Implementation Strategy Report for Community Health Needs

Transcription

1 2013 Implementation Strategy Report for Community Health Needs Kaiser Foundation Hospital SAN DIEGO License #

2 I. General Information Contact Person: 2013 KFH CHNA Implementation Strategy Report Kaiser Foundation Hospitals Community Health Needs Assessment (CHNA) Implementation Strategy Report 2013 Kaiser Foundation Hospital San Diego License # Zion Avenue San Diego, CA Date of Written Plan: September 20, 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: 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 Rodger Dougherty, Senior Director of Public Affairs and Brand Communications Kaiser Foundation Hospital/Health Plan Boards of Directors Body: N/A Name and EIN of Hospital Organization Operating Hospital Facility: Kaiser Foundation Hospitals, Address of Hospital Organization: One Kaiser Plaza, Oakland, CA 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, clean air, 1

3 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 San Diego Service Area The Kaiser Foundation Hospital (KFH) San Diego medical service area includes a large part of San Diego County. The following cities and communities are included: Bonita, Chula Vista, Coronado, Del Mar, Descanso, Dulzura, El Cajon, Encinitas, Leucadia, Olivenhain, Escondido, Fallbrook, Rainbow, Guatay, Imperial Beach, Jamul, La Jolla, La Mesa, Lakeside, Lemon Grove, Lincoln Acres, Mount Laguna, National City, Oceanside, Pala, Palomar Mountain, Pauma Valley, Pine Valley, Potrero, Poway, Ramona, Rancho Santa Fe, San Diego, San Luis Rey, San Marcos, San Ysidro, Santee, Solana Beach, Spring Valley, Tecate, Valley Center, Vista and Warner Springs. The population that KFH-San Diego medical service area serves is 0.4% smaller than the entire San Diego County population. Due to this small 0.4% difference between KFH-San Diego medical service area population and the overall San Diego County population the statistics and numbers at the county level are sufficient for understanding KFH-San Diego s population and demographics. Current population demographics and changes in demographic composition over time play a role in determining the types of health and social services needed by communities. In addition, economic insecurity and social inequities often are associated with poor health. Language, poverty, unemployment, and lack of educational achievement affect access to care and a community s ability to engage in healthy behaviors. The U.S. Census Bureau s American Community Survey (ACS), reports the total population of San Diego County as approximately 3 million with a median age of 34.5 years. There is an even distribution of both males and females in San Diego County (50.1% and 49.8% respectively). In the ACS, data for race and ethnicity (Hispanic origin) are collected as two separate categories. Of those who identified as non-hispanic in San Diego County approximately 1.5 million identify their race as white, followed by Asian (320,667) and Black (145,787). Of those who identify as Hispanic in San Diego County, approximately 650,000 identify their race as white, followed by other race, and those who identify with two or more races. The U.S. Bureau of Labor reports 2

4 Limited English Proficiency as the percentage of the population aged 5 and older unable to speak English, or who speak English less than "very well." An inability to speak English well creates barriers to healthcare access, provider communications, and health literacy/education. Sixteen percent of the San Diego total population is linguistically isolated which is lower than the state percentage of 19% but considerably higher than the national level of 9%. Twelve percent of the San Diego County population is considered below poverty level which is less than the California and U.S. poverty rate of 14%. In San Diego County 7% of the labor force is unemployed which is lower when compared to the state unemployment level of 9%. In San Diego County 15% of the population does not have a high school diploma or equivalent, which is lower than the state level of 19%. 3

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6 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 This implementation strategy describes KFH San Diego s planned response to the needs identified through the 2013 Community Health Needs Assessment (CHNA) process. For information about KFH -San Diego s 2013 CHNA process and for a copy of the report please visit 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 San Diego 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 prioritized health needs identified for the KFH-San Diego service area through the 2013 Community Health Needs Assessment process. Diabetes (Type 2) Obesity Cardiovascular Disease Mental/Behavioral Health Unintentional Injury High Risk Pregnancy Asthma Dementia & Alzheimer s Disease Breast Cancer Acute Respiratory Infections/Pneumonia Back Pain Colorectal Cancer Lung Cancer Prostate Cancer Skin Cancer In addition to the 15 health conditions that were named above, three additional conditions; Cervical Cancer, Chlamydia and HIV, were added for KFH-San Diego s consideration of possible indicators to include in their intervention/implementation process through discussion with the Implementation Strategy Engagement Team (ISET). 5

