Implementation Strategy Report for Community Health Needs

Transcription

1 2013 Implementation Strategy Report for Community Health Needs Kaiser Foundation Hospital WALNUT CREEK License #

2 Kaiser Foundation Hospitals Community Health Needs Assessment (CHNA) Implementation Strategy Report 2013 Kaiser Foundation Hospital Walnut Creek License # South Main St., Walnut Creek, CA I. General Information Contact Person: Deneen Wohlford, Interim Public Affairs Director Date of Written Plan: September 13, 2013 Date Written Plan Was Adopted by Authorized Governing Body: December 4, 2013 Date Written Plan Was Required to Be Adopted: December 31, 2013 Authorized Governing Body that Adopted the Written Plan: Kaiser Foundation Hospital/Health Plan Boards of Directors Was the Written Plan Adopted by Authorized Governing Body by End of Tax Year in Which CHNA was Made Available to the Public? Yes No Date Facility's Prior Written Plan Was Adopted by Organization's Governing Body: N/A Name and EIN of Hospital Organization Operating Hospital Facility: Kaiser Foundation Hospitals, Address of Hospital Organization: One Kaiser Plaza, Oakland, CA II. About Kaiser Permanente Kaiser Permanente is an integrated health care delivery system comprised of Kaiser Foundation Hospitals and Kaiser Foundation Health Plan (both California nonprofit public benefit corporations and exempt organizations under Section 501(c)(3) of the Internal Revenue Code), and a separate Permanente Medical Group in each region in which Kaiser Permanente operates. For more than 65 years, Kaiser Permanente has been dedicated to providing high quality, affordable health care services and to improving the health of our members and the communities we serve. Today we serve more than 9 million members in eight states and the District of Columbia. Kaiser Permanente is dedicated to improving the health of our communities through broad coverage, high quality care and continuous quality improvement and innovation in the care we deliver, clinical research, workforce development, health education and the support of community health interventions. III. About Kaiser Permanente Community Benefit Community Benefit is central to our mission. We believe good health is a fundamental aspiration of all people. We recognize that promotion of good health extends beyond the doctor s office and the hospital. Like our approach to medicine, our work in the community takes a prevention focused, evidence based approach. To be healthy, people need access to healthy and nutritious food in their neighborhood stores, 1

3 clean air, successful schools, and safe parks and playgrounds. Good health for the entire community also requires a focus on equity as well as social and economic well being. We focus our work on three broad areas: Providing access to high quality care for low income, underserved people Creating safe, healthy communities and environments where people live, work, and play Developing important new medical knowledge and sharing it widely with others and training a culturally competent health care workforce of the future. Across these areas, we work to inspire and support people to be healthier in all aspects of their lives, and build stronger, healthier communities. In pursuit of our mission we go beyond traditional corporate philanthropy and grant making to leverage our financial resources with medical research, physician expertise, and clinical practices. In addition to dedicating resources through Community Benefit, we also leverage substantial additional assets that improve community health, including our purchasing practices, our environmental stewardship efforts and workforce volunteerism. For many years, we have worked collaboratively with other organizations to address serious public health issues such as obesity, access to care, and violence. We have conducted Community Health Needs Assessments (CHNA) to better understand each community s unique needs and resources. The CHNA process informs our community investments and helps us develop strategies aimed at making long term, sustainable change and it allows us to deepen the strong relationships we have with other organizations that are working to improve community health. IV. Kaiser Foundation Hospital Walnut Creek Service Area Kaiser Foundation Hospitals defines the community served by a hospital as those individuals residing within its hospital service area. A hospital service area includes all residents in a defined geographic area surrounding the hospital and does not exclude low income or underserved populations. The Kaiser Foundation Hospital (KFH) Walnut Creek service area includes central Contra Costa County and the Tri Valley area of Alameda County. The service area includes the cities of Concord and Martinez to the north, Walnut Creek, Pleasant Hill, Lafayette, Orinda and Moraga in the center of the area, and Pleasanton, Livermore and Dublin to the south, comprising the Tri Valley. 2

