Community Health Needs Assessment 2013

Transcription

1 Community Health Needs Assessment 2013 Marshall

2 Good Shepherd Medical Center Marshall Community Health Needs Assessment May 2013 Contents Introduction... 1 Summary of Community Health Needs Assessment... 2 Summary of Findings... 3 General Description of the Medical Center... 4 Community Served by the Medical Center... 5 Defined Community... 6 Community Details... 8 Identification and Description of Geographical Community... 8 Community Population and Demographics... 9 Socioeconomic Characteristics of the Community Income and Employment Poverty Uninsured Education Health Status of the Community Summary Leading Causes of Death Health Outcomes and Factors Harrison County Marion County Panola County Health Care Resources Hospitals and Other Licensed Facilities and Providers... 37

3 Good Shepherd Medical Center Marshall Community Health Needs Assessment May 2013 Contents (Continued) Key Informant Interviews Methodology Key Informant Profiles Key Informant Interview Results Key Findings Community Health Input Questionnaire Methodology Input Questionnaire Community Health Input Results Prioritization of Identified Health Needs Northeast Texas Regional Healthcare Partnership Plan Appendices Sources Acknowledgements Key Informant Interview Protocol Northeast Texas Regional Healthcare Partnership Plan Community Health Input Questionnaire Detail Results

4 Introduction Community Health Needs Assessment 2013 As a result of the Affordable Care Act, tax-exempt hospitals are required to assess the health needs of their communities and adopt implementation strategies to address identified needs. Compliance with section 501(r) of the Internal Revenue Code (IRC) requires that a tax-exempt hospital facility: Conduct a community health needs assessment every three years. Adopt an implementation strategy to meet the community health needs identified through the assessment. Report how it is addressing the needs identified in the community health needs assessment and a description of needs that are not being addressed with the reasons why such needs are not being addressed. The community health needs assessment must take into account input from persons who represent the broad interest of the community served by the hospital facility, including those with special knowledge of or expertise in public health. The hospital facility must make the community health needs assessment widely available to the public. This community health needs assessment is intended to document Good Shepherd Medical Center Marshall s compliance with IRC Section 501(r). Health needs of the community have been identified and prioritized so that Good Shepherd Medical Center Marshall (Medical Center) may adopt an implementation strategy to address specific needs of the community. The process involved: Collection and analysis of a large range of data, including demographic, socioeconomic and health statistics, health care resources and patient use rates. Interviews with key informants who represent a) broad interests of the community, b) populations of need or c) persons with specialized knowledge in public health. Circulating a community health input questionnaire which gathered a wide range of information and was widely distributed to members of the community. This document is a summary of all the available evidence collected during the initial cycle of community health needs assessments required by the IRS. It will serve as a compliance document as well as a resource until the next assessment cycle. 1

5 Community Health Needs Assessment 2013 Summary of Community Health Needs Assessment The purpose of the community health needs assessment is to understand the unique health needs of the community served by the Medical Center and to document compliance with new federal laws outlined above. The Medical Center engaged BKD, LLP to conduct a formal community health needs assessment. BKD, LLP is one of the largest CPA and advisory firms in the United States, with approximately 2,000 partners and employees in 30 offices. BKD serves more than 900 hospitals and health care systems across the country. The community health needs assessment was conducted from December 2012 through May Based on current literature and other guidance from the U.S Treasury Department and the IRS, the following steps were conducted as part of the Medical Center s community health needs assessment: The community served by the Medical Center was defined by utilizing inpatient and outpatient data regarding patient origin. This process is further described in the section entitled Community Served by the Medical Center. Population demographics and socioeconomic characteristics of the community were gathered and reported utilizing various third parties (see references in Appendices). The health status of the community was then reviewed. Information on the leading causes of death and morbidity information was analyzed in conjunction with health outcomes and factors reported for the community by CountyHealthrankings.org. Health factors with significant opportunity for improvement were noted. An inventory of health care facilities and resources was prepared and a demand for physician and hospital services was estimated. Both were evaluated for unmet needs. Community input was provided through interviews of 20 key informants and a widely-distributed community health input questionnaire. The community health input questionnaire was completed by 917 individuals. Results and findings are described in the Key Informant and Community Health Input sections of this report. Information gathered in the above steps was analyzed and reviewed to identify health issues of uninsured persons, low-income persons and minority groups and the community as a whole. Health needs were ranked utilizing a weighting method that considers 1) the ability to evaluate and measure outcomes, 2) the size of the problem, 3) the seriousness of the problem and 4) the prevalence of common themes. Health needs were then prioritized taking into account the perceived degree of influence the Medical Center has to impact the need and the health needs impact on overall health for the community. Information gaps identified during the prioritization process have been reported. 2

6 Community Health Needs Assessment 2013 Summary of Findings The following health needs were identified based on the information gathered and analyzed through the Community Health Needs Assessment conducted by the Medical Center. These needs have been prioritized based on information gather through the Community Health Needs Assessment. Identified Community Health Needs 1. Uninsured / Lack of access to services (cost) 2. Obesity 3. Heart Disease 4. Lack of mental health services 5. Lack of primary care physicians 6. Physical inactivity 7. Diabetes 8. Poor nutrition 9. Utilization of emergency room for episodic care 10. Lack of health education These identified community health needs are discussed in greater detail later in this report. 3

7 Community Health Needs Assessment 2013 General Description of the Medical Center The Medical Center is located in Marshall, Texas, and is part of Good Shepherd Health System, a Texas nonprofit organization that operates three medical centers in East Texas. The Medical Center s board of directors governs the Medical Center and ensures that medical services are available to the residents of Harrison and surrounding areas. The Medical Center is an integrated health care provider serving residents of East Texas for more than 75 years. The Medical Center proudly offers a wide range of services and specialties to meet the needs of the citizens of East Texas. With primary care, mid-level and specialist physicians on the medical staff, and approximately 600 employees, the Medical Center is made up of an experienced and dedicated team. The Medical Center provides health care solutions with compassion and respect for the uniqueness of every individual. Guided by a values-based culture to consistently deliver clinical and service excellence to our patients, the Medical Center strives for excellent care, every time. 4

8 Community Health Needs Assessment 2013 Community Served by the Medical Center The Medical Center is located in Marshall, Texas, in Harrison County. Harrison County is approximately two hours East of Dallas, Texas, and three hours North of Houston, Texas. The Medical Center is located near Highway 20 and other state routes that service the Eastern part of Texas. The map pinpoints the Medical Center s location and can be identified by the symbol. 5

9 Community Health Needs Assessment 2013 Defined Community A community is defined as the geographic area from which a significant number of the patients utilizing hospital services reside. While the community health needs assessment considers other types of health care providers, the Medical Center is the single largest provider of acute care services. For this reason, the utilization of hospital services provides the clearest definition of the community. The criteria established to define the community is as follows: A zip code area must represent two percent or more of the Medical Center s total discharges. The Medical Center s market share in the zip code area must be greater than or equal to 20 percent. The area is contiguous to the geographical area encompassing the Medical Center. Based on the patient origin of acute care inpatient discharges from October 1, 2011, through September 30, 2012, management has identified the community to include the zip codes listed in Exhibit 1 (the Community). These zip codes are listed with corresponding demographic information in Exhibits 2 through 5. Pages 8 and 9 present maps of the Medical Center s geographical location and the footprint of the Community. The first map displays the Medical Center s geographic relationship to the Community, as well as significant roads and highways. The second map displays the Community in relation to surrounding counties. When specific information is not available for zip codes, the community health needs assessment relies on information for specific counties. The geographic area of the defined community based on the identified zip codes covers significant portions of Harrison, Marion and Panola Counties (see map on page 8). The community health needs assessment will utilize these three counties with all or significant portions included in the community when that corresponding information is more readily available. 6

10 Community Health Needs Assessment 2013 Exhibit 1 Good Shepherd Medical Center - Marshall Summary of Community Zip Codes Zip Code City Zip Code City Marshall, TX Hallsville, TX Marshall, TX Harleton, TX Jefferson, TX De Berry, TX Karnack, TX ** Scottsville, TX Waskom, TX ** Woodlawn, TX Carthage, TX Beckville, TX ** Marshall, TX ** Elysian Fields, TX ** Zip code is a PO Box and will not be used in the community summaries Source: Good Shepherd Health System 7

11 Community Health Needs Assessment 2013 Community Details Identification and Description of Geographical Community The following map geographically illustrates the Medical Center s community by showing the community zip codes shaded by number of inpatient discharges. 8

12 Community Population and Demographics Community Health Needs Assessment 2013 The U.S. Bureau of Census has compiled population and demographic data based on the 2010 census. The Nielson Company, a firm specializing in the analysis of demographic data, has extrapolated this data by zip code to estimate population trends from 2013 through The map below shows the community in relation to the three counties that are used for data collection when zip code level data is not available. Population estimates by age and zip code for the Medical Center s community are presented after the map in Exhibit 2. Exhibit 2 illustrates that the overall population is projected to increase over the five-year period from 261,884 to 274,103, or 4.7%. However, the age category that utilizes health care services the most, 65 years and over, is projected to increase from 39,703 to 45,704, or 15.1%. The ratio of males to females in the total community is projected to remain approximately the same over the five-year period. 9

13 Community Health Needs Assessment 2013 Exhibit 2 Good Shepherd Medical Center - Marshall Estimated 2013 Population and Projected 2018 Population Under years Zip Code City 15 years years years and over Total Male Female Estimated 2013 Population Marshall, TX 4,239 7,437 3,933 2,200 17,809 8,543 9, Marshall, TX 3,382 6,113 4,918 3,049 17,462 8,527 8, Jefferson, TX 1,467 2,727 2,833 1,993 9,020 4,400 4, Karnack, TX ,520 1,274 1, Waskom, TX 1,129 2,045 1, ,540 2,773 2, Carthage, TX 3,007 5,438 3,797 2,458 14,700 7,193 7, Hallsville, TX 1,992 3,316 2,336 1,008 8,652 4,282 4, Harleton, TX , De Berry, TX 712 1,214 1, ,580 1,836 1, Beckville, TX 616 1, ,838 1,426 1,412 PROVIDER SERVICE AREA 17,337 30,850 22,559 13,337 84,083 41,245 42,838 Projected 2018 Population Marshall, TX 4,512 7,651 3,876 2,487 18,526 8,932 9, Marshall, TX 3,552 6,311 4,676 3,554 18,093 8,838 9, Jefferson, TX 1,513 2,758 2,668 2,262 9,201 4,482 4, Karnack, TX ,621 1,315 1, Waskom, TX 1,218 2,113 1,478 1,033 5,842 2,918 2, Carthage, TX 3,158 5,725 3,696 2,819 15,398 7,544 7, Hallsville, TX 2,068 3,520 2,427 1,255 9,270 4,576 4, Harleton, TX ,071 1,043 1, De Berry, TX 742 1,323 1, ,777 1,927 1, Beckville, TX 630 1, ,011 1,501 1,510 PROVIDER SERVICE AREA 18,199 32,109 21,920 15,582 87,810 43,076 44,734 Source: The Nielson Company 10

14 Community Health Needs Assessment 2013 Exhibit 2.1 provides the percent difference for the Community from estimated 2013 to projected 2018 as well as a comparison to state and national changes. Exhibit 2.1 illustrates that the overall population is projected to increase at rates consistent with both state and national projections. Note that the age category that utilizes health care services the most, 65 years and over, is projected to increase by more than 15 percent. Additionally, as the 65 and older category is projected to increase, the years old age category is projected to decrease, demonstrating the aging of the population. This increase in the 65 year and over category will have a dramatic impact on both the amount and type of services required by the community. Exhibit 2.1 Good Shepherd Medical Center - Marshall Estimated 2013 Population vs Projected 2018 Population Percent Difference Under years Zip Code City 15 years years years and over Total Male Female Percent Difference Marshall, TX 6.4% 2.9% -1.4% 13.0% 4.0% 4.6% 3.5% Marshall, TX 5.0% 3.2% -4.9% 16.6% 3.6% 3.6% 3.6% Jefferson, TX 3.1% 1.1% -5.8% 13.5% 2.0% 1.9% 2.1% Karnack, TX 2.5% 4.6% -4.4% 18.2% 4.0% 3.2% 4.8% Waskom, TX 7.9% 3.3% -3.4% 23.6% 5.5% 5.2% 5.7% Carthage, TX 5.0% 5.3% -2.7% 14.7% 4.7% 4.9% 4.6% Hallsville, TX 3.8% 6.2% 3.9% 24.5% 7.1% 6.9% 7.4% Harleton, TX 0.8% 5.8% -1.1% 24.5% 5.6% 5.2% 5.9% De Berry, TX 4.2% 9.0% -5.2% 19.8% 5.5% 5.0% 6.1% Beckville, TX 2.3% 6.5% -1.8% 24.3% 6.1% 5.3% 6.9% PROVIDER SERVICE AREA 5.0% 4.1% -2.8% 16.8% 4.4% 4.4% 4.4% TEXAS 2013 ESTIMATED (1,000s) 5,949 11,068 6,358 2,922 26,297 13,041 13,256 TEXAS 2018 PROJECTED (1,000s) 6,343 11,545 6,862 3,583 28,333 14,046 14,287 PERCENT DIFFERENCE 6.6% 4.3% 7.9% 22.6% 7.7% 7.7% 7.8% UNITED STATES 2013 ESTIMATED (1,000s) 61, ,084 83,113 43, , , ,042 UNITED STATES 2018 PROJECTED (1,000s) 63, ,608 84,336 50, , , ,322 PERCENT DIFFERENCE 2.6% 0.4% 1.5% 16.3% 3.3% 3.3% 3.3% Source: The Nielson Company 11

15 Community Health Needs Assessment 2013 Certain characteristics of a population can be factors in determining the health care services required by a community. Exhibit 2.2 is an analysis of the age distribution of the population for the primary community. The analysis is provided by county and provides a comparison to Texas and the United States. Exhibit 2.2 Good Shepherd Medical Center - Marshall Estimated 2013 Population vs Projected 2018 Population with Percent Totals Under years Zip Code City 15 years years years and over Total Male Female Estimated 2013 Population Marshall, TX 23.8% 41.8% 22.1% 12.4% 100.0% 48.0% 52.0% Marshall, TX 19.4% 35.0% 28.2% 17.5% 100.0% 48.8% 51.2% Jefferson, TX 16.3% 30.2% 31.4% 22.1% 100.0% 48.8% 51.2% Karnack, TX 15.6% 30.0% 34.0% 20.5% 100.0% 50.6% 49.4% Waskom, TX 20.4% 36.9% 27.6% 15.1% 100.0% 50.1% 49.9% Carthage, TX 20.5% 37.0% 25.8% 16.7% 100.0% 48.9% 51.1% Hallsville, TX 23.0% 38.3% 27.0% 11.7% 100.0% 49.5% 50.5% Harleton, TX 20.4% 35.9% 29.0% 14.8% 100.0% 50.5% 49.5% De Berry, TX 19.9% 33.9% 30.1% 16.1% 100.0% 51.3% 48.7% Beckville, TX 21.7% 38.8% 25.0% 14.5% 100.0% 50.2% 49.8% TOTAL PROVIDER SERVICE AREA 20.6% 36.7% 26.8% 15.9% 100.0% 49.1% 50.9% Projected 2018 Population Marshall, TX 24.4% 41.3% 20.9% 13.4% 100.0% 48.2% 51.8% Marshall, TX 19.6% 34.9% 25.8% 19.6% 100.0% 48.8% 51.2% Jefferson, TX 16.4% 30.0% 29.0% 24.6% 100.0% 48.7% 51.3% Karnack, TX 15.4% 30.1% 31.2% 23.3% 100.0% 50.2% 49.8% Waskom, TX 20.8% 36.2% 25.3% 17.7% 100.0% 49.9% 50.1% Carthage, TX 20.5% 37.2% 24.0% 18.3% 100.0% 49.0% 51.0% Hallsville, TX 22.3% 38.0% 26.2% 13.5% 100.0% 49.4% 50.6% Harleton, TX 19.5% 36.0% 27.1% 17.4% 100.0% 50.4% 49.6% De Berry, TX 19.6% 35.0% 27.1% 18.3% 100.0% 51.0% 49.0% Beckville, TX 20.9% 39.0% 23.1% 17.0% 100.0% 49.9% 50.1% TOTAL PROVIDER SERVICE AREA 20.7% 36.6% 25.0% 17.7% 100.0% 49.1% 50.9% ESTIMATED 2013 POPULATION 20.6% 36.7% 26.8% 15.9% 100.0% 49.6% 50.4% PROJECTED 2018 POPULATION 20.7% 36.6% 25.0% 17.7% 100.0% 49.6% 50.4% PERCENT DIFFERENCE -0.1% 0.1% 1.9% -1.9% 0.0% # 0.0% 0.0% TEXAS 2013 ESTIMATED 22.6% 42.1% 24.2% 11.1% 100.0% 49.6% 50.4% TEXAS 2018 PROJECTED 22.4% 40.7% 24.2% 12.6% 100.0% 49.6% 50.4% UNITED STATES 2013 ESTIMATED 19.6% 40.0% 26.4% 13.9% 100.0% 49.2% 50.8% UNITED STATES 2018 PROJECTED 19.5% 38.9% 25.9% 15.7% 100.0% 49.2% 50.8% Source: The Nielson Company 12

16 Community Health Needs Assessment 2013 While the relative age of the community population can impact community health needs, so can the ethnicity and race of a population. The following Exhibit 3 shows the population of the community by ethnicity by illustrating the Hispanic versus non-hispanic residents. In total, the population breakdown for the Community is less than the state of Texas with Hispanic residents comprising more than 13% of the total population. However, a review of the specific zip code areas does show a relatively large percentage of Hispanic residents in the Marshall and Marshall zip codes. Additionally, the Hispanic population is projected to grow 22.5% from 2013 to 2018 as compared to the 2.1% growth in the non- Hispanic population. Exhibit 3 Good Shepherd Medical Center - Marshall Estimated 2013 Population vs Projected 2018 Population with Percent Difference Estimated 2013 Projected 2018 % Difference % Total Non- Non- Non- Non- Zip Code City Hispanic Hispanic Total Hispanic Hispanic Total Hispanic Hispanic Hispanic Hispanic Marshall, TX 3,771 14,038 17,809 4,546 13,980 18, % -0.4% 24.5% 75.5% Marshall, TX 1,980 15,482 17,462 2,448 15,645 18, % 1.1% 13.5% 86.5% Jefferson, TX 288 8,732 9, ,883 9, % 1.7% 3.5% 96.5% Karnack, TX 217 2,303 2, ,341 2, % 1.7% 10.7% 89.3% Waskom, TX 669 4,871 5, ,024 5, % 3.1% 14.0% 86.0% Carthage, TX 1,619 13,081 14,700 2,044 13,354 15, % 2.1% 13.3% 86.7% Hallsville, TX 512 8,140 8, ,619 9, % 5.9% 7.0% 93.0% Harleton, TX 96 1,866 1, ,951 2, % 4.6% 5.8% 94.2% De Berry, TX 190 3,390 3, ,545 3, % 4.6% 6.1% 93.9% Beckville, TX 257 2,581 2, ,712 3, % 5.1% 9.9% 90.1% PROVIDER SERVICE AREA 9,599 74,484 84,083 11,756 76,054 87, % 2.1% 13.4% 86.6% TEXAS (1,000s) 10,268 16,029 26,297 11,631 16,702 28, % 4.2% 41.1% 58.9% UNITED STATES (1,000s) 54, , ,862 61, , , % 1.5% 18.8% 81.2% Source: The Nielson Company Exhibit 4 shows the population of the community by race by illustrating three different categories, white, black and other residents. In total, the population breakdown for the community is comparable to Texas and the United States. The table illustrates that 68.9% of the people in the community are white, 18.8% of the people are black and 12.3% of the people are in the Other category. 13

17 Community Health Needs Assessment 2013 Exhibit 4 Good Shepherd Medical Center - Marshall Estimated 2013 Population vs Projected 2018 Population with Percent Difference Estimated 2013 Projected 2018 Percent Difference Percent Total Zip Code City White Black Other Total White Black Other Total White Black Other Total White Black Other Marshall, TX 7,255 7,645 2,909 17,809 7,373 7,626 3,527 18, % -0.2% 21.2% 4.0% 39.8% 41.2% 19.0% Marshall, TX 11,990 3,660 1,812 17,462 12,216 3,684 2,193 18, % 0.7% 21.0% 3.6% 67.5% 20.4% 12.1% Jefferson, TX 6,529 2, ,020 6,749 1, , % -4.1% 10.6% 2.0% 73.4% 21.4% 5.2% Karnack, TX 1, ,520 1, , % -10.6% 28.4% 4.0% 68.3% 21.6% 10.2% Waskom, TX 4, ,540 4, , % -5.3% 18.4% 5.5% 74.9% 14.0% 11.1% Carthage, TX 10,938 2,454 1,308 14,700 11,273 2,498 1,627 15, % 1.8% 24.4% 4.7% 73.2% 16.2% 10.6% Hallsville, TX 7, ,652 8, , % -0.9% 23.3% 7.1% 87.8% 6.0% 6.2% Harleton, TX 1, ,962 1, , % -5.1% 19.0% 5.6% 87.1% 8.1% 4.8% De Berry, TX 2, ,580 2, , % -2.2% 23.4% 5.5% 73.4% 19.6% 7.0% Beckville, TX 2, ,838 2, , % -10.3% 5.6% 6.1% 83.4% 10.4% 6.2% PROVIDER SERVICE AREA 56,767 19,155 8,161 84,083 59,002 18,939 9,869 87, % -1.1% 20.9% 4.4% 67.2% 21.6% 11.2% TEXAS (1,000s) 18,254 3,138 4,905 26,297 19,238 3,438 5,657 28, % 9.6% 15.3% 7.7% 67.9% 12.1% 20.0% UNITED STATES (1,000s) 225,086 40,007 49, , ,212 41,797 55, , % 4.5% 11.1% 3.3% 70.1% 12.8% 17.0% Source: The Nielson Company 14

