Putting HEALTH First. Table of Contents

Transcription

1 20 Memorial Memorial Hermann Hermann Community Community Benefit Corporation Benefit Corporation ANNUAL REPORT ANNUAL REPORT14

2 Putting HEALTH First Table of Contents Letter to the Community Community Benefit Corporation Creating a Culture of Health...5 Investing in Health...7 Responsive to the Community...8 Awards...8 Health Centers for Schools Medical...15 Mental Health...19 Mobile Dental...22 Nutrition...24 Childhood Obesity Initiative...27 Project Fit America Program...28 Community Resources ER Navigation/COPE Program...32 Nurse Health Line...35 Neighborhood Health Centers...36 Mental Health Psychiatric Response Team...40 Mental Health Crisis Clinics...42 Home Behavioral Health Services...42 Community Partners Gateway to Care...48 Children at Risk...49 Interfaith Community Clinic...50 Additional Partnerships...51 Memorial Hermann Overview of Services Services...53 During 2014, plans that had been in the making for a number of years came to fruition. Through the Affordable Care Act and subsequent changes to the 1115 Waiver, Memorial Hermann responded to the community need and expanded many of its premier programs to benefit those who needed them the most. Memorial Hermann kept pace with Houston s unprecedented population growth by providing our communities with increased access to health resources through expansion of programs like Health Centers for Schools and ER Navigation, and added a new Nurse Health Line. Located on school campuses, in our emergency centers and reaching into the community, these programs represent the heart of Memorial Hermann s mission to provide high-quality health services in order to improve the health of the people in Southeast Texas. We have grown to 10 school-based health centers, serving 70 schools across five school districts accessible to more than 65,000 students. And we added a third mobile dental clinic to rotate among the clinics. On-site social workers, dietitians and navigators ensure that students needs are met holistically and their families receive the social services they need to provide a safe, secure and healthy home environment. Seventeen ER Navigators support seven of our emergency centers that serve the patients most in need of assistance in finding an appropriate medical home, social services and follow-up care. The Nurse Health Line is accessible to anyone in the Greater Houston area who is sick or injured and needs immediate guidance from a nurse, in their language, who can advise them on where to seek appropriate care. Memorial Hermann s expanded Mental Health programs fill the gaps for patients experiencing a mental health crisis who, too often, turn to emergency centers for help. This Annual Report highlights the Community Benefit purpose, programs, accomplishments and partnerships that demonstrate Memorial Hermann s unwavering commitment to serving the residents of Southeast Texas. We provide more than just access to health and care, but also the supportive services that many of us might take for granted in our own lives. This commitment extends the impact of these programs beyond the communities we serve and into the lives of Houston families. Our insistence on establishing outcomes-based programs combined with purposeful collaboration is building the foundation for systemic change in the health of our community. Looking to the future, Memorial Hermann is responding to the unique health challenges of Greater Houston by developing programs and services that build a pathway to advancing health encouraging each adult and child to be mindful of their health and to enrich our community by putting health first. Dan Wolterman President and CEO Memorial Hermann Health System Will Williams Board Chair Memorial Hermann Health System 1

3 Community Benefit Corporation 2 3

4 Creating a Culture of Health As the largest not-for-profit health system in Southeast Texas, Memorial Hermann Health System has proudly worked for more than 108 years to improve the health of individuals and families in the Greater Houston community. With 13 hospitals and numerous specialty programs and services, Memorial Hermann annually contributes more than $438 million in uncompensated care and community benefits. What is Community Benefit? As a not-for-profit hospital system, Memorial Hermann is a steward of the community s health, not only for the health of the adults and children who seek medical care at a Memorial Hermann facility, but by providing programs and support to programs designed to improve the overall health of the community and increase access to health care. Through its subsidiary, the Memorial Hermann Community Benefit Corporation, Memorial Hermann implements programs in partnership with other healthcare providers, government agencies, business leaders and community stakeholders to increase access to health care and improve the overall health of the community. Memorial Hermann s longstanding commitment includes serving the longterm needs of at-risk and underserved populations through innovative models of care delivery that address the most common barriers to healthcare access, including low income, lack of knowledge of services available, lack of transportation and the inability to take time from work. To address these needs, Memorial Hermann Health System provides the following initiatives described in detail in this report: Health Centers for Schools Mobile Dental Program Childhood Obesity Health Initiative ER Navigation/COPE Program Nurse Health Line Neighborhood Health Centers Mental Health Community Partners These programs that serve Houstonians in need meet one or more of the following community benefit criteria: Improve access to healthcare services Enhance the health of the community Advance medical or healthcare knowledge Relieve or reduce the burden of government or other community efforts 4 5

5 Memorial Hermann Community Benefit Values Investing in Health We collaborate with others to improve the community s infrastructure for the uninsured. We embrace innovative approaches. We are advocates at the local, state and national levels to achieve 100 percent access to basic care. We support educational efforts focused on prevention and appropriate use of our community s healthcare resources. We measure the outcomes of each effort and only sustain and expand those with demonstrable outcomes. We are committed to engaging our employees, volunteers and medical staffs in our efforts. Memorial Hermann Health System s passion and commitment to improve residents health and quality of life in the Greater Houston community is evident in its governance, administration, service delivery and employee engagement. The board of directors and executive staff lend their resources and vision to initiatives that are designed to improve the health and quality of life of each and every resident of the community, ensuring that millions in uncompensated care and community benefits are just the beginning of Memorial Hermann s commitment to advancing health for every Houstonian. THE YEAR IN NUMBERS In 2014, community contributions were distributed to the following areas: FINANCIAL ASSISTANCE AND GOVERNMENT PROGRAMS Charity care at cost, the unreimbursed cost of Medicaid and means-tested government programs Programs and initiatives developed to improve access to care HEALTH PROFESSIONS EDUCATION Education and training of medical and allied health professionals, nurses, students, interns, residents and fellows Clinical services provided in response to community need despite financial loss incurred, including the Air Ambulance Program, End-Stage Renal Disease Program (ESRD) and obstetrics and delivery program RESEARCH $218,549,209 $143,420,512 $39,781,105 $27,310,395 $5,141,721 Research dollars serving the community $4,023,069 Community education and awareness initiatives and sponsorship of other organizations TOTAL CONTRIBUTIONS FOR 2014 $438,226,011 COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS SUBSIDIZED HEALTH SERVICES CASH AND IN-KIND CONTRIBUTIONS FOR COMMUNITY BENEFIT Memorial Hermann s annual contribution in uncompensated care and community benefit activities 6 6 7

