthier communities and bring about social change.
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CDC Community Health Improvement Navigator: Expert-vetted tools and resources for health system, hospital, public health agency and other community organization staff leading community health improvement efforts.
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CDC Health Impact in 5 Years (HI-5): Highlights non-clinical, community-wide approaches that have evidence reporting 1) positive health impacts, 2) results within five years, and 3) cost effectiveness or cost savings over population lifetime.
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CDC Social Determinants of Health: Resources for social determinants of health data, tools for action, programs and policy.
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Community Preventive Services Task Force Findings: What works to promote healthy communities.
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Healthy People 2020: Resources, organized by domain, to help learn how communities across the country are addressing the social determinants of health.
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Leveraging the Social Determinants of Health: The Massachusetts Foundation’s report on what works for interventions addressing social determinants of health.
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Mobilizing Action through Partnership and Planning is an evidence-based tool for development of CHAs and CHIP.
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OHA Health Evidence Review Commission: Multisector intervention reports on population-based health interventions or other types of interventions that happen outside of clinical settings.
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OHA Transformation Center has relevant guidance, training and upcoming technical assistance opportunities for CCOs.
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Place Matters Oregon foster sconversation about how place affects health and to inspire collective action, making healthy life available to all people in Oregon.
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Robert Wood Johnson Foundation (RWJF) is the nation’s largest philanthropy dedicated solely to health.
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Social Interventions Research & Evaluation Network (SIREN): University of California, San Francisco’s SIREN works to improve health and health equity by advancing high quality research on health care sector strategies to improve social conditions.
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SIREN Evidence & Resource Library: Includes both peer-reviewed and other types of resources, such as webinars and screening tools/toolkits on medical and social care integration.