7 VII. Who was Involved in the Implementation Strategy Development The Implementation Strategy Engagement Team (ISET) at KFH-San Diego included the following stakeholders: Bertha Aviles, Assistant Administrator, Hospital Operations Mary Ann Barnes, Senior Vice President and Executive Director Veronica DelaRosa, Assistant Medical Group Administrator, Health Support Services Rodger Dougherty, Director of Public Affairs and Brand Communications Dian Doyle, NICU Administrator Tana Lorah, Community and Government Relations Manager Jay Mongiardo MD, Area Physicians Leader Idara Inwek Ogunsaju, Gastroenterology & Endocrinology Department Administrator Rich Raynes, Assistant Medical Group Administrator, Surgical Services Shreya Sasaki, Senior Community Benefit Manager Linda Thornton, Department Administrator, Psychiatry and Addiction Medicine Sammy Totah, Pharm.D, Chief Operating Officer VIII. Health Needs that KFH-San Diego Plans to Address a. Process and Criteria Used In order to select the health needs that KFH-San Diego 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- San Diego 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. In order to select the needs that KFH-San Diego will address from the broader list of community health needs identified during the 2013 CHNA, the Community Benefit Manager applied the following criteria, grouped under the two headings of Need and Feasibility, using a scale of 1 to 5 from least to most, to each of the health needs listed in section VI. The resulting scores were translated to a four section grid (vertical and horizontal axes from Low to High) according to Need and Feasibility for review by the Implementation Strategy Team. The health needs receiving the highest scores for Need and Feasibility were selected as needs that KFH-San Diego would address, in the manner as presented in the Priority Areas listed in section VIII.b. The criteria used were: Need: 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 Disparities: the health need disproportionately impacts the health status of one or more vulnerable population groups Feasibility: Kaiser Permanente Assets: KP has relevant expertise and/or unique assets as an integrated health system to make a meaningful contribution Ability to leverage: opportunity to collaborate with existing community partners working to address the need, or to build on current programs, emerging opportunities, or other assets. 6

8 Prior to applying the prescribed feasibility criteria described above, the CB Manager and the consultants codesigned a matrix exercise that allowed for a consideration of assets and drivers related to the CHNA health needs in order to further inform the process. b. Health Needs that KFH-San Diego Plans to Address Priority Health Need 1: Access to Health Care: increasing access to clinical care as this drives poor health outcomes in many health needs. 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. In the CHNA, Access to Care or Insurance was described as access to primary care physicians and referral, and/or increased availability of insurance coverage. This need was selected because even with implementation of the Affordable Care Act, 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. For these groups, access barriers will continue. Even with insurance, for some populations those with Medicare, Medi-Cal, etc. and individuals with geographic or language barriers access is not guaranteed. In the prioritization process, access to care was not identified as a priority need through the selection process described above. Access to care was identified as a driver of health and not a health need per se. However, KFH-San Diego recognizes that access to care is an area of need in its medical center service area and therefore decided to adopt it as a priority need. Priority Health Need 2: Cardiovascular Disease: Preventing and managing this chronic condition that particularly impacts vulnerable populations residing in the high needs areas (as measured by the Community Need Index (CNI) 1 of San Diego County. The CDC s Behavioral Risk Factor Surveillance System (BRFSS) found 3.42% (78,780) of adults in San Diego County reported ever been told by a doctor that they have coronary heart disease or angina. The ageadjusted death rate for coronary heart disease in San Diego County is 117 per 100,000 which are lower when compared to the state death rate of 135 per 100,000. Males in the County have a higher rate than females ( versus respectively), as well as African Americans having the highest rate among the different ethnic groups ( per 100,000). This need was selected through the process described above and in the CHNA was also identified as one of the top 4 priority health needs identified through the community priority setting process. 1 The Community Need Index identifies severity of health vulnerability by ZIP code based on barriers to health care access. Measured on a scale of 1-5, with 5 representing communities with the highest vulnerability; 1 the lowest vulnerability. 7

