2013 COMMUNITY HEALTH NEEDS ASSESSMENT

Transcription

1 ST. JOHN PROVIDENCE HEALTH SYSTEM ST. JOHN MACOMB-OAKLAND HOSPITAL MACOMB CENTER E. 12 MILE RD. WARREN, MICHIGAN OAKLAND CENTER DEQUINDRE RD. MADISON HEIGHTS, MICHIGAN COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION PLAN

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3 St. John Providence Health System A PASSION FOR HEALING OUR MISSION ST. JOHN PROVIDENCE HEALTH SYSTEM, as a Catholic health ministry, is committed to providing spiritually centered, holistic care which sustains and improves the health of individuals in the communities we serve, with special attention to the poor and vulnerable. OUR VISION Our passion for healing calls us to cultivate trust, advocate wellness and transform healthcare. OUR VALUES We are called to: SERVICE OF THE POOR Generosity of spirit, especially for persons most in need REVERENCE Respect and compassion for the dignity and diversity of life INTEGRITY Inspiring trust through personal leadership WISDOM Integrating excellence and stewardship 3

4 Dear Community: We are pleased to present this 2013 Community Health Needs Assessment (CHNA) for the St. John Macomb-Oakland Hospital (SJMOH) service area. Our service area consists of the counties of Wayne, Oakland and Macomb where over 80% of our patients reside. This assessment was done using a model developed by the Association of Community Health Improvement, and is consistent with the current guidelines of the U.S. Internal Revenue Service (IRS). Our process was led by a Steering Committee who reviewed national, state of Michigan, and local health statistical and hospital data. We also consulted with local community leaders and others who serve our communities using surveys, focus group and interviews. Also reviewed was the 2012 County Health Rankings commissioned by the Robert Woods Johnson Foundation. Of the 83 Michigan counties, 82 are ranked based on four factors, behavioral, clinical, socioeconomic and environmental and are compared to the other counties in the same state. The counties in the SJMOH service area are ranked in health factors as follows: Wayne County, 82; Oakland, 6, and Macomb County, 28. The summary rankings for health outcomes are 81, 16, and 41 respectively. Following an objective prioritization process of the health needs identified by the assessment, the CHNA Steering Committee identified three Priority Health Areas which were subsequently endorsed by the SJPHS Board. These three areas are 1) Diabetes Prevention, 2) Infant Mortality Reduction, and 3) Access to Care What follows is a review of the assessment and the implementation plan to begin to address the priority health needs. I wish to express my appreciation to the Steering Committee and to the many others who provided input and assistance to complete this process. Sincerely, Terence Hamilton, President St. John Macomb-Oakland Hospital 4

5 ST. JOHN MACOMB-OAKLAND HOSPITAL Macomb & Oakland Center St. John Providence Health System 2013 Community Health Needs Assessment & Implementation Strategy TABLE OF CONTENTS EXECUTIVE SUMMARY 6 COMMUNITY HEALTH NEEDS ASSESSMENT 7 Background 7 Introduction 7 Service Area Demographics 7 Community Health Needs Assessment: The Process 8 Identified Health Needs and Concerns 10 Prioritization Process 11 Priority Health Areas 11 Diabetes Prevention 11 Infant Mortality Reduction 12 Access to Care 13 Summary 15 Insurance Coverage Estimates by SJPHS Service 16 Insurance Categories and Types of Coverage. 17 IMPLEMENTATION STRATEGY 18 How SJMOH Will Address Priority Health Needs 19 Needs Not Addressed in SJMOH s Implementation Plan 24 I. PRIORITY HEALTH AREAS - DETAILED 26 II. APPENDICES 32 Appendix 1 SJPHS Service Area County Health Rankings Appendix 2 Key Informants: CHNA Sub-Committee Members 33 Appendix 3 Hospitals in Southeast Michigan, By County 35 Appendix 4 Community Health Needs Assessment Steering Committee Members 37 Appendix 5 Key Informants: Local Health Departments and Community Agencies 39 Appendix 6 Representatives of Community Input 45 Appendix 7 Documents, Information and Data Reviewed by the Steering 48 Committee Appendix 8 The Prioritization Process 50 Appendix 9 Tool for Prioritization Process; Problem Importance Worksheet 51 Appendix 10 Michigan Dashboard of Health 52 Appendix 11 Healthy People 2020: 12 Leading Health Indicators/Objectives 53 Appendix 12 Key Informants: Implementation Strategies Team Members 54 5

6 EXECUTIVE SUMMARY ST. JOHN MACOMB-OAKLAND HOSPITAL The driving force behind conducting a community health needs assessment (CHNA) is the U.S. Internal Revenue Service requirements for non-profit hospitals mandating that this must be performed every three years. This assessment was done jointly for each of the six St. John Providence Health System (SJPHS) operating facilities, as allowed by current guidelines. The focus is the geographic service area for each facility which is determined to be the counties where 80% of its patients reside. For St. John Macomb-Oakland Hospital this area is Wayne, Oakland, and Macomb counties. A Steering Committee was convened to provide guidance and oversight in the development of the CHNA and included individuals from a variety of health professions in disciplines such as physicians, nurses, finance, health planning, social work, discharge planners, etc.. Extensive local, national, state and hospital utilization data and statistics were obtained from internal as well as external sources to identify health specific trends. These sources as well as information collected through a survey, other key informants, and focus groups enabled the Steering Committee to gain further insight into the needs and gaps in the hospital service area. The result of their analysis was consistent with the published 2012 county health rankings provided by the University of Wisconsin indicating that of the 82 ranked Michigan counties, Wayne County was 82 nd, Oakland County, 6 th, and Macomb County 28 th in Health Factors and 81 st, 16 th and 41 st in Health Outcomes respectively (Appendix 1). After a prioritization process that included assessing 1) the magnitude of the problems identified, 2) the seriousness of and potential burden to the community, 3) the feasibility of addressing or correcting the problem, and 4) the potential yield of measurable data toward outcome improvement, three priorities were selected. The priorities are Diabetes Prevention, Infant Mortality Reduction and Access to Care. Although other health needs were identified, it was determined that the health system will work with other organizations as needed to address health needs not selected. Subsequently, an overall strategy (Appendix 2) for each priority was identified as follows: Diabetes Prevention a. Increase opportunities for healthy lifestyle activities b. Increase education for diabetes prevention, early identification, and disease management. Infant Mortality Reduction a. Increase connectivity to and resources for pregnant women and their families b. Provide enhanced nutrition information and services that support the health of high-risk infants. c. Increase education to enhance access to primary care for mothers after the delivery of the infant and post-partum visit. Access to Care a. Reduce barriers to access the full continuum of health care for low income, uninsured and/or undersinsured residents of the service area. b. Increase/support safety net capacity in the service area Specific tactics and measures are outlined in the Implementation Plan Section of this document. 6

