Implementation Strategy Report for Community Health Needs

2013 Implementation Strategy Report for Community Health Needs Kaiser Foundation Hospital RICHMOND License #140000052

Kaiser Foundation Hospitals Community Health Needs Assessment (CHNA) Implementation Strategy Report 2013 Kaiser Foundation Hospital Richmond License # 140000052 901 Nevin Avenue Richmond, CA 94801 I. General Information Contact Person: Jennifer Scanlon, 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, 94 1105628 Address of Hospital Organization: One Kaiser Plaza, Oakland, CA 94612 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

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 Richmond 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) Richmond service area covers the western portion of Contra Costa County. The majority of the service area is urban, with some open space in the East Bay Regional Park District. The service area is bounded by the San Francisco Bay on the west side, San Pablo Bay to the north, and a ridge of hills on the east side. The service area has a total population of 242,277, representing 24% of the population of Contra Costa County. The remainder of Contra Costa County is served by KFH Antioch and KFH Walnut Creek. KFH Richmond serves the cities of San Pablo, Pinole, Hercules, Richmond and El Cerrito. 2

More than half of the KFH Richmond service area residents are adults between the ages of 18 64. The area s diverse demographics indicate that 45.7% are White, 19.2% are Black, 19.4% are Asian, 0.32% are Pacific Islander, 4.6% are Multi Race, 0.43% are Native America, and 31.2% are Latino. Nearly 13% of KFH Richmond service area residents live in poverty, approximately 16% are without health insurance, and 17.82% do not have high school diplomas. 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 3

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 2013. This implementation strategy describes KFH Richmond s planned response to the needs identified through the 2013 Community Health Needs Assessment (CHNA) process. For information about KFH Richmond s 2013 CHNA process and for a copy of the report please visit http://share.kaiserpermanente.org/article/community 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 Richmond 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 Richmond service area through the 2013 Community Health Needs Assessment process. The health needs are listed in priority order. Violence prevention Local, comprehensive and coordinated primary care, including peri natal care Economic security Asthma prevention and management Affordable community based mental health services Healthy eating Safe outdoor spaces Exercise and activity Local specialty care for low income populations Affordable community based substance abuse services VII. Who was Involved in the Implementation Strategy Development The implementation strategy development team at KFH Richmond included the following stakeholders representing Kaiser Foundation Hospital/Health Plan and the Permanente Medical Group, as well as area service providers. Kaiser Permanente Stakeholders Julie Hadnot, Director, Public Affairs Carol Azar, Manager, Health Education Erica Browne, Community Benefit Manager, Public Affairs Millicent Hunter, Compliance and Privacy Officer, Compliance Flo Raskin, Continuum Administrator, Continuing Care Juliette Fershtman, Patient Care Experience Leader, Administration Heather Keith Spellman, Communications Manager, Public Affairs Michon Coleman, Community and Government Relations Manager, Public Affairs Susan Lindheim, Physician, Pediatrics Karen Grisnak, Chief Operating Officer, Administration Cynthia Carmichael, Physician, Medicine 4

Kimberly Duir, Physician, Medicine Nicole Barnett, Assistant Medical Group Administrator, Administration Glenda Monterroza, Community Benefit Specialist, Public Affairs Adonna Osullivan, Senior Public Affairs Representative, Public Affairs Jodi Ravel, Group Leader, Community Benefit Northern California Region Beatriz Campos, Assistant Manager of Diabetes, Nutrition and Weight Management, Health Education Department, Kaiser Permanente In addition to the KFH Richmond stakeholders, the following community stakeholders contributed to the implementation strategy development for violence prevention and healthy eating active living. Violence Prevention Community Stakeholders Porter Sexton, Program Manager, Pogo Park Kimberly Aceves, Executive Director, RYSE Center HC Lee, Executive Director, The Link to Children Bisa French, Captain, Richmond Police Department Cynthia Peterson, Manager, Community Violence Solutions Lorena Huerta, Interim Executive Director, Familias Unidas Linnea Ashley, National Training and Advocacy Manager, Youth Alive! Charlene Harris, Executive Director, Circles of Hope Rebecca Bauen, Manager, Family Violence Law Center Jane Wise, Program Director, Alternatives in Action Nwamaka Agbo, Deputy Director, The Ella Baker Center Tamar Kurlaender, Manager, Native American Health Center Don Lau, Senior Vice President, YMCA of the East Bay Sabrina Wu, Project Director, HOPE Collaborative Lynn Martin, Executive Director, Early Childhood Mental Health Program Samantha Bell, Epidemiologist, Alameda County Public Health Crystal Johnson, Director of Clinical Services, The Wright Institute Kym Sites LMFT, Clinical Director, The Link to Children Healthy Eating and Active Living Community Stakeholders Anisha Johnson, Richmond High Clinic Coordinator, Contra Costa Health Services Allison Pratt, Program Manager, Alameda County Community Food Bank Michelle Oppen, Program Manager, Coordinated School Health, Oakland Unified School District Lianna Adauto, Program Office, East Bay Community Foundation Tonya Love, Program Coordinator, Healthy & Active Before 5 Toody Maher, Executive Director, Pogo Park Theresa Dade Boone, Pinole Valley High Clinic Coordinator, YMCA of the East Bay Tracey Rattray, Director of Community Wellness & Prevention Programs, Contra Costa Health Services Luz Gomez, Senior Staff, Office of Supervisor John Gioia Barbara Mccullough, Executive Director, Brighter Beginnings Laura Binczak, Oakland Unified School District Diane Woloshin, Program Manager, Alameda Country Public Health Department Linda Franklin, Alameda County Public Health Department Robyn Kumar, Nutritionist II, Alameda County Public Health Department Christina Weahunt, Nutrition and Fitness Director, Native American Health Center Maria Tiangha, Nutrition Coordinator, City of Oakland Head Start The process was led by staff from KFH Richmond Community Benefit and facilitated by Coleman Smith LLC, a consultant group. 5

