Community Benefit 2018 Report and 2019 Plan Mercy Medical Center Community Benefit FY 2018 Report...

Mercy Medical Center Merced, California

Community Benefit 2018 Report and 2019 Plan

Mercy Medical Center Community Benefit FY 2018 Report and FY 2019 Plan 1


TABLE OF CONTENTS At-a-Glace Summary Mission, Vision, and Values Page 5 Our Hospital and the Community Served Page 6 Community Benefit Planning Process

Community Health Needs Assessment Page 9 CHNA Significant Health Needs Page 9

Creating the Community Benefit Plan Page 10 2018 Report and 2019 Plan Report and Plan Summary Page 12 Community Grants Program Page 16 Anticipated Impact Page 16 Planned Collaboration Page 16 Financial Assistance for Medically Necessary Care Page 17 Program Digests Page 18 Economic Value of Community Benefit Page 26 Appendices Appendix A: Community Board and Committee Rosters Page 27 Appendix B: Other Programs and Non-Quantifiable Benefits Page 28 Appendix C: Financial Assistance Policy Summary Page 29


At-a-Glance Summary Community Served

Merced County is located in the heart of the San Joaquin Valley and spans from the coastal ranges to the foothills of Yosemite National Park. The county encompasses 1,934.46 square miles with a population density of 133.74 per square mile. The county is predominantly urban, with 85.7% of the population living in areas designated as urban. The City of Merced is the County seat and is the largest of the six incorporated cities. County and City municipalities are a major source of employment along with agricultural related industries, retailing, manufacturing, food processing and tourism.

Economic Value of Community Benefit

$8,582,961 in patient financial assistance, unreimbursed costs of Medicaid, community health improvement services, community grants and other community benefits $26,189,936 in unreimbursed costs of caring for patients covered by Medicare

Significant Community Health Needs Being Addressed

The significant community health needs the hospital is helping to address and that form the basis of this document were identified in the hospital’s most recent Community Health Needs Assessment (CHNA). Those needs are: Access to Health Care

Services Cancer Diabetes Infant Health & Family

Planning

Nutrition, Physical Activity & Weight Heart Disease & Stroke Respiratory Diseases

FY18 Actions to Address Needs

Chronic Disease Self-Management Program; a six week curriculum developed by Stanford University, taught in English and Spanish

Labor of Love & Lactation; an eight week program to help pregnant moms prepare for delivery and learn about baby care and baby nutrition.

Live Well with Diabetes; a weekly support group with diabetes education and offered in English and Spanish.

Mercy Cancer Center Community Programs; this program includes a monthly cancer support group meeting, help with transportation, a wig service and educational materials.

Diabetes Self-Management Program; a six week curriculum developed by Stanford University, taught in English and Spanish.

Stroke Support and Educational Program; offers support to persons who have had a stroke and to their families. Educational seminars are given quarterly.

Mercy Yoga and Zumba Classes; weekly yoga and Zumba classes offered to the community at no cost.


Planned Actions for FY19

All of the FY18 programs will continue into FY19 with the intention of them continuing on for the next three years. In addition to the current community programs three new programs will be added in FY19; “Walk with Ease”, a six week program targeting people with arthritis, “Asthma Self-Management Program” a partnership with CA Department of Public Health to provide asthma education, “Baby Café” a support group for new mothers with a focus on breastfeeding and postpartum depression.

This document is publicly available at mercymercedcares.org and on the Dignity Health website. Community members of the Mercy Community Board and the Community Advisory Committee are given a presentation of an overview of the report. The local newspaper informs the community that if they would like a copy sent either electronically or hard copy, they are to make a request to the hospital’s Community Benefit office by calling 209.564.5007. Written comments on this report can be submitted to the Mercy Medical Center‘s Community Health Office, 333 Mercy Avenue, Merced California or by e-mail [email protected].


MISSION, VISION AND VALUES Mercy Medical Center is part of Dignity Health, a non-profit health care system made up of more than 60,000 caregivers and staff who deliver excellent care to diverse communities in 21 states. Headquartered in San Francisco, Dignity Health is the fifth largest health system in the nations. At Dignity Health, we unleash the healing power of humanity through the work we do every day, in hospitals, in other care sites and in the community. Our Mission We are committed to furthering the healing ministry of Jesus. We dedicate our resources to: Delivering compassionate, high-quality, affordable health services; Serving and advocating for our sisters and brothers who are poor and disenfranchised; and Partnering with others in the community to improve the quality of life.

Our Vision A vibrant, national health care system known for service, chosen for clinical excellence, standing in partnership with patients, employees, and physicians to improve the health of all communities served.

Our Values Dignity Health is committed to providing high-quality, affordable healthcare to the communities we serve. Above all else we value:

Dignity - Respecting the inherent value and worth of each person. Collaboration - Working together with people who support common values and vision to achieve shared goals. Justice - Advocating for social change and acting in ways that promote respect for all persons. Stewardship - Cultivating the resources entrusted to us to promote healing and wholeness. Excellence - Exceeding expectations through teamwork and innovation.


