Chandler Regional Medical Center. Community Benefit 2017 Report and 2018 Plan

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1 Community Benefit 2017 Report and 2018 Plan

2 A message from Mark Slyter, president and CEO of and Dr. Paul McHale, Chair of the Dignity Health East Valley Community Board. Dignity Health s comprehensive approach to community health improvement aims to address significant health needs identified in the Community Health Needs Assessments that we conduct with community input, including from the local public health department. Our multi-pronged initiatives to improve community health include financial assistance for those unable to afford medically necessary care, a range of prevention and health improvement programs conducted by the hospital and with community partners, and investing in efforts that address social determinants of health. shares a commitment to improve the health of our community, and delivers programs and services to achieve that goal. The Community Benefit 2017 Report and 2018 Plan describes much of this work. This report meets requirements in California state law (Senate Bill 697) that not-for-profit hospitals produce an annual community benefit report and plan. Dignity Health produces these reports and plans for all of its hospitals, including those in Arizona and Nevada. We are proud of the outstanding programs, services and other community benefits our hospital delivers, and are pleased to report to our community. In fiscal year 2017 (FY17), provided $45,726,012 in patient financial assistance, unreimbursed costs of Medicaid, community health improvement services, and other community benefits. The hospital also incurred $30,848,276 in unreimbursed costs of caring for patients covered by Medicare. Dignity Health s Board of Directors reviewed, approved and adopted the Community Benefit 2017 Report and 2018 Plan at its October 17, 2017 meeting. 1

3 TABLE OF CONTENTS PAGE Executive Summary (3) Mission, Vision, and Values (5) Our Hospital and Our Commitment (6) Description of the Community Served (7) Community Benefit Planning Process Community Health Needs Assessment Process (10) CHNA Significant Health Needs (11) Creating the Community Benefit Plan (12) 2017 Report and 2018 Plan Strategy and Program Plan Summary (13) Anticipated Impact (17) Planned Collaboration (18) Financial Assistance for Medically Necessary Care (18) Program Digests (19) Economic Value of Community Benefit (43) Appendices Appendix A: Community Board and Committee Rosters (44) Appendix B: Other Programs and Non-Quantifiable Benefits (48) Appendix C: Financial Assistance Policy Summary (50) 2

4 EXECUTIVE SUMMARY Dignity Health defines the community served by a hospital as those individuals residing within its primary and secondary service areas. The primary service area includes all residents in a defined geographic area surrounding the hospital and does not exclude low-income or underserved populations. The city of Chandler is primarily served by (CRMC). Chandler is a growing and diverse city in Maricopa County, Arizona with over 250,000 residents of many ethnicities, various incomes and education levels. Surrounding communities include Gilbert, Mesa, Tempe, Ahwatukee, Sacaton, Apache Junction, Casa Grande, Pinal County, Gila River Indian Reservation, and Guadalupe. Chandler is home to several major industrial firms that include Intel, Microchip and Orbital. However, despite economic growth, there continues to be many factors and social determinants of health in the suburban Chandler Communities that need to be addressed in order to improve the health and wellbeing for the broader community and the underserved. According to the Community Need Index (CNI), a proprietary tool developed by Dignity Health, the primary service area includes both moderate and highrisk areas with significant socio-economic barriers. Zip code areas with the highest risk include 85122, 85128, 85139, 85202, 85225, 85282, and The significant community health needs that form the basis of this document were identified in the hospital s most recent Community Health Needs Assessment (CHNA), which is publicly available at Chandler Regional Dignity Health CHNA Additional detail about identified needs, data collected, community input obtained, and prioritization methods used can be found in the CHNA report. The significant community health needs identified are: Access to Care Problems of Aging Mental Health/Behavioral Health Diabetes Injury Prevention Cancer In FY17, took numerous actions to help address identified needs. These included: ACTIVATE: Transitional Care Program Building Blocks for Children Hearing and Visions Screening Center for Diabetes Management Center for Faith Health Ministries Chronic Disease Self-Management Circle the City: Hospice and Medical Respite for the Homeless Community Education: Prenatal Classes Community Education: Support Groups Community Education: Perinatal Mood Disorder Therapy sessions Dignity Health Children s Dental Clinic 3