9 Priority Health Need 3: Mental/Behavioral Health: Preventing and managing symptoms of this illness that particularly impacts vulnerable populations residing in the high needs areas (as measured by the CNI) of San Diego County. Suicide, an indicator of poor mental health, is one of the major complications of depression. The CDC s National Center for Health Statistics reports the age-adjusted suicide death rate in San Diego County as per 100,000 populations which are higher in comparison to the state suicide rate of per 100,000. When adjusting for age, males are more likely than females to commit suicide (18% versus 5% respectively). Both male and female rates of suicide in San Diego County are above those of the state. This need was selected through the process described above and in the CHNA was also identified as one of the top 4 priority health needs identified through the community priority setting process. Priority Health Need 4: Obesity: Preventing and managing this condition that particularly impacts vulnerable populations residing in the high needs areas (as measured by the CNI) of San Diego County. The CDC s BRFSS found that 22.8% of adults in San Diego self-report that they were obese which is lower than the state and national percentage (23.3% and 27.4% respectively). However 36.4% of adults in San Diego self-report being overweight which is higher than the state and national percentage (36.2% and 36.3% respectively). In San Diego County adult males are more likely to report being obese than females (24% versus 21% respectively). This need was selected through the process described above and in the CHNA was also identified as one of the top 4 priority health needs identified through the community priority setting process. Priority Health Need 5: Type 2 Diabetes: Preventing and managing this chronic condition that particularly impacts vulnerable populations residing in the high needs areas (as measured by the CNI) of San Diego County. Diabetes is a problem within San Diego as well as the nation and may indicate an unhealthy lifestyle that puts individuals at risk for further health issues. The CDC s Diabetes Data & Trends found in San Diego County that 7.3% (163,205) of adults aged 20 and older reported having diabetes. In San Diego County, males are more likely to report diabetes than females (8% versus 6.7% respectively). This need was selected through the process described above and in the CHNA was also identified as one of the top 4 priority health needs identified through the community priority setting process. Priority Health Need 6: Address Broader Health Care Delivery 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. 8

10 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-San Diego s Implementation Strategies As part of the Kaiser Permanente integrated health system, KFH-San Diego 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-San Diego 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-San Diego will continue to work in partnership to refine its goals and strategies over time so that they most effectively address the needs identified. Priority Health Need 1: Access to Health Care: Increasing access to clinical care as this drives poor health outcomes across many health needs. KFH-San Diego aims to increase access to health care for the medically underserved by aligning our strategies with the following goal: Improve access to clinical care services. There are several strategies KFH-San Diego will implement to address this goal: 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 to uninsured and underinsured individuals. 9

11 Provide medical financial assistance to individuals who cannot afford to pay for services KFH-San Diego will partner with Project Access San Diego to host two free surgical/diagnostic days at KFH- San Diego outpatient surgery centers. KFH-San Diego anticipates that our strategies will have the following outcomes, which can contribute toward achieving the overall goals for increasing access to clinical care: Increased enrollment and retention in health care coverage programs. Increased access to urgent or emergency clinical services. Increased access to routine clinical services including pharmaceuticals, primary and specialty care, appointments and other services. Increased access to outpatient procedures and diagnostic services. Priority Health Need 2: Cardiovascular Disease: Preventing and managing this chronic condition that particularly impacts vulnerable populations residing in the high needs areas (as measured by the Community Needs Index CNI ) of San Diego County. KFH-San Diego aims to prevent Cardiovascular Disease and improve management of this disease by aligning our strategies with the following goals: Increase healthy eating among vulnerable populations residing in the high need areas of San Diego County. Increase access to active living among vulnerable populations residing in the high need areas of San Diego County. Improve access to cardiovascular disease care management among vulnerable populations residing in the high need areas of San Diego County. There are several strategies KFH San-Diego will implement to address these goals: Partner with Educational Theatre Program s Amazing Food Detective to educate students on healthy eating. Collaborate with Regional CB Health Education to disseminate materials related to healthy eating. Promote use of Thriving Schools and Weight of the Nation Kids resources related to healthy eating and physical activity. Support continued implementation of the KP/IRC El Cajon Community Garden. Participate in the Healthier Hospitals Initiative through the Nutrition in Healthcare Leadership Team and provide healthier food offerings to members, visitors, staff and physicians. Provide grants to organizations that work on environmental and policy change efforts related to healthy eating and physical activity Participate in the San Diego Childhood Obesity Initiative s Leadership Council and the Lemon Grove HEAL Zone Committee to promote environmental and policy change related to healthy eating and active living Continue to provide Operation Splash grant in Chula Vista, aimed at increasing access to swim lessons. Increase access to sports physical exams through provision of free physical exams by KFH-San Diego s Primary Care Department. Increase access to KP-led Women Heart support group. Provide grants to community clinics that support programs or operational costs related to the provision of cardiovascular disease care management patient education and services for vulnerable populations. KFH-San Diego anticipates that our strategies will have the following outcomes, which can contribute toward achieving the overall goals for preventing Cardiovascular Disease and improving management of this disease: Increased awareness about the importance of healthy eating and physical activity 10