OUR HOSPITAL AND THE COMMUNITY SERVED

About Mercy Medical Center

Mercy Medical Center (MMC) is a 186-bed acute care, religious-sponsored, not-for-profit hospital located in the city of Merced, California. MMC is a member of Dignity Health, a family of over 60,000 caregivers and staff. On May 2, 2010 MMC moved into a brand new 262,000 square foot facility on Mercy Avenue. MMC has a staff of more than 1,300 and professional relationships with more than 250 local physicians. MMC opened on May 2, 2010 and employs over 1,300 people, making it one of the largest employees in Merced County. MMC has a professional relationship with more than 250 local physicians. Major programs and services include: one licensed acute care facility with a family birthing center, intensive care unit, emergency care and four floors housing, telemetry and medical/surgical nursing units. There are three outpatient facilities, Mercy UC Davis Cancer Center, Mercy Outpatient Center and the Mercy Medical Pavilion. Services at these outpatient centers include home care, physical and cardiac rehabilitation, ambulatory surgery, cancer care, laboratory, imaging and endoscopy. MMC primary service area includes Merced, Atwater, Winton and Planada for a total of 160,215 residents in Merced County. Secondary service areas include Los Banos, Livingston, Dos Palos, Chowchilla, Le Grand and Mariposa totaling 104,122 lives. MMC operates three rural health clinics that are part of the UC Davis Family Practice Residency Program. All three clinics patient population is primarily Medi-Cal patients. The clinics are; Family Care a primary care clinic, Kids Care a pediatric clinic and General Medicine Clinic a specialty clinic. Description of the Community Mercy Medical Center’s primary service area is comprised of the communities of Merced, Atwater, Winton and Livingston. There is only one other hospital in the county, Memorial Los Banos, a Sutter Health affiliate that is a 44-bed facility with basic emergency services. A summary description of the community is below, and additional details can be found in the CHNA report online. The city of Merced is the County seat and is the largest of the six incorporated cities in the county. Merced County is ranked 53rd among 58 California counties on social and economic health factors (including income, poverty unemployment, education and other factors) by County Health Rankings. Data gathering and reporting has shown poverty to be a chronic and pervasive reality affecting all aspects of healthy living. Merced County’s poverty rate is significantly higher for persons under the age of 18. It is important to understand the age distribution of the population as different age groups have unique health needs which should be considered separately from other along the age spectrum.


Demographic indicators provided by Truven Health Analytics LLC Total Population: 158,946

White – Non Hispanic: 28.3% Black/African American: 4.1% Hispanic or Latino: 54.8% Asian/Pacific Islander: 9.7% All Others: 3.2%

Median Income: $45,347 Unemployment: 8.1% No High School Diploma: 27.6% Medicaid* 46.7% Uninsured: 14.2%

*Does not include individual’s dually-eligible for Medicaid and Medicare.


One tool used to assess health needs is the Community Need Index (CNI) created and made publicly available by Dignity Health and Truven Health Analytics. The CNI analyzes data at the zip code level on five factors known to contribute be a barriers to health care access: income, culture/language, education, housing status, and insurance coverage. Scores from 1.0 (lowest barriers) to 5.0 (highest Barriers) for each factor are averaged to calculate a CNI score for each zip code in the community. Research has shown that communities with the highest CNI scores experience twice the rate of hospital admissions for ambulatory care sensitive conditions as those with the lowest scores.

Lowest Need

Highest Need 1 - 1.7 Lowest 1.8 - 2.5 2nd Lowest 2.6 - 3.3 Mid 3.4 - 4.1 2nd Highest 4.2 - 5 Highest

Zip Code CNI Score Population City County State

95301 4.6 40290 Atwater Merced California

95340 4.6 36434 Merced Merced California

95341 5 35085 Merced Merced California

95348 4.8 33501 Merced Merced California

95388 4.8 13636 Winton Merced California

© 2018 Dignity Health

5 km Map data ©2018 Google


COMMUNITY ASSESSMENT AND PLANNING PROCESS

The hospital engages in multiple activities to conduct its community benefit and community health improvement planning process. These include, but are not limited to: conducting a Community Health Needs Assessment with community input at least every three years; using five core principles to guide planning and program decisions; measuring and tracking program indicators; and engaging the Mercy Medical Center Community Advisory Committee and other stakeholders in the development and annual updating of the community benefit plan. Community Health Needs Assessment The significant needs that form the basis of the hospital’s community health programs were identified in the most recent Community Health Needs Assessment (CHNA, which was adopted in April 2015). In 2018 a new CHNA is being conducted and will be reported in the next community health annual report. The hospital conducts a CHNA at least every three years to inform its community health strategy and program planning. The CHNA report contains several key elements, including:

Description of the assessed community served by the hospital; Description of assessment processes and methods, including: how the hospital solicited and took

into account input from a public health department, members or representatives of medically underserved, low-income and minority populations; and the process and criteria used in identifying significant health needs and prioritizing them;

Presentation of data, information and assessment findings, including a prioritized list of identifies significant community health needs;

Community resources (e.g., organizations, facilities and programs) potentially available to help address identified needs; and

Discussion of impacts of actions taken by the hospital since the preceding CHNA. CHNA Significant Health Needs The community health needs assessment identified the following significant community health needs:

Access to Healthcare Services; Insurance instability, barriers to access, primary care physician ratio.

Cancer; Cancer deaths, Cancer incidence including lung and cervical, female breast cancer and colorectal cancer screening

Dementia, Including Alzheimer’s deaths Diabetes; diabetes ranked #2 as a major problem in the Online Key Informant Survey Heart Disease & Stroke; ranked #5 as a major problem in the Online key Informant Survey Immunization & Infectious Diseases; Hepatitis B vaccination Infant Health & Family Planning; prenatal care, teen births Injury & Violence; motor vehicle crash deaths, firearm-related deaths, homicide deaths and

violent crime rate Mental Health; symptoms of chronic depression, suicide deaths, seeking help for mental health,

ranked #1 as a major problem in the Online Key Informant Survey


Nutrition, Physical Activity and Weight; low healthy food access, overweight & obesity adult and children, moderate physical activity, access to recreation/fitness facilities, ranked #3 as a major problem in the Online Key Informant Survey