5 Dignity Health Community Grants Program: Total Awarded for FY17 - $307,060 o Senior Community Wellness: $70,000 o Transportation and case management for discharged high risk seniors o East Valley I-Help: $70,000 Shelter, case management, and housing for homeless men and women o Partnership to Build Resilient Families: $65,000 Substance abuse prevention for youth and families o Safe at Home: - $60,000 High risk seniors: Home safety, falls prevention, Chronic Disease, Case management o East Valley Perinatal Network $42,060 Perinatal Mood Disorder Early Childhood Oral Health Program Injury Prevention Program Lactation Services Mission of Mercy: Medical Home for Uninsured Patient Financial Services Teen Pregnant and Parenting Program East Valley Behavioral Health Coalition Chandler-Gilbert Substance Use and Treatment Taskforce For FY18, intends to continue supporting programs from FY17 and to expand with the following programs and initiatives: Expansion of Dignity Health Children s Dental Clinic, Chronic Disease Self-Management, Building Blocks for Children, Pre-Diabetes, Community Education and other Dignity Health community benefit services at the proposed Town of Gilbert Wellness and Resource Center Support and participation in the City of Maricopa development of a Family Advocacy Center to improve access to care for victims of domestic violence, rape, child abuse, and suicide Expansion of NaviHealth patient referral system to include Dignity Health outpatient services, community programs, and community agencies addressing social determinant of health The economic value of community benefit provided by in FY17 was $45,726,012, excluding unpaid costs of Medicare in the amount of $30,848,276. This document is publicly available at Chandler Regional Community Benefit Report and Plan The Community Benefit Report and Plan is available upon request, distributed to key community partners, board members, and constituents, and is on the and Dignity Health websites Written comments on this report can be submitted to the s Community Integration Department to Theresa Dettler, Senior Coordinator at 1760 E. Pecos Road, Suite 235, Gilbert AZ, or by to Chandler-CHNA@DignityHealth.org. 4

6 MISSION, VISION AND VALUES is a part of Dignity Health, a non-profit health care system made up of more than 60,000 caregivers and staff who deliver excellent care to diverse communities in 21 states. Headquartered in San Francisco, Dignity Health is the fifth largest health system in the nation. At Dignity Health, we unleash the healing power of humanity through the work we do every day, in hospitals, in other care sites and the community. Our Mission We are committed to furthering the healing ministry of Jesus. We dedicate our resources to: Delivering compassionate, high-quality, affordable health services; Serving and advocating for our sisters and brothers who are poor and disenfranchised; and Partnering with others in the community to improve the quality of life. Our Vision A vibrant, national health care system known for service, chosen for clinical excellence, standing in partnership with patients, employees, and physicians to improve the health of all communities served. Our Values Dignity Health is committed to providing high-quality, affordable healthcare to the communities we serve. Above all else we value: Dignity - Respecting the inherent value and worth of each person. Collaboration - Working together with people who support common values and vision to achieve shared goals. Justice - Advocating for social change and acting in ways that promote respect for all persons. Stewardship - Cultivating the resources entrusted to us to promote healing and wholeness. Excellence - Exceeding expectations through teamwork and innovation. 5

7 OUR HOSPITAL AND OUR COMMITMENT HOSPITAL DESCRIPTION (CRMC), a member of Dignity Health, is the longest established hospital in the southeast valley, providing more than 50 years of service to the community. CRMC has grown into a comprehensive acute care hospital that provides a full spectrum of services including a Level I Trauma Center, open heart surgery program, neurosurgery, orthopedics, and high risk obstetrics and newborn services. With 338 acute care licensed beds, more than 2,500 employees and over 970 physicians, CRMC provides comprehensive care, from routine check ups and diagnostic services to a wide range of specialties including advanced diagnostic, surgical, robotics and intensive care services. OUR COMMITMENT Rooted in Dignity Health s mission, vision and values, is dedicated to improving community health and delivering community benefit with the engagement of its management team, Community Board and Community Benefit Committee. The committee, hospital executive leadership, Community Board, and Dignity Health review community benefit plans and program updates. The board and committee are composed of community members who provide stewardship and direction for the hospital as a community resource. Key roles include: Executive Leadership Team: Reviews the Community Benefit Report and Plan prior to community board approval, ensuring alignment with the CHNA, strategic plan, and budgeting for resources. Community Benefit Committee (CBC): The CBC reviews and directly monitors the CHNA, Implementation Strategy, and Community Benefit Report and Plan. The CBC makes recommendations and reports monthly to the Community Board. Refer to Appendix A for a listing of the CBC members. Community Board: The role of the Community Board includes oversight, approval and monitoring of the CHNA, Implementation Strategy and annual Community Benefit Report and Plan. Refer to Appendix A for a complete listing of current board members. Community Benefit Department: The Community Benefit Department, is accountable for planning, implementing, evaluating, and reporting. Key staff positions include: Vice President of Mission Integration, Director of Community Health, Senior Coordinator for Community Benefit, and Managers to directly oversee Center for Diabetes Management, Manager of Community Education, Lactation, Oral Health Program, and Community Wellness. s community benefit program includes financial assistance provided to those who are unable to pay the cost of medically necessary care, unreimbursed costs of Medicaid, subsidized health services that meet a community need, and community health improvement services, and health professions education and research. Our community benefit also includes monetary grants we provide to not-for-profit organizations that are working together to improve health on significant needs identified in our Community Health Needs Assessment. Many of these programs and initiatives are described in this report. In addition, we are investing in community capacity to improve health including by addressing the social determinants of health through Dignity Health s Community Investment Program. Current investment projects are summarized in Appendix B. 6

