Let’s Talk About Community Health
Pat Young, Director of Community Health with Centra, joins Kate to talk about Centra’s Not-For-Profit status, Community Benefits, and why that status is so important for the function of the healthcare system and our surrounding neighbors and friends.
Note: Due to extra social distancing during recording for the safety of all parties, some audio may sound more muffled than normal.
Speaker 1:
Thanks for joining us for this episode of Centra Scripts, where we talk health and wellness, and practical tips for your everyday life. Now, here's your host Kate Justice.
Kate Justice:
Thanks again for joining us for were this episode of Centra Scripts. I am Kate Justice, and as always, we are so excited to sit down and have a conversation today about something that maybe you might not know about here in our area. We're going to have a conversation today with a new friend of mine, Ms. Pat Young. Pat, you are joining us today as a part of the Community Health Office at Centra. Is that right?
Pat Young:
Yeah, that's correct.
Kate Justice:
Making sure I got that correct. Pat, tell us a little bit about what it is that you do here at Centra, how long you've been here and how you interact with the community.
Pat Young:
Sure. I've been here at Centra for a little over a year, and the Department of Community Health has been at Centra for about a year and a half, started in January of 2020. We are responsible for a lot of what is called community benefit, which includes doing community health needs assessments every three years, and then creating action plans, which we call implementation plans to respond to the needs. We are also responsible for all the community based grants and sponsorships that used to be managed through our Centra Foundation. Now, we're a part of that. I think, finally, the other piece that's important is that we do all of these tasks, but most importantly, we are out in the community working with other nonprofits and leaders to try to come up with equitable solutions to improve the health of our communities.
Kate Justice:
No easy task, by any means. I think that you might have one of the more complicated job tasks on your plate over there. We really want to dive right in here to this concept because this podcast today is all about community health, and the things that Centra is doing to partner with people in the area, our give back, different things like that. I want to talk about this concept of, and I'm going to use air quotes here that nobody can see, but "community health." We throw that phrase around a lot. We use it, clearly, in the title of the department. What does that actually mean for our health system, and why is it important for us to have that?
Pat Young:
Great question. When we think about health from a health system perspective, traditionally, we think about the four walls of a hospital, or a primary care office, or X-ray department. Really, the health of our community is impacted by so much more than just clinical care. When I think about community health, I think about the social determinants of health that impact how we live, work, and play in our communities. Social determinants of health are everything from your social and economic status, where you live, what your zip code is, what your educational attainment status is, so much more. As a health system, if we don't have a healthy community, we don't have healthy patients. It's not an adjunct to our work, but it's a real integral part of who we are. I've been in this business a very long time and we always talk about working ourselves out of a job. Wouldn't it be great if day we had such a wonderful, utopian, healthy society that we didn't have to have hospitals and all the things that go with it. We will always need that. It is something that we need to think about. How do our health behaviors impact how we live. How does the physical environment impact us. Air and water quality, transportation, housing. All of those pieces is a much broader holistic view of what health is
Kate Justice:
I love that because we've been having consistent conversations here on the podcast, and in other ways of communicating, with our patients and our families, and communities that are, that are surrounding the Centra bubble, if you will. We've had these conversations about what it looks like to partner with you to live your best life. That's an important thing to us, right now, here at Centra. We're hoping that that message is starting to make it out there into the community. All of the things that you mentioned about all those social determinants and things that are important for that holistic view of health, that plays a huge part into that mission of partnering with you.
Pat Young:
Absolutely. It is the key. We want to work with people. We don't want to work for people, but with people. Partnering with you to live your best life, is a big part of that. I think that being a partner with the community is another way of saying it. It's a collective individual. It's just super important for us to recognize that we can't impose our thoughts and judgements on others, we really need to be able to walk into a community, understand how they're working and living, and what we can do to help without telling them what to do.
Kate Justice:
That's a perfectly stated statement right there, I think. I think there has maybe been this misnomer, or whatever, for years that as a large healthcare system, "They just must be coming in to tell me what I need to do with my life." Which is not at all what we want to do. I think you just stated it beautifully and perfectly there. We need to learn more about our community, learn more about each other, so that we can provide the type of healthcare and wellness care that we can, that will meet them where they, meet you where you are. That's perfect. Now, I want to talk about something here, at the beginning, as we move into some of these topics that you and I have stated that we want to look over today. There has been some pretty massive confusion, I think, in the past, over what type of a healthcare system we are. Are we nonprofit, are we not for profit, are we for profit. Let's talk about that for a minute, and the distinctions between the three of those, and what Centra actually is.
