COMMUNITY BENEFIT NARRATIVE REPORT FY2014 BON...

COMMUNITY BENEFIT NARRATIVE REPORT

FY2014

BON SECOURS

1

I1

BACKGROUND The Health Services Cost Review Commissionrsquos (HSCRC or Commission) Community BenefitReport required under sect19-303 of the Health General Article Maryland Annotated Code is theCommissionrsquos method of implementing a law that addresses the growing interest inunderstanding the types and scope of community benefit activities conducted by Marylandrsquosnonprofit hospitals The Commissionrsquos response to its mandate to oversee the legislation was to establish a reportingsystem for hospitals to report their community benefits activities The guidelines and inventoryspreadsheet were guided in part by the VHA CHA and othersrsquo community benefit reportingexperience and was then tailored to fit Marylandrsquos unique regulated environment The narrativerequirement is intended to strengthen and supplement the qualitative and quantitative informationthat hospitals have reported in the past The narrative is focused on (1) the general demographicsof the hospital community (2) how hospitals determined the needs of the communities theyserve and (3) hospital community benefit administration

Reporting Requirements

GENERAL HOSPITAL DEMOGRAPHICS AND CHARACTERISTICSPlease list the following information in Table I below For the purposes of thissection ldquoprimary services areardquo means the Maryland postal ZIP code areas fromwhich the first 60 percent of a hospitalrsquos patient discharges originate during the mostrecent 12 month period available where the discharges from each ZIP code areordered from largest to smallest number of discharges This information will beprovided to all hospitals by the HSCRC

Table I

BedDesignation

InpatientAdmissions

PrimaryService AreaZip Codes

All OtherMarylandHospitalsSharingPrimaryService Area

Percentage ofUninsuredPatients byCounty

Percentage ofPatients whoare MedicaidRecipientsby County

107 4681 21223212162121721229212022123021201

St AgnesHospital(21229)

BaltimoreCity- 86BaltimoreCounty- 8HowardCounty- 2Anne ArundelCounty- 1

BaltimoreCity- 92BaltimoreCounty- 5Anne ArundelCounty- 1Others- 1

2

2

a

-

-

-

-

-

For purposes of reporting on your community benefit activities please provide the followinginformation

In Table II describe significant demographic characteristics and socialdeterminants that are relevant to the needs of the community and include the source ofthe information in each response For purposes of this section social determinantsare factors that contribute to a personrsquos current state of healthThey may be biological socioeconomic psychosocial behavioral or social in nature(Examples gender age alcohol use income housing access to qualityhealth care education and environment having or not having health insurance)(Add rows in the table for other characteristics and determinants as necessary)

Some statistics may be accessed from The Maryland State Health ImprovementProcess httpdhmhmarylandgovshipand its Area Health Profiles 2013httpdhmhmarylandgovshipSitePagesLHICcontactsaspxThe Maryland Vital Statistics AdministrationhttpdhmhmarylandgovvsaSitePagesreportsaspx The Maryland Plan to Eliminate Minority Health Disparities (2010-2014)httpdhmhmarylandgovmhhdDocumentsMaryland_Health_Disparities_Plan_of_Action_61010pdf Maryland ChartBook of Minority Health and Minority Health Disparities 2nd EditionhttpdhmhmarylandgovmhhdDocumentsMaryland20Health20Disparities20Data20Chartbook20201220corrected20201320022022201120AMpdf

Table II

Community Benefit Service Area(CBSA)Target Population ( of people in targetpopulation by sex race ethnicity andaverage age)

Total population is 17885486 male 514 female758 African-American168 white36 Hispanic11 Asian06 Persons of All Other Races 21 two or more races8 0-5 years of age19 6-1811 19-2452 25-6410 65 and olderMedian age is 347 (Vital Signs 12 Community Statistical Area(CSA) Profiles Southwest Baltimore)3

Median Household Income within the CBSA $28085(Vital Signs 12 CommunityStatistical Area (CSA) Profiles SouthwestBaltimore)

Percentage of households with incomesbelow the federal poverty guidelines withinthe CBSA

