Implementation Strategy Report for Community Health Needs

2013 Implementation Strategy Report for Community Health Needs Kaiser Foundation Hospital SAN JOSE License #070000117

Kaiser Foundation Hospitals Community Health Needs Assessment (CHNA) Implementation Strategy Report 2013 Kaiser Foundation Hospital San Jose License #070000117 250 Hospital Parkway, San Jose, CA 95119 I. General Information Contact Person: Dawn F. Bussey, Interim Public Affairs Director Date of Written Plan: September 9, 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 San Jose 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. Geographically, the Kaiser Foundation Hospital (KFH) San Jose Service Area encompasses the following areas and cities in Santa Clara County: East San Jose, South San Jose and Southern Santa Clara County, including Morgan Hill and Gilroy. Over one quarter (27%) of the population served by the KFH San Jose Service Area are under the age of 18, while 39% are between the ages of 18 44, and over one third (34%) of the residents are over the age of 45. The KFH San Jose Service Area is also very diverse with 29% of the population White, 28% Asian, 38% Hispanic, 2% multi racial, 2% Black and 1% from another race. Nearly 50% of the children in the area are eligible for Free & Reduced Price lunch while one quarter of the population lives below the 200% Federal Poverty level. Over 1 in 10 people (13%) in the community is uninsured. The community is impacted by chronic diseases as diabetes is prevalent in 7% of the population, while heart disease prevalence is at 5%. The stroke mortality rate is 31 and cancer mortality rate is 139 per 100,000 people. 2

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. 3

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 San Jose s planned response to the needs identified through the 2013 Community Health Needs Assessment (CHNA) process. For information about KFH San Jose 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 San Jose 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 San Jose service area through the 2013 Community Health Needs Assessment process. Diabetes Obesity Violence Mental Health Oral/Dental Health Cardiovascular Disease, Heart Disease, and Stroke Substance Abuse Cancer Respiratory Conditions STDs, includinghiv AIDS Birth Outcomes Alzheimer's Disease Access to Health Care VII. Who was Involved in the Implementation Strategy Development The primary individuals involved were: Joanne Seavey Hultquist, Community Benefit Manager, Kaiser Permanente South Bay Public Affairs, San Jose and Santa Clara Community Benefit Contributions Committee members: Irene Chavez, Senior Vice President and Area Manager, Kaiser Permanente San Jose Chris Boyd, Senior Vice President and Area Manager, Kaiser Permanente Santa Clara Dawn Bussey, Interim Public Affairs Director, Kaiser Permanente San Jose and Santa Clara Cal Gordon, MD, Assistant Physician in Chief (APIC), Health Promotion, and Information Technology, Kaiser Permanente San Jose Todd Dray, MD, Assistant Physician in Chief (APIC), Member Outreach and Health Promotion, and Information Technology, Kaiser Permanente Santa Clara Mary Alice Ambrose, MD, Neurology & Chief of Patient Education, Kaiser Permanente Santa Clara Dao Nguyen, MD, Chief of Health Promotion and Patient Education, Kaiser Permanente San Jose Stephen Kalsman, Area Finance Officer, Kaiser Permanente San Jose Sean Fitzpatrick, Area Finance Officer, Kaiser Permanente Santa Clara 4

Consultants: Lisa Colvig Amir, Vice President of Evaluation, Applied Survey Research Jennifer van Stelle, PhD, Senior Research Analyst, Applied Survey Research Melanie Espino, Senior Research Analyst, Applied Survey Research In addition to working with the consultants at Applied Survey Research, we also collaborated with Kaiser Foundation Hospital San Mateo s Community Benefit Manager, Stephen Wahl. VIII. Health Needs that KFH San Jose Plans to Address a. Process and Criteria Used In order to select the health needs that KFH San Jose will address, the Community Benefit Contributions Committee (CBC) used the criteria listed below, which built on the criteria used in the CHNA prioritization process. In addition, we considered the ability for KFH San Jose to have a significant and meaningful impact on the needs given our expertise, our resources and the evidence base. KFH San Jose 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 criteria used were: Magnitude/scale of need: Large number of community members affected Severity of need: Has serious consequences including morbidity, mortality and/or economic burden Internal Kaiser Permanente assets exist to address need: Unique assets, expertise, or organizational commitment Existing/promising approaches to address need exist: Effective or promising strategies, preferably evidence based Health disparities for this need exist: Disproportionately impacts vulnerable population groups CBC members were provided with a copy of the CHNA report, and at a meeting on May 6, 2013, were given a presentation outlining key elements of each identified health need. After discussion, the CBC was provided with the criteria listed above and asked to vote, anonymously, for the five health needs they felt should be addressed by the organization. Once the votes were tallied, the three needs receiving the most votes were chosen, and then Access to Care was later chosen as an additional need with approval from the group. Discussion then took place over why other needs were not chosen or received far fewer votes, with members comments logged by the meeting facilitators. After the meeting, the team developed overall improvement goals. The consultants then conducted extensive literature reviews on the drivers of each of the chosen health needs/goals, to identify specific areas which would be appropriate for intermediate goals. The team met to determine intermediate goals based on the areas highlighted by the literature reviews and identify internal assets/programs that targeted these goals; then the consultants, using certain resources provided by Kaiser Permanente s Northern California Regional Office and other resources identified independently, reviewed evidencebased strategies that would target those intermediate goals. Together, the team then chose evidencebased strategies that would have the intended impact of achieving the implementation strategy goals, and outlined expected outcomes and tracking metrics. The Implementation Strategy Workplan Tables were then drafted and shared with the CBC for their input. The Workplan Tables were then finalized incorporating this input. 5