7 COMMUNITY HEALTH NEEDS ASSESSMENT ST. JOHN MACOMB-OAKLAND HOSPITAL BACKGROUND According to the Joint Committee on Taxation s Technical Explanation of the Revenue Provision of the Reconciliation Act of 2010 as amended in combination with the Patient Protection and Affordable Care Act of 2010 (JCX-18-10), tax-exempt hospitals are required to perform a community health needs assessment (CHNA) every three (3) years and adopt an implementation strategy to meet the community health needs identified through such an assessment. CHNA Must Take into account input from persons who represent the broad interests of the community served by the Hospital facility including those with special knowledge of or expertise in public health Be made widely available to the public CHNA May Be based on current information collected by a public health agency or non-profit organizations and may be conducted with one or more organizations including related organizations. Reporting Requirements Internal Revenue Code Section 6033(b) (15) (A) requires hospital organizations to include in their annual information return (i.e. Form 990) a description of how the organization is addressing the needs identified in each CHNA conducted under section 501 (3) and a description of any needs that are not being addressed along with the reasons why the needs are not being addressed. INTRODUCTION St. John Macomb Hospital, located in Warren, Michigan and St. John Oakland Hospital located in Madison Heights, Michigan merged in Today, we are St. John Macomb-Oakland Hospital (SJMOH) one hospital, two campuses, 535 beds, 3,436 nurses and associates, 600 volunteers, 195 residents and more than 1,200 physicians in over 45 specialties. More than 80% of patients served by SJMOH reside in Wayne, Oakland and Macomb counties. This geographic area also includes the following major healthcare facilities: St. John Hospital and Medical Center, Henry Ford Health System, Detroit Medical Center, and Beaumont Hospital. See Appendix 3 for a detailed listing of hospital and healthcare facilities in southeast Michigan by county. SERVICE AREA DEMOGRAPHICS The SJMOH service area demographics are summarized in the following documents entitled 2011 Demographic Snapshot and 2011 Demographic Snapshot Charts and are provided for Wayne, Macomb and St. Clair counties. The total population for this service area is 3,934,966 with slightly more females than males. Also, 65.1% of the population is white, 24.7% is Black (non-hispanic), 4.0% Hispanic, 3.6% is Asian & Pacific Islander (non-hispanic) and 2.6% is categorized as Other. Note the following table (Fig. 1) for additional demographic details by county. 7

8 St John Macomb-Oakland Hospital Primary Service Area, Selected Demographics, 2011 DATA Wayne County Oakland County Macomb County Total Population 1,879,458 1,226, ,701 White 930, , ,801 Black (Non-Hispanic) 747, ,699 70,613 Hispanic 100,548 40,098 18,289 Asian & Pacific Islander 46,778 69,179 25,343 Other 53,888 27,182 21,650 Average Household Income 54,971 87,358 64,434 % Persons Below Poverty % Children 0-17 below poverty % Household Income < $15, Source: 2011 The Nielsen Company, 2012 Thompson Reuters. All Rights Reserved, U.S. Census Quick Facts, Kids Count Data/Annie E. Casey Foundation Fig. 1. SJMOH Primary Service Area Selected Demographics COMMUNITY HEALTH NEEDS ASSESSMENT: THE PROCESS The CHNA was conducted with the guidance and oversight of a Steering Committee composed of professionals with a diversity of expertise in health care operations, administration and management, community health, health planning, medicine and other related health disciplines (see Fig. 2 and Appendix 4). The co-chairs were the Vice President of Mission Integration and the Vice President of Community Health. Additional input from approximately 100+ people was received as a result of a survey and focus group of local health department officials, community stakeholders, and community advocates (Appendix 6). The 6-Step model developed by the Association of Community Health Improvement was utilized to organize and facilitate the process of developing this CHNA (see Fig. 3). In addition to an array of pertinent information, the CHNA Steering Committee reviewed extensive data and information including national and state data on the 10 Leading Causes of Death, as well as the 10 Leading Causes of Death in the St. John Macomb-Oakland Hospital 8

9 service area (which include Macomb, Oakland and Wayne counties). The Committee also reviewed and discussed the Michigan Department of Community Health 2009 Health Disparities Report which identifies statewide priority health areas categorized by race and ethnicity, and highlights those races, ethnicities and minorities with significant disparity rates in Infant Mortality, Health Disease and Stroke mortality rates, HIV/AIDS prevalence, Diabetes prevalence and mortality rate, Cancer incidence and mortality rate, Suicide and Homicide rate, and Gonorrhea and Chlamydia prevalence. The priority health areas ultimately selected were greatly influenced by the needs of this population as identified in the aforementioned report. Given that the CHNA Steering Committee had a robust fund of information available for review, in addition to the input from 100+ individuals representing community input, there were no appreciable information gaps that limited the ability of the CHNA Steering Committee from adequately assessing the community s health needs. See Appendix 7 for a detailed listing of data and information used in the assessment. COMMUNITY HEALTH NEEDS ASSESSMENT STEERING COMMITTEE MEMBERS NAME TITLE NAME TITLE KAREN BEGER Director, Community Health WILLIAM (Jake) JEAKLE Senior Planner, Strategic Planning Dept. TIMOTHY BINDER Chief Administrative Officer, Medical Resources Group SANDRA l. KING Consultant, Community Health STEPHANIE BRADY Administrator, Behavioral Health MICHAEL KOBERNICK, M.D. Physician Primary Care MICHELLE CIOKAJLO Manager, Strategic Planning Dept. KATHY LaRAIA VP Oncology & Bariatric Center of Excellence KENNETH COLEMAN Director, Community Health School Based Health MARY NABER SVP Worklife, Comm. & Continuum of Care, SJPHS DEBORAH CONDINO VP Clinical & Support Services, East Region ROSEANNE PAGLIA Clinical Pharmacy Coordinator, Ambulatory/Management Care NADINE COOK Consultant, Marketing West Region JILL SCHNEIDERHAN, M.D. Primary Care Physician SCOTT EATHORNE, M.D. Primary Care Physicians; Volunteer KAREN SHEFFIELD Director, Community Health Open Arms ROBERT FISHER VP Neurosciences & Cardiovascular COE CYNTHIA TAUEG, DHA VP, Community Health Administration BETTY GRANGER, CSJ SVP Mission Integration MARY ALICE WORRELL Corporate Manager SJPHS Call Center Fig. 2. Community Health Needs Assessment Steering Committee Members 9

