What’s the Point of Doing a Community Health Assessment and Improvement Plan if it Doesn’t Lead to Real Change?

BRIGHT LIGHTS, BOLD IDEAS:�SHAPING THE FUTURE OF

PUBLIC HEALTH PRACTICE

�

Anaheim, California

July 14-18, 2025

#NA360

Agenda for Today

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• Present the problem or challenge

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• Discuss WHY this happens

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• Hear case studies from health department leaders about this challenge

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• Share tips and ideas to overcome this challenge:

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• BONUS: Give you a document that we use in the CHIP work plan development phase

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• We will share these slides (with helpful tips and tricks) AND a list of the solutions that YOU share today

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• The real MAGIC of today: YOU! (Understanding each other as people who “get it”, discussing challenges that you have had in implementing a CHIP, and best of all, SHARING SOLUTIONS with each other)

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• What this will take: YOU TALKING!

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Anaheim, California

July 14-18, 2025

#NA360

Stephanie Moxley, MPH

MOXLEY PUBLIC HEALTH

CEO & LEAD CONSULTANT

stephanie@moxleypublichealth.com

Gerald “Jerry” Bingham, MPH, REHS

OTTAWA COUNTY HEALTH DEPARTMENT (OH)

HEALTH COMMISSIONER

jbingham@ottawahealth.org

Rose Mary Rahn, BSN, RN

KINGS COUNTY DEPARTMENT OF PUBLIC HEALTH (CA)

DIRECTOR OF PUBLIC HEALTH

rosemary.rahn@co.kings.ca.us

Molly Pofahl, MS

EAST CENTRAL DISTRICT HEALTH DEPARTMENT (NE)

CHIEF PUBLIC HEALTH OFFICER

mpofahl@ecdhd.ne.gov

THE PROBLEM AND CHALLENGE

After time and resources have been put into the development of a Community Health Improvement Plan (CHIP), many organizations struggle with implementing their goals....and basically, many of the goals for health improvement don't happen at all, or very well.

Anaheim, California

July 14-18, 2025

#NA360

Why (in some cases) does a CHIP not lead to real change?

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• Confusion on the process of implementing the work plan for health improvement

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• Partner/staff turnover

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• Competing priorities of hospitals, health departments, and partners

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• Coordination challenges when multiple organizations are working together on a CHIP

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• Not having the capacity/time and financial resources

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• Amount of effort/time required to implement structural changes

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• Improvement plan work plan is not realistic

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• Lack of accountability

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• What else?

Anaheim, California

July 14-18, 2025

#NA360

What are the risks of not implementing a CHIP?

• Waste of resources in conducting needs assessment and developing CHIP

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• PHAB and other state or federal requirements not met

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• Goals for community health improvement are not achieved

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• Health outcomes are not improved for community residents as much as they could be

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• Work to improve community health is not as intentional or precise

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• Process to achieve improved health outcomes is not clear

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• Strategies may not be focused on who would benefit from them the most

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• What else?

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Anaheim, California

July 14-18, 2025

#NA360

What are SOLUTIONS to make sure a CHIP leads to real CHANGE?

• Create an action-oriented work plan that includes realistic and feasible strategies, SMART objectives, strategy contact leads, action steps, priority populations to target, process and outcome indicators, etc.

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• Keep the work plan somewhere that you see it regularly (versus keeping in a drawer or “somewhere” on your computer)

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• Create working groups/teams to focus on each priority health need, and have a leader of each group (these can be existing groups)

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• Meet regularly to talk about the work plan, report on progress, and discuss next steps (hold quarterly meetings? schedule meetings ahead for upcoming year?)

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• Key roles: “keeper” of the work plan, group leaders, and members of each group

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Anaheim, California

July 14-18, 2025

#NA360

What are SOLUTIONS to make sure a CHIP leads to real CHANGE? (continued)

• Involving a health equity group in both the development and implementation of the CHIP

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• Support and buy-in of the CHIP from a group in the community (like a foundation) that funds a lot of the goals/strategies

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• Presenting the priority health needs and work plan to others in the health department and/or hospital and community

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• Integrating your fiscal giving to the priorities of the health department and/or hospital (from the CHIP)

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• Strike a balance between having realistic goals (and a reasonable number of goals) and pushing the organization a bit…

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• What else?

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Anaheim, California

July 14-18, 2025

#NA360

Work Plan Example

Our work plans are designed to make sure your CHIP is as straightforward for you and your partners to implement as possible!

(We write a SMART objective for each strategy and assign a leader and co-leader to each group.)

Anaheim, California

July 14-18, 2025

#NA360

Jerry Bingham, MPH, REHS

• Health Commissioner, Ottawa County (OH) Health Department (since 2020)
• Population: 40,000
• Small, rural health department in a summer vacationland — population swells 5x during summer months
• Fun fact: Port Clinton is the Walleye Capital of the world!

Anaheim, California

July 14-18, 2025

#NA360

CHA/CHIP Challenges

• Previous health commissioner was there 50 years
• Challenges:
• Lack of technology
• Lack of relationships with county partners
• History of CHA/CHIP being a “check the box” process, no progress made
• Desire to restore relationships with partners and create an actionable plan

Put-in-Bay, OH

Anaheim, California

July 14-18, 2025

#NA360

Progress

• 2022-2023 — worked with Stephanie and Moxley Public Health team to develop CHA and CHIP
• Held meetings with county partners where we discussed CHA findings to develop our CHIP
• Partners were excited to be involved and about the prospect of seeing change
• Meet monthly as part of another established meeting
• Aim to get quarterly updates from partners
• It can still be a struggle at times
• Slowly seeing progress, but need to work on documenting better

