Implementation Strategy Addressing Identified Community Health Needs

2014-2017

Response to Schedule H – Form 990

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Table of Contents Page

Overview of the Patient Protection and Affordable Care Act 3 Defined Community 3 Implementation Strategy Development 3-4 Evidence-based Initiatives and Programs 4-5 Detailed Description of Action Plans, Evaluation Metrics and Partnerships

Prioritized Health Issue – Healthy Eating & Increased Physical Activity 6-7 Improving the Primary Care Physician Shortage in El Paso County 8-9 Services Aligned with Health Issues of Limited Resource Populations 10 Community Organizations Currently Addressing Other Identified Health Issues 11 Evaluation Plan Narrative 12

Protocol to Receive Community Comment 12 Conclusion and Next Steps 12

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Overview of the Patient Protection and Affordable Care Act

The passage of the Patient Protection and Affordable Care Act (PPACA) in 2010 added specific requirements for tax-exempt hospitals in relation to how they assess community need, plan community benefit services, provide and publicize financial assistance, and bill for services. Under the PPACA and the newly codified tax code Section 501(r), hospitals are now being asked to not only demonstrate their community benefit through the provision of emergency and charity services, but also to demonstrate it in other ways. This report summarizes the plan for UCHealth’s Memorial Hospital to sustain and develop community benefit programs that address the prioritized needs described within the 2014 Memorial Hospital Community Health Needs Assessment (CHNA) report. The report can be reviewed online through the following link: https://www.uchealth.org/Pages/About-UCHealth/Community-Health-Needs-Assessment.aspx The information within this Implementation Strategy report has been prepared with the primary goal of meeting the implementation strategy component of the reporting mandates for hospitals resulting from the PPACA. The contents and format of this report follow the guidance provided by the Internal Revenue Service within its Notice of Proposed Rulemaking (NPRM) issued in April 2013. Defined Community For purposes of conducting the CHNA, Memorial Hospital’s community is defined as all of El Paso County, Colorado. This reflects that, during 2013, 94 percent of patients served by Memorial Hospital (both inpatient and outpatient) were El Paso County residents. Implementation Strategy Development The UCHealth Implementation Strategy for Memorial Hospital (MH) is based primarily on the findings and health issue priorities established for community-wide action by the Healthy Community Collaborative (HCC) of El Paso County. The HCC consists of interested citizens as well as representatives from schools, hospitals and health systems (including MH), non-profit organizations, city and county government agencies, public health departments, and medical providers. A list of HCC member organizations can be found through this link: http://www.elpasocountyhealth.org/service/healthy-community-collaborative. The HCC utilized data and other statewide community health information from the Colorado Department of Public Health and Environment to complete an assessment of the health status of El Paso County residents during 2011-2012. The resulting overarching goal for the HCC is to focus community efforts and resources on evidence-based solutions to increase healthy eating and active living and stop the upward trend of overweight and obesity in El Paso County within the next five years (2012-2017).

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In addition to ongoing participation in the HCC, representatives of Memorial Hospital’s administrative team met during March and April 2014 to review the hospital’s existing community benefit resources and initiatives. The team also considered community input related to significant health issues identified during the March 2014 meeting of the Colorado Springs Health Foundation. Based on this review, the administrative team chose to complement the HCC’s efforts by also directing resources and focusing future strategic planning toward improving healthy eating and active living for residents in El Paso County. An equally high priority health issue, related to improving access to primary care health services in El Paso County, will also be described. The following guiding principles were mutually agreed upon by the administrative team and drove this plan’s development:

Keep it simple and actionable.

Bolster and expand existing programs.

Implement evidence-based initiatives and programs wherever possible.

Collaborate with the HCC and other community partners.

Demonstrate health outcomes, health impact, and financial impact.

Use resources wisely and recognize the hospital’s greater fiduciary duty.

Communicate clearly with recurring reports. Other identified health issues for El Paso County residents include tobacco use, mental health and substance abuse, motor vehicle injury, sexually transmitted infections, unintended pregnancy and oral health. Memorial Hospital will support other community organizations already actively involved in addressing these other issues. The next phase of this process will be identifying community resources with which to partner, and then evaluating the most effective way to work together to positively impact health outcomes. During their May 2014 meeting, the Memorial Hospital Board of Directors approved the strategies described within this report.

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Evidence-based Initiatives and Programs

Evidence-based programs are rigorously tested and when implemented with fidelity, are effective strategies that produce anticipated outcomes. The following evidence-based initiatives and programs, mentioned in this report, are described below.

El Paso County’s Healthy Community Collaborative - 5210 Campaign Strategy

The current focus of El Paso County’s HCC work is based on core concepts outlined in Let’s Go!, a program of The Kids Clinical Outcomes and Outreach Program at the Barbara Bush Children’s Hospital at Maine Medical Center. The Let’s Go! intervention is centered on the use of the common message of “5-2-1-0”: 5 fruits and vegetables daily, 2 hours or less of screen time, 1 hour or more of physical activity, and 0 consumption of sugary drinks plus more milk and/or water. These behaviors are supported by science and endorsed as recommendations by medical professionals. The program uses a multi-sector approach to reach youth and families where they live, study, work, and play to reinforce the importance of healthy eating and active living. See http://www.letsgo.org/ for further program details.

