Excellence: As a team, we pursue exceptional performance with passion. Accountability: We take personal responsibility for delivering results

Transcription

1 Community Service Plan September 14,

2 ACKNOWLEDGEMENTS This report was developed by two joint planning committees which included hospital and local health department representatives in Erie County and separately in Niagara County, New York. Representation on the Erie County Joint Planning Committee included individuals from the Erie County Department of Health, Kaleida Health, Erie County Medical Center, Catholic Health System and Sheehan Memorial Hospital; along with Buffalo Public School District, Catholic Dioceses Schools, Erie 1 BOCES and Niagara Health Quality Coalition (EC Joint Planning Committee). Representation on the Niagara County Joint Planning committee included individuals from the Niagara County Department of Health, Kaleida Health, Niagara Falls Memorial Hospital, St. Mary s Hospital, and Eastern Niagara Health System. 2

3 Mission Statement Kaleida Health s mission is to advance the health of our community. Our vision is to be a regional health care system providing exceptional quality Service, with a commitment to education and research, accessible to all. Our values clearly state who we are and how we perform our work: Patient-Centered: We put patients and families first Excellence: As a team, we pursue exceptional performance with passion Accountability: We take personal responsibility for delivering results Integrity: We demonstrate honesty in everything we do We have reviewed the mission statement and there have been no changes to the Kaleida mission statement. Kaleida Health is a voluntary, not-for-profit, Article 28 licensed, network serving the communities of Western New York State at various levels and at multiple locations throughout the region. Kaleida Health is a product of the 1998 merger of Buffalo General Health System (Buffalo General), Millard Fillmore Gates Circle Hospital (Millard Gates), Millard Fillmore Suburban Hospital (Millard Suburban), Women and Children s Hospital of Buffalo (Women & Children s), and DeGraff Memorial Hospital (DeGraff). In addition to the 5 Kaleida Health (Kaleida) hospitals, Kaleida operates four skilled nursing facilities, and more than 90 outpatient clinics. Our family of health care organizations is bonded together into one framework for leadership, governance, shared Service, financial infrastructure and information technology platforms. Kaleida Health is the largest health care provider in Western New York State. Collectively, Kaleida Health s five hospitals had 60,903 hospital discharges serving 31.4% of inpatients residing in the eight counties of Western New York in

4 Annually, one million combined inpatient, emergency department and outpatient visits occur at health care facilities in the Kaleida system, which employs 9,500 staff and has nearly 1,800 medical staff members. Kaleida Health s Hospital Service Areas Kaleida Health (Kaleida) serves the eight counties of Western New York State, with primary service area in Erie and Niagara Counties for the purposes of the Comprehensive Community Service Plan. The service area has a combined population of approximately 1.6 million people. The eight county service area includes: Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Orleans, Niagara and Wyoming Counties. The methods used to define Kaleida s primary service areas include analysis of inpatient zip code data. According to the U.S. Census 2008 estimates, the population of Erie County including the City of Buffalo is 909,845. Buffalo serves as the County seat. Buffalo has a population of 276,059. The City of Buffalo is the largest city in the region and the second largest city in New York State. Buffalo is ranked as the third poorest city in the nation. In addition to Buffalo, there are 16 villages, 25 towns, and two Native American Indian reservations within Erie County. The populations of Erie County and the City of Buffalo have been declining over the past decade. The City of Buffalo recorded a population decline of 10.8% from 1990 to However, overall there was an increase in the population of Erie County that resides outside the City of Buffalo of 2.6%. Erie County and Buffalo have a diverse population, with the county population of 81% White, 13% African- American, 4% Hispanic, and 2% Asian/Pacific Islanders. By comparison, the City of Buffalo s population is 53% White, 33% African-American, 9% Hispanic and 2% Asian/Pacific Islanders. The median household income in Erie County is $44,650. The median household income in the City of Buffalo is $