Potentially Disabling Conditions; sciatica/back pain, blindness/vision trouble Respiratory Diseases; CLRD, COPD Substance Abuse; cirrhosis/liver disease deaths, drug-induced deaths, seeking help for

alcohol/drug issues, ranked #4 as a major problem in the Online Key Informant Survey Health education was selected as a priority to address prevention of disease, to empower community members to assume responsibility for their health and to educate people about various medical conditions and the ability they have to make wise choices. MMC is addressing, as indicated in the “Digest Progress” section of this report, the following identified “areas of opportunity”: access to health services; cancer; diabetes; heart disease & stroke; immunization & infectious diseases; infant health; mental health; respiratory diseases; nutrition, physical activity and weight. Areas of opportunity that are identified but not being addressed by MMC are: family planning, dementia including Alzheimer’s death; injury and violence; potentially disabling conditions and substance abuse. Services for these health priorities are being provided in the community by other entities and MMC does not have expertise in these areas. Creating the Community Benefit Plan Rooted in Dignity Health’s mission, vision and values, Mercy Medical Center is dedicated to improving community health and delivering community benefit with the engagement of its management team, Community Board and the Community Advisory Committee. The board and committee are composed of community members who provide stewardship and direction for the hospital as a community resource (see Appendix A). These parties review community benefit plans and programs updates prepared by the hospital’s community health director and other staff. As a matter of Dignity Health policy, the hospital’s community health and community benefit programs are guided by five core principles. All of our initiatives relate to one of more of these principles:

Focus on Disproportionate Unmet Health-Related Needs Emphasize Prevention Contribute to a Seamless Continuum of Care Build Community Capacity Demonstrate Collaboration

Mercy Medical Center’s community health programs reflect our commitment to improve the quality of life in the community we serve. The Community Advisory Committee (CAC), Community Board, Mercy Administration along with key management staff provides oversight and policy guidance for all charitable services and activities supported by the hospital. The people on these committees and boards represent a health professionals as well as community residents. This group reviews the CHNA to determine that MMC’s community health programs are addressing identified needs. The CAC members


meets on a quarterly basis and the Community Board meets monthly. Identified needs are also reviewed by the Mercy Foundation to determine their philanthropic strategies. A rooster of members in the CAC and Community Board is attached in Appendix A.


2018 REPORT AND 2019 PLAN

This section presents strategies and program activities the hospital is delivering, funding or on which it is collaborating with others to address significant community health needs. It summarizes actions taken in FY18 and planned activities for FY19, with statements on anticipated impacts, planned collaboration, and patient financial assistance to address access. Program Digests provide detail on select programs’ goals, measurable objectives, expenses and other information. The strategy and plan specifies planned activities consistent with the hospital’s mission and capabilities. The hospital may amend the plan as circumstances warrant. For instance, changes in significant community health needs or in community assets and resources directed to those needs may merit refocusing the hospital’s limited resources to best serve the community. Strategy and Program Plan Summary

Health Need: Access to Healthcare Services Strategy or Activity Summary Description

Active FY18

Planned FY19

Family Practice Clinic

Clinic is in affiliation with UC Davis Residency program. Serves primarily Medi-Cal patients and the underinsured.

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Kids Care Pediatric Clinic

Pediatric and obstetric clinic with OB services provided by contracted physicians from Merced Faculty Associates. Primarily serves managed Medi-Cal patients.

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General Medicine Clinic

Clinic to provide rotating specialty physicians who see poor, underinsured and working poor individuals.

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Patient Financial Assistance Program

Financial assistance available to uninsured or underinsured patients.

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Community Medical Academy

A program in middle schools and high schools to stimulate interest in the medical field to the students in Merced County.

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Anticipated Impact: Provide well medicine to patients to prevent future illness and to treat medical needs of the uninsured and underinsured population of Merced County. By being more involved with schools, students will be interested in pursuing a career in medicine and stay to practice in Merced County.


Health Need: Cancer Strategy or Activity Summary Description

Active FY18

Planned FY19

Mercy UC Davis Cancer Center

Provides quality oncology care to the community. Partners with the American Cancer Society for various outreach programs and support services.

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American Cancer Society

The Collaborative Action Plan is a partnership with ACS and the cancer center to provide these three programs: Look Good, Feel Better; Wig Bank; I Can Cope.

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Cancer Support Group

Meets monthly at the cancer center, is facilitated through Mercy Spiritual Services and is open to any person affected by cancer, patient or family member, regardless of where they receive treatment.

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Massage Therapy Occurs after the support group meets, providing 15 minute massage by certified massage therapist to cancer patients to help decrease stress, anxiety, pain and fatigue.

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Anticipated Impact: Cancer patients given high quality care without having to leave Merced County. Cancer patients and their families will feel less stressed, will feel supported with the needed resources to help them cope while going to their oncology treatments.

Health Need: Diabetes Strategy or Activity Summary Description

Active FY18

Planned FY19

Chronic Disease Self -Management Program

A six week comprehensive, outcomes-based program developed by Stanford University which includes education and action planning for participants living with a chronic disease.

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Diabetes Classes Weekly diabetes education classes in English and Spanish. Classes provide the opportunity for participants to bond and offer each other support.

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Diabetes Self-Management Program

A six week comprehensive, outcomes-based program developed by Stanford University which includes education and action planning for participants living with diabetes.

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National Diabetes Prevention Program

Partnership with the Center for Disease Control offering participants to join a year-long lifestyle coach program.

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Anticipated Impact: Help diabetes patients manage their diabetes and to help pre-diabetic individuals prevent the onset of the disease.


Health Need: Heart Disease & Stroke Strategy or Activity Summary Description

Active FY18

Planned FY19

Certified Stroke Hospital

As a certified primary stroke center there is a dedicated stroke program focused on bringing high quality care to our community. The Stroke Center is certified by the Joint Commission and is staffed by qualified medical professionals trained in the care of the patient suffering from a stroke. The program focuses on high quality individualized care to meet the needs of our patients and improve the patient outcomes.

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Stroke Telemedicine The telemedicine for the treatment of stroke helps to bring highly specialized care to our community. It brings immediate access to Board Certified Neurologists who offer lifesaving medical care when time and treatment is of the highest importance.

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Cardiac Rehab Physical therapy for individuals with heart disease ☒ ☒ Stroke Support & Resource Class

Meets quarterly to offer individuals information on preventing another stroke, coping with disabilities after a stroke and help for caregivers.

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Anticipated Impact: To provide the community education about the signs and symptoms of a stroke so that potential stroke patients are brought to the ED as quickly as possible. For stroke patients and patients with heart disease programs will help them to manage their challenges as they cope with their lifestyle changes. Families of stroke and heart disease patients will feel less stressed and will learn about the resources available to them and the patients.