10 IDENTIFIED HEALTH NEEDS AND CONCERNS The CHNA Steering Committee s analysis resulted in the identification of the following health concerns/needs (in no particular order). Cardiovascular Disease This is the leading cause of death in all parts of the hospital service area and is widely addressed through St. John Providence Health System and it's Cardiovascular Centers of Excellence; the American Heart Association; and other programs such as the Project Healthy Living multi-county screening program. Cancer St. John Providence health system has four cancer centers with two located in the service area. Additionally the American Cancer Society, primary care standards of practice, and other cancer centers in the area provide screening and community-based education. Further, the state of Michigan with its BCCCP (Breast and Cervical Cancer Control Program) provides for routine mammograms for low-income and uninsured women Asthma Asthma is predominately a condition of children and youth in the service area. Through the SJPHS school-based health centers and other school-based health centers in the area this is being addressed. Asthma education, asthma screening, and summer asthma camps are provided along with the handling of acute episodes in the school clinics with parental consent. There is a local Asthma Coalition of health providers addressing this problem. Diabetes The number of cases of type II diabetes has been steadily increasing in the service area. Many diabetics also experience other co-morbid conditions and need to be hospitalized. The complications of diabetes are also a major risk factor for preventable hospitalizations. The American Diabetes Association is active in this region. Obesity The service area is experiencing a significant upward trend in the number of obese children and adults. It is well-known that obesity is a precursor to the development of type II diabetes. There are several model programs in the service area that address childhood obesity in addition to what is available for adults. Behavioral health/substance abuse/mental illness Behavioral health issues present significant risk factor for other causes of premature death and disability. Medicaid and other state funding for behavioral health largely comes through the state to the county-based community mental health agencies and local health departments. These agencies continue to provide the lead on addressing these issues. Infant mortality / inadequate prenatal care This continues to be a significant problem in the service area. While the rates have experienced a decline over the last 10 years, it appears to have leveled off. Further, the rate of infant mortality in African-Americans it's 2 to 3 times higher than that of other racial/ethnic groups. In parts of the service area where the IMR is comparable to the state rate there is still a significant problem with inadequate prenatal care. Infant death due to unsafe sleep practices is a growing concern. Access to primary care The service area continues to experience a significant number of uninsured and underinsured individuals. Estimates for the city of Detroit alone are that 200,000 individuals are uninsured. With the impending implementation of the Affordable Care Act, there is still need to address this issue in the service area. 10

11 Fig. 3. ACHI 6-Step Model for CHNA Development PRIORITIZATION PROCESS The CHNA Steering Committee proceeded with a prioritization process of selecting priority health areas for system-wide focus, and to recommend the same priority health areas for inclusion in the SJPHS Strategic Plan for fiscal years (Appendix 8). A Problem Importance Worksheet was utilized to facilitate the prioritization process (Appendix 9). Among the multitude of community health care needs from which to address the Steering Committee utilized a prioritization process to narrow down indicators and ultimately select the recommended priority heath areas. The criteria utilized to rank the identified health concerns included: 1) Assessing the magnitude of the problem, 2) Seriousness of the consequences and potential burden to the community 3) Feasibility of addressing or correcting the problem and 4) The potential yield of measurable data of process or outcome improvement. Using this criteria, the three priority areas selected are 1) Diabetes Prevention, 2) Infant Mortality Reduction and, 3) Access to Care. DIABETES PREVENTION activities will be categorized according to three levels of prevention: Primary diabetes prevention will target the well population. Secondary diabetes prevention activities will target the at-risk population, and tertiary diabetes prevention will target the established disease population. In 2010, Diabetes is listed as the 7 th leading cause of death in Michigan and typically exists as a condition of co-morbidity among individuals with obesity, heart disease, hypertension, renal failure, stroke and other illnesses. Diabetes can lead to serious complications and premature death, but people with diabetes can take steps to control the disease and lower the risk of complication (Centers for Disease Control and 11

12 Prevention). Just over 9% of the Michigan population has been diagnosed with Diabetes, which is an estimated 701,000 people (Michigan Department of Community Health). While in contrast, 8.0% of the United States is diagnosed with Diabetes. The risk factors for Diabetes include obesity, sedentary lifestyles and poor nutrition. For the five counties in Southeastern Michigan (Wayne, Oakland, Macomb, Livingston and St. Clair), there is an estimated 272,318 total cases of Diabetes in 2009, and this is expected to grow to 289,738 by 2014 (6.4%) (Thomson, Reuters). Priority Area #1 Diabetes Prevention Diabetes can lead to serious complications and premature death, but people with diabetes can take steps to control the disease and lower the risk of complications.* Just over 9% of the Michigan population have been diagnosed with Diabetes (an estimated 701,000 people)**, while 8.0% of the United States is diagnosed with Diabetes. Risk factors for Diabetes includes obesity, sedentary lifestyles and poor nutrition. For SEM (5 County), there is an estimated 272,318 total cases of Diabetes in 2009 and this is expected to grow to 289,738 by 2014 (6.4%).*** Sources: *CDC, ** MDCH ***Thomson 8 INFANT MORTALITY REDUCTION activities will be aligned with the four major Perinatal Periods of risk categories and will focus on the 1) Pre-pregnancy period, 2) Pregnancy/Maternal period, 3) Neonatal period (during the first month of life) and 4) Infant period (from the first month to one year of age). According to the Michigan Dashboard of Health (Appendix 10), the infant mortality rate in Michigan is worse than the national average, 6.39, last recorded in 2009 and has remained higher than the national average over the last 20 years. Also of concern is the 2010 Infant Mortality rate in Detroit at 13.5%. Also of concern is the higher rate of inadequate prenatal care across all of southeastern Michigan. For every 1,000 Michigan live births, approximately seven infants die before reaching their first birthday. In 2010, 817 infants under the age of one year died, resulting in an infant mortality rate of 7.1 per 1,000 live births. Michigan experienced a significant decline in infant mortality during the early 1990s; in recent years the infant mortality rates have tended to level off. 12

13 The disparity between the black and white infant mortality rate has started to narrow. In 2005, the white infant death rate was 5.5 and was comparable to the previous ten-year average of 6.0 deaths per 1,000 white births. The black infant death rate was 17.9 in 2005, and was also comparable to the previous decade average of 17.6 deaths per 1,000 black births. However, in 2010 the white infant mortality rate was 5.5 per 1,000 live births while the black rate was 14.2 per 1,000 live births. So, since 2005 the white infant mortality rate has remained consistently below or comparable to the national average. Further, the black rate has declined slightly or by 19.6%. The decline in the Michigan Infant mortality rate is largely due to a reduction in black infant deaths. Certain newborns are at higher risk of dying. In 2010 infants born with very low birth weight (less than 1,500 grams) experienced an infant death rate of per 1,000 live births compared to a rate of 2.3 for those infants weighing 2,500 grams or more. Multiple birth infants had an infant mortality rate of 24.8 per 1,000 live births compared to the rate of 6.4 for single birth infants. Women not receiving adequate and early prenatal care are at a higher risk of delivering a low birth weight infant. Also there has been a rise in infant deaths due to unsafe sleep practices. County/ City Priority Area #2 INFANT MORTALITY REDUCTION Number of Infant Deaths, Live Births and Infant Death Rates by County And City of Detroit, 2010 Infant Deaths Live Births Infant Mortality Rate Black IMR Inadequate Prenatal Care United 26,200 * NA States Michigan , % Livingsto 11 1, % n Macomb 48 9, % Oakland 83 13, % St. Clair 6 1, % Wayne , % City of Detroit , % Source: Michigan Department of Community Health, and Kids Count Data 2011 Fig. 5. Infant Mortality Statistics by Counties in SJPHS Service Area ACCESS TO CARE is an ongoing concern, and is listed in the Healthy People 2020 report as one of the twelve leading health indicators for the nation to focus upon (Appendix 11). Healthy People 2020 provides science-based, 10-year national objectives for improving the health of all Americans. As we move into 2014 and the next phase of implementation of the Affordable Care Act, more and more individuals will become insured with Medicaid expansion and through the Health Insurance Marketplaces (Exchanges) there will still remain the need to support those unfamiliar with the system in navigating the health system, locating a primary care physician, and obtaining support for other non-medical needs that, if not addressed, may present a barrier to 13