5 The total population of Niagara County, including the City of Niagara Falls is 214,464. The City of Niagara Falls has a population of 52,326. The City of Niagara Falls is the largest city in Niagara County. In addition to Niagara Falls, there are 5 villages, 18 towns, and two Native American Indian reservations within Niagara County. The population of Niagara County and the City of Niagara Falls has been declining over the past decade. The City of Niagara Falls recorded a population decline of 3% from 1990 to Niagara County and Niagara Falls have a diverse population, with the county population of 89.9% White, 6% African-American, 2% Hispanic, and 1% Asian/Pacific Islanders. By comparison, the City of Niagara Falls population is 75% White, 19% African-American, 2.6% Hispanic, 2% Native American and 1% Asian/Pacific Islanders. The median household income in Niagara County is $44,064. The median household income in the City of Niagara Falls is $30,324. The City of North Tonawanda has a population of 31,770; of which 98% are White, 1.1% are Hispanic. The median household income in North Tonawanda is $44,692. The current median household income nationally is $66,670, and $52,944 for New York State. (Census.gov) For the purposes of the Kaleida Comprehensive Community Service Plan, the population Kaleida s programs target in Erie County is low-income residents of the City of Buffalo, residing in the following zip codes, which reflect individuals with disproportionate unmet health needs and areas that are medically underserved. The zip codes include: 14201, 14202, 14203, 14204, 14205, 14206, 14207, 14208, 14209, 14210, 14211, 14212, 14213, 14214, 14215, 14216, and Our programs will focus on the African American and Latino populations, which are both at high risk of preventable chronic diseases, including cardiovascular disease. The population the programs target in Niagara County is residents of the City of North Tonawanda, residing in zip code Public Participation 5

6 The participants involved in assessing community health needs are varied. Kaleida Health sponsored a City of Buffalo community health needs assessment in January 2008, in which 1658 residents participated and provided information on how health care may be improved to best serve the community s needs, and identified what works well and what does not in the local health care environment for these residents. Additional information was gathered from community-based primary care providers to identify opportunities for collaboration on disease prevention initiatives for patients under their care. (Lwebuga-Mukasa, Jamson S. Kaleida Health Community and Provider Health Care Project. January 31, 2008). Additional participants involved in identifying and assessing community health needs include: A Buffalo Health Leaders Forum (June 20, 2009) with 68 persons in attendance, including primary care physicians and cardiologists, faith leaders, community leaders, community health advocates, consumers, and executives from the Association of Black Cardiologists, a national organization of minority physicians. Participants indicated a need for more community-based outreach, screenings and health education to improve cardiovascular health in the minority community in Buffalo. Residents of the Buffalo Municipal Housing Authority (8/31/09), 50 residents participated in an informational meeting, and indicated an interest in more health information and education on chronic disease (hypertension, diabetes, asthma) prevention, and access to primary care services, especially for youth. They also identified a need for reducing stress and crime in the housing centers, including more policing of the area. Minority Health Coalition (June 16, 2009) members received information on the Comprehensive Community Service Plan and Prevention Agenda priorities selected by the Erie County Joint Planning Committee. The Minority Health Coalition indicated that the priority selected is one that needs a comprehensive approach to begin addressing obesity in our community and its impact on chronic diseases. The Coalition expressed an interest in keeping abreast of developments of Kaleida s role and efforts on behalf of the Joint Planning Committee, and they wish to provide input and assistance with plan implementation. Near East and West Side Task Force (NEWSTF-June 9, 2009) 14 members in attendance, and suggested other community partners to include in the plans of the Erie County Joint Planning Committee, including P2 Collaborative of WNY, payers, and University at Buffalo. The NEWSTF 6