Health Need: Nutrition, Physical Activity and Weight Strategy or Activity Summary Description

Active FY18

Planned FY19

STEPS A joint replacement education program; how to prepare for joint replacement, stay in hospital, recovery exercise, nutrition & home environment. Offers a walking club and is open to any individual who has had a joint replacement. Program is offered in English and Spanish.

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Zumba Community Zumba classes offered twice a week to any adult individuals in the community. Dance exercise.

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Yoga Exercise classes one time a week for adults to increase balance, strengthen muscles, relieve stress, and to help maintain flexibility.

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School Outreach Program

Community Health Educators visits to local schools providing speakers to address with students, weight management, good nutrition and importance of physical activity.

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Family Health Festival & 5K Stroke Awareness Run

An annual event with over 40 vendors providing health information, screenings and physical activities.

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Walk with Ease In Collaboration with the City of Merced Parks and Recreation and the Arthritis Foundation to provide a six week program that targets people with arthritis.

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Anticipated Impact: Community members will become more active, learn to manage their weight, better understand nutritional needs and encourage others to do the same.

Health Need: Respiratory Diseases Strategy or Activity Summary Description

Active FY18

Planned FY19

Asthma Coalition Mercy is a partner on the coalition and the steering committee. Participates in World Asthma Day and community health fairs.

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Smoking Cessation Program

Future classes to help persons who smoke to stop by providing education, support and resources.

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Tobacco Coalition Mercy is a partner in the “education to the community” component of the coalition. Participates in community health fairs.

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Asthma Self-Management Program

In collaboration with the CA Department of Public Health to provide asthma education to persons with the condition to be better self-managers.

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Anticipated Impact: Community members will better understand how to manage their asthma. By providing education people will be less likely to start smoking and those that are smoking will hopefully stop.

Health Need: Community Classes Strategy or Activity Summary Description

Active FY18

Planned FY19

Childbirth Classes To help pregnant women and their support person to prepare and educate them on what to expect with childbirth.

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Lactation Classes Class covers the basics of breastfeeding: reasons to breastfeed, how to hold and latch your baby and how your support people can help.

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Breast Feeding Support Group

Child birth educator facilitates the support group which offers mothers who are breast feeding meet to help each other with the challenges they are having while breast feeding.

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Caesarian Class OB RN presents information to mothers to prepare them for their caesarian birth.

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Hmong Shaman Spiritual Healer

Six week long educational program designed for Shaman to learn about Western medicine and visit with hospital staff all in the efforts to bridge the understanding of the two cultures.

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Baby Café In collaboration with WIC, this support group will be for new mothers with a focus on breastfeeding and postpartum depression

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Spiritual Services 101 Twenty one hours of class for faith leaders to deepen their skill in ministry to the sick.

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Spiritual Services 102 Faith leaders who have completed SS 101 will take SS102 for additional training in order to become SS Volunteers.

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Anticipated Impact: Partnerships within the community are strengthened through our community classes.

Community Grants Program One important way the hospital helps to address community health needs is by awarding financial grants to non-profit organizations working together to improve health status and quality of life in the communities we serve. Grant funds are used to deliver services and strengthen service systems, to improve the health and well-being of vulnerable and underserved populations. In FY18, the hospital awarded two grants totaling $120,000. Below is a complete listing of FY18 grant projects; more description and FY19 plan is described in the Program Digest section of this report.

Merced Rescue Mission “HOPE Respite Care” $100,000 JMJ Maternity Home “Mary’s Mantle Home” $20,000

Anticipated Impact The anticipated impacts of the hospital’s activities on significant health needs are summarized above, and for select program initiatives are stated in the Program Digests on the following pages. Overall, the hospital anticipates that actions taken to address significant health needs will: improve health knowledge, behaviors, and status; increase access to needed and beneficial care; and help create conditions that support good health. The hospital is committed to measuring and evaluating key initiatives. The hospital creates and makes public an annual Community Benefit Report and Plan, and evaluates impact and sets priorities for its community health program in triennial Community Health Needs Assessments. Planned Collaboration MMC has engaged community-based partners representing the spectrum of agencies providing services vital to Merced County residents include: Merced Rescue Mission, Merced County Department of Public Health, Merced County Department of Mental Health, Central California Alliance for Health, Golden Valley Health Clinics, Asthma Coalition, Tobacco Coalition, American Cancer Society and the Livingston Community Health Center.


Financial Assistance for Medically Necessary Care Mercy Medical Center delivers compassionate, high quality, affordable health care and advocates for members of our community who are poor and disenfranchised. In furtherance of this mission, the hospital provides financial assistance to eligible patients who do not have the capacity to pay for medically necessary health care services, and who otherwise may not be able to receive these services. A plain language summary of the hospital’s Financial Assistance Policy is in Appendix C of this report. The hospital notifies and informs patients and members of the community about the Financial Assistance Policy in ways reasonably calculated to reach people who are most likely to require patient financial assistance. These include:

providing a paper copy of the plain language summary of the Policy to patients as part of the intake or discharge process;

providing patients a conspicuous written notice about the Policy at the time of billing; posting notices and providing brochures about the financial assistance program in hospital

locations visible to the public, including the emergency department and urgent care areas, admissions office and patient financial services office;

making the Financial Assistance Policy, Financial Assistance Application, and plain language summary of the Policy widely available on the hospital’s web site;

making paper copies of these documents available upon request and without charge, both by mail and in public locations of the hospital; and

providing these written and online materials in appropriate languages. The hospital notifies and informs patients about the Financial Assistance Policy by offering a paper copy of the plain language summary of the Policy to patients as part of the intake or discharge process. At the time of billing, each patient is offered a conspicuous written notice containing information about the availability of the Policy. Notice of the financial assistance program is posted in locations visible to the public, including the emergency department, billing office, admissions office, and other areas reasonably calculated to reach people who are most likely to require financial assistance from the hospital. The hospital provides brochures explaining the financial assistance program in registration, admitting, emergency and urgent care areas, and in patient financial services offices. The Financial Assistance Policy, the Financial Assistance Application, and plain language summary of the Policy are widely available on the hospital’s web site, and paper copies are available upon request and without charge, both by mail and in public locations of the hospital. Written notices, posted signs and brochures are printed and available online in appropriate languages.


