Nonprofit hospitals are federally required to conduct Community Health Needs Assessments (CHNA) every three years, a process that involves identifying and evaluating the health needs of the communities they serve while ensuring transparency and stakeholder involvement. CHNA evaluation for hospitals includes a systematic needs assessment with clear documentation of needs, assets, gaps, and resulting plans for community improvement.
This post walks readers through the key components of a CHNA, the potential challenges of the process, and the importance of partnering with an external evaluator.
What Is CHNA?
A Community Health Needs Assessment (CHNA) is a structured evaluation of the health concerns and strengths within a hospital’s surrounding community. The CHNA process helps not-for-profit health care organizations fulfill their community benefit mission. The provision of community benefits is essential to nonprofit healthcare organizations and is a requirement for maintaining their tax-exempt status under the IRS.
Section 501(r)(3)(A) requires a hospital organization to conduct a CHNA every three years and to develop and implement an action plan to address the community health needs identified through the CHNA.
This method helps hospitals determine priorities for improving local health, guides allocation of resources, and fulfills statutory requirements for nonprofit status. The process typically incorporates input from local organizations, agencies, residents, and public health experts.
Federal and State Requirements
Nonprofit hospitals must:
- Define the community served, taking into account its geography and population characteristics.
- Utilize systematic data collection methods (surveys, focus groups, and secondary data) and consult with community stakeholders to assess health needs.
- Identify and prioritize significant needs.
- Develop and publish an action-oriented implementation plan for the next three years.
- Make the CHNA and evaluation report publicly available after formal board adoption.
Importantly, hospitals may not define their community in a way that excludes medically underserved, low-income, or minority populations. These groups must be included in both the assessment process and the resulting strategies.
Key Components of Hospital CHNA
Hospitals must include these elements in their CHNA documentation:
- Definition of community served and rationale for the definition.
- Description of methods and process for assessment (including data sources and stakeholder engagement).
- Prioritized description of significant health needs found.
- List of available resources to address these needs.
- Evaluation of the impact of strategies addressing priorities in the previous CHNA cycle.
Community Engagement Requirements
Hospitals are required to solicit and take into account input from all the following three sources to identify and prioritize significant health needs, as well as to identify resources potentially available to address those health needs:
- At least one state, local, tribal, or regional governmental public health department (or equivalent department or agency), or a State Office of Rural Health described in Section 338J of the Public Health Services Act, with knowledge, information, or expertise relevant to the health needs of the community.
- Members of medically underserved, low-income, and minority populations in the community served by the hospital facility, or individuals or organizations serving or representing the interests of these populations.
- Written comments received on the hospital facility’s most recently conducted CHNA and most recently adopted implementation strategy.
In addition to soliciting input from the three required sources, a hospital facility may also solicit and consider input received from a broad range of individuals located in or serving its community. This includes, but is not limited to:
- Health care consumers and consumer advocates
- Nonprofit and community-based organizations
- Academic experts
- Local government officials
- Local school districts
- Health care providers and community health centers
- Health insurance and managed care organizations
- Private businesses
- Labor and workforce representatives
Although a hospital facility is not required to solicit input from additional persons, it must take into account input received from any person in the form of written comments on the most recently conducted CHNA or the most recently adopted implementation strategy.
Common Challenges During the CHNA Process
Quality CHNAs foster genuine community engagement and utilize diverse data sources. Challenges include inadequate representation of underserved groups in surveys and public input, as well as insufficient evaluation of previous impacts.
1. Compliance-Driven, Not Community-Driven
Some hospitals treat CHNAs as a regulatory “check-the-box” exercise. This results in lengthy reports that satisfy IRS rules but fail to drive real change.
2. Limited Community Engagement
Hospitals often rely heavily on secondary data and surveys, without investing in meaningful engagement with residents. Underserved voices are particularly at risk of being left out, resulting in assessments that are unrepresentative of the true community needs.
3. Overlooking Social Determinants of Health
Many CHNAs prioritize clinical data (chronic disease, ER use) while underestimating social and environmental drivers like housing stability, transportation, or access to healthy food.
4. Insufficient Evaluation of Past Efforts
Hospitals must evaluate the impact of their previous CHNA implementation strategies, yet this step is often superficial or overlooked entirely. Without robust evaluation, it’s difficult to know whether strategies are working—or how to improve them.
5. Fragmented Efforts and Missed Collaboration
Too often, hospitals work in silos, conducting CHNAs independently of public health departments or community-based organizations. This leads to duplication, wasted resources, and missed opportunities for collective impact.
Best Practices to Strengthen CHNAs
To address these challenges and move beyond compliance to collecting actionable data, hospitals can:
- Engage Broadly: Include residents, community advocates, and those most affected by inequities in every stage of the process.
- Leverage Diverse Data: Combine quantitative data with qualitative insights (e.g., focus groups, key informant interviews).
- Collaborate Across Sectors: Align with public health departments, nonprofits, and local government for coordinated strategies.
- Evaluate Impact: Commit to transparent measurement of progress, not just reporting on plans.
Why Partner with an External Evaluator
CHNAs represent a significant opportunity for hospitals to align resources with the most pressing community health needs. When treated as more than a compliance requirement, they become a catalyst for community partnerships, targeted strategies, and improved health outcomes—especially in medically underserved areas where the need is greatest.
There are also risks and penalties for non-compliance. The IRS has begun conducting audits of tax-exempt hospitals, with a particular focus on their community benefit and financial assistance policies. Their procedures for determining whether patients qualify for financial assistance are also being reviewed
External evaluators, like EVALCORP, bring added value to this process by:
- Ensuring Objectivity: As neutral facilitators, evaluators help balance hospital priorities with authentic community perspectives, ensuring assessments are credible and transparent.
- Expanding Capacity: External partners can bring the expertise and resources needed to conduct comprehensive, high-quality assessments that many hospital staff and teams lack the dedicated time or capacity to undertake.
- Leveraging Methodological Expertise: Evaluators are skilled in blending quantitative and qualitative methods—such as surveys, focus groups, and key informant interviews—to provide a more comprehensive picture of community health needs.
- Strengthening Community Engagement: Experienced evaluators understand how to amplify the voices of underserved and marginalized populations, promoting inclusivity and trust.
- Driving Accountability and Impact: By connecting assessment findings to measurable implementation strategies, evaluators help ensure that CHNAs lead to action, not just documentation.
Partnering with an evaluator transforms the CHNA from a regulatory exercise into a strategic opportunity to build healthier, more equitable communities.