VIII. Health Needs that KFH Richmond Plans to Address a. Process and Criteria Used KFH Richmond s Community Benefit Advisory Group (CBAG) the contributions committee comprised of KFH Richmond physicians, employees, and administrative leaders that review and approve all Community Benefit grants from the local Community Benefit budget led the process of selecting health needs, and defining goals, strategies, outcomes and tracking metrics. Engaging multiple stakeholders over a five month process, KFH Richmond s CBAG employed a three phase process that included the experiences and perspectives of practitioners (health and service oriented), government service agency employees, school district staff and community leaders. Phase I: Health Needs Selection In order to select the health needs that KFH Richmond will address, the CBAG used the criteria listed below, which built on the criteria used in the CHNA prioritization process. In addition, we considered the ability for KFH Richmond to have a significant and meaningful impact on the needs given our expertise, our resources and the evidence base. KFH Richmond 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. The CBAG first discussed each health need and scored them against the six criteria described below using a scale of 1 3. Scores were tallied, and in an attempt to validate the group s selections, an additional process was applied. Considering the relevance of the criteria, the CBAG members (individually) voted for their top three health needs (and simultaneously their bottom three health needs). Votes were tallied, and the top selected and ranked health needs were chosen as needs that KFH Richmond would address. The criterion used were: Magnitude/Scale of the Problem: The health need affects a large number of people within the community Severity of Problem: The health need has serious consequences (morbidity, mortality, and/or economic burden) for those affected Kaiser Permanente Assets: KP has relevant expertise and/or unique assets as an integrated health system to make a meaningful contribution Existing or Promising Approaches: There are effective or promising strategies to address the need Health Disparities: The health need disproportionately impacts the health status of one or more vulnerable population groups Community Prioritization: The community prioritizes the health need over other health needs Phase II: Goals Definition Informed by a literature review of evidence based strategies, KP Program Office and regional Community Benefit provided a list of preliminary long term and intermediate goals which were reviewed and considered by KFH Richmond CBAG members. The final set of long term and intermediate goals for each health need were also informed by strategies implemented during previous KFH Richmond grant funded programs. Using a consensus approach, CBAG agreed on a draft list of long term and intermediate goals. Once CBAG defined the long term and intermediate goals, a group of external experts were convened to gather feedback and validate the long term and intermediate goals for Violence Prevention and Healthy Eating Active Living. Once informed by the external expert feedback, the final long term and intermediate goals were then defined and confirmed. 6