4 Table 1 provides the age, sex and race/ethnicity distribution of the population in the KFH Walnut Creek area. Table 2 provides data on key socio economic drivers of health status: poverty, insurance coverage and educational attainment (high school diploma). These data show that the population is majority white, with over 90% of adults having a HS diploma. Across all three of the key drivers, the Hispanic/Latino population stands out as at high risk for poor health outcomes. Although the City of Walnut Creek itself and several areas immediately contiguous to it are relatively affluent, the cities of Concord and Martinez in Contra Costa County and Livermore in Alameda County have pockets of low income, vulnerable populations for whom health outcomes tend to be poor. The CHNs that have been identified in this CHNA are all most important to address in these targeted areas of poor health status and outcomes 3

5 TABLE 1: Population Distribution on Key Demographic Characteristics (Percent Total KFH Walnut Creek Service Area Population) Age/Sex Percent of Population Race Ethnicity Percent of Population <5 years old 6.09% White 72.77% 5 17 years old 17.75% Black 2.54% years old 18.86% Asian 15.05% years old 44.69% Pacific Islander 0.33% Over 65 years old 12.62% Multi Race 4.16% Male Native American 0.30% Female 50.93% Hispanic/Latino 14.02% Source: U.S. Census Bureau: A Compass for Understanding and Using American Community Survey Data (2008). TABLE 2: Key Drivers of Health Status by Population Demographics (Percent of Population Group) Percent in Poverty Percent without Health Insurance Percent without High School Diploma California 13.71% 17.92% 19.32% Contra Costa County 8.99% 11.86% 11.58% Alameda County 11.04% 12.44% 14.14% KFH Walnut Creek area 5.27% 7.85% 6.36% Male 4.92% 9.01% 6.53% Female 5.59% 6.68% 6.21% White 4.5% 7.01% 4.8% Black 11.04% 12.57% 11.53% Asian 4.5% 7.73% 6.01% Multiple Race 6.0% 7.19% 5.6% Hispanic 10.43% 19.41% 24.68% Source: U.S. Census Bureau: A Compass for Understanding and Using American Community Survey Data (2008) V. Purpose of Implementation Strategy This Implementation Strategy has been prepared in order to comply with federal tax law requirements set forth in Internal Revenue Code section 501(r) requiring hospital facilities owned and operated by an organization described in Code section 501(c)(3) to conduct a community health needs assessment at least once every three years and adopt an implementation strategy to meet the community health needs identified through the community health needs assessment. This Implementation Strategy is intended to satisfy each of the applicable requirements set forth in proposed regulations released April This implementation strategy describes KFH Walnut Creek s planned response to the needs identified through the 2013 Community Health Needs Assessment (CHNA) 4

6 process. For information about KFH Walnut Creek s 2013 CHNA process and for a copy of the report please visit health needs assessments 3/. This Implementation Strategy also serves as a foundation for further alignment and connection of other Kaiser Permanente initiatives that may not be described herein, but which together advance KFH Walnut Creek s commitment to improving the health of the communities it serves. Such other initiatives include but are not limited to our Supplier Diversity Program to promote the socio economic vitality that correlates with the health of our communities, our environmental stewardship to reduce waste and pollution, and organized matching of the altruism of our workforce with community volunteer opportunities that promote health. VI. List of Community Health Needs Identified in CHNA Report The list below summarizes the health needs identified for the KFH Walnut Creek service area through the 2013 Community Health Needs Assessment process. Primary care services and information (health literacy), including adequate Spanish capacity Increased exercise and activity Economic security Affordable, local mental health services Affordable, local substance abuse treatment service Asthma prevention Healthy eating Local specialty care for low income populations Parenting skills and support VII. Who was Involved in the Implementation Strategy Development The KFH Walnut Creek Implementation Strategy was develop in three steps, (1) identification of CHNs that KFH Walnut Creek will address, (2) development of the strategies that will be used to address the chosen needs, and (3) documentation of the Implementation Strategy and Plan. The first step in the process, identifying the needs that will be addressed, was completed by the KP Diablo Area Contributions Committee. This committee includes individuals from each of the KP entities in the Diablo Area and is responsible for reviewing and approving the Community Benefit grant making decisions for the Diablo Area (which includes both KFH Antioch and KFH Walnut Creek). The committee is staffed by Marianne Balin, Community Benefit Manager for KP Diablo Area, and Molly Bergstrom, Community Benefit Specialist for KP Diablo, and is comprised of the following individuals: Deneen Wohlford Bill Lide, MD Linda Krystof, RN, MSN Dana Simonson, RN, MBA Mary Grace Gardner, MPH Interim Public Affairs Director Assistant Physician In Charge for Health Promotion Chief Nursing Officer Associate Medical Group Administrator Project Director, Strategic Implementation 5