b. Health Needs that KFH San Jose Plans to Address The needs listed below were chosen based on a review of key health indicators identified in the hospital s CHNA report and a comparison by the CBC of all prioritized CHNA health needs using the five criteria listed in the previous section. A. Obesity (renamed Healthy Eating/Active Living to better capture the strategies needed to address the issue) is a health need among residents in the South Bay Area as evidenced by high rates of obesity among adults and children. Poor diet and lack of exercise are related to lack of knowledge about nutrition and exercise and poor attitudes about healthy eating and exercise. This health need was also selected because the magnitude of the problem is high, severely impacts our community, disparities exist among low income populations and in the Latino community. Furthermore, there are many evidence based practices that can be employed to address the problem and KFH has assets that can help combat this need. B. Poor mental health and substance abuse (renamed Behavioral health as a broad term for both issues) is a health need among residents in the South Bay, because of economic stress and environmental conditions; negative coping skills; lack of awareness of, or poor attitudes about, symptoms/treatment; and low access to treatment. This health need was also selected because community input indicated it was a problem that is not being addressed well with resources currently available in the community. Low income populations were also noted to have behavioral health issues that were going untreated. C. Violence is a health need among residents in the South Bay, because of economic stress and environmental conditions; lack of coping skills; and low access to treatment for mental health issues. This health need was also selected due to the significant rise in homicides in the city of San Jose as well as the prevalence of bullying in local schools. Low income youth of color are being disproportionally affected by violence in the South Bay. D. Access to Health Care is a need among residents in the South Bay, because of lack of health insurance; lack of transportation; and lack of health care providers, especially for those who do not speak English. 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. This health need was also selected because low income residents in the South Bay have difficulty accessing specialty care because of limitations within the public system and lack of affordability of services. KFH assets can also be leveraged to address this problem. E. 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 6

awareness of the changing health needs of diverse communities, addresses health disparities and improves effective health care delivery and health outcomes. IX. KFH San Jose s Implementation Strategies As part of the Kaiser Permanente integrated health system, KFH San Jose 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 San Jose 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 San Jose will continue to work in partnership to refine its goals and strategies over time so that they most effectively address the needs identified. Healthy Eating/Active Living Long term Goal Increase healthy eating and active living among children, youth, and adults Intermediate Goals Increase knowledge and skills about healthy eating among children, youth and adults Increase access to healthy foods Increase motivation and access to physical activity among children, youth and adults Increase healthy eating and physical activity among children, youth and adults Strategies Provide grants or sponsorships for efforts such as: Nutrition education and skill building programs that support healthy eating Providing breastfeeding education for worksites and support training in hospitals/clinics Adoption of policies and practices to restrict the availability of unhealthy foods, increase the availability of healthier foods and reduce overconsumption of sugary beverages Increasing the accessibility to farmers markets and the use of EBT for fresh fruits and vegetables Creating/enhancing places for physical activity and programs that increase physical activity Allocate KP Resources to support healthy eating and active living such as: Implementing Thriving Schools, a national initiative of KP that targets resources to schools in low income neighborhoods to improve the health and wellness of students and employees through improved nutrition, increased physical activity, and access to health care Promoting Farmer s Markets, health education materials and conducting clinician presentations Promoting physical activity or healthy eating initiatives such as Healthy Trails, ReThink your Drink, Everybody Walk and Weight of the Nation 7

