2013 BORGESS HEALTH SYSTEM Community Health Needs Assessment (CHNA) Report DESCRIPTION OF COMMUNITY: Assessment of Kalamazoo County and Borgess Health s Primary Service Area The City of Kalamazoo is located within county and represents approximately 30% of the total population. The average annual income of a Kalamazoo county resident is $46,019 annually with 18.6% of the population falling below the poverty level. The current unemployment rate is 8.8%. 2011 Kalamazoo County Vital Statistics Southwest Michigan Population Demographics and Trends Southwest Michigan is comprised of a nine-county region that borders Indiana. Kalamazoo County is at the heart of southwest Michigan and is the most densely populated of the nine counties. Together, the neighboring cities of Kalamazoo and Portage within the county represent the largest metropolitan area in the region. For the purpose of the Community Health Needs Assessment, we will define our focus on Kalamazoo County, which includes the cities Kalamazoo and Portage. In 2013 County Health Rankings were released on March 21, 2013 by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. Kalamazoo County places in the middle of the 82 Michigan counties at the 46 th rank. According to estimates by the U.S. Census, the City of Kalamazoo's population increased 0.64 percent from 74,262 to 74,743 between 2010 and 2011. During the same timeframe, the population of the City of Portage increased 0.71 percent from 46,292 to 46,624. The following vital statistics are provided as an overview. 1
2011 Kalamazoo County Vital Statistics Population 252,074 (0.7% growth since 2010) Median Age 34.6 Ethnicity: Caucasian African-American Hispanic or Latin Asian 82.8% 11.1% 4.1% 2.4% Female Population 51% Household Size 2.41 Number of Households 99,603 Median Home Cost $144,200 Median Household Income $46,019 Cost of Living 8.1% lower than national average Recent unemployment 8.8% (U.S. average 9.1%) Predicted Future Job Growth (10 yr.) 31.74% High School Graduates 92.3% Four Year College Degrees 21.00% Graduate Degrees 12.08% Persons Below Poverty Level 18.6% Source: United States Census, 2012; Kalamazoo Regional Chamber of Commerce, 2012 Population Living in Poverty 2
2008-2010 estimates projected that 19.2% of the Kalamazoo County population or 46,091 people lived below the poverty level. The proportions of people living below the poverty level in Michigan (15.7%) as well as the proportion in the United States (14.4%) were lower than the proportion in Kalamazoo County. Within Kalamazoo County, the proportion of the population living below the poverty level varied by city and township. In 2008-2010, the City of Kalamazoo had the highest poverty rate with 36.0% of residents living below the poverty level. Poverty estimates for all cities and townships in Kalamazoo County are available from the American Community Survey as an average rate between 2006 and 2010. The highest rate was in the City of Kalamazoo; lowest rates were in Texas Township, Cooper Township, Climax Township, Ross Township, and Prairie Ronde Township. Source: Kalamazoo County Health & Community Service, August 2012 WHO WAS INVOLVED IN THE ASSESSMENT: Community Benefit Advisory Committee In 2012, Borgess Health re-established the Community Benefit Advisory Committee. This committee represents sixteen (16) community agency leaders throughout Kalamazoo County and is intended to represent a wide range of expertise and services that impact our community s health status. Each committee member also holds numerous board and community committee positions in Kalamazoo and is adequately positioned to represent the community needs. The Community Benefit Advisory Committee represented a large cross section of community agencies. The committee members expertise involves public health, not-for-profit agencies, school/educational programs, elderly support services, family health centers, chronic disease specialty clinics, Borgess Health representatives involved in community work, and a local government official. All agencies and their representatives on the committee are involved with providing services to the medically underserved, low income and minority populations. The following list represents the Community Benefit Advisory Committee participating members and data sources: FY 12-13 Community Benefit Advisory Committee Members Name Agency Board/Agency Participation Denise Crawford Family Health Center, President & Chief Executive Officer Poverty Red. Init, United Way, LISC, Douglass Community Association, Federal Community Credit Union, Family Health Center 3
Fran Denny Van R. Dickerson Patrick Dyson Mary Gustas Bobby J. Hopewell Gregory Miller Bill Mayer, MD Margaret Patton Catholic Charities, Executive Director Kalamazoo Public Schools, Kalamazoo Central High School Borgess Health, Executive VP, Strategy & Corporate Services Comstock Community Center, Executive Director Borgess Health Park, Administrative Director Mayor, City of Kalamazoo Tendercare Kalamazoo, Portage and Westwood - Director of Provider Relations Bronson Healthcare Group, Vice President & Chief Quality Officer Borgess Health, Community Relations Specialist Catholic Charities Michigan, Early Music Michigan Board President, Catholic Family Services Boys and Girls of Greater Kalamazoo Susan Pozo Professor of Economics, WMU BH Board Representative Joint Venture and various subsidiary boards; Michigan Chamber of Commerce Board KVCC Trustee, Sunrise Kiwanis, GKUW Directors, River Manor Senior Housing, Senior Exercise, Healthy Eating Seniors/Kids, Diabetic Education Kalamazoo Communities in Schools, Board; Kalamazoo Community Youth Center, Advisory