18 Community Health Needs Assessment 2013 Socioeconomic Characteristics of the Community The socioeconomic characteristics of a geographic area influence the way residents access health care services and perceive the need for health care services within society. The economic status of an area may be assessed by examining multiple variables within the community. The following exhibits are a compilation of data that includes household income and poverty, labor force, employees by types of industry, employment rates, and educational attainment for the Community. These standard measures will be used to compare the socioeconomic status of the community to the state of Texas and the United States. Income and Employment Exhibit 5 presents the average and median income for households in each zip code. In total, the measures are projected to increase an average of 3% and 0.9% respectively. However, some individual zip codes are expected to see a much greater variation, with a decrease of 13.2% and an increase of up to 12%. Exhibit 5 Good Shepherd Medical Center - Marshall Estimated Family Income and Wealth for 2013 and 2018 with Percent Difference Estimated 2013 Projected 2018 Percent Difference Avg. Median Avg. Median Avg. Median Household Household Household Household Household Household Zip Code City Income Income Income Income Income Income Marshall, TX $ 48,035 $ 35,278 $ 52,817 $ 36, % 4.5% Marshall, TX $ 69,349 $ 53,087 $ 76,781 $ 57, % 8.9% Jefferson, TX $ 47,758 $ 32,130 $ 50,611 $ 33, % 4.3% Karnack, TX $ 61,395 $ 50,000 $ 66,690 $ 54, % 8.4% Waskom, TX $ 57,843 $ 52,157 $ 61,857 $ 54, % 5.1% Carthage, TX $ 61,860 $ 48,138 $ 69,223 $ 52, % 10.0% Hallsville, TX $ 74,477 $ 63,589 $ 81,384 $ 69, % 8.8% Harleton, TX $ 61,484 $ 51,020 $ 66,619 $ 54, % 6.1% De Berry, TX $ 55,877 $ 46,122 $ 61,738 $ 49, % 8.0% Beckville, TX $ 67,495 $ 56,838 $ 74,408 $ 63, % 12.0% TEXAS $ 68,955 $ 48,646 $ 71,829 $ 49, % 2.7% UNITED STATES $ 69,637 $ 49,297 $ 71,917 $ 49, % 1.1% Source: The Nielson Company 15

19 Community Health Needs Assessment 2013 Exhibit 6 presents the average annual resident unemployment rates for the counties included in the defined community. As Exhibit 6 illustrates, unemployment rates in most counties peaked in 2010 and improved slightly in On average, the unemployment rate for these three counties is relatively consistent with the rate for Texas as a whole and is stronger than that of the United States. Exhibit 6 Good Shepherd Medical Center - Marshall Unemployment Rates (%) County Harrison County Marion County Panola County Texas United States Source: FDIC 16

20 Exhibit 7 summarizes employment by major industry for the three counties. Exhibit 7 Good Shepherd Medical Center - Marshall Employment by Major Industry 2010 Community Health Needs Assessment 2013 Harrison County Marion County Panola County US Major Industries County % County % County % % Goods-producing Natural Resources and Mining % 9 5.1% % 1.4% Construction % 5 2.8% % 8.8% Manufacturing % % % 3.8% Service-providing Trade, Transportation, and Utilities % % % 20.8% Information % 2 1.1% 8 1.5% 1.6% Financial Activities % % % 9.1% Professional and Business Services % % % 17.1% Education and Health Services % % % 9.9% Leisure and Hospitality % % % 8.3% Other Services % % % 15.9% Federal Government % 4 2.3% % 0.7% State Government % 8 4.5% % 0.7% Local Government % 8 4.5% % 1.8% Total Employment 1, % % % 100% Source: U.S. Department of Census 17

21 Community Health Needs Assessment 2013 Exhibit 8 lists the major employers by county: Exhibit 8 Good Shepherd Medical Center - Marshall Employment by Top Employers (> 500 Employees) County Top Employers Harrison Marion Panola Dana Corp Good Shepherd Medical Center - Marshall Marshall Independent School District 1,000 + Republic Industries Texas Instruments Inc Trinity Industries Inc Wal-Mart Supercenter Tyson Foods Inc Source: Texas Workforce Commission Major industries within the community include education and health services, which makes up approximately 8 percent of the top employers, manufacturing, which makes up about 22 percent, government, which makes up about 7 percent, and other service-providing industries, which make up about 63 percent. Additionally, some counties are home to single businesses that employ a large percentage of the workforce. In Harrison County, Marshall Independent School District employs over 1,000 people, with other major employers with a range of employees. Large companies like these can be an economic asset to a community, but too much dependence on them can have a negative effect if they ever relocate or downsize. 18

22 Community Health Needs Assessment 2013 Poverty Exhibit 9 presents the percentage of total population in poverty (including under age 18) and median household income for households in each county versus the state of Texas and the United States. Exhibit 9 Good Shepherd Medical Center - Marshall Poverty Estimate: Percentage of Total Population in Poverty and Median Household Income 2010 & Median 2011 Median All Under Household All Under Household County Persons Age 18 Income Persons Age 18 Income Harrison County 17.3% 25.6% $ 44, % 25.2% $ 44,427 Marion County 23.7% 35.4% $ 32, % 33.3% $ 31,922 Panola County 13.8% 20.5% $ 48, % 22.4% $ 45,212 Texas 17.9% 25.7% $ 48, % 26.6% $ 49,390 United States 15.3% 21.6% $ 50, % 22.5% $ 50,502 Source: U.S. Census Bureau, Small Areas Estimates Branch In 2011, a family of two adults and two children was considered poor if their annual household income fell below $22,350 and Texas is consistently ranked one of the poorest states in the country. Poverty rates for Marion County rank unfavorably when compared to the state averages, while the other two counties were comparable. Marion and Harrison rank unfavorably when compared to the national averages. Panola also remained comparable to the national average. Additionally, all of the counties have a median household income that is lower than both the state and national median household income. 19

23 Community Health Needs Assessment 2013 Uninsured Exhibit 10 presents health insurance coverage status by age (under 65 years) and income (at or below 400 percent) of poverty for each county versus Texas and the United States. The table demonstrates that all of the counties rank unfavorably when compared to the national average while they are consistent with the state averages. The national percent of uninsured people for all income levels is 17.7% while the counties range from 22.5% to 27.4% for the same category. Other than Marion County, they are all below the Texas level of 26.3%. For people at or below 400% of the federal poverty level, all of the counties are unfavorable when compared to the national amount of 24.1%, but are all lower than the Texas state level of 34.2%. Exhibit 10 Good Shepherd Medical Center - Marshall Health Insurance Coverage Status by Age (Under 65 years) and Income (At or Below 400%) of Poverty 2010 All Income Levels At or Below 400% of FPL Under 65 Percent Under 65 Percent Under 65 Percent Under 65 Percent County Uninsured Uninsured Insured Insured Uninsured Uninsured Insured Insured Harrison County 14, % 41, % 12, % 27, % Marion County 2, % 5, % 2, % 4, % Panola County 4, % 15, % 3, % 9, % Texas (1,000s) 5, % 16, % 5, % 10, % United States (1,000s) 46, % 215, % 40, % 128, % Source: U.S. Census Bureau, SAHIE/ State and County by Demographic and Income Characteristics 20

24 Community Health Needs Assessment 2013 Education Exhibit 11 presents educational attainment by age cohort for individuals in each county versus Texas and the United States. Exhibit 11 Good Shepherd Medical Center - Marshall Educational Attainment - Total Population 2011 Age Cohort State/ County Completing High School Harrison County 28.5% 81.6% 85.8% 90.9% 73.9% Marion County 44.6% 87.3% 86.6% 81.9% 70.3% Panola County 32.2% 83.4% 89.3% 82.6% 74.1% Texas 30.9% 82.3% 81.5% 82.3% 72.1% Bachelor's Degree or More Harrison County 3.0% 18.2% 15.8% 20.9% 13.3% Marion County 2.4% 7.0% 9.6% 13.8% 12.7% Panola County 0.8% 8.1% 17.8% 9.6% 10.6% Texas 7.1% 26.1% 27.8% 27.3% 20.7% Source: U.S. Census Bureau, Current Population Survey Education levels obtained by community residents may impact the local economy. Higher levels of education generally lead to higher wages, less unemployment and job stability. These factors may indirectly influence community health. As noted in Exhibit 11, the amount of people in the Community completing high school is comparable to both state and national rates. Some counties are greater than both the state and national rates, while others are between the two. Residents of the Community obtaining a bachelor s degree or higher is below both the national and the state averages. 21

25 Community Health Needs Assessment 2013 Health Status of the Community This section of the assessment reviews the health status of Harrison, Marion and Panola County residents. As in the previous section, comparisons are provided with the state of Texas. This in-depth assessment of the mortality and morbidity data, health outcomes, health factors and mental health indicators of the county residents that make up the community will enable the Medical Center to identify priority health issues related to the health status of its residents. Good health can be defined as a state of physical, mental and social well-being, rather than the absence of disease or infirmity. According to Healthy People 2020, the national health objectives released by the U.S. Department of Health and Human Services, individual health is closely linked to community health. Community health, which includes both the physical and social environment in which individuals live, work and play, is profoundly affected by the collective behaviors, attitudes and beliefs of everyone who lives in the community. Healthy people are among a community s most essential resources. Numerous factors have a significant impact on an individual s health status: lifestyle and behavior, human biology, environmental and socioeconomic conditions, as well as access to adequate and appropriate health care and medical services. Studies by the American Society of Internal Medicine conclude that up to 70 percent of an individual s health status is directly attributable to personal lifestyle decisions and attitudes. Persons who do not smoke, who drink in moderation (if at all), use automobile seat belts (car seats for infants and small children), maintain a nutritious low-fat, high-fiber diet, reduce excess stress in daily living and exercise regularly have a significantly greater potential of avoiding debilitating diseases, infirmities and premature death. The interrelationship among lifestyle/behavior, personal health attitude and poor health status is gaining recognition and acceptance by both the general public and health care providers. Some examples of lifestyle/behavior and related health care problems include the following: Smoking Alcohol/drug abuse Poor nutrition Lifestyle Primary Disease Factor Lung cancer Cardiovascular disease Emphysema Chronic bronchitis Cirrhosis of liver Motor vehicle crashes Unintentional injuries Malnutrition Suicide Homicide Mental illness Obesity Digestive disease Depression Driving at excessive speeds Trauma Motor vehicle crashes 22

26 Community Health Needs Assessment 2013 Lifestyle Primary Disease Factor Lack of exercise Cardiovascular disease Depression Overstressed Mental illness Alcohol/drug abuse Cardiovascular disease Health problems should be examined in terms of morbidity as well as mortality. Morbidity is defined as the incidence of illness or injury and mortality is defined as the incidence of death. Due to limited morbidity data, this health status report relies heavily on death and death rate statistics for leading causes in death in Harrison, Marion and Panola Counties, and the state of Texas. Such information provides useful indicators of health status trends and permits an assessment of the impact of changes in health services on a resident population during an established period of time. Community attention and health care resources may then be directed to those areas of greatest impact and concern. Health problems should be examined in terms of morbidity as well as mortality. Morbidity is defined as the incidence of illness or injury and mortality is defined as the incidence of death. Due to limited morbidity data, this health status report relies heavily on death and death rate statistics for leading causes in death in Gregg, Upshur, Harrison, Panola, Rusk and Marion Counties, and the state of Texas. Such information provides useful indicators of health status trends and permits an assessment of the impact of changes in health services on a resident population during an established period of time. Community attention and health care resources may then be directed to those areas of greatest impact and concern. County Health Synopses (Leading Causes of Death & Health Outcomes and Factors) A number of different health factors shape a community s health outcomes. The leading cause of resident deaths compares the county rates of death to the State of Texas rates of death. Additional details related to the leading causes of death for each of the counties in the Medical Center s community are included in Exhibits The County Health Rankings model includes four types of health factors: health behaviors, clinical care, social and economic and the physical environment. These factors, detailed in Exhibits , compare the health factors of each of the counties in the Medical Center s community to Texas and national benchmarks. A synopsis for each of the counties in the Medical Center s community, noting significant deviations from Texas and national benchmarks, is provided below. Harrison County Health Synopsis: The following is a summary of causes of death that deviate significantly from State of Texas benchmarks for Harrison County (see also Exhibit 13). Cerebrovascular Disease - Harrison County 27.7% higher than state benchmark Nephritis, Nephrotic Syndrome, Nephrosis Harrison County is 28.8% higher than state benchmark The following is a summary of health factors that deviate significantly from national benchmarks for Harrison County (see also Exhibit 14 and 14.1). 23

27 Mortality / Premature Death Community Health Needs Assessment 2013 o Year of potential life lost before age 75 per 100,000 population Harrison County 10,393; national benchmark 5,466 Health Behaviors / Motor Vehicle Crash Death Rate o Motor vehicle deaths per 100K population Harrison County 36.0; national benchmark 12.0 Health Behaviors / Sexually Transmitted Infections o Chlamydia rate per 100K population - Harrison County 289.0; national benchmark 84.0 Health Behaviors / Teen Birth Rate o Per 1,000 female population, ages Harrison County 54.0; national benchmark 22.0 Clinical Care / Uninsured Adults o Percent of population under 65 without health insurance Harrison County 25.0%; national benchmark 11.0% Clinical Care / Primary Care Physicians o Ratio of population to primary care physicians Harrison County 2,899 to 1; national benchmark 631 to 1 Social & Economic Factors / Violent Crime Rate o Violent crime rate per 100,000 population Harrison County 456.0; national benchmark 73.0 Social & Economic Factors / Children in Poverty o Percent of children under age 18 in poverty Harrison County 26.0%; national benchmark 13.0% Social & Economic Factors / Children in Poverty and Children in Single-Parent Households Marion County Health Synopsis: o Percent of children that live in household headed by a single parent Harrison County 35%; national benchmark 20.0% The following is a summary of causes of death that deviate significantly from State of Texas benchmarks for Marion County (see also Exhibit 13.1). Chronic Lower Respiratory Disease - Marion County 31.7% higher than state benchmark Cerebrovascular Disease - Marion County 33.6% higher than state benchmark Alzheimer s Disease - Marion County 45.4% higher than state benchmark Nephritis, Nephrotic Syndrome, Nephrosis Marion County is 37.8% higher than state benchmark Intentional Self-Harm - Marion County 74.0% higher than state benchmark Influenza and Pneumonia - Marion County 45.3% higher than state benchmark 24

28 Community Health Needs Assessment 2013 Chronic Liver Disease and Cirrhosis - Marion County 61.2% higher than state benchmark The following is a summary of health factors that deviate significantly from national benchmarks for Marion County (see also Exhibit 15 and 15.1). Mortality / Premature Death o Year of potential life lost before age 75 per 100,000 population Marion County 14,160; national benchmark 5,466 Health Behaviors / Motor Vehicle Crash Death Rate o Motor vehicle deaths per 100K population Marion County 41.0; national benchmark 12.0 Health Behaviors / Sexually Transmitted Infections o Chlamydia rate per 100K population - Marion County 199.0; national benchmark 84.0 Health Behaviors / Teen Birth Rate o Per 1,000 female population, ages Marion County 70.0; national benchmark 22.0 Clinical Care / Uninsured Adults o Percent of population under 65 without health insurance Marion County 28.0%; national benchmark 11.0% Clinical Care / Primary Care Physicians o Ratio of population to primary care physicians Marion County 5,509 to 1; national benchmark 631 to 1 Clinical Care / Preventable Hospital Stays o Hospitalization rate for ambulatory care sensitive conditions per 1,000 Medicare enrollees Marion County 108.0; national benchmark 49 Social & Economic Factors / Violent Crime Rate o Violent crime rate per 100,000 population Marion County 771.0; national benchmark 73.0 Social & Economic Factors / Children in Poverty o Percent of children under age 18 in poverty Marion County 30.0%; national benchmark 13.0% Social & Economic Factors / Children in Poverty and Children in Single-Parent Households Panola County Health Synopsis: o Percent of children that live in household headed by a single parent Marion County 37%; national benchmark 20.0% The following is a summary of causes of death that deviate significantly from State of Texas benchmarks for Panola County (see also Exhibit 13.2). Accidents and Injuries - Panola County 45.9% higher than state benchmark 25

29 Community Health Needs Assessment 2013 Alzheimer s Disease - Panola County 47.8% higher than state benchmark Diabetes Mellitus - Panola County 31.4% higher than state benchmark Nephritis, Nephrotic Syndrome, Nephrosis Panola County is 48.8% higher than state benchmark The following is a summary of health factors that deviate significantly from national benchmarks for Panola County (see also Exhibit 16 and 16.1). Mortality / Premature Death o Year of potential life lost before age 75 per 100,000 population Panola County 9,490; national benchmark 5,466 Morbidity / Poor Mental Health Days o Average number of mentally unhealthy days reported in past 30 days Panola County 6.0; national benchmark 2.3 Health Behaviors / Motor Vehicle Crash Death Rate o Motor vehicle deaths per 100K population Panola County 51.0; national benchmark 12.0 Health Behaviors / Sexually Transmitted Infections o Chlamydia rate per 100K population - Panola County 247.0; national benchmark 84.0 Health Behaviors / Teen Birth Rate o Per 1,000 female population, ages Panola County 58.0; national benchmark 22.0 Clinical Care / Uninsured Adults o Percent of population under 65 without health insurance Panola County 23.0%; national benchmark 11.0% Clinical Care / Primary Care Physicians o Ratio of population to primary care physicians Panola County 3,312 to 1; national benchmark 631 to 1 Clinical Care / Preventable Hospital Stays o Hospitalization rate for ambulatory care sensitive conditions per 1,000 Medicare enrollees Panola County 107.0; national benchmark 49 26

30 Social & Economic Factors / Violent Crime Rate Community Health Needs Assessment 2013 o Violent crime rate per 100,000 population Panola County 266.0; national benchmark 73.0 Social & Economic Factors / Children in Poverty o Percent of children under age 18 in poverty Panola County 21.0%; national benchmark 13.0% Social & Economic Factors / Children in Poverty and Children in Single-Parent Households o Percent of children that live in household headed by a single parent Panola County 31%; national benchmark 20.0% 27

31 Community Health Needs Assessment 2013 Leading Causes of Death Exhibit 12 reflects the leading causes of death for the three counties within the community and compares the rates, per hundred thousand, to the state of Texas average rates, per hundred thousand. Exhibit 12 Good Shepherd Medical Center - Marshall Selected Causes of Resident Deaths: Number and Rate (2010) Harrison County Marion Panola All Texas Total % County % County % Counties % % Total Deaths, All Causes* % % % % 166, % Malignant Neoplasms % % % % 36, % Diseases of the Heart % % % % 38, % Cerebrovascular Disease % % % % 9, % Chronic Lower Respiratory Diseases % % % % 8, % Accidents and Injuries % 3 1.9% % % 9, % Alzheimer's Disease % 7 4.5% % % 5, % Nephritis, Nephrotic Syndrome, Nephrosis % 4 2.6% 8 3.1% % 3, % Diabetes Mellitus % 4 2.6% 9 3.4% % 4, % Influenza and Pneumonia % 3 1.9% 3 1.1% % 3, % Hypertension and Hypertensive Renal % 1 0.6% 6 2.3% % 1, % Intentional Self-Harm 6 1.1% 5 3.2% 2 0.8% % 2, % Septicemia 7 1.2% 1 0.6% 3 1.1% % 3, % * Total includes other causes of death not separately listed in the table Source: Texas Department of State Health Services 28

32 Community Health Needs Assessment 2013 Exhibit 13 compares the number of deaths for Harrison County residents, with U.S. Crude Rates and identifies causes of death that statistically differ from U.S. rates. Exhibit 13 CHNA Good Shepherd Health System Community Comparison of Rates for Selected Causes of Death: Rate per 100,000 Residents: Harrison County Harrison County TX US County Number Crude Adjusted Adjusted Adjusted Difference Selected Cause of Death of Deaths Rate Rate Rate Rate from US Total Deaths, All Causes % Malignant Neoplasms % Diseases of the Heart % Cerebrovascular Disease % Chronic Lower Respiratory Diseases % Accidents and Injuries % Alzheimer's Disease % Nephritis, Nephrotic Syndrome, Nephrosis % Diabetes Mellitus % Influenza and Pneumonia % Hypertension and Hypertensive Renal % Intentional Self-Harm % Septicemia % Source: The Texas Department of State Health Services Exhibit 13.1 compares the number of deaths for Marion County residents, with U.S. Crude Rates and identifies causes of death that statistically differ from U.S. rates. Exhibit 13.1 CHNA Good Shepherd Health System Community Comparison of Rates for Selected Causes of Death: Rate per 100,000 Residents: Marion County Marion County TX US County Number Crude Adjusted Adjusted Adjusted Difference Selected Cause of Death of Deaths Rate Rate Rate Rate from US Total Deaths, All Causes % Malignant Neoplasms % Diseases of the Heart % Cerebrovascular Disease % Chronic Lower Respiratory Diseases % Accidents and Injuries % Alzheimer's Disease % Nephritis, Nephrotic Syndrome, Nephrosis % Diabetes Mellitus % Influenza and Pneumonia % Hypertension and Hypertensive Renal % Intentional Self-Harm % Septicemia % Source: The Texas Department of State Health Services 29

33 Community Health Needs Assessment 2013 Exhibit 13.2 compares the number of deaths for Panola County residents, with U.S. Crude Rates and identifies causes of death that statistically differ from U.S. rates. Exhibit 13.2 CHNA Good Shepherd Health System Community Comparison of Rates for Selected Causes of Death: Rate per 100,000 Residents: Panola County Panola County TX US County Number Crude Adjusted Adjusted Adjusted Difference Selected Cause of Death of Deaths Rate Rate Rate Rate from US Total Deaths, All Causes % Malignant Neoplasms % Diseases of the Heart % Cerebrovascular Disease % Chronic Lower Respiratory Diseases % Accidents and Injuries % Alzheimer's Disease % Nephritis, Nephrotic Syndrome, Nephrosis % Diabetes Mellitus % Influenza and Pneumonia % Hypertension and Hypertensive Renal % Intentional Self-Harm % Septicemia % Source: The Texas Department of State Health Services 30

34 Community Health Needs Assessment 2013 Health Outcomes and Factors An analysis of various health outcomes and factors for a particular community can, if improved, help make that community a healthier place to live, learn, work and play. A better understanding of the factors that affect the health of the community will assist with how to improve the community s habits, culture and environment. This portion of the community health needs assessment utilizes information from County Health Rankings, a key component of the Mobilizing Action Toward Community Health (MATCH) project, a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. The County Health Rankings model is grounded in the belief that programs and policies implemented at the local, state and federal levels have an impact on the variety of factors that, in turn, determine the health outcomes for communities across the nation. The model provides a ranking method that ranks all 50 states and the counties within each state, based on the measurement of two types of health outcomes for each county: how long people live (mortality) and how healthy people feel (morbidity). These outcomes are the result of a collection of health factors and are influenced by programs and policies at the local, state and federal levels. Counties in each of the 50 states are ranked according to summaries of a variety of health measures. Those having high ranks, e.g. 1 or 2, are considered to be the healthiest. Counties are ranked relative to the health of other counties in the same state on the following summary measures: Health Outcomes rankings are based on an equal weighting of one length of life (mortality) measure and four quality of life (morbidity) measures. Health Factors rankings are based on weighted scores of four types of factors: o Health behaviors (six measures) o Clinical care (five measures) o Social and economic (seven measures) o Physical environment (four measures) A more detailed discussion about the ranking system, data sources and measures, data quality and calculating scores and ranks can be found at the website for County Health Rankings ( As part of the analysis of the needs assessment for the Community, the three counties that comprise the majority of the community will be used to compare the relative health status of each county to the state of Texas as well as to a national benchmark. A better understanding of the factors that affect the health of the Community will assist with how to improve the Community s habits, culture and environment. The following tables, from County Health Rankings, summarize the 2012 health outcomes for the three counties that comprise the majority of the Community for the Medical Center. Each measure is described and includes a confidence interval or error margin surrounding it. 31