6 Awards Memorial Hermann Community Benefit Corporation and its programs have been recognized by many different groups and associations for innovative efforts that address the issue of healthcare access for the underserved and uninsured. FOSTER G. MCGAW PRIZE One of three finalists for the prestigious Foster G. McGaw Prize, Memorial Hermann was recognized for its significant accomplishments in community service to advance the health of the people in Southeast Texas through trusted partnerships with physicians, employees and others to deliver the best possible health solutions while relentlessly pursuing quality and value. HOSPITAL CHARITABLE SERVICES AWARD Memorial Hermann Health Centers for Schools was named a Program of Excellence by Jackson Healthcare through its Hospital Charitable Services Award program. THE AMERICAN HOSPITAL ASSOCIATION (AHA) NOVA AWARD The second-highest hospital award given by the AHA, the NOVA Award recognized Memorial Herman Health Centers for Schools for working collaboratively and effectively to improve community health status. Responsive to the Community Memorial Hermann serves Greater Houston, a multicounty area along the Gulf Coast in Southeast Texas where several counties are without hospital district services. The fifth largest metropolitan area in the United States, the Greater Houston area is one of the fastest growing in the nation, with a population of more than 6 million. A source of strength in a global economy, Houston prizes its racial and ethnic diversity. More than 90 languages are spoken in the Houston community. Nearly half of individuals ages 5 and up live in homes where English is not the primary language. According to the County Health Rankings & Roadmaps 2014, social, economic and environmental factors contribute to 50 percent of health outcomes. Economic status is strongly correlated with health outcomes where individuals with lower incomes have higher rates of poor health behaviors and higher rates of most diseases. In 2013, more than 22 percent of Houston residents lived in poverty as compared to 17.6 and 15.4 percent of all Texas and U.S. residents, respectively. 43.8% 0.7% 6.2% 25.6% African-American Asian/Pacific Islander Hispanic Native American White 23.7% Education is one of the social factors that contribute to health. Only 29.2 percent of the Houston area population, age 25 or older, has a college degree as compared to other large metropolitan areas such as New York City at 34.5, Chicago at 34.2 and Los Angeles at 31.1 percent. These significant societal factors impact the major health needs and priorities of the Houston region and drive much of the community work in which Memorial Hermann is engaged. 8 9

7 Awards MONROE E. TROUT PREMIER CARES AWARD The Premier Cares Award spotlights innovative programs that help the medically underserved and focuses attention on the need to support and replicate such efforts. Memorial Hermann Health Centers for Schools was recognized as an award finalist. HISD HALL OF FAME AWARD Memorial Hermann was inducted into the Houston Independent School District (HISD) Hall of Fame for its partnership with HISD to develop the Memorial Hermann Health Centers for Schools. THE TEXAS ASSOCIATION OF PARTNERS IN EDUCATION GOLD AWARD The Texas Association of Partners in Education (TAPE) honored Memorial Hermann with its prestigious Gold Award for Texas Community Partnership for Memorial Hermann Health Centers for Schools. TAPE works to strengthen students performance through volunteer, community and business/school partnerships that enhance the success of young people in school. Uninsured rates are higher in Texas than the U.S. and are even higher in the Houston region. Compared to 15 percent of U.S. residents, 22.1 percent of Texans and 28.4 percent of Houstonians are uninsured. Health behaviors, including diet and exercise, factor into the Greater Houston community s health outcomes more than 64 percent of adults are overweight or obese and more than a third of children are overweight. To prioritize the needs of the community, Memorial Hermann conducts Community Health Needs Assessments (CHNAs) for each of its hospitals every three years. The studies include demographic data for Harris, Fort Bend, Montgomery and Brazoria counties, which comprise the majority of Memorial Hermann discharges. The qualitative and quantitative data collected includes a careful review of the most current health data available and input from numerous community representatives with special knowledge of public health on prioritizing community health needs and healthcare initiatives: 1) Education and prevention for diseases and chronic conditions 2) Address issues with service integration, such as coordination among providers and the fragmented continuum of care 3) Address barriers to primary care, such as affordability and shortage of providers 4) Address unhealthy lifestyles and behaviors 5) Address barriers to mental health care, such as access to services and shortage of providers 6) Decrease health disparities by targeting specific populations Following the CHNA, each Memorial Hermann hospital developed an Implementation Plan to address the identified needs. The process was reported to the board in March A new Community Health Needs Assessment will be available in June Other Awards BEACON OF HOPE RECIPIENT Mental Health America of Fort Bend County (awarded to the Lamar Clinic) VHA (VOLUNTARY HOSPITALS OF AMERICA) LEADERSHIP AWARD FOR COMMUNITY BENEFITS EXCELLENCE RECIPIENT OF THE EXCELLENCE IN COMMUNITY SERVICE AWARD FROM TEXAS HOSPITAL ASSOCIATION Memorial Hermann Health Centers for Schools RECIPIENT OF TEXAS DENTAL ASSOCIATION CERTIFICATE OF MERIT Memorial Hermann Mobile Dental Program 10 11

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9 Medical Working in school-based health care provides the opportunity to serve in many capacities: healthcare provider, mentor, role model, teacher, cheerleader, advocate, listener, and sometimes just a person who shows care and concern. Our goal in school-based health care is to improve each child s overall health, and healthy children make better learners. The reward I get is seeing kids thrive, and that is priceless. Kelly Poindexter, Nurse Practitioner, Memorial Hermann Health Centers for Schools Children in poor health, who are hungry, fearful, sad and living in poverty, face often insurmountable barriers to learning. Students who then do not graduate are less likely to be employed and insured, and they earn less all of which continues the cycle of poverty and disparities, including lifelong health risks, high medical costs and increased engagement in risky health behaviors. Research shows that school-based health centers increase educational success by providing medical and mental health care that allows students to stay in school and learn. Of the students served: 93% are on the free/reduced lunch program, a nationally accepted indicator of poverty 34% have limited English proficiency 44% are without any kind of health insurance coverage 27% have some form of Medicaid Memorial Hermann is committed to addressing the healthcare access issues experienced by the medically disadvantaged. We see school-based health care as an avenue to address these issues; health care is provided where children are located at school and children who feel better perform better. Their future is brighter. Deborah Ganelin, Director, Community Benefit Corporation for Memorial Hermann In addition to addressing health needs including acute and chronic illness, school-based health centers also address broader social factors that influence health, wellbeing and preparedness to learn, such as hunger, lack of basic needs, home environment and even homelessness. Memorial Hermann Health Centers for Schools provides a stable medical home for uninsured and underinsured children from pre-kindergarten through 12th grade. Primary medical care, nutrition counseling, mental health services and dental care are provided free of charge for children who may or may not have insurance, and may experience other barriers including low income, lack of knowledge about available health care, lack of transportation and parents inability to take time away from work. 29% are children who will not otherwise obtain health care due to access issues Insurance does not equate to healthcare access. Parents are often unable to take off work, may lack transportation or may be facing other challenges that push health care down on the list of priorities