Committee; Downtown Development Authority Board Friends of the Portage Senior Center Board Member Arcadia Commons West; Downtown Kalamazoo Inc.; Edison School Based Clinic; KRESA, Great Start Collaborative; Children's Healthcare Access Program, Steering Committee; Healthy Futures, Board of Directors, Kalamazoo Child Death Review Team, Team member, Kalamazoo Community Foundation, Women's Education Committee, Kalamazoo Community Youth Center Board of Directors; Greater Kalamazoo United Way, Community Investment Cabinet, member; Nurse Family Partnership; YWCA, Women of Achievement Selection Committee Linda Root Borgess Health - Vice Catholic Charities Development Committee President, Mission Integration John Ryder Borgess-Pipp Hospital, Deacon Diocese of Kalamazoo Administrator/COO Diane Schrock Portage Community Center Portage Public School District Advisory Committee, KBI Non-Profit Housing, United Way, Directors, Portage Library Cheryl Borgess Diabetes Center, Cole Solutions Tenenbaum Clinical Manager Linda Vail Kalamazoo County Health & Community Services MPRI, Kalamazoo Health Plan, WMU Medical School Curriculum Committee, WMU College of Health & Human Services, Michigan Association for Local Public Health, Multi-purpose Collaborative, United Interfaith Free Clinic, CKUW, Pioneering Healthy Committee; Champions for Healthy Kids 4
STATEMENT OF PURPOSE: In order to assist the Community Benefit Advisory Committee in defining its work and scope, the committee felt it was necessary to build and establish guiding principles and defining characteristics. This approach would set the stage for meaningful dialogue, discussions and establishment of work processes. The following represents the Community Benefit Advisory Committee adopted Vision, Mission and Statement of Purpose. Vision: We will advance the healthcare of our community. Mission: Our Community Benefit Advisory Committee is committed to improve our community health status, address quality of life concerns, and reduce health disparities, by improving access to health services. Priority Selection Criteria: 1. IMPACT on community health improvement 2. SCOPE of community affected 3. THREAT to long term quality of life 4. RESOURCES/CAPACITY to address identified issues 5. CONSEQUENCES of inaction ASSESSMENT PROCESS: Each agency/organization provided data they had collected over the past calendar or fiscal year. The data was brought to monthly committee meetings and each agency representative reviewed their data with the committee members. Formal presentations educated all members on the significance of the work, structure and service area, as well as populations served and key issues and concerns that impacted the ability to care for their particular area of focus. This process provided a significant amount of data collection that covered multiple categories which related to health needs of our community. The data of each agency/organization provided necessary insight and became the baseline assessment for our county. Summary of Measures Collected and Reviewed: Borgess Community Benefit Inventory for Social Accountability (CBISA) Borgess Diabetic Data Borgess Emergency Room Statistics Borgess Health Hospital Scorecard indicators Borgess Obesity Data Borgess Uninsured Data and Charity Care Indicators 5
Catholic Charities Indicators County Health Rankings County Health Status Measures Family Health Center Indicators and Health Data Kalamazoo County Health Department Indicators Kalamazoo County Health Surveillance Data Book (8/13/12) Michigan s Health Profile Chartbook 2011 Population, Socio-economic and Economic Status in Kalamazoo County Primary Care Physician/Providers Availability Region 5 Health Profile Chartbook 2011 Phases of the Assessment Process: 1. Community Agency/Organization Presentations 2. Review of Community/Agency/Organization data 3. Community Benefit Advisory Committee discussions and clarification of data 4. Community members identify health needs that need improvement/or addressing 5. Rank voting of identified health needs. Utilized nominal group planning methodology. 6. Discussion/strategy development on top three health needs 7. Development of indicators to assess/monitor top three health needs. Identification of Health Needs: The following list identifies health factors that were determined to impact the health of Kalamazoo County residents (Assessment Priorities) and the final three major areas of focus (Health Needs Identified) through our Community Health Needs Assessment process. Chronic Disease Management: 1. Cardiac-related 2. Diabetes 3. Cancer 4. Stroke Homelessness Obesity Access to Care Early Childhood Services: 1. Infant Mortality 2. Healthy Food/Nutrition 3. Childhood Diabetes Health Education Advancement 6
Three Primary Target Areas of Focus Identified: 1. Diabetes 2. Obesity 3. Access to Care The other remaining 8 areas of health need will not be addressed specifically by Borgess in this cycle. Borgess has invested its resources in both cardiac related and stroke management, and is currently refining its strategy related to cancer care. At this time Borgess will not address the larger societal issue of homelessness as our limited resources will be utilized to enhance our clinical services. Borgess continues to collaborate with Bronson Hospital on infant mortality. This area was not chosen as Bronson is our designated Level 3 Perinatal Center. Borgess does not have an inpatient pediatric service and the advisory committee felt that Bronson would address the areas of childhood health nutrition and diabetes within their designated status of being a children s service hospital. BORGESS HEALTH COMMITMENT: Borgess Health is committed to providing quality care and living up to Ascension Health s goal to provide healthcare that leaves no one behind. We, as a health ministry, support 100% access and 100% coverage and recognize that in order to achieve this goal that the healthcare delivery system needs to be redesigned in order to improve health outcomes. However, hospital systems cannot extend their services indefinitely and need to look at collaborative models, services and interventions. Borgess Health has invested resources in the three targeted focus areas. These focus areas need not exist apart from our current hospital strategy and activities. We intend for continued growth and support for these existing patient initiatives and recognize their impact on community based prevention and treatment activities. Working collaboratively with our Community Benefit Advisory Committee, Borgess Health intends to make use of its assets, capabilities and capacities and to continue to promote and develop these resources that will positively impact our three focus areas and their impact on our community s population health. SUPPORTING DATA AND STATISTICS FOR AREAS OF FOCUS: The following data and graphic depictions demonstrate problem areas and challenges that note contributing factors and underlying causes in our three primary areas of focus. Data and graphs from a state and county perspective were supplied by Kalamazoo County Health and Community Services and from the State Community Health Assessment Meeting Summary and Findings from Region 5 dated October 2011. All three areas impact the general population health concerns. 7
Data indicators, while focused on a particular area, may also reflect very complex issues that extend beyond our three areas of focus. Borgess data for the purpose of this report will reflect our current population served and focus on hospital centric statistics. Focus Area, Diabetes: Diabetes Incidence in Kalamazoo County Diabetes is the sixth leading cause of death in Kalamazoo County, Michigan, and in the United States. 8, 9 In Kalamazoo County in 2009, there were 87 deaths for which the underlying cause of death was diabetes mellitus (a rate of 35.0 deaths per 100,000 population). This represented 4.4% of all deaths in 2009. There were a total of 253 deaths that were diabetes-related (including the 87 deaths for which the main cause was diabetes mellitus), which represented 12.7% of all deaths in Kalamazoo County in 2009. 10 The following charts demonstrate that diabetes prevalence continues to be an issue in Kalamazoo County. Socio-economic factors play a role as well as race. Mortality rates related to diabetes are noted to have negatively impacted the Black population at a greater incidence. 8 Centers for Disease Control and Prevention, National Center for Health Statistics, Deaths: Final Data for 2007, accessed at http://www.cdc.gov/nchs/fastats/deaths.htm 9 Michigan Department of Community Health, Division for Vital Records and Health Data Development, Resident Death File. For more information about leading causes of death in Kalamazoo County, please refer to Section 3: Life Expectancy and Leading Causes of Death of the Kalamazoo County Health Surveillance Data Book. 10 Michigan Department of Community Health, Division for Vital Records and Health Data Development, Resident Death File; diabetes-related deaths include those for which the main underlying cause of death was determined to be diabetes mellitus, or diabetes mellitus was listed as a related cause of the death, even it was not the main cause. 8
Percentage of Population Kalamazoo County Diabetic Data: DIABETES PREVALENCE AMONG ADULTS BY INCOME, KALAMAZOO COUNTY 2009 25 21.6 20 15 10 8.8 8.8 6.7 5 0 LT $20,000 $20-34,999 $35-49,999 $50-74,999 $75,000+ 1.9 Source: Kalamazoo County Behavioral Risk Factor Survey, 2009-2010 9
Percentage Number of Hospitalization s 400 Ambulatory Care Sensitive Hospitalizations Due to Diabetes, Kalamazoo County 1991-2009 200 0 Source: Kalamazoo County Behavioral Risk Factor Survey, 2009-2010 14 12 10 Adult Diabetes Prevalence, Region 5 and Michigan 8 6 4 Region 5 Michigan 2 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Source: Michigan Department of Community Health, Region 5, 2011 10
Rate per 100,000 Population 200 180 160 140 120 100 80 60 40 Age-Adjusted Diabetes-Related Mortality Rates, Region 5 and Michigan Total - Region 5 Black - Region 5 Total - Michigan Black - Michigan HP 2020 Diabetes-related Target White - Region 5 Hispanic - Region 5 White - Michigan 20 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Hispanic - Michigan Source: Michigan Department of Community Health, Region 5, 2011 11
Borgess Health Diabetic Data: The following charts represent Borgess data from fiscal year 2011 and 2012. The incidence of Diabetes as a primary and secondary diagnosis continues to increase on the inpatient admissions. Our outpatient visits have demonstrated a decrease in primary diagnoses, but note a significant increase in those have diabetes as a secondary diagnosis. Our ambulatory services are following this trend and plans are underway to increase both service and access to address this need. 2011-2012 Borgess Medical Center Diabetes Clinical Services Year Location Diagnosis Inpatient Visits Outpatient Visits FY2011 Borgess Medical Center Diabetes Primary 173 19,410 Diabetes 3,436 13,130 Secondary FY2012 Borgess Medical Center Diabetes Primary 190 17,374 Diabetes 3,708 17,945 Secondary Source: Borgess Medical Center, 2012 Borgess also tracks demographic data on the patients receiving care in our Diabetes Center. Tracking this data allows us to analyze the impact of social determinants on our patient population and assists us in planning future services and care. Borgess Diabetes Center Patient Demographic Analysis Gender: Male Female Marital Status: Single Married Divorced Widowed Separated Insurance: Medicaid Medicare 430 590 238 596 85 41 6 128 266 41.8% 57.35 23.1% 57.9% 8.3% 4.0% 0.6% 12.4% 25.9% 12
