Communities We Serve. 500 South Oakwood Road, Oshkosh, Wisconsin Ministry Health Care 2

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2 Communities We Serve 500 South Oakwood Road, Oshkosh, Wisconsin Ministry Health Care 2

3 TABLE OF CONTENTS Introduction.. 4 Target Areas and Population... 5 How the Implementation Strategy Was Developed.. 5 Identified Needs and Priorities Addressing Community Needs Action Plans. 8 Next Steps.. 10 Needs Not Being Addressed Approval Appendices Appendix 1 _ Community Health Improvement Project (CHIP).. 12 Ministry Health Care 3

4 Mercy Medical Center Community Benefit Implementation Strategy Fiscal Years Mercy Medical Center has been meeting the health needs of Winnebago County residents for more than 125 years. Founded by the Sisters of the Sorrowful Mother in 1891 to serve the poor and sick, Mercy Medical Center continues to carry out its mission to further the healing ministry of Jesus by continually improving the health and well-being of all people, especially the poor, in the communities we serve. Mercy Medical Center is a licensed, 157-bed hospital located in Oshkosh, Wisconsin; it is a member of Ministry Health Care. Mercy Medical Center primarily serves Winnebago County, the Fox Cities and outlying rural communities, such as Omro, Winneconne, Menasha and Pickett, as identified by 80 percent of inpatient hospital discharges. This report summarizes the plans for Mercy Medical Center to sustain and develop new community benefit programs that 1) address prioritized needs from the Fiscal Year 2013 Community Health Needs Assessment (CHNA) conducted by Mercy Medical Center, and 2) respond to other identified community health needs. Description of Community Served by the Hospital The overarching goal of Mercy Medical Center s community benefit and outreach is to respond to identified community health needs, increase access, and improve health status, especially for the most vulnerable and underserved individuals and families in our community, and to be a leader and serve as an example to others in community service. Mercy Medical Center s approach to community benefit and outreach is to target the intersection of documented unmet community health needs and our organization s key strengths and mission commitments. We take prudent risks in developing innovative ideas and implementing responsive programs. We emphasize primary health care services, targeted health screening and promotion, and chronic disease prevention and management, especially for vulnerable and underserved persons, seniors, and racial, ethnic and linguistic minorities. Mercy Medical Center seeks out and nurtures relationships with a broad range of collaborative partners to build community and organizational capacity. We strive to sustain an effective community benefit and outreach ministry by thoughtfully linking areas in which the hospital has a demonstrated clinical competence with unmet community needs Mercy Medical Center traces its roots back to 1891, when the Sisters of the Sorrowful Mother opened the first hospital in Oshkosh. The community desperately needed medical care, and the sisters responded. For more than 125 years, Mercy Medical Center has been a leader in providing quality health care to Fox Valley residents, especially the medically underserved. With a history rich in hope and compassion, Mercy Medical Center mission is as relevant today as ever. Today, the hospital meets a broad variety of patient needs through general care, surgical services and numerous medical specialties including cardiology, oncology, pediatrics, emergency, intensive care and obstetrics. In 2012, Mercy Medical Center had 157 patient beds, 19,056 emergency department visits, 658 babies delivered and more than 106 skilled medical staff, 770 employees and 491 volunteers. The hospital offers complete, compassionate, quality health care for the entire family. Ministry Health Care 4