8 DESCRIPTION OF THE COMMUNITY SERVED Dignity Health defines the community served as those individuals residing within its primary and secondary service areas. The Primary Service Area (PCA) includes all residents in a defined geographic area surrounding the hospital and does not exclude low-income or underserved populations. The city of Chandler is primarily served by CRMC. The primary service area for CRMC includes the zip codes making up the top 75% of the total patient cases. The city of Chandler is primarily served by CRMC for acute care and trauma services. Surrounding communities also being served by CRMC include Gilbert, Mesa, Tempe, Ahwatukee, Sacaton, Apache Junction, Casa Grande, Pinal County, Gila River Indian Reservation, and Guadalupe. A summary description of the Chandler community is below, and additional community facts and details can be found in the CHNA report online. Demographic and Socioeconomic According to the Arizona Department of Health Services (ADHS), the Chandler Central PCA has been federally designated as a Medically Underserved Area. More than half of the population of CRMC s primary service area are adults between years of age. Nearly 8.7% of residents do not have a high school diploma, 7.1% are unemployed and approximately 13.6% are without health insurance. This data shows that the population as a whole is majority white, and with a median income above Maricopa County and the state of Arizona. Chandler is home to several major industrial firms that include Intel, Microchip and Orbital. Despite strong economic growth, there continue to be many factors and social determinants of health in the suburban Chandler community that needs to be addressed in order to improve the health and wellbeing for the broader community, and the underserved. Challenges for this community include high rates of poverty, violence-associated injuries, a large non-english speaking population, and low education attainment, all of which create barriers to access. Downtown Chandler has a significant population of uninsured and underinsured non-english speaking persons of all age groups. A large majority of this population is also indigent with their primary source of income through day labor and seasonal work. Refer to Table 1 and 2 below for more population demographics. 7

9 Table 1: Chandler Demographics 2017 Population Variable Count %of Pop Population 649, % White 456, % White Non-Hispanic 378, % White Hispanic 78, % Black 37, % Black Non-Hispanic 35, % Black Hispanic 2, % American Indian & Alaska Native 29, % American Indian & Alaska Native Non- Hispanic American Indian & Alaska Native Hispanic 23, % 5, % Asian/Pacific Islander 39, % Asian/Pacific Islander Non-Hispanic 38, % Asian/Pacific Islander Hispanic % 2+ Races 29, % 2+ Races Non-Hispanic 17, % 2+ Races Hispanic 11, % Other 57, % Other Non-Hispanic % Other Hispanic 56, % Hispanic Ancestry 155, % Non-Hispanic Ancestry 494, % Source: 2017 The Claritas Company, 2017 Truven Health Analytics LLC Table 2: Additional Statistics Median Income $65,917 Unemployment 4.9% No High School Diploma 9.6% Medicaid * 14.5% Uninsured 6.3% * Does not include individual s dually eligible for Medicaid and Medicare. Source: 2017 The Claritas Company, 2017 Truven Health Analytics LLC 8

10 One tool used to assess health need is the Community Need Index (CNI) created and made publicly available by Dignity Health and Truven Health Analytics. The CNI analyzes data at the zip code level on five factors known to contribute or be barriers to health care access: income, culture/language, education, housing status, and insurance coverage. Scores from 1.0 (lowest barriers) to 5.0 (highest barriers) for each factor are averaged to calculate a CNI score for each zip code in the community. Research has shown that communities with the highest CNI scores experience twice the rate of hospital admissions for ambulatory care sensitive conditions as those with the lowest scores. 9

11 COMMUNITY BENEFIT PLANNING PROCESS The hospital engages in multiple activities to conduct its community benefit and community health improvement planning process. These include, but are not limited to: conducting a Community Health Needs Assessment with community input at least every three years; using five core principles to guide planning and program decisions; measuring and tracking program indicators; and engaging the Community Benefit Committee and other stakeholders in the development and annual updating of the community benefit plan and triennial Implementation Strategy. Community Health Needs Assessment Process Development of the Community Health Needs Assessment adopted June 2016 involved engagement and recommendation from internal and external stakeholders. Internal stakeholders included Community Board, Community Benefit Committee, Grants Committee, and Executive Leadership. External stakeholders included Maricopa County Department of Public Health (MCDPH), Community Based organizations, s Community Partnership Collaboration, and community constituents. The process of conducting this assessment began with a review of approximately 100 indicators to measure health outcomes and associated health factors of Maricopa County residents. These indicators were based on the Center for Disease Control and Prevention s (CDC) Community Health Assessment for Population Health Improvement: Most Frequently Recommended Health Metrics report. Quantitative data used in the report were high quality, population-based data sources and were analyzed by MCDPH, Office of Epidemiology. Data came from local, state, and national sources such as the Maricopa County Department of Public Health, Arizona Department of Health Services, Arizona Criminal Justice Commission, U.S. Census Bureau, U.S. Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System survey, Youth Risk Behavior survey, and Chandler Regional Medical Center s Prevention Quality Indicators from Fiscal Year The broad interests of the community were incorporated through three means. First, data was collected through focus groups engaging members of underserved populations and communities. Second, surveys were conducted with key informants who serve the primary service area. Finally, a series of meetings were held with key stakeholders from CRMC s primary service area. Based on the review of the secondary data, a consultant team developed a primary data collection guide used in focus groups which were made up of representatives of minority and underserved populations who identified community concerns and assets. Surveys were collected from key informants who serve the primary service area to help determine community needs and priorities. Additionally, meetings were held with stakeholders from the Community Benefit Committee and Community Partnership Collaboration to assist with the analysis and interpretation of data findings. Members of the Community Benefit Committee and the Community Partnership Collaboration provided input on the selection of data indicators, provided feedback on data collected, and aided in the selection of final priorities. Membership of the above mentioned committees and collaborations intentionally 10