PROGRAM DIGESTS

Dignity Health Community Grants Program Significant Health Needs Addressed

X Maternal/Infant Health X Diabetes X Mental Health X Nutrition, Physical Activity and Weight X Cancer

Core Principles Addressed X Focus on Disproportionate Unmet Health-Related Needs X Emphasize Prevention X Contribute to a Seamless Continuum of Care X Build Community Capacity X Demonstrate Collaboration

Program Description The grants program objective is to award grants to organizations that partner together and whose proposals respond to the priorities identified in the health assessment and/or the community plans of the hospital. Grant funds are to be used to provide services to underserved populations (economically poor; women and children; mentally or physically disabled; or other disenfranchised populations). Funding is from $20,000 up to $100,000.

Community Benefit Category

E1 Financial Contributions: Grants

FY 2018 Report Program Goal / Anticipated Impact

To distribute grants in the total of $129,886 to organizations or agencies meeting the grant requirements and whose proposal is approved by the Community Advisory Committee and the Dignity Health BOD Investment Committee. The grant recipients will improve the health status and quality of life of residents in need of their services who reside in Merced County.

Measurable Objective(s) with Indicator(s)

The approved grant recipients will complete an 18 month accountability report to measure objectives and indicators.

Intervention Actions for Achieving Goal

Once the Community Advisory Committee has reviewed the identified health need/opportunities reported in the 2015 CHNA, they will announce to the community that they will be accepting letters of intent. Emails were distributed to not-for-profit organizations in Merced County. A total of four letters of intent were received. The CAC reviewed the LOI’s and voted to allow three of the four to submit a full proposal. The CAC received two proposals, they then voted to recommend both of the proposals to the Dignity Health BOD Investment Committee for final approval.

Planned Collaboration Collaboration with Merced County non-profit agencies and the Community Advisory Committee.

Program Performance / Outcome

Both of the recommended proposals were approved by Dignity Health. Allocations for the 2018 grant amount was $129,886. The two proposals totaled $120,000, therefore $9,886 will be rolled over to the 2019 grant program.

Merced County Rescue Mission “Merced Homeless Respite Care” - $100,000


Respite care for homeless persons, to allow them to rest and recover in a safe environment while receiving medical care and supportive services.

JMJ Maternity Homes/Mary’s Mantel - $20,000 Provides homeless or imminently homeless pregnant women; food, shelter, clothing and transportation to access medical and mental health services. Offers case management, in home programs, classes and other support in a safe, nurturing, homelike environment.

Hospital’s Contribution / Program Expense

Awarded grants in the amount of $120,000, plus MMC’s grant operational/administrational costs of $4750, totaled $124,750.

FY 2019 Plan Program Goal / Anticipated Impact

2018 grant awardees to submit an accountability report on their program. The CAC will determine the 2019 grant focus from the 2015 CHNA. The grant program announcement will be made to not-for-profit organizations in Merced County in the early Spring. CAC will review LOI’s and proposals and make grant recommendations to Dignity Health. Grant awards will total $145,886.


Three or four community not-for-profit organizations will receive the community grant allocations. The approved grant recipients will complete an 18 month accountability report to measure objectives and indicators.


MMC will announce to the community when the grant process will begin. Specific directions to non-profit agencies will be given, along with timelines on how/when to submit a LOI. The CAC will review the LOI’s and invite selected agencies to submit a proposal. CAC will send to Dignity Health BOD Investment Committed grant recommendations. Approved grants will be awarded in January 2019.

Planned Collaboration Collaboration with Merced County non-profit agencies and the Community Advisory Committee.

Mercy UC Davis Cancer Center Community Program Significant Health Needs Addressed

Maternal/Infant Health Diabetes Mental Health X Nutrition, Physical Activity and Weight X Cancer

Core Principles Addressed X Focus on Disproportionate Unmet Health-Related Needs Emphasize Prevention X Contribute to a Seamless Continuum of Care Build Community Capacity Demonstrate Collaboration

Program Description The community programs offered at the Mercy UC Davis Cancer Center are funded through the Mercy Foundation as well as through the cancer center itself. The hospital provides a team of staff from all disciplines to help coordinate, facilitate and raise awareness of the program for patients as well as


the community at large. The program provides to the community information, education, location and staffing.


A1-D Community Health Education


To address the need in the community for supportive programs, education and resources for cancer patients, their families and/or support persons.


Track the number of community outreach/education events that the Cancer Center participates in as well as the # of attendees at such events (health fairs, symposiums etc.).

Continue to collaborate with the American Cancer Society per our Collaborative Action Plan, to enhance supportive care programs such as monthly Cancer Support Group, Look Good Feel Better and the Wig Bank.

Continue to track the # of contacts made by Cancer Centre social worker to assist cancer patients for psychosocial concerns related to having cancer.


Cancer Center participated in 3 health fairs and 2 symposiums across Merced, Atwater and Sacramento.

15 people attended our monthly Cancer Support Group and 18 people received massages.

Cancer Center Social Worker made an average of 40 contacts per month to assist patients with psychosocial concerns.

A new smoking cessation class was started and had 9 graduates. Provide transportation cost to patients totaling $417.50.

Planned Collaboration Collaboration with the American Cancer Society and the Mercy Foundation. Program Performance / Outcome

Allowed for patients and community members to increase access to resources and services they need in the midst of their care and foster more positive outcomes.


The hospital contributed funding as well as the Mercy Foundation in the amount of $12,603.

FY 2019 Plan Program Goal / Anticipated Impact

To address the need in the community for supportive programs, education and resources for cancer patients, their families and/or support persons.