Pat Young:
Sure. The distinction obviously is, if you're a non-profit, or a for profit, basically, what that means is you have tax exempt status with the IRS. For a hospital system that is either in non-profit, or not for profit is used interchangeably. With that tax exempt status, hospital systems are required to give back to the community through a process called Community Benefit. If you're a for profit hospital, you are not tax exempt. You don't have tax savings, and you don't have the Community Benefit requirements that we do. Centra is a not for profit health system.
Kate Justice:
Now, that statement might surprise some people. I feel in our community, there has been a lot of conversation. "Centra must be for profit." There's a lot of, just frankly, a lot of conversations about the money, and how that works in our community. Why is it important that Centra is a not for profit, and how does that affect how we do our business of healthcare?
Pat Young:
If we're looking at it from a community perspective, it provides a lot of benefits. As an example, as a not for profit we're required to have some level of financial assistance for those who are not able to pay, whether they're uninsured, or underinsured. That's a huge savings. In addition, we're required, again, to provide community benefit. Community benefit can range from things like having activities in the community that benefit a certain vulnerable population, whether they're health screenings, or discounted services. Also, if we do research as a health system, that is considered a community benefit. The fact that we train health professionals is a community benefit. Then, the work we do, even as a department, all of that work is identified by the IRS's Community Benefit.
Kate Justice:
Okay. There is a large measure of, really, that give and take between what services we are offering, from just strictly the healthcare side of things, and then also, what things we are offering the community that are a benefit to them. I don't know that there has been an extensive amount of education about those benefits, in the past. That's a piece of what we're talking about here today. Before we get into a little bit more of that, because we will circle back around to that, I want to pause for a minute. You mentioned, just a few minutes ago, the community health needs assessment. You have just been through the ringer of what has been the three year process. Every three years this happens. We have just completed the 2021 round of this, because it was coming up for that. Explain to us, for those of us who might not completely understand it, this community health needs assessment, what is it, why do we need it, and what does it do for the community.
Pat Young:
Our community health needs assessment is part of that Community Benefit I was talking about. The IRS wants the health system to understand the needs of its community. As part of the Affordable Care Act in 2010, the IRS mandated that not for profit hospitals conduct a community health needs assessment every three years. What that assessment does, it's not us just sitting in a room somewhere collecting data from publicly available sources. Although, we do do that. The most important part is community engagement. We spend a great deal of time getting feedback from residents in the 9,000 square mile service region that is Centra, as well as stakeholders who are leaders in the community, that are representing the populations we're trying to serve. The other piece of it is, we don't just do one needs assessment. Each of our hospitals, we have four hospitals, are required to do a community health needs assessment every three years. We do three every three years.
Kate Justice:
Wow. That is a large undertaking.
Pat Young:
It is definitely a lot of work.
Kate Justice:
When we say that we gather this feedback from our community, in what ways are we doing that? How is that collected, how are we partnering to put that data together with other things that we're collecting from other resources?
Pat Young:
That's probably the most important question you could ask me about this process. Anyway. We like to preemptively say, we want to lift the voice of the community. You can do a needs assessment and get some feedback, and make decisions basically on hard data that you're getting, again, from sources outside of our community. Instead, we want to focus on what we call primary data. We have a couple of processes. Actually, in 2018, it was a little different, but COVID had changed it for us. This year, what we did is, as we did three years ago, we collected a community health survey. That survey is 38 questions. It asks everything. We were talking about social determinants earlier, we ask about social determinants. We ask about utilization of clinical services. We ask socio and economic status information. Despite a pandemic, we had a 34% increase in the number of surveys that we received. We had over 6,300 surveys across the 9,000 squares miles.
Kate Justice:
That's amazing,
Pat Young:
It's awesome.
Kate Justice:
Which also tells you that the community cares about this.