291

Please estimate the percentage of uninsuredpeople by County within the CBSA Thisinformation may be available using thefollowinglinkshttpwwwcensusgovhheswwwhlthinsdataacsaffhtmlhttpplanningmarylandgovmsdcAmerican_Community_Survey2009ACSshtml

171 (2010 Baltimore City HealthDepartment Report Card)

Percentage of Medicaid recipients by Countywithin the CBSA

31

Life Expectancy by County within the CBSA(including by race and ethnicity where dataare available)See SHIP websitehttpdhmhmarylandgovshipSitePagesHomeaspxand countyprofileshttpdhmhmarylandgovshipSitePagesLHICcontactsaspx

CBSA 678 Baltimore City 739

Mortality Rates by County within the CBSA(including by race and ethnicity where dataare available)

2012 Rates per 10000 residents in age group(CBSABaltimore City)Less than one year old 150971-14 years old 542515-24 years old 22011925-44 years old 44124045-64 years old 1696114165-84 years old 4739373885 and older 1315812315(Vital Signs 12Community Statistical Area (CSA) ProfilesSouthwest Baltimore)

Access to healthy food transportation andeducation housing quality and exposure toenvironmental factors that negatively affecthealth statusby County within the CBSA (tothe extent information is available fromlocalor county jurisdictions such as the localhealth officer local county officials or otherresources) See SHIP website for social andphysical environmental data and countyprofiles for primary service areainformationhttpdhmhmarylandgovshipSitePagesmeasuresaspx

Access to healthy food Most of the CBSAfalls within a designated ldquofood desertrdquodefined as more than a frac14 walk from a fullservice grocery store (only one full-servicegrocery store in CBSA)Transportation Most households are withinfrac14 mile of public transportation 522 ofhouseholds without access to a vehicle vs300 percent of Baltimore City householdsEducation 311 of adults 25 and older donot have a high school diploma 594 havea high school degree and 96 have abachelorrsquos degree or aboveHousing Quality 259 of properties arevacantabandoned vs 80 for BaltimoreCity 565 of renters and 337 ofhomeowners pay more than 30 of theirincome for housing Median sales price forhomes was $21250 in 2012 vs $135000 inBaltimore CityExposure to Environmental FactorsRate of Dirty StreetsAlleys reports per 1000residents is 2179 vs 705 for Baltimore CityRate of Clogged Storm Drain reports is 93per 1000 residents vs 62 for BaltimoreCity Lead Paint violation rate is 435 per10000 households vs 118 for BaltimoreCity4

b Please use the space provided to complete the description of your CBSA Provide anydetail that is not already stated in Table II (you may copy and paste the informationdirectly from your CHNA)

Bon Secours Hospital (ldquoBSBrdquo or the ldquoHospitalrdquo) has played a vital role in

West Baltimore since 1919 and the Sisters of Bon Secours have maintained

a constant presence in the community since 1881 Bon Secours Hospital

serves west and southwest Baltimore Dominated by the elderly women

and children BSBrsquos service area includes some stable neighborhoods but

far too many neighborhoods facing significant social challenges in the areas

of housing employment education and health BSBrsquos Community Health

Needs Assessment has taken into account challenges and conditions in its

primary service area as described above with a special emphasis on the

neighborhoods surrounding BSB known as ldquoOld Southwest Baltimorerdquo

Bon Secours has maintained a constant presence in this part of Baltimore

for over 130 years and it is the community where most of Bon Secours

Biltmore Health Systemrsquos (BSBHS)services are located A long standing

tradition of close engagement with this community has led to the creation of

many of the programs and services that BSBHS delivers particularly those

addressing the social determinants of health The relationship between

BSBHS and the surrounding community of Old Southwest Baltimore was of

great benefit to many of the assessment activities outlined below

In fact many of the conditions and social determinants of health in the direct

area serviced by BSBHS are of concern in the broader service area ndash West

Baltimore as a whole Taking that into account assessment findings and

interventions identified for the areas immediately surrounding ourhospital are

relevant and applicable to the entire West Baltimore community

Designated as a federal medically-underserved community Southwest

Baltimore also suffers from a high rate of foreclosures as many residents do

not have the financial capacity to maintain their homes Many of the streets

Available detail on race ethnicity andlanguage within CBSA See SHIP Countyprofiles for demographic information ofMaryland jurisdictions

