Implementation Strategy Reportfor Community Health Needs

License #930000078

Kaiser Foundation Hospital – DOWNEY

2013

2013 KFH CHNA Implementation Strategy Report

Kaiser Foundation Hospitals Community Health Needs Assessment (CHNA)

Implementation Strategy Report 2013

Kaiser Foundation Hospital – Downey License #930000078 9333 Imperial Hwy Downey, CA 90242

I. General Information Contact Person: Elizabeth Trombley, MPH,

Director, Public Affairs and Brand Communications Date of Written Plan: September 23, 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

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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, 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 – Downey Service Area The Kaiser Foundation Hospital (KFH) – Downey service area covers portions of southeast Los Angeles County and is identified by community, zip code and Service Planning Area (SPA) as listed below:

KFH – Downey Medical Center Service Area

City Zip Code SPA Artesia 90701 SPA 7 Bell 90201 SPA 7 Bellflower 90706 SPA 7 Bell Gardens 90201 SPA 7 Cerritos 90703 SPA 7 Commerce 90040 SPA 7 Compton 90221,90222 SPA 6 Cudahy 90201 SPA 7 Downey 90240,90241,90242 SPA 7 Hawaiian Gardens 90716 SPA 7 Huntington Park 90255 SPA 7 Lakewood 90712,90713,90715 SPA 7 North Long Beach 90805,90808 SPA 8 Lynwood 90262 SPA 6 Maywood 90270 SPA 7

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Norwalk 90650 SPA 7 Paramount 90723 SPA 6 Pico Rivera 90660 SPA 7 Santa Fe Springs 90670 SPA 7 South East Los Angeles 90001,90002,90003,90059 SPA 6 South Gate 90280 SPA 7 Vernon 90058 SPA 7 Whittier 90601,90602,90603,90604, 90605, 60606 SPA 7

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The population of the KFH – Downey service area is 1,581,222. Children and youth, ages 0-17, make up 30.6% of the population; 61.1% are adults, ages 18-64; and 8.3% of the population are seniors, ages 65 and over. In the KFH – Downey service area, the majority of the population is Hispanic/Latino (70.1%); 11.5% of the residents are White; 9.7% are African American; 6.9% are Asian; and 1.8% are American Indian/Alaskan Native or other race/ethnicity. There are a number of communities where over 90% of the population is Hispanic/Latino. These communities are: Bell, Bell Gardens, Commerce, Cudahy, Huntington Park, Maywood, Pico Rivera, and South Gate. Among the residents in the KFH – Downey service area, 17.1% are at or below 100% of the federal poverty level (FPL) and 43.1% are at 200% or below FPL. 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 – Downey’s planned response to the needs identified through the 2013 Community Health Needs Assessment (CHNA) process. For information about KFH – Downey’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 – Downey’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 – Downey service area through the 2013 Community Health Needs Assessment process.

Prioritized Health Needs as Identified by the Community 1. Youth safety/community violence 2. Mental health 3. Overweight/obesity 4. Access to care 5. Diabetes 6. Physical activity 7. Preventive health 8. Nutrition/healthy eating 9. Dental health

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VII. Who was Involved in the Implementation Strategy Development

The following individuals comprised the Implementation Strategy Engagement Team (ISET)and were involved in the Implementation Strategy development process:

Sheri Bathurst, Community Benefit Manager BineshBatra, MD, Area Medical Director Melissa Biel, DPA, RN, Community Benefit Consultant Jim Branchick, Chief Operations Officer Gregg Durkee, Area Chief Financial Officer Jane Finley, Senior Vice President and Executive Director Elizabeth Trombley, MPH, Director, Public Affairs and Brand Communications Mark Zuiderveen, Chief Administrative Officer

VIII. Health Needs that KFH – Downey Plans to Address a. Process and Criteria Used In order to select the health needs that KFH-Downey will address, the team used the criteria listed below, with a particular focus on choosing needs that Kaiser Permanente would have the ability to have a significant and meaningful impact on given our expertise, our resources and the evidence. In addition, KFH -Downey limited the number of needs selected to only a few in order to maximize the hospital's ability to have an impact and not spread resources too thinly across many needs. A number of criteria were designed to assess the identified health needs. The criteria focused on need and included measurements for magnitude of a health problem, severity, and disparities associated with the identified health need. A second component included criteria that focused on feasibility of addressing the health needs and included measurements of Kaiser Permanente assets and opportunities to leverage partnerships to address the need. A definition and rating system were developed for each of the criteria (magnitude, severity, disparities, assets, ability to leverage). The Implementation Strategy Engagement Team met on June 10, 2013. After a review of the identified health needs, they examined the criteria and agreed on its use to measure need and feasibility for the identified health needs. It was further agreed that the Community Benefit Consultant and Community Benefit Manager would apply the criteria to the health needs and present the results of the findings at the second team meeting. Upon applying the health needs selection criteria, the health needs were categorized by those needs rated as low need/low feasibility; low need/high feasibility; high need/low feasibility; and high need/high feasibility. These results were reviewed and discussed by the ISET. The ISET chose to address the health needs identified by the applied criteria as high need/high feasibility, and some selected health needs identified as high need/low-medium feasibility.