Track and collect data and information of the number of encounters/sessions and attendance. Collect data on the newly implemented programs and those that will be implemented later this fiscal year.


Continue and increase participation in supportive care programs that are offered through collaboration with the American Cancer Society.

Continue the grant funded social worker program enabling screening for cancer patients for distress due to psychosocial, transportation, anxiety, physical changes and related issues associated with having cancer.

Initiate Smoking Cessation Counseling Classes in order to focus on cancer prevention as tobacco consumption has a high correlation with lung cancer.

Planned Collaboration Collaboration with the American Cancer Society and the Mercy Foundation.


Childbirth Preparation Programs Significant Health Needs Addressed

X Maternal/Infant Health Diabetes Mental Health Nutrition, Physical Activity and Weight Cancer

Core Principles Addressed X Focus on Disproportionate Unmet Health-Related Needs X Emphasize Prevention X Contribute to a Seamless Continuum of Care Build Community Capacity Demonstrate Collaboration

Program Description This program prepares expectant mothers for the childbirth experience, including the stages of labor, what to expect during pregnancy and delivery, cesarean birth, the importance of prenatal care, breastfeeding and infant health care. In addition the program provides education on breastfeeding, cesarean births, boot camps for new moms and dads and support groups.


A1 Community Health Education

FY 2018 Report

Program Goal /

Anticipated Impact

Continue with the cesarean course offered quarterly to the community to address the need for education to emergency cesareans on previous pregnancy or scheduled first time cesareans. Grow our weekly Breastfeeding Support Group to provide a resource in the community for new moms that may have some challenges with breastfeeding to increase breastfeeding rates in our community by increasing attendance by 20%. Also creating a breastfeeding nook to allow for one-on-one education and troubleshooting for new moms in our community. Create a drop-in breastfeeding program in our rural health clinics to increase access for new mothers in south-side Merced. Targeting those mothers that have transportation issues.

Measurable Objective(s)

with Indicator(s)

Number of added sessions as well as the addition of the new programs. Tracking and monitoring the number of participants and the languages they are offered in. Utilization of the one-on-one sessions as well of number of drop-in sessions to assess the needs in different areas within our community.

Intervention Actions

for Achieving Goal

Partner with Merced County Human Services Agency to strategically increase the attendance in our New Mom and New Dad Boot Camp programs. Collaborate with neighboring FQHC’s and Merced County Department of Public Health Latch-Clinic Team to increase the number of sessions, locations and access to childbirth and breastfeeding programs. Enhance communication with participants prior to start date of program and follow-up to increase satisfaction and confidence in new moms and moms-to-be.

Planned Collaboration The Childbirth preparation Course addresses a community need and as a result there is collaboration within the community with local groups as well as local Federally Qualified Health Centers and the Merced County Human Services Agency, Merced County Department of Public Health and


Program Performance /

Outcome

The Childbirth Preparation Program provided 24 childbirth courses, 5 cesarean courses and 12 breastfeeding education courses and weekly breastfeeding support groups. With participation in the programs 692. In addition, the new mom and new dad boot camp collaboration with the Merced County Department of Human Services had participants totaling 253 participants.

Hospital’s Contribution /

Program Expense

Hospital’s contribution for all programs is $109,482

FY 2019 Plan Program Goal /

Anticipated Impact

The Childbirth Preparation Programs will continue to be offered twice a month and will include an accelerated course to increase access to classes. The cesarean course will be offered quarterly to the community to address the need for education to emergency cesareans on previous pregnancy or scheduled first time cesareans. Grow our weekly Breastfeeding Support Group to provide a resource in the community for new moms that may have some challenges with breastfeeding to increase breastfeeding rates in our community by increasing attendance by 20%. Also creating a breastfeeding nook to allow for one-on-one education and troubleshooting for new moms in our community. Create a drop-in breastfeeding program in our rural health clinics to increase access for new mothers in south-side Merced. Targeting those mothers that have transportation issues. Lastly, partnering with Community Action Agency WIC to start a new mom support group that will target mommies that are going through baby blues and postpartum depression.

Measurable Objective(s)

with Indicator(s)

Track the number of sessions offered as well as the number of participants and the languages they are offered in. Utilization of the one-on-one sessions and the number of drop-in sessions to assess the needs in different areas within our community. Completion of the Nursing Nook, Drop-In Latch Clinic and the Baby Café. In addition, through participant evaluation forms track the confidence levels pre and post intervention.

Intervention Actions

for Achieving Goal

Increase the outreach to local providers as well as community-based organizations that provide services to expectant mothers/fathers. Continued efforts to work with our partners in order to establish a Baby Café support group and a Drop-In Latch Clinic. Continue to offer the same frequency of classes to the community.

Planned Collaboration Collaboration will continue with the Community Action Agency WIC, Merced County All Moms Matter, and Merced County All Dads Matter. In addition, continued partnerships with local medical providers, FQHC’s, Alpha Pregnancy Center, Merced County Department of Public Health and other community-based agencies.


Live Well With Diabetes Significant Health Needs Addressed

Maternal/Infant Health X Diabetes Mental Health Nutrition, Physical Activity and Weight Cancer


Program Description This is a weekly program that teaches strategies for understanding, managing and living with diabetes. It’s a multi-purpose support program that features medical professional guest speakers, interactive educational experiences and develops personal actions plans. Program is offered in English and Spanish.

Community Benefit Category A1. Community Health Services

FY 2018 Report

Program Goal / Anticipated Impact

Collaborate with Shaman group and other leaders in the Hmong community to develop a Diabetes Program to be offered in Hmong in the community. Offer a Diabetes Support group monthly and educational program twice each month of the year in both English and Spanish. Continue to offer Diabetes Self-Management Program workshops in both English and Spanish. Develop a program that would provide more access to routine care for diabetics such as foot care, eye care, blood sugar monitoring and A1c tracking. In addition continue collaborating with walking groups as an added component to the support group.


Maintained the target attendance to both English and Spanish Diabetes Programs. Increased the total number of classes offered each month from 2 to 4 or more to increase access to the educational intervention. Increased the number of people screened for diabetes in the community at health fairs.