10 OUTCOME 7 28,000 annual visits Health Centers for Schools 4 2 Memorial Hermann Health Centers for Schools outcomes are numerous and are a result of both a defined population served and improved access to health care. School-based health centers are immediately accessible to children, do not require transportation, do not require parents to miss work and do not present a financial obstacle to families. The results are documented improvements, Asthma Children with asthma use a disproportionate amount of healthcare services. One solution is to provide children with the knowledge and skills to manage their disease. Children who take part in school-based asthma education programs have decreased asthma exacerbations and reduced ER visits and hospitalizations. 9,000 students served 10 school-based clinics 3 mobile dental vans 70 schools with a total population of approximately 65,000 The Health Centers for Schools program is funded by Memorial Hermann in collaboration with school districts, local foundations and state and federal grants Alief Health Center 6 Lamar Health Center (West of Crossroads, Alief ISD) (Lamar High School, Lamar Consolidated ISD/Fort Bend) 2 Burbank Health Center 7 Nimitz Health Center (Burbank Middle School, Houston ISD) (Dunn Elementary School, Aldine ISD) 3 Elrod Health Center 8 Sharpstown Health Center (Elrod Elementary School, Houston ISD) (Sharpstown High School, Houston ISD) 4 Hogg Health Center 9 Terry Health Center (Hogg Middle School, Houston ISD) (Terry High School, Lamar Consolidated ISD/Fort Bend) 5 Kruse Health Center 10 WAVE Health Center (Kruse Elementary School, Pasadena ISD) (Matthys Elementary School, Pasadena ISD) Each Health Centers for Schools clinic is staffed by a nurse practitioner/ physician assistant, licensed clinical social worker (LCSW), licensed vocational nurse (LVN) and a receptionist, with medical oversight provided by a Memorial Hermann-affiliated physician. Two dietitians and navigators rotate among the clinics. Services offered include sick and injury care, general 5 10 and sports physicals, immunizations, chronic care (asthma, obesity, cholesterol management), mental health therapy and social service referrals, nutritional guidance and other specific care to meet students needs. The school district provides transportation from the schools to the campuses housing the clinics. Clinics are open Monday through Friday, 7:30 a.m. to 4 p.m., 12 months a year. clinically as well as educationally. Access Uninsured or underinsured children often use the Emergency Room (ER) for primary care services. School-based health centers (SBHCs) improve healthcare access through the provision of an accessible medical home. Documenting that this increased access results in more appropriate use of hospital emergency rooms is important as ER visits continue at inappropriately high utilization rates. % Non-Urgent ER Visits Uninsured Community versus School-Based Health Centers 15.00% 10.00% 5.00% 0.00% 10.50% Uninsured Community 2.03% School-Based Health Centers Source for Uninsured Community: Community Tracking Study, Medicaid/SCHIP Cuts and Hospital Emergency Department Use, Peter J. Cunningham Asthma Patients Pre and Post Clinic Management 2014 (n=51) Exacerbations ER Visits Hospitalizations Absences pre-management post-management Education School-based health centers, placed on school campuses and working closely with school nurses, minimize the amount of time that children are out of the classroom. Disposition Status of Medical Patients During the School Day % 0.2% 4.8% 0.3% 92.6% 0 7 ER Home Home Against Advice Other School 16 17

11 Treating the Source, Not the Symptoms Sarah is an elementary school student who lives with her family in low-income apartments. She was referred to the school-based health center by the school nurse for a rash. It was found that Sarah did not have a rash, but was actually getting bitten by bed bugs while she slept at night. She was miserable during this visit, consistently scratching her skin. Her father was contacted and with much explanation he was informed of the problem, educated about Sarah s prescription and how to rid his apartment of these bugs. Sarah returned again one week later for a follow-up visit. This time her father came along. Sarah was very happy during this visit. Her skin was clear of all bug bites. Her father stated that with the information sent home, he exterminated her bedroom and home of the bugs and bought Sarah a new mattress for her bed. Unfortunately, during the skin exam, Sarah was now diagnosed with scabies. Her father stated that he had the same rash on his arm. Sarah was prescribed medication for the scabies, and her father was given another handout and explanation on how to rid the home of the bug that was causing it. The father was also advised about talking to the landlord on the condition of the apartment and how he can solve this problem. Sarah returned a week later for another follow-up visit. She was free of bug bites and scabies. She stated her family is happy that there are no more bugs, and they just welcomed a new baby brother into the home. Since the school-based clinic staff are located on school grounds, they periodically see Sarah smiling, happy and, most of all, not scratching. School-based health centers give students the chance to stay in school where they can learn. Mental Health Mental illnesses can cause severe impairment in a child s ability to cope in school and in daily life, and the high rate of uninsured children in the Greater Houston area results in many untreated mental health illnesses. According to the Mental Health and Mental Retardation Authority of Harris County, in 2012, 74 percent of area children and adolescents with a serious emotional disturbance could not access services from the public mental health system. Mental health services are offered through the Health Centers for Schools clinics where licensed clinical social workers provide students with the tools to improve their functioning at home, school and with peers, in collaboration with parents and school staff. Social workers work hand-in-hand with teachers to help determine how to deal with students with mental health issues so they don t disrupt classes and are able to get the most out of their school experience. Students who perform well in school feel better about themselves and their accomplishments and are encouraged to continue to perform well and remain in school

12 OUTCOME Collaboration Leads to Academic Success Each school year GPA rises; days absent and suspensions/detentions decline. Ben was 7 years old when he was first referred to Mental Health Therapy Academic Outcomes of Students with 4+ Visits 2014 (n=444 patients) the school-based health center for hyperactive, defiant and disruptive behaviors as well as inability to complete classwork and failing grades. His parents reported daily incidents involving hitting peers and arguing with parents and teachers. Ben disliked school and had psychosomatic complaints at school daily, requesting to go home. The parents and school staff were very frustrated and overwhelmed by his behaviors and were at a loss as to how to address the problems. There is nothing more rewarding and beautiful in life than to see a child who was marked for failure, strive and succeed. I have never met a child in whom I could not see the possibility for change and success. Ecenthia Burnett Memorial Hermann Health Centers for Schools Social Worker 0 grades pre-therapy absenteeism post-therapy susp/deten Mental Health Services provided within the Clinics are non-crisis in nature, but beyond the scope of service of school personnel. The services are diverse but predominantly include therapy for situational adjustment, anxiety, depression and conduct. 1.0% 5.3% 4.3% 5.8% 2.5% 3.2% 1.3% 2.0% 21.1% Social Work Diagnoses Categories FY % Abuse Academic Problem Adjustment Disorder Behavior Problem Bereavement Depression Other Phase of Life Problem Relational Problem Stress/Anxiety Collaboratively, the school and school-based clinic social worker and medical director conducted a psychosocial assessment and diagnostic evaluation which revealed a diagnosis of attention deficit hyperactivity disorder (ADHD). Additionally, it became apparent that the parents had extreme deficits in their parenting skills. Treatment began with education about ADHD; physician visits for medication consultation and monitoring; social worker visits with parents on effective parenting; social worker consults with school staff for classroom accommodations and behavioral management strategies; and social worker visits with Ben to work on impulse control, focus, task completions and social skills. Ben also began to participate in sports to help develop social skills and cooperation with others. Within two weeks Ben began to have more focused, cooperative behaviors. The teachers reported that he was able to complete more of his assignments, was more easily redirected Within six weeks, Ben s disruptive behaviors at home and school were abated. He was focused, productive and his grades improved from Cs and Ds to mostly As with a few Bs. He began to like school and his psychosomatic complaints were no longer a problem. The parents reported feeling more empowered and less worried about their son s future. Ben is currently 9 years old. He has been in the program for two years. He is a model student. He is an honor student and has not had one behavioral referral this school year. He is truly a success story! back on task and showed a significant decrease in defiant behaviors and peer conflict