7 Step two, developing the strategies that will be used to address the identified CHNs, was completed by the KP Community Benefit staff of Marianne Balin and Molly Bergstrom, with support from Caroline McCall, an external consultant. The third step, documenting the process and the implementation strategy and work plan, was completed by Caroline McCall, an external consultant, with review and refinement by the KP Diablo Area Community Benefit staff. VIII. Health Needs that KFH Walnut Creek Plans to Address a. Process and Criteria Used In order to select the health needs that KFH Walnut Creek will address, the Contributions Committee used the criteria listed below, which built on the criteria used in the CHNA prioritization process. In addition, we considered the ability for KFH Walnut Creek to have a significant and meaningful impact on the needs given our expertise, our resources and the evidence base. KFH Walnut Creek selected a smaller number of needs from the broader list identified as significant during the CHNA process in order to maximize the hospital s ability to focus resources and have a meaningful impact on these significant and complex health needs. Criteria Definition 1 Magnitude / Scale of Problem Affects a large number of people 2 Severity of problem Serious consequences (morbidity, mortality or economic burden) 3 Kaiser Permanente Assets Kaiser Permanente can make a meaningful contribution because of expertise, unique assets or organizational commitment 4 Existing or Promising Approaches Proven or promising evidence based strategies exist 5 Health Disparities Disproportionate impact on health status of one or more population groups 6 Ability to Leverage Other work is being done in the community that would increase the impact of our investment Each member of the Contributions Committee gave each CHN a score between 1 (low) and 3 (high) on each of the criteria. The CHNs with the highest total scores were then further analyzed to determine which would be addressed directly through the KFH Walnut Creek Community Benefit program. The CHNs that received relatively low scores on three or more of the criteria were not chosen as CHNs for KFH Walnut Creek to address. 1 For each of the CHNs the Contributions Committee identified to address, Community Benefit staff and an external consultant reviewed and discussed three types of information to inform strategy development: Available information on evidence based strategies; some of this information was compiled by the KFH Northern California Regional Community Benefit Department and some was gathered through additional consultant research, KP CB Staff knowledge of existing community efforts and community entities that may be able to partner with KP in implementation, and KP knowledge, assets and program commitments that can be leveraged. 1 Relatively low refers to a composite score of 10 or below for a single criterion. See Appendix A for a table showing the complete scoring. 6