35 Community Health Needs Assessment 2013 Harrison County Health Outcomes--rankings are based on an equal weighting of one length of life (mortality) measure and four quality of life (morbidity) measures. Exhibit 14 Good Shepherd Medical Center - Marshall Harrison County County Health Rankings - Health Outcomes (2011) Harrison County Error National Rank Margin Benchmark TX (of 221) Mortality 185 Premature death - Years of potential life lost before age 75 per 100,000 population (age-adjusted) 10,393 9,493-11,292 5,466 7,186 Morbidity 167 Poor or fair health - Percent of adults reporting fair or poor health (age-adjusted) 20% 15-26% 10% 19% Poor physical health days - Average number of physically unhealthy days reported in past 30 days (age-adjusted) Poor mental health days - Average number of mentally unhealthy days reported in past 30 days (age-adjusted) Low birthweight - Percent of live births with low birthweight (<2500 grams) 9.2% % 6.0% 8.2% Source: Countyhealthrankings.org 32

36 Community Health Needs Assessment 2013 A number of different health factors shape a community s health outcomes. The County Health Rankings model includes four types of health factors: health behaviors, clinical care, social and economic and the physical environment. The following table summarizes the health factors for Harrison County. Exhibit 14.1 Good Shepherd Medical Center - Marshall Harrison County County Health Rankings - Health Factors (2011) Harrison County Error National Rank Margin Benchmark TX (of 221) Health Behaviors 220 Adult smoking - Percent of adults that report smoking at least 100 cigarettes and that they currently smoke 22% 17-29% 14% 19% Adult obesity - Percent of adults that report a BMI >= 30 34% 28-40% 25% 29% Excessive drinking - Percent of adults that report excessive drinking in the past 30 days 18% 12-26% 8% 16% Motor vehicle crash death rate - Motor vehicle deaths per 100K population Sexually transmitted infections - Chlamydia rate per 100K population Teen birth rate - Per 1,000 female population, ages Clinical Care 68 Uninsured adults - Percent of population under age 65 without health insurance 25% 23-27% 11% 26% Primary care physicians - Ratio of population to primary care physicians 2899:1 631:1 1,378:1 Preventable hospital stays - Hospitalization rate for ambulatory-care sensitive conditions per 1,000 Medicare enrollees Diabetic screening - Percent of diabetic Medicare enrollees that receive HbA1c screening 86% 80-92% 89% 81% Mammography screening - Percent of female Medicare enrollees that receive mammography screening % 1 1 Social & Economic Factors 146 High school graduation - Percent of ninth grade cohort that graduates in 4 years 90% 0% 84% Some college - Percent of adults aged years with some postsecondary education 48% 43-52% 68% 56% Children in poverty - Percent of children under age 18 in poverty 26% 19-32% 13% 26% Inadequate social support - Percent of adults without social/emotional support 29% 21-37% 14% 23% Children in single-parent households - Percent of children that live in household headed by single parent 35% 30-40% 20% 32% Violent crime rate - Violent crime rate per 100,000 population Physical Environment 139 Air pollution-particulate matter days - Annual number of unhealthy air quality days due to fine particulate matter Air pollution-ozone days - Annual number of unhealthy air quality days due to ozone 8-18 Access to healthy foods - Healthy food outlets include grocery stores and produce stands/farmers' markets 83% - 62% Access to recreational facilities - Rate of recreational facilities per 100,000 population Source: Countyhealthrankings.org 33

37 Community Health Needs Assessment 2013 Marion County Health Outcomes--rankings are based on an equal weighting of one length of life (mortality) measure and four quality of life (morbidity) measures. Exhibit 15 Good Shepherd Medical Center - Marshall Marion County County Health Rankings - Health Outcomes (2011) Error National Rank Marion County Margin Benchmark TX (of 221) Mortality 220 Premature death - Years of potential life lost before age 75 per 100,000 population (age-adjusted) 14,160 11,556-16,763 5,466 7,186 Morbidity 221 Poor or fair health - Percent of adults reporting fair or poor health (age-adjusted) - 10% 19% Poor physical health days - Average number of physically unhealthy days reported in past 30 days (age-adjusted) Poor mental health days - Average number of mentally unhealthy days reported in past 30 days (age-adjusted) Low birthweight - Percent of live births with low birthweight (<2500 grams) 10.5% % 6.0% 8.2% Source: Countyhealthrankings.org 34

38 Community Health Needs Assessment 2013 A number of different health factors shape a community s health outcomes. The County Health Rankings model includes four types of health factors: health behaviors, clinical care, social and economic and the physical environment. The following table summarizes the health factors for Marion County. Exhibit 15.1 Good Shepherd Medical Center - Marshall Marion County County Health Rankings - Health Factors (2011) Marion County Error National Rank Margin Benchmark TX (of 221) Health Behaviors 158 Adult smoking - Percent of adults that report smoking at least 100 cigarettes and that they currently smoke - 14% 19% Adult obesity - Percent of adults that report a BMI >= 30 31% 24-38% 25% 29% Excessive drinking - Percent of adults that report excessive drinking in the past 30 days - 21% 25% Motor vehicle crash death rate - Motor vehicle deaths per 100K population Sexually transmitted infections - Chlamydia rate per 100K population Teen birth rate - Per 1,000 female population, ages Clinical Care 129 Uninsured adults - Percent of population under age 65 without health insurance 28% 25-30% 11% 26% Primary care physicians - Ratio of population to primary care physicians* 5,509:1 631:1 1,378:1 Preventable hospital stays - Hospitalization rate for ambulatory-care sensitive conditions per 1,000 Medicare enrollees Diabetic screening - Percent of diabetic Medicare enrollees that receive HbA1c screening 80% 67-93% 89% 81% Mammography screening - Percent of female Medicare enrollees that receive mammography screening 58% 44-73% 74% 62% Social & Economic Factors 203 High school graduation - Percent of ninth grade cohort that graduates in 4 years 83% - 84% Some college - Percent of adults aged years with some postsecondary education 42% 31-53% 68% 56% Children in poverty - Percent of children under age 18 in poverty 35% 27-44% 13% 26% Inadequate social support - Percent of adults without social/emotional support - 14% 23% Children in single-parent households - Percent of children that live in household headed by single parent 44% 29-58% 20% 32% Violent crime rate - Violent crime rate per 100,000 population Physical Environment 120 Air pollution-particulate matter days - Annual number of unhealthy air quality days due to fine particulate matter Air pollution-ozone days - Annual number of unhealthy air quality days due to ozone 1-18 Access to healthy foods - Healthy food outlets include grocery stores and produce stands/farmers' markets 100% - 62% Access to recreational facilities - Rate of recreational facilities per 100,000 population Source: Countyhealthrankings.org *Texas Department of State Health Services 35

39 Community Health Needs Assessment 2013 Panola County Health Outcomes--rankings are based on an equal weighting of one length of life (mortality) measure and four quality of life (morbidity) measures. Exhibit 16 Good Shepherd Medical Center - Marshall Panola County County Health Rankings - Health Outcomes (2011) Error National Rank Panola County Margin Benchmark TX (of 221) Mortality 156 Premature death - Years of potential life lost before age 75 per 100,000 population (age-adjusted) 9,490 8,051-10,930 5,466 7,186 Morbidity 142 Poor or fair health - Percent of adults reporting fair or poor health (age-adjusted) 16% 10-26% 10% 19% Poor physical health days - Average number of physically unhealthy days reported in past 30 days (age-adjusted) Poor mental health days - Average number of mentally unhealthy days reported in past 30 days (age-adjusted) Low birthweight - Percent of live births with low birthweight (<2500 grams) 7.3% % 6.0% 8.2% Source: Countyhealthrankings.org 36

40 Community Health Needs Assessment 2013 A number of different health factors shape a community s health outcomes. The County Health Rankings model includes four types of health factors: health behaviors, clinical care, social and economic and the physical environment. The following table summarizes the health factors for Panola County. Exhibit 16.1 Good Shepherd Medical Center - Marshall Panola County County Health Rankings - Health Factors (2011) Panola County Error National Rank Margin Benchmark TX (of 221) Health Behaviors 146 Adult smoking - Percent of adults that report smoking at least 100 cigarettes and that they currently smoke - 14% 19% Adult obesity - Percent of adults that report a BMI >= 30 30% 24-38% 25% 29% Excessive drinking - Percent of adults that report excessive drinking in the past 30 days - 21% 25% Motor vehicle crash death rate - Motor vehicle deaths per 100K population Sexually transmitted infections - Chlamydia rate per 100K population Teen birth rate - Per 1,000 female population, ages Clinical Care 92 Uninsured adults - Percent of population under age 65 without health insurance 23% 21-25% 11% 26% Primary care physicians - Ratio of population to primary care physicians 3,312:1 631:1 1,378:1 Preventable hospital stays - Hospitalization rate for ambulatory-care sensitive conditions per 1,000 Medicare enrollees Diabetic screening - Percent of diabetic Medicare enrollees that receive HbA1c screening 84% 75-93% 89% 81% Mammography screening - Percent of female Medicare enrollees that receive mammography screening 56% 47-66% 74% 62% Social & Economic Factors 75 High school graduation - Percent of ninth grade cohort that graduates in 4 years 85% - 84% Some college - Percent of adults aged years with some postsecondary education 50% 42-57% 68% 56% Children in poverty - Percent of children under age 18 in poverty 21% 15-26% 13% 26% Inadequate social support - Percent of adults without social/emotional support - 14% 23% Children in single-parent households - Percent of children that live in household headed by single parent 31% 23-40% 20% 32% Violent crime rate - Violent crime rate per 100,000 population % Physical Environment 138 Air pollution-particulate matter days - Annual number of unhealthy air quality days due to fine particulate matter Air pollution-ozone days - Annual number of unhealthy air quality days due to ozone Access to healthy foods - Healthy food outlets include grocery stores and produce stands/farmers' markets 40% - 62% Access to recreational facilities - Rate of recreational facilities per 100,000 population Source: Countyhealthrankings.org 37

41 Community Health Needs Assessment 2013 Health Care Resources The availability of health resources is a critical component to the health of a county s residents and a measure of the soundness of the area s health care delivery system. An adequate number of health care facilities and health care providers is vital for sustaining a community s health status. Fewer health care facilities and health care providers can impact the timely delivery of services. A limited supply of health resources, especially providers, results in the limited capacity of the health care delivery system to absorb charity and indigent care as there are fewer providers upon which to distribute the burden of indigent care. This section will address the availability of health care resources to the residents of the three counties in which the community resides. Hospitals and Other Licensed Facilities and Providers The Medical Center has 149 acute beds and is one of the two hospitals located within the Community. Residents of the Community also take advantage of services provided by hospitals in neighboring counties, as well as services offered by other facilities and providers. 38

42 Exhibit 17 summarizes hospital services available to the residents of the three counties in which the community resides: Community Health Needs Assessment 2013 Exhibit 17 Good Shepherd Medical Center - Marshall Summary of Area Hospitals and Health Centers Facility Miles from Bed Number Hospital Address Type *** Size 1 Good Shepherd Medical Center Marshall 811 S Washington Ave., Marshall, TX Acute Care *** Good Shepherd Medical Center - Longview 700 East Marshall Ave., Longview, TX Acute Care Select Specialty Hospital Of Longview 700 East Marshall Ave., Longview, TX Acute Care Longview Regional Medical Center 2901 N 4th St., Longview, TX Acute Care East Texas Medical Center - Carthage 409 West Cottage, Carthage, TX Acute Care Allegiance Specialty Hospital Of Kilgore 1612 S Henderson Blvd., Kilgore, TX Acute Care Good Shepherd Medical Center - Linden 404 N Kaufman St., Linden, TX Critical Access Hospitals Willis Knighton Medical Center 2600 Greenwood Rd., Shreveport, LA Acute Care LSU Health Sciences Center - Shreveport 1541 Kings Hwy., Shreveport, LA Acute Care East Texas Medical Center - Henderson 300 Wilson St., Henderson, TX Acute Care Christus Schumpert Medical Center 1 Saint Mary Pl., Shreveport, LA Acute Care East Texas Medical Center - Gilmer 712 N Wood St., Gilmer, TX Acute Care Promise Hospital Of Louisiana - Shreveport Campus 1800 Irving Pl., Shreveport, LA Acute Care Dubuis Hospital Of Shreveport One St Mary Pl., Shreveport, LA Acute Care Lifecare Hospital of Shreveport 9320 Linwood Ave., Shreveport, LA Acute Care North Caddo Medical Center 1000 S Spruce St., Vivian, LA Critical Access Hospitals University Of Texas Health Science Center At Tyler Us Highway 271, Tyler, TX Acute Care Trinity Mother Frances Hospital 800 E Dawson St., Tyler, TX Acute Care Tyler Continuecare Hospital (at Mother Frances) 800 E Dawson St., Tyler, TX Acute Care East Texas Medical Center - Tyler 1000 S Beckham Ave., Tyler, TX Acute Care East Texas Medical Center - Specialty 1000 S Beckham Ave., Tyler, TX Acute Care East Texas Medical Center - Rehab 701 Olympic Plaza Circle, Tyler, TX Rehabilitation Texas Spine And Joint Hospital 1814 Roseland Blvd., Tyler, TX Acute Care Trinity Mother Frances Rehabilitation Hospital 3131 Troup Hwy., Tyler, TX Rehabilitation Source: Costreportdata.com 39

43 Community Health Needs Assessment 2013 The following map depicts the location of the area hospitals and other health service providers listed in Exhibit 17. Numbers on the map correspond to the numbers in Exhibit 17: The following is a brief description of the health care services available at each of these facilities: Good Shepherd Medical Center Longview (GSMC Longview) Located in Longview, Texas, GSMC Longview is approximately a 25 minute drive west of GSMC - Marshall. Consisting of 367 beds, this large-sized medical center provides a wide variety of specialties and services that include: cancer services, minor and complicated surgeries, orthopedics, primary care, physical, speech and occupational therapy, diabetes educational services, emergency services, cardiac services, neurology, bariatrics and other general services. Select Specialty Hospital of Longview Located in Longview, Texas, Select Specialty Hospital of Longview is approximately a 25 minute drive west of Good Shepherd Medical Center Marshall and is located in the GSMC - Longview. Consisting of 32 beds, this small hospital provides specialties and services that include: respiratory therapy, discharge planning and case management, pharmacy services, physician visits, would care, an intensive care unit, radiology, individualized care planning, patient and family education, dietician and nutrition counseling, rehabilitation therapy and specialized monitoring. 40

44 Community Health Needs Assessment 2013 Longview Regional Medical Center (LRMC) Located in Longview, Texas, LRMC is approximately a 25 minute drive west of Good Shepherd Medical Center - Marshall. Consisting of 112 beds, this medium-sized medical center provides specialties and services, including, but not limited to: orthopedics, neurology, pediatrics, intermediate care, emergency and intensive care, and surgery. East Texas Medical Center Carthage (ETMC Carthage) Located in Carthage, Texas, ETMC - Carthage is approximately a 30 minute drive southeast of Good Shepherd Medical Center - Marshall. Consisting of 49 beds, including 3 surgical suites, this small medical center provides specialties and services that include: an emergency department, inpatient care, general surgeries, imaging, and a family medicine, pediatric and women s health clinic. Allegiance Specialty Hospital of Kilgore Located in Kilgore, Texas, Allegiance Specialty Hospital of Kilgore is approximately a 35 minute drive south of Good Shepherd Medical Center - Marshall. Consisting of 48 psychiatric beds, this medium-sized inpatient behavioral and health hospital provides psychiatric care and services, geriatric services, and health screenings. Good Shepherd Medical Center Linden (GSMC Linden) Located in Linden, Texas, GSMC Linden is approximately a 35 minute drive north of Good Shepherd Medical Center Marshall. The facility is a small-sized medical center, consists of 25 beds, and offers services that include: cardiac rehabilitation, emergency services, inpatient acute care, nutrition services, general surgery, wing bed care and gastroenterology. Willis Knighton Medical Center Located in Shreveport, Louisiana, Willis Knighton Medical Center is approximately a 40 minute drive east of Good Shepherd Medical Center Marshall. This facility is a large-sized medical center, consists of 662 beds, and offers a variety of services that include: a cancer center, behavioral medicine, emergency services, cardiology, orthopedics, physical therapy, medical imaging, general and complicated surgeries, and other diagnostic and laboratory services. LSU Health Sciences Center Shreveport Located in Shreveport, Louisiana, LSU Health Sciences Center Shreveport is approximately a 40 minute drive east of Good Shepherd Medical Center Marshall. This facility is a large-sized medical center, consists of 429 beds, and offers a variety of services that include: psychiatry, general and complicated surgeries, orthopedics, anesthesiology, neurology and neurosurgery, pathology, family medicine, pediatrics, and other general services. East Texas Medical Center Henderson (ETMC - Henderson) Located in Henderson, Texas, ETMC - Henderson is approximately a 40 minute drive southwest of Good Shepherd Medical Center - Marshall. Consisting of 49 beds, this small medical center provides specialties and services that include: emergency care, inpatient and outpatient surgery, maternity care and obstetrics, women s clinic, intensive care unit, radiology, respiratory therapy, diabetes outreach center, and has a family health clinic. Christus Schumpert Medical Center Located in Shreveport, Louisiana, Christus Schumpert Medical Center is approximately a 40 minute drive east of Good Shepherd Medical Center Marshall. This facility is a large-sized center, consists of 623 beds, and offers a variety of services that include gynecology, oncology, neurology and neurosurgery, family medicine, cardiology, orthopedic, and other general services. East Texas Medical Center - Gilmer (ETMC - Gilmer) Located in Gilmer, Texas, ETMC - Gilmer is approximately a 50 minute drive northwest of Good Shepherd Medical Center - Marshall. Consisting of 41

45 Community Health Needs Assessment beds, this small medical center provides specialties and services that include: a trauma center, respiratory and physical therapy, physician specializations, such as family medicine, pediatrics, internal medicine, urology, and pulmonology. Promise Hospital of Louisiana Shreveport Campus Located in Shreveport, Louisiana, Promise Hospital of Louisiana Shreveport Campus is approximately a 40 minute drive east of Good Shepherd Medical Center Marshall. This facility is a large-sized hospital, consists of 196 beds, and offers a variety of services that include: physical, occupational and speech therapy, nutritional services, diabetes management, radiology, cardiac rehabilitation, general and complicated surgeries, and other general services. Dubuis Hospital of Shreveport Located in Shreveport, Louisiana, Dubuis Hospital of Shreveport is approximately a 40 minute drive east of Good Shepherd Medical Center Marshall. This facility is a smallsized hospital, consists of 36 rooms, and offers services that primarily focus on providing long-term acute care to medically complex patients that require extended hospitalization, dependency, care and rehabilitation. Lifecare Hospital of Shreveport Located in Shreveport, Louisiana, Lifecare Hospital of Shreveport is approximately a 40 minute drive east of Good Shepherd Medical Center Marshall. This facility is a large-sized hospital, consists of 119 beds, and offers services that primarily focus on providing long-term acute care in areas such as: physical, speech and occupational therapy, respiratory therapy and psychological therapy. North Caddo Medical Center Located in Vivian, Louisiana, North Caddo Medical Center is approximately a 45 minute drive northeast of Good Shepherd Medical Center Marshall. This facility is a smallsized medical center, consists of 25 beds, and offers services that include: general surgeries, emergency and ambulatory services, fitness center, cardiology, pediatrics, and other diagnostic and laboratory services. University of Texas Health Science Center at Tyler (UTHCT) Located in Tyler, Texas, UTHCT is approximately a 45 minute drive west of Good Shepherd Medical Center - Marshall. Consisting of 116 beds, this medium-sized facility provides specialties and services that include: family medicine, pathology, pediatrics, an intensive care unit, and emergency services. Trinity Mother Frances Hospital Located in Tyler, Texas, Trinity Mother Frances Hospital is approximately a 55 minute drive southwest of Good Shepherd Medical Center - Marshall. Consisting of 367 beds, this large-sized hospital offers a complete range of specialties and services, including, but not limited to: emergency department, trauma center, rehabilitation, orthopedics, pain management, cosmetic surgery, primary specialty care, neurological services, cardiology and advanced surgeries. Tyler ContinueCARE Hospital Located in Tyler, Texas, Tyler ContinueCARE Hospital is located in Trinity Mother Frances Hospital and is approximately a 55 minute drive southwest of Good Shepherd Medical Center - Marshall. Consisting of 51 beds, this medium-sized hospital provides specialties and services that include: an emergency department, trauma center, rehabilitation, orthopedics, pain management, cosmetic surgery, primary specialty care, neurological services, cardiology, and advanced surgeries. East Texas Medical Center Tyler (ETMC Tyler) Located in Tyler, Texas, ETMC - Tyler is approximately a 60 minute drive southwest of Good Shepherd Medical Center - Marshall. Consisting of 451 beds, this large-sized medical center provides a variety of specialties and services, including: an emergen- 42

46 Community Health Needs Assessment 2013 cy department, inpatient care, general surgeries, imaging, and a family medicine, pediatric and women s health clinic. East Texas Medical Center Specialty Hospital (ETMC Specialty Hospital) Located in Tyler, Texas, ETMC - Specialty Hospital is located in ETMC Tyler approximately a 60 minute drive southwest of Good Shepherd Medical Center - Marshall. The facility is a small-sized medical center, consists of 36 beds, and offers services that include: respiratory care, cardiac monitoring, complex medical care, oncology, low-intensity rehabilitation, chemotherapy and radiation therapy, and advanced cardiac monitoring and intravenous medication. East Texas Medical Center Rehabilitation Center (ETMC Rehabilitation Center) Located in Tyler, Texas, ETMC Rehabilitation Center is located in ETMC Tyler approximately a 60 minute drive southwest of Good Shepherd Medical Center - Marshall. The facility is a small-sized medical center, consists of 49 beds, and offers services that include: neurological and orthopedic inpatient rehabilitation, physical, occupational and speech therapies, counseling and psychological services, and cardiovascular and pulmonary rehabilitation. Texas Spine and Joint Hospital (TSJH) Located in Tyler, Texas, TSJH is approximately a 60 minute drive southwest of Good Shepherd Medical Center - Marshall. The facility is a small-sized hospital, consists of 20 beds, and offers services that include: joint replacement, back and neck, orthopedics, radiology and outpatient surgery. Trinity Mother Frances Rehabilitation Hospital Located in Tyler, Texas, Trinity Mother Frances Rehabilitation Hospital is approximately a 60 minute drive southwest of Good Shepherd Medical Center - Marshall. The facility is a medium-sized hospital, consists of 74 beds, and treats conditions resulting from: stroke, brain, spinal cord injury, arthritis, hip and joint fractures and replacements, and neurological disorders. 43

