Implementation Strategy Report for Community Health Needs

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

Kaiser Foundation Hospitals Community Health Needs Assessment (CHNA) Implementation Strategy Report 2013 Kaiser Foundation Hospital Oakland License # 140000052 280 West MacArthur Boulevard Oakland, CA 94611 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 Oakland 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) Oakland service area extends from the cities of Berkeley and Albany in the north through Emeryville, Piedmont, Oakland and Alameda. All of the service area is in Alameda County. The majority of the service area is urban, with some open space in the East Bay Regional Park District. The San Francisco Bay bounds the service area on the west side and a ridge of hills on the east side. 2

The service area has a total population of 611,169, representing 41% of the population of Alameda County. KFH Fremont, KFH Hayward, and KFH Walnut Creek serve the remainder of Alameda County. More than half of the population are adults between the ages of 18 64 years of age. The area s diverse demographics indicate that 45.1% are White, 20.7% are Black, 19.5% are Asian, 0.48% are Pacific Islander, 19.8% are Latino, 0.51% are Native American and 4.7% are Multi Race. Nearly 17% of residents live in poverty, approximately 15% are without health insurance and 15.88% do not have a high school diploma. 3

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 Oakland s planned response to the needs identified through the 2013 Community Health Needs Assessment (CHNA) process. For information about KFH Oakland 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 Oakland 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 Oakland service area through the 2013 Community Health Needs Assessment process. The health needs are listed in priority order. Economic security Violence prevention Affordable community based mental health services Affordable community based substance abuse services Asthma prevention and management Local, comprehensive and coordinated primary care, including peri natal care Healthy eating Exercise and activity Local specialty care for low income populations VII. Who was Involved in the Implementation Strategy Development The implementation strategy development team at KFH Oakland included the following stakeholders representing Kaiser Foundation Hospital/Health Plan and The Permanente Medical Group, as well as area service providers. Kaiser Permanente Stakeholders Jennifer Slovis, Physician, APIC for Health Promotion, Medicine Administration Juanita Papillon, Psychiatrist, Psychiatry Lowanda Moore, MSW, Social Services Larry Liebmann, MFT, Psychiatry Beverly Green, MSW, Social Services Jennifer Key, Social Worker, Social Services Julie Hadnot, Director, Public Affairs Carol Azar, Manager, Health Education 4

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 Claude Watts, Chief Operating Officer, Administration Glenda Monterroza, Community Benefit Specialist, 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 Oakland stakeholders, the following community stakeholders contributed to implementation strategy development for the violence prevention and healthy eating active living needs. 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 5

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 Oakland Community Benefit and facilitated by Coleman Smith LLC, a consultant group. VIII. Health Needs that KFH Oakland Plans to Address a. Process and Criteria Used KFH Oakland s Community Benefit Advisory Group (CBAG) the contributions committee comprised of KFH Oakland 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 Oakland 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 Oakland will address, the team used the criteria listed below, which built on the criteria used in the CHNA prioritization process. In addition, we considered the ability for KFH Oakland to have a significant and meaningful impact on the needs given our expertise, our resources and the evidence base. KFH Oakland 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 Oakland 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 Oakland CBAG members. The final set of long term and intermediate goals for each health need were also informed by strategies implemented during previous KFH Oakland 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 confirmed and defined. 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 Oakland 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 Oakland 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 Oakland 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 Oakland service area. In Alameda 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 Act 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. Further, with high HIV prevalence of 380.1 per 100K, and high asthma prevalence at 15.84%, local residents require accessible targeted health services. For these residents, 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 Oakland service area. Although in the KFH Oakland service area less than 1% of residents live in areas designated as food deserts, there are only 12.2 WIC authorized food stores per 100,000, compared to the statewide average of 15.8 per 100,000, and food access challenges persist. 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. While residents in the KFH Oakland service area report having adequate healthy affordable food options, many residents indicated that they are unfamiliar with the available foods and lack food preparation recipes. For example, during focus groups conducted as part of the 2013 CHNA, Alameda County residents requested more culturally targeted cooking classes as a strategy for promoting healthy eating. Poor health outcomes in the KFH Oakland 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, they tend to have higher rates of crime and violence, and they tend to have fewer commercial areas that promote walking. Poor health outcomes in the KFH Oakland 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 Oakland service area, and is influenced by a lack of adequate mental health services and economic 7

security. Violence in the KFH Oakland service area is particularly present in neighborhoods in the City of Oakland itself. Community members, public health experts, and Oakland and Alameda County government officials and agencies have all placed a high priority on decreasing violence in Oakland, particularly among young people. According to CityRating.com and based on FBI crime statistics, the city violent crime rate for Oakland in 2010 was higher than the national violent crime rate average by 278.94%... In 2010 the city violent crime rate in Oakland was higher than the violent crime rate in California by 247.17%. Data indicates that youth and people of color are disproportionately represented among both violent crimes and homicides. 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 Oakland s Implementation Strategies As part of the Kaiser Permanente integrated health system, KFH Oakland 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 Oakland 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 Oakland will continue to work in partnership to refine its goals and strategies over time so that they most effectively address the needs identified. 8