758 African-American168 white36 Hispanic11 Asian06 Persons of All Other Races21 two or more races

Other Unemployment rate is 170 vs 98 forBaltimore City as a whole

5

are lined with neglected and vacant houses many are boarded up and

hazardous to the health and safety of children and adults Homes are twice

as likely to be sold in foreclosure or to have housing code violations as in

Baltimore City as a whole

The overall crime rate in Southwest Baltimore is 23 higher than the overall

citywith juvenile arrests domestic violence non-fatal shootings and

homicides occurring at rates significantly higher than for the City as a whole

(72 63 152 and 102 greater respectively)

Despite these challenging statistics and circumstances the neighborhoods

of Southwest Baltimore show signs of new life and hope Through our

community partnerships Bon Secours has initiated and supported

neighborhood development and community-driven revitalization efforts that

complement the health systemrsquos comprehensive services Despite

enormous challenges BSB serves as an anchor of stability and hope for the

residents of Southwest Baltimore providing health and wholeness to all in

need

6

II1

2

III1

COMMUNITY HEALTH NEEDS ASSESSMENTHas your hospital conducted a Community Health Needs Assessment that conformsto the IRS definition detailed on pages 4-5 within the past three fiscal years

X Yes_ No

Provide date here572013

If no please provide an explanation

If you answered yes to this question provide a link to thedocument here

httpbaltimorebonsecourscomassetspdfsCHNA-FINALpdf

Has your hospital adopted an implementation strategy that conforms to the definitiondetailed on page 5

X Yes_ No




httpbonsecoursbaltimorecomassetspdfsCHNA-ImplementationPlan-BSBHS-071513pdf

COMMUNITY BENEFIT ADMINISTRATIONPlease answer the following questions below regarding the decision making process ofdetermining which needs in the community would be addressed through community

7

a

b

i123

ii1234

iii12

3

benefits activities of your hospitalIs Community Benefits planning part of your hospitalrsquos strategic plan

X Yes_ No


What stakeholders in the hospital are involved in your hospital communitybenefit processstructure to implement and deliver community benefitactivities (Please place a check next to any individualgroup involved in thestructure of the CB processand provide additional information if necessary)

Senior LeadershipX CEOX CFOX Other (Please Specify)Vice President Mission Vice PresidentPhilanthropy

Clinical LeadershipX PhysicianX Nurse_ Social Worker_ Other (Please Specify)

Community Benefit DepartmentTeam_ Individual (please specify FTE)X Committee (please list members)Vice President ndash Mission (Chair) Manager ndashFinancial Grants Senior Director ofPrograms ndash Community Works ExecutiveDirector ndash Housing amp CommunityDevelopment Director ndash Marketing VicePresident ndash Philanthropy Director ndash Budgetamp Business IntelligenceX Other (Please Specify)The Boards of Directors of Bon SecoursBaltimore Health System and Bon SecoursCommunity Works receive approve the

8

c

d

IV

1

a

CHNA and community benefit plans beforesubmission and receive and review regularprogress reports

Is there an internal audit (ie an internal review conducted at the hospital)of the Community Benefit report

Spreadsheet X Yes _ No

If you answered no to this question please explain why Narrative X Yes _ No

If you answered no to this question please explain whyDoes the hospitalrsquos Board review and approve the FY Community Benefitreportthat is submitted to the HSCRC



If you answered no to this question please explain why

HOSPITAL COMMUNITY BENEFIT PROGRAM AND INITIATIVESThis information should come from the implementation strategy developed through theCHNA process

Please use Table III (see attachment) or as an alternative use Table IIIA toprovide a clear and concise description of the primary needs identified in theCHNA the principal objective of each initiative and how the results will bemeasured time allocated to each initiative key partners in the planning andimplementation of each initiative measured outcomes of each initiative whethereach initiative will be continued based on the measured outcomes and thecurrent FY costs associated with each initiative Please be sure these initiativesoccurred in the FY in which you are reporting For example for each principal initiative provide the following

