Key Objectives: Objective #1 - Increase the proportion of persons with a usual primary care provider Health People 2020, Objective AHS -3

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Implementation Plan for Needs Identified in Community Health Needs Assessment for Newaygo County General Hospital Association d/b/a Spectrum Health Gerber Memorial FY 2013-2015 Covered Facilities: Newaygo County General Hospital Association d/b/a Spectrum Health Gerber Memorial Community Health Needs Assessment: A Community Health Needs Assessment ( CHNA ) was performed in Fall 2011 in collaboration with The Carl Frost Research Center, the District 10 Health Department and local key stakeholders and informants to determine the most pressing health needs of the community served by Newaygo County General Hospital Association ( Hospital ). Implementation Plan Goals: the Board of Trustees of the Hospital has determined that the following health needs identified in the CHNA should be addressed through the implementation strategy noted for each such need: 1. Priority #1 Improve access to healthcare Key Objectives: Objective #1 - Increase the proportion of persons with a usual primary care provider Health People 2020, Objective AHS -3 Implementation Strategies: Strategy #1 - Develop and implement a staffing and recruitment plan for the primary care offices which takes into consideration the evolving needs and demographics of the community, the medical group and the hospital s strategic growth and market share plans. Strategy #2- Collaborate with all primary care providers in Newaygo County to address improving access to behavioral and mental health services through integration with primary care. Strategy #3 Increase public and consumer awareness of primary care services through a marketing and communications plan which includes maximizing current community based resources. Strategy #4 Implement a process for assisting patients in identifying, selecting and then accessing primary care when they ve entered the hospital system without a usual primary care Implementation Plan SHGM 2013-2015 1

provider. Special emphasis will be placed on case finding within the emergency department, medical offices and at sponsored community events. 2. Priority #2 Increase health literacy, awareness and education in Newaygo County Key Objectives: Objective #1 - Increase the number of community-based organizations (including local health departments, tribal health services, nongovernmental organization and State agencies) providing population based primary prevention services in the following area of Chronic Disease - Healthy People 2020 ECBP-10.7 Implementation Strategies: Strategy #1 Increase the number of individuals receiving health information on lifestyle choices for the prevention or management of chronic disease by maximizing the SHGM health education platform and integrating throughout the community, within the medical offices and across community agencies. Strategy #2 Facilitate the the Newaygo County Health Care Improvement Council toward a strategy which aligns more community agencies with a common health promotion platform and plan. Strategy #3 Develop and implement a hospital based health literacy strategy emphasizing discharge processes, medication reconciliation, teach back training and patient and family centered care as methodologies specifically targeted to increase health literacy for the intention of reduced avoidable readmissions. Specific Needs Identified in CHNA Priority # 1: Access to care o 11.4% of Newaygo County report not personal health care provider compared to the state level of 13.2% - Source MI Behavioral Risk Factor Survey 2006-2010 o Newaygo County has 40.9 Primary care physicians (MD/D0) per 100,000 population compared to the state level of 114.4 Source US Department of Health and Human Services, Community Health Status Indicators; County Health Rankings. o No health care access due to cost 13.9 in Newaygo County compared to 12.9 at the state level. BRFS 2006-2010. CHNA pg 18. o 3 in 10 have gone without a routine physical check up. BRFS 2006-2010. CHNA pg 19. Priority # 2: Health Literacy Key informants identified lack of awareness as a top barrier or obstacle to accessing health care programs and services. Q9- Key informant survey. Key informants identified Education as a top effective solution to eliminating barriers/obstacles to accessing health care programs and services. Q9 key informant survey. Implementation Plan SHGM 2013-2015 2

Key informants listed more/better health education as a top strategy for improving the overall health climate in Newaygo County. Q13- Key informant survey. Higher than state rates of ever told you have diabetes or asthma. BRFS 2006-2012. CHNA pg 14. Cancer diagnosis rate is lower than state average despite having a higher than state average of cancer death rates. MDCH County Health Ranking. CHNA pg 11. Other Needs Identified in the CHNA But Not Addressed in this Plan Each of the health needs listed below is important and is being addressed by numerous programs and initiatives operated by the Hospital, other organizations within Spectrum Health and other community partners of the Hospital. However, the Hospital will not address the following health needs identified in the CHNA as part of this Implementation Plan due to limited resources and the need to allocate significant resources on the two priority health needs identified above. See attached CHNA prioritization decision matrix. Implementation Plan SHGM 2013-2015 3