Stanford Chronic Disease Self-Management Programs

Over the past 30 years, the Stanford Patient Education Research Center has developed, tested, and evaluated self-management programs for people with chronic health problems. Their Chronic Disease Self-Management Program (the Program) is a workshop that teaches skills needed in the day-to-day management of chronic disease treatment and in maintaining and/or increasing life activities. Research has found that subjects who complete the Program, when compared to those who did not, demonstrate significant improvements in exercise, cognitive symptom management, communication with physicians, self-reported general health, health distress, fatigue, disability, and social-role activity limitations. They also spend fewer days in the hospital, and there is a trend toward fewer outpatient visits and hospitalizations. These data yield a cost to savings ratio of approximately 1:4. Programs targeted to persons with specific diseases such as diabetes, cancer, arthritis and chronic pain have also been developed and evaluated. More information is available at: http://patienteducation.stanford.edu/programs/cdsmp.html

Create Your Weight™ Create Your Weight (CYM) ™ is an adult weight management program developed by Sodexo Group’s Registered Dietitians. The CYM course utilizes evidence-based research and guidelines from the American Dietetic Association. The program encompasses nutrition education, physical activity, and the role of behavioral therapy in weight reduction and weight management. Participant data collected before and after the completion of the program measures its effectiveness. Program outcomes are reported in an aggregate fashion. Sodexo is the food service provider for Memorial Hospital; more information is available at: http://www.sodexo.com/en/services/on-site/offer.aspx

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At-a-glance table describing strategies to address the El Paso County prioritized health issue goal to

reverse the upward trend of overweight and obesity within the next five years (2012-2017)

Health Issue – Significance

CHNA Indicator

Value / Disparities

2014-2017 Action Plan –

Memorial Hospital Resources Directed to Address Healthy Eating and

Increased Physical Activity

Anticipated Health

Impacts – Evaluation Metrics

Existing or Planned

Collaborations to Address

Issue

Healthy eating and increased physical

activity ___________

Preventable diet/physical activity-related issues include heart disease, high blood pressure, diabetes, some cancers, and osteoporosis. In El Paso County, the number of adults with hypertension, high cholesterol, and diabetes has increased in the past decade, paralleling national trends in obesity.

37% of El Paso County adults are overweight and 21% are obese (2009-2010)

28.5% of children ages 2-14 have an unhealthy weight (2008-2010)

Disparities in El Paso

County = Trend in higher prevalence of

obesity in black adults and people in

households earning < $25,000 per year

Breastfeeding education (classes offered monthly)

Increased knowledge of role of breastfeeding in reduction

of obesity risk

Healthy Community

Collaborative – 5210 initiative

Children’s Hospital

Colorado at Memorial Hospital

LiveWell Colorado

Colorado Office

on Aging

Weight management classes (CYW offered quarterly)

Reduction in participant BMI

Chronic Disease Self-Management Program – Stanford University evidence-based

intervention using trained leaders and peer mentors within group meetings.

(2014 efforts will focus on planning strategies with 2015-2017 as the anticipated implementation phase)

Increased knowledge of healthy diet and physical

activity recommendations; increased rating of self-

efficacy in relation to disease management skill attainment

Diabetes prevention education classes (offered quarterly)

Adoption of healthy eating and physical activity

behaviors

Various fitness programs for adults (e.g., line dancing, Pilates, Tai Chi, yoga)

Increased options for participation in physical

activity

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SPECIFIC GOALS AND STRATEGIES TO ADDRESS HEALTHY EATING AND INCREASED PHYSICAL ACTIVITY IN EL PASO COUNTY: Goal: Lead and support efforts with the potential to improve the diet and physical activity choices of El Paso County residents Strategies:

Continue offering the Create Your Weight™ adult weight management program and monitoring program participant success.

Provide technical assistance to HCC community partners to promote implementation of a 5210 campaign.

Collaborate with community benefit operations staff from Children's Hospital Colorado to identify evidence-based initiatives targeted to prevent or reduce childhood obesity.

Identify (and evaluate for potential implementation) other current and future community and statewide health promotion or disease prevention initiatives (e.g., Stanford University's Chronic Disease Self-Management Program).

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At-a-glance table describing Memorial Hospital’s resources directed to improve access to primary care in El Paso County

Health Issue – Significance

CHNA Indicator

Value / Disparities

2014-2017 Action Plan –

Memorial Hospital Resources Directed to Improve Access to Primary Care

Anticipated Health

Impacts – Evaluation Metrics

Existing or Planned

Collaborations to Address

Issue

Insufficient primary care workforce ____________

Studies show that effective primary care

leads to improved health outcomes.

Primary care practices serve as the patient’s

first point of entry into the health care system and as the continuing

focal point for all needed health care

services.