8 Information from each of these sources informed KP Diablo CB staff decisions regarding the strategies to employ. b. Health Needs that KFH Walnut Creek Plans to Address KFH Walnut Creek will address four Community Health Needs through its Community Benefit investments. Each of the four CHNs was given a relatively high rating across the six criteria that were used to make the choices. The KFH Walnut Creek Contributions Committee believes each of these is a significant community health need for which Kaiser Permanente can feasibly make a difference through organizational investment of funds, expertise, and/or influence and partnerships in the community. 1. Increased exercise and activity Primary data sources identified many barriers to exercise and activity, particularly in poor or vulnerable communities throughout the KFH Walnut Creek area. These communities tend to have poor access to parks and recreation facilities and they tend to have fewer commercial areas that promote walking. Poor health outcomes in the KFH Walnut Creek area that are likely to be related to inadequate exercise and physical activity include over weight and obesity, diabetes hospitalizations, and death from heart disease and stroke 2. Healthy eating Healthy eating has significant health benefits in all communities. There is research evidence showing that people living in poor or vulnerable communities tend not to have easy access to healthy food and feel that healthy food for which they do have access is unaffordable relative to less healthy choices. In Concord, 44.2% of residents live in areas designated as food deserts. Poor health outcomes in the KFH Walnut Creek services area that are likely to be related to poor eating habits include over weight and obesity, some cancers, diabetes hospitalizations and heart disease mortality. 3. Primary care services and information (health literacy), including adequate Spanish capacity Increasing access to appropriate and effective health care services addresses a wide range of specific health needs. Achieving the goal of increased access to care requires reducing barriers to preventive screening, primary care, and specialty care through deploying a wide range of strategies encompassing programs, outreach, training, and policies. Primary and preventive care are among the most effective ways to prevent disease and to minimize the negative impact of health conditions. In the KFH Walnut Creek area, although commonly used indicators of access to primary care, such as primary care providers per 100,000 populations and designation as a Health Professional Shortage Area do not show a lack of access, indicators related to the use of primary care and health outcomes that are known to correlate with inadequate primary care indicate a need. Community members and health care experts from the Tri Valley area who were engaged in the CHNA process indicated that the lack of local, culturally relevant resources and the lack of coordination of primary care services for low income populations in the Tri Valley both contribute to the inadequate use of primary care services 4. Asthma prevention Asthma is a serious health issue for both children and adults in the Walnut Creek service area where 15.73% of the population has the condition. Asthma can affect the development of young children in multiple ways, both physically and cognitively. Asthma is frequently cited as one of the top health conditions keeping children out of the classroom. For adults, asthma has a negative impact on their ability to perform certain jobs, attendance at work, and productivity. Asthma cannot be cured, so improved prevention is needed in the communities served by KFH Walnut Creek 7

9 5. Broader health care system needs in our communities Kaiser Foundation Hospitals, which includes 37 licensed hospital facilities as of 2013, has identified a number of significant needs in addition to those identified above through the CHNA process which we are committed to addressing as part of an integrated healthcare delivery system. These needs, which are manifest in each of the communities we serve, include: 1) health care workforce shortages and the need to increase linguistic and cultural diversity in the health care workforce, and 2) access to and availability of robust public health and clinical care data and research. Supporting a well trained, culturally competent and diverse health care workforce helps ensure access to high quality care; this activity is also essential to making progress in the reduction of healthcare disparities which persist in most of our communities. Individuals trained through these workforce training programs are able to seek employment through Kaiser entities or at other health care providers in our communities. Deploying a wide range of research methods contribute to building general knowledge for improving health and health care services, including clinical research, health care services research, and epidemiological and translational studies on health care that are generalizable and broadly shared. Conducting high quality health research, and disseminating findings from it, increases awareness of the changing health needs of diverse communities, addresses health disparities and improves effective health care delivery and health outcomes. IX. KFH Walnut Creek s Implementation Strategies As part of the Kaiser Permanente integrated health system, KFH Walnut Creek has a long history of working with Kaiser Foundation Health Plan, The Permanente Medical Group, and other Kaiser Foundation Hospitals, as well as external stakeholders, to identify, develop and implement strategies to address the health needs in the community. These strategies are developed so that they: Are available broadly to the public and serve low income consumers. Reduce geographic, financial, or cultural barriers to accessing health services, and if they ceased would result in access problems. Address federal, state, or local public health priorities Leverage or enhance public health department activities Advance increased general knowledge through education or research that benefits the public Address needs that would otherwise become the responsibility of government or another tax exempt organization KFH Walnut Creek is committed to enhancing its understanding about how best to develop and implement effective strategies to address community health needs and recognizes that good health outcomes cannot be achieved without joint planning and partnerships with community stakeholders and leaders. As such, KFH Walnut Creek will continue to work in partnership to refine its goals and strategies over time so that they most effectively address the needs identified. Increased exercise and activity Long term Goal Decrease the number of individuals who suffer from negative health conditions related to limited exercise and activity, including overweight and obesity, diabetes, heart disease and stroke Intermediate Goals Increase access to and availability of options for safe exercise and physical activity Increase the number of low income people who engage in an active lifestyle 8