13 Mobile Dental OUTCOME The Surgeon General reports that despite improvements in oral health status, profound disparities remain among population groups. Oral health is related to wellbeing and quality of life. Diet, nutrition, sleep, psychological status, social interaction, school and work are affected by impaired oral and craniofacial health. Unlike medical care, where treatment can be sought at emergency rooms, no such safety net exists for dental services. Uninsured children are more than four times as likely as insured children to have an unmet dental need. The Mobile Dental Program compares the incidence of cavities of its patients to the goals set forth by Healthy People 2020, a national health promotion and disease initiative. Staff strive to complete all diagnosed dental work within the month in order to move students into a six-month recall program. Patients are provided with three- to six-month recall visits, which contribute to the amazing cavities-at-recall statistics. These outcomes are significant, given that 59 percent of initial patients are diagnosed with cavities and 20 percent are diagnosed with five or more cavities. 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Recall Patients with Cavities versus Healthy People 2020 Goals for Cavities % 48.3% 3.0% 0.3% ages 4-11 ages 12+ HP 2020 Student Population We are not only changing their appearances, we are changing their attitudes and their lives. Mahasti Chalajour, DDS, Mobile Dental Program Serving the Greater Houston community since 2000, three 40-foot mobile dental vans, staffed with a dentist and one to two dental assistants, provide access to preventive and restorative dental services at nine Health Centers for Schools sites and are available as a dental home for uninsured and underinsured students. The primary goal of the program is to provide children in need with regular dental care. Exams, X-rays, cleanings, sealants, fillings, extractions and some cosmetic procedures are provided at no cost to the student. A secondary goal is to educate children and families on proper dental care at home, including making healthy food choices. Some of the children I see have never been to a dentist, says Mahasti Chalajour, D.D.S. They have, at a minimum, five cavities on the first visit. Poor oral hygiene, excessive fluoride in drinking water and lack of education creates teeth defects that cause children to hide their teeth. A Reason to Smile With only one visit to a dentist in his entire young life, 17-year-old Alex arrived at the mobile dental van with excessive cavities. His chief complaint was his front tooth which was badly decayed. It was a black and brown stub. The dentist explained to him that the tooth would eventually need root canal therapy; however, in the meantime, she would make it look like a tooth. Alex wanted the work performed that very day, but the dentist explained that his teeth needed a good cleaning first. She was concerned that if the front tooth was taken care of first, he might not come back The dental vans rotate among the Health Centers for Schools clinics at three-month for the fillings. The dentist cleaned Alex s teeth at the The dentist told him that she needed the mirror, intervals. The mobile environment requires a close working relationship between first appointment and filled nine huge cavities. but that she understood that he could not wait the stationary school-based clinic and the dental clinic. Serving as an anchor, to see himself in the mirror again. Alex interrupted the school-based clinic staff schedules patients and contacts the clinic when Alex made a follow-up appointment for the next her and told her he could wait, but he did not think emergencies arise while the van is off-site. week to fix the front tooth. After the work was done, his mom could wait for him to show her his smile at the dentist handed him a mirror. Alex gasped. home. Alex had no cavities at his follow-up visit. Dental clinic staff diagnose dental problems, provide cleanings, treat cavities, perform He held the mirror in his hands looking at himself A graduating senior, he has been given referral other restorative work and provide oral health education for each patient. Professionals and started to leave the van with the mirror! options for affordable dental care. and educators, the staff also serves as the van drivers, cleaners and clerks. They have 22 received the Texas Dental Association s Certificate of Merit Award for their efforts. 23

14 Nutrition For families living in poverty, food insecurity is an underlying cause of obesity. When food is available, the least expensive food is often not the healthiest food. And Houston area food deserts, where healthy fruits and vegetables are scarce, exacerbate the problem. Poor nutrition, when combined with physical inactivity, is associated with many chronic conditions such as high blood pressure, diabetes and asthma. According to the 2013 Youth Risk Behavior Survey, 34 percent of Houston-area high school students are overweight or obese. More than one-fifth of these students had not exercised for 60 minutes a minimum of one day during the week prior to the survey. Studies show that overweight students are absent more often and grow up to have less educational attainment, lower wages and higher unemployment. To combat this alarming epidemic, nutrition counseling and education is offered by registered dietitians through the Health Centers for Schools clinics at no cost to students. The Healthy Eating and Lifestyles Program (HELP) is designed to educate children and their families on the importance of proper nutrition and exercise. Any child diagnosed as overweight/obese in body mass index (BMI) percentile 85 or higher is referred OUTCOME to HELP. After meeting with the student and his or her parents and reviewing the medical information, the dietitian will suggest healthy food choices, create meal plans, set weight loss goals and discuss how to read food labels and other topics related to nutrition. The goal is to provide children and their parents with a better understanding of how proper nutrition can improve the child s health and school performance. Quarterly dietitian visits continue for as long as the family remains engaged. In 2014, 126 students actively participated in HELP. Sixteen students realized statistically significant improvements in BMI, moving out of the obese percentile, into the overweight percentile range and, for eleven students, into a normal BMI level. BMI Percentile BMI Percentile (n, %)* Pre Post Difference Normal (<85th percentile) Overweight (85th to 94.9th percentile) Obese (>=95th percentile) Note: In the pediatric population the BMI percentiles as opposed to the BMI is more meaningful because children are still growing. BMI alone may misrepresent weight management progress. *Differences are statistically significant I may not see substantial weight loss results or perfectly balanced diets but our families truly amaze me with whatever little effort they are able to make to better their diets and physical fitness, despite the numerous financial, emotional, social and environmental barriers they face. These families inspire me to continue to help future families that need my services. Mehreen Ansari Dietitian, Health Centers for Schools Healthy People 2020 Objectives for Physical Activitiy and Nutrition: 65% met physical activity minutes 62% met goal for fruits and vegetables 77% met goals for % of calories from FMNV (Foods of Minimal Nutritional Value) 24 25

15 Childhood Obesity Initiative Memorial Hermann s Health Centers for Schools program focuses on encouraging children to eat healthy diets and participate in plenty of physical activity, and is an active part of many recent community efforts to address childhood obesity, including: Healthy Living Matters The 2013 National Youth Risk Behavior Survey indicates that among U.S. high school students: Healthy Living Matters Pasadena ECHOS (Epiphany Community Health Outreach Services) Healthy Living Adventure REACH (Racial and Ethnic Approaches to Community Health) 11% drank a soda three or more times per day Putting a Plan in Play Fifteen-year-old Jacob was referred to the school-based clinic s dietitian for weight His poor diet, lacking in most fresh foods, is due in part to financial barriers. His single mother works Through a grant from Marathon Oil, studies were conducted at Sharpstown High and Elrod Elementary Schools to identify and prioritize environmental and policy barriers impacting healthy eating and active living for students. Based on study results, community outreach was conducted to bring healthy resources to both schools from local organizations. Sharpstown students planted a community garden and the Sharpstown Health Corp Coordinator started a group called the Health Ambassadors to raise awareness on campus about the importance of eating healthier foods and staying active. 14% did not eat breakfast 15% did not participate in at least 60 minutes of physical activity management counseling. He was obese and two jobs, is only able to use public transportation had a history of attention deficit hyperactivity disorder (ADHD). He is on the school football team and motivated to lose weight for better sports due to her own mental health disorders, lacks time to prepare meals at home and has limited resources to buy fresh foods. Since improvement in diet quality The Sharpstown High School Health Ambassador students enthusiasm spilled over to Elrod as they held five booths at Elrod s Fall Festival and helped the school nurse develop topics for monthly health assemblies. Other activities 52% did not attend P.E. classes performance as well as for reducing health risks. is challenging due to these barriers, nutritional goals at Elrod included planting a community garden, applying for and receiving a His diet history is poor with excessive intake of highly processed, convenient foods such include limiting excessive caloric intake and limiting foods of minimal nutritive value. Within a month cylinder garden grant and implementing the Project Fit America program. 33% as frozen meals, instant soups, unhealthy snacks, sugar-sweetened beverages and consumption of the first nutrition visit Jacob lost 4 pounds. With ongoing nutritional guidance, he hopes to continue watched television 3 or more hours per day of fast-food restaurant meals at least three times to lose weight and improve his sports performance as a week. well as his overall health. 41% used computers 3 or more hours per day 26 27