14 access to care. In Detroit alone, there is an estimated 200,000 individuals who are uninsured or underinsured. The need to address and strengthen Access to Care is an ongoing system-wide initiative through the Ascension Health s Call to Action policy Healthcare That Leaves No One Behind. The policy represents Ascension Health s commitment to 100% access and coverage for all Americans. A significant milestone was reached in March 2010 as President Barack Obama signed into law comprehensive healthcare reform. Under the law, more than 30 million Americans will be newly insured. Looking forward, Ascension Health and St. John Providence Health System must continue its efforts on behalf of the uninsured, underinsured, and the underserved to be a collaborative voice in the communities we serve,.ascension Health has evolved its 2020 destination for Healthcare That Leaves No One Behind to describe that all people, particularly those who are poor and vulnerable, can access environments and healthcare that (1) create and support the best journey to improved health status for individuals and communities; and (2) are financed in an adequate and sustainable fashion. The vulnerable people we are focused on serving include individuals who remain uninsured in a post-reform era, but also include people who are vulnerable due to factors other than insurance coverage, including their economic situation, citizenship status, geographic location, health status, age, education level or decisionmaking ability. 1 Priority Area #3 ACCESS TO CARE 2011 Insurance Coverage Estimates, by County County Uninsured % Medicaid % Medicare % Medicare DE % Livingston Macomb Oakland St. Clair Wayne City of Detroit Source: 2011 Nielson Company 2012 Thomson Reuters Fig. 6. Insurance Coverage Estimates by Counties in SJPHS Service Area St. John Providence Health System is committed to reaching out to communities in need. Beyond our role in managing the health outcomes and costs for defined populations--is a strong interest in focusing more broadly on community health. Our Health Ministry will seek to work in collaboration with other community organizations to address the social determinants of health to measurably improve the health status of the entire SJPHS community. This work builds on SJPHS s commitment to continued collaborative work with our internal and external stakeholders. Additional information relative to scope of the issues around the three priority areas is located in Section I-Priority Health Areas Detailed. The overall SJPHS Strategies to address the three priority health areas are as follows: 14

15 1. Diabetes Prevention a) Increase opportunities for healthy lifestyle activities. b) Increase education for diabetes prevention, early identification, and disease management. 2. Infant Mortality Reduction a) Increase connectivity to and resources for pregnant women and their families. b) Provide enhanced nutrition information and services that support the health of high-risk infants. c) Increase education to enhance access to primary care for mothers after the delivery of the infant and post-partum visit. 3. Access to Care a) Reduce barriers to access the full continuum of health care for low income, uninsured and/or underinsured residents of SJPHS service area. b) Increase/support safety net capacity in SJPHS service area. SUMMARY To summarize, St. John Providence Health System will continue to provide quality patient care across all of our 41 service lines at all local operating units and at all facilities, and through all our programs. In addition to our established quality standard of care, we will also focus on the three priority health areas recommended by the Community Health Needs Assessment Steering Committee: 1) Diabetes Prevention, 2) Infant Mortality Reduction, and 3) Access to Care. Please see next pages for the Insurance Coverage Estimates for the SJPHS Service areas. For questions or more information, contact: Cynthia Taueg, DHA, MPH, BSN Vice President, Ambulatory and Community Health Services St. John Providence Health System (586) (586) (fax) 15

16 2011 Insurance Coverage Estimates By SJPHS Service Areas WAYNE COUNTY CITY OF DETROIT Private - ESI, 40.3% Private - Direct, 3.4% Medicare DE, 2.3% WAYNE COUNTY Medicare, 12.0% Uninsured, 20.5% Medicaid, 21.5% OAKLAND COUNTY CITY OF DETROIT Private - ESI, 21.1% Uninsured Private - Direct, 1.7% Medicaid Medicare DE, Medicare2.1% Medicare, Medicare DE 10.8% Private - Direct Medicaid, Private - ESI MACOMB COUNTY 32.9% Uninsured, 31.4% Private - ESI, 64.2% OAKLAND Uninsured, 6.8% Medicaid, 9.1% LIVINGSTON COUNTY LIVINGSTON Medicare, 13.1% Medicare DE, 1.4% Private - Direct, 5.5% Uninsured Medicaid Medicare Medicare DE Private - Direct Private - ESI Private - ESI, 58.3% MACOMB Uninsured, 8.2% ST. CLAIR Medicaid, 12.5% Medicare, 14.3% Medicare DE, 1.5% Private - Direct, 5.0% ST. CLAIR COUNTY Uninsured, 4.4% Uninsured, 10.5% Private - ESI, 72.1% Medicaid, 6.8% Medicare, 10.1% Medicare DE, 0.4% Private - Direct, 6.2% Uninsured Medicaid Medicare Medicare DE Private - Direct Private - ESI Private - ESI, 53.5% Medicaid, 14.3% Medicare, 14.1% Medicare DE, 1.8% Private - Direct, 4.6% Insurance Coverage Categories: Medicaid, Medicare, Medicare DE, Private-Direct, Private ESI and Uninsured 16

17 INSURANCE CATEGORIES AND TYPES OF COVERAGE Medicaid includes all individuals in traditional Medicaid and HMO Medicaid who are not also receiving Medicare benefits. Medicare includes all individuals in traditional Medicare and Medicare HMO who are not also receiving additional benefits through Medicaid. Medicare DE (Dual Eligible) includes all individuals currently enrolled in traditional Medicare and HMO Medicare who also receive additional benefits through Medicaid. Private-Direct includes all individuals who purchase insurance directly from an insurance provider, not through an employment agreement or through an insurance exchange. Private-ESI (Private Employer Sponsored) includes all individuals in HMO, FFS or PPO plans offered as part of an employment arrangement. Private-Exchange includes all individuals who purchase insurance through an insurance exchange or insurance market place not associated with employment. Uninsured includes all individuals without any insurance 17