10 Strategies Grant making to community programs that provide structured opportunities for exercise and activity Grant making to school and childcare based programs that promote physical activity Grant making to community programs that inform, motivate, and help sustain regular exercise among community members Active participation in and support for Healthy and Active Before 5 Provide KP s Educational Theater, a free theater program, designed with the advice of teachers, students, medical professionals, parents, and actors, to disseminate health education and inspire children, teens, and adults to make healthier choices and better decisions about their well being Expected Outcomes Increased opportunities for exercise and physical activity Increased physical activity among children, youth, and adults Increased awareness of and participation in both structured and informal exercise and physical activity Healthy eating Long term Goal Decrease the number of individuals who suffer from negative health conditions related to poor eating habits, including overweight and obesity, diabetes, heart disease and stroke Intermediate Goals Increase the availability of fruits and vegetables in low income neighborhoods Increase the proportion of people, particularly low income individuals, who consistently choose healthy food and beverage options Strategies Grant making to support programs that bring fresh fruits and vegetables in to low income neighborhoods Grant making to increase the fresh fruits and vegetables made available through community meal programs Grant making to support programs providing nutrition and cooking skills education to low income individuals and families Provide KP s Educational Theater, a free theater program, designed with the advice of teachers, students, medical professionals, parents, and actors, to disseminate health education and inspire children, teens, and adults to make healthier choices and better decisions about their well being Coaching, support and technical assistance regarding adoption of healthy food and beverage policies among funded grantees Support for and participation in Healthy and Active Before 5 community collaborative efforts targeting decreased availability and consumption of sugary beverages Expected Outcomes Increased availability and consumption of fresh fruit and vegetables by low income individuals and families An increase in the capacity for preparing fresh and healthy meals An increase in the healthy food and drink options provided within community organizations Primary care services and information (health literacy) including adequate Spanish capacity Long term Goal Increase the proportion of individuals in the KFH Walnut Creek service area who have access to and receive primary care services Intermediate Goals Reduce barriers to enrollment Increase health care coverage 9

11 Increase the proportion of low income individuals who have access to and receive appropriate and culturally competent primary care services Strategies Participate in Medi Cal Managed care, the State of California s Medicaid Program, to provide comprehensive inpatient and outpatient care to Medi Cal managed care members in California Participate in Medi Cal Fee for Service which provides subsidized health care on a fee for service basis for Medi Cal beneficiaries not enrolled as KFHP members Provide Medical Financial Assistance, which assists patients in need by subsidizing all or a portion of their KP medical expenses for a period of time. Eligibility is based on prescribed level of income, expenses and assets Provide subsidized health care coverage which provides comprehensive benefits to children (birth through age 18) in families with income up to 300% of the federal income guidelines who lack access to employer subsidized coverage and do not qualify for public programs because of immigration status or family income Work with Operation Access, a non profit organization dedicated to providing access to free surgery and specialty care, to enable KP medical volunteers to provide free outpatient consultations, specialty care and same day surgery appointments to uninsured patients Grant making to safety net providers of primary care Grant making to increase awareness and use of low/no cost options for primary care Expected Outcome Increase access to and use of primary care services Asthma prevention Long term Goal Decrease the negative impacts of asthma on children and adults in the KFH Walnut Creek service area Intermediate Goals Reduce the prevalence of asthma in low income communities Decrease hospitalizations and days lost from school because of asthma and asthma related emergencies Strategies Grant making to provide financial support for community and public health asthma prevention programs Provide community based health education materials and classes focused on asthma management, targeting children who are seen in emergency settings and their families Expected Outcomes Reduction in environmental and residential conditions associated with high rates of asthma Decrease in health emergencies resulting from asthma, particularly among low income children Broader health care system needs in our communities Workforce Long term Goal To address health care workforce shortages and cultural and linguistic disparities in the health care workforce Intermediate Goal Increase the number of skilled, culturally competent, diverse professionals working in and entering the health care workforce to provide access to quality culturally relevant care 10