Anaheim, California

July 14-18, 2025

#NA360

Rose Mary Rahn, BSN, RN

• Director of Public Health, Kings County (CA) Department of Public Health
• Population: 153,000
• Small, rural, agricultural county in Central California 

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• Fun facts:
• Lead singer of the Band “Journey”, Steve Perry was born and raised in Kings County.
• Hanford (town in Kings County) at one time had a robust China Alley which had a Taoist temple
• Kings County is also home to Lemoore Naval Air Station which houses over 11,000 naval personnel

Anaheim, California

July 14-18, 2025

#NA360

CHAs and CHIPs

• CHA started in 2023, CHIP report completed end of 2024
• CHIP process is a team sport
• Health Department
• Health System (hospital, providers, clinics, FQHCs)
• The Community (organizations, elected officials, community members)
• Created the Kings County Health Equity Advisory Panel, which involves members from the groups above
• Finalizing the CHIP involved meetings with the panel to identify priorities and interventions, as well as who could take the interventions forward

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Anaheim, California

July 14-18, 2025

#NA360

The Good, the Bad, and the Ugly…

• The Good:
• Diverse groups came together to make the outcome reflective of the county
• The Bad:
• Turnover in project leadership, with 2 lead personnel leaving the county
• April 2024 — a fire at the health department required us to move office locations, taking focus away from the CHIP
• The Ugly:
• Funding cuts
• Challenge to continue panel group
• Uncertainty around the future of health plans/Medicaid

Anaheim, California

July 14-18, 2025

#NA360

Next Steps

• Vision for the future and the CHIP is bright
• Plan to reorganize the department and identify new leadership
• Health Plans are on board — will align population health priorities with local CHIP
• Meet with collaborative group to:
• Identify CHIP priorities
• Create meaningful work groups that align all partners
• Leverage health plan dollars for this project

Anaheim, California

July 14-18, 2025

#NA360

Molly Pofahl, MS

• Chief Public Health Officer, East Central District (NE) Health Department
• Population: 55,000
• Rural health department that oversees a four-county jurisdiction

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• Fun fact: Columbus is home to the oldest tavern in Nebraska. Glurs was established in 1857

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Anaheim, California

July 14-18, 2025

#NA360

Managing Competing CHIP Priorities in a Four-County Jurisdiction

• Platte/Colfax
• Diverse, strong Hispanic population, technically rural
• Common issues — behavioral health, food security, housing, childcare, healthcare
• Boone/Nance
• Very rural, mostly White population, aging population
• Common issues — agricultural safety, food security, isolation (behavioral health), healthcare
• Rural healthcare and public health is different
• Same community leaders pushing initiatives
• Buy-in is difficult
• “Do more with less”
• One hospital in each county

Anaheim, California

July 14-18, 2025

#NA360

The Three Cs — CHAs, CHIPs, and COVID-19

• Challenges — community leader buy-in, time, and resources
• Previous CHA done in 2021
• Major turnover in 2022
• No institutional knowledge preserved
• Quickly realized that there were strained partner relationships within the community, specifically between hospitals
• Is there such thing as too many behavioral health initiatives?
• Declining participation in meetings, no steady meeting cadence
• Success — nonprofit was formed to encompass all behavioral health initiatives 

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Anaheim, California

July 14-18, 2025

#NA360

A New Cycle: August 2024

• Community leaders gathered to review 2024 CHA and agree on priority areas — group chose to focus on 5 priority areas 
• Three main barriers to address plus additional challenge of 5 priority areas
• How do we address competing priorities between counties?
• How do we include every county in each priority area?
• How do we encourage others to lead initiatives?
• 5 priority areas means being very realistic when it comes to goals
• Solutions
• Moxley Public Health provided each county with their own CHIP plus one “master CHIP”
• Hospital leadership were encouraged to step up and take a leadership position in an identified priority area
• Meeting cadence was set up for accountability and situational awareness

Anaheim, California

July 14-18, 2025

#NA360

It’s been just under a year – how’s it going?

• Successes and challenges:
• Food security initiatives — we are able to purchase beef, eggs, veggies, and potatoes from local farmers through a grant
• Mobile food pantry in the works — working out funding and logistics
• Housing — welcome center research being conducted
• Behavioral health — forming better relationships with schools to promote youth mental health. Still navigating the various behavioral health initiatives throughout the jurisdiction
• Health care access — a committee of physicians and providers from all specialties to better understand provider shortages
• Childcare — childcare providers have been directly engaged to inform work group’s strategies

Anaheim, California

July 14-18, 2025

#NA360

Questions/Comments?

Please share if you are experiencing any challenges with your CHIP implementation.

Share any helpful solutions or additional things that have worked for CHIP implementation in your community!!

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“Goals are good for setting a direction, but systems [or an action plan] are best for making progress.”��Atomic Habits (book by James Clear)

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Anaheim, California

July 14-18, 2025

#NA360

QR CODE TO GET THE SOLUTIONS SHARED TODAY AND OUR FREE CHIP WORK PLAN DOC!

Go to this link to put in your contact info to get these slides, the ideas/solutions that are shared today, and the document we use at Moxley Public Health to develop a CHIP work plan, and/or to share your idea/solution for implementing a CHIP successfully (that we will share with the rest of the group).

Anaheim, California

July 14-18, 2025

#NA360

Thank you for attending!

Scan the QR code to share your contact information and solutions for implementing the CHIP!

Stephanie Moxley, stephanie@moxleypublichealth.com

Jerry Bingham, jbingham@ottawahealth.org

Rose Mary Rahn, rosemary.rahn@co.kings.ca.us

Molly Pofahl, mpofahl@ecdhd.ne.gov

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BRIGHT LIGHTS, BOLD IDEAS:�SHAPING THE FUTURE OF

PUBLIC HEALTH PRACTICE

�

Anaheim, California

July 14-18, 2025

#NA360