18 ST. JOHN MACOMB-OAKLAND HOSPITAL IMPLEMENTATION STRATEGY SUMMARY FOR FISCAL YEARS

19 St. John Macomb-Oakland Hospital IMPLEMENTATION STRATEGY SUMMARY FOR FISCAL YEARS St. John Macomb Hospital, located in Warren, Michigan and St. John Oakland Hospital located in Madison Heights, Michigan merged in Today, we are St. John Macomb-Oakland Hospital (SJMOH) one hospital, two campuses, 535 beds, 3,436 nurses and associates, 600 volunteers, 195 residents and more than 1,200 physicians in over 45 specialties. More than 80% of our patient population resides in Wayne, Oakland and Macomb counties. This report summarizes the plans for St. John Macomb-Oakland Hospital to sustain and develop new community benefit programs that: 1) Address prioritized needs from the 2013 Community Health Needs Assessment (CHNA) conducted by the St. John Providence Health System CHNA Steering Committee with input from internal and external stakeholders, and 2) Respond to other identified community health needs. TARGET AREAS AND POPULATION: This CHNA encompasses the geographic area inclusive of Wayne, Oakland and Macomb counties where over 80% of our patient population resides. HOW THE IMPLEMENTATION STRATEGY WAS DEVELOPED: THE PROCESS 1. THE COMMUNITY HEALTH NEEDS ASSESSMENT The CHNA was conducted with the guidance and oversight of a Steering Committee composed of professions with a diversity of expertise in health care operations, administration and management, various community health programs, health planning, and clinical disciplines to name a few (see Fig. 2). The co-chairs were the Vice President of Mission Integration and the Vice President of Community Health. Additional input from approximately 100+ people was received as a result of a survey and focus group of local health department officials, community stakeholders, and community advocates. The 6-Step model developed by the Association of Community Health Improvement was utilized to organize and facilitate the process of developing this CHNA (see Fig. 3). Further extensive data from global, national, state and local levels including hospital specific data was reviewed and discussed by the committee as part of the assessment process. See Appendix 7 for a listing of data and information used in the assessment. 2. THE PRIORITIZATION PROCESS The CHNA Steering Committee proceeded with a prioritization process of selecting priority health areas for system-wide focus, and to recommend the same priority health areas for inclusion in the SJPHS Strategic Plan for fiscal years A Problem Importance Worksheet was utilized to facilitate the prioritization process (Appendix 9). Among the multitude of community health care needs from which to address, the Steering Committee utilized a prioritization process to narrow down indicators and ultimately select the recommended priority heath areas. The criteria utilized to rank the identified health concerns included: a. Assessing the magnitude of the problem. 19

20 b. Seriousness of the consequences and potential burden to the community c. Feasibility of addressing or correcting the problem and d. The potential yield of measurable data of process or outcome improvement. The leading health needs and concerns identified and considered were cardiovascular disease, cancer, asthma, diabetes, obesity, behavioral health, substance abuse, mental illness, infant mortality and access to primary care for the uninsured and underinsured. Ultimately, following an objective prioritization process, the three priority areas selected were 1) Diabetes Prevention, 2) Infant Mortality Reduction and, 3) Access to Care. 3. IMPLEMENTATION STRATEGY The overall SJPHS Strategies to address the three priority health areas are as follows: I. Diabetes Prevention a) Increase opportunities for healthy lifestyle activities. b) Increase education for diabetes prevention, early identification, and disease management. II. Infant Mortality Reduction c) Increase connectivity to and resources for pregnant women and their families. d) Provide enhanced nutrition information and services that support the health of high-risk infants. e) Increase education to enhance access to primary care for mothers after the delivery of the infant and post-partum visit. III. Access to Care a) Reduce barriers to access the full continuum of health care for low income, uninsured and/or underinsured residents of SJPHS service area. b) Increase/support safety net capacity in SJPHS service area. 4. IMPLEMENTATION PLAN St. John Macomb-Oakland Hospital s Implementation Plan was developed based on the priority health areas selected and recommended by the SJPHS CHNA Steering Committee, input from the three CHNA Sub-Committees (Appendix 2); (the three CHNA Sub-Committees were each tasked in alignment with the respective priority health areas), and the SJPHS system-wide fiscal years Strategic Plans. Subsequently, through guidance from Key Priority Health Area Leaders, and direction from SJMOH Implementation Strategies Team members (Appendix 12), the Implementation Plan was formalized which included a review of the hospital s resources, partnerships and existing community benefit activities. Priority Health Area #1: DIABETES PREVENTION Diabetes is a leading cause of death in Michigan and typically exists as a condition of co-morbidity among individuals with obesity, heart disease, hypertension and renal failure, stroke and other conditions. The activities will be categorized according to three levels of prevention: Primary Prevention will target the well population. Secondary Prevention will target the at-risk population, and Tertiary Prevention will target the established disease population. We will continue and/or expand the strategies, tactics and programs listed below: Strategy 1: Increase opportunities for healthy lifestyle activities 1.1 Diabetes Discovery Program Individual and group sessions with diabetes nurse educator and nutritionists. 4-6 sessions include initial assessment and follow-up sessions to check on progress. Attendees can be either insulin or non-insulin dependent diabetics, 20

21 and do not have to be new onset patients. The goal is to support self-management skills for managing diabetes through medication and diet. 1.2 Health Habits Program Individual initial and follow-up sessions with nurse and dietician. The goal is to create individualized prevention plans to promote habits to become more healthy, through meal planning, movement and stress reduction, to protect from obesity, diabetes, and cardiovascular disease. Baseline Measure for Strategy 1: Health Education Programs 1. The number of participants in the programs. 2. The number of sessions attended by program participants. Strategy 2: Increase education for diabetes prevention, early identification and disease management 2.1 Diabetes Support Group Free support group which meets monthly, led by certified diabetes educators and dieticians for people with diabetes, family members of people with diabetes, or community members who want to know more about diabetes prevention and management. The goal is to provide emotional support and information about detection, management and prevention of diabetes. 2.2 While You Wait Program Group sessions for expectant mothers diagnosed with gestational diabetes. The goal is to promote effective management of gestational diabetes, protect unborn child from risk, and provide skills for management of potential ongoing diabetes after delivery. Baseline Measure for Strategy 2: Diabetes Prevention 1. The number of participants in the programs. 2. The number of sessions attended by program participants. Priority Health Area #2: INFANT MORTALITY REDUCTION According to the State of Michigan Health Dashboard, the infant mortality rate (IMR) is worse than the national average and has remained so over the last 20 years in spite of an overall downward trend. Also of concern is the IMR for Detroit (13.5% compared to statewide 7.1%). The rate is also related to the high rates of inadequate prenatal care across southeastern Michigan. We will continue and/or expand the strategies, tactics and program listed below. A description of what St. John Macomb-Oakland Hospital will do to address Community Needs is as follows: Collaboration between nursing, case management, community health and social work to identify resources and communication method with patients (birth folders, prenatal clinic, etc.) Increase social work and nursing knowledge about programs available. Expectant mothers who receive care in Obstetrics clinic setting are given pro-breastfeeding information regarding prenatal nutrition and infant feeding and have the opportunity to ask questions. Strategy 1: Increase connectivity to and resources for pregnant women and their families. 1.1 Provide referral information about local Maternal Infant Health Programs (MIHP) to women with Medicaid Insurance who present for prenatal care and/or for delivery. Baseline Measure: Number of referrals made to MIHP programs. 1.2 Provide referrals to the Strong Start Enhanced Pregnancy Program to women with Medicaid Insurance who present for prenatal care and/or for delivery. Baseline Measure: Number of referrals made to the Strong Start program. 21