12 represent vulnerable and disenfranchised populations including the homeless, uninsured/underinsured, Medicaid, Medicare, immigrant, disabled, mentally ill, and elderly. Dignity Health s Board of Directors reviewed, approved, and adopted the Community Health Needs Assessment at its January 2016 meeting. The complete CHNA report is publicly available at: Chandler Regional Dignity Health CHNA Process and Criteria for Prioritization To be a considered a health need, a health outcome or a health factor had to meet two criteria; first, existing data had to demonstrate that the primary service area had a health outcome or factor rate worse than the average Maricopa County rate, demonstrate a worsening trend when compared to Maricopa County data in recent years, or indicate an apparent health disparity; second, the health outcome or factor had to be mentioned in a substantial way in at least two primary data collection sources which were focus groups, surveys, or stakeholder meetings. The process for prioritization included engagement with both internal Dignity Health stakeholders and external community partners. The first step of the process was a comprehensive presentation by MCDPH that included an overview of the CHNA findings and key emerging health needs. The second step in the process involved facilitated sessions using a 4-square, priority/benefit matrix process to review and prioritize key emerging health needs. The X axis showed the level of effort required to address a particular health need whereas the Y axis showed the benefit to the community by addressing the health need. As participants discussed each health need, consideration was given to the size of the problem, disparity and equity, known effective interventions, resource feasibility and sustainability, and community salience. Through consensus, participants made final recommendations to CRMC for priority health needs. CHNA Significant Health Needs The following statements from s CHNA summarize each of the areas of priority for CRMC, and are based on data and information gathered through the CHNA. The significant community health needs identified are: Access to Care: Within CRMC s primary service area, one out of every eight residents lack health insurance. Additionally, there are significant disparities experienced with Hispanics and American Indians. Problems of Aging: Problems of aging were ranked in the top five areas of concern by key informants with Alzheimer s and cardiovascular disease being identified as specific concerns. Mental Health/Behavioral Health: Mental Health/Behavioral Health was ranked as the most important health problem by key informants and community members. Mental health is among the top ten leading causes of emergency department visits. Substance abuse was identified as a key concern. Diabetes: Diabetes is the seventh leading cause of death in CRMC s primary service area indicating a sustained health need. Additionally, the number of adults reporting they have been told they have diabetes is increasing. 11

13 Injury Prevention: Unintentional injury is the sixth leading cause of death for CRMC s primary service area. It is also the leading cause of emergency department visits and the second leading cause of inpatient discharges. Cancer: Cancer remains the leading cause of death in CRMC s primary service area and was identified as one of the top five areas of concerns from key informants. The highest site-specific cancer incidence rate in the primary service area is due to lung cancer. Significant Health Needs Not Being Addressed by CRMC To address needs not specifically met by, strong and effective community partnerships ensure the community has access to care, regardless of the need. Services not met by CRMC include pediatrics, mental health, and outpatient cancer treatment. These services, while not met by, are met by other health care facilities or partners in the service area. Organizations addressing the identified need not met by include Mercy Gilbert Medical Center, Ironwood Cancer and Research Center, Banner Health Care, Phoenix Children s Hospital, Valley Hospital, Mercy Maricopa Mental Health Services for inpatient and outpatient services, and Honor Health. Creating the Community Benefit Plan As a matter of Dignity Health policy, the hospital s community health and community benefit programs are guided by five core principles. All of our initiatives are related to one or more of these principles: Focus on Disproportionate Unmet Health-Related Needs Emphasize Prevention Contribute to a Seamless Continuum of Care Build Community Capacity Demonstrate Collaboration Additionally, CRMC abides by the nine Dignity Health Mission Standards that include Organizational Identity, Spirituality and Culture, Ethical Principles, and Community Health and the Common Good. The Mission standards serve as a foundation and guide as we further our mission of compassion, advocacy and partnership. Standards seven, eight, and nine under Community Health and Common Good align with the scope of work recommended in the Implementation Strategy. Standard 7: Dignity Health partners with others in the community to improve the quality of life. Standard 8: Dignity Health employs a variety of approaches, including advocacy, innovation and philanthropy, to address the social, political and economic structures that affect the health of persons, especially those most vulnerable. Standard 9: Dignity Health exercises responsible stewardship of the environment and partners with others to advance ecological initiatives s Community Benefit Committee leads the planning process that includes review of all current and potential community benefit programs for alignment with identified significant health needs. Each program is evaluated for effectiveness, the need for continuation, discontinuation, or the need for enhancement. Committee site tours, presentations, and program reports provide additional perspective. In addition to the CBC, Dignity Health leadership, Community 12

