Implementation Strategy Report for Community Health Needs

2013 Implementation Strategy Report for Community Health Needs Kaiser Foundation Hospital REDWOOD CITY License #220000021

Kaiser Foundation Hospitals Community Health Needs Assessment (CHNA) Implementation Strategy Report 2013 Kaiser Foundation Hospital Redwood City License #220000021 1150 Veteran s Boulevard Redwood City, CA 94063 I. General Information Contact Person: Stacey K. Wagner, Public Affairs Director Date of Written Plan: September 6, 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 Redwood City 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) Redwood City Service Area encompasses those portions of San Mateo County termed central, south and coastside sub areas with a total population of 513,221, including the cities of Foster City, San Mateo, Atherton, Menlo Park, Palo Alto, East Palo Alto, Redwood City, Pescadero, Woodside, Portola Valley, Half Moon Bay, La Honda, and other coastside towns. Redwood City Service Area s population is 53.52% White, 3.04% African American, 16.69% Asian, 22.14% Hispanic, 0.18% Native American/Alaskan, 1.07% Native Hawaiian/Pacific Islander, 0.27% Other Race, 3.08% Multiple Races. The population identified as uninsured is 10.36%. The poverty rate (Below 100% FPL) for the service area is 7.24%. Residents lacking a high school diploma are 9.91%. Nearly one quarter (22.8%) are under the age of 18, while 38% are between the ages of 18 44, and nearly 40% are over the age of 45. Fifteen percent of the population 5 and older who speak a language other than English at home and speak English less than very well are linguistically isolated. This is relevant because an inability to speak English will creates barriers to health access, provider communications, and health literacy/education. In addition, mental health and substance abuse continues to affect many in our communities with over 43% of adults not knowing where to access treatment for drug related problems if needed. Over half the population is considered overweight and 10% of the population has diabetes with those numbers steadily increasing since 1998. Many area residents are healthier than in other places, however the data also demonstrates that preventable diseases are on the rise and we must do more to prevent these diseases from occurring in the first place. San Mateo County is recognized as one of the wealthiest counties in the United States, however health is not evenly distributed across the population and there are many communities that do not experience good health and a high quality of life. 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. 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 Redwood City s planned response to the needs identified through the 2013 Community Health Needs Assessment (CHNA) 3

process. For information about KFH Redwood City 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 Redwood City 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 Redwood City service area through the 2013 Community Health Needs Assessment process. Substance Abuse (Alcohol, Tobacco, and Other Drugs) Diabetes Obesity Poor Oral/Dental Health Poor Mental Health Cardiovascular Disease, Heart Disease, and Stroke Violence Infant Mortality Infectious disease STDs/HIV AIDS Cancer Respiratory Conditions Access to Health Care Services VII. Who was Involved in the Implementation Strategy Development The primary individuals involved were: Stephan Wahl, Community Health and Benefit Manager, Kaiser Permanente Medical Centers, San Mateo County Kaiser Permanente Community Benefit Advisory Board, Redwood City: Kaiser Foundation Health Plan Frank T. Beirne, Sr. VP & Area Manager Katherine Bond, RN, Chronic Conditions Case Manager Kathleen Steele, Social Services Manager Matthew Jacobs, Community & Government Relations Manager Maureen O Brien, Chief Operation Officer Stacey Wagner, Public Affairs Director Stephan Wahl, Community Benefit Manager The Permanente Medical Group Cameron D Alpe, Asst. Medical Group Administrator Maggie Kelly Lieras, CCM Program Asst. Marco Baisch, MD, Pediatrics Scott Brown, Health Education Director 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 VIII. Health Needs that KFH Redwood City Plans to Address a. Process and Criteria Used In order to select the health needs that KFH Redwood City will address, the Community Benefit Advisory Board (CBAB) used the criteria listed below, which built on the criteria used in the CHNA prioritization process. In addition, we considered the ability for KFH Redwood City to have a significant and meaningful impact on the needs given our expertise, our resources and the evidence base. KFH Redwood City 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. Magnitude: A large number of community members are affected Clear disparities/inequities exist among subpopulations in the community The community prioritizes the issue over other issues Effective or promising approaches exist to address the problem Kaiser Permanente assets exist (unique assets, expertise, or organizational commitment) CBAB members were provided with a copy of the CHNA report, and at a meeting on April 3, 2013, were given a presentation outlining key elements of each identified health need. After discussion, the CBAB 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, five needs receiving the most votes were chosen. These five were then condensed to two based on discussions about potential impact and high level prevention strategies that could prevent multiple conditions, and then access was later chosen as an additional need with approval from the group. Discussion followed about the reason why some health conditions were chosen and others were not. Meeting facilitators logged the reasons why other needs were not chosen or received far fewer votes in order to meet the IRS requirement of providing an explanation about why needs were not chosen. After the meeting, the team developed overall improvement goals. Our consultants then conducted extensive literature reviews on the drivers of each of the chosen health needs/goals, to identify 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 resources provided by Kaiser Permanente s Northern California Regional Office and other resources identified independently, reviewed evidence based strategies that would target those intermediate goals. Together, the team then chose evidence based strategies that would have the intended impact of achieving the implementation strategy goals, and outlined expected outcomes and tracking metrics. b. Health Needs that KFH Redwood City 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 CBAB of all prioritized CHNA health needs using the five criteria listed in the previous section. A. Substance Abuse and Poor Mental Health, combined as one health need under the broader term Behavioral Health, is a health need among residents in the San Mateo Area because of economic 5