Identified need This includes the community needs identified by theCHNAInclude any measurable disparities and poor health status of racial

9

bc

d

e

fg

h

i

and ethnic minority groupsName of Initiative insert name of initiativePrimary Objective of the Initiative This is a detailed description of theinitiative how it is intended to address the identified need and the metricsthat will be used to evaluate the results (Use several pages if necessary)Single or Multi-Year Plan Will the initiative span more than one yearWhat is the time period for the initiativeKey Partners in DevelopmentImplementation Name thepartners(community members andor hospitals) involved in thedevelopmentimplementation of the initiative Be sure to include hospitalswith which your hospital is collaborating on this initiativeHow were the outcomes of the initiative evaluatedOutcome What were the results of the initiative in addressing the identifiedcommunity health need such as a reduction or improvement in rate (Usedata to support the outcomes reported) How are these outcomes tied to theobjectives identified in item CContinuation of Initiative Will the initiative be continued based on theoutcomeExpense A What were the hospitalrsquos costs associated with this initiativeThe amount reported should include the dollars in-kind-donations or grantsassociated with the fiscal year being reportedB Of the total costsassociated with the initiative what if any amount was provided through arestricted grant or donation

10

Table III A Initiative 1


Identified Need Healthy Economy (CHNA) Support thecreation and preservation of strong healthyblocks via the development and managementof affordable housing

Hospital Initiative Community HousingPrimary Objective of the InitiativeMetricsthat will be used to evaluate the results

The Community Housing program providessafe and affordable housing to residents inneed of services Occupancy rates ofproperties along with quantitative (number ofresidents served services utilized) andqualitative (resident satisfaction individualpractice assessment) are tracked

Single or Multi-Year InitiativeTime Period This is a multi-year on-going initiativeKey Partners andor Hospitals in initiativedevelopment andor implementation

bullEnterprise Community PartnersbullEnterprise HomesbullUnited States Department of HUDbullBaltimore City Department of Housing andCommunity DevelopmentbullMaryland State Department of Housing ampCommunity DevelopmentbullWayland Baptist ChurchbullNew Shiloh Baptist ChurchbullSt Agnes HospitalbullCommunity Input

How were the outcomes evaluated We utilize CBISA community benefitsoftware to track volume and cost We alsocontract with National Church residences for3rd party quality assurance amp review

Outcome (Include process and impactmeasures)

Housing occupancy for FY13 was 974 for648 units Resident satisfaction averaged393 per property out of a possible score of40 Individual practice assessments averaged435 out of a possible score of 44 and Filereview averaged 19 out of a possible 21

Continuation of Initiative YesATotal Cost of Initiative $4856109BWhat amount is Restricted GrantsDirectoffsetting revenue

$2605966 in rental payments anddevelopment fees

Identified Need This initiative relates to the CommunityHealth Needs Assessment (ldquoCHNArdquo) HealthPeople Identified Needs area For thepopulation of Southwest Baltimore servedmore than 60000 of Baltimorersquos 645000residents abuse alcohol andor illegal drugs(Sources National Substance abuse Index2010 and Baltimore City Dept of Health)

Hospital Initiative Bon Secours Hospital Screening BriefIntervention Referral to Treatment(ldquoSBIRTrdquo) Peer Recovery Support Program

Primary Objective of the InitiativeMetricsthat will be used to evaluate the results

The SBIRT program is designed so that allpatients that enter the hospital through eitherthe emergency department or through a direct11


admission are screened by hospital nursingstaff as part of the nursing assessmentBased on established criteria nurses andother members of the care team refer patientsat high risk to the peer recovery coaches(ldquoPRCrdquo) to provide brief interventions andreferrals to treatment as appropriateThree full time peer recovery coaches areemployed by Bon Secours Hospital tosupport the program The three coachesprovide brief interventions usingmotivational interviewing techniques totargeted high risk patients The PRCsfollow-up with patients that are admitted ordischarged to continue to provide support andlinkage to treatment services as necessaryand where appropriate Services areintegrated and coordinated with the hospitalnursing staff social work discharge planningstaff and other case managers that providesupport to patients


bullBehavioral Health Systems BaltimorebullNew Hope Treatment CenterbullAdapt CaresbullNext PassagebullInpatient and outpatient mental healthservicesbullHealth Care Access MarylandbullDepartment of Homeless Services