Access to Care Long term Goal Increase number of low income people who have access to appropriate health care services in Northern Alameda 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 Provide subsidized health care coverage which provides comprehensive benefits to children (birth through 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 Grant making to support connecting asthmatic patients to medical homes that provide access to continuous, comprehensive, asthma management care Sponsorships to promote HIV testing and education events, and support to organizations providing HIV treatment and support services Expected Outcomes Increased access to care Increased number of patient navigators Decreased asthma related hospitalizations and ER visits Increased access to HIV testing 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 Northern Alameda 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 implementation, food literacy skills development, and nutrition education in schools, preschools, and childcare settings Grant making to support family focused engagement programs including peer education that promote healthy food consumption, affordable options, and breastfeeding 9

Grant making to promote adoption of health promoting food and beverage retailing and distribution policies and programs Provide KP s Educational Theatre, a free theater program designed to disseminate health education and inspire, to promote healthy eating and water consumption among students and families Leverage internal intellectual assets and clinical expertise to promote collaboration with community (non KP) providers, and increase their capacity to provide motivational counseling and coaching to promote healthy weight Leverage internal intellectual assets, health education materials, and clinical expertise to promote breastfeeding friendly environments, and healthcare providers encouraging breastfeeding and healthy weight gain during pregnancy 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 and policies that create and enhance physical activity spaces in combination with educational outreach activities Grant making and leveraging internal intellectual assets and clinical expertise to promote adoption and implementation of quality physical education and physical activity programs in schools Expected Outcomes Increased access to affordable, healthy foods and beverages Increased awareness and consumption of healthy food and beverage options Increased promotion of breastfeeding, and increased breastfeeding Increased engagement of community business partners Increased engagement of KP providers 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 restorative justice programs and training Grant making to support comprehensive child development programs that enhance the cognitive and social development of pre kindergarten, low income children Provide KP s Educational Theatre, a free theater program designed to disseminate health education and inspire, to promote conflict resolution and social responsibility among students Sponsorships to promote family and community focused extracurricular activities in neighborhood settings, including street outreach collaborations Leverage internal intellectual assets and technical assistance resources to support a violence prevention brain trust to cultivate community knowledge and strategies to increase corporate involvement in community safety promotion Grant making to support youth leadership development, entrepreneurship, and skills building programs 10

Leverage internal personnel resources, including the volunteerism of Kaiser Permanente physicians, employees and senior leaders to support mentorship programs and health care career presentations in schools and youth development programs Sponsorships to support programs that provide mental health, case management and support services to domestic violence survivors 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 Sponsorships to support community taskforces that inform and promote comprehensive traumainformed care training and practices Leverage internal intellectual assets, clinical expertise and training resources to support collaborations with community (non KP) providers emphasizing trauma informed care capacity building Expected Outcomes Increased participation in restorative justice programs Reduced number of intentional injuries on campus Increased access to mental health services and early cognitive and social development programs Increased participation in conflict resolution training and awareness of alternatives to violence Increased access to safe outdoor activities Increased engagement of KP leaders, physicians, and staff Increased number of youth trained in entrepreneurship and vocational skills Increased access to domestic violence support services Increased availability of trauma informed care training resources 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 11

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 X. Evaluation Plans KFH Oakland 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 Oakland 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 Oakland will not be addressed by KFH Oakland because, using the criteria described previously, they were not ranked as highly as access to care, healthy eating and active living and violence prevention. Specifically, asthma was determined to disproportionately impact African Americans in a specific section of Oakland, but not the broader service area. With few promising 12

approaches and KP s limited capacity and assets to support non KP members in a significant way, asthma prevention was not selected. Local specialty care for low income populations was also not selected primarily due to KP s limited capacity and assets, and low severity of impact. Instead, asthma prevention and local specialty care for low income populations will be addressed to some extent in KFH Oakland s access to care strategies. Affordable community based mental health services was determined to be both of high magnitude and severity for the general public as it undergirds many other health needs. Ultimately, it was not selected because of KPs limited capacity and assets to service county wide needs. Affordable community based substance abuse services was determined to be of high magnitude, but was also not selected due to KP s limited capacity and assets to employ current promising or existing practices to the broader county. While economic security was determined to be both severe in impact and widespread, it was determined that the needed strategies are beyond the scope of KP s work, resources and assets. 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 Oakland 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. Affordable community based substance abuse services 4. Asthma prevention and management 5. Local specialty care for low income populations 13