22 1.3 Provide information and referral to St. John Providence Health System Infant Mortality Program to women who present for prenatal care and/or deliver with other insurance coverage. Baseline Measure: Number of referrals to SJPHS Infant Mortality Program. Strategy 2: Provide enhanced nutrition information and services that support the health of highrisk infants. 2.1 Provide information and/or referrals to women delivering babies at SJMOH to the Mother Nurture Breastfeeding Program. Baseline Measure: Number of referrals made. 2.2 Provide referrals to the Outpatient Breastfeeding Clinic for consultation with a breastfeeding consultant. Baseline Measure: Number of referrals made to Breastfeeding Clinic. 2.3 Provide breast pump to low-income breastfeeding mothers to encourage breastfeeding. Baseline Measure: Number of breast pumps provided % of all women who deliver at SJMOH will receive information/referral to the WIC Program. WIC is a special supplemental nutrition program for Women, Infants and Children that provides nutritious foods (primarily through retail grocery stores), nutrition counseling, and referrals to health care and social services. WIC serves low-income pregnant, postpartum and breastfeeding women, infants and children up to age 5 who are at nutritional risk. Baseline Measure: Number of referrals to WIC, and the number of women participating in the WIC program. Strategy 3: Increase education to enhance access to primary care for mothers after delivery of infant and post-partum visit. 3.1 All mothers delivering at SJMOH will be provided information upon discharge on how to locate Primary Care Medical Home services via the SJPHS Health Connect service which can assist in making appointments and referrals to local Federally Qualified Safety Net Health Centers in their vicinity. SJPHS Health Connect is a free health information service designed to help callers locate primary and specialty care physicians, programs, clinics, classes and/or events that fit their health care needs. Baseline Measure: Number of discharge information packets given. Priority Health Area #3: ACCESS TO CARE Access to Care for individuals who are uninsured and underinsured is an ongoing concern. The need to address and strengthen Access to Care is an ongoing healthcare system-wide initiative through the SJMOH parent company, Ascension Health, through the Call to Action policy Healthcare That Leaves No One Behind. This policy represents Ascension Health s commitment to 100% access and coverage for all Americans. As we move into 2014 and the next phase of implementation of the Affordable Care Act, more and more individuals will become insured with Medicaid expansion and through the Health Insurance Marketplaces (Exchanges) there will still remain the need to support those unfamiliar with the system in navigating the health system, locating a primary care physician, and obtaining support for other non-medical needs that, if not addressed, may present a barrier to access to care. 22

23 Strategy 1: Reduce barriers to access the full continuum of health care for low income, uninsured and/or underinsured residents of the service area. 1.1 Continue to develop St. Vincent DePaul Access to Care program for uninsured patients entering the Emergency Department at Oakland Center. Monitor process to refer patients Baseline Measure: Track the number of referrals to program. 1.2 Partner with local Federally Qualified Safety Net Health Centers: Advantage Health Centers, Mercy Primary Care and Covenant Health Center. Baseline Measure: Evidence of bona-fide referral sites for low-income, uninsured, underinsured and self-pay patients. 1.3 Support recruitment of Physicians Who Care. A program comprised of specialists who volunteer to provide medical care for uninsured adults 19 to 64 years old who are referred from partner safety net health centers. Baseline Measure: Number of referrals for Physicians Who Care, and number of participating physicians. 1.4 Partner with community-based organizations to increase outreach and education about enrollment for health insurance coverage through the newly created Health Insurance Marketplaces (Exchanges) which are designed to help individuals find, consider options and purchase health insurance that is compatible with various income levels, and an individual s desired medical care coverage. Baseline Measure: Number of events/activities providing Health Insurance Marketplace enrollment support. 1.5 Provide health insurance enrollment assistance to uninsured adults presenting to hospital Emergency Department or inpatients. Baseline Measure: Number of patients receiving health insurance enrollment assistance. 1.6 Develop internet-based resource guide for associates/employees to utilize to locate safety net access points of care for patients. Baseline Measure: Establishment of internet-based resource guide. Strategy 2: Increase/support safety net capacity in the service area. 2.1 Referrals will be made to: Macomb, Oakland and Wayne County Health Clinics (free or low-cost clinics) Macomb, Oakland and Wayne County Adult Day Care Detroit Department of Health and Wellness Promotion Park Family Health Care Wayne County School-Based/Linked Health Centers Low-cost Dental and Vision Services in Detroit Sources for low cost prescription drugs Baseline Measure: Number of referrals to above-listed Federally Qualified Safety Net Clinical sites. 2.2 Oral Surgery and Dental Clinic Partnership with University of Detroit Mercy Dental School to provide dental care to the under/uninsured. Baseline Measure: Evidence of partnership and number of referrals. 2.3 Support completion of cultural diversity educational program for associates/employees and physicians to be completed in fiscal year Baseline Measure: Goal of 90% for associate/employee completion. 23

24 IDENTIFIED NEEDS NOT BEING ADDRESSED AND THE REASON: St. John Macomb-Oakland Hospital will not address certain identified health needs and concerns because other programs are currently offering an array of services for the community and those particular health needs and concerns are listed below with the resources, agencies and services currently established to address them: Cardiovascular Disease This is widely addressed through St. John Providence Health System and its Cardiovascular Centers of Excellence; the American Heart Association; and other programs such as the Project Healthy Living multi-county screening program. Cancer St. John Providence Health System has 4 cancer centers with 2 located in the service area. Additionally, the American Cancer Society, primary care standards of practice, and other cancer centers in the area provide screening and community-based education. Further, the state of Michigan with its BCCCP (Breast and Cervical Cancer Control Program) provides for routine mammograms for low-income and uninsured women Asthma Asthma is predominately a condition of children and youth in the service area. Through the SJPHS school-based health centers and other school-based health centers in the area, this is being addressed. Asthma education, asthma screening, and summer asthma camps are provided along with the handling of acute episodes in the school clinics with parental consent. Obesity It is well-known that obesity is a precursor to the development of type II diabetes. There are several model programs in the service area that address childhood obesity in addition to what is available for adults. Behavioral health/substance abuse/mental illness Medicaid and other state funding for behavioral health largely comes through the state to the county-based community mental health agencies and local health departments. These agencies continue to provide the lead on addressing these issues. The aforementioned services, programs and resources are sufficiently equipped and duly established to provide community-based resources to address cardiovascular disease, cancer, asthma, obesity, behavioral health, substance abuse, and mental illness. IMPLEMENTATION TEAM AND RESOURCES SJPHS, through its community health department will support the entire implementation plan by appointing a sponsor for each of the three selected priority health areas. These appointed individuals will work with each of the reporting hospitals Lead Contact Person(s) to implement tactics, consistent with the overall strategies that are specific to their respective service areas. Together, they will develop and implement a hospital-specific tracking and reporting system to measure progress toward achieving the outlined strategic goals and tactics. Currently, the health system provides programs and partnerships for each of the three priority health areas in some parts of the overall service area. Where additional partnerships or services are needed to fill gaps or support the tactics, the appointed sponsors will take the lead in seeking and/or initiating partnerships, collaboratives, or other programs as needed to implement the plan. Also, additional supporting resources in the form of grants, in-kind donations of services or materials, and redeployment of existing community health or health system resources will be considered. 24