12 Improved policy and environmental changes targeted towards healthy eating and physical activity (i.e. access to affordable, fresh produce in the community, establishment of safe walking / hiking trails and bike routes) Increased availability of community-based educational efforts. Increased access to clinic based care management and education services for vulnerable populations. Priority Health Need 3: Mental/Behavioral Health: Preventing and managing symptoms of this illness that particularly impacts vulnerable populations residing in the high need areas (as measured by the CNI) of San Diego County. Kaiser Permanente aims to prevent and manage mental illness symptoms and progression and prevent suicides in San Diego County by aligning our strategies with the following goals: Improve screening of mental health symptoms. Reduce suicide risk by strengthening protective factors. Prevent the onset of suicidal behaviors among specific high-risk subpopulations. There are several strategies KFH-San Diego will implement to address these goals: Provide grants to clinic organizations for projects that aim to increase access to case managers. KFH-San Diego s Psychiatry and Addiction Medicine Department will conduct depression and alcohol screening in partnership with a community clinic. Provide grants to non-profit organizations that aim to reduce stigma of mental illness through direct interpersonal contact education, advocacy, and/or coalition building. Identify a representative from KFH- San Diego s Psychiatry and Addiction Medicine Department to participate in CHIP s Suicide Prevention Action Plan Committee. Provide grants to community based non-profit organizations for projects that aim to prevent the onset of suicidal behaviors among specific high risk subpopulations. KFH-San Diego anticipates that our strategies will have the following outcomes, which can contribute toward achieving the overall goals for preventing and managing symptoms of mental illness: Increase access to case managers to improve collaborative care management among primary care providers, patients, and mental health specialists in community clinic settings. Increase access to active screening for depression and alcohol misuse/abuse among high risk populations such as the elderly, young adults (18-24) and pregnant or post-partum women. Reduce stigmatization of mental illness in order to increase support for individuals to obtain treatment for their mental health symptoms. Increase community support, remove barriers to mental health care and enhance community knowledge of what to do to help suicidal individuals. Increase access to screening programs, gatekeeper training for frontline adult caregivers and peer natural helpers, support and skill building groups for at-risk groups in the population, and enhanced accessible crisis services and referral sources. Priority Health Need 4: Obesity: Preventing this condition that particularly impacts vulnerable populations residing in the high need areas (as measured by the CNI ) of San Diego County. Kaiser Permanente aims to reduce obesity among vulnerable populations by aligning our strategies with the following goals: Improve healthy eating and active living among vulnerable populations residing in the high need areas of San Diego County. 11

13 There are several strategies KFH-San Diego will implement to address these goals: Partner with Educational Theatre Program s Amazing Food Detective to educate students on healthy eating and active living. Collaborate with Regional CB Health Education to disseminate materials related to healthy eating and activity living. Promote use of Thriving Schools and Weight of the Nation Kids resources related to healthy eating and active living. Support (growing produce, educational outreach, operations, etc.) continued implementation of the KP/IRC El Cajon Community Garden. Participate in the Healthier Hospitals Initiative through the Nutrition in Healthcare Leadership Team and provide healthier food offerings to members, visitors, staff and physicians. Provide grants to organizations that work on environmental and policy change efforts related to healthy eating and physical activity. Participate in the San Diego Childhood Obesity Initiative s Leadership Council and the Lemon Grove HEAL Zone Committee to promote environmental and policy change related to healthy eating. Continue to provide Operation Splash grant in Chula Vista, aimed at increasing access to swim lessons. Increase access to sports physical exams through provision of free physical exams by KFH-San Diego s Primary Care Department. KFH-San Diego anticipates that our strategies will have the following outcomes, which can contribute toward achieving the overall goal of increasing healthy eating and active living. Increased awareness about healthy eating and active living. Increased access to affordable, fresh produce in the community. Improved or created policy and environmental changes targeted towards healthy eating (i.e. access to fresh produce, establishment of safe walking / hiking trails and bike routes). Priority Health Need 5: Type 2 Diabetes: Preventing and managing this chronic condition that particularly impacts vulnerable populations residing in the high need areas (as measured by the CNI) of San Diego County. Kaiser Permanente aims to prevent Type 2 Diabetes and improve management of this disease among vulnerable populations by aligning our strategies with the following goals: Improve healthy eating and active living among vulnerable populations residing in the high need areas of San Diego County. Improve access to diabetes care management among vulnerable populations residing in the high need areas of San Diego County. There are several strategies KFH-San Diego will implement to address these goals: Partner with Educational Theatre Program s Amazing Food Detective to educate students on healthy eating and physical activity. Collaborate with Regional CB Health Education to disseminate materials related to healthy eating and physical activity. Promote use of Thriving Schools and Weight of the Nation Kids resources related to healthy eating and physical activity. Support the continued implementation of the KP/IRC El Cajon Community Garden. Participate in the Healthier Hospitals Initiative through the Nutrition in Healthcare Leadership Team and provide healthier food offerings to members, visitors, staff and physicians. Provide grants to organizations that work on environmental and policy change efforts related to healthy eating and active living. 12