Phase III: Strategies, Outcomes & Metrics Development The external experts that were gathered to confirm the long term and intermediate goals also offered strategies and outcomes for CBAG to consider. Guided by a broad discussion about local best practices and KP assets and engagement opportunities, external experts presented CBAG with a draft list of strategies and related outcomes. From this list the KFH Richmond CBAG considered over 45 strategies for each of the selected health needs and developed a final list of strategies, with accompanying outcomes and metrics. b. Health Needs that KFH Richmond Plans to Address Local, comprehensive and coordinated primary care has been framed more broadly as Access to Care in order to more accurately reflect the full range of strategies planned to address the health care access issues facing vulnerable populations in the KFH Richmond service area. 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. Access to Care supports the provision of comprehensive, quality health care services to promote prevention, chronic disease management and health equity in the KFH Richmond service area. In West Contra Costa County, limited access to care has a severe and disproportionate impact on low income communities, with lack of insurance being the primary barrier to care. While the Affordable Care will provide increased access to care starting in January 2014, it will not necessarily address the specialized needs of low income populations. Some low income populations, because of their immigration status, are ineligible for coverage under the new plans, and others may find the required premiums beyond their reach. For these groups, access barriers will certainly continue to exist. Healthy Eating and Exercise and Activity, shortened to Healthy Eating Active Living, seeks to support healthy weight management, and the prevention and management of related chronic conditions, in an effort to reduce overweight and obesity in the KFH Richmond service area. Healthy eating has significant health benefits. There is 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 the KFH Richmond service area, 6.5% of residents live in areas designated as food deserts, and there are only 12.4 WIC authorized food stores per 100,000, while statewide that number is 15.8 per 100,000. Poor health outcomes in the KFH Richmond service area that are likely to be related to poor eating habits include overweight and obesity, some cancers, diabetes and heart disease. Like healthy eating, many barriers to exercise and activity exist in poor or vulnerable communities. These communities tend to have poor access to parks and recreation facilities, higher rates of crime and violence, and fewer commercial areas that promote walking. Poor health outcomes in the KFH Richmond service area that are likely to be related to inadequate exercise and physical activity include overweight and obesity, heart disease and stroke. Violence Prevention is a public health issue that continues to plague communities in the KFH Richmond service area, and is influenced by a lack of adequate mental health services and economic insecurity. Violence in the KFH Richmond service area is particularly present in neighborhoods in the City of Richmond itself. Community members, public health experts, and Richmond and Contra Costa County government officials and agencies have all placed a high priority on decreasing violence in Richmond, particularly among young people. According to CityRating.com and based on FBI crime 7

statistics, the city violent crime rate for Richmond in 2010 was higher than the national violent crime rate average by 181.65%... In 2010 the city violent crime rate in Richmond was higher than the violent crime rate in California by 158.04%. Asthma Prevention and Management seeks to improve school attendance, workforce productivity and absenteeism, and overall quality of life in the KFH Richmond service area. Asthma is a serious health issue for both children and adults in the KFH Richmond service area. Asthma can affect the development of young children in multiple ways, both physically and cognitively. In Richmond, the school district reports that asthma is 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 and management are needed in the communities served by KFH Richmond. Asthma prevalence in the KFH Richmond service area is 15.84%, which is 2.62% higher than the statewide prevalence rate. Those with asthma are going to the hospital at very high rates the age adjusted rate of asthma discharges per 10,000 is 17.78, which is twice the state rate of 8.9 per 10,000. 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 Richmond s Implementation Strategies As part of the Kaiser Permanente integrated health system, KFH Richmond 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 8

KFH Richmond 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 Richmond will continue to work in partnership to refine its goals and strategies over time so that they most effectively address the needs identified. Access to Care Long term Goal Increase number of low income people who have access to appropriate health care services in West Contra Costa County Intermediate Goals Increase access to, enrollment in, and maintenance of health care coverage Increase access to specialized, culturally appropriate care 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 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 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 Collaborate 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 support Federally Qualified Health Centers, community health centers, and free clinics to provide culturally responsive health care to vulnerable populations Grant making to train and support patient navigators in the provision of culturally sensitive assistance, care coordination, and guiding patients through available medical, insurance, and social support systems Expected Outcomes Increased access to care Increased number of patient navigators Increased access to culturally responsive care Healthy Eating Active Living Long term Goal Reduce the number of overweight and obese children, adolescents, and adults in low income West Contra Costa County communities Intermediate Goals Increase healthy eating among children and families Increase physical activity in schools, community and institutional settings Strategies Grant making to ensure strong nutritional foods and beverages standards and policy implementation, food literacy skills development, and nutrition education in schools, preschools, and childcare settings 9