How were the outcomes evaluated Data collection of outcomes and qualityimprovement has been an essential andintegral component of the Bon SecoursSBIRT PRC Program A system for trackingnumbers of brief interventions referrals totreatment and referrals to other resourcesand linkage to treatment has been developedData is collected monthly and analyzed bythe Director of Emergency DepartmentServices and discussed with the PRC team


Percentage of Patients Screened Using theSBIRT Tool 100Number of Brief Interventions 3085Number of Referrals to Treatment 356Number of Patients with verified Entry intoTreatment 151Total Number of Follow-ups Completed byPeer Recovery Coaches 1312


$120635

12


Identified Need Healthy People (CHNA) Baltimore Cityaccounts for 41 of HIV cases in the state ofMaryland and Baltimore City has the 5thlargest metropolitan HIV population in thenation West Baltimore continues to have avery high prevalence of IV drug abuse andunprotected sex which is contributing to thehigh HIV rates in the region The HIV ratefor BSBHSrsquos primary zip codes is 1105compared to the rate for the entire city ofBaltimore of 814 Additionally there are anestimated 16 of patients in Maryland withHIV that remain undiagnosed

Hospital Initiative Rapid HIV TestingPrimary Objective of the InitiativeMetricsthat will be used to evaluate the results

The primary purpose of this grant is topromote safe practices promote HIV testingand link HIV patients to care Patientsreceive pre-counseling testing and post-counseling in the Emergency DepartmentThose patients who test positive are referredfor further careAn additional focus for this initiative is toprovide counseling on abstinence safe sexand the risks associated with IV Drug abuseDepending on the results of the HIV testclients are either linked to care or they areeducated on safe practices if they testnegative

Single or Multi-Year InitiativeTime Period This is a multiyear ongoing initiative topromote the prevention identification andlinkage of care associated with HIV

Key Partners andor Hospitals in initiativedevelopment andor implementation

bullBaltimore City Health DepartmentbullJohns Hopkins HospitalbullJacques Initiative Institute of HumanVirology (University of Maryland School ofMedicine) andbullSinai Hospital

How were the outcomes evaluated Outcomes were identified by the number oftests provided the continued identification ofnew positives and re-linking those patientswith HIV that have fallen out of care


From September 2013 - August 2014 therewere 2720 encounters and seven patientswho tested positive for HIV that were linkedor re-linked to care Over 2700 clientsreceived counseling on both safe sex and IVDrug use Patients that communicate druguse are connected with the Screening BriefIntervention Referral and Treatment team foradditional counseling 100 of patients whotested positive were referred to both care andpartner services


$90218

13

Identified Need Healthy People (CHNA) Prevalence of

chronic diseases and premature death issignificantly high in West Baltimore Thelife expectancy in our CBSA is among thelowest in the state There is a critical needfor patients to have access to services andeducation to assist in management as well asimprove outcomes and quality of life

Hospital Initiative Community Disease Management NurseMinistry (formerly called Tele-HeartProgram) Parish Nursing


A disease management and health educationprogram empowering Southwest Baltimoreresidents especially seniors amp those withchronic diseases The program is staffed by aRN who helps to identify newly diagnosedCongestive Heart Failure patients throughnurse review of hospital records or physicianreferral The program educates patients aboutdisease management and enrolls patients inTele-Heart conducts individualized post-discharge education and home assessmentsprovide individual monitoring educationmedication recommendations and supportand coordinate and provide reports on patientcare to physicians for Tele-Heart enrolleesThe RN also conducts health education anddisease management classes and screeningsfor Tele-Heart enrollees seniors andcommunity residents develops anddistributes a monthly newsletter on healthmanagement and related topics to Tele-Heartenrollees seniors and partner groupsFurther outreach and education is conductedfor physicians and healthcare providers onTele-Heart and Community Nursing Allianceprograms The RN also coordinates intakeand distribution of medical equipment andsupplies and manages and evaluates programdata and performance The program tracksthe number of persons served along with dataon how well they manage their chronicdisease conditions