HMO Blue Cross Other None Race: White Black Hispanic American Indian Asian Other Occupation: Manual Professional Retired Unemployed Disabled Spoken Language: English Spanish Written Language English Spanish DM Type Type 1 Type 2 (Non-Insulin) Type 2 (Insulin) Gestational Impaired Glucose Tolerance CFRD Pre-Diabetes (age > 18) Other 3 323 284 22 865 103 25 7 5 14 254 186 196 72 44 991 4 991 4 194 438 265 95 2 1 4 11 Source: Borgess Diabetes Center, 2011 0.3% 31.4% 27.6% 2.1% 84.1% 10.0% 2.4% 0.7% 0.5% 1.4% 24.7% 18.1% 19.0% 7.0% 4.3% 96.3% 0.4% 96.3% 0.4% 18.9% 42.6% 25.8% 9.2% 0.2% 0.1% 0.4% 1.1% 13
Percentage Focus Area, Obesity: Obesity Incidence in Kalamazoo County: According to 2009 self-reported weight and height measurements used in body mass index (BMI) calculations, 26.0% of Kalamazoo County adults were obese, 32.2% were overweight but not obese, and 41.8% were not overweight or obese. (A BMI of 30.0+ is considered obese, a BMI of 25.0+ but less than 30.0 is considered overweight, and a BMI less than 25.0 is considered to be not overweight or obese.) The prevalence of obesity varied across age groups in Kalamazoo County. The rate of obese or overweight adults was highest among those aged 25 years and over (almost twice as high as the rate among those aged 18 to 24 years). The rate of obesity was highest among the 35-44 age group. The age group with the greatest proportion of the population that was overweight or obese was 45-54 year olds (81.0% were overweight or obese). The rate of overweight and obesity was similar across educational and income levels. Source: Kalamazoo County 2009 Behavioral Risk Factor Survey 75 Prevelance of Overweight and Obesity Among Adults 20 Years and Older, Region 5 and Michigan 70 65 60 55 Region 5 Michigan 50 45 40 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Source: Michigan Department of Community Health, Region 5, 2011 14
Borgess Obesity Data: Borgess has begun tracking obesity data on both its inpatient and outpatient primary and secondary diagnosis codes. There has been a dramatic increase noted in morbid obesity affecting hospitalization and ambulatory visits. We will continue to gather information and analyze its effect on our patient population. 2012 Borgess Medical Center Obesity/Morbid Obesity Clinical Services Year Location Diagnosis Inpatient Outpatient Visits Visits FY 2012 Borgess Medical Center Obesity/Morbid 164 357 Obesity - Primary Obesity/Morbid 1,647 2,741 Obesity - Secondary Source: Borgess Medical Center, 2012 Frequency Distribution of Body Mass Index of Telephone Survey Respondents (n=451) Valid Percent Underweight 5.3% (Below 18.5) (24) Normal 28.8% (18.5-24.9) (130) Overweight 33.0% (25.0 29.9) (149) Obese 32.8% (30.0 and above) (148) Total 100% Source: 2012 Leadership for Healing, Catholic Health Assembly 15
Access to Care may have a correlation on Obesity rates as demonstrated below. Problem Area: Contributing Factors and Underlying Causes for Leading Problem Areas Social Determinants of Health Unaware of Resources or Services Insufficient Effective, Evidenced - Based Interventions Lack of Access to Providers Insurance, Reimbursement or Funding Access to X X X X Healthcare Obesity X X X X Source: Michigan Department of Community Health State Level Community Health Assessment, Region 5: August 25, 2011 Focus Area, Access to Care: From 2008 through 2010, the proportion of the total population that was uninsured (average per year) was similar in Kalamazoo County (10.6%) and in Michigan (11.7%) and lower in the county than in the United States (15%). Insurance coverage estimates among Kalamazoo County residents indicated that 14.7% of adults between the ages of 18 and 64 years old in the county were uninsured on average during 2008-2010. In Michigan during that same period, 16.9% of the adult population was uninsured. In Kalamazoo County 14.7% of the adult population equates to approximately 23,740 people between the ages of 18-64 with no health insurance. Among children less than 18 years of age, an estimated 4.0% or 2,271 were uninsured in Kalamazoo County on average from 2008-2010. A similar rate was observed throughout Michigan at 4.4%. Source: Kalamazoo County Health and Community Services 2011 16
Percentage 25 Percent Uninsured by Age Group: United States, Michigan, Kalamazoo County and City of Kalamazoo 2008-2010 20.4 20 16.9 18.3 15 14.7 10 8.7 5.3 4.4 5 4 0.9 0.4 0.3 0.2 0 under 18 years 18 to 64 years 65 years and older Source: American Community Survey (ACS 3-year estimates) 2008-2010 United States Michigan Kalamazoo County City of Kalamazoo 17
Percentage In Kalamazoo County educational level also impacts insurance coverage. Rates decrease with decreasing educational attainment. Approximately 15% of those without a college education age 25 and older are uninsured. That level drops to 5% with a bachelor s degree or higher. 35 Percent Uninsured Adults Age 25 Years and Older by Educational Attainment, United States, Michigan, and Kalamazoo County 2008-2010 30 25 20 15 United States Michigan Kalamazoo County 10 5 0 Less than high school graduate High school graduate, GED, or alternative Some college or Bachelor's degree associate's degree or higher Source: American Community Survey (ACS 3-year estimates) 2008-2010 18