47 Community Health Needs Assessment 2013 Key Informant Interviews Interviewing key informants (community stakeholders that represent the broad interest of the community with knowledge of or expertise in public health) is a technique employed to assess public perceptions of the county s health status and unmet needs. These interviews are intended to ascertain opinions among individuals likely to be knowledgeable about the community and influential over the opinions of others about health concerns in the community. Methodology Interviews with 20 key informants were conducted in February Informants were determined based on their a.) specialized knowledge or expertise in public health, b.) their affiliation with local government, schools and industry or c.) their involvement with underserved and minority populations. Interviews were conducted both at the Medical Center and in locations more convenient for the informant. All interviews were conducted by BKD personnel using a standard questionnaire. A copy of the interview instrument is included in Appendix C. A summary of their opinions is reported without judging the truthfulness or accuracy of their remarks. Community leaders provided comments on the following issues: Health and quality of life for residents of the primary community Barriers to improving health and quality of life for residents of the primary community Opinions regarding the important health issues that affect Community residents and the types of services that are important for addressing these issues Delineation of the most important health care issues or services discussed and actions necessary for addressing those issues Interview data was initially recorded in narrative form. Themes in the data were identified and representative quotes have been drawn from the data to illustrate the themes. Informants were assured that personal identifiers such as name or organizational affiliations would not be connected in any way to the information presented in this report. Therefore, quotes included in the report may have been altered slightly to preserve confidentiality. This technique does not provide a quantitative analysis of the leaders opinions, but reveals community input for some of the factors affecting the views and sentiments about overall health and quality of life within the community. Key Informant Profiles Key informants from the community (see Appendix B for a list of key informants) worked for the following types of organizations and agencies: Social service agencies Local city and county government Medical providers 44

48 Community Health Needs Assessment 2013 Key Informant Interview Results As stated earlier, the interview questions for each key informant were identical. The questions on the interview instrument are grouped into four major categories for discussion: 1. General opinions regarding health and quality of life in the community 2. Underserved populations and communities of need 3. Barriers 4. Most important health and quality of life issues A summary of the leaders responses by each of these categories follows. Paraphrased quotes are included to reflect some commonly held opinions and direct quotes are employed to emphasize strong feelings associated with the statements. This section of the report summarizes what the key informants said without assessing the credibility of their comments. 1. General opinions regarding health and quality of life in the community The key informants were asked to rate the health and quality of life in their respective county. They were also asked to provide their opinion whether the health and quality of life had improved, declined or stayed the same over the past few years. Lastly, key informants were asked to provide support for their answers. The responses ranged from poor to good; however, most of the key informants described the community s health as average or fair. When asked whether there are groups of people within the community who may experience lower quality of life, common responses included: the low-income and working poor, the Hispanic population, elderly, and mentally-ill individuals. When asked whether the health and quality of life had improved, declined or stayed the same, most of the key informants noted that health and quality of life had improved or at least remained the same over the last few years. The primary cause was the increase of health services available and the increase in health awareness and health education. Only a few respondents said the quality of life had gone down over the last few years. This decrease was primarily due to the increase in obesity, poor health habits, and less availability of care in the rural areas. Most of these were the result of barriers or factors preventing people from improving their quality of life. Many key informants noted that the community had made progress in implementing new programs and services meant to improve the community s health and quality of life. The progress was attributable to the efforts of a variety of organizations that focus on improving the health and lifestyle of the community. Preventative and education programs have helped spread awareness of the consequences of poor health choices. Several of the key informants were optimistic that these efforts would have a positive effect on the community s quality of life. However, despite these programs, many key informants noted that many members of the community did not take advantage of them. Some people living in more rural areas desired to improve their health, but lacked the transportation or gas money necessary to travel to the facilities. Many key informants also noted that the community s culture had a negative impact on people s health choices. Unhealthy habits such as smoking, alcohol and drug use, and eating unhealthy foods are ingrained in many people s lifestyles, and several key informants felt the people are simply not motivated to change. 45

49 Community Health Needs Assessment 2013 Overall, key informants value the attempts the community has made to improve health and quality of life for its residents, but feel that much more needs to be done. The regional culture, including healthy habits or lack thereof, was generally seen as the reason behind poor health and quality of life. Lack of access was seen as an issue for certain populations. Poor economic conditions are seen as detriment to community health. Obesity rate is increasing which decreases overall health. Health is improving due to hospital programs. We would much rather educate people than have them incur high medical bills. The public is taking more responsibility for their families. Offering services doesn t change the culture. The hospital has to influence lifestyle and culture change, not just be there when someone gets sick. 2. Underserved populations and communities of need Key informants were asked to provide their opinions regarding specific populations or groups of people whose health or quality of life may not be as good as others. Key informants were also asked to provide their opinions as to why they thought these populations were underserved or in need. Each key informant was asked to consider the specific populations they serve or those with which they usually work. Responses to this question varied. One underserved group the key informants noted is those struggling with mental health issues. This is a problem for both adults and teens in the community. These people subsequently struggle with sustaining steady jobs, which ultimately hinders them from maintaining insurance. Key informants noted that people do not have access to care due to cutbacks in psychiatric services and funding. There is no not-for-profit psychiatric center, so patients go to the emergency department for mental treatment. Another underserved group is the minority and immigrant population. They are generally part of the lower income, unemployed and uninsured population that does not have access to care. Some individuals in this population are not able to take advantage of available opportunities for care and or assistance, such as Medicaid. Although some are able to get help, a lot avoid seeking care unless there are no other options and others lack the knowledge of assistance programs that are available. A third underserved group is the working poor and people without insurance. The unemployed can get assistance, but the working poor are caught in the middle. Several key informants mentioned that there is a large number of people who are too old or whose incomes are too high to qualify for Medicaid, but they are too young to qualify for Medicare and do not have enough money to buy their own health insurance. These people suffer from a lack of access to necessary health care, especially preventative care, causing even greater health problems and greater problems for the community. These individuals end up using the emergency room as doctors offices because there are no community health clinics. Individuals who are discharged or should be in rehabilitation end up back in the emergency room because there is no continuity of care. The last group identified as underserved is the elderly population. The elderly feel an entitlement to care, but the lack of funding makes it hard for providers to offer the necessary care they need. Individuals often 46

50 Community Health Needs Assessment 2013 do not have family members to offer support, provide care, or provide them with transportation to and from health care providers. The unemployed can get assistance, but working poor are caught in the middle. Most are too old for Medicaid and too young for Medicare. People can t afford healthcare so they only come in when there is a problem. If you don t have insurance, you aren t going to get mental health care. The Emergency Room is bombarded with mental health patients because there is nowhere else for them to go. 3. Barriers The key informants were asked what barriers or problems keep community residents from obtaining necessary health services in their community. Responses from key informants include financial barriers, mental health, community culture, lack of available resources and the lack of transportation. Financial barriers were identified by the key informants. A lot of people cannot afford their own insurance, and even the people who can, don t want to spend the money on primary care or preventative services because it would only induce more of a financial hardship. Some people have to choose between life necessities and health care. People also cannot afford and are not willing to pay for healthy foods or other resources available that provide future health benefits. As previously noted, people s attitudes and culture, surrounding health and lifestyle choices, are seen as a barrier. Bad habits are passed down from generation to generation and there are not enough resources to bring about a change. Some of the Hispanic population don t know or speak English, which makes it hard to communicate health needs. With the community being rural, there is a lack of available resources. Some people either don t want to, or can t, drive the long distances to seek care. Respondents identified a lack of physicians and specific services for which members of the community need to travel further distances. If people don t drive or get the newspaper, they miss out on resources that are available to improve their health. Some of the key informants identified a lack of transportation for residents as a barrier to receiving care. Some people cannot afford their own vehicles, cannot afford to pay for gas, are elderly and do not drive or don t have family to provide transportation assistance. Other related issues include transportation from work to care facilities and back to work, while some simply cannot afford to take off of work for care. Some people have issues finding physicians that are taking new patients. Encouraging at-risk groups to make better health choices is difficult. We are spending time treating problems that they should be preventing. Hospital is breaking down barriers with health fairs that have greatly improved over the last 12 years. 47

51 Community Health Needs Assessment 2013 People are not motivated, can t afford access to care, don t follow-up, lack transportation, and lack family support. Barriers exist that are self-imposed. People have choices and many people choose the poor decisions. 4. Most important health and quality of life issues Key informants were asked to provide their opinion as to the most critical health and quality of life issues facing the county. The issues identified most frequently were: 1. Mental/behavioral health 2. Affordable primary and preventative care options 3. Diabetes/obesity 4. Accountability and responsibility for personal health 5. Lack of access to primary care/transportation Other issues that were identified are people not cooperating with services available for their benefit. People don t bring in the necessary paperwork and don t answer or return phone calls when the hospital calls to offer assistance. Poverty and poor living situations both discourages people from seeking preventative care and encourages unhealthy habits. Diabetes patients are not compliant with watching their diets. Education is the process needed. We need to encourage people to make better decisions. Funding needs to be re-routed to mental health. It should pay for treatment instead of prison. There is a need to get into schools at a younger age to encourage health lifestyles. We need more funding for people with lower income. They don t have money to get medications and to keep up with their prescriptions. Key Findings A summary of themes and key findings provided by the key informants follows: Quality of health is not always caused by a lack of access. People s attitudes and choices lead to poor health. Residents are apathetic regarding wellness and health as a result of socioeconomic status and culture. Information and education on health issues is a problem. There is a significant need to inform, educate and counsel specific categories of the community. The Medical Center is seen as a significant asset to the community. There is a lack of mental and behavioral health services. Alcohol and drug abuse are seen as a health and quality of life issue. People in the community have a sense of entitlement to [free] care. 48

52 Transportation is an issue for people and prevents them from seeking care. Community Health Needs Assessment 2013 While there are many health services available to residents of the community, they are not always fully utilized due to cultural habits, and they often suffer due to a lack of funding. 49

53 Community Health Needs Assessment 2013 Community Health Input Questionnaire The Medical Center circulated community health input questionnaires in order to gather broad community input regarding health issues. The input process occurred during the months of February and March of The community health input questionnaire was intended to gather information regarding the overall health of the community. The results are intended to provide information on different health and community factors. Requested community input included demographics and socioeconomic characteristics, behavioral risk factors, health conditions and access to health resources Methodology A web-based tool, Question Pro, was utilized to conduct the community input process electronically. Paper questionnaires, which were identical to the electronic questionnaire, were also distributed to populations who may not have access to the internet or generationally are more likely to complete a paper questionnaire. Electronic and paper questionnaires were circulated to the residents of the primary community. Community input was also received through a random sample of people within the community who participated and completed the questionnaire over the phone. Exhibit 18 displays the organizations that assisted in deploying the community health input questionnaire. Exhibit 18 Good Shepherd Medical Center - Marshall Summary of Community Health Input Questionnaire Organization Type of Organization Type of Survey Good Shepherd Health System Healthcare Paper, phone and electronic questionnaire Greater Longview United Way Non-profit Paper and electronic questionnaire There were 917 questionnaires completed and returned. The ages of the respondents skewed significantly older than the latest census data reported for the community, with over 70 percent of the respondents being 45 or older, compared to 43 percent in the community. Over 75 percent of the survey respondents were female, which is significantly higher than the percentage of the community. The respondents also tended to have higher education levels than the community as a whole. Input Questionnaire The instrument used for this input process was based largely on the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS), as well as various other public health surveys and customized questions. The final instrument was developed by the Medical Center representatives in conjunction with BKD. 50

54 Community Health Needs Assessment 2013 Community Health Input Results The questionnaire was quite detailed in nature, including many specific questions regarding general health, satisfaction with specific and general providers, and demographic information. A compilation of the results is included in Appendix D for each question to allow for a more detailed analysis. Health needs indicated include: Assessment of Personal Health When asked to assess their personal health status, 20 percent of the respondents described their health as being excellent, and 46 percent stated that their overall health was good. 27 percent described their health status as being fair, and 7 percent described their current health status as poor. When asked to rate their community as a healthy community, 29 percent of the respondents indicated their community was healthy or very healthy. Nearly 16 percent of the respondents indicated their community was unhealthy or very unhealthy. The remaining 55 percent of the respondents indicated their community was somewhat healthy. Health Care Access Issues Over 73 percent of the respondents reported having health insurance with only 36 percent of health insurance being provided by private insurance companies. Health care access issues are primarily related to cost. Respondents noted the following main reasons for not receiving medical care: 1. No insurance, cannot afford insurance premiums/too expensive 2. Health insurance did not cover procedure or test 3. Deductible or co-pay was too high Nine percent of respondents noted they could not pay for needed prescription medication, over 7 percent of respondents noted they could not get an appointment or get time off of work, and almost 3 percent of respondents did not receive medical care due to the lack of transportation. Lifestyle Behavioral Risk Factors Proper diet and nutrition seem to be a challenge as only 18 percent of the respondents report always eating the daily recommended servings of fruits and vegetables. Almost 70 percent of respondents reported they sometimes, or always, eat fast food at least once a week. Approximately 23 percent of the respondents report that they never exercise, while 43 percent report exercising at least three times per week. Nearly 17 percent of the respondents habitually smoke cigarettes and 27 percent are exposed to secondhand smoke in their home or workplace. Over 10 percent habitually consume at least 3 alcoholic drinks per day (female) or more than 5 per day (male). Approximately 4 percent of the respondents indicated they regularly use illegal drugs. Use of seat belts is high (over 95 percent) and when applicable, respondents children use seat belts and/or child safety seats. 51

55 Community Health Needs Assessment 2013 Social and Mental Health Over 15 percent of the respondents rated their stress level as high or very high on a typical day. Approximately 42 percent of the respondents rated their stress level as moderate on a typical day. Over 24 percent reported that they did less than they would like due of mental health or emotional issues. Over 24 percent of respondents reported that their finances are stressful, over 18 percent reported their personal health is stressful, and almost 13 percent reported their current employment is stressful. Most people responded with the following when asked how they cope with stress: pray, talk to friends, watch tv, exercise, listen to music, talk to family, or read. Almost 7 percent reported they smoke, almost 5 percent reported they drink alcohol, and over 1 percent reported they consume illegal drugs. What do citizens say about the health of their community? The five most important health problems: 1. Child and elder abuse or neglect 2. Poor birth outcomes (prematurity, low birth weight, defects, etc.) 3. Obesity 4. Heart disease and stroke 5. Cancer The five most risky behaviors: 1. Drug abuse 2. Not using seat belts, child safety seats or helmets 3. Dropping out of school 4. Alcohol abuse 5. Not using birth control and unsafe sexual practices The five most important factors for a healthy community: 1. Affordable and available health care 2. Low level of child abuse 3. Emergency response services (ambulance/fire/police) 4. Low crime and safe environments 5. Good schools 52

56 Community Health Needs Assessment 2013 Additional items to consider in planning Respondents were asked to provide input as to what items or programs they believe should be considered in planning for the next three years. The following items were recurring suggestions provided: 1. Increased level of community involvement and after school programs for youth and teens that would provide positive examples for healthy behaviors, physical activity and homework assistance. 2. Additional programs, services, and financial assistance for people with mental health issues to receive treatment and care. 3. Increased wellness programs that include general education, preventive procedures/screenings, and affordable clinics and health fairs. 53

57 Community Health Needs Assessment 2013 Prioritization of Identified Health Needs Using findings obtained through the community survey and collection of primary and secondary data, the Medical Center completed an analysis of these inputs (see Appendices) to identify community health needs. The following data was analyzed to identify health needs for the community: Leading Causes of Death Leading causes of death for the community and the death rates for the leading causes of death for each county within the Medical Center CHNA community were compared to U.S. adjusted death rates. Causes of death in which the county rate compared unfavorably to the U.S. adjusted death rate resulted in a health need for the Medical Center CHNA community. Health Outcomes and Factors An analysis of the County Health Rankings health outcomes and factors data was prepared for each county within the Medical Center CHNA community. County rates and measurements for health behaviors, clinical care, social and economic factors and the physical environment were compared to national benchmarks. County rankings in which the county rate compared unfavorably (by greater than 30 percent of the national benchmark) resulted in an identified health need. Primary Data Health needs identified through community surveys, focus groups and key informant interviews (if applicable) were included as health needs. Needs for vulnerable populations were separately reported on the analysis in order to facilitate the prioritization process. 54

58 As a result, the following summary list of needs was identified: Community Health Needs Assessment 2013 Uninsured / Lack of access to services (cost) Obesity Heart Disease Lack of mental health services Lack of primary care physicians Physical inactivity Diabetes Poor nutrition Utilization of emergency room for episodic care Lack of health education Drug / Alcohol abuse Transportation Language / Cultural barriers Diabetic screen rates Limited access to healthy foods High blood pressure Adult Smoking Children in poverty Sexually transmitted infections COPD/Respiratory Disease To facilitate prioritization of identified health needs, a ranking and prioritization process was used. Health needs were ranked based on the following seven factors. Each factor received a score between 0 and 5. 1) How many people are affected by the issue or size of the issue? For this factor ratings were based on the percentage of the community who are impacted by the identified need. The following scale was utilized. >25% of the community= 5; >15% and <25%=4; >10% and <15%=3; >5% and <10%=2 and <5%=1. 2) What are the consequences of not addressing this problem? Identified health needs which have a high death rate or have a high impact on chronic diseases received a higher rating for this factor. 3) The impact of the problem on vulnerable populations. Needs identified which pertained to vulnerable populations were rated for this factor. 4) How important the problem is to the community. Needs identified through community surveys and/or focus groups were rated for this factor. 5) Prevalence of common themes. The rating for this factor was determined by how many sources of data (Leading Causes of Death, Primary Causes for Inpatient Hospitalization, Health Outcomes and Factors and Primary Data) identified the need. Each need was ranked based on the five prioritization metrics. 55

59 Community Health Needs Assessment 2013 Exhibit 19 Good Shepherd Medical Center - Marshall Prioritization of Health Needs How many people are affected by the issue? What are the consequences of not addressing this problem? What is the impact on vulnerable populations? How Important is it to the community? How many sources identified the need? Total Score * 1 Uninsured / Lack of Access to Services (Cost) Obesity Diseases of the Heart Lack of Mental Health Services Primary Care Physicians Physical Inactivity Diabetes Poor Nutrition Utilization of Emergency Room for Episodic Care Lack of Health Education Excessive Drinking / Drug Use Transportation Language / Cultural Barriers Diabetic Screen Rate Limited Access to Healthy Foods High Blood Pressure Adult Smoking Children in Poverty Sexually Transmitted Infections Chronic Lower Respiratory Diseases * Highest possible score = 25 56

60 Community Health Needs Assessment 2013 The Medical Center s management reviewed the identified needs reported in Exhibit 24. Through discussion and debate, management agreed on priorities the Medical Center should focus on for fiscal years The Medical Center has determined the following to be priority areas that will be addressed through its implementation strategy. 1. Uninsured / Lack of access to services (cost) 2. Obesity 3. Heart Disease 4. Lack of mental health services 5. Lack of primary care physicians 6. Physical inactivity 7. Diabetes 8. Poor nutrition 9. Utilization of emergency room for episodic care 10. Lack of health education 57

61 Northeast Texas Regional Healthcare Partnership Plan Community Health Needs Assessment 2013 In March 2013 the Northeast Texas Regional Healthcare Partnership issued the Texas Healthcare Transformation and Quality Improvement Program Regional Healthcare Partnership Plan. The Texas Healthcare Transformation and Quality Improvement Program was designed to encourage activities that support hospitals collaborative efforts to improve access to care and the health of the patients and families they serve. Consistent with that goal, the overarching goal and vision of the Northeast Texas Regional Healthcare Partnership is to move toward a realization of the triple aim: 1. Improving the patient experience of care (including quality and satisfaction) 2. Improving the health of populations; and 3. Reducing the per capita cost of health care. In addition, addressing gaps in access to care (both physical and behavioral health services) is a key focus of the regional healthcare partnership. The area covered by the report includes 28 counties and borders three states and includes over 1.2 million people. Approximately 54% of the regional population is either uninsured or enrolled in some form of publicly funded health coverage. The community served by the Medical Center is located with the area coved by the report. As described in the report, Northeast Texas is an area where patients face many challenges in accessing primary care, acute care, and mental and behavioral health services. Key health challenges include high numbers of medically underserved areas/populations, health professional shortages in primary care and mental health, lack of sufficient specialists to serve the patient population, high chronic disease burden, and high rates of potentially preventable hospitalization. Taken as a whole, Northeast Texas is older, poorer, and less well educated than the state average. As a result, over half of counties in Region 1 are in the bottom quartile of Texas counties in health outcomes. The report identified six major community health needs. The needs identified are: 1. Insufficient access to primary and specialty care services. 2. Insufficient access to mental and behavioral health services. 3. High rates of chronic disease, including diabetes, heart disease, asthma, obesity, and cancer. 4. High costs due to potentially preventable hospitalizations. 5. Inappropriate emergency room utilization. 6. Efficiency in and effectiveness of health care delivery. The needs identified by the Northeast Texas Regional Healthcare Partnership are similar to the needs identified in the Community Health Needs Assessment conducted by the Medical Center. An excerpt from the Northeast Texas Regional Healthcare Partnership is included as an Appendix to this report. 58

62 Community Health Needs Assessment 2013 APPENDICES 59

63 Community Health Needs Assessment 2013 SOURCES 60

64 Community Health Needs Assessment 2013 Sources Nielson Demographic Update, The Nielson Company, July 2012 Regional Economic Conditions (RECON) , Federal Deposit Insurance Corporation, 21 Dec < United States Department of Labor: Bureau of Labor Statistics U.S. Department of Census. 12 Dec < Standardized Occupational Components for Research and Analysis of Trends in Employment System. Texas Workforce Commission: Labor Market and Career Information, December Poverty and Median Income Estimates Counties, U.S. Census Bureau, Small Areas Estimate Branch, December Poverty and Median Income Estimates Counties, U.S. Census Bureau, Small Areas Estimate Branch, November Health Insurance Coverage Status for Counties and States: Interactive Tables. U.S. Census Bureau, Small Area Health Insurance Estimates. 31 Dec < Health Insurance Coverage Status for Counties and States: Interactive Tables. U.S. Census Bureau, Small Area Health Insurance Estimates. 31 Dec < American FactFinder. United States Census Bureau Educational Attainment. < Deaths: Final Data for National Vital Statistics Report. Centers for Disease Control and Prevention, October Cause of Death: NCHS Rankable Causes, and Non-Rankable. The Texas Department of State Health Services, Center for Health Statistics. 18 Jan County Health Rankings: A Healthier Nation, County by County Dec < Cost Report Data. Online Medicare Cost Report Worksheets and Data Sets. < Physician Specialty. U.S. Department of Health and Human Services: Health Resources and Services Administration. < HealthyPeople.gov U.S. Department of Health and Human Services. 21 Dec < 61