The rate of primary care physicians per

population in El Paso County has been

consistently lower than the state average

requiring growth of full-time primary care

providers by 54 percent to meet the benchmark ratio of

1900:1 people to full-time primary care

physician

Nurse Advisor Call Line – Provides

appropriate health advice and health promotion referrals using evidence-based

clinical decision tools.

Nurse triage programs

ensure appropriate Emergency Department utilization, help prevent

unnecessary readmissions, and refer callers to

appropriate providers. Metrics will include the

number of callers referred to primary care physicians.

Peak Vista Community

Health Centers

University of Colorado School

of Medicine

Primary care physician recruitment

activities facilitated by UCHealth’s Colorado Health Medical Group (CHMG)

Planned (2016 launch) enrollment of third-

and fourth-year University of Colorado School of Medicine (UCSOM) students completing their residency in El Paso

County

Increase in number of primary care providers

practicing in El Paso County; measured by:

1) tracking the number of new primary care physicians

joining CHMG annually 2) tracking the number of

graduating UCSOM students who remain and practice in

Colorado Springs.

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SPECIFIC GOALS AND STRATEGIES TO ADDRESS THE PRIMARY CARE PHYSICIAN SHORTAGE IN EL PASO COUNTY: Goal #1: Improve the capacity of primary care services

Strategies:

Collaborate with community primary care providers through ongoing communication and care coordination.

Support Memorial Hospital’s HealthLink Call Center connections to primary care providers to facilitate appropriate transitions of Care. Goal #2: Increase the number of primary care physicians practicing in El Paso County Strategies:

Enroll University of Colorado School of Medicine medical students into residency training within El Paso County.

Continue efforts to recruit additional primary care physicians into UCHealth’s Colorado Health Medical Group offices located in El Paso County.

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In addition to identifying health issues for the general population within our target communities, IRS Schedule H, Part V, Section B, line 1(f) requires that “primary and chronic disease needs and other health issues of uninsured or low-income persons and minority groups” be described within the hospital facility’s community health needs assessment. To satisfy this requirement, stratified data provided within the El Paso County 2012 Health Indicators report was used to identify specific health issues for these individuals. The table below identifies those issues and indicates where Memorial Hospital provides direct-impact resources. This report is available through the following link: http://www.elpasocountyhealth.org/services/health-indicators

Memorial Hospital’s Available and Planned Resources Serving Health

Issues of Limited-resource Populations in El Paso County

Tobacco Use (documented

disparity - low-income)

Obesity (documented disparity –

minority, low-income)

Unintended Pregnancy (documented disparity –

minority, low-income)

Life Expectancy (documented

disparity – minority, uninsured)

Discounted lung cancer screenings

Chronic Disease Self-Management Programs (planned launch 2015)

Tobacco cessation classes

Clinical trials / Cancer screenings

Weight management classes

Diabetes prevention classes

Fitness classes

Online Heart Attack Risk Assessment

Nurse Advisor Call Line (HealthLink)

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Community Organizations Currently Addressing Other Identified Health Issues in El Paso County Memorial Hospital’s community benefit staff will use this information to determine a “best fit” for providing in-kind or sponsorship support as a means to address other significant health issues in El Paso County. Donations may be leveraged based on the organization’s ability to measure health impact.

Community Organizations Addressing

Other Significant Health Issues in El Paso County

Tobacco Use

Mental Health and Substance

Abuse

Motor Vehicle Injury

Unintended Pregnancy and Unsafe Sexual

Practices

Oral Health

Depression and Bipolar Support Alliance

Drive Smart (Colorado Department of Transportation)

El Paso County Public Health Tobacco Education and Prevention Services

El Paso County Public Health Women’s Reproductive Health

Greenberg Center for Learning and Tolerance

Let’s Ride Safe Campaign (motorcycle safety)

Peak Vista Community Health Centers Foundation

Suicide Prevention Partnership

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Evaluation Plan Narrative

Evaluation metrics as described in this report are tracked routinely and reported periodically. Overall, the Memorial Hospital administrative team will continue to lead the charge to generate measureable metrics and report outcomes over time that will demonstrate the success of the various initiatives described within this report.

Obtaining Community Comment

The IRS requires that a hospital facility establish an ongoing feedback mechanism to consider written comments received on its most recently adopted implementation strategy. This feedback mechanism will be established through Memorial Hospital’s ongoing collaboration with the HCC as well as during periodic meetings of the Colorado Springs Health Foundation.

Conclusion and Next Steps

UCHealth, as an organization, believes improving health care can only be accomplished through ongoing collaboration with community partners and providers to assist in addressing the complexities involved in meeting the variety of community health needs. Implementation activities for Memorial Hospital will emphasize partnering with listed community providers that are also actively addressing the health issues described. This synergistic approach takes advantage of proven expertise and can be used to expand or refine successful programs. In compliance with the revised federal reporting requirements, a report describing progress toward the anticipated health outcomes resulting from this implementation strategy will be submitted annually to the Internal Revenue Service as part of the filing of Form 990.