Percent Employment status also impacts the uninsured, noting that the unemployed have a 35% uninsured rate and of those working part time, 20% are uninsured. 50 45 40 35 30 25 20 15 10 5 0 Percent Adults 18 Years and Older Uninsured by Employment Status and Work Experience, United States, Michigan and Kalamazoo County 2008-2010 13 35 6 9 20 8 United States Michigan Kalamazoo County Source: American Community Survey (ACS 3-year estimates) 2008-2010 for Kalamazoo County In Kalamazoo County in 2010, 29,997 or 97.5% of seniors age 65 and older were enrolled in Medicare. There were 7,276 disabled individuals younger than 65 also enrolled. Medicare Enrollees in Kalamazoo County by Eligibility, 2010 Disabled 20% Aged 80% Aged Disabled Source: U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS), Medicare County enrollment as of July 1, 2010 In 2011 the monthly average of persons enrolled in Medicaid in Kalamazoo County was 44,808. 19
Number of People Average Number of Persons Enrolled in Medicaid Only by Basis of Eligibility, Kalamazoo County 2011 10,000 9,000 8,697 8,000 7513 7,000 6,000 5432 5,000 4,000 3,000 2,000 1,000 2318 612 0 Pregnant women and children under 19 Families with dependent children Disabled Other children under 21 Aged 67 Blind Source: Department of Human Services, Program Statistics, 2011 Access to healthcare providers continues to be of concern. According to data obtained from the Family Health Center in Kalamazoo, approximately 35,000 people with Medicaid and 35,000 under and under-insured people do not have primary care providers. The Family Health Center has capacity to serve 40,000 patients, with a community need ranging approximately for 70,000 patients. This leaves 30,000 patients without access to any provider. Their assessment sites the following obstacles that patients encounter when trying to secure healthcare: providers are not open to new patients, providers will not accept people without insurance, practices are closed to Medicaid, and referrals to the Family Health Center. The Family Health Center is in the process of developing strategies for partnerships and access. A three year strategic planning retreat will explore these issues in June 2013. A community the size of Kalamazoo County should have approximately 103 primary care providers in Family Medicine which includes MDs, Dos and mid-levels. There also should be 57 Internists available to serve the current and projected population of Kalamazoo County.. Source: Family Health Center of Kalamazoo 20
Rate per 100,000 Population Workforce - Primary Care Physicians 140 120 100 80 Borgess Region 5 60 Michigan 40 20 0 Total Primary Care Physicians General Family Practice Internal Medicine Pediatrics OB/GYN Source: Michigan Department of Community Health, Region 5, 2011; Borgess Medical Center NEXT STEPS: The Community Benefit Advisory Committee has representation from a large segment of agencies/organizations that are striving to improve the health status of our county. The intention of committee members is to continue to meet and guide the implementation strategies for our three primary target areas of focus. As part of the implementation strategy, Borgess Health has also organized an internal Community Benefit task force that will be involved in the development of metrics, indicators and program support. Information and progress will be shared with the Community Benefit Advisory Committee. The committee will continue to collaborate, 21
review and address these priorities. BORGESS HEALTH SYSTEM OVERVIEW: A Legacy of Caring The Borgess legacy began nearly 125 years ago, in Kalamazoo, Michigan, when Bishop Caspar Borgess donated $5,000 from his mother s estate to establish a 20-bed hospital. One year later in 1889, eleven Sisters of St. Joseph arrived from Watertown, New York, to staff the hospital at the request of Monsignor O Brien. By the 1970 s, the original 20-bed hospital had grown into a tertiary care teaching center. Today, Borgess Medical Center, a part of Borgess Health, is a 422-bed regional referral center offering expertise in 30+ medical specialties including cardiovascular, neurosciences, orthopedics, vascular surgery, advanced robotic surgery, minimally invasive procedures, women s health and primary care. The Borgess Health network serves 10 counties in southwest and south-central Michigan with nearly one million residents through its 100-plus sites of care. These geographically dispersed sites of care include 3 owned hospitals, two affiliated hospitals, numerous primary care and specialty physician practices, a nursing home, a cancer center, and air ambulance service. A member of our nation s largest Catholic health system, Ascension Health, Borgess Health is also one of the region s largest employers with a staff of 4,296. Our Mission Borgess Health, as a Catholic health ministry rooted in the values of Ascension Health and its sponsors, is committed to providing holistic, spiritually centered care, which strives to improve the health of individuals in communities we serve with special attention to the poor and vulnerable. Our Vision By putting safety and quality at the core of all we do, Borgess Health will provide health care that is coordinated across the continuum based on meeting the needs and expectations of the patients we serve. Our Values We are called to: Service of the Poor - generosity of spirit, especially for persons most in need Reverence - respect and compassion for the dignity and diversity of life Integrity - inspiring trust through personal leadership Wisdom - integrating excellence and stewardship Creativity - courageous innovation Dedication - affirming the hope and joy of our ministry 22