Pat Young:
Yes. That's exactly right. We were, truthfully, walking into this in March of this year with a pandemic still just going crazy. We felt we'd be lucky to get half of what we got in 2018. The fact that we had such a strong response rate, and that data, that information, was so rich. Truly. It allows us to take a peak into everyone's life. Anonymously, obviously. We don't know who's answering these things. It allows us to see how people in Lynchburg are living compared to folks in Farmville, or someone who is living in Blackstone, or Bedford, or Pittsylvania. It's a huge gift to us as a health system. The other thing we do is we engage our stakeholders throughout the entire process. We have three regional, we call them community health assessment teams. They meet throughout the entire needs assessment process. We share what we're going to do, then we have focus group meetings with them so that they give us an idea of what they see as the needs in the community. Then we review data with them. Finally, those stakeholders are the individuals who go through a process called prioritization of needs. They basically, after nine months of a pretty rigorous process, have to go, basically, go through a list of identified needs in each region, and they rank those needs. This year we saw some really different needs than we saw in 2018.
Kate Justice:
Interesting. That care model, then, that comes out of this, the way that we take that data, the way that we envelope that and put it together, there are reports then that come out of this, which is what you have just walked through. Bless your heart. I think you're probably sighing a big sigh of relief right now that that's all done. I actually just placed them on the website yesterday. We're very excited. Those reports, then, what's the intention behind providing that data back to the community?
Pat Young:
There are a couple of pieces. First, from a back to the community perspective, it's a gift because we have a lot of nonprofits and a lot of... Even our localities, boards of supervisors, and our city managers, use this data for grant writing and fundraising. They use it to look at the needs of their targeted populations, too. From that perspective, we're giving back to that part of the community. Also, it's available to anyone in the community. You can go on our website, hit one click of a button, and you can look at the needs and the health of where you live.
Kate Justice:
I'll be honest, I've worked here at Centra for a little over six years, now. I've been a part of two of these, now, in my time here. It was so enlightening, to me, to read these documents when we were getting them. I didn't just place them on the website, I actually had to look through them, help proof, different things like that. As I was reading through, I just thought what valuable insight that this is something that we were given, by people in these communities, themselves, this is your words that you have given to us that we've been able to use and put forward, now, into implementation plans for these are maybe the soft spots that are not getting enough attention, these are problem areas, these are things that we're doing really, really well. That's the other thing that I want to bring up is that in these surveys, there's the opportunity to see these are some places for improvement, but there was a lot of reflection on things that were actually going very well in our surrounding areas. Talk about that for a minute.
Pat Young:
One of the things that we saw in 2018, that's a little different than this go round is that we saw the infrastructure. There was more of an infrastructure in place, in our communities, around things like opportunities for physical activity, and for access to healthy foods. Although it's just been three years, I know that there's been a lot of work to make that happen. That didn't just happen by accident. That's a good thing. Another thing is that more people are using dental services. I truly believe that is the result of our safety net. I say safety net, I mean our free clinics and our federally qualified health centers, that are doing a bang up job of getting into the communities and providing that care. I think even people's perception of health has changed a little bit. On the other side of it, though, I have to say we really are seeing what I think is going to be the next pandemic of this world we live in. We are seeing an uptick in mental health and substance use disorders. We're seeing a dramatic increase in domestic violence and child neglect. we're seeing a huge need for childcare, elder care, transportation. Something we wouldn't consider health, broadband access. This pandemic has really brought to light the intense need to be connected without leaving your home.
Kate Justice:
It's so true. I think of the things that you're stating there, this concept of mental health concerns and the domestic abuse rising, and different things like that. We've talked about this a little bit before on episodes and just around the organization as we've had different planning meetings and things, the world as we know it, is not what it was, even two years ago. COVID has done a dramatic shift in how we do life, and in how we look in the future to doing things. I think for maybe a long time, during that first nine, 10, even first year of the pandemic, we kept thinking, when are we going to go back to normal, when does normal come back. I think we've reached, maybe, a finally point here of a resignation to, there is no back to normal.
Pat Young:
Yeah. There isn't. If there's a positive silver lining to the pandemic, from our perspective as a health system, one of the things that it has done is, it's allowed us to really look at how we can use telehealth to get to people who live in remote areas, or who maybe have limited access to care. I think it's also allowed us, as a community, to step up to the plate a little bit and perhaps become more socially connected, even though we're not physically connected, if that makes sense.
Kate Justice:
That's an excellent point.
Pat Young:
We asked a question on our community health surveys about that, how connected do you feel with your community. I expected everyone to say not connected. In reality, most people felt connected, and in some ways, even more connected than they did in 2018 when we did this survey.
Kate Justice:
All very good learning points as we continue to assess this. I think that's one of the beautiful parts about what your office does in the community health benefits side of it, is that this is not a once and done conversation, at all.