CHNA Prioritization Decision Matrix - Spectrum Health Geber Memorial March 2012 Criteria Categories 1. 2. Hospital (SHGM) currently has an action plan or process in place to address the identified need. 3. Outside of the scope of the hospital/health care setting. 4. Resources not available to address the identified need at this time. Chronic Disease Stakeholders Criteria Category Comments Recommended strategies Pine Medical Group Family Health Care Coordination of care for chronic disease; particularly diabetes and asthma. Improve self management skills. Increase early detection; particularly with cancer an identified leading cause of death. Increase community resources. Services for mild to moderate mental illness. Substance Abuse services. Strategy for impacting depression. Spectrum Health Hospital (SHGM) currently has an action plan/process to address the need. SHGM has added an additional oncology and expanded treatment availability for cancer patients. SHGM has a Diabetes Self Management Center and partners with the surrounding medical offices to provide diabetes management across the community. SHGM promotes health care consumerism and self management skills through the health education platform Spirit of Women. An annual calendar of events, screenings, and education sessions are available throughout the community and across the age span. Pine Medical Group is a patient centered medical home with a case management model which emphasizes disease management and encourages self management. Mental Health Stakeholders Criteria Category Comments Recommended strategies Community Mental Health Outside the scope of the hospital/health care setting. Community mental health is an active participant of the NCHCIC along with SHGM and is actively partnering with a variety of community and social service agencies on the care and delivery of mental health services within Newaygo County.

Obesity Stakeholders Criteria Category Comments Recommended strategies Newaygo County Health Care Improvement Council (NCHCIC) Increased public awareness of lifestyle interventions. Increase access to affordable foods. Incentives for self management. Discounted wellness services. Community partnerships with evidenced based strategies. Promote the appropriate use of alcohol and the consequences of excessive use. Promote social services in place to support reduction of smoking, illegal substance use, and excessive drinking. Build incentives for individual who reduce risk behaviors. Develop community partnerships that work to reduce adult risk behaviors. SHGM Hospital (SHGM) currently has an action plan or process in place to address the identified need. The NCHCIC, an affiliate of the Newaygo County Community Collaborative (NC3) identified Obesity as a key focus area in its community health action plan. The goal states: Increase primary interventions focused on the prevention of chronic disease including diabetes, cardiovascular disease, pulmonary disease and obesity. SHGM owns and operates a medical wellness center which offers several programs to address obesity including a non-surgical weight management program offered in two locations across the community. SHGM medical wellness center offers free memberships based upon financial and medial need. SHGM has partnered with other Spectrum system hospital to write grants for the funding a pediatric weight management program Fit Kids 360 and has historically worked to offer or partner with community agencies such as the schools on child and adolescent weight management programs. Adult Risk Behaviors Stakeholders Criteria Category Comments Recommended strategies Newaygo County Outside of the scope Community of the Collaborative (NC3) hospital/health care Drug and substance setting. abuse affiliate District Health Department #10 Resources not available to address the identified need. The District Health Department #10 and SHGM have identified the need to take a regional approach to addressing the high risk behavior of smoking while pregnant. SHGM will continue to collaborate with and under that leadership of the health department on a regional strategy and action plan. Newaygo County has an active council affiliate group Suicide and Substance Abuse Prevention affiliate with the aim to reduce the rates of suicide and substance use and abuse for both children and adults.

Coordinated Community Approach Recommended strategy Maximize technology for a regional data exchange. Create a community health action plan. Encourage more involvement in community health by local residents. Develop population based outcomes and targets for intervention. Stakeholders Criteria Category Comments Newaygo County Health Care Improvement Council (NCHCIC) Newaygo County Community Collaborative (NC3) Hospital (SHGM) currently has an action plan or process in place to address the identified need The NCHCIC, an affiliate of the Newaygo County Community Collaborative (NC3) is made of multiple community health and service agencies and facilitated by SHGM. NCHCIC has developed a community health strategy which will be reported back to NCs. See attached coordinated community health strategy plan. Sub-population focus Stakeholders Criteria Category Comments Recommended strategies: address barriers for the following populations Hispanic residents Low income residents Teen pregnancies Infants and children True North District Health Department #10 Family Health Care Department of human services.resources not available to address the identified need. SHGM services all of Newaygo and several surrounding counties with an OBGYN clinic and birthing center. SHGM will pay particular attention to and work to continue to better understand the needs of subpopulations as it relates to access to care. SHGM will work to have representation from the identified groups on various work teams/initiatives such as women s health and patient and family experience as evidenced by participation on the patient and family advisory council.

Other recommended priorities Health Care Access specific to dental care and transportation Stakeholders Criteria Category Comments Family Health Care NC3 Newaygo County Economic Development Council Outside of the scope of the hospital/health care setting. Family Health care provides free and low cost dental services to the Newaygo community NC3 along with the Newaygo County Economic Development Council has conducted a transportation assessment. As a member of the executive council of NC3, SHGM will continue to support this identified community need.