Our Guiding Principles Your care will be safe. We know who you are and are ready for you We will see you when you want to be seen You will know what to expect We will be your trusted partner in health We will exceed your expectations We will coordinate your care The Borgess Health Service Area Situated in southwest Michigan, halfway between Chicago and Detroit, Kalamazoo County is home to Stryker Medical, one of the world s leading medical technology companies, and a large manufacturing division of Pfizer Pharmaceuticals. Kalamazoo also enjoys the presence of Western Michigan University, the state s fourth-largest public university that includes a school of nursing and a privately funded medical school named W-Med; Kalamazoo College, one of the oldest private schools in the country; as well as Kalamazoo Valley Community College with nursing and medical technician programs. 23
Borgess Health Primary, Secondary and Tertiary Service Areas BORGESS HEALTH CONTINUUM OF CARE FACILITIES: Borgess Medical Center a 422-bed tertiary care hospital and flagship of Borgess Health with a continuum of health services from a Level I Trauma Center to primary and specialty care practices throughout southwest Michigan. The majority of Borgess Health inpatient and outpatient services are provided at Borgess Medical Center. Borgess-Pipp Hospital a 43-bed long-term acute care hospital with an emergency department, diagnostics, rehabilitation services and an affiliated primary care practice. Borgess-Lee Memorial Hospital a critical care access hospital with 25 swing beds, an emergency department, rehabilitation services, diagnostics, outpatient surgery, and owned primary care practices. Borgess at Woodbridge Hills a large ambulatory care facility with an immediate medical care center, an endoscopy and outpatient surgery center, diagnostics, rehabilitation services, pharmacy and two large primary care practices. Borgess Gardens a 101-bed skilled nursing and short-stay rehabilitation facility. Borgess Medical Group a multidisciplinary group of 114 physicians and 71 midlevel providers with practice locations throughout southwest Michigan (excludes hospital based). 24
Reverence Home Health & Hospice a statewide home health and hospice organization offering immunization clinics, home health services, in-home rehabilitation services and more. Borgess Health & Wellness Programs a service of Borgess Health offering community health screenings and educational programs including some free screenings and events. 2012 Borgess Health Key Statistics 591 Licensed Beds 543 Available Beds 21,779 Discharges 231 ADC 4.4 ALOS 75,882 ER Visits 1,258 Births 5,563 Inpatient Surgeries 8,211 Outpatient Surgeries 128,649 Patient Days 88.5 Borgess-employed Primary Care 25
Physicians and Mid-levels (excludes hospital-based) Borgess-employed Specialty 96.8 Physicians and Mid-levels (excludes hospital-based) 348,102 PCP Visits 254,027 Specialty Visits Source: Borgess Medical Center, 2012 26
IMPLEMENTATION PLAN STRATEGY FOR FISCAL YEAR 2013: PROCESSS AND PLAN OVERVIEW: Borgess Health s priority focus identification and implementation strategy were developed based on the findings established by the Community Benefit Advisory Committee, the CHNA, our strengths, strategic direction and a review of our health system s existing community benefit activities. The following is a summary of the activities and objectives that have been accomplished and will continue to be assessed as we determine actions. 1. Community Benefit Advisory Committee re-established 2. Community defined as Kalamazoo County 3. Review of data and expert input on community needs 4. Identification and discussion on community health needs 5. Three areas of focus identified Diabetes Obesity Access to Care 6. Presentation of Community Benefit work and approval of focus priorities from Borgess Health Board 7. Establishment of Borgess internal committee to oversee CHNA work 8. Internal and external support of the Community Benefit process and plan 9. Develop Implementation Plan based on resources Ensure integration of Community Benefit Plan in Borgess Health strategy Prioritize and recommend strategies and tactics to address focus areas Assess appropriate resources needed Develop measures of success for focus priorities 10. Assessment and Implementation Plans presented and approved by Borgess Health Board and Strategic & Financial Planning Committee. 11. Ensure compliance with federal and state guidelines, regulations and filings 12. Annual status report developed and reported to Borgess Health Board 27
BORGESS HEALTH GOALS, OBJECTIVES AND PLANS: DIABETES The following graphs demonstrate the percentages of diabetics seen within Borgess Health. We track demographic data, type of diabetes, age distribution and the uninsured that we serve. We also track and assure that all Borgess Health practices monitor and collect data on their diabetic patients. We are involved in a variety of quality programs to improve the care we render to diabetics in our community. Demographic Distribution Physician Practice DSME Kalamazoo County Male 48.2% 41.1% 51% Female 51.8% 58.3% 49% White 79.9% 81.4% 81.9% African Amer. 9.5% 11.3% 14% Other 10.6% 6.1% 4% Type 1 ~19% 16% 5-10% Type 2 ~81% 72.5% 90-95% GDM 8.3% Diabetic Age Distribution Source: Borgess Health, 2012 Physician Practice DSME <18 2.2% 1.5% 19-44 28.6% 23.3% 45-65 59.4% 50.7% >65 11% 24.5% 28