14 Integration Department, community partners, and constituency feedback influence prioritization of programs and services identified in the Community Benefit Plan REPORT AND 2018 PLAN This section presents strategies and program activities the hospital is delivering, funding or on which it is collaborating with others to address significant community health needs. It summarizes actions taken in FY17 and planned activities for FY18, with statements on anticipated impacts, planned collaboration, and patient financial assistance to address access. Program Digests provide detail on select programs goals, measurable objectives, expenses and other information. The strategy and plan specifies planned activities consistent with the hospital s mission and capabilities. The hospital may amend the plan as circumstances warrant. For instance, changes in significant community health needs or in community assets and resources directed to those needs may merit refocusing the hospital s limited resources to best serve the community. Programs officially designated as Evidenced-Based are noted with an asterisk. Strategy and Program Plan Summary Health Need: Access to Care Strategy or Activity Summary Description Active FY17 School-based healthcare for children and families Free and low -cost community-based health services and information Free and low cost community-based health services and information Homeless population Transportation to medical appointments Access to healthcare information and available resources, including basic needs. 1. Chandler Care Center 2. services provided at school locations 1. Mission of Mercy: Primary care for uninsured 2. AZCEND Community Center 3. community benefit services 1. Proposed: Town of Gilbert Wellness and Resource Center 2. City of Maricopa Family Advocacy & Resource Center for crisis intervention 1. Dignity Health Community of Care Grant I-Help (Interfaith Homeless Emergency Lodging 2. Circle the City: Respite, hospice, and case management 1. Senior Community Wellness Community of Care grant 1. AZCEND Community Center 2. Resource Link and website 3. Chandler and Gilbert Community Action Program (CAP) 4. FindHelp Phoenix Planned FY18 13

15 Access to healthcare information and available resources, including crisis and basic needs. Education on insurance, including eligibility, enrollment, and understanding one s medical bills Access to healthy food Patient continuum of care 1. Proposed: Gilbert Wellness and Resource Center 2. City of Maricopa Family Advocacy Center 1. Chandler Care Center, 2. Dignity Health Community of Care I-Help, Senior Community Wellness, Safe At Home 3. Keogh Foundation, 4., including Financial Assistance and Financial Assistance policy awareness 1. Chandler Care Center 2. Mathew s Crossing 3. AZCEND Community Center 4. Community Action Program 1. ACTIVATE 2. Mission of Mercy 3. Circle the City 4. NaviHealth referral project to refer patients to Dignity Health Community programs 6.Mercy Gilbert Medical Center for Faith Health Ministry Patient continuum of care 1. NaviHealth patient referral project for community agencies and Community of Care granted agencies Anticipated Impact: Improved access to care, information, resources, and ultimately health. Increased access will lead to reduced need for healthcare services, hospitalization, and cost. Health Need: Problems of Aging Strategy or Activity Summary Description Active FY17 Support to caregivers Alzheimer s Alzheimer s Awareness and education on insurance eligibility, enrollment process, 1. Foundation for Senior Living 2. Chronic Disease Self- Management * 3. Dignity Health Community of Care: Senior Community Wellness, Safe at Home 1. Foundation for Senior Living 2. Dignity Health Community of Care Grant: Senior Community Wellness, Safe at Home. Work with organizations that provide Alzheimer s education and support to determine specific strategies to offer education, early detection screening, support, and/or resources 1. Chandler Care Center 2. Dignity Health Community of Care:, I-Help, Senior Community Wellness 3. Keogh Foundation 4., including Patient Planned FY18 14

16 and understanding medical bill Reduction in fall risk Reduction in fall risk through education Chronic Disease Transportation to medical appointments Chandler Regional Medical Center sponsored support Financial Assistance Policy 1. Dignity Health Community of care Safe At Home Balance Matters* 2. Dignity Health Community of Care Senior Community Wellness 3. ACTIVATE 1. Proposed: Town of Gilbert Family and Resource Center 1. Mercy Gilbert Medical Center, Center for Diabetes Management- (Accredited)* 2. Chronic Disease Self-Management Program * 3. Cardiovascular education on early signs of heart attack* 1. Dignity Health Community of Care: Senior Community Wellness 1. Stroke Support group 2. Better Breathers Support Group groups Anticipated Impact: Through improved focus on problems of aging, aging adults will have improved disease management and independence. Education and resources will also reduce injury, isolation, and the need to access healthcare services. Health Need: Mental Health/Behavioral Health Strategy or Activity Summary Description Improve education, awareness, referral, and resources Improve education, awareness, referral, and resources Education to professionals and community on prescriptions use storage, disposal, and resourcing Access to crisis intervention services 1. East Valley Behavioral Health Coalition 2. Chandler-Gilbert Substance use and Treatment Taskforce 3. Center for Faith Health Ministries 4. NaviHealth referral project for referrals to Chandler Community Programs 4. Dignity Health Community of Care Grant recipients NaviHealth referral project for referrals to Chandler Community Agencies 1. Sponsor evidenced-based 360 RX presentations on prescription and drug Abuse* 2. Partnership to Build Resilient Families Sponsor evidenced-based Mental Health First Aid presentations on recognizing and resourcing for individuals and families suffering from mental illness Active FY17 Planned FY18 15