12 Strategies Implement health care workforce pipeline programs to introduce diverse, underrepresented school age youth and college students to health careers Provide workforce training programs to train current and future health care providers with the skills, linguistic, and cultural competence to meet the health care needs of diverse communities Disseminate knowledge to educational and community partners to inform curricula, training and health career ladder/pipeline programs To leverage CB funded programs to develop strategies to increase access to allied health, clinical training and residency programs for linguistic and culturally diverse candidates Increase capacity in allied health, clinical training and residency programs to address health care workforce shortages through the provision of clinical training and residency programs Leverage KP resources to support organizations and research institutions to collect, standardize and improve access to workforce data to enhance planning and coordination of workforce training and residency training programs Expected Outcomes Increase the number of diverse youth entering health care workforce educational, training programs and health careers Increase the number of culturally and linguistically competent and skilled providers Increase awareness among academia of what is required to adequately train current and future allied health, clinical and physician residents on how to address the health care needs of our diverse communities Increase the participation of diverse professionals in allied health, clinical training and residency programs Improve access to relevant workforce data to inform health care workforce planning and academic curricula Research Long term Goal To increase awareness of the changing health needs of diverse communities Intermediate Goal Increase access to, and the availability of, relevant public health and clinical care data and research Strategies Disseminate knowledge and expertise to providers to increase awareness of the changing health needs of diverse communities to improve health outcomes and care delivery models Translate clinical data and practices to disseminate findings to safety net providers to increase quality in care delivery and to improve health outcomes Conduct, publish and disseminate high quality health services research to the broader community to address health disparities, and to improve effective health care delivery and health outcomes Leverage KP resources to support organizations and research institutions to collect, analyze and publish data to inform public and clinical health policy, organizational practices and community health interventions to improve health outcomes and to address health disparities Expected Outcomes Improve health care delivery in community clinics and public hospitals Improve health outcomes in diverse populations disproportionally impacted by heath disparities Increase the availability of research and publications to inform clinical practices and guidelines 11

13 X. Evaluation Plans KFH Walnut Creek will monitor and evaluate the strategies listed above for the purpose of tracking the implementation of those strategies as well as to document the anticipated impact. Plans to monitor will be tailored to each strategy and will include the collection and documentation of tracking measures, such as the number of grants made, number of dollars spent, number of people reached/served, number and role of volunteers, and volunteer hours. In addition, KFH Walnut Creek will require grantees to propose, track and report outcomes, including behavior and health outcomes as appropriate. For example, outcome measures for a strategy that addresses obesity/overweight by increasing access to physical activity and healthy eating options might include number of students walking or biking to school, access to fresh locally grown fruits and vegetables at schools, or number of weekly physical activity minutes. XI. Health Needs Facility Does Not Intend to Address Although nine significant community health needs were identified through the CHNA process, the Diablo Contributions Committee made the decision to address no more than four community health needs in order to enhance the impact of our investment and effort. The Contributions Committee process described above led to the decision not to address the following five needs directly as they did not rank as highly in terms of scale or severity of the problem, the ability to leverage existing KP or community assets, the existence of promising approaches or the presence of health disparities. In addition, there are other strong community partners who are currently addressing the needs below. While this Implementation Strategy Report responds to the CHNA and Implementation Strategy requirements in the Affordable Care Act and IRS Notices, it is not exhaustive of everything we do to enhance the health of our communities. KFH Walnut Creek will look for collaboration opportunities that address needs not selected where it can appropriately contribute to addressing those needs. The needs that will not be addressed are: 1. Economic Security 2. Affordable, Local Mental Health Services 3. Affordable, Local Substance Abuse Treatment Services 4. Local Specialty Care for Low Income Populations 5. Parenting Skills and Support 12