10. Cardiovascular disease 11. Teen births 12. STDs 13. Asthma

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b. Health Needs that KFH – Downey Plans to Address Access to Care Access to comprehensive, quality health care services is important for health equity and for increasing the quality of a healthy life. Increasing access to appropriate and effective health care services addresses a wide range of specific health needs. Health care access is a key requirement for early detection of illnesses, chronic disease management and reduction of Emergency Room usage. 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. In the KFH – Downey service area, 26% of residents are uninsured. In California the rate of uninsured is 17.9% (American Community Survey, 2008-2010).

• Insurance Coverage – In the KFH – Downey Service Area, 74% of residents have health insurance, which can include Medi-Cal, employer-based insurance and other public and private coverage (American Community Survey, 2008-2010).

• Health Professional Shortage Area (HPSA) – 15% of the KFH – Downey service area population live in a HPSA (which includes shortages of medical, dental, and mental health providers) compared to 13.8% of the state population (Health Resources and Services Administration, 2012).

Residents who have a medical home have access to a primary care provider. Among the residents in the KFH – Downey Service Area, over 90% of children and youth have a usual source of care. Among adults, in SPA 6, 68.7% have a usual source of care, and 77.5% of adults in SPA 7 have a source of care. And, 86.3% of seniors in SPA 6 and 95.4% of seniors in SPA 7 have a usual source of care (California Health Interview Survey, 2009). Low-income populations face increased barriers to accessing health care; 43.1% of the population in the service area is categorized as low-income and 17.1% are living in poverty. In 2010, the poverty level income for a family of four was $22,050 (American Community Survey, 2006-2010).

Access to care enhances prevention of disease and disability. Therefore, KFH – Downey plans to address access to care by increasing access to primary and specialty care services throughout the service area. Overweight/Obesity Being overweight or obese affects a wide range of health issues and are major risk factors for diabetes, cardiovascular disease, and other chronic diseases.

• Overweight – Over one-third of adults in the KFH – Downey service area are overweight. Among teens, 11.3% in SPA 6 and 18.8% in SPA 7 are overweight. 11.8% of children in SPA 6 and 15.2% in SPA 7 are overweight (California Health Interview Survey, 2009).

• Obesity – When adult obesity levels were tracked over time, a 9% increase in obesity is seen in SPA 6, and a 10.3% increase in obesity is seen in SPA 7 from 2005 to 2011. In 2011, 32.7% of adults in SPA 6 and 30.1% of adults in SPA 7 were obese, higher than the County rate of 23.6% (Los Angeles County Department of Public Health, 2012).

Unhealthy eating has been found to be a risk factor for overweight and obesity.

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• Diets High in Fat: 21.9% of the residents in SPA 6 consume fast food 3-4 times a week. In SPA 7, over one-third (33.5%) of the residents eat fast food 3-4 times a week. The state rate is 19.6% (California Health Interview Survey, 2009). Soda Consumption: In comparison to the 14.7% rate of soda consumption in California, children and teens consume much higher rates of soda / sweetened drinks in SPA 6 (21.7%) and SPA 7 (23.5%) (California Health Interview Survey, 2009).

Physical activity also plays a key role in levels of overweight and obesity. • Adult Physical Activity – In the KFH – Downey Service Area, 78.8% in SPA 6 and 81.4% in SPA 7 walked

for transportation, fun or exercise, compared to 77.2% of adults in the state (California Health Interview Survey, 2009).

• Child Physical Activity – 15.2% of children in SPA 6 and 17% in SPA 7 were sedentary during the week, which is higher than the state rate of 11.8% (California Health Interview Survey, 2009).

• Teen Physical Activity – 14.4% of teens in SPA 6 and 14.1% in SPA 7 were sedentary during the week, less than the state rate of 16.2% (California Health Interview Survey, 2009).