5 Target Areas and Populations While there is no precise definition of vulnerability, Mercy Medical Center s work focuses on people who don t have the same kind of opportunities to make as healthy decisions as others, and whose opportunities for good health are compromised by insufficient education, inadequate housing, racism or low income. Examples include the homeless, limited income families and children, the uninsured and ethnic minority groups. Mercy Medical Center utilized a breakthrough approach to assess their community need and strategically allocate resources, as one means to identify disparities. The Community Need Index (CNI) assisted Mercy Medical Center in understanding the public health needs of every zip code served Winnebago County, the Fox Cities and outlying rural communities, which in turn helped to guide Mercy Medical Center in the development of community benefit programming. The CNI demonstrates the link between community need, access to care, and preventable hospitalization for conditions that, if effectively diagnosed and managed, should be treatable in an outpatient setting. Residents of communities with the highest CNI scores are twice as likely to be hospitalized for manageable conditions such as asthma, pneumonia, or congestive heart failure as communities with the lowest CNI scores. The CNI for Winnebago County was used to further validate the identification of communities (by zip codes) that are the most socio-economically disadvantaged and thus most in need. Residents of these communities tend to have Disproportionate Unmet Health-Related Needs (DUHN): lack of education or health care insurance; homelessness or transient lifestyles; no or limited access to quality health care; high prevalence of conditions, such as diabetes, heart disease, obesity and substance abuse. With this tool, we can focus quickly on the areas of most need and devote more time and resources to planning interventions that can assure health issues are addressed in sufficient time, and in the most cost effective settings. How the Implementation Strategy Was Developed Mercy Medical Center identifies unmet community health care needs in our community in a variety of ways. We used a range of quantitative and qualitative information based on review of health and quality of life data and interviews with community members and representatives of local agencies. We primarily utilized the following to assess community needs and the effectiveness of their response to these challenges: Community Commons, key informant interviews, Community Need Index, County Health Rankings, Fox Cities L.I.F.E. Study, Southern Winnebago County L.I.F.E. Study, hospital and clinic utilization, Winnebago County Behavioral Risk Factor Surveillance System, Winnebago County, Workforce Profile, Youth Risk Behavior Survey (YRBS), State of Wisconsin Best Practice Models, and other published data from reliable secondary sources. Mercy Medical Center participated in the CHNA processes that gathered input from both private and public Outagamie, Calumet and Winnebago County organization members including: medical staff, nurses and administrators; clinic personnel; public health nurses and educators; behavioral health staff and leaders; health insurance-health management staff, elementary, high school and post high school educators, nurses and administrators; police and emergency personnel; child, women's, family and senior social services; as well as community members interested in the health needs assessment process. Ministry Health Care 5

6 As an adjunct to the organization s Strategic Planning Process, community benefit and outreach planning derives input and guidance from the Community Benefit Council, as well as executive, management and employees of the hospital. As a result, adjustments are made to programs and services. Other stakeholders involved in the selection of priorities are those organizations with which our hospital provides support to for community benefit programs and outreach activities. Some include the Winnebago County Public Health Department, University of Wisconsin-Oshkosh, Oshkosh Area United Way, Community for Hope, Oshkosh Area Community Foundation and Mercy Health Foundation. Coalitions composed of individuals and groups committed to improving the identified health issues have been organized. Many coalition members were drawn from local committees and/or organizations engaged in the process to date, and other community residents are encouraged to step forward. A Community Health Improvement Project (CHIP) form is completed for each strategy, relating to a health priority. The CHIP form consists of a program description, measurable outcome/metrics, budget information, the hospital s required contribution/program expense, as well as strategies and asset inventory. An example of a completed CHIP form can be found in Appendix 1. Identified Needs and How Priorities Were Established Mercy Medical Center strives to fulfill every element of our Mission Statement through actions, not just our words. Three community benefit and outreach themes, which emerged from the FY planning process, framed the selected annual initiatives: 1) Play a lead role in building a better system of care for those without insurance and with limited access to health care; 2) Target low income and/or disadvantage populations; and 3) Demonstrate value of community-based programs, processes and outcomes, and strengthen our leadership position in community benefit and outreach. Mercy Medical Center recognizes that to have a meaningful effect on the populations we hope to help, we must consider how complex social factors such as poverty, education and housing affect people s health. These factors that lead to poor health are often referred to as the social determinants of health, and are documented by a significant body of research. The focus of Mercy Medical Center s community health implementation strategies are therefore based on overall determinants of health. The hospital is committed to developing partnerships with community-based organizations who share the hospital s goals to improve health, as well as advocating for policies that improve the health of whole populations equitably. Mercy Medical Center, in collaboration with a variety of internal and external stakeholders, undertook a structured approach to review public health data and conduct interviews of city and county residents and public health officials. This assessment resulted in a list of 23 health needs which were reviewed and discussed. Community health leaders came to an agreement on a set of criteria (below) to evaluate the list of health needs identified through the CHNA process. Each member voted on their top three focus areas. Addresses/Impact multi health issues Addresses Disproportionate Unmet Health-Related Needs (DUHN)* Number of persons impacted by health issue (magnitude) To what extent (severity) Aligned with Healthy Wisconsin 2020 Ministry Health Care 6