Bon Secours partners with communityorganizations to provide these services to theresidents of West Baltimore These churchesand other faith-based organizations includeTransfiguration Catholic Church StBernadinersquos Catholic Church Central BaptistChurch Jones Tabernacle St GregoryCatholic Church St James EpiscopalChurch St Edwardrsquos Catholic Church SaintPeter Claver and St Benedict CatholicCommunity among others We also provideservices screening and referrals to 17 SeniorLiving Buildings and Senior Centers in ourWest Baltimore Community St AgnesHospital and University of Maryland MedicalSystem are partners that are referral sourcesfor services not provided at Bon Secours14


How were the outcomes evaluated We utilize CBISA community benefitsoftware to track volume and cost of theseservices and to develop reports for grantorsWe also look at various health indicators toshow impact of interventions ie bloodglucose levels


11852 persons were served during FY14After participating in our education programsand learning to manage their diet 40 ofparticipants with blood glucose levels of210mgdl or higher found success inmedication compliancy and sticking to aroutine exercise program We have seen anaverage 10 drop in blood glucose levelsWe have also seen participants succeed indietary management making better foodchoices and at least 50 of participants haveworked hard to reduce their total sodiumintake cholesterol levels and lose weight


$139034

Identified Need Healthy People (CHNA) SouthwestBaltimore residents have evolving needs forcomprehensive and integrated healthservices including behavioral health BonSecours has expanded its service line overthe last several years to become one of themost extensive in the City of Baltimore as itrelates to behavioral health services and is aninvaluable asset to the Southwest BaltimoreCommunity In an effort to meet the growingdemand for integrated services in ourcommunity the focus for FY13-FY16 isprogram growth and development

Hospital Initiative The Department of Behavioral Healthprovides the following outpatient mentalhealth and substance abuse programsbullAssertive Community TreatmentbullSpecialized Case ManagementbullPsychiatric Day ProgrambullVocational ServicesbullResidentialbullOutpatient Mental HealthbullPartial Hospitalization Programs for Adultsand ChildrenbullCrisis StabilizationbullOpioid Maintenance Treatment withMethadone and SuboxonebullIntensive Outpatient Substance AbuseTreatmentbullScreening Brief Intervention Referral toTreatment (SBIRT) Services


Our objective is to improve access to andincrease utilization of our community-basedbehavioral health and medical servicesMetrics include program accessibility15

population served appointment availabilityassessment of client program participationtreatment outcomes and efficacy of servicesprovided


bullDepartment of Health and Mental Hygiene(DHMH)bullBehavioral Health Systems Baltimore(BHSB)bullBaltimore Crisis Response Inc (BCRI)bullNational Alliance on Mental Illness (NAMI)bullSubstance Abuse and Mental HealthServices Administration (SAMHSA)bullHospitals within the zip codes of 2120121229 and 21215

How were the outcomes evaluated The Department of Behavioral HealthrsquosDirector of Quality Improvement providesdirection and oversight of quality initiativesto our programs BSBHSrsquos Department ofQuality Improvement provides oversight ofthe Department of Behavioral HealthrsquosQuality Improvement Programrsquosperformance measures and quality initiativesQuality initiatives and quality outcomes arereported to the BSBHSrsquos PerformanceImprovement CommitteeQuality improvement measures areimplemented to ensure that targetedthresholds are met When outcomes fallbelow the threshold an analysis of thefindings is conducted to determine factorsthat impacted the data Such factors includethe following human factorsorganizationregulatory constraints orcommon cause variations Processes andoutcomes are monitored closely throughconducting data analysis Our goal is to meetthe clinical needs of our patient populationby providing quality care