7 suggested they would assist with hosting additional community meetings to share information and offer input and implementation of the plans. Prevention Agenda Priority (1): Physical Activity and Nutrition (Erie County) Criteria for Public Health Priorities: After the initial planning meeting hosted by the Western Regional Office of the New York State Department of Health (NYSDOH) and Erie County Department of Health (ECDOH), with hospital executives attending (February 2009), an Erie County Joint Planning Committee was formed to identify a joint prevention priority and strategies to focus on collaboratively over the next 3 years. The Erie County Joint Planning Committee (EC Joint Planning Committee) consists of representatives from Erie County Department of Health, Catholic Health System, Erie County Medical Center, Kaleida Health and Sheehan Memorial Hospital. The EC Joint Planning Committee conducted a preliminary review of the 2009 Erie County Community Health Assessment, and reviewed other local health assessments to determine areas of community need with respect to prevention services. Each hospital organization also considered their primary service area and their own patient/community assessments during this process. After considering public health priorities from the NYSDOH s Prevention Agenda Towards a Healthier State (Prevention Agenda), the EC Joint Planning Committee selected Physical Activity & Nutrition as the priority that the group would work on collaboratively over the next 3 years. The Committee also plans to engage additional organizations and individuals in planning and implementing annual goals and objectives. Each hospital system will determine at least one additional Prevention Agenda priority to work on at their organization, which will be included in their respective organization s plan. Data Sources: 1. NY State Expanded Behavioral Risk Factor Surveillance System results for January 2008 reveals that participants reported being overweight among adults in Erie County (34.2%) are similar to the NY State average (34.6%), however, obesity among adults in NYS (23.6%), is lower than the Erie County average (30.5%). In addition, Erie County has a higher percent of overweight or obesity among adults (64.8%) than NY State (58.2%). Participants reported No Leisure-time physical activity among adults (22.7%) higher for NY State than for Erie County (17.4%). Consumption of 5 or more servings of fruits 7

8 and vegetables daily among adults revealed similar percentages of respondents at 26.7% for NY State and 24.2% for Erie County, however both results indicate that three-fourths of the adult population is not consuming fruits and vegetables as recommended. 2. A. Erie County Department of Health 2009 Community Health Assessment/Consumer Survey preliminary results reveal that 48% of consumers are interested in health information about nutrition-- more than any other health topic. Among the top 3 health issues most consumers report concern about, obesity or overweight (28.7%) was second in frequency and physical activity (24.5%) was third in frequency of responses. The topic of most concern was health insurance (30.4%). B. The Erie County Department of Health 2009 Community Health Assessment/Professional Survey preliminary results indicate that 46.4% of health professionals indicated a need for health information and education on obesity; 36.8% indicated a great need for health information and education on physical activity. In addition, physical activity and nutrition (48.7% n=346 responses) was third when asked to identify 3 health issues that are most pressing in Erie County (# 1 was access to quality health care (65.7%) and # 2 was mental health/substance abuse (50.6%). (See Preliminary Survey Results in Appendix Section). 3. A Community Report: What People Want for the Future of Health Care in WNY revealed that WNY residents identified helping consumers to understand their role in taking responsibility for shifting toward preventive care and healthier lifestyles (third of top 5 priority areas identified), and making healthy choices (fourth of top 5 priority areas identified). The report of the forums indicate a need to develop educational programs and improve providers ability to supply health information, assist patients in obtaining follow-up care, including self care, providing clear and accurate information, supporting and advocating preventive care in the community, and the patients role must include seeking preventive care and adopting healthy behaviors. (Reaching For Excellence: Community Vision and voices for Western New York Health Care. July 28, 2009). 4. Buffalo Public Schools: Body Mass Index baseline data collected during the school year indicate the percent of overweight students (85 th percentile and above) by grade level: Pre- Kindergarten (28%), Kindergarten (30%), Second, (37%), Fifth (44%), Seventh (43%) and Tenth (38%). (See report in Appendix Section) 8