65 Community Health Needs Assessment 2013 Acknowledgements 62

66 Community Health Needs Assessment 2013 Acknowledgements The project Steering Committee was the convening body for this project. Many other individuals including community residents, key informants and community-based organizations contributed to this community health needs assessment. Key Informants Thank you to the following individuals who participated in our key informant interview process: Bernie Krupa, Harrison County United Way, Director Bob Cole, City of Marshall, EMS Coordinator Debbie Romero, GSMC, Director of Patient Financial Services Hugh Taylor, Harrison County, Judge Jan Henderson, GSMC, Director of Radiology Jennifer Hancock, GSMC, Director of Endoscopy Jennifer Kranzman, GSMC, Acute Rehabilitation Program Director Jerry Neel, GSMC, Trauma Coordinator June Moseley, GSMC, Director of Medical and Inpatient Surgical Units Kandi Horn, GSMC, Physician Offices Operations Manager Keith Creel, GSMC, Executive Director of Ancillary Services Keith Kirbow, GSMC, Chief Nursing Officer Linda Sheneman, GSMC, Director of Quality Melissa Anderson, GSMC, Clinical Director of Care Metosha Brantley, GSMC, Clinical of Family Care Services Roy Terhune, Director of Laboratory Services Russ Collier, GSMC, CEO Sherry Brackeen, GSMC, Director of Intensive Care Unit Tom McKool, Harrison County Sherriff s Department, Sherriff Toni Nixon, GSMC, Emergency Department Director 63

67 Community Health Needs Assessment 2013 KEY INFORMANT INTERVIEW PROTOCOL 64

68 Community Health Needs Assessment 2013 KEY INFORMANT INTERVIEW PROTOCOL Community Health Needs Assessment for: Good Shepherd Medical Center - Marshall Interviewer s Initials: Date: Start Time: End Time: Name: Title: Agency/Organization: # of years living in County: # of years in current position: address: Introduction: Good morning/afternoon. My name is [interviewer s name]. Thank you for taking time out of your busy day to speak with me. I ll try to keep our time to approximately 40 minutes, but we may find that we run over up to 50 minutes total - once we get into the interview. (Check to see if this is okay). [Name of Organization] is gathering local data as part of developing a plan to improve health and quality of life in County. Community input is essential to this process. A combination of surveys and key informant interviews are being used to engage community members. You have been selected for a key informant interview because of your knowledge, insight, and familiarity with the community. The themes that emerge from these interviews will be summarized and made available to the public; however, individual interviews will be kept strictly confidential. To get us started, can you tell me briefly about the work that you and your organization do in the community? Thank you. Next I ll be asking you a series of questions about health and quality of life in County. As you consider these questions, keep in mind the broad definition of health adopted by the World Health Organization: 'Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity,' while sharing the local perspectives you have from your current position and from experiences in this community. Questions: 1. In general, how would you rate health and quality of life in County? 2. In your opinion, has health and quality of life in County improved, stayed the same, or declined over the past few years? 3. Why do you think it has (based on answer from previous question: improved, declined, or stayed the same)? 65

69 Community Health Needs Assessment What other factors have contributed to the (based on answer to question 2: improvement, decline or to health and quality of life staying the same)? 5. Are there people or groups of people in the County whose health or quality of life may not be as good as others? a. Who are these persons or groups (whose health or quality of life is not as good as others)? b. Why do you think their health/quality of life is not as good as others? 6. What barriers, if any, exist to improving health and quality of life in County? 7. In your opinion, what are the most critical health and quality of life issues in County? 8. What needs to be done to address these issues? 9. In your opinion, what else will improve health and quality of life in the County? 10. Is there someone (who) you would recommend as a key informant for this assessment? Close: Thanks so much for sharing your concerns and perspectives on these issues. The information you have provided will contribute to develop a better understanding about factors impacting health and quality of life in County. Before we conclude the interview, Is there anything you would like to add? As a reminder, summary results will be made available by the [Name of organization] and used to develop a community-wide health improvement plan. Should you have any questions, please feel free to contact at [Name of organization]. Here is his/her contact information [provide business card]. Thanks once more for your time. It s been a pleasure to meet you. 66

70 Community Health Needs Assessment 2013 NORTHEAST TEXAS REGIONAL HEALTHCARE PARTNERSHIP PLAN 67

71 TexasHealthcareTransformationandQuality ImprovementProgram REGIONALHEALTHCAREPARTNERSHIP(RHP) PLAN March11,2013 RHP1/TheNortheastTexasRegionalHealthcarePartnership RHPLeadContact: DanielDeslatte,MPA TheUniversityofTexasHealthScienceCenterTyler 11937USHwy271 Tyler,Texas (office) (cell) (fax) 1 68

72 1 TableofContents Instructions...1 SectionI.RHPOrganization...3 SectionII.ExecutiveOverviewofRHPPlan...14 A. RHPGoalsandVision...14 B. SummaryofExistingHealthcareEnvironment...14 C. RealizingtheVision...15 SectionIII.CommunityNeedsAssessment...31 A.ExecutiveSummary...31 B.Demographics...33 C.HealthcareInfrastructure...38 D.HealthChallenges...40 E.HealthcareCost,Efficiency,andEffectiveness...42 F.RelatedFederalInitiatives...44 G.RelevantDeliverySystemReformInitiatives...44 H.ProjectedMajorChangesFFY2012 FFY SectionIV.StakeholderEngagement...46 A. RHPParticipantsEngagement...47 B. PublicEngagement...48 SectionV.DSRIPProjects...51 A. RHPPlanDevelopment...51 B. ProjectValuation...55 C. Category1:InfrastructureDevelopment...56 D. Category2:ProgramInnovationandRedesign E. Category3:QualityImprovements F. Category4:PopulationFocusedImprovements(Hospitalsonly) SectionVI.RHPParticipationCertifications SectionVII.Addendums

73 1 Instructions SupportingDocuments:RHPsshallrefertoAttachmentI(RHPPlanningProtocol),AttachmentJ (RHPProgramFundingandMechanicsProtocol),theAnchorChecklist,andtheCompanion Documentasguidestocompletethesectionsthatfollow.Thisplanmustcomportwiththetwo protocolsandfulfilltherequirementsofthechecklist. Timeline: HHSCReceiptDeadline Whattosubmit Howtosubmit 10:00amCentralTime, October31,2012 SectionsI,II,&IIIoftheRHPPlan&Community NeedsSupplementalInformation Submitelectronicallyto HHSCWaiverMailbox 5:00pmCentralTime, November16,2012 Pass1DSRIP(includingapplicableRHPPlan sections,pass1workbook,&checklist) Mailtoaddressbelow 5:00pmCentralTime, December31,2012 CompleteRHPPlan(includingRHPPlan, Workbooks,&Checklist) Mailtoaddressbelow Allsubmissionswillbedateandtimestampedwhenreceived.ItistheRHP sresponsibiilityto appropriatelymarkanddelivertherhpplantohhscbythespecifieddateandtime. SubmissionRequirements:Allsectionsarerequiredunlessindicatedasoptional. ThePlanTemplate,FinancialWorkbook,andAnchorChecklistmustbesubmittedaselectronic Word/ExcelfilescompatiblewithMicrosoftOffice2003.RHPPlanCertificationsand AddendumsmustbesubmittedasPDFfilesthatallowforOCRtextrecognition.Pleaseplace Addendumsinazippedfolder. Youmustadheretothepagelimitsspecifiedineachsectionusingaminimum12pointfontfor narrativeandaminimum10pointfontfortables,ortherhpplanwillbeimmediatelyreturned. MailedSubmissions:RHPPacketsshouldincludeoneCDwithallrequiredelectronicfilesand twohardboundcopiesoftherhpplan(donotincludehardboundcopiesofthefinanical workbook). Pleas RHPPlanpacketsto: LaelaEstus,MCH425 TexasHealthandHumanServicesCommission HealthcareTransformationWaiverOperations 11209MetricBlvd. Austin,Texas

74 Communication:HHSCwillcontacttheRHPLeadContactlistedonthecoverpagewithany questionsorconcerns.igtentitiesandperformingproviderswillalsobecontactedinreference totheirspecificdeliverysystemreformincentivepayment(dsrip)projects. 2 71

75 SectionI.RHPOrganization LeadRepresentativeContact Information(address, ,phone number) Lead Representative Organization Name Ownership Type (state owned, nonstate public, private) Texas Identification Number(TIN) RHPParticipantType Texas Provider Identifier (TPI) AnchoringEntity 11937USHwy271 Tyler,Texas DanielDeslatte TheUniversity oftexashealth ScienceCenter attyler Hospital AcademicMedicalCenter StateOwned IGTEntities 11937USHwy271 Tyler,Texas VernonMoore TheUniversity oftexashealth ScienceCenter attyler Hospital AcademicMedicalCenter StateOwned 11937USHwy271 Tyler,Texas VernonMoore TheUniversity oftexashealth ScienceCenter attyler MSRDP (University Physician Associates) AcademicMedicalCenter StateOwned 72 3

76 LeadRepresentativeContact Information(address, ,phone number) Lead Representative Organization Name Ownership Type (state owned, nonstate public, private) Texas Identification Number(TIN) RHPParticipantType Texas Provider Identifier (TPI) 107WoodbinePl Longview,TX RickRoberts Community Healthcore NonState Public LocalMentalHealth Authority 2323WestFrontStreet Tyler,TX WaymonStewart Andrews Center NonState Public LocalMentalHealth Authority P.O.Box1102 Athens,TX MartinBennett Henderson County Hospital Authority NonState Public HospitalAuthority S.Sycamore,Room213A Carthage,TX SidneyBurns, CountyAuditor PanolaCounty NonState Public County N/A N.Donoho Clarksville,TX WilliamBryson President RedRiver Hospital Authority NonState Public HospitalAuthority N/A E.HoustonStreet Crockett,Texas DickMurchison Houston County Hospital District NonState Public HospitalDistrict N/A WestCommerceSt. Fairfield,TX TonyPrice Executive Assistant Fairfield Hospital District NonState Public HospitalDistrict N.KaufmanStreet MtVernon,TX75457 FranklinCounty PaulLovier NonState Public County N/A

77 LeadRepresentativeContact Information(address, ,phone number) Lead Representative Organization Name Ownership Type (state owned, nonstate public, private) Texas Identification Number(TIN) RHPParticipantType Texas Provider Identifier (TPI) (903) ,Ext6 126ChurchStreet Pittsburg,TX75686 (903) CampCounty ThomasCravey NonState Public County N/A Nathan Quitman,TX JackDickerson WoodCounty Central Hospital District NonState Public IGTEntityisapplying foranewtinbased onfeedbackfrom HHSC. HospitalDistrict N/A P.O.Box3169 Trinity,Texas LarryKing Trinity Memorial Hospital District NonState Public HospitalDistrict N/A JoeRamseyBlvd Greenville,TX RichardCarter HuntRegional MedicalCenter Greenville NonState Public HospitalDistrict SMedfordDrive Lufkin,Texas BurkeCenter SusanRushing NonState Public LocalMentalHealth Authority 115AirportRoad SulphurSprings,TX Michael McAndrew HopkinsCounty Memorial Hospital NonState Public HospitalDistrict AirportRd. Terrell,TX ext.1150 JohnDelaney LakesRegional MHMRCenter NonState Public LocalMentalHealth Authority 74 5

78 LeadRepresentativeContact Information(address, ,phone number) Lead Representative Organization Name Ownership Type (state owned, nonstate public, private) Texas Identification Number(TIN) RHPParticipantType Texas Provider Identifier (TPI) 740SW6 th Street Paris,TX GinaPrestidge ParisLamar CountyHealth Department NonState Public LocalPublicHealth Department P.O.Box1087 Sherman,TX SylviaCave Texoma Community Center NonState Public LocalMentalHealth Authority 2001N.Jefferson MountPleasant,Texas TerryScoggin TitusRegional MedicalCenter NonState Public HospitalDistrict NBroadway, Ste404 Tyler,TX GeorgeT. Roberts,Jr., FACHE Northeast TexasPublic HealthDistrict NonState Public LocalPublicHealth Department 710JamesBowieDrive NewBoston,Texas BowieCounty SterlingLacy NonState Public County N/A SWilliam Atlanta,Texas SheilaRobinson Atlanta Hospital Authority NonState Public HospitalAuthority EMethvin Longview,TX GreggCounty LaurieWoloszyn NonState Public County N/A County N/A NonState LamarCounty ChuckSuperville 119NMain 75 6

79 LeadRepresentativeContact Information(address, ,phone number) Lead Representative Organization Name Ownership Type (state owned, nonstate public, private) Texas Identification Number(TIN) RHPParticipantType Texas Provider Identifier (TPI) Public Paris,TX LipscombBlvd. Bonham,TX DavidConjeo FanninCounty Hospital Authority NonState Public HospitalAuthority W49 th St Austin,TX OlgaRodriguez RuskState Hospital StateHospital StateOwned PerformingProviders 11937USHwy271 Tyler,Texas JeffLevin,MD, MSPH TheUniversity oftexashealth ScienceCenter attyler MSRDP (University Physician Associates) AcademicMedicalCenter StateOwned 107WoodbinePl Longview,TX RickRoberts Community Healthcore NonState Public CommunityMental HealthCenter 2323WestFrontStreet Tyler,TX75702 WaymonStewart Andrews Center NonState Public CommunityMental HealthCenter 76 7

80 LeadRepresentativeContact Information(address, ,phone number) Lead Representative Organization Name Ownership Type (state owned, nonstate public, private) Texas Identification Number(TIN) RHPParticipantType Texas Provider Identifier (TPI) S.BeckhamAve,Tyler,TX75701 P.O.Box6400(75711) (903) ByronHale,CFO ETMCRHS EastTexas MedicalCenter Athens PrivateHospital Private 1000S.BeckhamAve,Tyler,TX75701 P.O.Box6400(75711) ByronHale,CFO ETMCRHS EastTexas MedicalCenter Carthage PrivateHospital Private (903) S.BeckhamAve,Tyler,TX75701 P.O.Box6400(75711) ByronHale,CFO ETMCRHS EastTexas MedicalCenter Clarksville NonState Public PublicHospital (903) S.BeckhamAve,Tyler,TX75701 P.O.Box6400(75711) ByronHale,CFO ETMCRHS EastTexas MedicalCenter Crockett PrivateHospital Private (903) S.BeckhamAve,Tyler,TX75701 P.O.Box6400(75711) ByronHale,CFO ETMCRHS EastTexas MedicalCenter Fairfield PrivateHospital Private (903) S.BeckhamAve,Tyler,TX75701 P.O.Box6400(75711) ByronHale,CFO ETMCRHS EastTexas MedicalCenter Henderson NonState Public PublicHospital (903) S.BeckhamAve,Tyler,TX75701 P.O.Box6400(75711) ByronHale,CFO ETMCRHS EastTexas MedicalCenter Jacksonville PrivateHospital Private 77 8

81 LeadRepresentativeContact Information(address, ,phone number) Lead Representative Organization Name Ownership Type (state owned, nonstate public, private) Texas Identification Number(TIN) RHPParticipantType Texas Provider Identifier (TPI) (903) S.BeckhamAve,Tyler,TX75701 P.O.Box6400(75711) (903) ByronHale,CFO ETMCRHS EastTexas MedicalCenter MountVernon NonState Public PublicHospital S.BeckhamAve,Tyler,TX75701 P.O.Box6400(75711) ByronHale,CFO ETMCRHS EastTexas MedicalCenter Pittsburg NonState Public PublicHospital (903) S.BeckhamAve,Tyler,TX75701 P.O.Box6400(75711) ByronHale,CFO ETMCRHS EastTexas MedicalCenter Quitman NonState Public PublicHospital (903) S.BeckhamAve,Tyler,TX75701 P.O.Box6400(75711) ByronHale,CFO ETMCRHS EastTexas MedicalCenter Trinity PrivateHospital Private (903) S.BeckhamAve,Tyler,TX75701 P.O.Box6400(75711) ByronHale,CFO ETMCRHS EastTexas MedicalCenter PrivateHospital Private (903) S.BeckhamAve,Tyler,TX75701 P.O.Box6400(75711) ByronHale,CFO ETMCRHS EastTexas MedicalCenter Gilmer PrivateHospital Private (903) JoeRamseyBlvd Greenville,TX RichardCarter HuntRegional MedicalCenter Greenville NonState Public PublicHospital

82 LeadRepresentativeContact Information(address, ,phone number) Lead Representative Organization Name Ownership Type (state owned, nonstate public, private) Texas Identification Number(TIN) RHPParticipantType Texas Provider Identifier (TPI) 611SFleishel Tyler,TX MaryElizabeth Jackson Mother Frances Hospital PrivateHospital Private 2001S.MedfordDrive Lufkin,TX BurkeCenter SusanRushing NonState Public CommunityMental HealthCenter 115AirportRoad SulphurSprings,TX Michael McAndrew HopkinsCounty Memorial Hospital NonState Public PublicHospital AirportRd. Terrell,TX ext.1150 JohnDelaney LakesRegional MHMRCenter NonState Public CommunityMental HealthCenter 740SW6 th Street Paris,TX GinaPrestidge ParisLamar CountyHealth Department NonState Public LocalPublicHealth Department P.O.Box1087 Sherman,TX SylviaCave Texoma Community Center NonState Public CommunityMental HealthCenter 2001N.Jefferson MountPleasant,Texas TerryScoggin TitusRegional MedicalCenter NonState Public PublicHospital LocalPublicHealth NonState Northeast GeorgeT. 315NBroadway,Ste

83 LeadRepresentativeContact Information(address, ,phone number) Lead Representative Organization Name Ownership Type (state owned, nonstate public, private) Texas Identification Number(TIN) RHPParticipantType Texas Provider Identifier (TPI) Tyler,TX Roberts,Jr., FACHE Department Public TexasPublic HealthDistrict 700EMarshall Longview,Texas PatKeel GoodShepherd MedicalCenter Longview PrivateHospital Private 504LipscombBlvd. Bonham,TX DavidConjeo RedRiver Regional Hospital NonState Public PublicHospital UConlyHospitals 611SFleishel Tyler,TX MaryElizabeth Jackson Mother Frances Hospital Jacksonville PrivateHospital Private 611SFleishel Tyler,TX75701 MaryElizabeth Jackson Mother Frances Hospital Winnsboro PrivateHospital Private JoeRamseyBlvd Greenville,TX RichardCarter HuntRegional Community Hospital NonState Public PublicHospital PineStreet Texarkana,TX RebeccaJohnson Brim Healthcareof Texas,LLCdba Wadley PrivateHospital Private 80 11

84 LeadRepresentativeContact Information(address, ,phone number) Lead Representative Organization Name Ownership Type (state owned, nonstate public, private) Texas Identification Number(TIN) RHPParticipantType Texas Provider Identifier (TPI) Regional MedicalCenter 2901NFourthSt. Longview,TX ToddJohnson Longview Regional MedicalCenter PrivateHospital Private 2600St.MichaelDrive Texarkana,TX GlenBoles CHRISTUSSt. MichaelHealth System PrivateHospital Private 2900SLoop256 PalestineTX ChristiWatkins Palestine Regional MedicalCenter PrivateHospital Private 11937USHwy271 Tyler,Texas VernonMoore TheUniversity oftexashealth ScienceCenter attyler Hospital AcademicMedicalCenter StateOwned 700EMarshall Longview,Texas PatKeel GoodShepherd MedicalCenter Marshall PrivateHospital Private 1007SWilliam Atlanta,Texas SheilaRobinson Atlanta Memorial Hospital NonState Public PublicHospital Clarksville Paris,Texas75460 KenMiller ParisRegional MedicalCenter PrivateHospital Private 81 12

85 LeadRepresentativeContact Information(address, ,phone number) Lead Representative Organization Name Ownership Type (state owned, nonstate public, private) Texas Identification Number(TIN) RHPParticipantType Texas Provider Identifier (TPI) W49 th St. Austin,TX OlgaRodriguez RuskState Hospital StateHospital StateOwned OtherStakeholders CountyMedical Associations/Societies CountyMedical Associations/Societies 1517WFrontSt. Tyler,Texas Dr.PaulMcGaha Departmentof StateHealth Services, Region4/5N RegionalPublicHealth Directors Othersignificantsafety netproviderswithinthe region(specifytype) Others(specifytype,e.g. advocacygroups, associations) 82 13

86 SectionII.ExecutiveOverviewofRHPPlan A. RHPGoalsandVision The Texas Healthcare Transformation and Quality Improvement Program (Demonstration) is designedtoencourage activitiesthatsupporthospitals collaborativeeffortstoimproveaccess tocareandthehealthofthepatientsandfamiliestheyserve. 1 Consistentwiththatgoal,the overarchinggoalandvisionofthenortheasttexasregionalhealthcarepartnership(rhp1)is tomovetowardarealizationofthetripleaim 2 : Improvingthepatientexperienceofcare(includingqualityandsatisfaction) Improvingthehealthofpopulations;and Reducingthepercapitacostofhealthcare. Inaddition,addressinggapsinaccesstocare(bothphysicalandbehavioralhealthservices)isa keyfocusoftheregionalhealthcarepartnership. B. SummaryofExistingHealthcareEnvironment Geographically,theNortheastTexasRegionalHealthcarePartnership(RHP1)spans28counties andbordersthreestates.at21,000squaremiles,region1islargerthanninestatesandthe DistrictofColumbiaandisnearly250milesfrompointtopoint.Over1.2millionpeoplelivein NortheastTexas,butthereisnocitywithapopulationgreaterthan100,000.Approximately 54%oftheregionalpopulationiseitheruninsuredorenrolledinsomeformofpubliclyfunded healthcoverage. Northeast Texas is an area where patients face many challenges in accessing primary care, acute care, and mental and behavioral health services.key health challenges include high numbersofmedicallyunderservedareas/populations,healthprofessionalshortagesinprimary care and mental health, lack of sufficient specialists to serve the patient population, high chronicdiseaseburden,andhighratesofpotentiallypreventablehospitalization.takenasa whole,northeasttexasisolder,poorer,andlesswelleducatedthanthestateaverage.asa result,overhalfofcountiesinregion1areinthebottomquartileoftexascountiesinhealth outcomes. 1 CentersforMedicareandMedicaidServices:TexasHealthcareTransformationandQualityImprovement ProgramStandardTermsandConditions.Washington,DC.U.S.DepartmentofHealth&HumanServices (December2011). 2 InstituteforHealthcareImprovement.(2012,October).TheIHITripleAim.RetrievedOctober2012from InstituteforHealthcareImprovement:

87 Sixmajorcommunityneedsareidentifiedintheregionalhealthplan: CN.1:Insufficientaccesstoprimaryandspecialtycareservices CN.2:Insufficientaccesstomentalandbehavioralhealthservices CN.3: High rates of chronic disease, including diabetes, heart disease, asthma, obesity, and cancer. CN.4:Highcostsduetopotentiallypreventablehospitalizations. CN.5:Inappropriateemergencyroomutilization. CN.6:Efficiencyinandeffectivenessofhealthcaredelivery. C. RealizingtheVision Addressingthesecommunityneedsisapriorityfortheregion.Asaresult,thedeliverysystem reform projects developed by the regional healthcare partnership show an integration of individualcommunityneeds,withmanyprojectsaddressingmultiplecommunityneeds.the clearfocusoftheregionisonexpandingaccesstocare bothphysicalandmental/behavioral healthcareservices. Thetablebelowshowsasummaryofprojectsthat,together,realizetheregionalvision: SummaryofCategories12Projects BriefProjectDescription ProjectTitle(include uniquerhpprojectid numberforeach project.) Expand ExistingPrimaryCare Capacity(ETMCQuitman ) Expand SpecialtyCareCapacity (ETMCTyler ) Expand SpecialtyCareCapacity (ETMCTyler ) Category1:InfrastructureDevelopment Improveaccesstoprimarycare. Improveaccesstospecialtycare Improveaccesstospecialtycare RelatedCategory3 OutcomeMeasure(s) (includeunique Category3 ImprovementTarget (IT)Identifierspecific torhpandoutcome title) IT2.11 AmbulatoryCareSensitive ConditionsAdmissions Rate IT1.10 DiabetesCare:HbA1c PoorControl(>9.0%)233 NQF IT3.2CHF 30DayReadmissionRate Estimated Incentive Amount (DSRIP)for DYs25 $2,059,983 $3,802,962 $6,220,

88 16 ProjectTitle(include uniquerhpprojectid numberforeach project.) BriefProjectDescription RelatedCategory3 OutcomeMeasure(s) (includeunique Category3 ImprovementTarget (IT)Identifierspecific torhpandoutcome title) Estimated Incentive Amount (DSRIP)for DYs Expand SpecialtyCareCapacity (ETMCTyler ) Improveaccesstospecialtycare IT1.18 FollowUpAfter HospitalizationforMental IllnessNQF $3,254, Expand TelehealthServices (TexomaCommunity Center ) Theprojectseekstodevelop,enhanceandpromotetelemedicine andtelehealthprotocolsandpracticestoimproveaccesstocare andexpandtheoverallpopulationserved IT10.1QualityofLife $199, Develop SubstanceAbuseServices (TexomaCommunity Center ) Theprojectseekstodevelopandimplementcomprehensive outpatientsubstanceabuseprogramtoexpandaccesstocare withinthecommunityandreduceunnecessaryhospitalizations IT10.1QualityofLife $166, Enhance ServiceAvailability (TexomaCommunity Center ) Theprojectseekstodevelopandenhancecounselingservices withinthecommunityandexpandaccesstounfundedand underservedindividuals IT10.1QualityofLife $265, Expand QualityImprovement Capacity(Texoma CommunityCenter ) Theprojectseekstoimplementprocessimprovement methodologiestoenhancesafety,qualityandefficiencyinoverall healthcareserviceprovisionwhilemaintainingexcellentqualityof carestandards IT9.2EDAppropriate Utilization $80, ExpandPrimaryCare Capacity(MotherFrances Hospital ) Accesstoprimarycareproviderswillbeaddressedbyrecruiting andestablishingaminimumof7newpractices.theywillbein ruralandurbansettingandwillexpandexistingclinicsandhours. TargetedpopulationsareMedicaid,Medicare,anduninsuredbut allpayerswillhaveaccess.patientvisitswillbecounted IT6.1 Percentimprovement overbaselineofpatient satisfactionscores $11,692, ExpandSpecialtyCare Capacity(MotherFrances Hospital ) Expansionofspecialtywillresultinaminimumof7newproviders servingtheurbanandruralareasforspecialclinics.theywillalso provideservicesfortheer,asappropriate,inpatientneeds,and outpatientservices.patientvisitswillbecountedaswellas implementingareferralmanagementsystem IT3.1 Allcause30day readmissionratenqf 1789 $17,538, Introduce,Expand,or Enhance Telemedicine/Telehealth (MotherFrancesHospital ) Thegoalofthisprojectistoexpandandenhancethecapacityof providersintheregiontomanagecomplexpediatricpatients locallythroughtimelyaccesstopediatricsubspecialistsand specialistsviatelemedicine IT9.2 EDAppropriateutilization Reducepediatric EmergencyDepartment visits(chipracore Measure) $3,581,145 85

89 17 ProjectTitle(include uniquerhpprojectid numberforeach project.) BriefProjectDescription RelatedCategory3 OutcomeMeasure(s) (includeunique Category3 ImprovementTarget (IT)Identifierspecific torhpandoutcome title) Estimated Incentive Amount (DSRIP)for DYs Expand PrimaryCareCapacity (ETMCCarthage ) Expandexistingprimarycarecapacity IT2.11AmbulatoryCare SensitiveConditions AdmissionRate $1,508, Expand PrimaryCareCapacity (ETMCFairfield ) Expandexistingprimarycarecapacity IT2.11AmbulatoryCare SensitiveConditions AdmissionRate $439, Expand PrimaryCareCapacity (ETMCTrinity ) Expandexistingprimarycarecapacity IT2.11AmbulatoryCare SensitiveConditions AdmissionRate $1,698, Depression/Trauma CounselingCenters (LakesRegionalMHMR Center ) Expandnumberofcommunitybasedsettingswherebehavioral healthservicesmaybedeliveredinunderservedareas:(lakes RegionalDepression/TraumaCounselingCenters) IT10.1 QualityofLife $4,268, Increase, ExpandandEnhanceOral HealthPreventiveServices (UTHSCTMSRDP UniversityPhysician Associates(UPA) ) CollaborationbetweenUniversityPhysicianAssociatesandTyler JuniorCollegetoenhancedentalpreventiveservicesandtrain dentalhygienestudents IT7.8 ChronicDiseasePatients AccessingDental Services $5,444, Pass3b ( )Improve AccesstoSpecialtyCare forupa (UTHSCTMSRDP UniversityPhysician Associates(UPA) ) Expandselectivespecialtycareservicesforreferralfromthe PCMHtoincludepodiatry,neurology/pain,ophthalmology, infectiousdiseases,dermatology,rheumatologyand endocrinology Pass3b ( ) IT1.12 Diabetescare:Retinal eyeexam Pass3b ( ) IT1.13 Diabetescare:Footexam Pass3b ( ) IT1.14 Diabetescare: Microalbumin/Neuropat hy $9,172, Pass3b ( ) ImplementTechnology AssistedServicesto Support,Coordinate,or DeliverBehavioralHealth CollaborationbetweenUniversityPhysicianAssociates,Good ShepherdMedicalCenterandPalestineRegionalMedicalCenter toincreaseaccesstointegratedprimaryandbehavioralhealth careservicesalongwithspecialtyconsultationbypsychiatry Pass3b ( ) IT9.1 Decreaseinmental healthadmissionsand readmissionstocriminal justicesettingssuchas $3,660,478 86

90 18 ProjectTitle(include uniquerhpprojectid numberforeach project.) BriefProjectDescription RelatedCategory3 OutcomeMeasure(s) (includeunique Category3 ImprovementTarget (IT)Identifierspecific torhpandoutcome title) Estimated Incentive Amount (DSRIP)for DYs25 ServicesinNortheast Texas (UTHSCTMSRDP UniversityPhysician Associates(UPA) ) jailsorprisons Increase TrainingofPrimaryCare Workforce:Capacity BuildingThrough WorkforceDevelopment: TrainingCommunity HealthWorkers (UTHSCTMSRDP UniversityPhysician Associates(UPA) ) EstablishCHWcertificationprogramswithspecialtytracksfor chronicdiseaseselfmanagement,behavioralhealth,andtele healthfacilitation IT9.4 Other IncreaseNumberofDSHS certifiedchws $4,117, Pass3b ( )Expand PrimaryCareCapacity (UTHSCTMSRDP UniversityPhysician Associates(UPA) ) WithChristusSt.MichaelHealthSystem,increaseprimarycare capacitybyincreasingthenumberofprimarycareclinic appointmentsavailabletothelowincomemembersofthe communityandindoingso,creatingmoreaccess Pass3b ( ) IT 2.11 Ambulatorycaresensitive conditionsadmissions rate $4,909, Pass3b ( )Expand DentalServices(UTHSCT MSRDPUniversity PhysicianAssociates(UPA) ) WithChristusSt.MichaelHealthSystem,expandservicestofive groupsthatareunderservedwithregardtodentalhealth problemsservingasthefoundationthatwillallowamore appropriatesettingforexpandeddentalhealthserviceforthe identified atrisk population Pass3b ( ) IT 7.10 Other Decrease thepercentage emergencydepartment visitsfordentalcare $4,657, Pass3b ( )Crisis StabilizationUnit(UTHSCT MSRDPUniversity PhysicianAssociates(UPA) ) PalestineRegionalMedicalCenterwillpartnerwithUPAto establishacrisisstabilizationunitforbehavioralhealthcare Pass3b ( ) IT9.2 ReduceinappropriateED utilization $2,876, Expand PrimaryCareNorthTyler Clinic(UTHSCTMSRDP UniversityPhysician Associates(UPA) Increaseaccesstoapoor,largelyminority,underservedareaof SmithCountybyestablishinganopenaccessclinicwithinthe communitytoprovidebasiscareservicesandareferralchannelto patientcenteredmedicalhomesandspecialtyproviders IT11.1 ImprovementinClinical Indicatorinidentified disparitygroup IT12.5 $9,349,243 87

91 19 ProjectTitle(include uniquerhpprojectid numberforeach project.) BriefProjectDescription RelatedCategory3 OutcomeMeasure(s) (includeunique Category3 ImprovementTarget (IT)Identifierspecific torhpandoutcome title) Estimated Incentive Amount (DSRIP)for DYs ) OtherUSPSTFendorsed screeningoutcome measures Expand PrimaryCareCapacity (ETMCJacksonville ) Expandexistingprimarycarecapacity IT2.11AmbulatoryCare SensitiveConditions AdmissionRate $2,259, Expand PrimaryCareCapacity (ETMCClarksville ) Expandexistingprimarycarecapacity IT2.11AmbulatoryCare SensitiveConditions AdmissionRate $2,031, Expand PrimaryCareCapacity (HopkinsCountyMemorial Hospital ) Expandexistingprimarycarecapacity IT6.1 Percentimprovement overbaselineofpatient satisfactionscores. $2,903, Expand primarycarecapacity (HopkinsCountyMemorial Hospital ) Expandexistingprimarycarecapcity IT9.4 OtherOutcome Improvements $458, ExpandPrimaryCare Capacity(HuntRegional MedicalCenterGreenville, ) PartnerwithCommunityHealthServiceAgency(FQHC)to increaseprimarycareproviders,clinichours,availabilityofurgent visitsandaddaclinicinsouthernhuntcounty IT1.6Cholesterol managementforpatients withcardiovascular conditions $6,204, Introduce,Expandor EnhanceTelehealth (HuntRegionalMedical CenterGreenville, ) Thisprojectwillimplementtelehealthtoprovideremotepatient monitoringandoutpatientdiseasemanagementtocongestive heartfailurepatientsinthehomesetting IT3.2 CongestiveHeartFailure 30dayReadmissionRate $1,377, EnhancePerformance Improvementand ReportingCapacity (HuntRegionalMedical CenterGreenville, ) HuntRegionalMedicalCenter willimplementaprojectto enhanceperformanceimprovementandreportingcapacity throughpeople,processesandtechnology.wewillhiretwo additionalqualityanalyststocollect,analyzeandperform performanceimprovement,purchaseandinstalladatarepository andinterfacetocollectrealtimedata,developaquality dashboardtomeasureimprovementandselectqualityindicators includingpotentiallypreventablecomplicationsforrapid improvement IT4.1 Improvementinrisk adjustedpotentially preventablecomplications rates $932,910 88

92 20 ProjectTitle(include uniquerhpprojectid numberforeach project.) BriefProjectDescription RelatedCategory3 OutcomeMeasure(s) (includeunique Category3 ImprovementTarget (IT)Identifierspecific torhpandoutcome title) Estimated Incentive Amount (DSRIP)for DYs Expand PrimaryCareCapacity (ETMCMt.Vernon ) Expandexistingprimarycarecapacity IT2.11AmbulatoryCare SensitiveConditions AdmissionRate $470, Enhance ServiceAvailabilityof AppropriateLevelsof BehavioralHealthCare (BurkeCenter ) ThisprojectwillexpandthecapacityoftheBurkeCentertoserve morechildrenandadultswithmentalillness.wewillprovide outpatientpsychiatriccare,therapy,medicationservicesand patienteducationasneeded IT6.1 Percentimprovement overbaselineofpatient satisfactionscores. $1,251, Expand PrimaryCareCapacity (ETMCCrockett ) Expandexistingprimarycarecapacity IT2.11AmbulatoryCare SensitiveConditions AdmissionRate $1,682, Developmentof behavioralhealthcrisis stabilizationservicesas alternativesto hospitalization (CommunityHealthcore ) Evidencebasedcrisisintervention/stabilizationanddetoxcenter forbehavioralhealthwithearlyinterventionandintensivewrap aroundservicesinthenorthernportionofregion IT9.2EDappropriate utilization $12,907, Pass3B Developmentof behavioralhealthcrisis stabilizationservicesas alternativesto hospitalization (CommunityHealthcore ) Evidencebasedcrisisintervention/stabilizationanddetoxcenter forbehavioralhealthwithearlyinterventionandintensivewrap aroundservicesinthesouthernportionofregion Pass3B IT9.2EDappropriate utilization $11,936, Improveaccessto specialtycare (CommunityHealthcore ) CommunityHealthcorewilloperateanambulatorydetoxification clinicinanonresidentialsettingcolocatedwiththeuniversityof TexasHealthScienceCenterTylerprimarycareclinic.The programwillprovideasafewithdrawalfromthedrug(s)of dependenceandenabletheindividualtobecomedrugfree throughamedicalmodelprogram IT3.8BehavioralHealth /SubstanceAbuse30day readmissionrate $2,079, Expand SpecialtyCareCapacity ETMCPittsburg ) Improveaccesstospecialtycare IT4.4SurgicalSite Infection(SSI)Rates $4,310,504 89

93 21 ProjectTitle(include uniquerhpprojectid numberforeach project.) BriefProjectDescription RelatedCategory3 OutcomeMeasure(s) (includeunique Category3 ImprovementTarget (IT)Identifierspecific torhpandoutcome title) Estimated Incentive Amount (DSRIP)for DYs Crisis Intervention(Andrews Center ) Developmentofbehavioralhealthcrisisstabilizationcenteras alternativetohospitalization IT9.2EDAppropriate Utilization $3,475, ExpandPrimaryCare Capacity(TitusRegional MedicalCenter ) Establishmoreprimarycareclinics.TRMCplanstobuildanew FamilyCareCenterinanunderservedlocationofthecity IT6.1 PercentImprovement OverBaselineofPatient SatisfactionScores IT9.2 EDAppropriateUtilization $4,365, ExpandSpecialtyCare Capacity(TitusRegional MedicalCenter ) Improveaccesstospecialtycare IT3.3 Diabetes30day readmissionrate $545, (Pass3B) Expandhighimpact specialtycarecapacityin mostimpactedmedical specialties(titusregional MedicalCenter ) IncreasesthecapacityofspecialtyhealthcareinNortheastTexas throughtrmcachievingthetexascertificationasalevelii PrimaryStrokeCenterandtherecruitmentofafulltime neurologisttoestablishaspecialtycliniclocation IT3.7 StrokeCVA30day readmissionrate $3,111, Expand PrimaryCareCapacity (ETMCAthens ) Establishmoreprimarycareclinics IT2.11AmbulatoryCare SensitiveConditions AdmissionRate $3,096, Expand PrimaryCareCapacity (ETMCAthens ) Expandexistingprimarycarecapacity IT2.11AmbulatoryCare SensitiveConditions AdmissionRate $6,468, Expand ExistingPrimaryCare Capacity(ParisLamar CountyHealth Department ) Thegoalofthisprojectistoexpandthecapacityofpreventive andprimarycareservicestobetteraccommodatetheneedsof thepatientpopulationandcommunitysothatpatientscan receivetherightcareattherighttimeintherightsetting IT6.1 PercentImprovement overbaselineofpatient satisfactionscores $1,331, Expand PrimaryCare(ETMC Gilmer ) Expandexistingprimarycarecapacity IT2.11AmbulatoryCare SensitiveConditions AdmissionRate $1,597,796 90

94 22 ProjectTitle(include uniquerhpprojectid numberforeach project.) BriefProjectDescription RelatedCategory3 OutcomeMeasure(s) (includeunique Category3 ImprovementTarget (IT)Identifierspecific torhpandoutcome title) Estimated Incentive Amount (DSRIP)for DYs Expand existingprimarycare capacity (RedRiverRegional Hospital ) Expandprimarycarecapacitythroughextendedclinichours, recruitingafamilypracticephysicianandaphysicianassistant, andaddingneededsupportstaff IT2.11AmbulatoryCare SensitiveConditions AdmissionsRate $2,196, Expand PrimaryCareCapacity (ETMCHenderson ) Expandexistingprimarycarecapacity IT2.11AmbulatoryCare SensitiveConditions AdmissionRate $515, Expand SpecialtyCareCapacity (ETMCHenderson ) Improveaccesstospecialtycare IT4.4SurgicalSite Infection(SSI)Rates $2,060,899 Category2:ProgramInnovationandRedesign Establish/ExpandaPatient CareNavigationProgram (ETMCTyler ) Providenavigationservicestotargetedpatientswhoareathigh riskofdisconnectfrominstitutionalizedhealthcare. IT2.11AmbulatoryCare SensitiveConditions AdmissionRate $4,048, Implement/ExpandCare TransitionsProgram (ETMCTyler ) Develop,implement,andevaluatestandardizedclinicalprotocols andevidencebasedcaredeliverymodeltoimprovecare transitions. IT3.2CHF30Day ReadmissionRate $1,918, Redesignto ImprovePatient Experience(ETMCTyler ) Implementprocessestomeasureandimprovepatientexperience. IT6.1%Improvement OverBaselinePatientSat Scores $6,663, Combine PrimaryandBehavioral Healthcare(Texoma CommunityCenter ) Theprojectseekstocombineprimaryandbehavioralhealthcare foroverutilizersoflocalhealthcareresourcesandthosewithin thecommunitywhoareunderservedorpoorlyserved IT10.1QualityofLife $248, Expand CommunityBased InterventionsforTargeted BehavioralHealth Population(Texoma CommunityCenter ) Theprojectwillprovidespecializedservicestocomplexbehavioral healthpopulations,withseverementalillnessesand/ora combinationofbehavioralandphysicalhealthissuesinorderto avertpotentiallyavoidableinpatientadmissionsandreadmissions toamorerestrictiveandexpensivesettingsuchasacuteand/or psychiatrichospitalsorthecriminaljusticesystem IT9.2EDAppropriate Utilization $80,249 91

95 23 ProjectTitle(include uniquerhpprojectid numberforeach project.) BriefProjectDescription RelatedCategory3 OutcomeMeasure(s) (includeunique Category3 ImprovementTarget (IT)Identifierspecific torhpandoutcome title) Estimated Incentive Amount (DSRIP)for DYs Establish/ExpandaPatient CareNavigationProgram (GoodShepherdMedical CenterLongview ) GoodShepherdMedicalCenter(GSMC)willidentifyfrequentED usersandusenavigatorsaspartofapreventableedreduction programcollaboratingwithcommunityhealthcoreleadagency fortheeasttexasagingdisabilityresourcecenterandthrough thenetworkwillliaisonwithothercommunityresourcesto addressnonmedicalneeds IT9.2ED AppropriateUtilization. $1,981, Redesign forcostcontainment (MotherFrancesHospital ) Anewcostaccountingsystemwillbeimplementedaspartofa clinictransformationprocess IT5.1 Improvedcostsavings: Demonstratecostsavings incaredelivery $9,743, Establish/ExpandAPatient CareNavigationProgram (MotherFrancesHospital ) Thisprojectwillimplementapatientnavigatordedicatedtothe RossBreastCenterthatwillguidenewlydiagnosedpatientswith breastcancer.theinterventionswillincludebutnotbelimitedto referraltoprimarycaremedicalhome,specialtycarereferralfor disenfranchisedormedicallycomplexpatients,andeducationon appropriatelevelofcareneededandmedicalinstructions,and followupwithpatients IT6.1 Percentimprovement overbaselineofpatient satisfactionscores $1,432, Implement/ExpandCare TransitionsPrograms (MotherFrancesHospital ) Thegoalofthisprojectistoimplementimprovementsincare transitionsandcoordinationofcarefrominpatienttooutpatient, postacute,andhomecaresettingsinordertopreventincreased healthcarecostsandhospitalreadmissions IT3.1 Allcause90day readmissionratenqf 1789 $1,432, Establish/ExpandaPatient CareNavigationProgram (ETMCCarthage ) Providenavigationservicestotargetedpatientswhoareathigh riskofdisconnectfrominstitutionalizedhealthcare. IT2.11AmbulatoryCare SensitiveConditions AdmissionRate $1,216, Establish/ExpandaPatient CareNavigationProgram (ETMCFairfield ) Providenavigationservicestotargetedpatientswhoareathigh riskofdisconnectfrominstitutionalizedhealthcare. IT2.11AmbulatoryCare SensitiveConditions AdmissionRate $761, Establish/ExpandaPatient CareNavigationProgram (ETMCTrinity ) Providenavigationservicestotargetedpatientswhoareathigh riskofdisconnectfrominstitutionalizedhealthcare. IT2.11AmbulatoryCare SensitiveConditions AdmissionRate $1,096, IntegratedPrimary Care/BehavioralHealth MobileClinic(Lakes RegionalMHMRCenter Design,implementandevaluateprojectsthatprovideintegrated primaryandbehavioralhealthcareservices:(lakesregionalcare IntegrationProject) IT6.1 PatientSatisfaction $3,438,954 92