7 Organizational burning platform to address the issue Community burning platform to address the issue Is it already being worked on? (i.e. who else is working on this? What is our role? Is it meaningful? How can we best complement/enhance an existing effort?) Likelihood of success (i.e. what is the track record to date on this approach? Are there adequate resources to implement this intervention strategy?) Evidence-based practice (EVB) Is it measurable? *Disproportionate Unmet Health-Related Needs (DUHN) seek to accommodate the needs of communities/neighborhoods with socio-economic barriers that increase resident vulnerability to poorer health/health disparities. **Evidence-based practices (EVB): the practice of health care in which the practitioner systematically finds, appraises, and uses the most current and valid research findings as the basis for clinical decisions. In addition to the above criteria Mercy Medical Center assessed the congruency and relevance of the health need to our mission, promise, values and strategic goals. The results of the prioritization processes identified seven priority issues Mercy Medical Center would need to address in order to create a healthier community: 1. Alcohol consumption (frequency and amount) 2. Asthma prevalence 3. Mental health 4. Newborn health and safety 5. Obesity and diabetes 6. Preventive health services 7. Smoking Description of What Mercy Medical Center Will Do to Address Community Needs It is clear that the communities served by Mercy Medical Center have many health and qualityof-life areas that need attention and concerted effort to improve. The FY Mercy Medical Center Implementation Plan is the beginning effort to address the most pressing needs. These needs will be addressed by the individual hospital, health and human service organizations within the community, as well as the collaborative efforts by the organizations gathered to prioritize the most significant needs summarized in the needs assessment. Mercy Medical Center seeks to improve the health of our community by empowering people with information, knowledge and awareness. While we cannot realistically address every issue, we strive to resolve those that most heavily affect our local community. Using the results of the 2013 Community Health Needs Assessment, Mercy Medical Center has thoughtfully linked areas in which the hospital has a demonstrated clinical competence with unmet community needs. Working collaboratively with community partners, Mercy Medical Center provides leadership and advocacy, stewardship of resources, assistance with local capacity building, and participation in community-wide health planning. Employees and leaders participate and chair a variety of collaborative committees throughout their service area, such as the Fox Valley Regional Community Health Coalition; Northeastern Wisconsin Mental Health Connection; Winnebago Community Health Improvement Project, including the re:th!nk Mental Health Ministry Health Care 7

8 Shareshop; Lifestyle, and Nutrition, Obesity and Diabetes Action Teams; the Living Healthy Community Clinic Advisory Board; Oshkosh Collaboration Workgroup; Tri-County Community Dental Clinic; Day by Day Warming Shelter; and Parent Connection. Our participation as a collaborative partner provides an opportunity to share information, resources and ideas, solve problems, identify options, and evaluate the success of our efforts. In addition, Mercy Medical Center is committed to providing financial assistance to persons who have health care needs and are uninsured, underinsured, ineligible for a government program, or are otherwise unable to pay for medically necessary care based on their individual financial situations. Consistent with our mission, Mercy Medical Center strives to ensure that the financial capacity of people who need health care services does not prevent them from seeking or receiving care. Mercy Medical Center offers financial assistance to patients in Northeast Wisconsin because the hospital believes all patients deserve high-quality health care, regardless of their ability to pay. Financial assistance is not considered to be a substitute for personal responsibility, and patients are expected to cooperate with the hospital s procedures for obtaining financial assistance and contribute to the cost of their care based on individual ability to pay. Brochures announcing financial assistance are located in each emergency department, patient registration area and at various locations throughout each facility for patient and family review. Every patient is given a financial assistance brochure upon admission. If admitted in an emergent manner, the patient information binder contains the financial assistance information. Each facility also has financial counselors on-site to assist patients and their families upon discharge with bill resolution and applications for government sponsored insurance services. Individuals with financial capacity to purchase health insurance shall be encouraged to do so as a means of assuring access to health care services. Action Plans This important work is a fulfillment of our mission, which calls us to advocate for the underserved and partner with others in the community to improve the quality of life. Therefore, the implementation strategy is a collaborative effort by Mercy Medical Center, Affinity Medical Group, Aurora Health Care, Living Healthy Community Clinic, Menasha City Health Department, Winnebago Department of Health and Human Services, Division of Public Health, Healthy Weight Fox Valley, Mental Health Shareshop, Northeastern Wisconsin Mental Health Connection, re:th!nk, Fox Valley Regional Community Health Coalition and other community partners. Mercy Medical Center strives to sustain an effective community benefit and outreach ministry by thoughtfully linking areas in which the hospital has a demonstrated clinical competence with unmet community needs. Below are the priority areas of focus and key community based programs of Mercy Medical Center. These needs will be addressed by the hospital itself and/or in collaboration with other community partners. No single organization has the depth of resources needed to raise community health to an optimal level or even to maintain it at its current level. However, in collaboration with our community partners, Mercy Medical Center plans to address three of the identified community health needs by: Access to health care targeting low income and disadvantaged persons Mercy Medical Center strives to ensure that all community residents have timely and ready access to the full array of medical and behavioral health services required to maintain and Ministry Health Care 8