Physician Practice Groups Diabetes Uninsured Clinic Demographics Male 46.7% Female 53.3% 19-44 years 33.1% 45 65 years 65.2% >65 1% White 77% African American 14.6% Source: Borgess Health, 2012 Diabetes Measure Patient Visits 1/31/12 through 2/1/13 BMG Overall BFM-G BFM-L BFM-P BIM-Columbia BIM-Currier BIM-G BIM-NP ProMed-MW ProMed FP-Richland ProMed-Three Rivers ProMed FP-WB ProMed Peds-Richland ProMed Peds-WB 80% 94.30% 98% 92.60% 96.30% 100% 93% 97.10% 94.10% 97.20% 96.10% 94.20% 92.90% 100% 0% 20% 40% 60% 80% 100% 120% Percentage Source: Borgess Health, 2013 Definition: number of patients ages 18-75 (pediatrics of all ages) with an Office Visit in the last 12 months, divided by the patient count in the specified timeframe. 29
ACTION PLAN FOR DIABETES: Identified as a community health need and as a condition that affects a large cross section of the population in Kalamazoo County, diabetic care continues to be a priority. Borgess Health will continue to advance our Diabetic Center and Diabetes Self-Management Education Services throughout the county, providing both preventative and treatment services. Our Diabetic Center will lead, participate, implement and remain involved in a variety of activities, coalitions, and health education opportunities. We anticipate adding additional providers to meet the increasing demand of diabetic care in our community. Goal: Borgess Health will increase educational opportunities and patient access (visits) that address the needs of diabetic patients. Borgess will continue to provide and strengthen its quality diabetic care, educational support services and specific appointment opportunities that address prevention and treatment modalities. Objective: The Diabetic Self Education Service and Diabetes Center will increase the availability of diabetic care within Kalamazoo County. Implementation Strategies: Develop and deliver educational support services to the community that address and, provide education on insulin and insulin pumps and prevention and treatment courses. Advance Borgess Health quality initiatives for diabetic management in primary care and specialty practices. Expand shared medical appointments to increase access within Borgess Health Diabetic Center for new patient visits, follow up visits, insulin pump instruction and thyroid complications. Explore partnership opportunities with other community providers to address the diabetic population needs. Host an educational symposium for health care providers addressing management of diabetes. Continue to sponsor community events/campaigns that increase and raise awareness concerning the importance of prevention and treatment of diabetes. Explore sponsorship, grants and events that support care for the uninsured diabetic. Expand and recruit additional providers for the Borgess Diabetic Center. 30
OBESITY: ACTION PLAN FOR OBESITY: Identified as a community health need and a condition that impacts Kalamazoo county residents as a contributor to the development of chronic disease conditions, Borgess Health will continue to develop, participate and enhance its services to address obesity and obesity related complications. According to a study in the American Journal of Preventative Medicine, scientists predict that nearly half the population in the U.S. will be obese or overweight by 2030. This rise in obesity also means a rise in healthcare related costs, potentially a shorter life span and an increase in disease related conditions. We intend to enhance and advance our Borgess Medical Weight Loss Program and Bariatric services in order to address obesity in our county. Obesity affects life styles, is linked to other health factors such as diseases, nutrition, access to healthy foods, physical activity, chronic conditions, mental health and mortality. We recognize that obesity is a multi-generational issue and requires a multi-dimensional and holistic approach in order to impact cultural and societal change. Borgess intends to address obesity by the development of programs, educational opportunities and services that will meet these issues. Goal: Borgess will continue to strengthen their obesity-related services provided to the community, by advancing medical care, increasing access to patients, educational programs, community sponsored events, and participation in community opportunities. Objective: Borgess Medical Weight Loss and Bariatric Services will increase its visibility and availability. Implementation Strategies: Explore partnerships with community agencies on initiatives that support healthy nutrition, physical activity and educational programs. Assure Borgess Health participation and outreach at community Health Fairs, screenings, etc. Implement and expand group visits/shared medical appointments for obesity and obesity related conditions. Promote Borgess Medical Weight Loss and Borgess Bariatrics to Borgess internal audience (associates) as well as provide education and information to our Primary Care physicians. Promote employee wellness incentives internally and with other community employers, addressing exercise, nutrition and healthy food choice options. 31
Support Farmer s market opportunities internally and in the community. Enhance Borgess fitness Center memberships for the community, develop and offer community classes on weight control, cooking and healthy eating. Continue to sponsor annual Run for the Health of it and increase participants and awareness. Attain and maintain Center of Excellence certification: ASMBS accredited. Expand access and visits for Borgess Medical Weight Loss program. Participate in Michigan Bariatric Collaborative research project. Provide outreach community services in the area of education, support groups, cooking and exercise classes. Enhance web site access and information for public Self-Reported Obesity Among U.S. Adults in 2011 No state had a prevalence of obesity less than 20% Eleven states and the District of Columbia had a prevalence between 20-<25% Twelve states (Alabama, Arkansas, Indiana, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Oklahoma, South Carolina, Texas, and West Virginia) had prevalence equal to or greater than 30%. Source: http://www.cec.gov/obesity/data/adult.html Kalamazoo Data Weight Status Among Adults o Obese 26% o Overweight 32% o Not Overweight 42% 32