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 Participate in collaboration & partnerships to promote healthy eating and/or active living such as: Participating in The Bay Area Nutrition and Physical Activity Collaborative (BANPAC) Leadership Team and policy or program initiatives focused on nutrition and physical activity Participating in Let s Move Salad Bars to Schools in partnership with local organizations Participation in the Collaborative Addressing Childhood Obesity in Sunnyvale Expected Outcomes Create policies/ practices that support increased physical activity and improved access to healthy foods Increase in physical activity and consumption of fresh fruits and vegetables Decrease access to less healthy foods and beverages Improve attitudes and awareness about good nutrition, physical activity and breastfeeding Increase resource sharing and best practices around nutrition and physical activity among community partners Behavioral Health Long term Goals Reduce stress and depression among South Bay residents Reduce substance abuse among South Bay residents Increase access to trauma informed mental health care Intermediate Goals Improve self care and coping skills among youth and adults Increase family functioning, especially practice of positive parenting Reduce alcohol and drug use among South Bay youth Service providers practice trauma informed care Strategies Provide grants or sponsorships for programs such as: Cognitive behavioral group prevention/intervention programs or trainings for adolescents or adults focused on coping with stress, anxiety or depression to improve general mental health Group cognitive behavioral therapy for children, adolescents who have experienced trauma and training for service providers about ACES/trauma and trauma focused care Group cognitive behavioral therapy for offenders to reduce recidivism and violent crime Addiction education or programs for youth to prevent alcohol, tobacco, and marijuana use Parent and youth substance use and aggression reducing programs focused on skill building Programs providing early childhood screening for developmental delays and behavioral problems Programs, home visiting or support groups for parents that increase family functioning Participate in collaborations and allocate KP resources to support positive mental health: Participating in the Santa Clara County Mental Health Department s School Linked Services Collaborative, which coordinates social services at schools to provide youth with the knowledge and skills necessary to ensure a healthy transition to successful adult roles and responsibilities Distributing KP health education resources on coping with stress, anxiety and depression Expected Outcomes Increase positive communication skills and personal and social skills that build resilience Increase knowledge of coping with peer pressure, depression and stress reducing practices Increase early screening and prevention Increase value of/practice of positive parenting 8

Increase access to culturally competent and trauma informed mental health services Violence Long term Goals Reduce youth and family violence among South Bay residents Improve the safety of public environments where residents go to school, live and work Provide trauma informed & mental health care to youth (at risk, as well as offenders) Intermediate Goals Improve self care and coping with stress among youth without the use of violence Improve healthy relationships between family members in terms of engagement and connection Create safe environments where children go to school and people live and work Mental Health Service providers practice trauma informed care Strategies Provide grants or sponsorships for programs such as: Mentoring programs for high risk youth Life skills education to develop healthy relationships, coping and healthy response skills Cognitive behavioral group prevention/intervention programs or trainings for adolescents or adults focused on coping with stress, anxiety or depression to improve general mental health Programs for parents that teach effective parenting and communication skills, positive discipline, and focus on developmental stages of children and positive parent child interactions Programs to prevent intimate partner violence or family violence Routine screening by clinical and mental health professionals for intimate partner violence Programs that create caring school climates that discourage bullying and reduce violence Participate in collaboration & partnerships such as: Participating in the Santa Clara County Public Health Department Injury and Violence Prevention Collaborative Collaborating on violence prevention campaigns Allocate KP Resources to support violence prevention programs such as: 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 Distributing health education materials on stress reduction and healthy coping skills Clinician speakers at violence prevention forums or community events Expected Outcomes Adopt policies or practices that promote positive climates in schools, workplaces or neighborhoods Improvement in school norms among staff, students and parents and youth feeling safe at school Improvement in attitudes about peer violence and non violence Increase knowledge of coping with peer pressure, depression, healthy relationships and stressreducing practices Increase family engagement in lives of youth, positive communication skills, and effective coping skills Increase screening for intimate partner violence Access to Health Care Long term Goal Increase number of people who have access to appropriate health care services Intermediate Goals Reduce barriers to enrollment and increase health care coverage 9

Improve access to culturally competent care Reduce workforce shortages Strategies Provide grants, sponsorships or in kind support to community health centers, clinics or Federally Qualified Health Centers for efforts such as: Expanding use of community health workers or utilizing patient navigators to provide culturally sensitive assistance and care coordination Interventions to improve health literacy Establishing a Medical Home with an emphasis on preventative care and screening Oral health services Participate in collaborations, partnerships or provide sponsorships for workforce development: Participate in the Community Benefit Hospital Coalition, which shares information on funding strategies and collaborates on projects that benefit the health of the community Sponsor programs focused on exposing youth and young adults to health care opportunities or build capacity of health care workers to provide culturally competent care to patients Allocate KP Resources to support: 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 Implement SYEP, a program that offers paid summer internships for underserved high school students at Kaiser Permanente medical centers and administrative offices throughout NCAL Participate in, and implement activities, that support three college level internship programs that offer paid employment opportunities to underrepresented college students at Kaiser Permanente medical centers and administrative offices throughout NCAL Expected Outcomes Increase access to health care coverage and health care services Increase utilization of health care services Increase leveraging of hospital resources Increase in knowledge about health care careers Increase in knowledge about care delivery 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