Pat Young:
No. No. I love this work, I just have to say. It allows us, first off, to take a temperature check every three years, or so, so that we don't let needs aggregate to a point that our communities are imploding, which has a direct impact on our health system. Secondly, it allows us to continually work on addressing those needs. We don't just take this assessment and put it on a shelf for three years, we actually, then, turn it around, look at the needs that are identified, and then we come up with solutions and action steps to address those needs.
Kate Justice:
Which is huge, when you think about that. We've mentioned a couple of times, now, it's a 9,000 mile radius of this hospital system. That's a lot of ground to cover.
Pat Young:
It is. It's huge.
Kate Justice:
We used to have a caregiver here in leadership that he used to say, "We're roughly the size of New Jersey."
Pat Young:
That's exactly right. It's true.
Kate Justice:
That was the ground that we cover, if you put it all together. That's a large healthcare community. That's a large reflection of the surrounding communities, around us, and the people that are represented there. I think the conversation that we want to keep having here is that this is not Centra's ideal, this is not Centra's plan for anything, this is a community effort.
Pat Young:
Absolutely.
Kate Justice:
We want to be well reflective of what is going on in the communities around us. Just huge opportunity there.
Pat Young:
All of our decision making is based on what we learned from our community health surveys and our stakeholders. Really, we used what we call secondary data to back things up, "That's right. Look at what the Virginia employment commission is saying." We saw an increase in joblessness from our survey respondents. That was similar to the trend, actually, a little bit more so, again, we really are partnering with you with this. We don't do it in a silo. Obviously, we had over 6,300 surveys, and about 150 stakeholders all together, across the three service areas. It is a gift to the community. It's a gift to Centra to be able to do that.
Kate Justice:
Yes. I was just going to say, I feel we've talked a lot about the community benefits of it, but to flip that coin around, we're receiving just as much back from this feedback, from you all, and the way that you've been able to just tell us what your needs are, and what's going on with your neighbors, and your family, and your friends, that sort of thing. That's a huge, huge win for us, as a healthcare system. We can't help you live that best life unless we know what's going on with you. That's great. Let's circle back, then, here to the idea of not for profit. It's weaved in and out of what we've been talking about here. You mentioned, at the beginning of this podcast, that a huge portion of what your office is in charge of helping with is those benefits. That we are required, because of our tax status as not for profit, to give back to the community. Let's talk about that give back for a minute. I think that's a phrase that is thrown around a lot, especially this time of year. At the time of the recording, it's almost Christmas. It's the holiday season. I think people feel warm and fuzzy about that idea of giving back. What people might not know is that this give back from Centra, this happens year round.
Pat Young:
It does.
Kate Justice:
What does that look like for your office?
Pat Young:
I think one of the important things is to talk a little bit about our grants and sponsorships. How we fund grants and sponsorships in the community, just to tie it all together, is related to what we identify as needs in our community health needs assessment. That's an important little piece of information. This year, alone, we've invested 1.5 million dollars into our communities. Again, across our New Jersey service area. We have funded, not only small nonprofits, but larger nonprofits. We have provided funding, projects of what we call projects of regional significance. Something that is not necessarily considered an access to healthcare issue, but really something that benefits the community at large. As an example, this one is coming jumping out at me, and I'm not sure why. We're a sponsor the the New Art in the Alley, in Lynchburg, which is an art project. It's beautiful. It's an enhancement to the downtown area. Just that little piece. Art brings joy, it impacts your mental health. People might say, "Why is Centra giving money to Art in the Alley?" It's a big part of the wellness of our community. In 2020, when the pandemic hit, our focus really was on basic need funding. Food insecurity, we were supportive of our United Way, that then takes that money and invests even further in the Central Virginia region. That's a big piece.
Kate Justice:
All right. We're talking about those benefits from a grants and sponsorships standpoint. That's not all that the give back, that we see from your office, and from the organization. What else exists out there?
Pat Young:
Other things, as an example, free health screenings in the community. Vaccine clinics. Health education. We get a lot of requests from community members for speakers for different events that they're having. We have an amazing cache of health professionals who are able to go out and provide some significant education to our community members. We are able to do things like community building. As an example, we might have a piece of real estate, or a building somewhere that's vacant that we're not using, that we could actually donate to a nonprofit organization so they could use it. We, as a unity benefit, can report that to the IRS. At the same time, that nonprofit is given the opportunity to have a physical infrastructure. Then, again, I think I said this to you earlier, all of the work that we do in the Department of Community Health is considered Community Benefit. There's a lot to it. Talk to anyone in the finance department, who's filling out our 990s every year, there's a lot of tracking, and a lot of reporting that goes along with it.