9 improve their health, regardless of their ability to pay. Additionally, Mercy Medical Center continues to work on improving access to medical, social and mental health services while improving transitions of care across health care delivery system. Some of the ways we plan on doing this are: AffinityCares/Charity Care* Catalpa Health, a new joint venture between Affinity, ThedaCare and Children's Hospital of Wisconsin, reaffirming its promise to provide comprehensive outpatient pediatric mental health services Living Healthy Community Clinic* (community partnership) Mercy Medical Center Financial Advocates* Mercy Medical Center Transition of Care* 24/7 Sexual Assault Nurse Examiner (SANE)* (community partnership) Mental Health Mercy Medical Center is committed to improving access to mental and behavioral health services, especially in the area of child and adolescent and the uninsured. Mercy Medical Center will continue its collaboration with existing community providers and agencies to increase access, along with providing effective case management to link patients and their families to necessary resources. Some of the ways we plan on doing this are: Catalpa Health, with a proposed future satellite location in Oshkosh* Northeastern Wisconsin Mental Health Connection, (community partnership) strengthening 24/7 crisis response, No Wrong Door, support school-based mental health and primary care support Pace Plus Software Pilot Project* Winnebago County re:th!nk Mental Health Shareshop* (community partnership) Newborn Health and Safety Mercy Medical Center understands an expectant mother s ability to care for herself during pregnancy is the key to giving her baby a healthy, happy start in life. Mercy Medical Center offers a wide assortment of childbirth, sibling and breastfeeding classes to expectant mothers. Classes, resource libraries and other educational opportunities are available to help expectant mothers ensure a healthy pregnancy and delivery. Some additional ways we plan on doing this are: Parent Connection program* (community partnership) Mercy Medical Center Teen pregnancy program* Mercy Medical Center Moms Club* Obesity and diabetes In collaboration with public health Mercy Medical Center will be assisting in the promotion of wellness and prevention activities to assure Winnebago County residents have an opportunity to live a healthy lifestyle. Some additional ways we plan on doing this are: The Weight of the Fox Valley* (community partnership) Eatsmart! N.E.W. program (community partnership) Winnebago County Transform Wisconsin Project: re:th!nking What Healthy Looks Like (community partnership) Affinity Medical Home Model, disease case management* *Indicates projects in which Mercy Medical Center directly participates. Ministry Health Care 9