9 Physical Activity and Nutrition have been selected because (a) these are common behavioral factors in chronic disease prevention, (b), WNY health care consumers identified a need for health information and education on this topic in our community, and (c) the data reveals a need for improvement in physical activity and nutrition for adults and children in our community. The joint Physical Activity and Nutrition interventions will offer evidence-based (where available) health education curricula, tools and methods that are proven to be effective. The Joint Planning Committee will coordinate a broad-based initiative with outreach in Buffalo and Erie County. There are specific interventions aimed at addressing the needs of underserved communities, to ensure equity throughout the programming. There are community representatives invited to provide input into program planning and implementation, to garner participation and support of the interventions. Interventions include community-wide information and education to sensitize the public about the local need and individual responsibility for increased physical activity and improved nutrition, which leads to improvement in preventable diseases of lifestyle, such as heart disease, stroke, diabetes, obesity, hypertension, and result in reducing suffering, premature death and improved quality of life for Erie County residents. Status of the Priority: The joint Erie County Prevention Agenda priority is a new community initiative. In addition to the local health department and local hospitals, Buffalo Public Schools, Catholic Schools located in Buffalo/Erie County, Erie 1 BOCES, the Minority Health Coalition, P2 Collaborative of Western New York, the Near East and West Side Task Force, Inc. and Niagara Health Quality Coalition have expressed interest in working with the EC Joint Planning Committee in developing and implementing interventions. Also, additional community organizations, payers and physicians will be invited to participate in this community-wide initiative. Priorities Considered in Assessment Process: Kaleida Health offers a number of community/public health Service (see Appendix for Table of Community/Public Health Service offered at Kaleida Health), ranging from prevention, screenings, community health education programs, linkages and referral services, emergency preparedness, family financial assistance programs, employee wellness services, support groups, direct care 9

10 such as family planning and reproductive health services, immunizations, medical home including primary care, school nursing services and school-based health centers. During the Erie County Joint Planning meetings beginning in February 2009, representatives of the New York State Department of Health, Erie County Department of Health, and hospital executives from Kaleida Health, Erie County Medical Center, Catholic Health System, and Sheehan Memorial Hospital conducted a multi-vote exercise to identify and gain consensus on the top 3 Prevention Agenda priorities for Erie County s Joint Planning Committee. The top 3 selected were: healthy mothers, healthy babies, access to quality health care and chronic disease prevention. From there, the EC Joint Planning Committee researched local community health assessment data and recommended a focus on Physical Activity and Nutrition. It was agreed that lack of physical activity and poor nutrition are behaviors that lead to preventable chronic disease, and is important for healthy mothers and babies as well. Therefore, it was deemed that a focus on interventions leading to increasing the rate of physical activity and improving nutrition will serve our community well in the long term. In addition to the activity described above, each hospital conducted an internal assessment of its capacity for this work, and have identified at least one additional Prevention Agenda priority that it will focus on during the next 3 years. 3-Year Plan of Action: Physical Activity and Nutrition: The EC Joint Planning Committee selected Physical Activity and Nutrition, to work on together in offering interventions for our community. The strategies selected include the following: Develop and conduct community health information and education programs emphasizing healthy food and beverage choices, food portion sizes and weight control; understanding personal barriers (financial, cultural, emotional) to making healthy choices. Sensitize the public about the local need for increased physical activity and improved nutrition, and encourage participation in community/neighborhood efforts. Develop and launch a social marketing mass-media campaign, promoting healthy nutrition and the food guide pyramid. Conduct health education programs in community settings on healthy food and nutrition, daily physical activity, risk factors for chronic disease, self-care behaviors, and similar topics. 10

11 Engage community leaders and faith leaders in the various campaigns and activities. Develop and conduct community education lectures that emphasize good nutrition, physical activity, medical home and lowering risks for chronic diseases in families. The hospitals, local health department and community partners will develop annual implementation plans that include goals and objectives, specific activities to support the goals, roles and responsibilities, and an annual evaluation plan. The EC Joint Planning Committee will meet monthly throughout the 4 th quarter of 2009 to develop the 2010 Annual Plan, then at least quarterly after, to monitor and report program activities. The goals of the strategies that support increasing Physical Activity and Improving Nutrition for City of Buffalo and Erie County residents are as follows--by the end of the 3-year collaborative: Goal 1: Increase consumer knowledge and adoption of healthy lifestyle behaviors by encouraging frequent physical activity and healthy nutrition, leading to improved health status and reduced chronic disease prevalence in residents of Buffalo and Erie County. Goal 2: Increase the ability to identify risk factors for cardiovascular disease in participants. Goal 3: Develop systemic (i.e. school-based, faith-based, community-based, and primary care based) interventions for early identification and notification of adolescents and adults with high body mass index, and provide them with information about options and resources to address their problem and the consequences of not addressing their BMI status. Goal 4: Implement a social marketing campaign to positively influence voluntary behavior of target population to take action to maximize health. Goal 5: Restrict the availability of less healthy foods and beverages in public service venues. Measures of Effectiveness: A program evaluation plan will be established to measure program effectiveness. The metrics include: Numbers of educational programs and number of participants (impact measure) Pre-post test of participants in educational programs (outcome measure change in knowledge) Change in BRFSS statistics on physical activity and nutrition rates for Erie County residents (outcome measure) Participant satisfaction with educational programs (outcome measures) Numbers and reach (spread in the community) of media, publications, etc. (impact measure) 11