Increase in number of classes offered the diabetes support and education programs. Continuing partnerships with the Shaman group, rural health clinics and in addition the development of a referral form for our community healthcare providers. Provide post intervention follow-up and participants self-reporting to track outcomes.

Planned Collaboration Strengthen and continue to develop relationships with local private physician groups, RHC’s, FQHC’s, Care Coordinators, Emergency Room Patient Navigators and Shaman group.


An increase in attendance in correlation to increased access with the addition of scheduled classes. Through surveying and self-reporting there have been positive outcomes in regards to reduction of hospitalizations and A1c numbers amongst participants of the diabetes educational programs.


Hospital’s contribution was $36,632 for the diabetes educational program including DSMP.


FY 2019 Plan


Offer a Diabetes Support group monthly and educational program twice each month of the year and the Diabetes Self-Management Program workshops the in both English and Spanish. Develop a program that would provide more access to routine care for diabetics such as foot care, eye care, blood sugar monitoring and A1c tracking. Continue with collaboration with walking groups as an added component to the support group. Strengthen relationship with local private physicians to increase awareness and referrals to the programs.


Measure impact through number of referrals to the program and who is referring to increase outreach in areas that are underutilized. Tracking attendance and self-reported health outcomes post intervention.


Increase the outreach to community healthcare providers and community-based organizations for referrals to the program. Maintain the current schedule of class offerings to at least 4 a month total. Also, track participants through attendance and participation in programs. Provide follow-up surveys to participants to measure outcomes of intervention.

Planned Collaboration Strengthen and continue to develop relationships with local private physician groups, RHC’s, FQHC’s, Care Coordinators, Emergency Room Patient Navigators and Shaman group.

Chronic Disease Self‐Management Program, CDSMP

Significant Health Needs Addressed

Maternal/Infant Health Diabetes Mental Health X Nutrition, Physical Activity and Weight Cancer


Program Description This is a six-week comprehensive, outcomes-based program developed by Stanford University which includes education and action planning for participants living with a chronic disease. Management tools help to control symptoms such as pain and difficult emotions; improving nutrition, physical activity, health literacy and communication with physicians; managing medications and making appropriate plans that work with their lifestyle.


A-1 Community Health Education


This program will address each and every identified chronic condition ranging from obesity, asthma, COPD, high blood pressure, heart disease, kidney disease etc. Our goal is to provide resources and tools to those in the community either dealing with a chronic condition or supporting someone with a chronic condition. Provide education and tools that help with making healthier food choices and living an active life to help control and manage weight.



Number of enrollees in workshops provided will be collected as well as completion of program. In addition there will be follow-ups post intervention on how well participants have maintained their weight and changes to their lifestyle.


Schedule workshops throughout the year and at various locations in the community to increase access to these sessions. Develop partnerships with community partners that have the same goal to enhance our impact. Additional certified leaders to help build capacity of program and workshop offerings. Build stronger relationships with local physician groups to increase referrals and awareness of program to the broader community.

Planned Collaboration Collaboration is planned to include the following community partners: Merced County Department of Public Health, Central California Alliance for Health, FQHC’s, RHC’s, and local physician groups.


This program had a total of 62 contacts through the workshop and training sessions throughout our service area. Locations were both onsite and also other community locations to increase access to program, we were able to partner with local organizations that also have trained leaders to deliver workshops. Participants completed both pre and post surveys to self-assess their overall health and impact of intervention.


Hospital’s contribution is and expense for the CDSMP program was $2775

FY 2019 Plan


This program will address each and every identified chronic condition ranging from obesity, asthma, COPD, high blood pressure, heart disease, kidney disease etc. Our goal is to provide resources and tools to those in the community either dealing with a chronic condition or supporting someone with a chronic condition. Provide education and tools that help with making healthier food choices and living an active life to help control and manage weight.


Number of enrollees in workshops provided will be collected as well as completion of program. Develop an efficient data collection and tracking process of outcomes from pre-intervention through post-intervention in regards to overall health and maintaining weight and lifestyle changes.


Schedule workshops throughout the year and at various locations in the community to increase access to these sessions including unincorporated areas of our community. Develop partnerships with community partners that have the same goal to enhance our impact and reach. Deliver Leader Trainings to help build capacity of program and workshop offerings. Build stronger relationships with local physician groups by developing a referral form to increase awareness and utilization of program in the broader community.


ECONOMIC VALUE OF COMMUNITY BENEFIT

Mercy Medical Center Merced

Complete Summary - Classified Including Non Community Benefit (Medicare)

For period from 7/1/2017 through 6/30/2018

Persons Net % of Org.

Served Benefit Expenses

Benefits for Living in Poverty

Financial Assistance 2,231 2,985,544 1.0

Medicaid * 101,738 0 0.0

Community Services

A - Community Health Improvement Services 2,841 102,625 0.0

E - Cash and In-Kind Contributions 77 1,603,479 0.5

G - Community Benefit Operations 16 13,580 0.0

Totals for Community Services 2,934 1,719,684 0.6

Totals for Living in Poverty 106,903 4,705,228 1.6

Benefits for Broader Community

Community Services

A - Community Health Improvement Services 19,315 384,529 0.1

B - Health Professions Education 29 3,405,005 1.1

E - Cash and In-Kind Contributions 725 3,482 0.0

F - Community Building Activities 3,692 71,142 0.0

G - Community Benefit Operations 16 13,575 0.0

Totals for Community Services 23,777 3,877,733 1.3

Totals for Broader Community 23,777 3,877,733 1.3

Totals - Community Benefit 130,680 8,582,961 2.9

Medicare 32,493 26,189,936 8.8

Totals with Medicare 163,173 34,772,897 11.6

Net Benefit equals costs minus any revenue from patient services, grants or other sources.