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 met criteria 1 4. B. Obesity, Diabetes, Cardiovascular Disease, Heart Disease and Stroke (renamed as a single health need, Healthy Eating/Active Living, to better capture the types of strategies that are effective in addressing these health issues) are health needs among residents in the San Mateo Area as evidenced by high rates of obesity among adults and children, type 2 diabetes, cardiovascular disease, heart disease, and stroke. Poor diet and lack of exercise are related to lack of knowledge and poor attitudes about healthy eating and exercise. This health need met all 5 criteria. C. Access to Health Care Services is a need among residents in the San Mateo Area, 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. D. 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 Redwood City s Implementation Strategies As part of the Kaiser Permanente integrated health system, KFH Redwood City 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 Redwood City 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 6

be achieved without joint planning and partnerships with community stakeholders and leaders. As such, KFH Redwood City 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 Decrease rates of overweight and obesity among children, youth and adults Intermediate Goals Increase healthy eating among children, youth and adults Increase physical activity among children, youth and adults Strategies Provide grants for nutritional education programs which are focused on specific behaviors (e.g., eating fruits and vegetables) and recognize motivations of students/participants Provide grants that support physical activity or physical fitness programs Provide KP programs (Educational Theater and Thriving Schools) to isolated/underserved areas whose schools have not participated in the past to educate students and staff on the benefits of eating healthy and being physically active and provide opportunities for healthy eating and physical activity Participate in collaboration & partnerships to promote public health policy aimed at increasing access and availability of healthy foods and decreasing access and advertising of unhealthy foods and beverages Participate in collaboration and partnerships focused on improving community design, land use policies and public spaces to encourage physical activity Participate with community based organizations to increase the accessibility to farmers markets by partnering with stakeholders to implement new farmers markets and/or promote existing famers markets and the use of EBT (Electronic Benefits Transfer) for SNAP (Supplemental Nutrition Assistance Program) for fresh fruits and vegetables Expected Outcomes Increase healthy eating and physical activity among children, youth and adults Improve knowledge and attitudes about good nutrition and physical activity Increase access to healthy foods and beverages Increase access to physical activity at schools Improve safety of parks for active recreation Behavioral Health Long term Goal Improve mental health and reduce substance abuse among San Mateo Area residents Intermediate Goals Improve self care and coping with stress among youth and adults Reduce drug use and problem drinking among adults Increase delay of initiation of alcohol and drug use and decrease overall alcohol and drug use among youth Improve access to behavioral health services for youth and adults Strategies Provide grants for school based education/training on coping skills that focus on nonresponse to provocative situations and improved communication Provide grants to support therapeutic interventions for adolescents (e.g., cognitive behavioral therapy and Mindfulness Based Stress Reduction) 7