12 Local government facilities, hospitals and school districts adopt policies that limit the portion size of any entrée by either reducing the standard portion size of entrees or offering smaller portion sizes in addition to standard portion sizes within local government facilities, hospitals and school districts. 100% of the Joint Planning Committee organizations are representatives or active members of at least one local coalition or partnership that aims to promote environmental and policy change for active living and/or healthy eating. The strategies, goals and objectives may be modified as the Joint Planning Committee and its partners deem necessary, in order to meet the needs of community residents, and in consideration of available resources. As part of the ongoing evaluation of program progress and outcomes, the Committee will review progress regularly and remain open to input from Committee members and partners that will improve interventions leading to achieving program goals. An evaluation plan will be developed to support this work. Prevention Agenda Priority (2): Diabetes Management (Niagara County) Criteria for Public Health Priority: Similar to the process described above for the EC Joint Planning Committee, Niagara County also convened a Joint Planning Committee (NC Joint Planning Committee) in which Kaleida participated. Kaleida s DeGraff Memorial Hospital is located in the City of North Tonawanda and serves residents of North Tonawanda and other Niagara County communities. The NC Joint Planning Committee consists of representatives of the New York State Department of Health, Niagara County Department of Health, DeGraff Memorial Hospital, Niagara Falls Memorial Medical Center, Mount Saint Mary s Hospital, and Eastern Niagara Hospitals (formerly known as Lockport Memorial and Inter-Community Hospital of Newfane). Since the initial meeting held on January 29, 2009, monthly meetings were held to identify the joint Prevention Agenda priority for NC Joint Planning Committee, and strategies and goals were developed with input from all represented organizations. Chronic disease management, specifically Diabetes prevention/ management was selected as the focus for Niagara County. A task group was formed to identify issues and barriers to diabetes prevention and management, as well as to establish a comprehensive overview of services offered throughout Niagara County. Hospital Certified Diabetes Educators and Registered Dietitians were invited to join the group. Data Sources: Data from the BRFSS, CDC and NYSDOH was reviewed. Additional data from the Reach for Excellence Community Report: What People Want for the Future of Health Care in WNY was also considered, as noted in the Erie County section. The current BRFSS statistics indicate that the rate of diabetes in Niagara County is 11.9%, with 10.6% prevalence in males and 13.2% prevalence in females. 12

13 These statistics are higher than the NYS rates of 9.7% overall, 7.6% in males overall and 11.6% in females overall. Additionally, the American Diabetes Educators Association, in the revised national Standard for Diabetes Self-Management Education (DSME) states that diabetes education is effective for improving clinical outcomes and quality of life, and that ongoing support is critical to sustain progress made by participants during the DSME program. Status of Priority: The joint Niagara County Prevention Agenda priority is a new community initiative. In addition to the local health department and local hospitals, other community organizations, payers and physicians will be invited to participate in the plans for implementation, as a community-wide approach is necessary to ensure program success. Priorities Considered in Assessment Process: The NC Joint Planning Committee decided on diabetes prevention/management early on in the planning process. 3-Year Plan of Action: Diabetes Prevention and Management (Niagara County) The NC Joint Planning Committee selected the new priority: Diabetes prevention and management, to work together to develop interventions for our community. The strategies selected include: Assisting patients with access to diabetes education classes Develop no cost community education classes focusing on lowering risk factors for diabetes, prediabetes and management of diabetes Develop a Niagara County Diabetes Resource Guide and make it available at physician s offices, hospital waiting areas and in community locations Use local media sources to educate the public regarding lowering risk factors for diabetes, prediabetes and management of diabetes The goals related to the strategies that support diabetes prevention and improved management of diabetes for Niagara County residents are: 13

