At Lourdes, we promise

Transcription

1 169 Riverside Drive Binghamton, NY (607) FAX: September 15, 2009 Ms. Mary Ellen Hennessy Deputy Director Division of Certification and Surveillance New York State Department of Health 433 River Street, Suite 303 Troy, New York Dear Ms. Hennessy: On behalf of Our Lady of Lourdes Memorial Hospital, we are pleased to submit Our Lady of Lourdes Memorial Hospital s Community Health Assessment (CHA). We will be forwarding a copy to the attention of Ms. Sue Ellen Wagner, Director of the Continuing Care and Community Health Division of the Healthcare Association of New York State, and Mrs. Claudia Edwards, Director, Broome County Health Department. Also, on behalf of the Board of Directors and the staff at Lourdes, I want to express our appreciation for the opportunity to participate in this process. We are appreciative that the cycle for submitting the CHA coincides with the local health department. This will facilitate the effective coordination of tactics which positively impact the health of our community. The needs that Lourdes will be focusing on during the period will be those identified through the collaborative process we participated in with the Broome County Health Department s Community Health Assessment Steering Committee. We will continue to utilize the information from both the local and state health departments as we design and implement strategies to improve the health status of our community. Should you have questions on the attached, feel free to contact me at (607) or Lisanne Bobby, Director of Strategic Planning at (607) Sincerely, David Patak President and Chief Executive Officer cc: Mrs. Claudia Edwards Director, Broome County Health Department Ms. Sue Ellen Wagner, Director Continuing Care and Community Health, HANYS Ms. Lisanne Bobby Director, Strategic Planning, Lourdes At Lourdes, we promise Healthcare that works. Healthcare that is safe. Healthcare that leaves no one behind.

2 HEALTHCARE THAT WORKS. HEALTHCARE THAT IS SAFE. HEALTHCARE THAT LEAVES NO ONE BEHIND Community Health Assessment/ Community Service Plan 169 Riverside Drive Binghamton, NY

3 Our Lady of Lourdes Memorial Hospital, Inc. Binghamton, New York Community Health Assessment/ Community Service Plan Table of Contents 1. Executive Summary.2 2. Mission Statement 3 3. Service Area 4 4. Public Participation.4 5. Assessment of Public Health Priorities 7 6. Three Year Plan of Action Financial Aid Program 9 8. Changes Impacting Community Health/ Provision of Charity Care/ Access to Services Dissemination of Report Financial Statement 11 Attachments #1: Lourdes FY Integrated Strategic, Operating, and Financial Plan #2: Public Participation in Process #3: 2009 Community Health Assessment Analytic Hi-lites #4: Lourdes Community Health Assessment/CSP Planning Matrix #5: Broome County Community Health Assessment Community Health Planning Matrix #6: BCDOH Public Health Priority Matrix #7: Lourdes 2008 Community Service Plan #8: Lourdes Focus Group Research, Creating a Senior Friendly Environment #9: Lourdes Focus Group Research: Access to Care Research Referral Focus Groups #10: AmeriMed Consulting, Inc., Fall 2008 Medical Staff Development Plan - 1 -

4 Our Lady of Lourdes Memorial Hospital, Inc. Binghamton, New York Community Health Assessment/ Community Service Plan EXECUTIVE SUMMARY Community Service Plan This three year comprehensive Community Service Plan reflects the collaborative process between Our Lady of Lourdes Memorial Hospital, Inc., the Broome County Health Department Steering Committee member organizations, United Health Services, and other community partners. The plan demonstrates Lourdes current and future commitment clinically and financially to address the Community s Health Status by fulfilling its Call to provide Health Care that Works, Health Care that is Safe, and Health Care that Leaves No One Behind. Lourdes is committed to making our community a stronger, healthier place to live. Comprehensive 3-Year Plan Format Guided by Our Lady of Lourdes Memorial Hospital s mission, this Community Service Plan is a comprehensive assessment of the community s health needs and Lourdes strategic response to community public health priorities. This plan focuses on opportunities for Lourdes to improve the health and well being of underserved, poor and vulnerable, or high-risk residents through service, leadership, partnership, and collaboration. The Plan was developed consistent with the New York State Health Care Reform Act of 1996, Article and related New York State Department of Health guidance. Lourdes concurs with the selection of the Community s Health priorities around access and coverage to health care, and chronic disease prevention and chronic disease management. In addition to these collaboratively selected public health priorities, Lourdes will continue to seek and create opportunities to improve the health status of the frail and elderly; and women, children and adolescents. Lourdes commitment to addressing community need is reflected in the Lourdes five (5) year Integrated Strategic, Operating and Financial Plan ( ISOFP ) which is updated annually (Attachment #1). Community health priorities will continue to be addressed through Lourdes ISOFP. Measurable outcomes have, are, and will be reported to the community annually, regarding this plan through Lourdes annual Community Service Plan report. These outcomes will continue to be readily available to the public on Lourdes website and through Lourdes media venues to educate the public. Lourdes will participate in the on-going assessment of the Community s Health Status by participating on the Broome County Health Department s Community Health Assessment Steering Committee. It is the intent of the Steering Committee to meet quarterly to further develop and monitor tactics and strategies designed to address the community s health status. Furthermore, Lourdes will also monitor specific outcome measures to ensure that public health priorities are effectively being addressed

5 Our Lady of Lourdes Memorial Hospital, Inc. Binghamton, New York Community Health Assessment/ Community Service Plan 1. Mission Statement Reaffirm the hospital s mission statement that identifies commitment to the community it serves. Indicate if there have been no changes to the mission statement in this section. There have been no changes to Our Lady of Lourdes Memorial Hospital s mission statement, or core values. Providing community benefit is an important part of Our Lady of Lourdes Hospital s Mission. It represents a vital link to the community and neighbors. Lourdes strength is in rooted in its history and Mission. The Mission and work of Lourdes goes on; as it has, since Our Lady of Lourdes Memorial Hospital, Inc. (also referred to herein as Lourdes, Lourdes Hospital or the Lourdes Health System ) is a community not-for-profit health care system sponsored by Ascension Health. Rooted in the loving ministry of Jesus as healer and in the tradition of the Daughters of Charity of St. Vincent de Paul, Lourdes is committed to serving all persons with special attention to those who are poor and vulnerable. As a Catholic entity, Lourdes is guided by the moral and ethical teachings of the Roman Catholic Church. Lourdes Catholic health ministry is dedicated to spiritually centered, holistic care which sustains and improves the health of individuals and communities. Lourdes associates are advocates for a compassionate and just society through their actions and work. Lourdes goal is to provide the highest quality health care to all who need it, particularly care for the poor and vulnerable. Lourdes is committed to being a well run organization. Lourdes commits to promoting a healthier community through collaboration with the Medical Staff and members of the communities it serves. Central to Lourdes services are the core values of Ascension Health: Service of the Poor Generosity of spirit, especially for persons most in need. Reverence Respect and compassion for the dignity and diversity of life. Integrity Inspiring trust through personal leadership. Wisdom Integrating excellence and stewardship. Creativity Courageous innovation. Dedication Affirming the hope and joy of our ministry. Lourdes Hospital is based in Binghamton, New York. Lourdes primarily serves residents in Broome County. Residents from Tioga, Delaware, Chenango, and contiguous counties in the Southern Tier of New York and Northern Tier of Pennsylvania are served through its comprehensive range of primary care, outpatient diagnostic services, specialty care, acute care, home health care, durable medical equipment company, hospice care, youth behavioral health and development, oral health, occupational health services and worker s compensation preferred provider organization programs, as well as health education and outreach programs

6 Our Lady of Lourdes Memorial Hospital, Inc. Binghamton, New York Community Health Assessment/ Community Service Plan Lourdes embraces the Ascension Health Call to Action to provide Healthcare that is Safe, Healthcare that Works, and Healthcare that Leaves No One Behind. More information on this three pronged approach to transform healthcare can be found on the Ascension Health website at 2. Service area Define the area the hospital uses for community/local health planning for the purposes of the Community Service Plan (CSP). Please include the method used to determine the service area e.g. zip codes, census data, etc. Method used to determine Service Area Lourdes Hospital is based in Binghamton, New York. For community and local health planning purposes, this Community Health Assessment and Community Service Plan addresses the needs of the residents of Broome County, as over 80% of those served by Lourdes reside in Broome County. This primary service area definition is consistent with physician needs assessment methodologies based on qualitative standards established by the Internal Revenue Service (IRS) in a variety of General Counsel Memorandums, and was reinforced by its (the IRS s) private letter ruling with Hermann Hospital and by its Final Revenue Ruling on Physician Recruitment (Revenue Rule 97-21). These and other rulings have better defined the position of the Internal Revenue Service and the Federal Department of Health and Human Services relative to physician recruitment and community needs assessment. 1 While this plan addresses residents in Broome County, Lourdes extends its services and sphere of influence to the residents of Tioga, Delaware, and Chenango, New York, and to the residents of Susquehanna Pennsylvania. Persons are served through Lourdes comprehensive range of primary care (available in 15 locations within three counties), Endocrinology & Diabetes Centers of Excellence, outpatient diagnostic services, mobile van services (primary care, cancer screening, mammography, dental care), regional cancer center services, specialty care, acute care, home health care, durable medical equipment company, hospice care, youth behavioral health and development, oral health, occupational health services and worker s compensation preferred provider organization programs, as well as health education and outreach programs. Additional information is available on Lourdes web site at 3. Public Participation Identifies the participants involved in assessing community health needs, e.g. community-based organizations; other health care providers such as community health centers, family planning clinics, physician groups, and home care agencies; facility advisory boards and the public. Lourdes recognizes that Public Participation is an important aspect of the CSP. The Broome County Community Health Assessment is the result of collaboration and the basis for the Public Health Priorities framing Lourdes Community Service Plan

7 Our Lady of Lourdes Memorial Hospital, Inc. Binghamton, New York Community Health Assessment/ Community Service Plan This comprehensive plan reflects extensive communication and interaction with stakeholders from many sectors, to identify and prioritize un-met community needs and strategies for addressing them. As recommended by the New York State Department of Health, Lourdes s was involved in the Community Health Assessment and planning process of the local health department (Broome County). Outreach to health and human service organizations, consumers, community groups, and facility advisory boards were accomplished in collaboration with the Broome County Health Department Community Health Assessment Steering Committee. This collective collaboration enabled the community to have more public participation in identifying community need than could have been accomplished independently. Additionally, Lourdes provided input to consultants contracted by the Tioga County Health Department (TCDOH) to complete the TCDOH s Community Health Assessment. Demonstration of public involvement in this process (See Attachment 2 Public Participation Process for documentation of public involvement in this process): Public Input Process Methods used to obtain public involvement in the identification of Broome County s public health status and health needs included: 1) Coordination of community wide efforts to obtain public input through the Broome County Health Department s CHA Steering Committee; 2) The use of an independent consultant making random phone calls to recruit focus group participants; 3) Consultant interviews with physicians and physician office staff; 4) Survey mailings to all active members of the Lourdes Medical Staff; 5) Random patient and physician surveys mailed; 6) Meetings were convened with stakeholders at mutually agreed upon times. 1. Broome County Health Department: Lourdes participated on the Broome County Health Department s Community Health Assessment Steering Committee. Representatives from community agencies participated on the task force and were notified of meeting times and dates by the steering committee chair. Nine meetings were held. All meetings were scheduled one year in advance, with monthly reminders to committee members. 2 Meetings were held for one and a half hours from October 2008-September Meeting content included: Integrated County Planning Focus Group: Community Themes & Strengths Assessment October The MAPP process was used to conduct assessments of: Community Themes & Strengths, Local Public Health System, Community Health Status, and Forces of Change. The process relied heavily on the capture and analysis of data through focus groups and surveys, and the analysis of existing data sets (New York State Department of Health s Community Health Data Set as reviewed through participation in the local Health Department s Community Health Assessment. County Health Assessment Indictors, BRFSS, YRBS, SPARCS, PQI, and other county level data available on the NYS Health Information Network) in comparison to the 2013 Prevention Agenda goals. Analysis of Broome residents leaving the county for health care, and of PA residents in-migrating for services; population-based trends in health status, socioeconomic, demographic indicators was conducted