* The hospital was required to record some Medicaid Provider Fee revenue in FY18 that was attributable to FY17 services. This resulted in the hospital receiving more Medicaid revenue than expense incurred, and thus $0 net benefit. If all FY17 Medicaid Provider Fee revenue had been recorded in FY17, the hospital's FY18 net benefit for Medicaid would have been $8,271,772.


APPENDIX A: COMMUNITY BOARD AND COMMITTEE ROSTERS

Hospital Administration A six-member senior management team operates the hospital administration.

Chuck Kassis, President Mike Strasser, CFO/VP Finance Janet Ruscoe, VP Nursing Services/CNE Joerg Schuller, M.D., VP Medical Affairs Kathy Kohrman, VP/Strategy and Business Development Community Board A fourteen-member board supports the vision, mission, values, charitable and philanthropic goals of the hospital and Dignity Health. Members are regarded in their community as respected and knowledgeable in their field, are contributing citizens in their community and are knowledgeable about or willing to become educated about hospital and healthcare matters. Walter Adams, III – Retired Branch Manager/Crop Consultant Michelle Allison - Retired Humberto Barragan, D.O. – Vice Chair Doug Fluetsch – President, Fluetsch Insurance Company Sr. Katherine Hamilton, OP St. Joseph’s Medical Center – Board Secretary Mason Brawley Garth Pecchenino, Principal Engineer/Branch Manger Chris Vitelli, Merced College President Leslie McGowan, CEO Livingston Health Services – Board Chair Sr. Mary Cornelius O’Conner, RSM VP/Mission Integration Mercy Hospital Folsom Gabriel Garcia-Diaz, M.D. – Ortho Spine Advance Health, Inc. Ajinder Singh, M.D. Chuck Kassis – Hospital President (Ex-Officio)


APPENDIX B: OTHER PROGRAMS AND NON‐QUANTIFIABLE BENEFITS MMC works collaboratively with community partners. The hospital provided leadership and advocacy, stewardship of resources, assisted with local capacity building, and participated in community-wide health planning. The hospital delivers a number of community programs and non-quantifiable benefits in addition to those described elsewhere in this report. Like those programs and initiatives, the ones below are a reflection of the hospital’s mission and its commitment to improving community health and well-being.

MMC staff raised funds and walked in the Merced and Atwater’s Cancer Society’s “Relay for Life” and the “Alzheimer Walk” weekend events.

MMC staff raised funds and walked in Merced’s Hinds Hospice “Angel Babies” walk. Angel Babies is a program that MMC’s Family Birthing Center partners with Hinds Hospice to provide support for parents that have had a fetal demise.

In December 2017 hospital departments participate in the Spiritual Services “Christmas Sharing Project” by adopting needy families and providing non-profit agencies with needed resources (toys, food, clothing).

Participated in the Samaritan’s Purse, “Operation Christmas Child” project by donating 18 shoeboxes filled with items appropriate for specific ages of children living in poverty stricken areas around the world.

The St. Mary’s Orthodox Church uses the hospital chapel for their weekly worship services and uses the hospital multipurpose room for weekly parish gatherings.

Mercy has donated to local physicians many pieces of medical equipment and supplies to be taken to third world countries.

Mercy staff represents MMC by being members of the Merced/Mariposa Cancer Society, Merced Rotary, Merced Kiwanis, Merced Greater Chamber of Commerce, Tobacco Coalition, Asthma Coalition, the Bi-National Committee, Central CA Health Alliance, and the Hinds Hospice “Angel Babies” committee.

Mercy is part of the Merced County Health Care Consortium steering committee initiating the Children’s Health Initiative to create Healthy Kids health coverage.

MMC Pet Therapy Program has dogs that are certified through “Share A Pet”. The dogs along with their owners, visit patients, staff and visitors.


APPENDIX C: FINANCIAL ASSISTANCE POLICY SUMMARY Dignity Health’s Financial Assistance Policy describes the financial assistance programs available to uninsured or under-insured patients who meet certain income requirements to help pay for medically necessary hospital services provided by Dignity Health. An uninsured patient is someone who does not have health coverage, whether through private insurance or a government program, and who does not have the right to be reimbursed by anyone else for their hospital bills. An underinsured patient is someone who has health coverage, but who has large hospital bills that are not fully covered by their insurance. Free Care If you are uninsured or underinsured with a family income of up to 200% of the Federal Poverty Level

you may be eligible to receive hospital services at no cost to you.

Discounted Care If you are uninsured or underinsured with an annual family income between 200-350% of the Federal

Poverty level, you may be eligible to have your bills for hospital services reduced to the highest amount reasonably expected to be paid by a government payer, which is usually the amount that Medicare would pay for the same services.

If you are uninsured or underinsured with an annual family income between 350-500% of the Federal Poverty level you may be eligible to have your bills for hospital services reduced to the Amount Generally Billed, which is an amount set under federal law that reflects the amount that would have been paid to the hospital by private health insurers and Medicare (including co-pays and deductibles) for the medically necessary services.

If you are eligible for financial assistance under our Financial Assistance Policy you will not be required to pay more than the Amount Generally Billed described above. If you qualify, you may also request an interest-free extended payment plan. You will never be required to make advance payment or other payment arrangements in order to receive emergency services. Free copies of the hospital’s Financial Assistance Policy and financial assistance application forms are available online at your hospital’s website listed below or at the hospital Admitting areas located near the main entrance. (Follow the signs to “Admitting” or “Registration”). Copies of these documents can also be mailed to you upon request if you call Patient Financial Services at the telephone number listed below for your hospital. Traducción disponible: You may also obtain Spanish and other language translations of these documents at your hospital’s website, in your hospital’s Admitting area, or by calling your hospital’s telephone number. Dignity Health Financial Counselors are available to answer questions, provide information about our Financial Assistance Policy and help guide you through the financial assistance application process. Our staff is located in the hospital’s Admitting area and can be reached at the telephone number listed below. Mercy Medical Center 333 Mercy Ave, Merced, CA 95340 | Financial Counseling 209-564-5105

Community Benefit 2018 Report and 2019 Plan Mercy Medical Center Community Benefit FY 2018 Report...

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