14 Goal 1: Empower participants by increasing access to information and improving knowledge, skill-building techniques and self-care behaviors that lead to positive behavior change and reduction in diabetes prevalence. Goal 2: Develop and implement pre-diabetes education and offer regularly in community settings. Goal 3: Develop community education lectures and public service announcements that emphasize good nutrition, increased physical activity, mental health and risk factors for chronic disease including diabetes. Goal 4: Develop and implement a protocol for patients with diabetes entering hospitals to promote referrals for diabetes education class/counseling (SSME), and regular A1C testing. Measures of Effectiveness: A program evaluation plan will be established to measure program effectiveness. The metrics include: Numbers of pre-diabetes self-care educational programs and numbers of participants Pre-post test of participants in educational programs Change in BRFSS statistics on diabetes rates in Niagara County Participant satisfaction with educational programs Numbers and reach (spread) in the community of media publications Numbers and satisfaction of community and/or faith-based organizations in the initiatives Numbers of referrals for diabetes education classes Numbers of referrals and completion of A1C testing 14

15 Support for these initiatives will be obtained through the NC Joint Planning Committee s hospitals, local health department, and by engaging payers to assist community residents with access to low cost or no cost diabetes education resources. We will also offer physician education highlighting diabetes and pre-diabetes management and referral, and build capacity for developing protocols for persons with diabetes entering the hospitals to include a physician checklist emphasizing A1C testing and referral for diabetes education. An evaluation plan that includes evaluation of impact and outcome measures will be developed for this work. A list of diabetes resources available through Niagara County hospitals in included in the Appendix section. Other Prevention Agenda Priorities: (Kaleida-Specific) In addition to the joint priorities, Kaleida will continue programs currently offered in our community that focus on the Prevention Agenda priorities of healthy moms and healthy babies, increasing seasonal flu vaccine for school-age children, tobacco-use prevention (Kaleida has implemented Smoke-Free campuses throughout our system), and increase mammography screenings in minority populations. We also continue to collaborate with the local health department, community agencies and school districts to offer youth health literacy initiatives, employee wellness initiatives, the school asthma management program, poison control outreach, H1N1 flu vaccine preparedness for health care workers and for Buffalo Public School District, shaken baby prevention education, adolescent pregnancy prevention, sexually transmissible disease prevention and falls prevention among the elderly. Financial Aid Program Successes in Providing Financial Assistance: The economic outlook in Buffalo and Western New York has been grim, as it is elsewhere in the State and nation. Unemployment is rising, and the poor and middle class continue to struggle to meet their family s daily needs. It is not uncommon for people to report that they are choosing between purchasing basic necessities such as food and clothing, while foregoing other necessities such as 15

16 medical care. Adults in particular are finding that their limited income may prohibit them from qualifying for government programs, and they look to Kaleida Health s Financial Assistance Programs to assist with medical costs. New York State has expanded Child Health Plus for youth from birth to age 19, which lessens the burden on families for payment of health care services. Kaleida Health (Kaleida) is committed to providing assistance for individuals with financial challenges. Kaleida offers the Financial Assistance Program, which is designed to assist patients who have been treated at a Kaleida facility, but are unable to pay for the medical care they receive. The Kaleida facilitated enrollment team was established in 2003, and we have been able to increase efforts in assisting the uninsured population. During 2008, Kaleida completed 2,238 applications for Child Health Plus/Family Health Plus/Medicaid, and Prenatal Care Assistance Program for the community, 200 applications for the Family Planning Benefit Program, and 40 applications for State Aid for children with special needs. In addition to the above, other accomplishments include: Partnerships with community agencies to offer outreach events and health fairs, including access to information regarding health insurance enrollment for eligible community residents. Our presence in the community has been a driving force in educating and bringing resources to the uninsured and underinsured. The Kaleida team has participated in more than 15 community events thus far this year, as well as a series of events during Cover the Uninsured Week (3/22-3/28/09). The result of the outreach is the community s understanding of financial assistance options for those in need. Partnership with the NYSDOH and the 8 WNY local health agencies to provide information regarding the Children with Special Needs programs. Several outlying counties have funded services such as prescriptions, special formulas, durable medical equipment and payment for hospital care and/or insurance co-pays for eligible families. Kaleida s team assists patients and families with applications for the program, and offers guidance, support and advocacy on behalf of the families, to ensure those eligible receive the financial support they require for children with special needs. 16