16 Project Fit America Memorial Hermann Health System is the exclusive sponsor of Project Fit America (PFA) in the Houston area. With the addition of Elrod Elementary School through the grant from Marathon Oil, Houston now has two PFA schools. The first was implemented in 2012, through a grant from Memorial Hermann, Senior Games and General Electric, at Eugene Field Elementary School. Both Elrod and Field are schools served by the Health Centers for Schools program. Serving communities for 25 years, Project Fit America (PFA) provides elementary schools with indoor and outdoor fitness equipment and a curriculum designed to enhance existing physical education programs. PFA works with schools to fully train the teaching staff and integrate the program into the school curriculum. At the end of the program, the school is able to run PFA without any outside intervention. PFA is designed to be a permanent program in each school, as the need to get children fit will never diminish. PFA s benefits include: To learn how to set and achieve goals To take charge of one s own Fitness Quest for Life To give all kids, not just the already gifted athletes, the chance to discover, explore, improve and be recognized for their physical, mental and fitness efforts To improve a students overall productivity and brain power, because exercise can increase serotonin levels which can help improve focus and mental clarity To develop not only physically, but mentally and emotionally as well, through leadership, communication, teamwork, cooperation and understanding OUTCOME All PFA schools participate in two years of testing and evaluation for project measurement. Tests are administered to the students at the beginning of the fall semester, prior to implementing PFA and at the end of the spring semester after using the program. The data is analyzed by Sonoma State University, Department of Mathematics and Statistical Consulting, and reports are compiled for each school as well as national school averages. Proven before and after outcomes for 850 Project Fit schools in indicate that participating students show an average improvement in the following: 21.12% Upper Body Strength 24.33% Abdominal Strength 22.86% Lower Body Strength 10.07% Cardiovascular Endurance 28 29

17 Community Resources Since 2003, The University of Texas Health Science Center at Houston School of Public Health has conducted an annual survey of hospital emergency room (ER) visits in Houston area hospitals, including the Memorial Hermann hospitals. The most recent survey published in 2013 revealed that 41 percent of all ER visits are primary care related. The potential to decrease this percentage is great when patients are provided with options such as the following Community Benefit Corporation programs: ER Navigation/COPE Nurse Health Line Neighborhood Health Centers 30 31

18 ER Navigation/ COPE Program The ER is the primary care physician for a significant percentage of our population. I was hired to work in the ER to assist patients along the care continuum and to solve patient barrier to care problems that the clinical staff does not have time to address. A major loophole that we all experience on a daily basis involves patients who will see case managers and social workers multiple times in the ER, receive resources and applications, and then after discharge show right back up in the ER with similar complaints and problems, as if no one had ever intervened or given assistance. Before we label this group as noncompliant, I challenge everyone to think about one story of a friend, family member or even yourself trying to navigate the healthcare system. Imagine trying to gain access WITHOUT an insurance card. Now think of what a relief it would be if you were able to call someone who has met you and knows your problems and cares that you find the right place to get answers and relief. That is what the CHW does for our ER every day. Dee Gunter, RN, CCM, Nurse Case Manager, Memorial Hermann-Texas Medical Center In 2008, Memorial Hermann launched the ER Navigation program as a natural response to the community need of educating patients on how to navigate through existing resources, increasing access and using healthcare resources appropriately to reduce healthcare costs. Today ER Navigation is in place at seven Memorial Hermann emergency centers. The ER Navigation program places a community health worker (CHW) or navigator on-site in emergency rooms to educate patients on the importance of identifying and using a consistent medical home rather than relying on emergency rooms for their primary care. Patients eligible for the program are ages 18 months to 65 years and are uninsured, on Medicaid or self-pay. Certified CHW training covers the navigator role, barriers to care, communicating with patients, supporting the emotional needs of patients and privacy concerns. CHWs offer a vital service, working with patients to identify clinics that are the best fit according to patient location, income, language, work hours and bus routes, and they also work to address issues that may lower the priority of health care for many, such as the need for food stamps, rental support and assistance with utilities. Working in tandem with ER Navigation is the Community Outreach for Personal Empowerment (COPE) program for patients at the highest risk of declining health and recidivism resulting from the lack of appropriate self/community care. COPE employs social workers to help these patients navigate the healthcare system. The intervention focus is on key elements of empowerment to maximize the potential for health and wellness: knowledge, behavioral skills and selfresponsibility. While CHWs and social workers initially meet patients during a hospital visit, much of their work is done in follow-up: ensuring a clinic appointment was made, helping fill out the required paperwork for qualification for Medicaid, CHIP or county indigent programs, and assisting with navigating future heath concerns

19 OUTCOME Patients in a six month pre/post navigation intervention timeframe experienced a 77% reduction in ER visits as compared to pre-er activity after navigation assistance from community health workers. Mean Visits Mean Visits to Memorial Hermann ERs by Navigated Patients Decreased Significantly* from Pre- to Post-Intervention Visits Months Pre-, Post-Intervention 2.0 All* 1* 2* 3* 4* 5 or more* Pre Intervention Dates: 03/01/2013 to 08/31/2014 Making Health a Priority Jessica is a 20-year-old college student, caring for an ailing father, who is noncompliant in her own diabetes management. She met the COPE social worker when she was hospitalized for cellulitis. The social worker connected her to Memorial Hermann s diabetic disease management program and to a local clinic providing free services to females 21 years of age and under. The social worker then worked with the clinic to consider extending the services beyond Jessica s 21st birthday. She assisted Jessica in collecting the Post *Mean differences significant at alpha< documentation she would need to qualify for the program, and ensuring that the appointment was both scheduled and attended. Jessica reported back that her future visits will indeed be free! She was very pleased and excited to have found a primary medical home. She received insulin pens for free, was set up on the prescription assistance plan and scheduled to be seen every three months. The social worker was equally excited, knowing that she was making an impact, one patient at a time. Nurse Health Line Memorial Hermann established the Nurse Health Line in This free telephone service was created for Greater Houston residents who are experiencing a health concern and are unsure of what to do or where to go. Experienced, bilingual nurses use their training and expertise to conduct assessments by phone, and are available to answer calls 24 hours a day, seven days a week for any resident living in Harris or surrounding counties. Experienced nurse operators help callers decide when and where to go for medical care. The operators are not charged with diagnosing or treating patients but rather with helping callers make decisions that will support a positive outcome. While a large percentage of callers are uninsured or on Medicaid, others have insurance but are simply looking for guidance on what level of care is needed, such as a physician s office, an urgent care clinic or an emergency room. If callers do not have a primary physician, operators can recommend clinics or after-hour facilities. They also assist with community resource referrals and transportation needs. Callers receive healthcare advice and education using nationally recognized standardized protocols. OUTCOME Nurse Health Line Callers: 50% of callers would have called % of callers would have gone to the nearest emergency room 99% of callers would use the service again Nurse Health Line Growth in Calls Since Inception: 222 FEB-MAR ,409 APR-JUN ,091 JUL-SEPT ,392 OCT-DEC ,388 JAN-MAR ,502 TOTAL CALLS 34 35