Provide grants to local community based organizations, community agencies, community stakeholder groups and/or teen health centers that focus on providing mental health screening and treatment programs Provide grants to implement substance abuse enforcement strategies such as merchant education, police alcohol compliance checks with merchants, sobriety/traffic safety checkpoints, social host liability laws Provide grants to support substance abuse prevention and treatment programs for youth and families Provide grants that support collaborative care for the management of depressive disorders a multicomponent, healthcare system level intervention that uses case managers to link primary care providers, patients, and mental health specialists Provide KP Educational Theater programs focused on conflict resolution, coping skills and self esteem to isolated/underserved areas whose schools have not participated in the past Expected Outcomes Mental Health Increase screening and treatment of stress and depression Increase knowledge of coping strategies for stress, depression, and suicide Increase knowledge of community resources and activities to help with self care and coping Improved youth self esteem and communication with peers, parents and other adults Improve access to behavioral health service providers Substance Abuse Increase youth awareness of effects of drinking and drug use and increase skills to successfully deal with negative peer pressure Increase in the number of youth who believe that youth drinking and drug use is harmful Reduce access to alcohol for underage youth Increase knowledge of community resources and activities to prevent youth drinking/drug use Access to Health Care Services 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 Improve access to culturally competent care Strategies Provide technical assistance or clinical expertise to community based organizations and local non profit organizations to decrease barriers to care Provide grants and or participate in collaboratives that support community health workers and insurance enrollment experts to increase, maintain, and access insurance coverage Provide grants and/or informational resources for Patient Navigators to offer culturally sensitive assistance and care coordination, guiding patients through available medical, insurance, and social support systems Provide culturally appropriate information and educational resources to support health literacy 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 8

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. Implement Operation Access Expected Outcomes Increase access to health care services Increase number of eligible individuals enrolled in government sponsored and/or subsidized health care coverage programs Increase number of underserved populations that receive needed primary and/or specialty care medical services 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 9

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 X. Evaluation Plans KFH Redwood City 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 Redwood City 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. Cancer Description: San Mateo County incidence rates for breast, colorectal, and prostate cancers are higher than benchmarks/state averages. Certain ethnic subgroups experience different incidence and mortality rates. For instance, the overall county colorectal cancer incidence rate is 44.1, compared with the Healthy People 2020 target of 38.6, and even worse for county African Americans (48.9). Explanation why not chosen: The spectrum of the problem is so broad that Community Benefit investments could not impact it. Kaiser Permanente is doing research. Smoking prevention efforts already in place could prevent lung cancer. B. Infant Mortality Description: Infant mortality is often of concern for mothers of color (18% for African Americans). Explanation why not chosen: Magnitude of the problem is small, and infant mortality rates are better than those in other counties. The health need was a lower priority for the community overall. C. Infectious Disease Description: Pneumonia/influenza was among the top ten causes of death in San Mateo County. The overall rate of tuberculosis incidence in the county (10.0) is higher than the state average (6.8), as are the rates for most of the ethnic populations. Explanation why not chosen: This issue is of lower impact. It is also very general, and some of the diseases fluctuate, so there are fewer proven methods to address the health need. There does not 10

appear to be a high level of organizational commitment to the issue in comparison to other issues, and the community placed this health need as a lower priority than those ultimately chosen. D. Poor Oral/Dental Health Description: Oral/Dental Health problems were reported by youth and adults alike, as indicated by levels of poor dental health among San Mateo adults that are essentially no better than the state average. Also, some ethnic subgroups are much less likely to have dental insurance, which is a driver of poor oral health. Explanation why not chosen: Not many internal assets (resources nor expertise). Needs are addressed by San Mateo County programs. Effective approaches could be incorporated under Access to Care (which is a chosen need). E. Respiratory Conditions Description: Respiratory Conditions are a health need as indicated by the rate of asthma prevalence among county youth (18.4%) that is higher than the state average (14.2%). The health need is likely being impacted by smoking among youth/adults as well as poor air quality levels. Explanation why not chosen: The need and potential impact of KP investment not as great as other needs. The need is currently being addressed by healthcare systems directly. F. STDs/HIV AIDS Description: Sexually Transmitted Diseases, including HIV AIDS were prioritized as a health need in part due to the disproportionately high chlamydia incidence rates among county females ages 15 24 (535 to 3091, depending upon ethnicity) compared to the overall state average (399). African American and Latino males of the same age are similarly affected. The health need is likely driven by low screening rates and lack of health education. Explanation why not chosen: This issue is less of a problem in San Mateo County compared with other health needs. There does not appear to be a high level of organizational commitment to the issue in comparison to other issues, and the community placed this health need as a lower priority than those ultimately chosen. G. Violence Description: Violence is a health need because the rates of child maltreatment and homicide among African Americans in San Mateo County are higher than state averages/national benchmarks. Homicide rates also miss the Healthy People 2020 benchmark in certain geographical areas, such as East Palo Alto and Daly City. Explanation why not chosen: Systemic issues related to mental health and substance abuse issues were of greater concern than violence as a standalone health need. Effective approaches could be incorporated under Behavioral Health (which is a chosen 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 Redwood City will look for collaboration opportunities that address needs not selected where it can appropriately contribute to addressing those needs. 11