To address these health needs, efforts will be targeted to reduce and treat overweight and obesity, and focus on prevention through healthy eating and physical activity programs and initiatives. Preventive Care Preventive care reduces death and disability and improves health. Health care preventive services prevent and detect illnesses and diseases in earlier, more treatable stages, significantly reducing the risk of illness, disability, early death, and medical care costs for individuals and the community (Healthy People 2020). KFH – Downey will address preventive care services including screenings for cancer, STDs and chronic diseases, and will target mental health services, and those issues specific to at-risk youth, including community violence. Residents who have a medical home are able to access preventive care services. Among the residents in the KFH – Downey service area, over 90% of children and youth have a usual source of care. 68.7% of adults in SPA 6, and 77.5% of adults in SPA 7 have a usual source of care. And, 86.3% of seniors and 95.4% of seniors in SPA 7 have a source of care. 85.8% of state residents have a usual source of care (California Health Interview Survey, 2009). Low-income populations face barriers obtaining preventive care: 43.1% of the population in the service area is categorized as low-income, compared to 32.8% in the state (American Community Survey, 2006-2010). Mammograms: The Healthy People 2020 objective for mammograms is 81.1% of women 40+ years have a mammogram in the past two years. In SPA 6, 72% of women, age 40+, have had a mammogram, and 77% of women in SPA 7 have had a mammogram, which falls short of the Healthy People 2020 objective (Los Angeles County Department of Public Health, 2007). Colorectal Cancer Screening: In SPA 6, 67.1% of adults have had the recommended screening for colorectal cancer. In SPA 7, the rate of compliance is 71.1%, which exceeds the Healthy People 2020 objective for colorectal cancer screening of 70.5%. Of adults advised to obtain screening, 57.9% in SPA 6 and 59.2% in SPA 7 were compliant at the time of the recommendation (California Health Interview Survey, 2009).

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Sexually Transmitted Diseases (STDs) have been identified as a health need in the KFH – Downey service area. SPA 6 has high rates of Chlamydia, Gonorrhea, Early Latent Syphilis and HIV/AIDS, while SPA 7 has lower rates of STDs than L.A. County as a whole. Community focus groups commented on the social stigma associated with discussing sex and intimacy, which Healthy People 2020 notes is the most important social factor contributing to the spread of STDs. Mental health disorders can have a serious impact on physical health and are associated with the prevalence, progression and outcome of chronic diseases (Healthy People 2020).

• Adults – In SPA 6, 14.8% of adults had serious psychological distress, compared to 6.5% of adults in California (California Health Interview Survey, 2009).

• Teens – 26.4% of teens in SPA 6 and 16.7% of teens in SPA 7 needed help for emotional issues/substance abuse (California Health Interview Survey, 2009).

• In SPA 6 10.9% of adults reported needing mental health care but not being able to afford to access it. This is in comparison to 5.9% of adults in LA County who could not afford mental health care (Los Angeles County Health Survey, 2007).

Community violence is pervasive, especially in lower-income urban areas. Socioeconomics and crime interconnect and contribute to community violence. In the KFH – Downey service area the rate of homicide is 13.1 per 100,000 persons (age-adjusted, averaged over three years, 2008-2010) (California Department of Health, 2008-2010). Communities negatively impacted by violence include Compton (547.4), Commerce (436.7) and Hawaiian Gardens (427.9), which have the highest rate of arrests among adults for violent crimes per 100,000 persons in the KFH – Downey service area. Bell, Bellflower, Cudahy, Huntington Park and Lynwood also have high rates of violent crimes (California Department of Justice, 2010). Broader Health Care Delivery System Needs 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.

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IX. KFH-Downey’s Implementation Strategies

As part of the Kaiser Permanente integrated health system, KFH-Downey 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-Downey 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-Downey will continue to work in partnership to refine its goals and strategies over time so that they most effectively address the needs identified. Access to Care Long-Term Goal Increase access to health care for medically underserved. Intermediate Goals Expand access to free and low cost services. Increase health care coverage among vulnerable populations. Improve timely access to needed medical care. Reduce workforce shortages.

Strategies Provide grants and in-kind donations to community clinics and health care providers to build safety net

capacity and expand access to care. Explore partnership with community clinic(s) to implement KP Cares, a physician community

engagement program. Provide access to health care and preventive services at school-based clinics. Partner with Southern California Permanente Medical Group to continue community access program

providing free surgical and/or specialty care services. Participate in government-sponsored programs for low-income individuals (i.e., Medi-Cal Managed

Care and Medi-Cal Fee-For-Service). Provide care to low income children under 19 in families at or below 300% of FPL who lack access to

employer-subsidized coverage and do not qualify for public programs pursuant to a program that provides these children with heavily subsidized health care coverage.

Provide Medical Financial Assistance (i.e., Charity Care) and financial counseling services to connect patients with available sources of coverage.

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Continue to support youth pipeline programs (i.e., Summer Youth and INROADS) to introduce diverse, under-represented school age youth and college students to careers in health care.