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

X. Evaluation Plans KFH San Jose 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 San Jose 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 A. Birth outcomes Description: Birth outcomes are often of concern for mothers of color. Although the percentage of low birth weight babies in Santa Clara County overall is about the same as the state average (approximately 7%), African Americans in Santa Clara County have higher percentages of low birthweight babies (9%), pre term babies, and infant mortality. A driver of this health need is inadequate early prenatal care. Explanation why not chosen: Magnitude of the problem is small since overall indicators meet targets. African Americans are a small percentage of the population, and the Santa Clara County Public Health Department has an effective, existing Black Infant Health Program addressing this need. B. Cancers Description: Cancer incidence and mortality rates in Santa Clara County are higher than national benchmarks or state averages for breast, cervical, liver and prostate cancers. Certain ethnic subgroups experience different incidence and mortality rates. For instance, the overall county liver cancer mortality rate is 6.8, but is worse for county Latinos (9.0) and Asian/Pacific Islanders (11.9). Health behaviors including smoking and drinking, and lack of cancer screening contribute to these poor outcomes. Explanation why not chosen: The spectrum of the problem is so broad that Community Benefit investments could not impact it. Kaiser Permanente already has significant investment in research around this health need. Santa Clara County Public Health Department has an initiative to reduce smoking rates that could prevent lung cancer. C. Cardiovascular disease, heart disease, stroke Description: Cardiovascular disease, heart disease and stroke are among the top ten causes of death in Santa Clara County and statewide. The overall rate of high cholesterol in the county (29%) is higher than the HP2020 target (17%), as are the rates for all ethnic groups. Behaviors including smoking, drinking, poor nutrition and lack of exercise are related to poor cardiovascular health. Explanation why not chosen: The ability to make an impact with limited Community Benefit funds is low. KFH is already addressing this need through Public Affairs sponsorships. There is the potential to affect this need with obesity prevention efforts (one of the chosen needs). D. Alzheimer's disease Description: Alzheimer's disease is one of the top ten leading causes of death in the county. This health need is expected to become even more prevalent with the increasing proportion of county residents over 60 years old, and the proportion living with Alzheimer s disease. It is estimated that between 2015 and 2030, Santa Clara County will see a 78% increase in the population 55 and older with Alzheimer s disease. 12

Explanation why not chosen: No prevention opportunity/promising approaches exist. Need more data on the population affected. E. Diabetes Description: Diabetes is a problem for both adults and youth, particularly those of color. The prevalence of diabetes among adults is 8% (no better than the state average of about 8%), but for the county s African American population diabetes prevalence is 14%, and for Hispanic/Latinos it is 11%. Key drivers of diabetes include poor nutrition and lack of exercise, and environmental factors such as lower availability of fresh food and an overabundance of fast food. Explanation why not chosen: Type 2 (majority of cases) can be addressed through same strategies as obesity (which is a chosen need). F. Oral/dental health Description: Oral/Dental Health problems were reported by youth and adults alike. About 16% of youth surveyed said that their teeth were in fair or poor condition, which is worse than the state average (12%). Also, some ethnic subgroups are less likely to have dental insurance, which is a driver of poor oral health. In a 2009 survey by the Santa Clara County Department of Public Health, about a third of adults reported that they had experienced tooth loss due to gum problems or tooth decay. About half of African American adults reported tooth loss. The Santa Clara County Community Benefit Coalition has designated oral health as a health need that merits more research, especially because of its effect on school attendance for children. Explanation why not chosen: Not many internal assets (resources nor expertise). Needs to be addressed at a systems level, including increasing numbers of dentists who accept Denti Cal. Specific, effective approaches could be incorporated under Access to Care (which is a chosen need). G. Respiratory conditions Description: Respiratory Conditions are a health need as indicated by the high asthma hospitalization rate of Santa Clara County children ages 0 4 (24.5 per 10,000). Asthma prevalence among county adults is no better than the HP2020 target of 13% and should be monitored. The health need is likely being impacted by smoking among youth/adults as well as poor air quality levels. Community input demonstrated a concern about the costs of asthma treatment due to lack of medical insurance. Explanation why not chosen: Need is not as great as others. Currently being addressed by health care systems directly. H. Sexually Transmitted Diseases, including HIV AIDS Description: Sexually Transmitted Diseases, including HIV AIDS were prioritized as a health need in part due to the disproportionately high HIV incidence rates among African Americans (50.4, compared with 10.3 overall). The health need is likely driven by low screening rates and lack of prevention education. Explanation why not chosen: County as a whole meeting targets. The Santa Clara County Public Health Department addresses this issue; they have a specific new campaign underway. 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 San Jose will look for collaboration opportunities that address needs not selected where it can appropriately contribute to addressing those needs. 13