Community Health Needs Assessment & Improvement Plan

Every three years, since the implementation of the Affordable Care Act, non-profit hospitals conduct a Community Health Needs Assessment to identify priority health needs for the community. An important part of this process is to solicit input from the Monroe County Department of Public Health and members of the community. 

The Community Health Improvement Workgroup (CHIW) conducts this work. Several partners are instrumental in the community health planning process, including Common Ground Health, Finger Lakes Performing Providers System (FLPPS), the City of Rochester, the Monroe County Office of Mental Health, and several other community-based organizations.

The Community Health Needs Assessment (CHNA) pulls together critical information from several data sources, including Common Ground Health, RocHealthData, and the New York State Prevention Agenda. More resources can be found here.

Based on data and driven by community voice, the 2025 Monroe County Community Health Needs Assessment (pending health system board approvals) has identified the following priority areas: 

• Underlying Poverty
• Maternal and Child Health
• Stress and Anxiety

The 2025-2027 Community Health Improvement Plan details are being finalized, to be released summer 2025. Find previous reports here. 

The CHIW meets monthly to discuss implementation of the Community Health Improvement Plan (CHIP) to address the needs identified in the CHNA. Evaluation metrics have been identified and will be tracked. Each hospital, the Health Department, and several community agencies have specific roles in implementation of the improvement plan, and each hospital board has voted to approve the CHNA and CHIP, committing to its implementation.

The process used in Monroe County for CHIP development has been recognized as one of the 10 'best practices' in the country. Health Resources in Action, a nonprofit organization dedicated to promoting public health and advancing medical research, completed this evaluation project with funding from the Robert Wood Johnson Foundation.