Continue to support physician training programs (i.e. Graduate Medical Education). Expected Outcomes Increase capacity for community and school based clinics who serve the medically underserved. Increase availability of specialty care and diagnostic services for the medically uninsured or

underinsured. Increase number of eligible individuals enrolled in government-sponsored and/or subsidized health

care coverage programs. Increase number of underserved populations who receive needed primary and/or specialty care

medical services. Increase safety net capacity of the community Improve diversity of trained physicians.

Overweight and Obesity Long-Term Goal Reduce incidence of overweight and obesity in the community. Intermediate Goals Increase healthy eating among service area residents. Increase active living among residents of the service area.

Strategies Provide grants and in-kind donations to community organizations that will carry out evidence-based

interventions to increase availability and awareness of healthy foods and increase physical activity. Implement Thriving Schools, a KP initiative that aligns and targets resources to schools in low-

income neighborhoods to improve the health and wellness of students and employees through improved nutrition and increased physical activity.Participate in community partnerships, serve on and support boards that are focused on reducing overweight and obesity.

Connect Healthy Lifestyles for Families Program (train-the-trainer) from Regional Health Education to appropriate clinics, schools and community based organizations.

Explore opportunities to provide Continuing Medical Education classes for obesity prevention and treatment to community health providers.

Support efforts to increase physical activity in the community and schools through KP volunteerism at community events and program support (e.g. Walk with a Doc; Walking School Bus; KP’s EverybodyWalks).

Expected Outcomes Increase awareness about healthy eating. Healthy food options will be increased in community settings. Increase availability of community-based physical activity opportunities.

Preventive Practices Long-Term Goal Improve community health and wellness through preventive practices. Intermediate Goals

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Increase access to preventive care in the community. Improve access to preventive interventions for at-risk youth.

Strategies Explore opportunities to provide health screenings (e.g. retinal screening, mammograms, FIT-Fecal

Immunochemical Testing, STDs) in the community for targeted populations. Provide grants to community organizations offering free or low-cost mental health services, mentoring

programs, violence prevention, and school based interventions. Partner with Southern California Permanente Medical Group physicians to support uninsured students

with Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder. Connect Educational Theatre resources and/or presentations to local schools. Explore opportunities to partner with Federally Qualified Health Center school based clinics to support

mental health and health and wellness efforts. Expected Outcomes Increase the identification and treatment of adult health needs. Increase opportunities for youth to improve social behaviors, mental health, and health and wellness.

Broader Health Care Delivery System Needs Workforce Long-term Goals To address health care workforce shortages and cultural and linguistic disparities in the health care

workforce

Intermediate Goals Increase the number of skilled, culturally competent, diverse professionals working in and entering the

health care workforce to provide access to quality culturally relevant care

Strategies Implement health care workforce pipeline programs to introduce diverse, underrepresented school

age youth and college students to health careers Provide workforce training programs to train current and future health care providers with the skills,

linguistic, and cultural competence to meet the health care needs of diverse communities Disseminate knowledge to educational and community partners to inform curricula, training and

health career ladder/pipeline programs To leverage CB funded programs to develop strategies to increase access to allied health, clinical

training and residency programs for linguistic and culturally diverse candidates Increase capacity in allied health, clinical training and residency programs to address health care

workforce shortages through the provision of clinical training and residency programs Leverage KP resources to support organizations and research institutions to collect, standardize and

improve access to workforce data to enhance planning and coordination of workforce training and residency training programs

Expected Outcomes Increase the number of diverse youth entering health care workforce educational, training programs

and health careers Increase the number of culturally and linguistically competent and skilled providers

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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 Goals To increase awareness of the changing health needs of diverse communities

Intermediate Goals 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 – Downey 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 – Downey will require grantees to propose, track and report outcomes, including behavior and health outcomes as appropriate. For example, outcome measures for a strategy that addresses obesity/overweight by increasing access to physical activity and healthy eating options might include number of students walking or biking to school, access to fresh locally grown fruits and vegetables at schools, or number of weekly physical activity minutes. XI. Health Needs Facility Does Not Intend to Address The health needs that Kaiser Foundation Hospital – Downey does not intend to directly address are: asthma, cardiovascular disease, dental health, diabetes, and teen births. These needs were deemed to be of relatively

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lower need based on the defined criteria. Taking existing community resources into consideration, KFH – Downey has selected to concentrate on those health needs that we can most effectively address given our areas of focus. Moreover, KFH – Downey strategies addressing obesity and preventive health impact behaviors that impact cardiovascular disease and diabetes. 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-Downey will look for collaboration opportunities that address needs not selected where it can appropriately contribute to addressing those needs.

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