25 APPROVAL: Each year at their June board meeting, the St. John Macomb-Oakland Hospital Board reviews the prior fiscal year s Community Benefit Report and approves the Community Benefit Implementation Strategy for addressing priority health areas identified in the most recent Community Health Needs Assessment and other plans for community benefit. The St. John Providence Health System Board on 3/11/2013 approved the overall Community Health Needs Assessment priorities and implementation plan. St. John Macomb-Oakland Hospital Board Approval Dates East Region Board Approval February 28, 2013 St. John Providence Health System Approval March 11, 2013 President June 17, 2013_ By Name and Title Date 25

26 I. Priority Health Areas - Detailed DIABETES PREVENTION, INFANT MORTALITY REDUCTION and ACCESS TO CARE DIABETES PREVENTION - Activities focusing on Diabetes Prevention will be structured according to three levels of prevention. Primary diabetes prevention activities will focus on the well population. Secondary diabetes prevention activities will focus on the at risk population. Tertiary diabetes prevention activities will focus on the established disease population. An assessment was conducted to determine the available services and resources for Diabetes treatment, education and management within the SJPHS service area. Surveys and questionnaires were forwarded to, completed and returned from all six local public health departments within the SJPHS service area as well as the Joslin Diabetes Centers (in Southfield and Novi, Michigan), Community Health Centers, and Michigan State University Extension-Health and Nutrition Institute, Disease Prevention and Management Work Team (see Appendix 5). Their responses specified the scope and extent of their diabetes prevention activities. Findings indicated conclusively that services and resources do indeed exist in the community for diabetes education, treatment and management; however, the reality is that gaps in service and access to care continue to exist. INFANT MORTALITY REDUCTION - Activities focusing on Infant Mortality Reduction will be aligned with the Perinatal Periods of Risk (PPOR) model. The PPOR is an investigative model designed for exploring factors relating to fetal and infant deaths according to birthweight and time of demise. The model s categories and alignment of activities will focus on 1) the Pre-pregnancy period, 2) the Pregnancy/Maternal period, 3) the Neonatal period (from birth to one month of age),and 4) the Infant period (from one month to one year of age). Infant Mortality Reduction is on Governor Rick Snyder s Dashboard of Progress as a significant health care concern. The Michigan Dashboard tells how the state performs in areas that affect individuals and families. The dashboard (on the following page) can be used to view Michigan's performance and how it compares with other states, and is divided into the following five categories 1. Economic Strength 4. Quality of Life 2. Health and Education 5. Public Safety 3. Value for Government 26

27 Measuring Michigan s Performance- Michigan s Dashboard Das Members of the SJPHS Executive team and the Community Health Needs Assessment Steering Committee have presented the recommended priority health areas to the SJPHS Board of Directors, executive leadership committees and councils as well as advisory boards, physician management group, local health department executive leadership, and community advisory committees recommending the priority health areas for inclusion in the St. John Providence Health System Strategic Plan FY Unanimous agreement for the recommended priority health areas was given, as well as consensus for the recommendation of the priority health areas to be included in the SJPHS 3-Year Strategic Plan. 27

28 CHNA Priority Health Area: INFANT MORTALITY PROGRAM - Fact Sheet The communities of women religious who sponsor Catholic health care institutions in Michigan founded The Infant Mortality Program (IMP) in The original sponsors included: Daughters of Charity (Providence Hospital); Sisters of St. Joseph (St. John Hospital); Sisters of Bon Secours (Bon Secours Hospital); Sisters of Mercy (Mercy Health/now Trinity Health); Felician Sisters (St. Mary Mercy Hospital); and the Sisters of Charity of Cincinnati, Ohio. It was hoped by the founders that the Infant Mortality Program would demonstrate collaboration in addressing a critical health care problem in Detroit; an infant mortality rate that was then receiving national attention, because it exceeded rates of some developing countries. Currently, three IMP components help serve at-risk pregnant women and their families in an effort to produce healthy maternal outcomes as well as reduce the number of infant deaths at birth and during the first year of life. Issues such as illiteracy and a lack of positive parenting skills are addressed, as well. These three programs include: Parent Infant Partner, Jubilee Parenting Support and Read Write Now. The Parent-Infant Partner program trains community volunteers to act as advocates/mentors to at-risk pregnant mothers through in-home visits; the Jubilee Parenting Support Group, provides ten-week parenting classes for training and support to parents with young children under the age of five; and the Read Write Now program, provides educational counseling and tutors for clients that have reading deficiencies or desire to obtain their GED. The IMP target client population consists primarily of females, ages 16 to 25 years old. However, we have provided services to clients as young as fourteen and as old as forty. Ninetyeight (98) percent are single mothers, some of which are living in shelters, and most have little or no family support. Many of the at-risk pregnant clients referred to the program have inadequate health care insurance, mental health issues, low literacy skills, lack prenatal care or have other barriers that contribute to premature, low birth weight babies and infant deaths in Detroit, Highland Park, Hamtramck and surrounding Metro Detroit and Wayne County areas. Almost half (46%) of patients served are referred by previous program participants and 32% are from area hospitals including Hutzel Women s Hospital, St. John Hospital & Medical Center and Henry Ford Health Systems. Infant Mortality Program - Measurable Outcomes FY Number of Parent-Infant-Partner participants 143 Number of home visits 956 Number of women following through with the PIP program 96/67% Number of women following through with pre-natal care 96/100% Number of babies born to participants 75 Number of pre-term births 2/3% Number of low birth weigh babies born to participants 2/3% Number of infants who received their required immunizations 91/95% Number of neglect and abuse cases among participants 0 Number of parents participating in parenting classes 77 Number of parents graduating from parenting classes* 30/39% *Ten parents returned to complete parenting classes in the fiscal year. 28