10 These key strategies will be continually monitored for performance and quality with ongoing improvements to facilitate their success. The Affinity Board of Directors, hospital leadership and Affinity Community Benefit Council will receive quarterly updates on program performance. Next Step for Priorities For each of four priority areas listed above, Mercy Medical Center will work with community coalitions and partners to: Identify any related activities being conducted by others in the community that could be built upon Develop measurable goals and objectives to measure that the effectiveness of their efforts can be measured Build support for the strategies within the community and among other health care providers Develop detailed work plans - Affinity Community Health Improvement Plan (ACHIP) Priority Needs Not Being Addressed and the Reasons Four other health issues were identified by the Community Health Needs Assessment process. Given the reasons indicated below, Mercy Medical Center will not be focusing on these health needs at this time. Alcohol consumption (frequency and amount) is being addressed by Winnebago County re:th!nk alcohol prevention and control, a program of the Winnebago County Health Department. Asthma prevalence is being addressed on a case by case basis through individual physicians in Affinity Medical Group Medical Home practices. This concern has not yet emerged as an actionable priority at the community level. Preventive health services are available through primary care services at the Living Healthy Community Clinic and Fox Cities Community Health Center for uninsured and underinsured low income individuals and families, as well as through the Wisconsin Well Woman Program. Gaps in services have not yet been addressed by the community. Smoking is being addressed by re:th!nk tobacco prevention and control, a program of the Winnebago County Health Department and Affinity s Call it Quits program. While we will focus the majority of our efforts on the identified needs that are outlined, we will review the complete set of priorities defined by FY2013 Community Health Needs Assessment (CHNA) process as they emerge to determine our response and make any adjustments in our plans. In addition, we will seek the advice of our external review group as we determine our FY2014 plans. Ministry Health Care 10

11 By definition the Community Health Needs Assessment and Planning process is a cyclical progression toward community health improvement. With the completion of the Community Health Implementation Plan, Mercy Medical Center will move to the Action Phase. This part of the cycle consists of implementing and evaluating initiatives and interventions to reach measurable objectives. Members of the Mercy Medical Center have already joined community coalitions and taskforces that will focus on each of the seven priority health issues. Their next step will be to bring more community members to the table who will help set measurable objectives and select strategies to reach them. Evaluation will remain foremost so that progress toward goals can be quantified. The level of achievement will result from the commitment of the community coalitions and task forces members. All residents and community and civic organizations are invited to join the effort. To become involved or for more information, contact Mercy Medical Center Community Benefit and Outreach Department at (920) or (920) Lastly, Mercy Medical Center s CHNA and Implementation plans are freely available to the public. We also widely distribute our annual community benefit report, including posting on our website, as well as provide a detailed narrative response to the supplemental questions on our Form 990 Schedule H submission to the Internal Revenue Service. Approval Annually, the Mercy Medical Center Governing Board, which includes representatives from Winnebago County and the surrounding community, will review the prior fiscal year s Community Benefit Report and approve the Community Benefit Implementation Strategy for addressing priorities identified in the most recent Community Assessment and other plans for community benefit. This report was prepared for the May 14 th, 2013 meeting of the Governing Board. Affinity Governing Board Approval: By Name and Title Date Ministry Health Care 11

12 Community Health Improvement project (CHIP) PROGRAM OVERVIEW PACE Plus Mental Health Appendix 1 Affinity is committed to improving the health, well-being and quality of life of the communities we serve. The CHIP process is an ambitious and bold effort at community engagement for a common good (Justice). No single organization has the depth of resources needed to raise community health to an optimal level or even to maintain it at its current level. The CHIP process is based on the idea that through collaboration and synergy two plus two will equal a great deal more than four. Another important feature of CHIP is that the plan arises out of the community, which then has a greater investment in its implementation (Teamwork). Issue identified as a health priority Access to mental health services was identified as a community need by both the Fox Cities L.I.F.E. Study: Area Strengths, and the Southern Winnebago County L.I.F.E. Study, as well as the Winnebago County Community Health Improvement Project (CHIP). How was this issue identified? X A community needs assessment developed or accessed by the organization. Documentation that demonstrated community need or a request from a public agency or community group was the basis for initiating or continuing the activity or program. X The involvement of unrelated, collaborative tax-exempt or government organizations as partners in the activity or programs. Program Emphasis Disproportionate Unmet Health-Related Needs Primary Prevention X Seamless Continuum of Care X Build Community Capacity Collaborative Governance Meets at least one of the following X Improve access to health care services, e.g.: barrier (geographic financial or cultural) to access is reduced X or eliminated; out in the community providing service vs. the patient coming to you. Enhance health of the community, e.g.: designed around public health goals or Yields measurable improvement in health. Advanced medical or health care knowledge. Relieve/reduce the burden of gov t or other community affect e.g.: enhanced public health dept activities or if the program were closed; cost to gov t or another tax-exempt org would increase. Supporting data that identify this as a health priority (community metrics, CHNA findings and other statistical data) The 2011 Southern Winnebago County L.I.F.E. Study noted insufficient treatment for mental illness in the area due to stigma about mental illness, complexity of treatment, failure to take medications and too few psychiatrists that serve those with low incomes. The Lifestyle Workgroup of the Winnebago County CHIP placed a priority on finding solutions to accessing and navigating mental health services and reducing the stigma of mental illness by creating a Mental Health Shareshop made up of representatives from agencies addressing mental illness to find solutions. This group is coordinating with the North East Wisconsin Mental Health Connection serving the Fox Valley region to implement solutions. In 2011, 13 percent of Winnebago County residents reported 1-2 days of poor mental health (BRFS). In 2011, 21 percent of Winnebago County residents reported 3 or more days of poor mental health (BRFS). There were 24 suicides in Winnebago County in 2011 and 32 in In 2011, about 13.5 percent of high school students reported seriously considering suicide in the previous 12 months and 6.7 percent reported making at least one attempt (YBRFS). In 2010, about 7.1 percent of all discharges from Mercy Medical Center were psychiatric. Best Practice Intervention Strategies Consumers connect with the right service at the right time in the right place. No Wrong Door to finding appropriate services. Increase community awareness of services available. Ministry Health Care 12