Grant making to support urban agriculture programs, farmer s markets and on site nutrition education targeting low income residents Grant making to promote adoption of health promoting food and beverage retailing and distribution policies and programs 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 Leverage internal health education resources, clinical and organizational practices that promote breastfeeding friendly environments, and healthcare providers encouraging breastfeeding and healthy weight gain during pregnancy Leverage internal health education resources, organizational practices, and KP volunteerism resources to promote the adoption of policies and implementation of practices to reduce overconsumption of sugar sweetened beverages and encourage water consumption Grant making to promote and support community based physical activity programs for children, adolescents and adults, including social support interventions that strengthen social networks Grant making to support programs that create and enhance physical activity spaces in combination with educational outreach activities Grant making and leveraging internal resources to promote adoption and implementation of quality physical education and physical activity programs in schools in partnership with the West County Community Schools initiative Expected Outcomes Increased access to affordable healthy foods and beverages Increased awareness and consumption of healthy food and beverage options (including water) Increased engagement of community business partners Increased participation in nutrition education Increased promotion of breastfeeding Decreased consumption of sugar sweetened beverages Increased access to and adoption of physical activity, and physical activity programs (including physical education) Increased social cohesion Increased awareness of importance of physical activity and reducing screen time Violence Prevention Long term Goal Reduce the number of adolescents, young adults, and people of color exposed to violence, including witnesses, survivors and perpetrators Intermediate Goals Create and maintain safe environments in schools, residential neighborhoods, and workplace settings Increase skills building and employment opportunities for high risk youth Increase access to services that identify, address and prevent domestic violence Increase access to trauma informed, mental health services and training Strategies Grant making to expand and sustain the provision of school based conflict resolution, bullying prevention, and restorative justice programs and training Grant making to support universal school based violence reduction programs, including comprehensive cognitive and social development programs for pre kindergarten, low income children Provide KP s Educational Theater, a free theater program designed to disseminate health education and inspire, to promote conflict resolution and responsibility among students Sponsorships to promote family and community focused extracurricular activities in neighborhood settings, including family justice programs 10

Leverage internal intellectual assets, communication resources and technical expertise resources and influence to increase awareness and accountability for corporate involvement in community safety Grant making to support youth leadership development, entrepreneurship, and skills building programs Grant making to support family focused domestic violence prevention and support services Leverage internal intellectual assets and clinical practices developed by the Kaiser Permanente Family Violence Prevention Program to promote collaboration with community agencies Grant making to support school based mental health services, including cognitive behavioral therapy to reduce psychological harm resulting from trauma exposure Grant making to support community based mental health and case management services, including cognitive behavioral therapy for young adult/adult offenders Leverage internal intellectual assets, clinical expertise and training resources to support collaborations with community (non KP) providers emphasizing trauma informed care capacity building Leverage internal clinical practices and training resources to support implementation of trauma informed, hospital based violence prevention programs Expected Outcomes Increased participation in restorative justice programs, conflict resolution programs and bullying prevention programs Reduced number of campus conflicts and number of intentional injuries on campus Increased participation in violence prevention education and conflict resolution training Increased access to mental health screening and services, and early cognitive and social development programs Increased number of youth trained in entrepreneurship and vocational skills Increased awareness of alternatives to violence Increased access to safe outdoor activities Increased engagement of KP leaders, physicians, and staff Increased awareness among community businesses about their role in safety promotion Increased access to domestic violence support services Increased availability of trauma informed care training resources Asthma Prevention Long term Goal Reduce asthma episodes among high risk children and adolescents residing in West Contra Costa County Intermediate Goals Improve asthma management among high risk asthma sufferers emphasizing environmental impacts and policies Improve asthma management among high risk children and adolescents through behavioral and clinical strategies Strategies Grant making to reduce exposures to home based environmental triggers (i.e. allergens, irritants) by implementing multicomponent interventions with an environmental focus Grant making to support establishing policies and procedures to support children with asthma in schools (including pre school) Grant making to educate children and families about creating asthma action plans Grant making to support connecting asthmatic patients to medical homes that provide access to continuous, comprehensive, asthma management care Sponsorships to train school staff to recognize the signs of an asthma attack and to support the appropriate use of medications Leverage internal clinical practices, health education materials and technical assistance resources to integrate asthma self management education into all aspects of asthma care 11

Expected Outcomes Increased home based and school based asthma management practice Decreased number of asthma episode incidents Decreased number of school based asthma emergencies Increased access to asthma care and decreased asthma hospitalizations and ER visits Increased school based capacity to support children with asthma Increased asthma management awareness, collaboration, and engagement of KP providers 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 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 12

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 X. Evaluation Plans KFH Richmond 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 Richmond 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 the 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 The remaining prioritized health needs for Richmond will not be addressed by KFH Richmond because, using the criteria described previously, they were not ranked as highly as access to care, healthy eating active living, violence prevention and asthma prevention. Specifically, economic security will be indirectly addressed through the access to care and violence prevention strategies. Affordable community based mental health services and affordable community based substance abuse services were not selected because of KP s limited capacity and assets to provide services that can impact the broader service area. Although safe outdoor spaces similarly was not selected as a priority health need because of KP s limited capacity and assets to provide such services, it is addressed in the violence prevention health need. 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 Richmond will look for collaboration opportunities that address needs not selected where it can appropriately contribute to addressing those needs. The health needs that will not be addressed are: 1. Economic security 2. Affordable community based mental health services 3. Safe outdoor spaces 4. Local specialty care for low income populations 5. Affordable community based substance abuse services 13