29 The Infant Mortality Program is partially funded by two community health systems, St. John Providence Health ($70,000) and Trinity Health ($62,500). The remainder of the $395, budget is achieved through individual donors, two fundraisers a year and grant writing efforts. As of May 1, 2011, the program is a Michigan Department of Community Health approved Maternal Infant Health Program. During the fiscal years, the Infant Mortality Program received 204 referrals. Seventy-five mothers delivered healthy babies. Two mothers had low birth weight babies. One was a twin weighing 3lbs. 1oz and the other baby was born three months premature weighing 2lbs 2ozs. Both babies have been seen regularly by their Parent-Infant-Partner and are growing and developing. Since the inception of the Infant Mortality Program in 1986, over 1,600 babies have been born to Parent-Infant-Partner participants with only five infant deaths. Sixty parents participated in the Jubilee Parenting support program, and 95% of the parents in the program completed the immunization requirements for their children. There were no reported cases of abuse or neglect among parents participating in the Jubilee Parenting support groups. The Read Right Now literacy program has been modified due to budget reductions. However, clients are still referred to literacy programs to complete their GED or provided a tutor to increase their reading skills when they are available. AWARDS Hospital Charitable Service Awards, February 2011, from Jackson Healthcare Doug M. Patterson Maternal Child Advocate Award, June 4, 2010, from the Healthy Mother Healthy Baby Coalition Child Advocate of the Year Award, April 27, 2010, from Child s Hope Living the Mission and Values National Award, April 2001, from Ascension Health In 2000, the American Hospital Association honored the Infant Mortality Program as one of five innovative hospital volunteer programs as winners of the association s Hospital Awards for Volunteer Excellence (HAVE) The Michigan Department of Community Health (MDCH) and the Community Public Health Agency (CPHA) honored the IMP in 2000 as one of five exemplary programs for reducing infant mortality in the state of Michigan. 29

30 SUMMARY OF 2010 INFANT DEATH STATISTICS INFANT MORTALITY: For every 1,000 Michigan live births, approximately seven infants die before reaching their first birthday. In 2010, 817 infants under the age of one year died, resulting in an infant mortality rate of 7.1 per 1,000 live births. Michigan experienced a significant decline in infant mortality during the early 1990s; in recent years the infant mortality rates have tended to level off. The disparity between the black and white infant mortality rate has started to narrow. In 2005, the white infant death rate was 5.5 and was comparable to the previous ten-year average of 6.0 deaths per 1,000 white births. The black infant death rate was 17.9 in 2005, and was also comparable to the previous decade average of 17.6 deaths per 1,000 black births. However, in 2010 the white infant mortality rate was 5.5 per 1,000 live births while the black rate was 14.2 per 1,000 live births. So, since 2005 the white infant morality rate has leveled off, while the black rate has declined by 19.6%. The decline in the Michigan Infant mortality rate is largely due to a reduction in black infant deaths. The Michigan infant mortality rate continues to be higher than the national rate. The provisional 2010 infant death rate for the United States is 6.1. LIVE BIRTHS: Live births decreased in Michigan in Between 2009 and 2010 live births to Michigan residents decreased 2.2 percent, from 117,309 in 2009 to 114,717 in Nationally, there were provisionally 4,007,000 births in the U.S. in 2010, a decline of 8% from the record number reported for CHARACTERISTICS OF NEWBORN: Certain newborns are at higher risk of dying. In 2010 infants born with very low birth weight (less than 1,500 grams) experienced an infant death rate of per 1,000 live births compared to a rate of 2.3 for those infants weighing 2,500 grams or more. Multiple birth infants had an infant mortality rate of 24.8 per 1,000 live births compared to the rate of 6.4 for single birth infants. The infant mortality rate was higher for male infants (7.6 per 1,000 male live births) than for female infants (6.6 per 1,000 female live births). CHARACTERISTICS OF MOTHER: Infant death rates were the lowest for mothers aged years old and highest for mothers less than 20 years old. Unmarried mothers had infant mortality rates nearly twice those of married mothers. Women receiving inadequate prenatal care experienced infant mortality rates three times as high as those women receiving adequate prenatal care. Mothers exposed to secondhand smoking while pregnant had an infant death rate of 9.5 per 1,000 live births compared to a rate of 6/0 for mothers who were not exposed to secondhand smoking during pregnancy. Questions regarding Infant Death Statistics should be directed to: Michael Beebe Vital Records and Health Data Development Section Michigan Department of Community Health 201 Townsend Lansing, MI (517) Voice (517) FAX BeebeM@Michigan.gov Source: Michigan Department of Community Health: 30

31 CHNA Priority Health Area: ACCESS TO CARE ACCESS TO CARE - 1 The need to address and strengthen Access to Care is an ongoing systemwide initiative through the Ascension Health s Call to Action policy Healthcare That Leaves No One Behind. The policy represents Ascension Health s commitment to 100% access and coverage for all Americans. A significant milestone was reached in March 2010 as President Barack Obama signed into law comprehensive healthcare reform. Under the law, more than 30 million Americans will be newly insured. Looking forward, Ascension Health and St. John Providence Health System must continue efforts on behalf of the uninsured, underinsured, and the underserved to be a collaborative voice in the communities we serve. In a post-health reform era, what does Healthcare That Leaves No One Behind mean? While many people will gain coverage as a result of the passage of the Affordable Care Act, millions more will remain without coverage, and many of the newly covered individuals will continue to struggle with access to healthcare services. Over the next decade, an estimated 32 million individuals currently without health insurance will gain coverage. However, millions of individuals will still be without coverage. And of those now covered under the new law, many will now face the challenge of navigating how to access the medical care they need. 1 As a result, Ascension Health has evolved its 2020 destination for Healthcare That Leaves No One Behind to describe that all people, particularly those who are poor and vulnerable, can access environments and healthcare that (1) create and support the best journey to improved health status for individuals and communities; and (2) are financed in an adequate and sustainable fashion. The vulnerable people we are focused on serving include individuals who remain uninsured in a postreform era, but also include people who are vulnerable due to factors other than insurance coverage, including their economic situation, citizenship status, geographic location, health status, age, education level or decision-making ability. 1 St. John Providence Health System is committed to reaching out to communities in need. Beyond our role in managing the health outcomes and costs for defined populations--is a strong interest in focusing more broadly on community health. Our Health Ministry will seek to work in collaboration with other community organizations to address the social determinants of health to measurably improve the health status of the entire SJPHS community. This work builds on SJPHS s commitment to continued collaborative work with our internal and external stakeholders. 1 Source: 31

32 II. APPENDICES APPENDIX 1 SJPHS Service Area Michigan County Health Rankings 2012 HEALTH FACTORS HEALTH OUTCOMES Wayne Oakland 6 16 Macomb Livingston 2 4 St. Clair HEALTH FACTORS: The summary health factors rankings are based on weighted scores of four types of factors: 1) Behavioral, 2) Clinical, 3) Social and Economic, and 40 Environmental. The weights for the factors are abased upon a review of the literature and expert input, but represent just one way of combining these factors HEALTH OUTCOMES: The summary health outcomes rankings are based on an equal weighting of mortality and morbidity measures. Source: County Health Rankings & Roadmaps Report,