Each program develops quality indicators toidentify opportunities for improvement in theareas of service delivery and treatmentoutcomes Data is collected and tracked on amonthly basis to identify trends and ensurecompliance with established performancemeasures Program specific patientsatisfaction surveys are conducted on amonthly basis Survey findings are reviewedand analyzed Based on findings programenhancements and improvements areimplemented accordinglyFrom FY13 to FY 14 (September 2013through August 2014) 1216 individualsenrolled in our substance abuse programsreceived individual group and intensiveoutpatient services Over 3300 receivedoutpatient treatment such as medicationmanagement individual and group andfamily therapy Additional services providedinclude job training housing social supportand rehabilitation Approximately 3000received psychiatric assessment and referral

16



information through our crisis stabilizationservices


$2256562

Identified Need Healthy Economy (CHNA) MoreSouthwest Baltimore women are at risk forhomelessness

Hospital Initiative Womenrsquos Resource CenterPrimary Objective of the InitiativeMetricsthat will be used to evaluate the results

BSBHSrsquos Womenrsquos Resource Centersupports women in need in SouthwestWestBaltimore The Center is the ONLY drop-inhospitality facility in the area making it amuch needed resource for women who are incrisis as well as a safe secure and supportiveenvironment for women who are progressingfrom recognizing the need for changebullTo meet the basic needs of women who arehomeless or at risk of homelessness byproviding a broad range of servicesbullTo provide women with resources for healthservices through Bon Secours Baltimore orother agencies


bullParents AnonymousbullMercy Supportive HousingbullRecovery in the Community (RIC)bullSisters of Bon Secours MinistrybullMayorrsquos Office of Homeless Services

How were the outcomes evaluated Several metrics are tracked to monitor andevaluate the effectiveness of the programincludingbull of participants visitsbull of meals providedbull of visits made to the computer labbull of visits for clothing assistancebull of counseling sessions


From September 2013 through August 20142653 visits were made to the WomenrsquosResource Center The Womenrsquos ResourceCenter provided 2059 meals to communityresidents In addition 108 visits were madeto the computer lab 171 visits were made forclothing assistance and 88 counselingsessions were conducted


$137412

17


Identified Need Healthy Economy (CHNA) SouthwestBaltimore suffers from a high rate offoreclosures as many residents do not havethe financial capacity to maintain theirhomes Southwest Baltimore has a highpercentage of families living below self-sufficiency standards

Hospital Initiative Financial Services (formerly Center forWorking Families)


To assist residents and teach them how toestablish economic independence and how tolive stronger healthier lives by offering one-on-one and group financial counseling andtraining credit repair connection to low-costlawyers insurance products free and low-cost tax preparation and other asset buildingproducts Group classes include tax trainingand expense management for the self-employed


bullBaltimore City Cash CampaignbullOperation ReachOut SouthwestbullSeedcobullT Rowe Price FoundationbullMayorrsquos Office of Homeless Services

How were the outcomes evaluated Several metrics are tracked to monitor andevaluate the effectiveness of the programincludingbull of participants receiving tax preparationservicesbull of families with eviction prevented for oneyearbull of families with increased financialawarenessbull of participants screened for social benefits


From September 2013 through August 2014656 participants received tax preparationservices and 132 participants avoidedhomelessness through the eviction preventionprogram with no repeat request for cashassistance within one year 80 of alleviction prevention participants had anincrease in awareness of the importance ofcredit reports as an important factor inaccessing housing and managing finances Inaddition 395 participants were screened forsocial benefits


$97573

18

Identified Need Healthy People (CHNA) Academicresearchers are not always effective inrelating with community residents and thusare challenged in designing effectiveinterventions for addressing healthdisparities

Hospital Initiative Patient-centered Involvement in Evaluatingeffectiveness of Treatments also known asPATIENTS is a five-year (2013-2018)infrastructure development program


1) Building sustainable partnerships amongscholars patients communities andhealthcare systems locally regionally andnationally to increase cultural competency ofresearchers and improve Patient-CenteredOutcome Research (PCOR) and healthoutcome2) Facilitating and enhancing PCOR toinform healthcare delivery and empowerpatients and their caregivers to make betterhealthcare decisions and3) Establishing infrastructure to disseminateand implement evidence-based PCORfindings and interventions