20 Neighborhood Health Centers Northeast and Northwest Interviewees for Memorial Hermann s 2013 Community Health Needs Assessment (CHNA) reported that lack of availability of primary care services, difficulty accessing primary care and lack of coverage/financial hardship are the top barriers to primary and preventive care for low-income residents in the community. According to the most recent Houston and Harris County State of Health Survey, one-third of Harris County residents rely on safety net clinics. Recognizing the need to help bridge the gap for individuals and families who may have some disposable income, but not enough to afford private health insurance, Memorial Hermann Neighborhood Health Centers offer an appropriate alternative to emergency room care for non-urgent conditions. Originally designed to serve as a medical home for uninsured working families, today the Northeast and Northwest Neighborhood Health Centers provide uninsured, Medicaid and Medicare populations with preventive, acute and chronic care, seven days a week with extended weekday hours. Patients with chronic conditions represent the most neglected area of care among underinsured populations. At Neighborhood Health Centers these patients are monitored for hypertension, diabetes and other conditions to prevent frequent ER visits and exacerbated and debilitating conditions. Neighborhood Health Centers are designed for cost-conscious patients who are seeking quality care at affordable prices, said Chips Adams, associate vice president of Outpatient Clinic Services. Our proven model of care delivery used at the Centers ensures patients receive personalized treatment for short- and long-term healthcare Patients use the services of needs. Our staff and affiliated physicians Neighborhood Health Centers for a work to find financially obtainable variety of reasons, such as lower costs solutions so that patients are capable than emergency room visits, urgent care of the recommended follow-up that is 1,000+ patient visits per month centers and not-for-profit community clinics; location and hours; and quality of care provided. Of the patients seen each year, 70 percent consider Neighborhood Health Centers as their home for medical treatment, preventive care and medical education. Patients also rely on the Centers for annual health physicals, sports physicals, wellness exams and immunizations. so important for them to get well. Each Neighborhood Health Center provides a wide range of services, including wound treatment, STD screenings, preventive care, sports physicals, immunizations, urgent care and treatment for illnesses such as influenza or strep throat. The clinics also provide much-needed management of chronic illnesses such as asthma, diabetes and high blood pressure

21 Mental Health 38 39

22 Mental Health In Harris County, 36.8 percent of all patients given a primary diagnosis of a mental health disorder in the ER were uninsured in According to the Mental Health and Mental Retardation Authority of Harris County (MHMRA), the high rate of uninsured residents in Harris County has resulted in many untreated mental health illnesses. With a shortage of psychiatric facilities, coupled with a lack of financial resources, patients both insured and uninsured seek treatment from emergency room physicians and clinical staff untrained in psychiatry. These patients often experience long wait times while emergency personnel attend to others with more pressing physical needs. Additionally, patients visiting Houston emergency rooms with a primary diagnosis of mental health conditions are 3.4 times more likely to be hospitalized following the emergency room visit compared to persons with a primary diagnosis unrelated to behavioral health. In response to the community need, Memorial Hermann s dynamic mental health services include the Psychiatric Response Team and Case Managers, Mental Health Crisis Clinics and Home Behavioral Health Services Program. These innovative programs are staffed with professionals with the expertise needed to provide the necessary care and ongoing support for mental health patients, both inside acute care facilities and in the community. PSYCHIATRIC RESPONSE TEAM Since 2000, on call 24 hours a day, the Psychiatric Response Team has worked across the Memorial Hermann Health System to provide mental health expertise to all acute care campuses, delivering care to the emergency rooms and inpatient units. The team is comprised of master s-level licensed clinicians and responds to all patients with behavioral health needs, ranging from depression and psychosis to chemical dependency. The clinicians evaluate, stabilize, arrange for transfer and develop aftercare plans for patients. A coordinated effort, the team refers patients to more than 200 mental health community treatment providers within Harris, Fort Bend and Montgomery counties. This large referral network allows the program to leverage the Volume Jul 2015 Psychiatric Response Team Volumes Volume - Comparison of FY 13, FY 14 and FY 15 Aug Sep Oct Nov Dec Jan Feb Mar mental health community s resourced patients to obtain care for non-resourced patients; patients are seen regardless of ability to pay. No longer is it one ER/nurse/physician competing with the rest of the ERs for a limited amount of psychiatric resources. Supporting the Psychiatric Response Team are the Psychiatric Response Case Managers, who work with patients to improve outpatient treatment compliance. Also available 24 hours a day, case managers not only refer to the Mental Health Crisis Clinics and other community agencies, but actively Month April May June engage patients in the development of their own mental healthcare plan and long-term recovery goals, with the ultimate objective of improved patient wellness. Behind the scenes, case managers work to identify individuals whose chronic mental illness predicts the likelihood of repeat visits to emergency room facilities, and to educate them about mental health outpatient treatment centers and support networks. The case manager also connects these individuals with a community-based social worker who will help them navigate the barriers to outpatient treatment. OUTCOME The Psychiatric Response Team has seen, on average, a percent volume reduction in emergency room utilization. Once the patient has been successfully discharged from the program, on average, there has been a percent reduction in emergency room visits in the six months following program discharge

23 The graphic below depicts how the Psychiatric Response Team, Psychiatric Response Case Managers, Mental Health Crisis Clinics and Psychiatric Home Health Services work collaboratively to create a continuum of services for the community s mentally ill population. MENTAL HEALTH CRISIS CLINICS After identifying Humble and Spring Branch as having the highest clusters of chronic mental health issues, in 2014 Memorial Hermann opened two Mental Health Crisis Clinics to respond to each community s significant gap in mental and behavioral health services. These clinics operate as urgent care mental health service providers for individuals in crisis situations. These clinics are not designed to provide continuous outpatient follow-up for mental health needs; rather, they serve as a part of the mental health safety net as an alternative to expensive emergency Memorial Hermann and Community Partners Collaboration - Patient Movement Overview The Psych Response Team Community Agency Mental Health Crisis Clinic room visits. Clinicians work with patients needing immediate access to psychiatric services, and refer them to the Psychiatric Response Team case managers and other community agencies as appropriate. To assist outpatient follow-up, the clinic staff helps patients establish an appointment with an outpatient provider or directs them to resources and referrals. These clinics promote better health outcomes for patients with mental health treatment needs, decrease unnecessary emergency room visits, and decrease inpatient hospitalizations and incarcerations due to noncompliance with mental health treatment plans. The emergency center is not the place for these patients, said Theresa Fawvor, associate vice president, Behavioral Health Services. The Mental Health Crisis Clinics allow us to provide the appropriate care and put these patients in front of the provider they need outside of the acute care hospital setting. Community Agency MH Psych Home Health Community Agency Psych Response Case Management Patient movement within Memorial Hermann services Patient movement between Memorial Hermann and community agencies Community Agency HOME BEHAVIORAL HEALTH SERVICES Patients with behavioral health issues in addition to medical conditions have few options for treatment. Facilities that treat mental or behavioral issues will not accept patients with existing medical conditions such as feeding tubes, pregnancy, cardiac disorders and other conditions. Alternatively, hospitals 42 43