8 Our Lady of Lourdes Memorial Hospital, Inc. Binghamton, New York Community Health Assessment/ Community Service Plan Additional analysis included: the review of all the National and local trends/indicators available through the New York State Health Department, local Health Department, Ascension Health s Environmental Scan, Health Institute Technology of the Future, the American Hospital Association, private consultants, and SG2 (a Strategic Intelligence think tank company). The steering committee synthesized the data/findings in order to identify strategic issues, formulate goals and strategies to address public health. 2. Tioga County Health Department: Lourdes provided input to consultants for the Tioga County Health Department s Community Health Assessment through an interview and Lourdes Focus Groups: (Attachments #8 & 9) Lourdes, through a Market Research Consulting firm, RMS, elicited feedback through community focus groups: 3 Community Access Focus Groups, 3 Community-Provider Access Focus Groups ; and 2 Senior focus groups, 2 Caregivers of Senior focus groups 4. Lourdes Consultants (Attachment #10): AmeriMed, Inc for planning Community Medical Staff needs. 5. On-going Feedback: Lourdes receives formal and informal input on Community Health Needs on an on-going basis through participation in National, New York State, Regional, County, local community coalitions and agencies; patient and physician satisfaction surveys. 6. Lourdes Associates. Input will continue to be sought on an on-going basis from nearly 100 organizations/agencies/service groups which over 75 Lourdes Associates serve on to ensure that intervention strategies are achieving the desired outcomes, and to identify new community needs. Outcomes of Public Input in the Community Service Plan & Assessment Process Barriers to Care and/ or Gaps in services were identified through a variety of methods: focus groups, surveys, Community Services Assessments; The Broome County Health Department CHA Steering Committee, and qualitative and quantitative analytics. This information was incorporated into the identification and recommendations around Public Health Priorities identified in the Broome County Health Department s Community Health Assessment. Comprehensive findings are detailed in the Broome County Community Health Assessment document ( Attachment #3: 2009 Community Health Assessment Analytic Hi-lites summarizes key findings. Interventions will address health status priorities 3. Most likely the positive clinical outcomes reported on, are a reflection of successful interventions previously deployed by Broome County s health care systems targeting the particular public health issue. Lourdes Hospital and United Health Services Hospitals collaborated in establishing hospital public health priorities. This information was incorporated into the hospital and County Community Service Plans

9 Our Lady of Lourdes Memorial Hospital, Inc. Binghamton, New York Community Health Assessment/ Community Service Plan (Attachment # 4: Lourdes Community Planning Matrix; Attachment #5: Broome County Health Assessment Planning Matrix). 4. Assessment of Public Health Priorities Hospitals are considered co-conveners of the community assessment process with the LHDs with which they work most closely. Hospitals, LHDs and other community partners (community-based organizations, health care providers, and consumers, etc.) should form a partnership to share and analyze data to identify the 2 to 3 Prevention Agenda priorities. This section must describe the criteria by which the priorities were selected, including how data were used to target a community or a segment of the community. Describe whether the priorities selected represent new community initiatives or existing programs that will be supplemented by input and support from community partners. The recommended Broome County Public Health Priorities are similar to those listed in the Broome County CHA. The Broome County Health Department CHA Steering Committee reviewed progress made on the priorities. Several other Public Health Priority sources were reviewed. Each of these sources was also reviewed by Lourdes Hospital. 1. Public Health Priorities Established by New York State Commissioner of Health 2. Review of Local Health Priority Outcomes and comparisons to local, regional, state, and national benchmarks. Healthy People 2010 Objectives were reviewed by the Steering Committee 3. Review of Lourdes Public Health Priorities 1. Public Health Priorities Established by New York State Commissioner of Health Background In April of 2008, Commissioner Daines launched the Prevention Agenda for the Healthiest State. The Prevention Agenda established 10 public health priorities and asks that hospitals, local health departments, and health care and community partners work together to bring about measurable progress toward mutually established goals. Public health priorities Established by the NYS Health Commissioner Access to Quality Health Care Tobacco Use Healthy Mothers, Healthy Babies Healthy Environment Physical Activity & Nutrition Community Preparedness Unintentional Injury Mental Health & Substance Abuse Chronic Disease Infectious Disease - 7 -

10 Our Lady of Lourdes Memorial Hospital, Inc. Binghamton, New York Community Health Assessment/ Community Service Plan Subsequent to Commissioner Daines establishment of Public Health Priorities, Local Health Departments (LHDs) received similar encouragement from the Department to participate in a collaborative Community Health Assessment (CHA) process and to record their efforts in their CHA and Municipal Public Health Service Plans. Local Health Departments were charged to complete their plans by July of The intent of completing plans in July was to provide hospitals the opportunity to develop Community Service Plans supportive and integrative of the local health department s community health assessment. By collaborating with community health partners and developing a collaborative approach, all participants will be better able to meet the needs of their community while avoiding duplicative efforts and achieving economies of scale. Further information regarding the Prevention Agenda can be found at the following link: 2. Broome County CHA Steering Committee Prioritization Process The Steering Committee used the following criteria to rate the Prevention Agenda priorities and additional priorities identified by task force members: Potential Costs to the Health Care System Absolute Number of Individuals Affected Worsening Trend Over the Past 5 Years Underperforming Healthy People 2010 and/or New York State 2013 Prevention Agenda Goals. Work Time Lost or Disability Particular Areas of Concern (Disparities) Feasibility for Potential Intervention Availability of Funding for Initiative Forces of Change (Trends, Factors and Events) Measurability over Time Reference Attachment #6: BCDOH Public Health Priority Matrix. 3. Lourdes Public Health Priorities, Review Lourdes participated in the development of the Broome County Community Health Assessment Community Health Planning Matrix to Achieve the New York State Prevention Agenda. (See Attachment# 5: Broome County Community Health Assessment Community Planning Matrix for description of priority scope, objectives and accomplishments) 5. Three Year Plan of Action For the Public Health Priorities identified in Section 4, including the 2 to 3 Prevention Agenda priorities, describe the strategies proposed to address them; whether they are new or existing priorities; how they may be addressed by the hospital and community partners and by whom, e.g., a service or program will be implemented within the hospital, a community health center or local health department clinic, an educational effort will be undertaken by local schools, businesses, or health department(s). Prevention Agenda priorities should be addressed jointly with other community partners performing services or activities within their scope or mission. In the case of hospital public health programs falling outside the Prevention Agenda priorities, the hospital does not need to implement a collaborative approach to address the issue. The overall goals of the strategies, how the goals will be measured for effectiveness and how these current strategies may be modified to include on-going input and support from the hospital s community partners

11 Our Lady of Lourdes Memorial Hospital, Inc. Binghamton, New York Community Health Assessment/ Community Service Plan Through the BCDOH CHA Steering Committee, Prevention Agenda priorities will be addressed jointly with other community partners performing services or activities within their scope or mission. Attachment# 5: Broome County Community Health Assessment Community Planning Matrix identifies the Community s Public Health Priorities, whether they are existing or new, and how they may be addressed and by whom. There will be on-going input and support from the CHA Steering Committee Partners, Lourdes Hospital, and United Health Services Hospitals in the review of selected Community Priorities, the overall goals of the strategies, how the goals will be measured for effectiveness. Note that some of the interventions specified in the Community Planning Matrix s (Attachments #4 and 5) have been or are currently in place. Lourdes, in conjunction with the CHA Steering Committee, will recommend the length of time the intervention should be in place before its effectiveness can be determined Broome County Public Health Priorities (and Adopted as the Lourdes Public Health Priorities) Priority Areas Concerns within Each Priority Area Access to Quality Health Care Increase health care coverage. Increase access to mental health / substance abuse services. Increase access to prescription drug medication. Chronic Disease & Chronic Disease Prevention Decrease the proportion of children and adults who are obese. Reduce the prevalence of diabetes and reduce diabetes-related hospitalizations. Reduce hospitalizations due to heart failure Lourdes Public Health Priorities supporting Broome County Public Health Priorities Lourdes will collaborate with members of the Broome County Health Department Community Health Assessment Steering Committee to monitor current and develop new initiatives to address the Public Health Priorities around 1) Access and Coverage to high quality health care; and 2) Chronic disease and chronic disease prevention around diabetes and cardiovascular disease (see above table). In conjunction with the Community Public Health Priorities established herein, Lourdes will continue to monitor and address Public Health priorities as provided in the Lourdes CHA/CSP plan: Access to Healthcare; Behavioral/Mental Health; Frail Elderly; Maternal/Child/Adolescent Health; Preventing & Managing Chronic Disease, including cancer, diabetes, pneumonia, asthma, cardiovascular disease/stroke, and obesity. 6. Financial Aid Program Describe the hospital s successes and challenges related to the provision of financial aid in accordance with Public Health Law 2807(k) (9-a). Do not include the summary of the hospital s policy or financial data required by Exhibit 50 of the ICR; rather discuss general accomplishments, process improvements and/or best practices related to the hospital s financial aid program

12 Our Lady of Lourdes Memorial Hospital, Inc. Binghamton, New York Community Health Assessment/ Community Service Plan Our Lady of Lourdes Memorial Hospital remains committed to providing the highest quality health care to all who need it, particularly care to the poor and vulnerable. In spite of the national economic crisis of , Lourdes continued to 1) expand services to the poor 2) to provide financial assistance to those in need. From CY 2007 to 2008, charity care provided by Lourdes increased 13.4% and community benefit contributions increased 4% for a total increase in charity care of $1.1 million. Total Charity Care provided in CY 2008 was $18.9 million; 3) Purchased the Medicaider software designed to screen persons in need for eligibility for NYS funded programs; 4) the Hired six financial counselors to administer the Medicaider product. The financial counselors were placed in Lourdes emergency department, the hospital, and primary care practices. Lourdes is the only provider offering the Medicaider service/program. Various local agencies/coalitions desire to replicate this service. 5) Opened the Hope Dispensary of the Southern Tier of New York (a free pharmaceutical program); and 6) Expanded dental services and youth services for the poor. Lourdes administers nearly $3 million in grants annually to serve poor and vulnerable youth. (Reference Attachment #6: Lourdes 2008 Community Service Plan) 7. Changes Impacting Community Health/ Provision of Charity Care/Access to Services Describe any changes to the hospital s operation or financial situation that impacts the care of the community, financial assistance and/or access to health care. This could include, but is not limited to, impending mergers, increasing financial constraints, and key personnel turn over. Lourdes remains a fiscally strong organization. Lourdes does not anticipate a reduction in services to the community. This report along with the 2008 Community Service Report (Appendix #7) demonstrates Lourdes ability to continue to address community need. Additionally, as a member of Ascension Health, Lourdes is actively involved in the Ascension health 100% Access and Coverage Agenda. Lourdes will continue to provide a local and state leadership role for 100% Access and Coverage. 8. Dissemination of the Report to the Public The Lourdes Hospital Community Service Plan and interim Community Service Plan Reports will be made available to the public on the Lourdes web site. The annual CSP report is approved by the Lourdes Board of Directors. Lourdes participates in local, state, and federal public health programs. Information about Lourdes financial assistance programs are disseminated throughout Lourdes locations, 15 Lourdes Physician Network primary care offices; health fairs; Community Coalitions; local employers; and is available to the public and the medical at all Lourdes. Lourdes Management Services Organization (a physician billing service) also provides information to independent physician practices on Lourdes financial assistance programs. Among the unique financial assistance programs that Lourdes offers or participates in are: Lourdes Patient Financial Assistance Program (PFAP); prompt pay program; Medicaider; Hope Dispensary; Lourdes Care

13 Our Lady of Lourdes Memorial Hospital, Inc. Binghamton, New York Community Health Assessment/ Community Service Plan Plus; Prenatal Care Assistance Program; Child Health Plus, Medicaid, Medicaid Managed Care. Lourdes also participates in Health Prevention Initiatives through the Healthy Living Partnership (Breast, Cervical, Colorectal Cancer screening), and the Star Alliance Initiative (Childhood Obesity). Lourdes administers nearly $3 million annually in grant programs for at risk children and youth. 9. Financial statement (Attachment #6: Lourdes 2008 Community Service Plan) The Department of Health will not require a separate financial statement to be submitted as part of the Community Service Plan. Financial data already reported to the Department through the Institutional Cost Report (ICR) will satisfy the statutory requirement. Our Lady of Lourdes Memorial Hospitals financial data is available to the New York State Department of Health through the Institutional Cost Report (ICR), and through the annual Community Service Plan report which is available on Our Lady of Lourdes Memorial Hospital s web site:

14 Our Lady of Lourdes Memorial Hospital, Inc. Binghamton, New York Community Health Assessment/ Community Service Plan 1 Fall 2008 AmeriMed Consulting Medical Staff Development Plan for Our Lady of Lourdes Memorial Hospital, Executive Summary, page 1. 2 Broome County Health Department, Community Health Assessment. Power Point Presentation, Integrated Community Planning Focus Group: Community Themes & Strengths Assessment, by Yvonne Johnston Broome County Health Department Community Health Assessment, pgs Table: Selected Morbidity Indicators, Broome County, Interpretation of estimated rates should be made with caution, as (a) Broome County borders Pennsylvania and (b) some Broome County residents seek services outside of the local area

15 FY ISOFP ATTACHMENT # 1 FY10 - FY14 INTEGRATED STRATEGIC, OPERATIONAL AND FINANCIAL PLAN April 17, 2009 FY10-14 ISOFP Template Page 1

16 FY ISOFP Table of Contents 1. Health Ministry Information... Page # 3 2. Market Characteristics... Page # 4 3. Ascension Health Strategic Direction... Page # 15 a) Call to Action: Healthcare that Works...Page # 16 b) Call to Action: Healthcare that is Safe...Page # 17 c) Call to Action: Healthcare that Leaves No One Behind...Page # 19 d) Enabling Strength: Model Community...Page # 21 e) Enabling Strength: Alliance Network...Page # 23 f) Enabling Strength: Connected Ministry...Page # 25 g) Enabling Strength: Vital Presence...Page # Capital Plan... Page # Financial Plan... Page # 28 April 17, 2009 FY10-14 ISOFP Template Page 2

17 FY ISOFP 1. Health Ministry Information Health Ministry Our Lady of Lourdes Memorial Hospital, Inc. Submitted by David Patak, Interim President & CEO Gregg Hayton, Vice President, Finance/CFO Ministry Finance Contact Ministry Strategy Contact Ministry Operations Contact David Clements, Director Financial Planning Lisanne Bobby, Director Strategic Planning & Business Analysis Linda A. Miller, Sr. VP of Nursing & Operations April 17, 2009 FY10-14 ISOFP Template Page 3

18 Our Lady of Lourdes Memorial Hospital, Inc. Binghamton, New York Community Service Plan Attachement # 2 : Public Participation Process Lourdes used the following methods to ensure extensive and meaningful community input: 1. Broome County Health Department Community Health Assessment Steering Committee A Steering Committee was convened in August 2008 and charged with providing the leadership for conducting the Community Health Assessment The Steering Committee convened nine times over the course of the year, and participated in on-line surveys and communication. Quantitative and qualitative data was analyzed by the Steering Committee. Analytics combined with the experience of direct service providers was used to develop the Community s Health priorities. Presentations and information were shared with the CHA Steering Committee throughout the year. i The participating agencies listed below provided information from multiple consumer focus groups, and shared information with the Steering Committee throughout the year. Consumer groups included: business community at large, health care agencies, at risk populations, health insurance payor groups, and health care providers. Participating Community Organizations: Binghamton University Broome County Council of Churches Broome County Department of Social Services Broome County Environmental Management Council Broome County Health Department Broome County Mental Health Department Broome County Office for Aging Broome County Urban League Broome County Youth Bureau Excellus BlueCross BlueShield Our Lady of Lourdes Memorial Hospital Mothers & Babies Perinatal Network of CNY Rural Health Network of SCNY SUNY Upstate Medical University Clinical Campus at Binghamton United Health Services Hospitals United Way of Broome County The Steering Committee was chaired by the Community Health Assessment (CHA) Coordinator, Yvonne Johnston,MS, MPH,RN,FP, Decker School of Nursing, Binghamton University. Broome County Health Department Leadership The senior staff of the local public health department were updated on MAPP activities and provided input into the process. A core support team assisted with planning and included the Broome County Health Department Director, Medical Director, and Community Health Assessment Coordinator as well as administrative, technology, Geographic Information System (GIS), and interdisciplinary planning support team members. 2. Community Focus Groups (Conducted for Lourdes Hospital by Research & Marketing Strategies, Inc., ( RMS ) Attachments 8 & 9 provide information on the participant selection process) Access to Care Research, Fall 2008 (Attachment #9) Purpose of the Focus Groups: To assess access issues, barriers, gaps, and solutions around (1) patient/community access to inpatient, outpatient and emergency room services. (2) Identify opportunities to improve access and patient flow. 1

19 Our Lady of Lourdes Memorial Hospital, Inc. Binghamton, New York Community Service Plan 1. Patient Focus Groups: Three focus groups, with 36 community participants. Conducted in September Referral Focus Groups: Three focus groups, with 29 provider office staff who assist patients in navigating/accessing the health care system (provider, payor; local and regional). Conducted in December Findings/Outcomes 1. Opportunities exist to improve the physical access to services; and to improve patient wait times. 2. Patients stated that Lourdes has a reputation for caring for all regardless of socio-economic status. Strategic Interventions 1. Physical access issues will be addressed through the Lourdes Master Facility Plan and operational changes. Outpatient services will be (and many have been) relocated to a central location on the campus. Proximity of parking to the main campus for those who have difficulty walking (elderly, cancer, orthopedic, GI patients), has been addressed through the implementation of a pilot shuttle service; and an increased number of parking spaces proximal to patient entrances. 2. Outreach and education to the community regarding financial assistance for the under and uninsured will continue. During 2009, Lourdes hired six additional financial counselors and purchased the Medicaider software tool which is designed to simply screen the uninsured for access to NYS programs. It is the intent of Lourdes to expand this program throughout the Lourdes Health Care System, and to assist local agencies in implementing this software and program. This goal is reflected in the Broome County Health Department CHA. Senior Friendly Focus Groups, May 2006 (See Attachment #8) Purpose: The purpose of this study was to determine the opinions and perceptions of area senior residents and caregivers regarding how the Lourdes organization can create a more senior friendly environment. The results of this research have been incorporated into Lourdes operations, and will be incorporated into Lourdes master facility plan. Focus Groups: 2 Focus Groups of seniors and 2 Focus Groups of Caregivers were held May 16 th and 18 th, There were 42 participants. Findings/Outcomes/ Strategic Interventions: The focus group participants identified areas in which Lourdes did well and could improve upon to meet community need for seniors and caregivers. Recommendations were made relative to parking/physical access; physical environment of health care facilities (floors, lighting, signage, and color), telecommunications, advocacy/navigation, oncampus physician offices and outpatient/ancillary testing, patient and community education, wayfinding, and the Internet design. Tactics have been and will continue to be implemented to address the recommendations. Particular focus will be through Lourdes Master Facility Plan. 2

20 Our Lady of Lourdes Memorial Hospital, Inc. Binghamton, New York Community Service Plan 3. Hope Dispensary of the Southern Tier Coalition (September 2009 Forward, this will be called the Community Advisory Group ) Lourdes provided the leadership for the Cover the Uninsured Coalition. This Coalition identified pharmaceutical access for the uninsured as a priority issue. As a result, the Hope Dispensary of the Southern Tier coalition was organized. Monthly meetings were held. Lourdes provided the leadership for this coalition to address access to prescription drugs for the uninsured. Community members of the coalition are listed below. Additionally, those who enabled the Hope Dispensary to become an reality include: Lourdes Legal Counsel, an Ascension Health hospital St. Thomas Hospital from Nashville Tennessee, Ascension Health Access Leadership Team, and the NYS Health Foundation. Community Advisory Group Lenore Boris Administrative Dir. Free Clinic Claudia Edwards, Director, Broome Cty. Health Dept. Bob Ford Director, Lourdes Social Services Art Johnson Broome Cty. Commissioner, Social Services Melissa Klinko Regional Communication Manager BC/BS Janet Krcha Clinical Dir. Lourdes Physician Network Paul Mollo Director, Lourdes Pharmacy Peggy Phillips Quality Specialist, Lourdes Jack Salo Executive Dir., Rural Health Network, SCNY 1. Findings/ Outcomes: Meetings were held over the course of several years. The outcome was that Lourdes agreed to take responsibility to open the Hope Dispensary of the Southern Tier (a free pharmaceutical program) in August Lourdes received $257,000 in grants to bring this service to the community. Lourdes has accepted operational responsibility for this critical community service. The New York State Health Foundation and Lourdes goal is to be able to replicate this pharmacy access model throughout New York State. The Hope Dispensary provides a screening process for existing health care coverage programs, as well as provides assistance to the uninsured and those without a primary care provider in obtaining a Medical Home. Other desired outcomes will be to achieve growth targets; increased compliance to medication regimes; decreased unnecessary emergency room visits. 2. Strategic interventions: Achieve outcome targets. Work with the NYS Health Foundation to identify how to replicate the Hope Dispensary throughout NYS. Involve additional providers and health systems in the Hope Dispensary. 3

21 Our Lady of Lourdes Memorial Hospital, Inc. Binghamton, New York Community Service Plan Achieve goals to enroll persons using the Hope Dispensary in financial programs, e.g., Child Health Plus, Medicaid. Achieve goals to provide a medical home for Hope Dispensary clients. 4. Our Lady of Lourdes Memorial Hospital, Medical Staff Development Plan. Conducted, Fall 2008, AmeriMed Consulting, Inc. Lourdes conducts a medical staff development plan (MSDP) every three years. The MSDP identifies the community s current and potential physician needs assessment. Lourdes monitors the medical resources on-going with the medical community. Findings/Outcomes: Community Physician Needs Primary Care Specialties (Primary Care, Internal Medicine, Pediatrics) Total FTEs to Evaluate for Potential Recruitment to meet Community Need (Current Needs + Succession Planning) 36.9 Hospital Based Specialties 9.0 Medical Specialties 46.5 Surgical Specialties 35.8 Total FTE s, All Physicians Strategies/Interventions: Continue to monitor and work with the medical community to address medical staffing needs of the community. 5. Our Lady of Lourdes Memorial Hospital & United Health Services Hospitals Collaborative Approach to identifying Hospital priorities for addressing Community Health Need. Meeting: June 8, Associated follow up s and conversations June-September Lourdes Hospital: Lisa Bobby. UHS Hospitals: Sara Dellafield, Robin Kinslow-Evans, Patricia Fell, Patricia Williams. Priorities selected jointly by the UHSH and Lourdes: 1. Access: Coverage; Pharmacy, Primary Care. Chronic Diseases: Congestive Heart Failure (CHF). Interventions to continue with smoking cessation & tobacco use initiatives; inpatient management of CHF. Diabetes. Continue to participate in community initiatives targeting childhood obesity; nutrition, physical activity. 2. Continued outreach and education regarding Access and Chronic Disease. i Documents & presentations reviewed by the CHA Steering Committee (available of Binghamton University Blackboard): 4

22 Our Lady of Lourdes Memorial Hospital, Inc. Binghamton, New York Community Service Plan CHA Guidance Documents: 1) CHA Guidance; 2) CHA Checklist; 3) Prevention Agenda Fact Sheet ; 4) Public Health matrix & Data Sources, May 27 CHA Steering Committee Documents: 1. CHA Steering Committee Presentation & CHA Time line, 8/26/08 2. Indicators for Tracking Public Health Priority Areas, 10/7/08 3. Broome county Health Survey, 8/08 (presented 11/20/08) 4. CTSA Integrated County Planning Focus Group, 11/20/ Steps BRFSS County Specific Questions, 11/20/09 6. Public Health Indicator Matrix US-NY-BC, 10/7/08 7. MAPP Assessment Planning, 11/20/08 8. CHA Demographics & Demographic Information, 12/16/09 9. NYS Prevention Quality Indicators: Broome County & Tool, 1/6/ NYS Prevention Quality Indicators- UHS Presentation, 2/3/ Lourdes Hospital: CHA Community Needs, 3/17/ Broome County Elders, 3/17/09 MAPP Documents National Public Health Performance Standards Data Sources Impact of Community Assessments in NYS The Process to Develop a Meaningful CHA in NYS Department of Health Collaboration. 5

23 Attachment #3: Analytic Hi-lites: Broome County Community Health Assessment Broome County experiences a greater burden of care for their elderly than NYS or the US as a whole. There is also an increased out-migration of young adults which results in a growing burden of care on working families in order to support an aging population. 2. Detailed poverty levels and demographics were provided. Poverty in childhood is associated with a wide range of social, educational, and health-related problems. The poverty indicator offers an important leverage point for primary interventions for obesity, mental health, and prenatal care. 3. Broome County exceeded the state unemployment average. This has implications for providing access and coverage to care, and safety net services. 4. Because insurance status is linked to employment, lower rates of employment are associated with lack of health insurance and access and lack of/poor coverage to health care, which in turn are related to higher morbidity and mortality. 5. Factors influencing access: Five percent of households in Broome County do not have telephone access and 10.3% do not have transportation. This is of particular concern for the frail elderly. 6. Racial, cultural, gender, and age diversity of the community and health care workforce. 7. Broome County ranked in the fourth quartile for teen pregnancy in year olds (which is positive), and was below the Healthy People 2010 objective (also positive), but was significantly higher than other Upstate NY counties. Though pregnancy rates are generally lower than the state, fertility rate and trend data suggest the need for close monitoring of and continued public health efforts in the area of teenage pregnancy. Implications associated with teen pregnancy at risk behaviors can have a short term and long term impact on public health issues including sexually transmitted diseases, HIV risk exposure cervical cancer, poverty and the public health ramifications of poverty. 8. Morbidity. In general, Broome County observed admissions rates were lower than NYS except for pneumonia. Pneumonia hospitalizations among adults were significantly higher in Broome County than in NYS. There may be opportunities for Lourdes and other Ascension Health ministries to share best practice which has resulted in reduced pneumonia hospitalizations at Lourdes i. 9. Broome County experiences a greater mortality than the rest of the state In almost all of the top six leading causes of death, in order, for the United States: heart disease, cancer, stroke, chronic lower respiratory diseases, accidents (unintentional injury), and diabetes. Areas in which the mortality rate is lower than the Healthy People 2010 objectives are: cancer of the oral cavity and pharynx, cervical/uterine cancer, prostate cancer, childhood mortality (ages 5-9, 10-14), premature deaths (ages 35-64) due to coronary heart disease and cerebrovascular disease, age-adjusted homicide Our Lady of Lourdes Memorial Hospital, Inc Community Health Assessment/CSP 1

24 Attachment #3: Analytic Hi-lites: Broome County Community Health Assessment mortality, and age-adjusted motor vehicle mortality. Continued public health efforts in these areas will likely be needed to maintain these rates below national goals. 10. Dental Health. a) The data support the ongoing and critical need for dental education in order to preserve permanent dentition and maintain oral health. Poor dental health can lead to localized infections of the bone and surrounding structures, and has been linked to obesity and other chronic diseases including cardiovascular disease and diabetes. b) While the data indicates that the prevalence of tooth decay in children was considerably higher than the Prevention Agenda 2013 Goal and Healthy People 2010 Objective of 42%, it should be noted that there is a significant lag in the data. Significant interventions have been occurring in the community to impact oral health through the local health department s sealant program, and Lourdes Center of Oral Health. The decreased rate of children with dental carries suggests that the County sealant program and increased access to sealants through Lourdes Center for Oral Health have been effective and should continue. 11. Data for primary and preventive health care for cholesterol screening, mammography was better than the Health People Opportunities for improvement exist with self-reported hypertension. 12. Infant mortality. Opportunity for improvement for early entry into prenatal care in the first trimester. Infant mortality was higher for Broome County than for NYS and Upstate NY, and higher than the Healthy People 2010 goal. 13. Communicable diseases. A potential opportunity to decrease the incidence of whooping cough exists. 14. Immunizations. While the percentage of adults over 65 being immunized was higher in Broome County than NYS, this percentage was well below the Health People 2010 goals (positive). Though this indicates there may still be an opportunity to improve immunization rates for this target population. Interventions (flu clinics throughout Broome County and offered through Lourdes Primary Care physician offices) since the data may have already addressed this. 15. Cancer. a) The greatest burden of disease based on absolute number of cancer cases results from prostate cancer. b) 45% of Broome County colorectal cancer cases are diagnosed early stage; thought the mortality rate is in the highest quartile for NYS. Higher than expected colorectal cancer rates exist for men residing in Deposit and women in Port Crane. c) Lung and breast cancer incidence was higher in Broome County than NYS. Lourdes initiatives with disease specific cancer teams should positively impact cancer morbidity and mortality. Lourdes Regional Cancer Center will continue to work with the medical community to address community health needs around cancer. Lourdes will continue to maintain its Outstanding Achievement Award from the Commission on Cancer. Lourdes is one of 95 Cancer Programs in the United States, and the only one regionally to have this designation. The implication for the community is that Lourdes adheres to standards which demonstrate commitment to providing the highest quality cancer services to the community. Our Lady of Lourdes Memorial Hospital, Inc Community Health Assessment/CSP 2

25 Attachment #3: Analytic Hi-lites: Broome County Community Health Assessment Cardiovascular Disease. The number of deaths per year associated with cardiovascular disease and high mortality rates warrant continued focus on the cardiovascular health of Broome County residents. Data indicate that with appropriate outpatient management of cardiovascular disease, hospitalization may be avoidable. Lourdes will continue with cardiovascular education and screening strategies. High pre-transport mortality for stroke suggests a need to focus on public health intervention. However, the data is also several years old and most likely does not reflect improvements resulting from community initiatives. Lourdes will continue to maintain its NYSDOH Stroke Certification. 17. Diabetes. Data indicated that appropriate diabetes care is being delivered in Broome County, but also suggests opportunities for improvement. There needs to be a continued focus on obesity among youth. 18. Asthma. Asthma management has been a targeted focus for Broome County during the last CHA time frame. Interventions appear to have been successful as Broome County s asthma morbidity has decreased significantly compared to the rest of NYS. As asthma is the primary reason for missed school days, which carries important developmental, social, academic, and economic consequences. Thus, directed efforts in this area should likely continue. i BCDOH CHA. Data is for , and thus does not recognize the impact of interventions post Our Lady of Lourdes Memorial Hospital, Inc Community Health Assessment/CSP 3

26 Attachment #4: Our Lady of Lourdes - Community Health Planning Matrix Community Health Assessment / Community Service Plan Achieving New York State Prevention Agenda Goals Key Partners that Lourdes will be working with to achieve the Community Public Health Priorities include but are not limited to: American Cancer Association, American Diabetes Association, American Heart Association, Broome County Health Department CHA Steering Committee members, Broome County Health Department, local health departments in whose county Lourdes provides services, Action for Older Persons, Binghamton VA Outpatient Clinic, Broome County Health Department Community Free Clinic, Broome Cover the Uninsured Week Coalition, Community Alternative Systems Agency (CASA), Community Advisory Group (for the Dispensary of Hope), Communities Joined in Action, Department of Social Services, Mothers & Babies Perinatal Network of SCNY, Office of Mental Health, Rural Health Network, Southern Tier Health Link Reference Attachment #3: CHA Analytic Hi lites FOCUS Outpatient, Primary Care, ER & Inpatient Services KEY PARTNERS (in addition to those listed above) Ascension Health Access Committee, St. Thomas Hospital (AH Nashville Hospital), Grantors NYS Perinatal Association Health care providers/medical community/ EMS PRIORITY AREA #1: ACCESS AND COVERAGE TO QUALITY HEALTH CARE CURRENT STRATEGIES / APPROACHES POTENTIAL APPROACHES / STRATEGIES INDICATORS/ Measures 1. Coordinated approach to the administration of grant funded educational and service programs (private and government funded) through community coalitions. Hospital participating in the NYS Prenatal Care Assistance Program. Hospitals provide financial screening for this program in addition to providing comprehensive prenatal care and newborn services Continued promotion of Lourdes Patient Financial Assistance Program (through health fairs, other communication venues); Lourdes Prompt Pay program. Provide a facilitation role on Community Advisory Groups: Hospice Advisory Group, Long Term Care Coordinating Council, Lourdes at Home Implementation of Network Patient Service Centers to increase access to laboratory testing. Two additional sites were made operational in CY 2008, bringing the total to 6. Increase access to walk in services based on community need. In July 2009, Lourdes opened a walk in service in Owego NY, the 1. As changes in reimbursement occur, continue to identify & remove barriers to coverage through coordinated enrollment in private and public sectors. 2. Develop strategic alliances to streamline administration of programs and funds which serve at risk populations including, but not limited to, the under & uninsured and Veterans Administration recipients. 3. Increase the coordination of safety net programs to maximize use of federal, state, and community grant programs and services. 4. Develop primary, secondary, and tertiary care strategies to address effective implementation of health care reform. In conjunction with the BCDOH CHA Steering Committee, discuss appropriateness & feasibility of the following measures: 1. Percentage of adults with health care coverage [BRFSS] 2. Percentage of children with healthcare coverage 3. Percent uninsured [Current population Survey] 4. Percentage of adults who have a regular health care provider [BRFSS] 5. Number of women enrolled in the Prenatal Care Assistance Program 6. Percent early entry into prenatal care [NYSDOH] 7. Infant mortality number of deaths & mortality rate [SPARCS] 8. Achieve Ascension Health & Lourdes specific clinical, financial and enrollment targets. Rev 9/10/09 1

27 FOCUS KEY PARTNERS (in addition to those listed above) Attachment #4: Our Lady of Lourdes - Community Health Planning Matrix Community Health Assessment / Community Service Plan Achieving New York State Prevention Agenda Goals CURRENT STRATEGIES / APPROACHES POTENTIAL APPROACHES / STRATEGIES INDICATORS/ Measures rural county of Tioga. Community 2. Coordinated approach working with the local Continuation. Identification of new venues. Number served. outreach & education for informed access health department and local service providers and agencies to increase coverage to address community need. Broome County Covered the Uninsured Week. Provide leadership for the Community Advisory Group (pharmaceutical coverage) Health Fairs dissemination of information; scheduling for screening programs; linking to medical homes. Lourdes Patient Financial Assistance Program (PFAP) 3. Facilitated enrollment for insurance products for which individuals may be eligible Implementation and utilization of a financial screening and enrollment program/software called Medicaider. Lourdes hired six financial counselors to assist the uninsured with the Medicaider program. This program provides quick screening to determine eligibility for New York State programs. Collaboration with NYS DSS for on site Facilitated enrollers. Lourdes Patient Financial Avocate Services Develop an implementation strategy to identify and replicate successful services and programs throughout the service area. Examples: Expand Medicaider product in additional venues at Lourdes as appropriate. Assist community agencies in implementing the Medicaider software tool. 4. Increase access and coverage to vulnerable and atrisk Continue to work with community populations locally and through Lourdes mobile coalitions & the CHA steering committee to services (primary care, cancer education & screening, identify at risk populations and strategies mammography, oral health) to address needs. Continued provision of services the VA (colorectal cancer screening) Employers Rural communities School systems Medical community Nursing homes Home based services (home care, DME) Provider & Beryl Provide physician and community referrals through Continued Number of Referrals. Achieve Lourdes enrolment targets; increase above baseline. Measure outcomes against baseline established through the CHA Steering committee process; NYS local, region, state benchmarks e.g., screening guidelines; early diagnosis of cancer. Rev 9/10/09 2

28 FOCUS Education Access Physician / Health Care Work Force Mental Health Services Prescription Medication Access KEY PARTNERS (in addition to those listed above) Medical community Hospital Association of NYS Medical, Nursing, Technical Schools Office of Mental Health Broome County Youth Bureau Law Enforcement/ Juvenile Justice System Homeless Coalition Pharmacists Health care providers with prescriptive privileges Rural Health Network of South Central New York Pharmaceutical companies Attachment #4: Our Lady of Lourdes - Community Health Planning Matrix Community Health Assessment / Community Service Plan Achieving New York State Prevention Agenda Goals CURRENT STRATEGIES / APPROACHES POTENTIAL APPROACHES / STRATEGIES INDICATORS/ Measures Lourdes Referral Services. 5. Develop and implement medical staff planning to ensure that current & future community physician supply and demand needs are addressed. Outreach and education through community agencies (OMH, DSS, OFA), education system, medical community. (1) Lourdes Youth Services (The Corner), Mental Health Juvenile Justice Project, Detention Alternative After School Program, Juvenile Arrest Diversion Endeavor, Student Assistance Program, Alcohol & Drug Education Prevention Program, Teen Nurturing Parenting Program. 1. Provide Community outreach and education around prescription services / prescription assistance programs. Provide referrals through the Lourdes Physician Network (15 primary care locations), Lourdes Physician Referrals Services; Lourdes Internet; media campaigns. 2. Lourdes Hope Dispensary of the Southern Tier (a free pharmaceutical program, opened in August 2009, with the support of a community coalition Develop and implement medical staff planning to ensure that current & future community physician supply and demand needs are addressed. (1) Lourdes Youth Services will continue to administer, expand and implement services to address the mental needs of youth served. Explore continued grant funding opportunities to increase access. (2) Refine care models to maximize the delivery of mental health/ behavioral health services across the continuum of care and in various care delivery settings such as primary care, specialists, utilization of allied health professionals. Lourdes will work with the Lourdes Primary Care Network and community mental health providers. (3) Work with Binghamton University School of Nursing programs to support new Psychiatric/Mental Health Nurse Practitioner Program at Binghamton University 1. Increase the coordination of pharmacy safety net programs. 2. Education for providers about Prescription Assistance Programs (PAPs) and prescribing practices. 3. Increase awareness of PAPs and expand number of programs and organizations that will assist patients to complete applications. On going monitoring of community need: compare annual current to projected needs. Community & physician surveys around access (time to get an appointment; perception of access). TBD Number of individuals accessing Mental Health services [NYS OMH]. Achieve Lourdes Youth Services goals for mental health related services. 1. Number of individuals enrolled in prescription assistance programs 2. Developmental: Track referrals, sales, reimbursement through Medicaid or Medicare Rev 9/10/09 3

29 FOCUS KEY PARTNERS (in addition to those listed above) Attachment #4: Our Lady of Lourdes - Community Health Planning Matrix Community Health Assessment / Community Service Plan Achieving New York State Prevention Agenda Goals CURRENT STRATEGIES / APPROACHES POTENTIAL APPROACHES / STRATEGIES INDICATORS/ Measures and a partnership with Ascension Health s St. Thomas Hospital in Nashville, Tennessee). Lourdes Hospital operates the Hope Dispensary. The Hope Dispensary provides a screening process for existing health care coverage programs, as well as provides assistance in obtaining a Medical Home. 3. Elderly Pharmaceutical Insurance Coverage (EPIC) 4. Lourdes Care Plus FOCUS Decrease the proportion of children and adults who are obese KEY PARTNERS (in addition to those listed above) Lourdes Community Relations& Physician Network Family Enrichment Network Strategic Alliance for Health (BCDOH) BOCES Food Service WSKG Radio Binghamton Metropolitan Transportation Study (BMTS) NYS Department of Transportation Cornell Cooperative Extension Farmers Markets Broome County Parks and Recreation PRIORITY AREA #2: CHRONIC DISEASE PREVENTION & MANAGEMENT CURRENT STRATEGIES / APPROACHES POTENTIAL APPROACHES / STRATEGIES INDICATORS/ Measures 1. Outreach and education to promote physical activity and nutrition. Lourdes Primary Care Network BMI initiative Lourdes Fitness membership (on site fitness program). 2. Provision of physical activity & nutrition programs / services for Lourdes associates. Lourdes associate well ness programs for associates and families: fitness center, aerobics, yoga, zumba, weight watchers. Excellus BCBS s Healthy Rewards incentive program promoting health life style for Lourdes Associates Employee wellness / health benefit screening programs. Spice of Life cafeteria weight watchers options. In conjunction with the BCDOH CHA Steering Committee, discuss appropriateness & feasibility of the following strategies: 1. Develop (community, business, and population specific) sustainable behavioral modification programs to address factors contributing to obesity: mental/emotional, physical, environmental, and nutritional. 2. Modify physical environment and infrastructure to increase physical activity for Lourdes associates. 3. Develop food systems changes that support access to healthy locally grown foods 4. Involve media in social marketing campaigns for physical activity and nutrition initiatives 5. Explore grant funding opportunities and evidence based strategies for increasing physical activity and improving dietary choices. This will most likely be done in The following indicators will be for the community at large. For those whom Lourdes has access to information, this will be monitored as well (for adults and children) 1. Prevalence of overweight and obesity in adults [BRFSS] 2. Prevalence of overweight and at risk for becoming overweight in children [YRBS] 3. Percent of WIC & PCAP children who are overweight [WIC & PCAP] 4. Percentage of adults who engage in some type of leisure time physical activity [BRFSS] 5. The percentage of adults who consume at least five servings of fruits & vegetables per day [BRFSS] 6. Percentage of mothers participating in the WIC program who breastfeed for at least 6 months [WIC] 7. Lourdes Physician Network BMI targets will be met. 3. Intervention & prevention through engaging the community in health lifestyle and behavioral changes. Strategic Alliance for Health: Involving Rev 9/10/09 4

30 FOCUS Reduce the prevalence of diabetes Reduce diabetesrelated hospitalizations KEY PARTNERS (in addition to those listed above) Lourdes Endocrinology & Diabetes Center Primary care providers Local support groups Rural Health Network of SCNY Attachment #4: Our Lady of Lourdes - Community Health Planning Matrix Community Health Assessment / Community Service Plan Achieving New York State Prevention Agenda Goals CURRENT STRATEGIES / APPROACHES POTENTIAL APPROACHES / STRATEGIES INDICATORS/ Measures pediatricians, making healthy choices easier to make through environmental changes and social marketing, Steps to a Healthier NY: BC Walks, Working on Wellness, Mission Melt a way Team Act Coalition Working on Wellness ( WOW ) program. Lourdes Endocrinology & Diabetes Center of Excellence outreach and education, screening/testing. Continue to address dental barriers through the Lourdes Oral Health Center which impact nutrition & obesity. The Lourdes PCAP program, inpatient maternity programs,depaul pediatrics will continue to refer to WIC. 1. Hospital based diabetes education clinical, and outreach programs. Lourdes Endocrinology & Diabetes Center Employment of Inpatient Diabetes Nurse Practitioner. Continued succession planning. Continue affiliation agreement with American Health ways. Introduction of the Glucose Stabilizer in CY Lourdes associate diabetes screening. Excelles Healthy Rewards lifestyle screening. 2. Chronic disease self management programs 3. Case management of patients with diabetes 4. Provide support, as appropriate for the Rural Health Network Chronic Disease Case Management Project 5. Community collaborative efforts through the American Diabetes Association. through Lourdes Youth Services. 6. Continue to address dental barriers through the Lourdes Oral Health Center which impact nutrition & obesity. 7. Develop an implementation strategy to replicate successful services and programs throughout the service area. 1. Lourdes will hire a pediatric endocrinology as part of succession planning for Dr. Richard Wu, pediatric endocrinologist who will be retiring/ modifying his practice. Develop innovative programming such as move your A1c to help motivate diabetics. 2. Healthcare provider education through the Lourdes Diabetes Center and through the Lourdes Physician Network. 3. Address disparities in morbidity through engagement with specific subpopulations As a community: 1. Prevalence of diabetes in adults [BRFSS] 2. Prevalence of diabetes in children [YRBS] 3. Hospitalizations for acute complications [SPARCS/PQI] 4. Hospitalizations for chronic complications (renal, eye, neurological, circulatory, or complications not otherwise specified) [SPARCS/PQI] 5. Diabetes self management practices (self blood glucose monitoring, selffoot exams) [BRFSS] 6. Outpatient diabetes management by health care providers (A1c, foot exams, eye exams) [BRFSS] Chronic Disease: Emergency 1. Continue with provider patient & provider 1. Share best practice with area facilities to Number of hospitalizations due to heart Rev 9/10/09 5

31 FOCUS Heart Disease Reduce hospitalizations due to heart failure KEY PARTNERS (in addition to those listed above) Medical Services Hospitals Nursing homes Home health agencies American Heart Association Primary care sites Health care providers Attachment #4: Our Lady of Lourdes - Community Health Planning Matrix Community Health Assessment / Community Service Plan Achieving New York State Prevention Agenda Goals CURRENT STRATEGIES / APPROACHES POTENTIAL APPROACHES / STRATEGIES INDICATORS/ Measures hospital initiatives to identify and provide disease management to patients with congestive heart failure. Lourdes exceeds local, regional, and State targets.. 2. Provide innovative home care programming and continuum of care to patients when they leave the hospital. 3. Home Health tele health monitoring services. 4. Post hospital discharge follow up calls. 5. Lourdes cardiovascular risk screening initiatives and community education programs. 6. Continue to maintain NYSDOH stroke designation; community and professional education programs. help improve community rates. Develop an implementation strategy to replicate successful services and programs throughout the service area. 2. Provide continuum of care to monitor and assist patient with compliance issues. 3. Provide innovative home care programs and services for management of heart failure. 4. Expand linkages to local colleges that offer health careers for community health education 5. Address disparities in morbidity through engagement with specific sub populations failure [SPARCS/PQI] Heart failure hospitalization rates [SPARCS/PQI] OTHER / ON GOING PRIORITIES around Access & Coverage KEY PARTNERS FOCUS (in addition to CURRENT STRATEGIES / APPROACHES POTENTIAL APPROACHES / STRATEGIES INDICATORS/ Measures those listed above) Children & Youth Services School Systems Reference strategies: Access priorities, childhood obesity; dental services Reference strategies: Access priorities, childhood obesity ; dental services Reference strategies: Access priorities, childhood obesity ; dental services Chronic Disease: Cancer Specialty providers 1. Provide outreach, education, and screening to: a) increase early diagnosis of cancers; b) decrease morbidity and mortality. Work with the medical community to ensure access to cancer screening services Increase access to cancer screening services through Lourdes mobile vans, targeting rural communities and populations with transportation and other access barriers. Physician led disease site specific cancer teams will increase access to services and improve clinical outcomes. Provide access to advanced surgical and radiation oncology (DaVinci robotic surgery; IGRT) Continue current strategies. Increased persons screened. Increased number of early stage diagnosis. Rev 9/10/09 6

32 FOCUS Dental Health Frail & Elderly KEY PARTNERS (in addition to those listed above) Lourdes Center for Oral Health Head Start School Systems CASA Office for Aging Lourdes at Home Attachment #4: Our Lady of Lourdes - Community Health Planning Matrix Community Health Assessment / Community Service Plan Achieving New York State Prevention Agenda Goals CURRENT STRATEGIES / APPROACHES POTENTIAL APPROACHES / STRATEGIES INDICATORS/ Measures 2. Provide increased continuity of care for cancer patients. Create and improve the patient experience through care coordination across the continuum. 1. Provide office based and mobile dental services to uninsured and Medicaid children and their families. 1. Provide medical directorships to area nursing homes. 2. Tele health home health monitoring services to provide appropriate site specific care in the home will result in decreased ER visits and unnecessary admissions. 3. Elderly Pharmaceutical Insurance Coverage (EPIC) 1. Increase access to children and their families (increased hours, outreach, oral cancer screenings) Continue. Expand as appropriate. Number served. Number served. Effectiveness of the Lourdes at Home telehealth program will be monitored internally to achieve programmatic goals. Homeless Maternal/ Child Health Local & State agencies Mothers & Babies Perinatal Network 1. Develop relationships with agencies serving the homeless to ensure that these agencies are aware of Lourdes Services; emphasizing the commitment to provide care regardless of ability to pay. 1. Provide outreach, education, and financial screening services for the Prenatal Care Assistance program in order to increase a) access to PCAP services; b) achieve HP 2010 goals for early entry into prenatal care for the defined population. Provide leadership to identify and prioritize strategies which will address the needs of the homeless. Continue. Increase a) access to PCAP services; b) achieve HP 2010 goals for early entry into prenatal care for the defined population. TBD Rev 9/10/09 7

33 Attachment# 5: Broome County Community Health Assessment Achieving New York State Prevention Agenda Goals Community Health Planning Matrix Access to Quality Health Care: Increase Healthcare Coverage +PRIORITY AREA # 1: ACCESS TO QUALITY HEALTH CARE FOCUS KEY PARTNERS CURRENT STRATEGIES / APPROACHES POTENTIAL APPROACHES / STRATEGIES INDICATORS Southern Tier 1. Coordinated approach to the administration of grant 1. As changes in reimbursement occur, Health Link funded educational and service programs (private and continue to identify & remove barriers Mothers & Babies government funded) through community coalitions. to coverage through coordinated Perinatal 2. Coordinated approach working with the local health enrollment in private and public Network of SCNY department and local service providers and agencies to sectors. Action for Older increase coverage to address community need. 2. Develop strategic alliances to Persons 3. Facilitated enrollment for insurance products for which streamline administration of programs Rural Health individuals may be eligible and funds which serve at risk Network populations including, but not limited Community Examples of Current Initiatives: to, the under & uninsured and Alternative 1. Implementation and utilization of a financial screening Veterans Administration recipients. Systems Agency and enrollment program/software called Medicaider. 3. Develop an implementation strategy (CASA) Lourdes hired six financial counselors to assist the to identify and replicate successful Broome Cover uninsured with the Medicaider program. This program services and programs throughout the the Uninsured provides quick screening to determine eligibility for service area. Week Coalition New York State programs. 4. Increase the coordination of safety Communities 2. Broome County Covered the Uninsured Week. net programs to maximize use of Joined in Action 3. Hospital participating in the NYS Prenatal Care federal, state, and community grant Dr. Garabed A. Assistance Program. Hospitals provide financial programs and services. Fattal Community screening for this program in addition to providing 5. Develop primary, secondary, and Free Clinic comprehensive prenatal care and newborn services. tertiary care strategies to address Binghamton VA 4. Referrals at the free clinic. effective implementation of health Outpatient Clinic care reform. Department of Social Services Broome County Health Department 1. Percentage of adults with health care coverage [BRFSS] 2. Percentage of children with healthcare coverage 3. Percent uninsured [Current population Survey] 4. Percentage of adults who have a regular health care provider [BRFSS] 5. Number of women enrolled in the Prenatal Care Assistance Program 6. Percent early entry into prenatal care [NYSDOH] 7. Infant mortality number of deaths & mortality rate [SPARCS] Consider other Agency for Healthcare Quality & Research (AHRQ) safety net indicators Rev 9/10/09 1

34 Attachment# 5: Broome County Community Health Assessment Achieving New York State Prevention Agenda Goals Community Health Planning Matrix PRIORITY AREA # 1: ACCESS TO QUALITY HEALTH CARE FOCUS KEY PARTNERS CURRENT STRATEGIES / APPROACHES Access to Quality Health Care: Increase access to mental health services Broome County Mental Health Department Mental Health Association of the Southern Tier Greater Binghamton Health Center Dr. Garabed A. Fattal Community Free Clinic Binghamton University Catholic Charities of Broome County The Family & Children s Society Department of Social Services (DSS) Broome Tioga Board of Cooperative Education Services (BOCES) Keep Youth Doing Something (KYDS) Coalition United Way of Broome County Broome County Office for Aging (OFA) Broome County Youth Bureau Law Enforcement Homeless Coalition 1. Provision of mental and behavioral health services through: (a) state, county, and private agencies and providers/medical community; (b) grant funded programs; and (c) education system (counseling services). 2. Outreach and education through community agencies (OMH, DSS, OFA), education system, medical community. Examples of Current Initiatives: 1. Child & Family Clinic Plus [Broome County Mental Health Child & Adolescent Clinic] 2. Safe Healthy Action Requires Education (SHARE) [BOCES] 3. Broome County Single Point of Access (SPOA) for children and Single Point of Entry (SPOE) for adults [Catholic Charities] 4. Nurse Direct [United Health Services] 5. First Call for Help [United Way] 6. Faith in Action [Binghamton University] 7. Lourdes Youth Services (The Corner), Mental Health Juvenile Justice Project, Detention Alternative After School Program, Juvenile Arrest Diversion Endeavor, Student Assistance Program, Alcohol & Drug Education Prevention Program, Teen Nurturing Parenting Program. POTENTIAL APPROACHES / STRATEGIES 1. Refine care models to maximize the delivery of mental health/ behavioral health services across the continuum of care and in various care delivery settings such as primary care, specialists, utilization of allied health professionals. 2. Expand linkages with Binghamton University to increase service learning and community based projects. 3. Explore grant funding opportunities and evidencebased strategies for increasing access to mental health services. 4. Develop an implementation strategy to replicate successful services and programs throughout the service area. 5. Expand partnerships to support new Psychiatric/Mental Health Nurse Practitioner Program at Binghamton University INDICATORS 1. Number of individuals accessing Mental Health services [NYS OMH] 2. Suicide mortality [NSDOH] Rev 9/10/09 2

35 Attachment# 5: Broome County Community Health Assessment Achieving New York State Prevention Agenda Goals Community Health Planning Matrix PRIORITY AREA # 1: ACCESS TO QUALITY HEALTH CARE FOCUS KEY PARTNERS CURRENT STRATEGIES / APPROACHES Access to Quality Health Care: Increase access to prescription medications Pharmacists Health care providers with prescriptive privileges Rural Health Network of South Central New York Action for Older Persons Broome County Health Department Community Alternative Systems Agency (CASA) Rural Health Network of SCNY Our Lady of Lourdes Memorial Hospital United Health Service Hospitals Dr. Garabed A. Fattal Community Free Clinic Mothers & Babies Perinatal Network of SCNY Broome County Health Department Pharmaceutical companies Examples of current initiatives: 1. Nurse Direct referrals to prescription assistance programs 2. Hope Dispensary of the Southern Tier (a free pharmaceutical program, opened in August 2009, with the support of a community coalition and a partnership with Ascension Health s St. Thomas Hospital in Nashville, Tennessee). Lourdes Hospital operates the Hope Dispensary. The Hope Dispensary provides a screening process for existing health care coverage programs, as well as provides assistance in obtaining a Medical Home. 3. Elderly Pharmaceutical Insurance Coverage (EPIC) 4. Enrollment in Prescription Assistance Programs (PAP) by: Community Free Clinic Rural Health Network 5. Pharma Rx Program (national program) & other low cost programs POTENTIAL APPROACHES / STRATEGIES 1. Increase the coordination of pharmacy safety net programs. 2. Education for providers about Prescription Assistance Programs (PAPs) and prescribing practices. 3. Increase awareness of PAPs and expand number of programs and organizations that will assist patients to complete applications. INDICATORS 1. Number of individuals enrolled in prescription assistance programs 2. Developmental: Track referrals, sales, reimbursement through Medicaid or Medicare Rev 9/10/09 3

36 Attachment# 5: Broome County Community Health Assessment Achieving New York State Prevention Agenda Goals Community Health Planning Matrix Physical Activity & Nutrition [Chronic Disease Prevention]: Decrease the proportion of children and adults who are obese PRIORITY AREA # 2: CHRONIC DISEASE & CHRONIC DISEASE PREVENTION FOCUS KEY PARTNERS CURRENT STRATEGIES / APPROACHES POTENTIAL APPROACHES / STRATEGIES INDICATORS Stay Healthy Center 1. Outreach and education to promote 1. Develop (community, business, and Family Enrichment physical activity and nutrition. population specific) sustainable Network 2. Intervention & prevention through behavioral modification programs to Strategic Alliance for engaging the community in health lifestyle address factors contributing to Health and behavioral changes. obesity: mental/emotional, physical, BOCES Food Service 3. Policy and systems level changes in schools environmental, and nutritional. WSKG Radio and worksites. 2. Modify physical environment and Binghamton Metropolitan infrastructure to increase physical Transportation Study Examples of Current Initiatives: activity (BMTS) 1. Strategic Alliance for Health: 3. Increase access to public spaces NYS Department of Involving pediatricians, making healthy where residents can be physically Transportation choices easier to make through active and safe Education system (public environmental changes and social 4. Develop food systems changes that & private) marketing, support access to healthy locally Broome County Office for Implementing evidenced based programs grown foods Aging such as the parent component of WE 5. Involve media in social marketing Aging Futures Partnership CAN. campaigns for physical activity and Rural Health Network of 2. Steps to a Healthier NY: BC Walks, Working nutrition initiatives SCNY on Wellness, Mission Melt a way 6. Explore grant funding opportunities Cornell Cooperative 3. Team Act Coalition and evidence based strategies for Extension 4. Employer health insurance plan incentives increasing physical activity and Farmers Markets promoting healthy life style, e.g., Excellus improving dietary choices Dr. Garabed A. Fattal BCBS s Healthy Rewards 7. Develop an implementation strategy Community Free Clinic 5. Community initiatives to expand walking to replicate successful services and Mothers & Babies trails and parks. programs throughout the service area Perinatal Network of 6. School based initiatives to improve dietary 8. Expand linkages to local colleges that SCNY options and promote healthy eating in offer health careers for community Broome County Parks and schools: Power Up with Breakfast, Rock on health education Recreation Café, Five a Day, Farm to Schools Department of Social 7. Fitnessgram testing and BMI measurement Services of children in schools. Broome County Health 8. Lourdes Primary Care Network BMI Department initiative 1. Prevalence of overweight and obesity in adults [BRFSS] 2. Prevalence of overweight and at risk for becoming overweight in children [YRBS] 3. Percent of WIC & PCAP children who are overweight [WIC & PCAP] 4. Percentage of adults who engage in some type of leisure time physical activity [BRFSS] 5. The percentage of adults who consume at least five servings of fruits & vegetables per day [BRFSS] 6. The percentage of adults who consume at least five servings of fruits & vegetables per day [YRBS] 7. Percentage of mothers participating in the WIC program who breastfeed for at least 6 months [WIC] Rev 9/10/09 4

37 Attachment# 5: Broome County Community Health Assessment Achieving New York State Prevention Agenda Goals Community Health Planning Matrix PRIORITY AREA # 2: CHRONIC DISEASE & CHRONIC DISEASE PREVENTION FOCUS Chronic Disease: Diabetes Reduce the prevalence of diabetes Reduce diabetesrelated hospitalizations KEY PARTNERS Hospital based Endocrinology & Diabetes Centers [Lourdes & UHS] Endocrinology specialty practices Primary care providers Stay Healthy Center & Nurse Direct [UHS] Local support groups Rural Health Network of SCNY Dr. Garabed A. Fattal Community Free Clinic Broome County Office for Aging Aging Futures Partnership Community Alternative Systems Agency (CASA) Senior Centers Meals on Wheels CURRENT STRATEGIES / APPROACHES 1. Hospital based diabetes education programs 2. Chronic disease selfmanagement programs 3. Case management of patients with diabetes Examples of Current Initiatives: 1. Rural Health Network Chronic Disease Case Management Project 2. Community collaborative efforts through the American Diabetes Association. POTENTIAL APPROACHES / STRATEGIES 1. Develop innovative programming such as move your A1c to help motivate diabetics. 1. Expand linkages to local colleges that offer health careers for community health education 2. Healthcare provider education 3. Explore grant funding opportunities and evidence based strategies for increasing self management and case management of patients with diabetes. 4. Develop an implementation strategy to identify and replicate successful services and programs throughout the service area. 5. Address disparities in morbidity through engagement with specific sub populations INDICATORS 1. Prevalence of diabetes in adults [BRFSS] 2. Prevalence of diabetes in children [YRBS] 3. Hospitalizations for acute complications (ketoacidosis, hyperosmolarity, coma) [SPARCS/PQI] 4. Hospitalizations for chronic complications (renal, eye, neurological, circulatory, or complications not otherwise specified) [SPARCS/PQI] 5. Diabetes self management practices (self blood glucose monitoring, selffoot exams) [BRFSS] 6. Outpatient diabetes management by health care providers (A1c, foot exams, eye exams) [BRFSS] Rev 9/10/09 5

38 Attachment# 5: Broome County Community Health Assessment Achieving New York State Prevention Agenda Goals Community Health Planning Matrix PRIORITY AREA # 2: CHRONIC DISEASE & CHRONIC DISEASE PREVENTION FOCUS Chronic Disease: Heart Disease Reduce hospitalizations due to heart failure KEY PARTNERS Emergency Medical Services Hospitals Nursing homes Home health agencies American Heart Association Dr. Garabed A. Fattal Community Free Clinic Primary care sites Health care providers Stay Healthy Center & Nurse Direct [UHS] Local support groups Rural Health Network of SCNY Broome County Office for Aging Aging Futures Partnership Community Alternative Systems Agency (CASA) Senior Centers Meals on Wheels CURRENT STRATEGIES / APPROACHES 1. Provider patient & provider hospital initiatives to identify and provide disease management to patients with congestive heart failure. 2. Provide innovative home care programming and continuum of care to patients when they leave the hospital. 3. Home Health tele health monitoring services. 4. Post hospital discharge follow up calls. POTENTIAL APPROACHES / STRATEGIES 1. Provide continuum of care to monitor and assist patient with compliance issues. 2. Provide innovative home care programs and services for management of heart failure. 3. Expand linkages to local colleges that offer health careers for community health education 4. Explore grant funding opportunities and evidence based strategies for increasing disease management of patients with heart failure. 5. Develop an implementation strategy to replicate successful services and programs throughout the service area. 6. Address disparities in morbidity through engagement with specific sub populations INDICATORS Number of hospitalizations due to heart failure [SPARCS/PQI] Heart failure hospitalization rates [SPARCS/PQI] Rev 9/10/09 6

39 Attachment #6: Setting Priorities for the Broome County Community Health Assessment SUMMARY REPORT August 20, 2009 Attached below is a tool designed to assist in setting priorities for the Broome County Community Health Assessment. This tool was revised at the June CHA Steering Committee Meeting. Please refer to the various data documents and presentations from past meetings for information about which areas are health concerns for Broome County (e.g., Indicators for Tracking Public Health Priority Areas ). All documents are available on the Blackboard website and are located in the CHA Steering Committee Documents folder. Please let me know if you are having difficulty accessing any of these files. The SETTING PRIORITIES FOR THE BROOME COUNTY COMMUNITY HEALTH ASSESSMENT tool lists various potential health priorities vertically down the left column and factors by which to rate their importance horizontally across the top row. The priority areas include the ten (10) New York State Prevention Agenda Priorities as well as additional areas for consideration. You are asked to complete this tool by placing a score (from 1 to 5) in each box. Each assigned score should reflect the weighted importance of that factor in relation to its corresponding priority area. A score of 1 indicates lowest weighting (least important) and a score of 5 indicates highest weighting (most important). The factor scores will be summed across each row to obtain a total score for each priority area; thus each priority area can receive a maximum of 50 points. The total scores will then be ranked in descending order (from highest to lowest) to determine the highest priority items. Responses based on data are preferred; where data is not available, the rating may be derived intuitively based on your knowledge and experience is acceptable. If you don t know or are not sure of its importance, you may choose a score of 0. The following Rating Factor definitions are provided for clarification purposes: Potential Health Care Costs potential cost to the healthcare system. Potential costs include diagnostic and treatment expenses over the lifetime of affected Broome County residents (e.g., inpatient and outpatient costs including hospitalizations, medical office visits, medications, medical transport, durable medical equipment, and home care). These costs will be different if the priority area is an acute self limiting episode versus a lifelong chronic condition. These costs are viewed as direct costs to the healthcare system. Absolute Number of Individuals Affected the total number of persons in Broome County affected by the priority area. This indicator reflects the public health burden or impact within the local (county) population. 1

40 Attachment #6: Setting Priorities for the Broome County Community Health Assessment Worsening Trend over the Past 5 Years the extent to which there has been a significant or meaningful increase or decrease in the priority area resulting in a worsening pattern over the time period in Broome County. Underperforming National or State Health Goals the extent to which Broome County is not currently meeting Healthy People 2010 Goals and/or New York State 2013 Prevention Agenda Goals in the priority area. Work Time Lost or Disability this factor considers indirect costs representing the value of lost productivity for all affected Broome County residents. Particular Areas of Concern the extent to which the priority area demonstrates evidence of age, gender, racial, geographic, income, or other types of disparities among residents of Broome County. Feasibility for Potential Intervention the extent to which the priority area can be reasonably addressed by interventions at the local (county) level. Availability of Funding for Initiative reflects the extent to which public and/or private funding can be sought at the local (county) level for the priority area. Forces of Change includes national, state, and local trends (patterns over time such as demographic shifts), factors (discrete elements such as a rural setting), and events (one time occurrences such as a flood). These forces may be categorized as political, economic, social, technological, environmental, scientific, legal, or ethical in origin and have a direct or indirect effect on health or the social determinants of health for Broome County residents. Measurability over Time the extent to which outcomes can be readily measured for local interventions directed toward achieving improvements in the priority area. COLOR CODE: Red = Performance indicator in the highest quartile for NYS, Yellow = Performance indicator worse than NYS, Green = Prevention indicator meets or exceeds NYS Prevention Agenda 2013 Goal 2

41 Attachment #6: Setting Priorities for the Broome County Community Health Assessment SETTING PRIORITIES FOR THE BROOME COUNTY COMMUNITY HEALTH ASSESSMENT PRIORITY AREAS RATING FACTORS h Care Total Healt Costs Absolute Number of Individuals Affected Worsening Trend over the Past 5 Years Access to Quality Health Care Increase health care coverage Increase access to a regular health provider Increase access to dental health services Increase early detection of cancer [Cervical; Underperforming Health Goals Work Time Lost or Disability Particular Areas of Concern Feasib ility for Potential Intervention Availability of Funding for Initiative Forces of Change Measurability over Time also Cervical cancer mortality] Increase access to prescription medications Increase access to mental health services Tobacco Use Reduce the percentage of adolescents and adults who smoke [adults > NYS rate] Reduce the incidence of lung cancer Healthy Mothers / Healthy Babies / Healthy Children Increase access to early prenatal care Reduce poor birth outcomes [infant mortality > NYS] Reduce the prevalence of tooth decay in children Reduce the rate of pregnancies in adolescents OVERALL CATEGORY RANK ITEM RANK 3

42 Attachment #6: Setting Priorities for the Broome County Community Health Assessment PRIORITY AREAS RATING FACTORS Total Health Care Costs Absolute Number of Individuals Affected Worsening Trend over the Past 5 Years Reduce the proportion of adolescents who smoke during pregnancy Physical Activity / Nutrition Decrease the proportion of children and adults who are obese [adult obesity > NYS] Increase the proportion of adults who engage in some type of physical activity Increase the proportion of mothers who breastfeed their infants Unintentional Injuries Decrease hospitalizations and deaths due to unintentional injuries [mortality > NYS] Decrease fall-related hospitalizations in the elderly Reduce motor vehicle and pedestrian injuries Healthy Environment Reduce asthma-related hospitalizations Reduce occupational-related hospitalizations Reduce the incidence of childhood and adult Underperforming Health Goals Work Time Lost or Disabilit y Particular Areas of Concern Feasibility for Potential Intervention Availability of Fundin g for Initiative Forces of Change Measurability over Time lead poisonings Chronic Disease Decrease the prevalence of diabetes Reduce diabetes-related hospitalizations Reduce hospitalizations due to coronary heart disease [also CHF] OVERALL CATEGORY RANK ITEM RANK

43 Attachment #6: Setting Priorities for the Broome County Community Health Assessment PRIORITY AREAS RATING FACTORS Total Health Care Costs Absolute Number of Individuals Affected Worsening Trend over the Past 5 Years Cerebrovascular disease (stroke) mortality COPD hospitalizations among adults Infectious Disease Reduce the incidence of HIV infection [highest quartile for NYS but < Prevention Agenda Goal] Reduce the incidence of sexually transmitted diseases Increase the proportion of the elderly who have been immunized for influenza and pneumonia Community Preparedness All jurisdictions have a state-approved preparedness plan Mental Health / Substance Abuse Decrease deaths due to suicide Reduce problem drinking Reduce drug-related hospitalizations Decrease inappropriate substance abuse Increase availability of services for dual diagnosis / co-occurring dependencies Underperforming Health Goals Work Time Lost or Disability Particular Areas of Concern Feasibility for Potential Intervention Availability of Funding for Initiative Forces of Change Measurability over Time OVERALL CATEGORY RANK ITEM RANK 5

44 Attachment #6: Setting Priorities for the Broome County Community Health Assessment Rating Factors: Please rank (from 1 to 10) the following factors in order of importance [1 = lowest weighting (least important) and 10 = highest weighting (most important)] REVERSE SCORED 1 Total Health Care Costs 2 Measurability over Time 3 Absolute Number of Individuals Affected 4 Feasibility for Potential Intervention 5 Particular Areas of Concern 6 Worsening Trend over the Past 5 Years 7 Availability of Funding for Initiative 8 Forces of Change 9 Underperforming National or State Health Goals 10 Work Time Lost or Disability Prevention Agenda Priorities: Please rank (from 1 to 10) the following factors in order of importance [1 = lowest weighting (least important) and 10 = highest weighting (most important)] REVERSE SCORED 1 Access to Quality Care 2 Tobacco Use 3 Physical Activity / Nutrition 4 Healthy Mothers / Healthy Babies / Healthy Children 5 Chronic Disease 6 Mental Health / Substance Abuse 7Infectious Disease 8 Unintentional Injuries 9 Healthy Environment 10 Community Preparedness 6

45 HEALTHCARE THAT WORKS. HEALTHCARE THAT IS SAFE. HEALTHCARE THAT LEAVES NO ONE BEHIND Community Service Plan 169 Riverside Drive Binghamton, NY

46 MESSAGE Overview from of the Programs CEO & Services Dear Friends, Providing community benefit is an important part of our Mission. It represents a vital link to our community and neighbors. Our strength is in our history and Mission. The Mission and work of Lourdes goes on- as it has since You will hear more about our Mission 2012: Building Tomorrow s Health Care Today program in next year s report. This program is designed to address the future health care needs of our community. Every year we learn the importance of depending upon each other in times of need. This past year our community experienced changes resulting from a turbulent economy. The numbers of uninsured and underinsured continued to rise. Lourdes responded to the community s needs by increasing access and coverage to health care by adding much needed services such as hyperbaric oxygen therapy to treat wounds; expanded access to laboratory services, primary care, cancer screening, and diabetes services. We expanded access to dental services to six new school sites and two head start sites through our Mobile Dental Services. We began providing increased preventative services for youth through $3 million in additional grants which will be administered over the next few years to serve youth. And, we are thrilled to announce that we were awarded $257,000 in grants to bring a free pharmaceutical prescription program to the community, called the Hope Dispensary of the Southern Tier. This program will begin in August 2009 and will serve thousands of uninsured in need of pharmaceuticals. We express our heart felt gratitude to our community partners and our Ascension Health Ministry in Nashville, Tennessee, who helped make this dream a reality. Our associates extended our ministry into the community by providing supplies to elementary schools, participating in food drives, and ensuring that nearly 600 persons were able to enjoy the blessings of the holiday season. As a leading health care provider, each year we provide millions of dollars in charity care and health education programs to our community. Lourdes is pleased to report to the community the services provided during 2008 which address the Community s Health Status and Health Priorities. We remain committed to our call to provide Health Care that Works, Health Care that is Safe, and Health Care that leaves No One Behind. We look forward to continuing to partner with the community in the future. Our relationships inspire us and make our community a stronger, healthier place to live. We invite you to Experience Lourdes and to participate in furthering the healing ministry to which we ve been called. David Patak President/CEO HEALTHCARE THAT WORKS. HEALTHCARE THAT IS SAFE. HEALTHCARE THAT LEAVES NO ONE BEHIND.

47 Overview Priorities for of the Programs Year & Services During , Lourdes collaborated with community agencies under the direction of the New York State Health Department and County Health Departments to address public health issues and contributing factors, underlying causes to health status, and chronic disease. This report to the Community demonstrates how Lourdes has worked over the last year to help the Greater Binghamton community in the following key community health areas: Access to Healthcare Behavioral/Mental Health Frail & Elderly Maternal/Child/Adolescent Health Preventing & Managing Chronic Disease, including cancer, diabetes, pneumonia, asthma, cardiovascular disease/stroke, and obesity The following chart gives an overview of some of the programs and services Lourdes offers that impact the community s health status. More information about these programs is available on our website at PROGRAM Access To Healthcare Patient Financial Assistance Program 3,600 enrolled Discounted self-pay accounts Over 24,000 LECCO Total Donations $91,000 8 Community Agencies which assist with Access to services and to persons in need Medicaid Facilitated Enrollment 2,900 screened with 21% being enrolled in a health coverage program Community Awareness Events Health Fairs Over 5,200 persons served Mission in Motion Over 1,200 Mobile Mammography Nearly 2,500 Physician Referral Services/Call Center 3,300 persons served Behavioral/Mental Health The Corner (for health and counseling) 4,200 visits Mental Health Juvenile Justice Project (MHJJ) Detention Alternative After School Program (DAASP) and Juvenile Arrest Diversion Endeavor (JADE) Student Assistance Program Alcohol & Drug Education Prevention Program Teen Nurturing Parenting Program Frail & Elderly Hospice PERSON S SERVED 219 youth and family members 138 served 8 schools, 7,066 units of service 2,378 units of service 9 families and 25 family members Over 39,000 visits Volunteers 8,500 volunteer hours; Drove over 48,600 miles to assist patients and their families Palliative Care Nearly 900 consultations and visits (continued on next page) HEALTHCARE THAT WORKS. HEALTHCARE THAT IS SAFE. HEALTHCARE THAT LEAVES NO ONE BEHIND.

48 PROGRAM Maternal/Child/Adolescent Health DeMarillac Prenatal Program DePaul Pediatric Program Center for Oral Health Center Mobile Van (new 2006) Community Outreach and Oral Health Education PERSON S SERVED Over 5,560 visits Over 9,730 visits 4,147 patients and 10,755 visits 1,546 patients and 2,649 visits 209 patients for 501 visits (provided at area schools) 1,874 persons at 16 community and school events Parents And Children Together (PACT) 390 families and 3,500 home visits; Expansion to Tioga County to serve over 100 children and parents Family Support Program - Families and Schools Together (FAST) 11 School Districts, over 6,700 contacts Summer Evening Program 109 families and 490 family members Mission in Action (Community Outreach) School Supply, Holiday Programs, Thanksgiving and other service Community Awareness Events - Donations raised by Lourdes Associates (American Heart Association, American Cancer Society Events, Diabetes Walk, March of Dimes and other events) Preventing & Managing Chronic Disease Cancer Breast Cancer Screening Radiation Therapy Mission in Motion 1,200 persons served $7,000 donated by the Medical Staff $23,000 Cardiovascular Screenings Nearly 1,300 Diabetes Community Education, support groups Minority glucose screenings Endocrinology visits Over 14,000 Screenings, a 14.5% increase; Nearly 2,500 Mobile Mammography 10,400 Treatments Over 1,200 2,000 Over 100 Over 11,000 Infectious Disease/Pneumonia Influenza Vaccines Nearly 20,000 Our Mission Rooted in the loving ministry of Jesus as healer, we commit ourselves to serving all persons with special attention to those who are poor and vulnerable. Our Catholic health ministry is dedicated to spiritually centered, holistic care which sustains and improves the health of individuals and communities. We are advocates for a compassionate and just society through our actions and our work.

49 Overview of Programs & Services In addition to these specific Lourdes programs, Lourdes was also involved in a variety of Community coalitions and efforts to further address these community needs. COMMITMENT TO COMMUNITY HEALTH STATUS Access to Health Care Lourdes made a significant investment in helping to provide healthcare access and coverage to help the uninsured. Lourdes provided leadership for the Cover the Uninsured week; hired six financial counselors to assist uninsured individuals to determine eligibility for healthcare coverage. Provided the leadership in the development and design of the Hope Dispensary of the Southern Tier, a free pharmaceutical prescription program which will serve thousands in need of pharmaceuticals. Behavioral & Mental Health and Maternal, Child, and Adolescent Health Lourdes Youth Services reaches thousands of children and families each year with quality, comprehensive services. Lourdes Youth Services touched the lives of nearly 40,000 youth and their families during the year through collaboration with area schools, coalitions, the health department, the New York State Juvenile Justice System, and the Lourdes Oral Health Center. The year was a special year in which Lourdes was awarded over $3 million to be received over several years, in grants and donations to expand programs and services: methamphetamine and drug and alcohol prevention, PACT home visiting (expanded to Tioga County), and Teen Nurturing Parent Programs. Dental services were expanded to elementary schools and for adults. Chronic Disease Lourdes Regional Cancer Center provided outreach and education services for breast, cervical and colorectal cancer through the Healthy Living Partnership, community health fairs, and support groups. Lourdes Regional Cancer Center was named a recipient of the 2008 Commission on Cancer (CoC) Outstanding Achievement Award. As one of only 95 programs nation-wide, to achieve this award, Lourdes demonstrated the highest levels of commitment to high quality cancer services to all. Lourdes is an active partner in the Steps to a Healthier NY consortium. Steps is a part of a national health promotion and disease prevention initiative (Steps to a Healthier US). This program aims at helping Americans live healthier, longer, better lives by reducing the burden of diabetes, obesity and asthma by addressing three related risk factors: physical inactivity, poor nutrition and tobacco use. Locally, Lourdes has been involved with Steps to a Healthier New York through events such as: BC Walks for the Gold (physical activity) Working on Wellness (WOW), a program designed to address childhood obesity issues and their relationship to health, disease, and Type II diabetes. Reducing heart disease: through activities such as Mission Meltaway; maintaining a smoke free environment. Smoking cessation programs were expanded throughout the Lourdes Primary Care Network with the local Team Act coalition. Lourdes introduced the Glucose Stabilizer, the latest in diabetes management technology. HEALTHCARE THAT WORKS. HEALTHCARE THAT IS SAFE. HEALTHCARE THAT LEAVES NO ONE BEHIND.

50 Frail & Elderly Lourdes addressed the needs of the frail and elderly and their families through many venues, among which were participation in the Aging Futures community-wide coalition whose mission is to address the needs of the senior population in the community. Lourdes at Home served over 2,000 persons, providing nearly 44,000 home health visits. Lourdes at Home expanded its tele-health program to 26 monitors which were utilized to capacity, and demonstrated improved patient outcomes. During the year, Lourdes at Home accepted their first external heart pump patient into Home Care. Lourdes provides the leadership for the Southern Tier End of Life Coalition, whose mission is to improve the quality of life at the end of life, and provides the area s only palliative care services. In 2008 Dr. Francine Rainone, received board certification in Hospice and Palliative Medicine, a newly added subspecialty by the American Board of Medical Subspecialties. The clinical expertise provided by Dr. Rainone and the Hospice and Palliative Care Team at Lourdes will continue to be an important resource in addressing community health status and quality of life. Commitment to Health Care that is Safe Lourdes is committed to providing quality care to everyone we serve. By instituting a number of quality improvement initiatives, Lourdes continues to offer improved community health status. Cardiovascular disease, including stroke and heart failure, remains a significant health concern locally and nationally. Through Lourdes heart failure disease management programs and home care heart failure program Lourdes met or exceeded local and New York State clinical outcomes for Heart Failure, Pneumonia, and Surgical Site Infection. Public and professional education on stroke prevention and treatment was provided throughout the year, along with cardiovascular screenings. Lourdes maintains its New York State Health Department Stroke Center designation. Infectious Disease & Pneumonia. Lourdes participated in the Institute for Health care Improvement (IHI) 100k Lives Campaign, and is a designated mentor hospital, in recognition of efforts and results with the campaign. Issues being addressed through the campaign included ventilator acquired pneumonia, acute myocardial infarctions, preventing central line infections and preventing adverse drug events. Lourdes Financial Commitment to the Community 2008 CALENDAR YEAR Charity Care Free Care...$4,442,000 Community Benefit Programs...$14,470,000 Total Charity Care...$18,912,000 Bad Debt... $10,248,000 Medicaid Shortfall... $8,071,345 Medicare Shortfall... $11,547,635

51 Core Values SERVICE OF THE POOR Generosity of spirit, especially for persons most in need. REVERENCE Respect and compassion for the dignity and diversity of life. INTEGRITY Inspiring trust through personal leadership. WISDOM Integrating excellence and stewardship. CREATIVITY Courageous innovation. DEDICATION Affirming the hope and joy of our ministry. ABOUT Lourdes For over 80 years, Lourdes has been a cornerstone of our community, offering resources that have made a difference. With our spiritual, Catholic faith tradition, Lourdes Hospital provides the compassionate care that every patient deserves. Lourdes is more than an inpatient acute care hospital we are an outpatient ambulatory surgery center we are a Regional Cancer Center. We provide Palliative Care and Hospice Care, an orthopedics program, diabetes care, home health care, and much more. Reaching beyond the boundaries of our main campus, Lourdes has established a network of primary care physician offices at convenient sites throughout the region. The Mission In Motion, Mobile Mammography and Dental Care programs provide primary care cancer screening services, mobile mammography and dental care through three mobile medical vans, making health care accessible to rural populations and children in need. Lourdes is also a member of Ascension Health, the largest, Catholic, nonprofit healthcare system in the nation with more than 107,000 associates represented across 20 states and the District of Columbia. Much has changed in the community and at Lourdes since the Daughters of Charity opened a small 25-bed hospital on Riverside Drive over 80 years ago, but one thing remains constant: the commitment and Mission of caring found here each and every day. HEALTHCARE THAT WORKS. HEALTHCARE THAT IS SAFE. HEALTHCARE THAT LEAVES NO ONE BEHIND.

52 Creating a Senior Friendly Environment Focus Group Research Binghamton, New York Lourdes Hospital 169 Riverside Drive Binghamton, NY May 2006 Prepared by: Research & Marketing Strategies, Inc. 45 Oswego Street, Suite 300 Baldwinsville, New York (315)

53 TABLE OF CONTENTS Page Executive Summary / Suggestions & Recommendations 3 Key Findings 9 Background and Methodology 27 ATTACHMENTS Attachment 1: Composite Response Scores Attachment 2: Moderator s Guide Attachment 3: Participation Packet Attachment 4: Correspondence Attachment 5: Screener/Recruitment Materials and Postings Attachment 6: Participant Lists/Willingness to Participate in Future Focus Groups and Reimbursement Forms Lourdes Senior Friendly Customer Service Focus Groups

54 BACKGROUND AND METHODOLOGY RMS managed the participant recruitment, developed session materials, moderated the focus group sessions, and preparation of the Report, which summarizes the research findings. Two focus groups were conducted on Tuesday, May 16, 2006 and two on Thursday, May 18, The afternoon session consisted of seniors who had visited a Lourdes facility within the last 12 months. The evening focus groups consisted of caregivers who transported or assisted seniors in their medical treatment at a Lourdes facility. All focus groups were conducted at Lourdes Hospital in the Binghamton area. The sessions were audio taped. Focus Group Sessions Participants Date Time Seniors Tuesday, May 16 4:00 PM 6:00 PM Caregivers Tuesday, May 16 7:00 PM 9:00 PM Seniors Thursday, May 18 4:00 PM 6:00 PM Caregivers Thursday, May 18 7:00 PM 9:00 PM Participant Recruitment RMS telephone surveyors conducted a telephone recruitment to solicit participants for the senior focus group sessions. Lourdes supplied RMS with the sample, identifying a pool of senior aged individuals, who had received services at Lourdes in the last 12 months. The list was randomized and only phone numbers were provided to recruitment callers. Participants were then randomly recruited from this list. The caregiver participants were recruited via multiple recruitment strategies. This included phone calls and postings at area Senior Citizen Centers and churches. The table on the next page lists all the senior centers and churches that were contacted and/or provided flyers to be posted. Lourdes administrators also posted flyers in Lourdes physician offices and labs. Copies of the flyers are included as Attachment 5 of this report. Finally, random digit dialing in the Binghamton area was conducted in Binghamton, Conklin, Kirkwood, Endwell, Endicott, Johnson City and Vestal. Only one member per household was recruited as a participant. RMS utilized a screening tool to qualify the participants and assign them to the appropriate focus group session. The screening instrument included questions that asked the prospective participant if they had received medical services at a Lourdes facility in the last twelve months. RMS recruited 14 participants for each session, recognizing that typically 3 to 4 individuals fail to show up for a focus group session. Each recruit was sent a confirmation letter identifying the time of their respective focus group session, directions and an explanation sheet briefly describing the focus group process. Reminder telephone calls were made one, to two days in advance of the focus groups. Senior participants received an additional reminder one week in advance. Copies of these materials are included as Attachment 4 of this report. Participants were given a $40 honorarium for their time and participation in the focus group. Lourdes Senior Friendly Focus Groups 27

55 FINAL REPORT Access to Care Research Referral Groups Qualitative Research Focus Groups Lourdes and Non-Lourdes Employees Fall 2008 Lourdes Ms. Lisanne Bobby Director of Strategic t Planning/Business i Analysis 169 Riverside Drive Binghamton, New York Prepared dby: Research & Marketing Strategies, Inc. 15 East Genesee Street, Suite 130 Baldwinsville, New York (315) Fall 2008 Access to Care Research CONFIDENTIAL