100% Diabetic Patient Population Obesity Level 80% 60% 62.0% Normal 52.3% Overweight 40% Obese No Value Recorded 20% 22.0% 18.6% 22% 0% 8% 8.0% 7.1% FY12 (N = 7362) FY13 (N = 8068) Borgess data 2012-2013 related to Diabetes from patients seen either by a Primary Care or Specialty Provider from Borgess Medical Group. We will continue to monitor data annually on Diabetes, CAD, CHF, and Asthma. 33
100% CAD Patient Population Obesity Level 80% 60% 40% 20% 0% 48.2% 37.5% 32.9% 25.4% 22.8% 17.0% 14.3% 1.9% FY12 (N = 4596) FY13 (N = 5170) Normal Overweight Obese No Value Recorded Borgess data 2012-2013 related to CAD from patients seen either by a Primary Care or Specialty Provider from Borgess Medical Group. 34
100% CHF Patient Population Obesity Level 80% 60% Normal 40% 51.7% 42.6% Overweight Obese No Value Recorded 20% 0% 27.6% 23.8% 17.7% 15.6% 18.0% 3.0% FY12 (N = 995) FY13 (N = 1266) Borgess data 2012-2013 related to CHF from patients seen either by a Primary Care or Specialty Provider from Borgess Medical Group. 35
100% Asthma Patient Population Obesity Level 80% 60% Normal Overweight 40% 37.3% 45.8% Obese No Value Recorded 20% 0% 24.7% 26.8% 21.9% 16.1% 12.7% 14.7% FY12 (N =4106) FY13 (N =4783 ) Borgess data 2012-2013 related to Asthma from patients seen either by a Primary Care or Specialty Provider from Borgess Medical Group. 36
ACCESS TO CARE IN KALAMAZOO COUNTY Hospitals bring experience in the care and treatment of the community population that is marginalized. Borgess Health is committed to providing care to the poor and vulnerable and plays a role in bringing needed perspective to the health equity perspective. We are committed to better-organized systems of care and recognize that lack of access must be tackled from the community perspective. The following graphic depictions demonstrate Borgess contribution as the assistance we provide for access to care in fiscal year 2012. We anticipate that these trends will continue to increase in the upcoming years. Borgess will continue to provide resources for patients with access needs. Our Mission assures that we are invested in this area. FY 12 Borgess Community Assistance for Access to Care* $20,662 $650 $8,439 Discounted Equipment & Supplies Discounted/Free Prescription Drug Program Transportation- Ambulance/Wheelchair Van $24,419 Transportation - Taxi Transportation - Bus $3,995 Source: Borgess Health, 2012 37
FY 12 Borgess Community Referrals for Access to Care* 9 53 Free Clinic Referrals PCP Procurement for Uninsured Prescription Assistance Programs 163 95 Misc. Basic Needs *Represents 320 individuals referred for services in FY 2012 Source: Borgess Health, 2012 Borgess employs 88.5 primary care physicians and mid-levels under the Borgess Medical Group and 96.8 specialty physicians and mid-levels (excludes hospital based). We serve the community by providing 348,102 primary care visits and 254,027 specialty visits annually. The following graph demonstrates the increasing trend in patient visits. The providers include those who work in primary care, internists, pediatrics and a variety of specialists and sub-specialists. Our visits continue to increase and we are actively recruiting new providers to our system as we anticipate this trend to grow in the upcoming years. Our medical staff development plan would indicate a need for 20 and 28 family medicine and internal medicine physicians, respectively, by 2014 to meet current needs and anticipated retirements. We are currently updating the medical staff development plan. 38
$18,000 $16,000 $15,842 $17,584 Borgess Medical Center Care of The Poor $14,000 $12,000 $11,209 $10,000 $9,623 $9,621 $8,772 FY11 $8,000 FY12 $6,000 $4,000 $2,000 $1,019 $937 $1,430 $1,100 $- Charity, at Cost Unpaid Cost of Public Prog Other Programs for the Poor Other Prog for the Gen Community B/D Attritutable to Charity 39
Percentage Borgess Medical Group Trend - Patient Visits 100.00% 90.00% 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% 87.60% 87.20% 89.60% 94.30% FY 11 FY 12 Aug-12 Jan-13 Source: Borgess Health, 2012 ACCESS TO CARE ACTION PLAN: Goal: Ensure that the community has access to affordable healthcare and healthcare services, including care for the uninsured, under-insured and working poor. Objective: Increase the number of persons/visits that identify with a primary care provider and specialty physician network. Develop strategies to increase the number of primary care providers in the community. Implementation Strategies: Adopt Revisions to Ascension Health policy 16 which provides guidelines for assistance to persons who are under-insured. Continue to explore and pursue strategic partnerships/relationships to meet regional health care needs (Family Health Center, W-Med and Bronson). Increase the number of Borgess Health Primary care providers over a 3 year period (FY'13-'16) within the Borgess Medical Group. Expand Ambulatory Network and geographic presence. Continue the work between Borgess Advocacy representatives and local Michigan legislators on Medicaid expansion in Michigan, Develop web based resources that facilitate access for patients, such as on-line appointments, medical questions and answer services and education registration capabilities. 40
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