17 Access to crisis intervention services Pregnant and postpartum adjustment support TEEN4Teen support City of Maricopa Family Advocacy & Resource 1. Postpartum Adjustment Support group 2. Perinatal Mood Disorder Therapy Sessions* 3. Breastfeeding Support Group 1. pregnant and parenting teen support group Anticipated Impact: Individuals and families will have improved and proactive access to education, resources, and referrals for addressing mental health and/or behavioral health concerns and needs. Additionally, community members, professionals, and faith community will have access to education and resources Health Need: Diabetes Strategy or Activity Summary Description Active FY17 Access to diabetes management and support Access to free Chronic Disease Self-Management education Access to healthy foods Access to fitness 1. Mercy Gilbert Medical Center, Center for Diabetes Management classes, management, and support.* 1. Chronic Disease Self- Management Program (CDSMP) Workshops.* 2. Safe at Home Work with Maricopa County Department of Public Health, community food banks, farmers markets, community gardens, and access for SNAP clients. 1. Chandler/Gilbert YMCA 2. Boys and Girls Club 4. ICAN 5. pregnancy and postpartum fitness Anticipated Impact: Improved nutrition, fitness, education, self-management, and quality of life. Anticipated impact includes reduction in hospitalization, readmission, and cost of healthcare. Planned FY18 Health Need: Injury Prevention Strategy or Activity Summary Description Active FY17 Injury prevention education for children Injury prevention for adults 1. Think First injury prevention* 2. Car seat safety clinics 3. Community based health fair education 4. Safe Sitter Class * 1.Dignity Health Community of Care Safe at Home falls prevention Balance Matters* 2 Dignity Health Community of Care Senior Community Wellness fall prevention with clients Planned FY18 16

18 Anticipated Impact: Reduction in injury or death as a result of improved education and safety practices. Health Need: Cancer Strategy or Activity Summary Description Active FY17 Planned FY18 Education on importance of early detection and availability of resources 1. Desert Cancer Foundation 2. Ironwood Cancer and Research Center 3. Comfy Cozy for Children Education on importance of early detection and availability of resources Improve awareness of cancer screening events 1. Chronic Disease Self-Management Workshops Thriving and Surviving 2. Conduct a strategy session with Ironwood Cancer and Research Center, Desert Cancer Foundation, and other community agencies 1. Conduct a strategy session and/or individual discussion with Ironwood Cancer and Research Center and Desert Cancer Foundation. Anticipated Impact: Improved education and awareness leading increased prevention practices and access to resources. Anticipated Impact The anticipated impacts of the hospital s activities on significant health needs are summarized above, and for select program initiatives are stated in the Program Digests on the following pages. Overall, the hospital anticipates that actions taken to address significant health needs will: improve health knowledge, behaviors, and status; increase access to needed and beneficial care; and help create conditions that support good health. The hospital is committed to measuring and evaluating key initiatives. The hospital creates and makes public an annual Community Benefit Report and Plan, and evaluates impact and sets priorities for its community health program in triennial Community Health Needs Assessments. Planned Collaboration Maricopa County Department of Public Health (MCDPH): Dignity Health Arizona is part of the Collaborative Community Health Needs Assessment (CCHNA) and Health Improvement Partnership of Maricopa County (HIPMC) with other local health systems for the 2017 Maricopa County, AZ CHNA and Implementation Plan. Additionally, MCDPH is currently contracted for the Dignity Health, Arizona CHNA Town of Gilbert: Dignity Health is a lead collaborator with the Town of Gilbert, along with several nonprofit agencies, collaborating on the proposed Gilbert Wellness and Resource Center to improve access to care in the East Valley, including medical, dental, social service needs, education, counseling and availability of information and resources. 17

19 Financial Assistance for Medically Necessary Care delivers compassionate, high quality, affordable health care and advocates for members of our community who are poor and disenfranchised. In furtherance of this mission, the hospital provides financial assistance to eligible patients who do not have the capacity to pay for medically necessary health care services, and who otherwise may not be able to receive these services. A plain language summary of the hospital s Financial Assistance Policy is in Appendix C. The amount of financial assistance provided in FY17 is listed in the Economic Value of Community Benefit section of this report. The hospital notifies and informs patients and members of the community about the Financial Assistance Policy in ways reasonably calculated to reach people who are most likely to require patient financial assistance. These include: providing a paper copy of the plain language summary of the Policy to patients as part of the intake or discharge process; providing patients a conspicuous written notice about the Policy at the time of billing; posting notices and providing brochures about the financial assistance program in hospital locations visible to the public, including the emergency department and urgent care areas, admissions office and patient financial services office; making the Financial Assistance Policy, Financial Assistance Application, and plain language summary of the Policy widely available on the hospital s web site; making paper copies of these documents available upon request and without charge, both by mail and in public locations of the hospital; and providing these written and online materials in appropriate languages. In addition to staff awareness and education, the community is made aware of the Financial Assistance Policy, including postings throughout the hospital that financial assistance is available. Specifically, signage is in English and Spanish in both the admitting areas and the emergency room, at urgent care, and other outpatient centers. Additionally, the Financial Assistance Policy is posted on the website. Program Digests The following pages include Program Digests describing key programs and initiatives that address one or more significant health needs in the most recent CHNA report. The digests include program descriptions and intervention actions, statements of which health needs are being addressed, any planned collaboration, and program goals and measurable objectives. Significant Health Needs Addressed Core Principles Addressed Communitiy Grants Program X Access to Care X Problems of Aging X Mental Health/Behavioral Health X Diabetes X Injury Prevention X Focus on Disproportionate Unmet Health-Related Needs X Emphasize Prevention X Contribute to a Seamless Continuum of Care 18

20 Program Description Community Benefit Category Program Goal / Anticipated Impact Measurable Objective(s) with Indicator(s) Intervention Actions for Achieving Goal Planned Collaboration X Build Community Capacity X Demonstrate Collaboration Each year the hospital allocates a percentage (0.05) of the previous year s expenses to support the efforts of other not-for-profit organizations in the local communities. An objective of the Community Grants Program is to award grants to nonprofit organizations whose proposals respond to identified priorities in the Community Health Needs Assessment and initiative. Additionally, it is required that a minimum of three organizations work together in a Community of Care to address an identified health priority. E2-a Grants: Community Grants Program FY 2017 Report 1. To award funds to nonprofit organizations whose proposals respond to the priorities identified in the CHNA and/or Community Benefit plan. 2. Fund programs that align with the Community Benefit Core Principles a) disenfranchised populations with unmet health needs b) primary prevention c) continuum of care d) capacity building e) collaborative governance 3. Fund Communities of Care initiatives to address identified needs and provide a more integrated approach and a collective impact on improving health. Specifically to address health priorities of chronic disease, access to health, oral health, mental health, and obesity. 4. Increase membership of community based partners by a least one. 5. Conduct committee and agency survey and consider changes to improve program, including forms and process. 6. Monitor funded initiatives through site visits, six month report, and Dignity Health sponsored networking/workshops % of agencies awarded a community grant will be addressing an identified need as stated in the initiative, CHNA, and community benefit plan % of the agencies awarded a community grant will be providing services to underserved/disenfranchised populations and align with the majority of Community Benefit Core Principles % of the agencies funded will be part of a Community of Care whereas three or more agencies working collaboratively to address an identified need. 4. One to two new members will be added to the community grants committee 5. Survey completed, and at least one program improvement made as a response to the Survey. 6. Committee members will complete site visits for 100% of awarded agencies, 100% of six month reports will be submitted and reviewed, and Dignity Health will sponsor at least one workshop. 1. Use the Request for Proposal (RFP) process to fund Communities of Care that address identified needs, align with significant health needs identified in the CHNA, and align with core community benefit principles. 2. Meet and recruit community leaders to participate in the Committee. 3. Monitor and support funded agencies through reporting, site visits, and one: one, workshops, and connection to needed resources. Through the grant awards, Dignity Health becomes a collaborative partner with each Community of Care, and associated agencies. To ensure success of the program. Specific planned collaborations over the past year include: About 19

21 Program Performance / Outcome Hospital s Contribution / Program Expense Program Goal / Anticipated Impact Measurable Objective(s) with Indicator(s) Care, Neighbors Who Care, Valley of the Sun YMCA/Ahwatukee, AZCEND Community Center, Lutheran Social Services of the Southwest, Tempe Community in Action, Chandler Education Foundation, ICAN, Valley of the Sun YMCA/Chandler/Gilbert, East Valley Adult Resources, Rebuilding Together Valley of the Sun, AT Still University, Women s Health Innovations of Arizona, Postpartum Support International, Arizona Chapter, Pregnancy Care Center of Chandler. 100% of stated objectives for the Community Grants Program were met. 1. The Community Grants Committee awarded $340,275 ($218,894 for CRMC and $121,381 for MGMC) 2. The following Community of Care projects were funded: Senior Community Wellness: $70,000 Transportation, support and case management for high risk senior population admitted to Dignity Health hospital. I-Help: $70,000 Shelter, wrap around services, and case management for homeless population. Partnership to Build Resilient Families: $65,000 Education for at risk youth and parents for reduction in drug abuse and improved fitness and nutrition. Safe at Home: $60,000 Home safety equipment installation, chronic disease management, falls prevention education and resources for high risk seniors in mobile home parks. East Valley Perinatal: $42,060 Connect women and families at risk for perinatal/postpartum mood and anxiety disorders to existing resources by creating a coordinated referral system and tracking referrals to ensure that women connect to care % of the identified health priorities are addressed through the Community Grants Program. Allocated funding: for $ 218,894 FY 2018 Plan 1. To award funds to nonprofit organizations whose proposals respond to the priorities identified in the CHNA and/or Community Benefit plan/ 2. Fund programs that align with the Community Benefit Core Principles a) disenfranchised populations with unmet health needs b) primary prevention c) continuum of care d) capacity building e) collaborative governance/ 3. Fund Communities of Care initiatives to address identified needs and provide a more integrated approach and a collective impact on improving health. Specifically to address health priorities of chronic disease, access to health, oral health, mental health, and obesity. 4. Increase membership of community based partners by a least one. 5. Conduct committee and agency survey and consider changes to improve program, including forms and process. 6. Monitor funded initiatives through site visits, six month report, and Dignity Health sponsored networking/workshops/ 1.100% of agencies awarded a community grant will be addressing an identified need a stated in the initiative, CHNA, and community benefit plan % of the agencies awarded a community grant will be providing services 20