24 OUTCOME This past year, the Home Behavioral Health Services Program documented an increase in visits, medication compliance and discharge planning. Getting Back on Her Feet For years, Connie, 60, struggled with major depressive disorder. When she presented at Memorial Hermann Southwest Hospital in the spring of 2014, she had fallen into such a deep depression that pulling herself up again was not a possibility. She had no job, no insurance, no resources and no hope. to be angry. But she just kept coming back. She and Kimberly were godsends. They were my angels. Working in partnership, Gilmore and Johnson literally got Connie back on her feet both mentally and physically. Now, she is looking to get a job, attending an amputee support group and waiting to be fitted Coupled with her depression, she was overweight and with a prosthetic leg. In addition, she has also: suffered with other chronic medical problems, including diabetes. She was a frequent patient at Memorial Hermann Obtained a Gold Card, now receiving Harris Health with two lengthy hospitalizations. When told she was Outpatient Services, including a primary care 800+ visits and outpatient clinics that provide care for medical treatment do not offer services to treat mental health issues. With few to no resources available in the community, coupled with the high cost of treatment, most patients fall through the cracks of the healthcare system and seek treatment only through emergency rooms when their behavioral issue is exacerbated. The Home Behavioral Health Services Program is a team of specialty nurses and social workers who help patients with medical conditions are made from case managers in emergency rooms, hospital intake departments, physician offices, community clinics and home health staff, who often determine patients currently receiving medical treatment are in need of behavioral or mental health care as well. Patients with and without resources are accepted, and services are available 24 hours a day, seven days a week. The project s goal is to reduce emergency room visits by patients whose behavioral issues can be going to lose her right leg due to an infection, she thought about ending it all, but didn t have the courage. When all glimmers of hope nearly faded for Connie, in stepped her angels in the form of Kimberly Gilmore, Case Manager, Memorial Hermann Psychiatric Reponse, and Jessica Johnson, RN, Home Behavioral Health Services. When I first came home and thought about how difficult it was going to be without a leg, I thought rather than deal with that, I would rather die, Connie said. I was mad. I was furious. But the Memorial Hermann physical therapy team helped me. I vented at Nurse Jessica, but she allowed me to vent because I needed physician, psychiatrist, vision care, and physical and occupational therapy Supplemental Nutrition Assistance Program (SNAP) benefits Red Cross transportation METROLift transportation Services to obtain Social Security disability payments I would never have gotten through this without them, said Connie, adding that she is now determined to find a job as an accountant. Even though I pulled away from all my friends, they were not going to go away. Now, I have been lifted up because of my family and Memorial Hermann. I can t believe that you guys are still holding my hand. I m amazed. and behavioral issues in their homes. managed within the community Treatment offerings include developing coping skills, medication compliance, disease management education, and help with accessing resources such as transportation and medications. Team members also work collaboratively with other established mental health programs such as the Memorial Hermann Crisis Clinics and Case Management programs. Referrals setting. Emergency rooms will still be the best choice for patients whose symptoms have become exacerbated or whose medical condition has deteriorated to the point where they may pose a danger to themselves or others. Providing services for patients who are unable to leave their homes due to a mental or medical condition benefits the entire Houston community. Combining physical and mental services in addition to offering therapies, education and support for patients can be life-altering, and in some cases, life-saving. Susan Markland, Administrative Director of Patient Care, Home-Based Programs 44 45

25 Community Partners 46 47

26 Community Partners Through the years, Memorial Hermann has taken a leadership role in several Gateway to Care initiatives, including the Gateway to Care Provider Health Network (PHN) launched in November It is based on a national model called Project Access that connects people to medical specialists so they can receive the right treatments earlier in their illness. Connecting people to the appropriate specialty care sooner results in improved clinical outcomes and improved productivity as patients are able to return to their daily lives sooner rather than later. It really does take a village. It is very rewarding to know that by working together with our community partners, we can harness the amazing collective energy, talent and resources of several organizations to improve the health of those who need it most. Carol Paret, Senior Vice President and Chief Community Health Officer As a leader in health and wellness for more than 100 years, Memorial Hermann recognizes that there are many organizations doing tremendous work for the underserved, often with limited resources. These organizations provide a high level of expertise, fluidity and depth of service in working with their particular populations and communities. By actively partnering with these organizations, Memorial Hermann furthers its vision of 100 percent access to basic care and improving the health and enriching the lives of adults and children residing in Southeast Texas. To amplify their collective impact on a community, Community Benefit programs are collaborative in nature. Prospective partners are carefully selected based on their shared values and measurable impact on the community. Memorial Hermann provides program support and in-kind support for these organizations, each of which is a proven leader committed to resolving the most pressing social issues in the Houston community. GATEWAY TO CARE Funding to support the Provider Health Network (PHN) and Surgical Saturday Established in 2000, Gateway to Care began with six member organizations, including Memorial Hermann, and today works with more than 170 leaders in health care, government and the business sector toward the shared vision of 100 percent access to health care for the uninsured and underinsured residing in the Harris County/Greater Houston area. Operating as a collaborative of member and affiliated organizations working together to coordinate resources and streamline healthcare services in the local community, the Gateway to Care Collaborative is responsible for: Bringing in more than $100 million in healthcare resources and improving the health lives of more than 100,000 individuals and families 12 new federally qualified health centers (FQHCs) and a total of 33 clinics serving the Harris County region Establishment, training and use of community health workers (or navigators) in hospitals, clinics and community organizations Creation of a Provider Health Network (PHN) to provide pro bono specialty care Implementation of Surgical Saturday, an extension of the PHN, that covers general surgical ambulatory cases on selected Saturdays CHILDREN AT RISK Memorial Hermann provided funding to support a policy coordinator for a Food in Schools initiative Children at Risk s mission is to serve as a catalyst for change to improve the quality of life for children through strategic research, public policy analysis, education, collaboration and advocacy. The only organization in the Houston area focused solely on the wellbeing of the whole child, Children at Risk tracks key indicators through its publication Growing Up in Houston and proactively drives change for children by educating legislators on the importance of improving each of the key indicators. Children at Risk makes children s needs a priority and ensures ample resources are available for children and their families to thrive. Children at Risk s focus areas include: Public education Human trafficking Health and nutrition Parenting Current legislative session 48 49

27 The Interfaith Community Clinic provides: Opening Doors through Partnership 50+ weekly hours of medical service Betty was caught between a rock and a hard place she couldn t afford private insurance, but she made too much You just don t know what you would do if Interfaith Community Clinic wasn t here. treats the whole person medical, dental and mental health from every corner of Montgomery County. ICC opened in 1994 with one patient the first night, and two patients the second night, Snyder said. 10 weekly hours of dental service for public assistance. This quandary was preventing her from undergoing regular well-woman checkups, until she discovered Interfaith Community Clinic (ICC) in Montgomery County. They re available After that, people started hearing about us. None of this would have been possible if not for collaborative relationships, she added, including the 75+ licensed professional volunteer staff for anything I need them for, Betty said, but certainly the life-saving exams the Pap smears, the mammograms. Up to 68 percent of patients at ICC are women, said one with Memorial Hermann. Their funding has given us the freedom to provide staff and expanded hours of operation. In addition to our professional volunteers, we now contract with a medical doctor and a dentist. We are a safety net that provides care and a consistent 8,000+ president and CEO Ann Snyder, adding that ICC medical home to those who fall between the cracks. patients per year 14,150 total social service, medical and dental visits INTERFAITH COMMUNITY CLINIC Memorial Hermann provided funding to support general operations Established in 1996, Interfaith Community Clinic is a volunteer-based healthcare center whose primary goal is to provide medical and dental care, mental health counseling and social service support to those individuals in the north Houston community of Conroe who have no form of health insurance. Among the many services provided are: Primary medical care management of both acute and chronic health problems Primary dental care, including extractions, restorations and oral hygiene care Individual, couple and family counseling Childhood immunizations Health and lifestyle education Social service support and advocacy ADDITIONAL PARTNERSHIPS Aldine Independent School District Alief Independent School District CanCare of Houston Covenant House Epiphany Community Health Outreach Services (ECHOS) The George Foundation The Gulf Coast Regional Blood Center Health Resources and Services Administration Healthy Living Matters Healthy Living Matters Pasadena Houston Independent School District Lamar Consolidated Independent School District Medical Missions Newspring One Voice Pasadena Independent School District Project Fit America Racial and Ethnic Approaches to Community Health (REACH) San Jose Clinic Spring Branch Community Health Department of State Health Services, School Health Program Tomagwa Ministries, Inc. The University of Texas Health Science Center at Houston School of Public Health (ER Algorithm Study) The University of Texas Health Science Center at Houston School of Nursing 50 51