96 24 ProjectTitle(include uniquerhpprojectid numberforeach project.) BriefProjectDescription RelatedCategory3 OutcomeMeasure(s) (includeunique Category3 ImprovementTarget (IT)Identifierspecific torhpandoutcome title) Estimated Incentive Amount (DSRIP)for DYs ) Physicalwellness/Health Mentorprogramfora targetedbehavioralhealth population.(lakes RegionalMHMRCenter ) Provideaninterventionforatargetedbehavioralhealth populationtopreventunnecessaryuseofservicesinaspecific setting:(lakesregionalinshapeprogram) IT6.1 PatientSatisfaction $641, Enhance/ExpandMedical HomesforUPAPrimary CareClinics (UTHSCTMSRDP UniversityPhysician Associates(UPA) ) ImplementPCMH;expandprimarycarecapacity;implementCHW chronicdiseaseselfmanagement,behavioralhealth,andtele healthfacilitation IT 12.3 Colorectalcancer screening IT12.4 Pneumoniavaccination statusforolderadults IT12.5 Other USPSTFendorsed screeningoutcome measure $7,522, Pass3b ( ) Enhance/ExpandMedical HomesforGSMCInternal MedicineResidencyClinic (UTHSCTMSRDP UniversityPhysician Associates(UPA) ) CollaborationbetweenUniversityPhysicianAssociatesandGood ShepherdMedicalCentertoimplementPCMH;expandprimary carecapacity;implementchwchronicdiseaseselfmanagement, behavioralhealth,andtelehealthfacilitation Pass3b ( ) IT 12.3Colorectalcancer screening Pass3b ( ) IT 12.4Pneumonia vaccinationstatusfor olderadults Pass3b ( ) IT 12.5OtherUSPSTF endorsedscreening outcomemeasure $7,347, Pass3b ( )Useof PalliativeCarePrograms: SupportiveCarefor PatientswithDebilitating Diseases (UTHSCTMSRDP UniversityPhysician CollaborationbetweenUniversityPhysicianAssociatesandGood ShepherdMedicalCenterwheresupportivecareteamswilluse evidencebasedmodelsofeffectiveadvancecareplanningfor patientswithchronic,debilitatingdiseasestoimplement palliativecare,reduceunnecessaryedvisitsandhospitalizations Pass3b ( ) IT13.1 Percentimprovementin painassessment(nqf 1637) Pass3b ( ) IT 13.2Percent $8,735,499 93

97 25 ProjectTitle(include uniquerhpprojectid numberforeach project.) BriefProjectDescription RelatedCategory3 OutcomeMeasure(s) (includeunique Category3 ImprovementTarget (IT)Identifierspecific torhpandoutcome title) Estimated Incentive Amount (DSRIP)for DYs25 Associates(UPA) ) improvementin treatmentpreferences (NQF1641) Pass3b ( ) IT 13.5Percent improvementin discussionof spiritual/religious concerns(nqf1647 modified) Pass3b ( )Improve SelfManagementfor PediatricAsthmaPatients (UTHSCTMSRDP UniversityPhysician Associates(UPA) ) CollaborationbetweenUniversityPhysicianAssociates,Christus St.MichaelHealthSystemandlocalindependentschooldistricts todeploymobileunitstofacilitateearlydiagnosisanddisease managementforchildrenwithasthmathroughouttheregion Pass3b ( ) IT.6.1 PatientSatisfaction percentimprovement overbaselineofpatient satisfactionscores $9,352, Evidence baseddiseaseprevention: ExpandDeliveryofEarly ColonCancerTreatment andsecondaryprevention Management (UTHSCTMSRDP UniversityPhysician Associates(UPA) ) Increaseaccesstocoloncancerspecialtymanagement (gastroenterology/medicaloncology/surgicaloncology)viathe PCMHandutilizeCHWsforawidespreadcommunityoutreach andeducationcampaign IT6.1 PatientSatisfaction percentimprovement overbaselineofpatient satisfactionscores $9,166, Pass3b ( )Applya SystematicApproachto ImproveQuality/ EfficiencyforCHFPatients (UTHSCTMSRDP UniversityPhysician Associates(UPA) ) ThroughacollaborationfacilitatedbyUniversityPhysician Associates,PalestineRegionalMedicalCenter,GoodShepherd MedicalCenter,andChristusSt.MichaelHealthSystemwillusea learningcollaborativeformattoselect,implementandevaluate QI/Eprocessesandmeetregularlytosharechallenges,successes, lessonslearned,andestablishacompendiumofbestpractices Pass3b ( ) IT3.2 Congestiveheartfailure 30dayreadmissionrate $6,747, Pass3b ( )Integrate PrimaryandBehavioral HealthCareServices (UTHSCTMSRDP ThroughcollaborationbetweenUniversityPhysicianAssociates andgoodshepherdmedicalcenter,behavioralhealth professionalsandchwswillbeaddedtoprimarycareteamsto fosterintegrationofbehavioralhealthservicesforpatientsinthe primarycaresetting Pass3b ( ) IT1.8 Depressionmanagement: screening&treatment planforclinical $10,552,740 94

98 26 ProjectTitle(include uniquerhpprojectid numberforeach project.) BriefProjectDescription RelatedCategory3 OutcomeMeasure(s) (includeunique Category3 ImprovementTarget (IT)Identifierspecific torhpandoutcome title) Estimated Incentive Amount (DSRIP)for DYs25 UniversityPhysician Associates(UPA) ) depression Pass3b ( ) IT1.9 Depressionmanagement: remissionattwelve months Pass3b ( ) ImplementPatientCare NavigatorandCHW chronicdiseaseself managementprogramto reduceemergency departmentvisits (UTHSCTMSRDP UniversityPhysician Associates(UPA) ) TrainanddeployPatientCareNavigatorstofacilitatehospital dischargeandpartnerwiththepcmhteamtopreventhospital admissions/readmissions Pass3b ( ) IT9.2 EDAppropriateUtilization $10,040, Pass3b Enhance MedicalHome (UTHSCTMSRDP UniversityPhysician Associates(UPA) ) CreateapartnershipbetweenChristusSt.MichaelHealthSystem andamedicalhomethatinitiativespreventivecareandreduces relianceonemergencydepartmentsforprimarycare Pass3b ( ) IT3.1 Allcause30day readmissionrate $4,983, Pass3b ( ) ExpandCareTransition Programs (UTHSCTMSRDP UniversityPhysician Associates(UPA) ) WithChristusSt.Michaels,createsmoothtransitionsofcarefrom inpatienttooutpatientsettings,alternativeinpatientsettings,or homecaresothatpatientsbeingdischargedunderstandthecare regimen,havefollowupcarescheduled,andareatreducedrisk foravoidablereadmissions Pass3b ( ) IT3.2 CongestiveHeartFailure 30dayreadmissionrate $4,865, Pass3b ( ) Design,implement,and evaluateresearch supportedandevidence basedinterventions tailoredtowards individualsinthetarget population(uthsct MSRDPUniversity WithPalestineRegionalMedicalCenter,developanintensive outpatientbehavioralhealththerapyprogramtocontinuecare foradultbehavioralhealthpatientsaftercompletingtheexisting inpatientprogramsorforpatientsleavingthecrisisstabilization unitthatdonotmeetinpatientcriteriaandpatientsrequiring behavioralhealththerapyinordertoavoidcrisissituations Pass3b ( ) IT9.2 EDappropriateutilization $1,438,451 95

99 27 ProjectTitle(include uniquerhpprojectid numberforeach project.) BriefProjectDescription RelatedCategory3 OutcomeMeasure(s) (includeunique Category3 ImprovementTarget (IT)Identifierspecific torhpandoutcome title) Estimated Incentive Amount (DSRIP)for DYs25 PhysicianAssociates(UPA) ) Implementevidence basedstrategiestoreduce andpreventobesityin childrenandadolescents (UTHSCTMSRDP UniversityPhysician Associates(UPA) ) Extendtheevidencebased,multidisciplinarypediatricweight managementprogramfromthecenterforobesityandit s ComplicationsonHealth(COACH)atChildren smedicalcenterin DallastoaruralcountyinNortheastTexas(Lamar) IT10.1 Percentimprovement overbaselineofpatient qualityoflife $814, Establish/ExpandaPatient CareNavigationProgram (ETMCJacksonville ) Providenavigationservicestotargetedpatientswhoareathigh riskofdisconnectfrominstitutionalizedhealthcare. IT2.11AmbulatoryCare SensitiveConditions AdmissionRate $1,586, Establish/ExpandaPatient CareNavigationProgram (ETMCClarksville ) Providenavigationservicestotargetedpatientswhoareathigh riskofdisconnectfrominstitutionalizedhealthcare. IT2.11AmbulatoryCare SensitiveConditions AdmissionRate $855, Implement andinnovativeand evidencebased interventionthatwilllead tocostsavingsfor providersthathave demonstratedneedor unsatisfactory performanceinthisarea (HopkinsCountyMemorial Hospital ) Implementacostaccountsystemtoidentifyuniqueandspecific costsofprovidingcareforthetop25drgsbyvolume IT5.1Cost ofcare $2,587, Develop, implement,andevaluate standardizedclinical protocolsandevidence baseddeliverymodelsto improvecaretransitions (HopkinsCountyMemorial Hospital ) Develop,implement,andevaluatestandardizedclinicalprotocols andevidencebasedcaredeliverymodelstoimprovecare transitionsfocusingoncongestiveheartfailurepatients IT3.2 CongestiveHeartFailure 30dayReadmissionRate $519,527 96

100 28 ProjectTitle(include uniquerhpprojectid numberforeach project.) BriefProjectDescription RelatedCategory3 OutcomeMeasure(s) (includeunique Category3 ImprovementTarget (IT)Identifierspecific torhpandoutcome title) Estimated Incentive Amount (DSRIP)for DYs Establish/ExpandaPatient CareNavigationProgram (HuntRegionalMedical CenterGreenville ) Implementapatientnavigationprogramtomakehomevisitsto EDsuperuserpatientsandprovideintensecasemanagementto highmedicalandsocialneedpatientsincluding:medication management,implementingevidencebasedcareplans, coordinationofprimaryandspecialtycarevisits,communicate healthinformationtoproviders,providepatient/familyself managementtoolsanddiseaseeducation,conducttelephone followupandassistpatientsconnectwithoutpatientresources IT9.2EDAppropriate Utilization $8,005, Implement/ExpandCare TransitionsPrograms (HuntRegionalMedical CenterGreenville ) ImplementationofProjectRED,acomprehensive,standardized dischargeprogramthatimplementsbestpracticestoimprovethe hospitaldischargeprocessinawaythatpromotespatientsafety andreducesrehospitalizationrates IT3.1Allcause30day readmissionrate $2,301, Establish/ExpandaPatient CareNavigationProgram (ETMCMt.Vernon ) Providenavigationservicestotargetedpatientswhoareathigh riskofdisconnectfrominstitutionalizedhealthcare. IT2.11AmbulatoryCare SensitiveConditions AdmissionRate $430, Establish/ExpandaPatient CareNavigationProgram (ETMCCrockett ) Providenavigationservicestotargetedpatientswhoareathigh riskofdisconnectfrominstitutionalizedhealthcare. IT2.11AmbulatoryCare SensitiveConditions AdmissionRate $1,849, Design,implement, andevaluateprojectsthat provideintegratedprimary andbehavioralhealthcare services. (CommunityHealthcore ) CommunityHealthcorewillcollaboratewithGoodShepherd MedicalCenterandthelocalFQHCintheLongviewareato integrateprimaryandbehavioralhealthcareservicestoresultin anintegratedapproachtohealthcarethatis MoreThanCo Location. IT1.7Controllinghigh bloodpressure (NCQAHEDIS2012,NQF 0018)228 IT1.11Diabetescare:BP control(<140/80mm Hg)234 NQF0061 $558, Centerfor HealthyLiving(Northeast TexasPublicHealthDistrict ) TheCenterforHealthyLivingwillfocusonimprovingthequality oflifeofcitizensoftyler.thecenterwillestablishself managementandwellnessprogramsusingevidence based practices.selfmanagementprogramswillinclude:diabetic managementclassesandscreeningssuchasmobile mammography,bloodpressure,bloodglucose,cholesterol, weightandbmiwillbeprovided ,IT10.1, QualityofLife $532,000 97

101 29 ProjectTitle(include uniquerhpprojectid numberforeach project.) BriefProjectDescription RelatedCategory3 OutcomeMeasure(s) (includeunique Category3 ImprovementTarget (IT)Identifierspecific torhpandoutcome title) Estimated Incentive Amount (DSRIP)for DYs Jail Diversion(AndrewsCenter ) Interceptbehavioralhealthpatientsfromseveralpointswithin thejusticesystem IT9.1Decreaseinmental healthadmissionsto criminaljusticesettings $2,895, Primary BehavioralHealth Integration(Andrews Center ) Provideintegratedprimaryandbehavioralhealthservices throughclinichours IT9.2EDAppropriate Utilization $5,212, Outpatient TherapyExpansion (AndrewsCenter ) IncreasetherapyservicesinSmith,Henderson,VanZandt,Wood, andrainscountiesbyexpandinganintensivetherapyprogramfor thebehavioralhealthpopulation IT9.2EDAppropriate Utilization $967, RedesignforCost Containment (TitusRegionalMedical Center ) DevelopaBusinessIntelligencesystemwiththecapabilitytotest methodologiesformeasuringcostcontainment,interventionand innovationimpactssotheymaybeappliedtootherprojectsor effortsgivingtitusregionalmedicalcentertheabilitytomeasure theefficiencyoftheseinitiativesandexpandtheabilityto generatedatareportstoprioritizeourdecisionsforimprovement initiatives IT5.2 PerEpisodeCostofCare $2,182, RedesigntoImprove PatientExperience (TitusRegionalMedical Center ) Design,develop,andimplementaprogramofcontinuous,rapid processimprovementthatwilladdressissuesofsafety,quality, andefficiency IT6.1 PercentImprovement OverBaselineofPatient SatisfactionScores (1) Aregettingtimely care, appointments andinformation $482, Establish/ExpandaPatient CareNavigationProgram (ETMCAthens ) Providenavigationservicestotargetedpatientswhoareathigh riskofdisconnectfrominstitutionalizedhealthcare. IT2.11AmbulatoryCare SensitiveConditions AdmissionRate $3,951, Implement/ExpandCare TransitionsProgram(ETMC Athens ) Develop,implement,andevaluatestandardizedclinicalprotocols andevidencebasedcaredeliverymodeltoimprovecare transitions. IT3.2CHF30Day ReadmissionRate $875, Redesignto ImprovePatient Experience(ETMCAthens ) Implementprocessestomeasureandimprovepatientexperience. IT6.1%Improvement OverBaselinePatientSat Scores $2,005,823 98

102 30 ProjectTitle(include uniquerhpprojectid numberforeach project.) BriefProjectDescription RelatedCategory3 OutcomeMeasure(s) (includeunique Category3 ImprovementTarget (IT)Identifierspecific torhpandoutcome title) Estimated Incentive Amount (DSRIP)for DYs Establish selfmanagementprogram (RedRiverRegional Hospital ) Implementanevidencebaseddiabetesmanagementprogram IT1.10Diabetescare: HbA1cpoorcontrol (>9.0%) $817, Implement processestoimprove patientexperience (RedRiverRegional Hospital ) Developandimplementapatientexperienceimprovementplan inordertoimprovehowthepatientexperiencescare IT6.1Percent improvementover baselineofpatient satisfactionscores $930, Interventionstailored towardsgeriatric, behavioralhealthpatients (RedRiverRegional Hospital ) Provideastructuredoutpatientprogram(SOP)forgeriatric, behavioralhealthpatients IT3.8BehavioralHealth /SubstanceAbuse30day readmissionrate $144,399 ThefollowingprojectswerepreviouslyincludedintheSummaryofCategory12Projectstable butwereremovedfromtheregionalhealthplan: ProjectTitle(include uniquerhpprojectid numberforeach project.) BriefProjectDescription RelatedCategory3Outcome Measure(s)(includeunique Category3ImprovementTarget (IT)IdentifierspecifictoRHPand outcometitle) Estimated Incentive Amount (DSRIP)for DYs25 RemovedduringPass3B: Apply ProcessImprovement MethodologytoImprove Quality/Efficiency(UTHSCT MSRDP University PhysicianAssociates(UPA) ) WithChristusSt.MichaelHealthSystem,reduce harmordeathtopatientsseekingcareduetosepsis byfollowingtheinstituteforhealthcare ImprovementrecommendedSurvivingSepsis Campaignwhilesupportinganinterdisciplinaryteam approach IT4.8SepsisMortality $6,117,377 RemovedbyPerforming Provider: ImplementPalliativeCare Program(TexasPalliative Care ) Expandpalliativecareconsultingprogramtohelp hospitalpatientswithendoflifedecisions IT13.4Proportion admittedtotheicuinthelast30days oflife(nqf0213) $1,230,304 99

103 SectionIII.CommunityNeedsAssessment This community needs assessment draws from data collected from federal and state governmental agencies, academic studies, and local providers. The 2012 County Health RankingsreportfromtheUniversityofWisconsinandtheRobertWoodJohnsonFoundation and data from the Texas Department of State Health Services 2007 East Texas Community Health Needs Assessment (ETCHNA) were particularly useful to the development of this communityneedsassessmentbecauseaccuratedatacollectioncanbedifficultinruralareasof the state. The ETCHNA report, included in the addendum to the regional health plan, representsamajorefforttodocumentthehealthissuesinourregionandincludesdatafrom 1,924individualswhocompletedasurvey,470individualswhoattendedacommunityforum, andavailabledemographicandepidemiologicaldata 3.Additionaldataweregatheredfromthe US Census Bureau, the Health Resources and Services Administration, and the Centers for Medicare and Medicaid Services. When necessary, these major data sources were supplementedwithproviderdata. The health needs in Northeast Texas are great, but this community needs assessment is intendedtohighlighttheregion smostpressingneeds.performingprovidersselectedprojects that address regional needs and included data specific to the populations served by their deliverysystemreformprojectsintheactualnarrativesofthoseprojects. A.ExecutiveSummary Geographically,theNortheastTexasRegionalHealthcarePartnership (RHP1)spans28countiesandbordersthreestates.At21,000square miles,region1islargerthanninestatesandthedistrictofcolumbia andisnearly250milesfrompointtopoint.over1.2millionpeople liveinnortheasttexas,butthereisnocitywithapopulationgreater than100,000. Northeast Texas is an area where patients face many challenges in accessingprimarycare,acutecare,andmentalandbehavioralhealth services.belowarekeyhealthchallengesinnortheasttexas: 3 TexasDepartmentofStateHealthServices.(2007).EastTexasCommunityHealthNeedsAssessment.Austin: StateofTexas

104 Medically Underserved Areas/Populations:All but three counties in Region 1 are eitherwhollydesignatedasmedicallyunderservedareas/populations(mua/p)orhave serviceareaswithinthecountythataredesignatedasmua/p. 4 PrimaryMedicalCareHealthProfessionalShortageAreas:89.3%ofcountiesinRegion 1haveshortagesinprimarycareprofessionals 5.Insomecounties,theratioofpatients toprimarycareprovidersisfivetimesthestatewideaverageandnearlyeighttimesthe nationalbenchmark. 6 Mental/Behavioral Health Professional Shortage Areas: Over 85% of counties in NortheastTexashaveashortageofmentalhealthproviders. 7 Theratioofpatientsto mental health providers in some communities of Northeast Texas is nearly 25,000 to one,seventimesthestateaverage. 8 Health Factors & Outcomes:Over half of counties in Region 1 are in the bottom quartile of Texas counties in health outcomes and over one third are in the bottom quartileoftexascountiesinhealthfactors. 9 HighChronicDiseaseBurden:Theregionhashigherratesofhighbloodpressure,lower ratesofcholesterolscreening, 10 andhigherageadjustedinvasivecancerincidenceand mortalityratesthanthestateaverage. 11 High Rates of Potentially Preventable Hospitalizations:The majority of counties in Region 1 have higher rates of potentially preventable hospitalizations than the state average U.S.DepartmentofHealthandHumanServices.(2012,October).FindShortageAreas:MUA/PbyStateand County.RetrievedOctober2012,fromHealthResourcesandServicesAdministration: 5 U.S.DepartmentofHealthandHumanServices.(2012,October).FindShortageAreas:HPSAbyState&County. RetrievedOctober2012,fromHealthResourcesandServicesAdministration: 6 UniversityofWisconsinPopulationHealthInstitute.(2012,July).CountyHealthRankings2012.RetrievedJuly 2012,fromCountyHealthRankings: 7 U.S.DepartmentofHealthandHumanServices.(2012,October).FindShortageAreas:HPSAbyState&County. RetrievedOctober2012,fromHealthResourcesandServicesAdministration: 8 UniversityofWisconsinPopulationHealthInstitute.(2012,July).CountyHealthRankings2012.RetrievedJuly 2012,fromCountyHealthRankings: 9 UniversityofWisconsinPopulationHealthInstitute.(2012,July).CountyHealthRankings2012.RetrievedJuly 2012,fromCountyHealthRankings: 10 TexasDepartmentofStateHealthServices.(2007).EastTexasCommunityHealthNeedsAssessment.Austin: StateofTexas. 11 TexasDepartmentofStateHealthServices.AgeAdjustedInvasiveCancerIncidenceRatesinTexas,AllSites, TexasDepartmentofStateHealthServices.(2012,October).PreventableHospitalizationsCountyProfiles. RetrievedOctober2012,fromTexasDepartmentofStateHealthServices:

105 Afterconsideringthedataavailabletotheregion,stakeholdersagreedthatthefollowingsix communityneedsrepresentthemostpressingneedsinnortheasttexas: SummaryofCommunityNeeds Identification Number CN.1 CN.2 CN.3 CN.4 CN.5 BriefDescriptionofCommunityNeedsAddressed throughrhpplan Insufficientaccesstoprimaryandspecialtyhealthcare services. Insufficientaccesstomentalandbehavioralhealth services. Highratesofchronicdisease,includingdiabetes,heart disease,asthma,obesity,andcancer. Highcostsduetopotentiallypreventablehospitalizations. Inappropriateemergencydepartmentutilization. DataSourceforIdentifiedNeed 2012CountyHealthRankings; HealthResources&Services Administration(USDept.ofHealth &HumanServices). HealthResources&Services Administration(USDepartmentof Health&HumanServices);Texas DepartmentofStateHealth Services;Providerdata. TexasDepartmentofStateHealth Services;2012CancerRegistry TexasDepartmentofStateHealth Services. NationalInstituteforHealthCare Reform CentersforMedicareand CN.6 Efficiencyinandeffectivenessofhealthcaredelivery. MedicaidServices Thesecommunityneeds,whileshownassixdistinctneeds,areinterrelated.Accesstocare,for example,impactsratesforchronicdisease,potentiallypreventablehospitalizations,emergency room utilization, and the overall efficiency in and effectiveness of our health care delivery system.as a result, the delivery system reform projects developed by the regional health partnershipshowanintegrationofindividualcommunityneeds,withmanyprojectsaddressing multiplecommunityneeds. The following subsections will address demographic and healthcare related data specific to NortheastTexas. B.Demographics This section highlights basic demographic data for Region 1, including population, insurance coverage status, age, race/ethnicity/language, income, education, employment, and poverty. Demographicdataisimportanttounderstandingthefullarrayoffactorscontributingtodisease andhealth