14 Participate in the San Diego Childhood Obesity Initiative s Leadership Council and the Lemon Grove HEAL Zone Committee to promote environmental and policy change related to healthy eating and active living. Continue to provide Operation Splash grant in Chula Vista, aimed at increasing access to swim lessons. Increase access to sports physical exams through provision of free physical exams by KFH-San Diego s Primary Care Department. Provide grants to organizations that aim to educate patients and family members about diabetes care management. Provide grants to community clinics that support programs or operational costs related to the provision of diabetes care management services for vulnerable populations. Provide continued grant support to the Council of Community Clinics to support education and care management of the San Diego safety net. KFH-San Diego Sr. CB Manager continues to participate in quarterly project steering committee. KP Physician Champion Dr. Wu will conduct diabetes self-management education in community gathering places for adults with Type 2 diabetes. KFH-San Diego anticipates that our strategies will have the following outcomes, which can contribute toward achieving the overall goals for preventing and managing Type 2 Diabetes: Increased awareness about healthy eating and active living. Increased access to affordable, fresh produce in the community. Improved policy and environmental changes targeted towards healthy eating and active living (i.e. access to affordable fresh produce, establishment of safe walking / hiking trails and bike routes). Increased access to community based educational efforts. Increased access to healthcare services in the community clinic setting for vulnerable populations. Increased access to KP clinic protocol, Project ALL, to improve care management among patients with diabetes, hypertension and high cholesterol in the community clinic setting. Priority Health Need 6: Broader health care delivery system needs in our communities. Workforce Kaiser Permanente aims to address health care workforce shortages by aligning our strategies with the following goal: Increase the number of skilled, culturally competent, diverse professionals entering the healthcare workforce to provide access to quality culturally relevant care. There are several strategies KFH-San Diego will implement to address this goal: 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. 13

15 KFH-San Diego anticipates that our strategies will have the following outcomes, which can contribute toward achieving the overall goals for health care delivery system needs: 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 Kaiser Permanente aims to increase awareness of the changing health needs of diverse communities with the following goal: Increase access to, and the availability of, relevant public health and clinical care data and research. There are several strategies KFH-San Diego will implement to address this goal: 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. KFH-San-Diego anticipates that our strategies will have the following outcomes, which can contribute toward achieving the overall goals for health care delivery system needs: 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-San Diego 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-San Diego 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. 14

16 XI. Health Needs Facility Does Not Intend to Address The remaining prioritized health needs for San Diego will not be addressed by KFH-San Diego because, using the criteria described previously, they were not ranked as highly as Access to Care, Diabetes (Type 2), Mental and Behavioral Health and Obesity. KFH-San Diego has particular resources and capacity to dedicate to the chosen priority areas and related health needs. The needs that will not be addressed are: 1. Unintentional Injury 2. High Risk Pregnancy 3. Asthma 4. Dementia & Alzheimer s Disease 5. Breast Cancer 6. Acute Respiratory Infections/Pneumonia 7. Back Pain 8. Colorectal Cancer 9. Lung Cancer 10. Prostate Cancer 11. Skin Cancer Cervical Cancer, Chlamydia and HIV, were added for KFH San Diego s consideration of possible indicators to include in their intervention/implementation process. These issues were not selected either, due to the reasons stated above. Though not selected as a priority need in the Implementation Strategy process, some of the above noted needs will be indirectly addressed through enhancing access to health care. 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-San Diego will look for collaboration opportunities that address needs not selected where it can appropriately contribute to addressing those needs. 15