13 Establish protocols for inter-agency communication, cooperation. Asset Inventory (Resources that are current available within the community): Winnebago County re:th!nk Mental Health Shareshop Catalpa (children s mental health) Northeast Wisconsin Mental Health Connection (NEWMHC) Program Description: The NEWMHC is proposing a pilot of Pace Plus software at up to 10 agencies or organizations providing mental health services in Outagamie and Winnebago counties. The software allows sending and receiving of referrals and information electronically among the users. Referrals are automatically redirected to a higher level if action isn t taken within a specified time to make sure no referrals are dropped. The patient does not have to tell his or her story over and over. Procedures and protocols are standardized to enhance communication and navigation of the system. Mercy Medical Center/Affinity Health System has indicated interest in being a pilot site through Affinity Behavioral Health Outpatient Services at the Tower West facility in Oshkosh. Duration of the program: The pilot period will last approximately one year. Measurable Outcomes/Metrics: Specific outcomes and metrics are yet to be determined, but are expected to be centered around decreasing wait time for services and increasing the number of individuals who access appropriate services within a specified period of time. Risk Factors to Success 1. Inadequate funding 2. Limited agency participation 3. Inter-agency barriers Budget Information: Total Cost: $100,000 ($10,000 per agency) Funds already obtained: $0 Amount requested in this proposal: $10,000 Funding Partners: $90,000 Please attach a complete project budget (including revenues and expenses) Example of revenue: other grants, service revenue and other supporters. Community Benefit Category *Refer to A Guide for Planning and Reporting Community Benefit (CHA) UPDATE Per FY INSERT FY Goal: INSERT FY Objectives Measure/Indicator of Success include current state metrics and desired metrics Intervention Strategy for Achieving Goal: Results to Date: Hospital s Contribution / Program Expense INSERT hospital and/or system contribution or in-kind donations and over what period of time (e.g. $15,000 annually for three years) Submitted by: Submitted date: AET Champion Signature: To be completed by the Community Benefit Council Chairperson Reviewed by: Ministry Health Care 13

14 Reviewed date: Approved Denied Comments: All cash and in-kind contributions that Affinity/Business Unit reports (or may report) as a "community benefit" on its Form 990, Schedule H, as described below, must acknowledge the contribution with a formal, IRS compliant gift acknowledgement. The IRS does not require a specific method for restricting a contribution to a given community benefit. However, to ensure that Affinity/Business Unit cash and in-kind contributions are restricted appropriately, it is strongly recommend that Affinity/Business Unit provide a letter with the contribution that expressly restricts the entity or community group s use of the contribution to a specific community benefit. The letter should also indicate that the receiving entity s purpose is consistent with Affinity/Business Unit mission (Contact Mission Services for a sample letter). Ministry Health Care 14