Synapse: A Platform for Community Health Partnership

Maricopa County is called the Valley of the Sun and attracts over 80,000 new residents annually. The weather and affordable cost of living are significant motivators for people from all walks of life. This annual migration has elevated Maricopa County to the position of 2^nd largest county in the United States, with an estimated 4.5 million residents across 9,224 square miles. Maricopa County holds 62% of the state's population within 24 cities, towns, tribal land, and unincorporated communities. This size propels Maricopa County into the 3^rd largest health jurisdiction in the United States. Given this dynamic, the Maricopa County Department of Public Health must find a way best to serve its residents as the only local health department. The size of Maricopa County creates challenges to collecting data that accurately reflects the diverse voices across the county.  

In 2011 MCDPH began its partnership with two local hospital systems to conduct a Coordinated Community Health Needs Assessment. The success of this collaboration encouraged more hospitals and healthcare systems to join MCDPH. In 2014 the Synapse coalition was officially formed to assess and address the health needs of the Maricopa County Community. One of Synapse's purposes is to collect data to inform public health response, local healthcare partner strategic development, and targeted grants, which will help support prevention planning efforts, needs assessments at the local level, and resource allocation.

In 2019 MCDPH mobilized six healthcare partners, four hospital systems, and two federally qualified healthcare centers. The CHNA conducted that year proved to be a hugely successful effort that paved the way to increased data representation and solid collaborative efforts between healthcare systems that historically hadn't worked together. The data collected served to inform public health response, local healthcare partner strategic development, and targeted grants which helped support prevention planning efforts, needs assessments at the local level, and resource allocation. Although another CHNA wasn't planned until 2022, the COVID-19 pandemic presented another opportunity to collect data and mobilize partners to identify opportunities to support the response and recovery of Maricopa County.

MCDPH worked with the Synapse coalition and the Health Improvement Partnership of Maricopa County (HIPMC) to develop a data collection tool that would serve as supplemental community health needs assessment focusing on COVID-19 impact. To collect data, the Synapse coalition and MCDPH leveraged regional Public Health Liaisons and COVID-19 response units to engage with different community organizations, refugee/immigrant/migrant (RIM) networks, faith-based communities, hospital/healthcare systems, university research groups, municipalities, school districts, and local coalitions. Local coalitions were supported with mini-grants to center the community's voice and represent those historically marginalized in public health data collection. Additionally, a communication toolkit that included graphics, flyers, and social media sample post templates was developed and shared with the community to promote survey engagement.

In 2021 the Synapse Coalition grew to represent seven healthcare facilities (four hospital systems and three FQHCs). These partners were also on the front lines of the COVID-19 response. MCDPH leveraged Synapse and community partners' testing and vaccine events and extensive social networks to connect and collect surveys from residents.  MCDPH monitored all survey entries and outreach efforts weekly to collect real-time data on population representation. A weekly data report was generated to identify the population underrepresentation of specific groups by zip code, age, race/ethnicity, and unique population. This gap analysis led to focused outreach efforts with community partners specifically serving any underrepresented groups.

MCDPH increased participation in the 2021 CHNA by 21% compared to the 2019 CHNA, despite collecting data mid-pandemic for ten fewer weeks. Data collection resulted in 14,380 responses. MCDPH collected and analyzed over 4,500 qualitative responses from open-ended survey questions. Thematic analysis revealed top community issues and concerns generated by the public, and quotes were utilized in reports and presentations to contextualize data with individual stories. Data analysis and reporting engaged local stakeholders through frequent presentations to public health partners, healthcare partners, towns, and cities.

The Synapse cross-sector partnerships enabled the successful identification of societal factors and health needs through the CHNA while strengthening the collaboration models required to address these issues strategically. 

Website: maricopahealthmatters.org

The responsiveness and innovation of the Synapse Coalition have been as follows:

• As a result of the ACA requirements for 501c3 organizations to conduct a regular Community Health Needs Assessment (CHNA), MCDPH recognized the value they could bring to coordinating partnerships, data collection, and reporting for the agencies.
• Coalition builds sustainable partnerships between public health and healthcare systems to complete the MAPP and CHNA process. It aligns multiple sectors with sharing common understandings of the county and developing shared goals. This partnership is built around meeting important organizational targets – such as IRS requirements for nonprofit hospitals and Public Health Accreditation Board (PHAB) requirements for health departments.
• The target population is the 4.5 million residents of Maricopa County. The 2021 survey reached 14,380 residents to understand the community's needs better. Initiatives that have been implemented as a result target the specific needs of focus populations based on the data.
• The project addresses health equity through:
  • Collecting diverse data that reflects the county's population
  • Taking input from a variety of community organizations and members into the development of the CHNA, as well as the implementation strategies developed by the hospitals
  • We are training healthcare partners on topics such as race, gender/sexual orientation, and other social determinants of health.
  • The current practice is evidence-based in that it follows requirements from the IRS, PHAB, and the MAPP process for data collection.

Synapse is a coalition of non-profit and federally qualified healthcare providers who collaborate to collect data that informs investment into the needs of our community by completing a community health needs assessment. This collaboration is a contracted partnership where each healthcare system pays MCDPH to pull financial resources to support the staffing and data collection efforts for the CHNA and its supplement analysis. The contract cycles are three years long and include the planning, implementation, and analysis of the CHNA and all of its associated reports for they systems to meet IRS and HRSA requirements. The success of the CHNA and the Synapse Coalition efforts has allowed the coalition to grow through new membership and the ability to leverage additional grant funds to increase staff and outreach. The vision of Synapse is to participate in a collaborative approach that identifies community needs, assets, resources, and strategies toward assuring better health and health equity for all Maricopa County residents.

This collaborative/coalition was created to:

Eliminate duplicative efforts; create a compelling and sustainable CHNA process; build stronger relationships between healthcare systems and public health; identify opportunities for joint efforts to improve the health and well-being of Maricopa County; help healthcare systems, public health, and community partners focus available resources to address the communities' most critical health needs.  

Steps to Implement Program

In 2014 and 2015, MCDPH worked with a group of hospitals and FQHCs to develop the structure. After some surveying and discussion, the members identified the following reasons for joining the coalition:

Training opportunities - 0%

Technical assistance opportunities - 0%

Access to high quality data - 100%

Access to public health experts - 0%

Networking with other health professions colleagues - 20%

Participating in a community health improvement planning process - 80%

Collaborating with diverse colleagues for health improvement - 20%

Other - 20%

As a result, the Synapse Coalition decided to meet monthly, collect CHNA data, and work individually with MCDPH to develop each organization's CHNA report.  Starting July 2023 will be the 4^th full-cycle for the Synapse coalition contracts, now with eight healthcare partners (four hospitals and four FQHCs). 

LHD Role

As of 2023, MCDPH had four full-time staff working on Synapse: Program Manager, Health Impact Specialists, and Community Health Epidemiologist.

Each partner's contracted amount is based on the number of facilities they have, which require separate reports. FQHCs have flat fees due to their role as community healthcare safety nets.

Contract fees pay for the program managers and are part of the epidemiology salary. The remaining money is used for data collection and analysis. Additional Synapse-related staff is typically funded through other relevant grants. 

Contracts between MCDPH and Synapse Coalition members outline the following deliverables.

County agrees to: Produce a final CHNA report for the healthcare facility/partner by the deadline determined by the healthcare facility/partner and MCDPH; Administer the data gathering, cleaning, and analysis for community health indicators in Maricopa County, including data collection from focus groups; Administer and convene meetings of the CHNA partners at least quarterly; Provide for ad-hoc data analysis on community health indicators at the request of the healthcare facility/partner.

Healthcare partner agrees to: Allow employees of the healthcare facility/partner to participate as necessary on the Synapse coalition and/or workgroups; Facilitate the timely review and approval of the final CHNA report by the necessary Administrators and Boards with the Hospital/Healthcare system.

Work with the Synapse coalition has led to increasing in partner participation, staff expansion, and improvement of quality data collection.

Past Survey & Focus Group Participation

2012: 973 survey participants; 148 focus group participants

2017: 6,708 survey participants; 367 focus group participants

2019: 11,986 survey participants; 500 focus group participants

2021: 14,380 survey participants; 186 focus group participants

Data Collection efforts have grown since 2012 to include a virtual survey format, translation into 13 languages, grants for community organizations to conduct focused outreach and engagement, regional approach and mapping, and partnership with local municipalities and elected officials.  

Despite these improvements, we continue to see lower representation from specific demographics, highlighting the need for increased accessibility and direct engagement with populations. Based on these outcomes, we target outreach and data collection to better reach the underrepresented populations.

Sustainable LHD Infrastructure

o   The 3-year contract cycle (image below) provides sustainable funding for MCDPH to produce robust work without gaps in focus or funding. This time frame allows staff to focus on survey development, data collection, analysis, public reporting, partner prioritization, and partner report development while continuing monthly Synapse collaboration meetings.

o   The consistent revenue stream allows hiring and maintaining staff in the public health department. From 2019-2023, Synapse FTEs have grown from 2 to 5. This allows more vital and ongoing work.

o   Synapse and HIPMC are both organized by MCDPH. This alignment of staff and coordination between healthcare and community-led organizations leads to LHD capacity growth and more significant impact.

Sustainable Partner Funding

o   Healthcare partners pay less participating in the coalition than they would spend hiring a consultant.

o   Many healthcare organizations deal with frequent turnover. Partnering with MCDPH ensures that their CHNA work continues despite staff changes.

Sustainable Health Strategies

o   Healthcare organizations that may have initially been competing for market share come together to develop collaborative solutions.

o   The work leads to a coordinated vision across agencies and longstanding collaborations instead of each organization doing work in siloes.

o   By reducing multiple agencies surveying the same population in different ways, the vision is aligned, and the work is not duplicated.