Kate Justice:
There is a very technical side to it.
Pat Young:
There is. There is.
Kate Justice:
For sure. For those that are wondering, this is awesome, I didn't know that this give back was in place. Maybe they're aware of organizations that might need help. Is there a process for people to find out more information about those grants and scholarships? How does that work, in terms of how you decision make for those types of things?
Pat Young:
That's question, actually. I'll give you a little bit of a process answer to that, and then I'll tell you how you can go about it. We do, primarily, base our decision making for grants and sponsorships on the findings of our needs assessments. Usually the top five to 10 needs are the criteria. Also, you have to be a nonprofit. You also have to have not for profit status. You need demonstrate that you're serving vulnerable populations in our service region. We have a board appointed community benefit committee, that is composed of members of both our Centra Foundation board and our Centra board of directors, and members at large. Those individuals, twice a year, or actually, more than twice a year, are making funding decisions based on the applications that we received. This year, alone, we received almost 100 grant applications. That's a lot.
Kate Justice:
Oh, wow. That's a lot.
Pat Young:
If you want to know more about it, you can go to our community health website, and it explains the process if you're interested in applying for a grant or sponsorship. There's actually a link on the website, you can go right to it. I'm trying to think. There are some eligibility criteria, but that's all spelled out on the website.
Kate Justice:
It's very easy to find that information. You can see everything in detail. That's a piece of what we want the community to understand, too, that this is a very open and transparent conversation.
Pat Young:
Absolutely.
Kate Justice:
This is not some clandestine group of five random people in a closet somewhere coming up with this idea. It's a very detailed process that this goes through. The easy part is on the submission side. Then, the harder part is on the board decision to go through it. That's a huge piece of really making sure that all these voices are heard, as we continue to have this conversation.
Pat Young:
Absolutely. Right. Exactly. We learn so much through the applications we receive every year, about the organizations and our communities, and how much they're doing. I wish that we had five million. I wish we could get Jeff Bezo to give us a little bit of his billions and billions. At least we have something to give back. It's not just an IRS requirement, it's a commitment from this health system to take care of our communities. That is a message I really would like for people to understand. This is not just something we're doing to check off a list, it's because we are committed to the health of our communities.
Kate Justice:
I'm so, so glad that you said that. I think the temptation, sometimes, in hearing about organizations like ours, that have this tax status that does require us to do certain things, there are steps involved in that to keeping that tax status. I'm so glad that you just said what you said, with the passion behind it. We do want people to understand, Centra is here for you, for the community. This is not a situation where we are looking to see how many boxes we can check off to make sure that our name stays where it needs to be. This is very much about having those ongoing open and vulnerable well conversations with our neighbors, our friends, our families. The big part that I think that we want to make sure that people understand, too, is that, we are your neighbors, your friends and family, working here at Centra, as the caregivers here. It's just as important, to us, as it is to you as individuals in the community, that these conversations are happening.
Pat Young:
Yes. Just to, actually, to say to you, our community health surveys, a lot of folks who answer those surveys are our own caregivers. We are the community, too. It is a real important distinction. Also, just to point out, we didn't have a Department of Community Health when we did the last needs assessment. I think, as an organization, there was a realization that this work is so important that it needs to be institutionalized.
Kate Justice:
Absolutely.
Pat Young:
There's another commitment, right there, from Centra.
Kate Justice:
Yeah. If there's nothing else that you take away from this podcast today, I hope that you hear the heart behind this desire for community health to be a piece of who we are at Centra, and a defining piece of who we are at Centra. As we do continue to partner with you to live your best life, and vice versa, there's that community partnership and involvement there together. Pat, is there anything else that I've missed today, that you would want to make sure that people understand?
Pat Young:
No. Thank you so much for the opportunity.
Kate Justice:
Absolutely. It's been a pleasure to sit down and talk with you today.
Pat Young:
Same.
Kate Justice:
You can find more information, as always, on our website at Centrahealth.com. If you're interested in reading those brand-new reports that just came out, it's Centrahealth.com/CHNA. That stands for those community health needs assessments. You can find all kinds of information there. Also, feel free to listen, or read back about this podcast on Centratoday.com. As always, we will catch you next time.