106 Region1andTexas Table 1: Demographic Summary RHP1 Texas Population 1,289,873 25,145,561 MedianAge PerCapitaIncome $19,386 $24,870 Bachelor sdegreeorhigher 13.2% 25.8% MinorityPopulation 24.8% 29.6% PercentageHispanic/LatinoOrigin 13.1% 37.6% PercentageLivinginRuralArea 53.9% 17.5% Table1aboveshowsacomparisonofhighleveldemographicdataforRegion1comparedwith statewide averages.region 1 represents slightly more than five percent of the state s total population but is older, poorer, and is less well educated that the state average.while the overall minority population is comparable to the state average, only 13.1% of the region s populationidentifiesashispanicorlatinoorigin,comparedtoastateaverageof37.6%.over halfoftheregion spopulationlivesinaruralarea,comparedtolessthanonefifthofthestate s population. Varioussourceswereusedtodeterminehealthinsurancecoveragestatus,manyofwhichrely onestimates.inaddition,uscensusbureaudatawereunavailableforsomeruralcounties, whichfurthercomplicatesestimationsofprivatehealthinsurancecoverage.table2reports availabledataonhealthinsurancecoveragetypesbycountyinregion1: Table 2: Health Insurance Coverage Status County Population Private Public Coverage 13 Coverage 14 Uninsured 15 Anderson 57, % 28.3% 25.4% Bowie 93, % 33.3% 20.1% Camp 12,793 N/A 41.8% 23.2% Cass 29, % 40.9% 17.7% Cherokee 48, % 34.3% 23.2% Delta 5,410 N/A 36.8% 20.1% Fannin 32, % 31.9% 22.0% Franklin 10,841 N/A 27.5% 20.9% Freestone 19,390 N/A 28.3% 21.2% Gregg 119, % 36.6% 20.6% Harrison 64, % 29.4% 21.3% Henderson 78, % 32.1% 22.0% Hopkins 34, % 32.5% 23.9% 13 U.S.CensusBureau, AmericanCommunitySurvey3YearEstimates 14 MedicareHospitaland/orSupplementalMedicalCountyEnrollment,CentersforMedicareandMedicaid Services(2010);MedicaidEnrollmentbyCounty,PointinTime,HealthandHumanServicesCommission(February 2012);TexasChildren shealthinsuranceprogramenrollmentbycountyandmonth,healthandhumanservices Commission(February2012). 15 U.S.CensusBureau,HealthInsuranceCoverageStatus(2009)

107 Houston 22, % 38.1% 23.2% Hunt 82, % 31.6% 22.5% Lamar 48, % 37.8% 20.0% Marion 10,306 N/A 35.7% 21.1% Morris 12,635 N/A 44.5% 18.3% Panola 23, % 30.1% 18.5% Rains 11,287 N/A 31.6% 22.6% RedRiver 12,765 N/A 41.4% 21.8% Rusk 49, % 29.0% 21.1% Smith 204, % 32.7% 20.8% Titus 30, % 35.8% 26.2% Trinity 13,897 N/A 43.3% 20.7% Upshur 38, % 32.7% 20.6% VanZandt 52, % 32.1% 23.9% Wood 43, % 39.3% 20.4% Takenasawhole,approximately54%ofresidentsinRegion1areuninsuredoronsomeformof publiclysupportedinsurance(medicare,medicaid,orthechildren shealthinsuranceprogram). The highest private insurance coverage rates were found in Harrison, Smith, and Panola Counties. Table 3: Urbanization, Age and Race/Ethnicity/Language 16 County Population Rural Population Population <18Yrs Population 65+Yrs African American Hispanic Not Proficientin English Anderson 57, % 20.2% 13.0% 22.5% 14.6% 4.1% Bowie 93, % 24.4% 13.7% 24.6% 6.1% 2.8% Camp 12, % 28.0% 15.4% 17.0% 22.9% 11.6% Cass 29, % 22.9% 19.4% 18.8% 2.8% 1.8% Cherokee 48, % 26.1% 14.5% 14.6% 19.5% 8.1% Delta 5, % 21.6% 18.6% 7.9% 5.4% 2.0% Fannin 32, % 22.6% 16.8% 7.6% 8.2% 3.6% Franklin 10, % 23.8% 18.1% 5.6% 14.2% 5.6% Freestone 19, % 23.4% 15.6% 17.8% 12.5% 3.7% Gregg 119, % 26.9% 13.7% 20.3% 14.1% 7.5% Harrison 64, % 25.4% 12.8% 22.4% 9.6% 4.7% Henderson 78, % 23.0% 18.7% 6.5% 10.3% 4.5% Hopkins 34, % 25.7% 14.8% 7.8% 14.6% 7.4% Houston 22, % 21.5% 18.7% 25.9% 10.5% 2.7% Hunt 82, % 25.0% 13.5% 8.8% 12.4% 4.6% Lamar 48, % 24.7% 16.2% 13.3% 5.9% 2.9% Marion 10, % 20.0% 21.2% 21.3% 3.7% 0.8% Morris 12, % 24.8% 19.0% 22.9% 6.4% 2.5% Panola 23, % 24.8% 15.8% 18.0% 7.1% 2.6% Rains 11, % 20.4% 20.5% 3.1% 9.0% 1.8% RedRiver 12, % 21.6% 19.5% 17.0% 5.9% 2.4% 16 UniversityofWisconsinPopulationHealthInstitute.(2012,July).CountyHealthRankings2012.RetrievedJuly 2012,fromCountyHealthRankings:

108 Rusk 49, % 24.1% 14.7% 18.1% 12.6% 4.6% Smith 204, % 25.8% 14.6% 18.0% 16.3% 7.2% Titus 30, % 31.5% 11.7% 10.1% 39.1% 19.4% Trinity 13, % 21.8% 22.5% 11.2% 7.4% 4.2% Upshur 38, % 25.5% 13.8% 9.6% 5.6% 2.1% VanZandt 52, % 23.5% 17.7% 3.6% 10.0% 3.6% Wood 43, % 20.6% 23.4% 6.0% 8.4% 3.5% RHP1 1,263, % 24.6% 15.5% 15.4% 12.2% 5.3% TEXAS 24,782, % 27.8% 10.2% 11.5% 36.9% 14.4% Table3showsdatarelatedtourbanization,age,andrace,ethnicity,andlanguagedemographic datafortheregionandeachcountywithintheregion.asshowninthetable,overhalfofthe region sresidentsliveinaruralarea,whichcontributestochallengesaccessingprimarycare, specialtycare,andmentalhealthservices. Table 4: Educational Attainment 17 County HighSchool Graduation SomeCollege Anderson 92.9% 36.9% Bowie 92.7% 51.9% Camp 97.3% 38.2% Cass 96.6% 51.4% Cherokee 91.9% 34.9% Delta 95.8% 46.3% Fannin 94.0% 42.6% Franklin 97.9% 46.7% Freestone 94.8% 46.5% Gregg 86.5% 55.4% Harrison 90.2% 47.9% Henderson 93.7% 46.9% Hopkins 94.5% 49.0% Houston 93.1% 38.7% Hunt 88.1% 46.2% Lamar 91.4% 51.8% Marion 82.7% 42.4% Morris 93.3% 57.4% Panola 84.9% 49.7% Rains 96.4% 40.8% RedRiver 95.2% 39.0% Rusk 94.0% 44.2% Smith 87.8% 57.7% Titus 97.8% 37.1% Trinity 83.8% 32.3% Upshur 94.2% 51.1% VanZandt 89.7% 43.8% Wood 93.5% 41.9% 17 UniversityofWisconsinPopulationHealthInstitute.(2012,July).CountyHealthRankings2012.RetrievedJuly 2012,fromCountyHealthRankings:

109 RHP1 91.1% 48.2% TEXAS 84.3% 56.2% Whiletheregionhasahigherhighschoolgraduationratethanthestateaverage,itlagsbehind the state on college education.as shown in Table 4, only 48.2% of the regional population reportedhaving somecollege comparedto56.2%ofthestate spopulation.thepercentage achievingatleastabachelor sdegreeisevenlower 13.1%inregion1comparedtoover25% forthestate. Table 5: Income, Employment, and Poverty 18 County Median Household Income Unemployment Childrenin Poverty SingleParent Households Anderson $40, % 27.2% 32.3% Bowie $42, % 27.8% 39.3% Camp $37, % 33.7% 41.1% Cass $34, % 32.4% 42.5% Cherokee $34, % 35.4% 32.1% Delta $36, % 27.8% 30.1% Fannin $40, % 24.1% 24.9% Franklin $40, % 25.3% 29.7% Freestone $42, % 23.7% 20.5% Gregg $41, % 29.8% 36.9% Harrison $44, % 25.6% 35.3% Henderson $37, % 30.7% 31.7% Hopkins $40, % 28.4% 26.0% Houston $33, % 32.7% 39.5% Hunt $41, % 28.0% 32.5% Lamar $38, % 27.4% 31.2% Marion $32, % 35.4% 43.6% Morris $34, % 31.7% 46.1% Panola $48, % 20.5% 31.2% Rains $40, % 28.1% 35.3% RedRiver $32, % 31.7% 35.2% Rusk $43, % 23.6% 27.1% Smith $44, % 21.7% 32.1% Titus $37, % 29.5% 30.0% Trinity $34, % 32.0% 36.9% Upshur $42, % 25.5% 31.8% VanZandt $41, % 23.6% 25.5% Wood $40, % 33.9% 25.9% TEXAS $48, % 25.7% 32.2% AccordingtotheWorldHealthOrganization, peoplewhoarelesswelloffhavesubstantially shorterlifeexpectanciesandmoreillnessesthantherich eveninthemostwealthycountries 18 UniversityofWisconsinPopulationHealthInstitute.(2012,July).CountyHealthRankings2012.RetrievedJuly 2012,fromCountyHealthRankings:

110 intheworld. 19 AsshowninTable5above,medianhouseholdincomeislessthanthestatewide averageineverycountyinregion1,with11ofthe28countiesreportingmedianhousehold incomesatleast$10,000lessthanthestatewideaverage.over27%ofchildrenliveinpoverty and32.7%ofhouseholdsaresingleparenthouseholdsintheregion. C.HealthcareInfrastructure This subsection examines the existing healthcare environment in Region 1, including the numberofhealthcareprofessionalsworkinginnortheasttexasandthehospitalinfrastructure intheregion. ResearchbytheSchoolofRuralPublicHealthatTexasA&MUniversityreportsthat accessto timelyandeffectiveprimarycareisdeemedcriticaltoavoidinghospitalizationsforambulatory caresensitiveconditions 20 yetthereisasignificantprovidershortageinnortheasttexas. Table6belowsummarizesthehealthprofessionalsbycountyinRegion1. Table 6: Health Professionals by County County PrimaryCare HPSADesignation 21 Dental Mental Health Medically Underserved Areaor Population 22 PCP ProviderRatios 23 Dentist Mental Health Anderson Yes No Yes Yes 2268:1 3404:1 5155:1 Bowie Yes Yes Yes Yes 702:1 2010:1 4633:1 Camp Yes No Yes Yes 1056:1 4084: :0 Cass Yes No Yes Yes 1720:1 4310: :0 Cherokee No No Yes Yes 1786:1 4139:1 1786:1 Delta Yes Yes Yes Yes 2728:1 5199:1 5455:0 Fannin Yes Yes Yes Yes 4717: : :1 Franklin Yes No Yes Yes 1357:1 5399: :0 Freestone Yes No Yes Yes 3180:1 6387: :0 Gregg Yes Yes Yes Yes 829:1 1478:1 4707:1 Harrison Yes Yes Yes Yes 2199:1 4547: :1 Henderson Yes No Yes No 1432:1 4886:1 9845:1 Hopkins No No No Yes 1101:1 4291: :1 Houston Yes No Yes Yes 1609:1 2955: :1 19 Wilkinson,RobertandMarmot,Michael,editors.SocialDeterminantsofHealth:TheSolidFacts.2 nd Edition. TheWorldHealthOrganization(2003). 20 Gamm,LarryD.,HutchisonLinnaL.,Dabney,BettyJ.andDorsey,AliciaM.,eds.(2003).RuralHealthyPeople 2010:ACompanionDocumenttoHealthyPeople2010.Volume1.CollegeStation,Texas:TheTexasA&M UniversityHealthScienceCenter,SchoolofRuralPublicHealth,SouthwestRuralHealthResearchCenter. 21 U.S.DepartmentofHealthandHumanServices.HealthResourcesandServicesAdministration.HPSAbyState& County. 22 U.S.DepartmentofHealthandHumanServices.HealthResourcesandServicesAdministration.MUA/PbyState &County. 23 UniversityofWisconsinPopulationHealthInstitute.(2012,July).CountyHealthRankings2012.RetrievedJuly 2012,fromCountyHealthRankings:

111 Hunt Yes Yes Yes Yes 2165:1 3667:1 4839:1 Lamar No No No Yes 1749:1 1899:1 9792:1 Marion Yes No Yes Yes N/A 10951:1 N/A Morris Yes No No Yes 2564:1 2208: :1 Panola Yes Yes Yes Yes 2108:1 5837: :1 Rains Yes No Yes No 3756: :1 5635:1 RedRiver Yes No Yes Yes 3230:1 6536: :0 Rusk Yes Yes Yes Yes 1748:1 4273: :1 Smith Yes Yes Yes Yes 617:1 1999:1 2756:1 Titus Yes Yes No No 1411:1 2325: :1 Trinity Yes Yes Yes Yes 3484:1 7212: :0 Upshur Yes No Yes Yes 2228:1 7655: :1 VanZandt Yes No Yes Yes 4739:1 3476: :1 Wood Yes Yes Yes Yes 1710:1 3764: :1 RHP1 89.3% 42.9% 85.7% 89.3% Asshowninthetableabove,accesstocareisapressingneedinNortheastTexas.Nearly90% ofcountiesinregion1aredesignatedashealthprofessionalshortageareasforprimarycare, andslightlyfewer(85.7%)aredesignatedasshortageareasformentalhealthprofessionals.as a whole, 89.3% of counties (all but three) are listed as medically underserved areas or populations.the ratio of patients to providers (both for primary care and mental health) is significantly higher than statewide averages or national benchmarks.for example, in some communities,therationofpatientstoprimarycareprovidersisnearly5,000toone,compared tostatewideaverageof1,050tooneandanationalbenchmarkof631toone.theproblemis evenmoreseriousinmentalandbehavioralhealth,wheretheratioapproaches30,000toone in one community, compared to a statewide average of 3,600 to one.providers tend to be clustered in more populated areas (Smith, Gregg, and Bowie Counties), but the majority of residentsinnortheasttexasliveinruralareas.eveninthelargerareassuchassmith,gregg, andbowiecounties,thereisnocitywithapopulationgreaterthan100,000. Likehealthprofessionals,hospitalinfrastructuretendstobeclusteredinlargercommunitiesof Region 1. Table 7 below shows data from the 2010 Department of State Health Services/AmericanHospitalAssociation/TexasHospitalAssociationAnnualSurveyofHospitals andhospitaltrackingdatabase. County Acute Care Hospitals Acute Care Staffed Beds Behavioral Health Inpatient Beds 25 Table 7: Hospital Infrastructure 24 AcuteCareInpatientDays Total Days Medicare Days Medicaid Days UncompensatedCare(UC) Total Uncompensated CareCharges UCas%of Gross Patient Revenue Anderson ,505 12,255 4,206 $23,174, % Bowie ,396 86,458 15,655 $207,191, % 24 DSHS/AHA/THAAnnualSurveyofHospitalsandHospitalTrackingDatabase(2010). 25 ProvidersurveyconductedbyPalestineRegionalMedicalCenter(September2012)

112 Camp ,813 3, $14,886, % Cass ,213 7, $9,161, % Cherokee ,794 7,589 2,058 $45,378, % Delta $0 0.0% Fannin ,180 2, $2,486, % Franklin ,120 1, $2,673, % Freestone ,682 2, $8,754, % Gregg ,842 74,355 22,187 $199,549, % Harrison ,494 7,055 3,385 $41,575, % Henderson ,382 16,247 3,793 $69,969, % Hopkins ,430 6,843 2,402 $11,695, % Houston ,024 4,241 1,383 $10,461, % Hunt ,019 13,315 3,493 $30,442, % Lamar ,917 24,268 5,185 $28,741, % Marion $0 0.0% Morris $0 0.0% Panola ,761 1, $14,232, % Rains $0 0.0% RedRiver ,246 3, $8,798, % Rusk ,616 4,012 1,246 $13,119, % Smith 8 1, , ,089 35,494 $467,898, % Titus ,718 13,716 2,146 $17,256, % Trinity ,661 1, $5,453, % Upshur ,997 1, $9,495, % VanZandt ,227 1, $235, % Wood ,141 2, $9,658, % RHP1 44 3, , , ,639 $1,252,291, % Many of the region s acute care hospitals are small hospitals located in rural communities. Becausethesesamecommunitieslacksufficientprimarycarephysicians,residentsmustdrive greatdistancestoaccessprimaryhealthcareservicesandacutehealthcareservices. As mentioned previously, the demands on the region s mental and behavioral health infrastructure is strained.at the community level, community mental health centers need additional providers and technology to meet the growing demand for services.rusk State Hospital,thesinglepsychiatrichospitallocatedintheregion,wasondiversionfor213of365 daysinstatefiscalyear D.HealthChallenges Many of the health challenges in Northeast Texas are related to chronic diseases and ambulatorycaresensitiveconditions.belowisasummaryofhealthoutcomesandchallenges innortheasttexas: 26 TexasDepartmentofStateHealthServices(2012).DiversionReportsFY2012Summary

113 HighBloodPressure:DSHSestimatesthat43.1%oftheAfricanAmericanpopulationin East Texas has high blood pressure compared to 33.9% of the African American population in Texas.High blood pressure among Caucasians in East Texas is slightly higher(32.4%)comparedtothestate(28.2%) 27. Cholesterol Screenings: DSHS estimates that the African American, Hispanic, and CaucasianpopulationinEastTexashavelowercholesterolscreeningratesthanthestate asawhole.accordingtodshs,83.5%ofthehispanicpopulationineasttexashasnot had their cholesterol checked within the last five years (compared to 57.5% of the statewide Hispanic population).for African Americans in East Texas, 45.3% have not hadacholesterolscreeninginthelastfiveyears(comparedwith26.1%ofthestatewide African American population). 28.3% of Caucasians in East Texas had not had a cholesterol screening in five years (compared with 22.4% of the statewide Caucasian population). 28 Mental/Behavioral Health: An estimated 85,000 individuals in East Texas have a serious mental illness, and approximately 113,000 individuals need treatment for alcoholordrugabuse,butdonotreceiveit.easttexashasasuiciderate65%higher thantheratefortexas(18.2per100,000ineasttexascomparedto11.0per100,000in Texas). 29 Obesity:The percentage of theadult population that isobese ranges from 25.5% to 34.1%inRegion1counties.Statewide,theprevalenceofadultobesityisestimatedat 30.4%.Obesityisacostlycondition.AccordingtotheCentersforDiseaseControland Prevention,nationwidemedicalcostsassociatedwithobesitywereestimatedat$147 billion in 2008.The medical costs for individuals who are obese were $1,429 higher thanthoseofnormalweight. 30 Diabetes:The 2009 Texas Behavioral Risk Factor Surveillance System estimated that 9.3%ofadultsinTexashavebeendiagnosedwithdiabetes. 31 InRegion1,estimatesof theadultdiabeticpopulationrangebetweenalowof9.2%toahighof13.0% TexasDepartmentofStateHealthServices.(2007).EastTexasCommunityHealthNeedsAssessment.Austin: StateofTexas. 28 TexasDepartmentofStateHealthServices.(2007).EastTexasCommunityHealthNeedsAssessment.Austin: StateofTexas. 29 TexasDepartmentofStateHealthServices.(2007).EastTexasCommunityHealthNeedsAssessment.Austin: StateofTexas. 30 CentersforDiseaseControlandPrevention.(2012,October).OverweightandObesity.RetrievedOctober2012, fromcentersfordiseasecontrolandprevention: 31 TexasDepartmentofStateHealthServices.TexasBehavioralRiskFactorSurveillanceSystem(2009). 32 UniversityofWisconsinPopulationHealthInstitute.(2012,July).CountyHealthRankings2012.RetrievedJuly 2012,fromCountyHealthRankings:

114 CardiovascularDisease:EastTexashasahighproportionofcountieswheretheage adjusted mortality rates for congestive heart failure and ischemic heart disease were higherthanthestaterate. 33 Cancer Incidence & Mortality:The map (at right) shows that NortheastTexashashigherageadjustedinvasivecancerincidence rates(allsites)thanthestatewideaverage. 34 Themortalityrates for men for all sites cancer is per 100,000 in the Northeast Texas region compared to a statewide rate of 212.4, with lung, colorectal, and pancreatic cancer showing the greatest difference between regional and statewide rates.forwomen,themortalityrateis154.2per100,000in theregioncomparedtoastatewiderateof142.8,withlung and ovarian cancer showing the greatest difference in regionalandstatewidemortalityrates. 35 E.HealthcareCost,Efficiency,andEffectiveness Animportantfactorinreformstothehealthcaredeliverysystemiscost.Threemajorfunctions of cost potentially preventable hospitalizations, emergency department utilization, and nationalhealthexpenditures areexaminedhere. PotentiallyPreventableHospitalizations The Texas Department of State Health Services collects data on potentially preventable hospitalizations. Preventable hospitalization conditions were selected by the Agency for Healthcare Research and Quality, the lead federal agency responsible for research on health carequality,costs,outcomes,andpatientsafety.table7belowshowsdatafromregion1on hospitalizations for ten conditions that are potentially preventable, meaning that if the individual had access to and cooperated with appropriate outpatient healthcare, the hospitalizationwouldlikelynothaveoccurred TexasDepartmentofStateHealthServices.TexasChronicDiseaseReport(2010). 34 TexasDepartmentofStateHealthServices.AgeAdjustedInvasiveCancerIncidenceRatesinTexas,AllSites, TexasDepartmentofStateHealthServices.2012TexasSelectedCancerFactsforHealthServiceRegion4. 36 TexasDepartmentofStateHealthServices.(2012,October).PotentiallyPreventableHospitalizations.Retrieved October2012,fromTexasDepartmentofStateHealthServices: