St. Jude Medical Center St. Jude Heritage Healthcare. FY 09 FY 11 Community Benefit Plan

St. Jude Medical Center St. Jude Heritage Healthcare FY 09 FY 11 Community Benefit Plan 1

St. Jude Medical Center FY 09 - FY 11 Community Benefit Plan TABLE OF CONTENTS Executive Summary 3 A. Community Profile 4 B. Community Needs and Assets Assessment Process 5 C. Identification and Selection of DUHN Communities 7 D. Initiative/Program Prioritization 7 E. FY 09 - FY 11 Community Benefit Plan 8 ASACB Alignment F. Ministry s Governance and Management Structure 9 Attachments: FY 09 - FY 11 Community Benefit Plan Initiative Templates 10 All Other Community Benefit Initiatives and/or Activities/Programs DUHN and Broader Community 14 2

Executive Summary St. Jude Medical Center s community benefit service area and St. Jude Heritage Healthcare s integrated medical practice foundation includes the following cities of North Orange County: Fullerton, Brea, Placentia, Buena Park, La Habra and Yorba Linda. This service area with a population of 409,383 represents communities of wealth, pockets of poverty and middle class areas. While the average household income in the service area is almost $66,000, there are several neighborhoods where the household income is half of the average. The SJMC service area is ethnically diverse with Hispanics comprising almost 30% of the population and Asian-Pacific Islanders slightly less than 15%. In some neighborhoods the majority of the community is Hispanic and Spanish is the primary language. St. Jude Medical Center s community benefit programs focus on neighborhoods that are lower in income and more ethnically diverse (DUHN Disproportionate Unmet Health Need neighborhoods). Major needs identified in FY 09 FY 11 Community Benefit Plan include: 1) lack of access to medical and dental care, 2) higher rates of childhood obesity, 3) higher rates of inappropriate use of Emergency Department for conditions that could be treated in alternative settings. 3

A. Community Profile SJMC s community needs assessment and plan includes most of our primary service area (Brea, Fullerton, La Habra, Placentia and Yorba Linda) and Buena Park which is in our secondary service area. The socio-demographic characteristics of these communities include: Median HH Income City Population % White % Hispanic % API % Black HH Size Brea 35,419 60.8% 20.3% 9.3% 1.3% 2.7 $59,759 3.4% Buena 78,282 25.9% 33.5% 21.6% 3.8% 3.32 $50,336 8.0% Park % below FPL Fullerton 126,003 36.4% 30.2% 16.3% 2.3% 3.0 $62,124 6.2% La Habra 58,974 19.6% 49.0% 6.1% 1.6% 3.08 $47,652 9.1% Placentia 46,488 41.8% 31.1% 12.2% 1.8% 3.07 $62,803 5.7% Yorba 64,226 67.2% 10.2% 16.4% 1.9% 3.1 $121,075 2.1% Linda Total 409,383 39.4% 29.6% 14.7% 2.3% 3.05 $65,952 5.75% The racial break-down is less than 100% due to the high percentage of individuals who indicated they were other races in the 2000 United States Census. This might include individuals who marked themselves as more than one race. The data shows that there are wide disparities in ethnic and economic indicators within the service area. La Habra is the city with the lowest income and the greatest ethnic diversity while Yorba Linda has the highest income and least ethnic diversity. Within each city except Yorba Linda there are neighborhoods that have a high percentage of populations with disproportionate unmet health needs. The map below outlines these neighborhoods which are red (highest need) and pink (high need): 4

Key Indicators of High Need The table below identifies some of the key indicators for the highest need areas in each city and compares it with the county-wide data as based on the most recent United States Census Data: City Fullerton Brea La Habra Placentia Buena Park Orange Cty Indicators Total Population 17,183 3,388 9,428 12,326 19,721 3,002048 Average Household Size 4.308 2.96 3.93 3.46 3.85 3.0 Unemployment Rate 13.838 5.05 6.96 8.2 9.67 5,4% Average Household Income $50,557 $63,964 $52,658 $56,492 $50,190 $70,232 Percent of Households Below FPL (19,999) 19.4 7.92 19.06 14.95 16.14 n/a % Children Living Below Poverty 31.1 20.6 24.94 21.36 24.61 n/a % Families Living Below Poverty 23.74 11.05 16.72 14.21 16.87 6.6% B. Community Needs and Assets Assessment Process The process followed in conducting the needs and assets assessment included the following: Orange County Health Needs Assessment 2007 Survey Orange County Health Care Agency Secondary Data UCI Círculos de Acción Orange County Needs Assessment (OCHNA) Survey The Orange County Health Needs Assessment (OCHNA) is a random telephone based survey of 5,000 households in Orange County that was conducted in the Fall, 2007. The survey utilized the Center for Disease Control s Behavioral Risk Factor Surveillance System as the core module with additional questions developed by the OCHNA Steering Committee. The primary quantitative data collected in the Orange County Health Care Agency includes mortality and morbidity data by zip code. This data was obtained from death certificates. The key findings of the Orange County Health Needs Assessment Report demonstrate health care disparities based on income and ethnicity. Following are the key findings: The percentage of uninsured children in our service area has declined from 7.7% in 2001 to 3.5% in 2007. 34,000 persons are uninsured in our service area. 39.7% of low income adults (annual income under $25,000) lacked health insurance as compared with 1.6% of higher income adults. 5

21% of low income adults self-rate their health as fair or poor as compared to 2% of higher income adults. 26.1 % of the total population surveyed and 60.4% of low income persons lack dental insurance. 36% of low income adults reported missing work because of untreated dental problems. 8.5% of Caucasians are smokers as compared to 0.2% of Hispanics. 25.4% of the total population are obese while 36.6% of Hispanics are obese, 75% of low income persons are obese. 52.5% of children living in low income families are obese as compared to 11.1% of children living in higher income families. Focus Groups St. Jude Medical Center also partnered with the University Of California Irvine, School of Social Ecology graduate students to conduct a series of focus groups in the Valencia neighborhood. These focus groups provided an opportunity to engage the residents in identifying the assets and challenges in their community. Orange County Health Care Agency The Orange County Health Care Agency provides the most recent morbidity and mortality data available for the State of California. The available data is primarily from 2005 and 2006 which was before the opening of the St. Jude Neighborhood Health Center. Zip codes exhibiting among the highest rates of morbidity and mortality in Orange County include: Fullerton (92835): Heart disease, Lung Cancer, Breast Cancer, Prostate Cancer, Alzheimer s, Influenza/Pneumonia Fullerton (92832): Infant mortality, Births to adolescent mothers, Late/No/Inadequate prenatal care, Heart disease Fullerton (92833): Diabetes Placentia (92870): Infant mortality La Habra (90631): Inadequate prenatal care Buena Park (90621): Late/no/inadequate prenatal care, Births to adolescent mothers Zip code 92835 is the area where St. Jude Medical Center is located. The high mortality rates may be a result of the high number of frail elderly in local skilled nursing facilities. This zip code has a population 65 and over that is twice the county rate. The mortality rate in zip code 92832 is four-times the county rate and the second highest in the County. The Medical Center partnered with UCI Community Scholars Program to conduct Circulos de Acción in the Richman neighborhood of Fullerton. The Circulos de Acción are serial reflexive dialogues that target community activists. Top health priorities from these groups were childhood obesity, and enhancing access to medical and dental 6

services. The residents were particularly concerned about the high rate of childhood obesity, the school meal program and the need for safe places for children to play. C. Identification and Selection of DUHN Communities The following DUHN communities have been identified in our community health needs and asset assessment: Low income geographic neighborhoods South Fullerton, Central La Habra, West Placentia and East Buena Park. Low-income Latino population Adults lacking health insurance Adults and children lacking dental insurance Overweight and obese children Persons utilizing the Medical Center Emergency Department inappropriately Homeless Chronically mentally ill and substance abusers Frail low-income seniors Alienated youth Victims of domestic violence and abuse St. Jude Medical Center s Community Benefit Committee reviewed and prioritized the aforementioned communities which are the focus of SJMC s FY 09 FY 11 Community Benefit Plan, listed below. DUHN Group Key Community Needs Key Community Assets Access to primary health care St. Jude Neighborhood Health Access to specialty care Center Adults lacking medical insurance in North Orange County Children and adults lacking dental insurance in North Orange County Overweight and obese children Population utilizing Emergency Department inappropriately D. Initiative/Program Prioritization Access to dental care Increased physical activity in schools. Safe places to play. Healthy school meals. Accessible healthy foods. Obesity treatment programs. Accessible and affordable after-hours care. Chronic Disease management. Local community clinics St. Jude Neighborhood Health Center St. Jude Dental Clinic Vida Sana Program Fullerton and La Habra Obesity Prevention Plans Community Soccer Programs St. Jude Health Resource Line Community clinics The St. Jude Medical Center s Community Benefit Committee is composed of community stakeholders and hospital staff. Committee members were requested to identify their individual top priorities according to specific criteria that had been identified in St. Jude Medical Center s community benefit policies. These criteria include: size 7

and seriousness of the need (based on the results of the needs assessment and focus group); effectiveness of proposed interventions; economic feasibility; legality; time commitment; degree of controversy; existing efforts; implications for not proceeding and sustainability potential. Top group priorities were identified using a consensus group process. Resident involvement was primarily in the form of gaining input through focus groups. This input was provided to the Committee members to help to inform their prioritization process. E. FY 09 - FY 11 Community Benefit Plan: Key DUHN Community Benefit Initiatives The FY 09 FY 11 Community Benefit Plan will focus on the following initiatives: Increasing access to primary and specialty care for the uninsured in North Orange County. The primary programs that impact this initiative include the St. Jude Community Clinics and the involvement of the Medical Center in the Access OC program. The Access OC program provides free same-day surgeries to community clinic patients through a network of volunteer physicians and staff. Community stakeholders are involved through the Valencia Task Force in providing input on these programs. Programmatic enhancements for these programs include expanding services at the La Habra satellite and recruiting volunteer specialists to initiate specialty services at the Neighborhood Health Center. Increasing access to dental services for the uninsured in North Orange County. The primary programs that impact this initiative include the St. Jude Neighborhood Health Center Dental Clinic and the St. Jude Children s Dental Clinic. Community stakeholders are involved through the Valencia Task Force in providing input on these programs. Programmatic enhancements for these programs include adding dental hygiene services and participation in the Orange County Children s Dental Collaborative. This initiative addresses primary prevention as well as treatment. Reducing the rate of childhood obesity in North Orange County. The primary programs that impact this initiative include Healthy 4 Life, Vida Sana Program and the St. Jude Obesity Prevention Plan. Community stakeholders are involved through our community collaboratives related to childhood obesity. Programmatic enhancements include adding a childhood obesity treatment program at the Centers for Rehabilitation and Wellness. This initiative addresses primary prevention along the continuum of care and is focused on both prevention and treatment. Reducing the number of inappropriate Emergency Department visits for Ambulatory Care Sensitive Conditions. The primary programs that impact this initiative include the Health Resource Line and the Community Clinics. The Medical Center Community Benefit Committee can provide community collaborative governance to these programs. Programmatic enhancements include improved coordination of referrals between programs. 8

Please see the attachments for detailed Initiative templates. F. Ministries Organizational Structure Governance The St. Jude Medical Center Community Benefit Committee is a committee of the Medical Center s Board of Trustees. It is composed of 25 members: 13 community members, of whom 2 are Board of Trustees members and 11, are Medical Center/Heritage leadership. The Charter of the Committee includes the oversight and development of the Community Needs Assessment and Community Benefit Plan. In addition, the Committee is responsible to review and approve community benefit program design, budgets, geographic and population targeting, program continuation and termination, fund development support and community engagement. This structure reflects the principle of collaborative governance addressed in the Advancing the State of the Art of Community Benefit standards by being composed of a majority of community stakeholders who either represent or are knowledgeable about the needs of the DUHN population. Management The St. Jude Medical Center s Executive Management Team is involved in community benefit planning and monitoring through membership on the Community Benefit Committee. The Community Benefit Committee is composed of the Medical Center CEO, COO, CFO, Sr. VP Mission Integration, VP Healthy Communities, VP Medical Affairs, Director, Government and Community Relations; and CEO, VP Operations and Director Mission Services St. Jude Heritage Healthcare. In addition, monthly updates regarding community benefit issues are provided to the EMT. The Community Benefit Plan is integrated with the SJMC strategic plan through the Healthy Communities strategic goal. 9

E. FY 09- FY 11 Community Benefit Plan Key DUHN Community Benefit Initiatives Initiative: Expanding Access to Primary Care in North Orange County Activity/Program Name: 1. St. Jude Neighborhood Health Center 2. St. Jude Mobile Health Clinics Outcome Measure (if available) DUHN target group: Content category 1 of activity 1 and 2: Sub-content category of activity 1 and 2: % of uninsured population served Adults who lack health insurance Community Health Services Community Based Clinical Services How does this activity fit with the identified DUHN assets and needs? How many unduplicated persons do you target to serve in this program in FY 09? 2 There are 34,000 uninsured persons in service area. This activity provides access for the uninsured. 5,000 GOAL STRATEGIES STRATEGIES MEASURE Increase hours of operation Strategy 1: # increased at La Habra satellite hours of operation Serve 20% of the uninsured population of service area Develop specialty clinics utilizing retired physicians Strategy 2: # of specialty clinics held % of uninsured persons served 1 ASACB Content Categories were developed in partnership with the internal ASACB Work Group partners (including SJHS) and the external National Advisory Committee and can be found in ASACB: A User s Guide for Excellence and Accountability, 2004. http://www.communityhlth.org/communityhlth/projects/asacb/asacbhome.html 2 This definition of unduplicated persons is the same as CBISA persons served definition. The target number of persons served is your projection; CBISA tracks actual persons served.) See Appendix 3: SJHS Uniform Community Benefit Programmatic Accounting Guidelines (Version 2) 10

Key DUHN Community Benefit Initiatives Initiative: County. Expanding access to dental services for the uninsured in North Orange Activity/Program Name: 1. St. Jude Children s Dental Clinic Buena Park 2. St. Jude Neighborhood Health Center Dental Clinic Outcome Measure (if available) % of uninsured population served DUHN target group Adults and children who lack dental insurance Content category of activity 1 and 2 Community Health Services Sub-content category of activity 1 and 2 Community Based Clinical Services How does this activity fit with the identified DUHN assets and needs? How many unduplicated persons do you target to serve in this program in FY 09? 60.4% of low income persons in service area lack dental insurance. This activity seeks to provide access to care for this population (25,165 persons) 1,500 (6% 0f total) GOAL STRATEGIES STRATEGIES MEASURE 1. Increase productivity Strategy 1: # of visits through use of new practice management system and participation in Orange County Children s Oral Health Collaborative Serve 10% of uninsured persons in service area 2. Add part-time dental hygiene services Strategy 2: # of visits, % of uninsured served in North Orange County 11

Key DUHN Community Benefit Initiatives Initiative: Reducing Prevalence of Childhood Obesity in North Orange County Activity/Program Name: 1. Healthy 4 Life Program 2. Vida Sana Program 3. Obesity Prevention Plan Implementation Outcome Measure (if available) % of low income children who are obese (52.5%) DUHN target group Low income children who are obese Content category 1 of activities 1, 2 and 3 Community Health Services Sub-content category of activity 1 Community Health Education Sub-content category of activity 2 Community based clinical services Sub content category of activity 3 Community building How does this activity fit with the identified DUHN assets and needs? How many unduplicated persons do you target to serve in this program in FY 09? 52.5% of low income children in service area are obese (3,540). This initiative seeks to reduce this number over time to 10%. 600 GOAL STRATEGIES STRATEGIES MEASURE 1. Implement Healthy 4 Life # of schools program Program in 9 schools implemented serving a majority of low % of students with income children in service decrease in BMI and waist area. circumference 1. Enhance obesity prevention programs in schools. 2. Reduce obesity in clinic pediatric population. 3. Implement Obesity Prevention Plans in at least two cities in service area. 1. Continue Vida Sana Program at St. Jude Neighborhood Health Center. 1. Work with community collaborations in Fullerton and La Habra on plan implementation. # of children in clinic who have decreased BMI # Plans implemented 12

Key DUHN Community Benefit Initiatives Initiative: Reducing Inappropriate Utilization of Emergency Department for Ambulatory Care Sensitive Conditions Activity/Program Name: 1. St. Jude Health Resource Line 2. St. Jude Community Clinics Outcome Measure (if available) DUHN target group Content category 1 of activities 1, 2 and 3 Sub-content category of activity 1 Sub-content category of activity 2 % of Level 1 and Level 2 ED visits for ACS conditions Persons who utilize Emergency Department for Ambulatory Care Sensitive Conditions Community Health Services Community based clinical services Community based clinical services How does this activity fit with the identified DUHN assets and needs? How many unduplicated persons do you target to serve in this program in FY 09? % of population who access Emergency Department for Ambulatory Care Sensitive Conditions may due so for lack of a medical home, lack of insurance, lack of ability to access care when needed. Hospital has services to assist this population. To be determined. GOAL STRATEGIES STRATEGIES MEASURE 1. Gather data on ACS 1. Data collection conditions in ED. completed 2. Establish a task force to 2. Task Force established prioritize conditions to work and meeting on. 1. Identify priority ACS conditions to focus on. 2. Maximize effectiveness of existing resources to reduce ED use for ACS conditions. 1. Coordinate Health Resource Line, Clinic services and Heritage services to address priorities identified. 1. Reduction of ED visits for ACS conditions 13

Attachment F All Other Community Benefit Initiatives and/or Activities/Programs DUHN and Broader Community # All Other Community Benefit Initiatives and/or Activities/Programs 1 Activity/Program Name: Asthma Disease Management Program Activity/Program Description: Two programs: 1) Asthma Control Today is a series of classes and asthma self management; 2) Open Airways training workshops for children 8-11 are conducted in the schools in collaboration with local fire departments (Program for the Broader Community) Target Group: Persons suffering from asthma 2 Activity/Program Name: Cancer Center Community Program Activity/Program Description: Program that offers cancer support services provided by a social worker, clinical nurse specialist, genetic counselor, nurse navigator, and research nurse in addition to support groups, education and resource library. (Program for the Broader Community) Target Group: Cancer patients and family members 3 Activity/Program Name: Caring Neighbors Activity/Program Description: Offers home bound frail elderly a health risk assessment and opportunity for volunteer assistance for friendly visiting, help with chores or shopping. (Program for Care for the Poor) Target Group: Low-income home bound frail elderly 4 Activity/Program Name: CHF Clinic Activity/Program Description: Outpatient program which assists patients with heart failure in improving self-management and quality of life. (Program for the Broader Community) Target Group: Adult men and women suffering from CHF 14

Attachment F (Continued) All Other Community Benefit Initiatives and/or Activities/Programs DUHN and Broader Community # All Other Community Benefit Initiatives and/or Activities/Programs 5 Activity/Program Name: Community Health Education Activity/Program Description: Coordinates and provides health education classes, disease management programs, health screenings and support groups. (Program for the Broader Community) Target Group: Community members of varying ages 6 Activity/Program Name: Donation of Medical Supplies and Equipment Activity/Program Description: Donation of medical supplies and equipment to approved hospitals and/or groups in poor countries outside of the United States, such as Hospital Civil in Guadalajara, Mexico. (Program for Care for the Poor) Target Group: Approved needy hospitals/groups 7 Activity/Program Name: ED Social Worker Program Activity/Program Description: Social workers who assist ED patients with psycho-social support and necessary referrals and placement. (Program for the Broader Community) Target Group: ED patients 8 9 Activity/Program Name: Falls Risk Reduction Activity/Program Description: Provides in-home safety assessments for atrisk seniors and patients who are scheduled for elective joint procedures. (Program for the Broader Community) Target Group: At-risk seniors and patients scheduled for elective joint procedures Activity/Program Name: Healthy Steps TAPP Activity/Program Description: Provides mildly ill child care center and support to pregnant teens and teen moms who attend the La Sierra High School. Target Group: Teenage mothers and their babies/children 15

Attachment F (Continued) All Other Community Benefit Initiatives and/or Activities/Programs DUHN and Broader Community # All Other Community Benefit Initiatives and/or Activities/Programs 10 Activity/Program Name: Indigent Patient Discharge Service Activity/Program Description: Subsidizes medication and durable medical supplies for indigent patients who are discharged from the hospital. (Program for Care for the Poor) Target Group: Low-income patients 11 Activity/Program Name: Meals on Wheels Activity/Program Description: Provide nutritious hot meals to the Meals on Wheels program. (Program for the Broader Community) Target Group: Men and women who are elderly, homebound, disabled, frail, or at risk 12 Activity/Program Name: Mother Baby Assessment Center Activity/Program Description: Provides assessment of mothers and babies within three-four days after discharge. Includes clinical assessment, psychosocial support and assistance with breastfeeding. Target Group: New mothers, newborns and extended family members 13 Activity/Program Name: Paramedic Services Activity/Program Description: Provides the community with a paramedic base station for emergency services and provides education to paramedics. (Program for the Broader Community) Target Group: Community members requiring ED services and paramedics 14 Activity/Program Name: Pulmonary Wellness Activity/Program Description: Outpatient pulmonary wellness program for patients with chronic obstructive pulmonary disease. (Program for the Broader Community) Target Group: Patients with chronic obstructive pulmonary disease 16

Attachment F (Continued) All Other Community Benefit Initiatives and/or Activities/Programs DUHN and Broader Community # All Other Community Benefit Initiatives and/or Activities/Programs 15 Activity/Program Name: Rehab Community Follow-up Activity/Program Description: Nurse follow-up program that educates and links services for patients along the continuum. (Program for the Broader Community) Target Group: Persons with major disabilities 16 Activity/Program Name: Rehab Community Reintegration Activity/Program Description: Provides recreational, exercise, communication and other groups for persons with a disability to assist in their re-entry into the community. (Program for the Broader Community) Target Group: Persons with disabilities 17 Activity/Program Name: Senior Services Activity/Program Description: Coordinates information and referral to seniors, as well as the senior programs offered at SJMC. Insurance counseling is available. (Program for the Broader Community) Target Group: Seniors 18 Activity/Program Name: Transportation Program Activity/Program Description: Provides transportation to seniors and persons with a disability to SJMC and its affiliated physician offices for medical appointments and op services. NOC Sr. Transportation funded by the Office on Aging provides non-emergency medical transportation to low income seniors to any doctor or hospital in NOC and parts of central OC. (Program for the Broader Community) Target Group: Seniors and persons with disabilities 17