22 Intervention Actions for Achieving Goal Planned Collaboration Significant Health Needs Addressed to underserved/disenfranchised populations and align with the majority of Community Benefit Core Principles/ % Awarded Community of Cares will address social determinants of health/ % of the agencies funded will be part of a Community of Care whereas three or more agencies working collaboratively to address an identified need. 4. One to two new members will be added to the community grants committee 5. Survey completed, and at least one program improvement made as a response to the Survey. 6. Committee members will complete site visits for 100% of awarded agencies, 100% of six month reports will be submitted and reviewed, and Dignity Health will sponsor at least one workshop. 1. Use the Request for Proposal (RFP) process to fund Communities of Care that address identified needs, align with significant health needs identified in the CHNA, and align with core community benefit principles. 2. Meet and recruit community leaders to participate in the Committee. 3. Monitor and support funded agencies through reporting, site visits, and one to one, workshops, and connection to needed resources. Through the grant awards, Dignity Health becomes a collaborative partner with each Community of Care, and associated agencies. To ensure success of the program. Specific planned collaborations over the past year include: About Care, Neighbors Who Care, Valley of the Sun YMCA/Ahwatukee, Christian Community Center, Lutheran Social Services of the Southwest, Tempe Community in Action, Chandler Education Foundation, ICAN, Valley of the Sun YMCA/Chandler/Gilbert, East Valley Adult Resources, Rebuilding Together Valley of the Sun, AT Still University, Women s Health Innovations of Arizona, Postpartum Support International, Arizona Chapter, Pregnancy Care Center of Chandler. Center for Diabetes Management Program Access to Care Problems of Aging Mental Health/Behavioral Health X Diabetes Injury Prevention Cancer Program Emphasis Focus on Disproportionate Unmet Health-Related Needs X Emphasize Prevention X Contribute to a Seamless Continuum of Care Program Description Build Community Capacity Demonstrate Collaboration Our comprehensive Center for Diabetes Management offers education for a wide variety of patient needs: Diabetes self-management training for people with type 1 and type 2 diabetes Gestational diabetes/diabetes and pregnancy classes Blood glucose meter training Insulin initiation and management Pre-diabetes/metabolic syndrome Continuous glucose monitoring Insulin pump management 21

23 Community Benefit Category Program Goal / Anticipated Impact Measurable Objective(s) with Indicator(s) Intervention Actions for Achieving Goal Planned Collaboration Program Performance / Outcome Hospital s Contribution / Program Expense Program Goal / Anticipated Impact Measurable Objective(s) with Indicator(s) Intervention Actions for Achieving Goal Planned Collaboration Services available in languages other than English through Cyracom, Interpreter services, and American Sign Language interpreters. The Center also participates in community events, health fairs and seminars, and offers support groups and screenings to promote community awareness on lifestyle changes and the prevention and management of diabetes. A-1 Community Health Education FY 2017 Report Actively marketed Center for Diabetes Management to promote our services to patients, hospital staff and health care providers to achieve an average of 360 patient visits per month. Goal was to increase patient volume by 3%, with a subsequent increase in units of service. Offered 428 classes 4365 patient visits, serving 1704 unique patients 266 people in attendance at free outreach groups We will continue to work with existing community partners and local municipalities. Collaboration planned with the Gilbert Wellness and Resource Center was put on hold this year by the Town of Gilbert. Average reduction in Hemoglobin A1c of 1.6% six months after participation in classes Percentage of referred to scheduled continued to improve. (Highest month was 60%, up from 57% in FY 16) Participated in 4 community health fairs and 6 community presentations. Achieved a high of 412 patient visits during the month of June. (Average of 332) $466,511: Total Center for Diabetes Program $20,262: Community Benefit Program FY 2018 Plan Actively market Center for Diabetes Management to promote our services to patients, hospital staff and health care providers to achieve an average of 350 patient visits per month. Continue classes through Dignity Health Medical Group (DHMG), with a goal to add support group and classes in Spanish during FY18. Increase patient volume by 3%. Complete 250 patient visits at Transition clinic of DHMG Actively market Center for Diabetes Management to providers in the service area, and directly to patients via media coverage, website, and mailings Participate in community events Participate in AZ Diabetes Coalition. Continue making second calls on referrals as staffing allows to improve referral to scheduled percentage. Continue to collaborate with the Town of Gilbert for the planned Wellness and Resource Center; collaborate with DHMG to expand diabetes services on the St. Joseph s Hospital and Medical Center campus. 22