17 A team of 18 facilitated enrollers to assist individuals in our facilities and in the community with financial resources to cover the cost of medical services. The enrollers are placed at venues throughout the system, to provide education and application assistance by devoting time to outpatient and inpatient areas, and in community-based locations. Our enrollers provide an opportunity to receive home visit when necessary, to assist in applying for insurance benefits. In early 2009, we began an initiative to identify patients arriving at the Kaleida Emergency Departments that have no primary care physician and no health insurance coverage. The goal is to educate this population on the opportunity to receive care from a primary care provider. When possible, the financial outreach team schedules the patient s Emergency Department follow up visit with a primary care physician prior to their leaving the department, and those identified with no insurance are offered insurance enrollment. A community hotline ( ) has been established to assist individuals with applying for financial assistance. The telephone number is available on our website, pamphlets and other publications. In March 2008 we received 442 calls for assistance with insurance enrollment and/or financial assistance. Currently we average more than 50% increase in calls for assistance since Spring This indicates the increased need for financial assistance as well as the increased pressure on our capacity to meet the new level of need. Automated work queues have been developed within our hospital information system to capture automatic referrals. This process improvement includes enhanced reporting, to assist in allocating resources where needed. Challenges Related to the Provision of Financial Assistance: Challenges faced include: Individuals requiring financial assistance often are unprepared to complete the application process. They often come into facilities for services, not realizing the paperwork required to complete an application. The Kaleida Financial Assistance Plan requires that the applicant provide evidence of income and resources, so that eligibility may be determined. Patients 17

18 arrive without the documentation, therefore making it difficult to apply for financial assistance or government-sponsored programs. Many individuals remain reluctant to reach out for assistance. They may be overwhelmed by the day-to-day hardships they experience in their lives. They are afraid to reach out to determine if financial help is available because of outstanding medical bills. Once they do reach out, people are often grateful to learn that they do indeed qualify for assistance, and that the burden of financing their medical needs is lifted. There is a small percentage of individuals who will start the process, however become noncompliant and not complete the application process. Although Kaleida currently has a large team of employees devoted to the Financial Assistance and Facilitated Enrollment programs, they are available Monday through Friday during the regular work day. There is a need to expand these Service to include face-to-face enrollers during the evening and on weekends, however our resource limitations do not allow us to schedule such at this time. Changes Impacting Community Health/Provision of Charity Care/Access to Service Over the next several years, health care reimbursement reform efforts at the national and state level will impact how Kaleida Health offers community health services and the provision of charity care in the future. However, it is more likely that local payer negotiations will directly impact our ability to provide the necessary community health and community benefit programs that our community desires, in a cost effective manner. The continuation of transition of care from an acute care setting to alternative delivery settings continue to impact our financial status, and this trend will likely accelerate in the future. The expected payment reforms that are leading to increases in payments for primary care providers are a result of reductions in payments to hospitals for acute and emergency care that our community continues to seek. However, at Kaleida Health, we continue to focus efforts on our mission to advance the health of our community, and to do so, we are making the investment in community health services and are providing financial resources for those in need, in order to ensure they receive access to the right care, at the right time, in the right setting. 18

19 Dissemination of the Report to the Public A summary of the Comprehensive Community Service Plan will be mailed to community leaders and available to the public through the Kaleida Health website. Information on Kaleida s Financial Assistance and Facilitated Enrollment programs are readily available on the website and are disseminated at community health fairs, schools and numerous other community events. 19

20 APPENDIX SECTION Erie County Department of Health 2009 Community Health Assessment Preliminary Results: Text and Essay Responses Related to Access to Care Kaleida Health/Buffalo Public Schools: School Health Services School Year BMI Data Kaleida Health Community (Public) Health Services Inventory Diabetes Resources Available Through Hospitals in Niagara County 20

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