28 Overview of Services One of the largest not-for-profit health systems in the nation, Memorial Hermann is an integrated system with an exceptional medical staff and more than 22,000 employees. Memorial Hermann s 13 hospitals include four hospitals in the Texas Medical Center: an acute care hospital which houses a Level I trauma center, a hospital for children, a rehabilitation hospital and an orthopedic and spine hospital; eight suburban hospitals; and a second rehabilitation hospital in Katy. Affiliated with UTHealth Medical School, the system also operates three Heart & Vascular Institute locations; the Memorial Hermann Mischer Neuroscience Institute at the Texas Medical Center; the IRONMAN Sports Medicine Institute at three locations; Women s Memorial Hermann; Memorial Hermann Life Flight, the largest and busiest air ambulance service in the United States; the Prevention and Recovery Center (PaRC) for chemical dependency treatment; and a comprehensive array of home health services, rehabilitation centers, outpatient imaging and laboratory services. Memorial Hermann has been a trusted healthcare resource for more than a century. As Houston s only full service health system, Memorial Hermann continues to identify and meet our region s healthcare needs. Our specialty services include: HEART AND VASCULAR CARE We are one of the world s largest providers of cardiovascular care, annually performing more than 50,000 heart procedures. Patients at our three Memorial Hermann Heart & Vascular Institute locations and our Heart & Vascular centers across the community have access to affiliated heart specialists with extensive training and experience in the complete range of cardiac treatments, from interventional cardiology to electrophysiology and the most complex heart transplants. 1system serving Southeast Texas and the Greater Houston community 13 hospitals, include four hospitals in the Texas Medical Center: an acute care hospital which houses a Level I trauma center, a hospital for children, a rehabilitation hospital and an orthopedic and spine hospital; eight suburban hospitals; and a second rehabilitation hospital in Katy 22,000+ employees across the system 52 53

29 of patients with a variety of neurological disorders, including those caused by aneurysm, stroke, brain tumors, disorders of the spine, peripheral nerve problems, neurodegenerative disorders, infections of the nervous system and movement disorders. CANCER CARE Memorial Hermann has been accredited by the American College of Surgeons Commission on Cancer as the first Integrated Network Cancer Program in Houston. Memorial Hermann Cancer Centers provide a full continuum of ORTHOPEDICS AND SPORTS MEDICINE trauma patients of all ages, throughout the continuum of care. Supporting this services, including targeted anticancer Memorial Hermann offers expert care vision, Memorial Hermann Life Flight NEUROSCIENCES drugs, intensity-modulated radiation therapy (IMRT), image-guided radiation in orthopedics and sports medicine, from injury prevention and evaluation has completed more than 140,000 missions since its inception in It Offering the largest and most therapy (IGRT), the most advanced linear to joint replacement and post-surgery continues to be one of the busiest air comprehensive neuroscience program accelerators, prostate seed implantation rehabilitation. Memorial Hermann ambulance services in the nation and in Texas, Memorial Hermann continues and the innovative MammoSite and operates an orthopedic and spine the only area program accredited by to push the boundaries in the diagnosis, Contura radiation therapy systems hospital, more than 30 Sports Medicine the Commission on Accreditation of evaluation, management and treatment for breast cancer. & Rehabilitation clinics, seven Memorial Medical Transport Systems. Hermann Joint Centers and three Memorial Hermann IRONMAN Sports Medicine Institute locations, led by WOMEN S AND CHILDREN S SERVICES a group of affiliated sports medicine With 240 pediatric beds and 68 beds fellowship-trained physicians. The dedicated to Women s Services, Institute uses scientific discovery to help Children s Memorial Hermann Hospital athletes of all ages and abilities prevent in the Texas Medical Center has been injury and improve performance. caring for women and children under TEXAS TRAUMA INSTITUTE AND MEMORIAL HERMANN LIFE FLIGHT one roof longer than any other hospital in Houston and is the Gulf Coast region s leading Level I pediatric trauma center. The Fetal Center at Children s Memorial Hermann Hospital ensures that mothers The collaborative, multidisciplinary team with high-risk pregnancies and their at the Memorial Hermann Texas Trauma babies receive the latest treatments Institute provides leading-edge care for and comprehensive, quality care

30 REHABILITATION Named among the top five rehabilitation hospitals in U.S.News & World Report s list of America s Best Hospitals for 25 consecutive years, TIRR Memorial Hermann has achieved world-renowned excellence in research and treatment for traumatic brain injury, stroke, spinal cord injury, amputations, multiple sclerosis and other neurological diseases and disorders. TIRR Memorial Hermann is designated as a Model System by the National Institute on Disability and Rehabilitation Research for its traumatic brain injury program and provides follow-up data for the NIDRR spinal cord injury program. It recently created the Memorial Hermann Rehabilitation Network, offering inpatient and outpatient rehabilitation for adults and children at select locations around Houston. RESEARCH AND INNOVATION Memorial Hermann achieves improvements in patient care through clinical discovery and the development of new treatments for patients. Nearly 1,300 studies are in progress or pending across the system all intent on finding new ways to advance health. Dallas Memorial Hermann Cypress Austin Keller Springs Rd Bee Cave Rd. Westlake Dr. Midway Rd. Love Field Memorial Hermann Katy Preston Rd. Richmond Rosenberg Grand Parkway West Memorial Hermann Sugar Land Memorial Hermann Memorial City Memorial Hermann The Woodlands Memorial Hermann Orthopedic & Spine Memorial Hermann Southwest Memorial Hermann Northwest 8 Children s Memorial Hermann Hospital 8 GEORGE BUSH INTERCONTINENTAL AIRPORT 288 Hardy Toll Road Pearland TIRR Memorial Hermann 90A Memorial Hermann - Texas Medical Center HOBBY AIRPORT Memorial Hermann Northeast Spencer Hwy. Memorial Hermann Southeast 225 ELLINGTON FIELD 45 Conroe Teas Rd. N. Frazier St. Beaumont Wall St N. Twin City Hwy LBJ SPACE CNTR. 336 Mid County 347 Nederland Southeast Texas Regional Airport 71 N. Mechanic St. El Campo State Hwy FM N. Richmond Rd. Wharton State Hwy. 183 FM Richmond Rd. Charity St. Main St. FM 360 Needville 36 School St. FM 1236 Manvel 6 22 Imaging Centers 10 Breast Care Centers 34 Sports Medicine & Rehabilitation 22 Diagnostic Laboratories 18 Surgery Centers 3 24 Hr Emergency Center 3 Home Health 7 Cancer Centers 3 Heart & Vascular Institutes 1 Physicians at Sugar Creek 10 School-Based Health Centers 2 Neighborhood Health Centers 2 Convenient Care Centers 227 Memorial Hermann Facilities 3 IRONMAN Sports Medicine Institutes 2 Women s Memorial Hermann Hospitals 1 Mischer Neuroscience Institute 5 Prevention & Recovery Centers (PaRC) 60 Memorial Hermann Medical Group 2 Executive Health Centers 1 Rehabilitation Katy 9 Acute-Care Hospitals 1 Children s Memorial Hermann Hospital 1 TIRR Memorial Hermann 2 Acute-Care Hospitals Under Construction 2 Convenient Care Centers Under Construction 1 Orthopedic & Spine Hospital TIRR is a registered trademark of TIRR Foundation