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Using Technology to Get the Most Out of Community Health Needs Assessments

Analysis  |  By Scott Mace  
   June 29, 2022

CHRISTUS Health is looking to make a difference beyond the hospital walls by using technology to understand the social determinants of health and lived experiences of both patients and employees.

As system vice president of community benefit, health equity, diversity, and inclusion at CHRISTUS Health, an international Catholic health system headquartered in Irving, Texas, Marcos Pesquera sees techology as an inflection point in the health of his community and employees.

And an innovative, systemwide, community needs survey is helping the health system leverage data to understand the needs, assets, and lived realities of patients and employees to accelerate progress on health equity.

The Centers for Medicare & Medicaid Services requires all nonprofit hospitals to do a community health needs assessment (CHNA) every three years. These hospitals subsequently create community health improvement plans.

"This year, we're in the middle of that process," Pesquera says.

Marcos Pesquera, system vice president of community benefit, health equity, diversity, and inclusion at CHRISTUS Health. Photo courtesy CHRISTUS Health.

Anonymous responses to the survey are revealing realities to a degree that previous demographic data, gathered laboriously from multiple sources, including focus groups, failed to illuminate, he says.

The survey gathering and analysis process is being facilitated by Metopio, a cloud-based data analysis platform that is able to view visualizations of layers of data, including the survey responses, to highlight health disparities.

Six months in, the survey has exceeded expectations, with 6,000 responses received through three phases, double the number of responses that were expected by now, Pesquera says.

By including employee voices in the CHNA process, CHRISTUS Health has been able to better understand alignment and divergence between the needs of its 30,000 associates – employees and contractors – and the broader community.

Using the principles of the societal factors that influence health, with a specific focus on social determinants of health such as education level, income level, health insurance coverage, food security, unemployment rate, and life expectancy, the health system has identified zip codes with historically marginalized populations. They're now monitoring these zip codes closely during the CHNA process, to ensure that the needs of these areas were adequately addressed.

The assessment process also captures demographic data mirroring data captured clinically, such as race, ethnicity, age, preferred language, veteran status, sexual orientation, and gender identity, as well as payer and disability status.

The analysis also brings in hospital data, such as emergency room utilization, and analyzes it through an equity lens, Pesquera says. Through special permissions, the analysis also draws upon anonymized EHR records.

"This is very much going to give hospitals the public health eyes that hospitals have been missing for a thousand years," he says.

Survey respondents are also asked to describe such social determinants as inability to pay for housing or utility bills, Pesquera says.

As a result of community improvement plans, CHRISTUS Health has issued more than 30 small grants, of between $50,000 and $100,000, to institutions such as food banks to address issues such as food insecurity.

"We're not asking them for anything in return other than just let us give your phone number and address to our patients that are in need," Pesquera says.

Survey results also serve as a conduit to invite employees to volunteer their skills and share their interests with the community.

"We consider our hospitals as anchor institutions, and we have all these nonprofits," Pesquera says. Strengthening the health equity agenda may involve introducing those nonprofits to employees and patients.

Following such introductions, both may then volunteer their skills to those nonprofits, he adds.

In certain circumstances, results from the CHNA also help public health departments in the communities served by CHRISTUS Health hospitals and clinics.

The analytics software permits extensive geomapping of data across service areas, to identify resources ranging from federally qualified health centers to internet service providers, he says.

This CHRISTUS Health system initiative includes 40 hospitals in Texas, Louisiana, New Mexico, and Arkansas. CHRISTUS Health also operates hospitals in Mexico, Chile, and Colombia, although this initiative is not focused outside the US at this time, Pesquera says.

"We ask them to do community health needs assessments and be responsive to those needs that they find, but it's not as structured as it is in the US," he says.

The anchor organization designation does not mean that CHRISTUS Health is leading the initiative among all stakeholders.

"We want to make sure that as hospitals, we're not viewed as leading anything," he says. "We want to just be at a circular table, a member of a coalition. We recognize that in many of our communities, we're the largest employer, and also a consumer of goods and transportation. There's a commitment to just be part of the community, and get outside of the four walls of the hospital to help."

Pesquera hopes to finish collecting surveys by the end of July, giving CHRISTUS Health through October to finalize results and priorities and publish the CHNAs on its web sites, as required by CMS.

The cost of conducting the assessments with the technology assist compares to the previous cost of hiring consultants to gather a subset of the demographic data collected this time, Pesquera says.

"I'm very encouraged by people's willingness to share with us their lived experiences, their challenges, but also, I'm also very encouraged to see that there are so many people and organizations ready and willing to meet the needs," Pesquera says. "For whatever reason, as crazy as the world is, I see a huge heart and desire for people to really care for others in ways that I have not seen before."

“This is very much going to give hospitals the public health eyes that hospitals have been missing for a thousand years.”

Scott Mace is a contributing writer for HealthLeaders.


CHRISTUS Health is using a data analytics platform to survey staff and patients in Texas, Louisiana, New Mexico, and Arkansas, as part of a CMS-mandated program conducted every three years.

The health system has received some 6,000 results so far, double what was expected.

Survey results are used to identify underserved communities, as well as the barriers and challenges that make them underserved, and drive programs aimed at improving access and outcomes.

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