Single or Multi-Year InitiativeTime Period Five-years (2013-2018)Key Partners andor Hospitals in initiativedevelopment andor implementation

bullAgency for Healthcare Research and Quality(AHRQ)bullUniversity of Maryland Baltimore (UMB)

How were the outcomes evaluated Partnering with researchers at University ofMaryland Baltimore (UMB) in assessingtreatment of preference CER (comparativeeffectiveness research)


Bon Secours Baltimore worked closely withpartnering organizations through regularmeetings and conference calls Together weidentified needs of different partneringcommunities through baseline NeedsAssessment and community involvementAs it relates to research we maderecommendations on building effectivecommunication among partners as well as onfurthering training opportunities communityengagement and proposal developmentbullWe along with our partners reached out tolocal communities by attending HousingHealth and Wellness Fair organized byMount Lebanon Baptist Church and othercommunity organizationsbullEducated other researchers and partners onthe importance of community education andengagement and held discussions regardingstrategies on how to engage communities andindividuals in the research processbullHeld meaningful roundtables discussions atUMB on the processes of identifyingindividuals in the community and educatingthem on the importance of participation inresearch activities and partnering withresearchers in assessing treatment ofpreference CER (comparative effectivenessresearch)19


bullReviewed and discussed outcomes from ourinteraction with individuals on CommunityDay and made recommendations on how tofurther understand and meet the needs of thepopulation we serve

Continuation of Initiative Yes ndash through grant periodATotal Cost of Initiative $103863BWhat amount is Restricted GrantsDirectoffsetting revenue

$66686

Identified Need Healthy Economy (CHNA) Bon SecoursBaltimorersquos CBSA has a high incidence ofsingle parents low educational attainmentlow availability of licensedquality child careand the need for ongoing adult education

Hospital Initiative Family Support Center


Healthy Families America is an evidence-based program designed to work with over-burdened families who are at risk for childabuse neglect and other childhoodexperiences Objectives include-To reduce child maltreatment-To increase utilization of prenatal care anddecreased pre-term low weight babies-To improve parent ndash child interaction andschool readiness-To decrease dependency on welfare orTANF (Temporary Assistance to NeedyFamilies) and other social services-To increase access to primary care medicalservices-To increase immunization rates

Research reveals that fathers do play animportant role in economic well-being socialdevelopment and emotional growth in theirchildren There is an increase in teenpregnancy and high school dropout rates inBaltimore City Family Support Center iscommitted to serving pregnant and teenageparents by providing various health socialpsychological and academic success and toprevent subsequent pregnancies Recognizingthat parents are one of the most importantfactors to a childrsquos physical mental andemotional development ldquoBabyologyrdquo willteach parents how to nurture and understandthe importance of the parent as the childrsquosfirst teacher Some objectives related to thisinitiative include-To educate expecting andor parenting teenfathers young adult males and non-custodial fathers on healthy and appropriateparenting knowledge and skills continuededucation and independent self-sufficientadult life-To provide pregnant and parenting teenagersbetween the ages 13-19 with healthy and20


appropriate parenting knowledge and skillscontinued education for an independent self-sufficient adult life-To educate parents who are expecting orhave infantstoddlers on their primary role intheir childrsquos life and assist them in acquiringappropriate parenting skills and knowledge

Single or Multi-Year InitiativeTime Period This is a multi-year grant providing ongoinghome visiting services to at-risk children aswell as services to teen fathers young adultmales non-custodial fathers pregnant andteen parents and parents who are expectingor have an infanttoddler


bullFamily NetworkbullFamily League of Baltimore CitybullChildfindbullHouse of RuthbullTurnaround

How were the outcomes evaluated Several metrics are tracked to monitor andevaluate the effectiveness of the programincludingbull of home visits conductedbull of center visitbull of services providedbull of participants attending GED preparationclassesbull of families servedbull participants attaining a GED


Family Support Center served 252 families(66 home visits 35 teen parents 40fatherhood and 111 FSC) for a total of 5550center visits 1561 home visits and 12930services Services consist of adult educationbasic life skills employment job trainingparenting education mental health socialsupport pre-natal care medical referrals andother applicable services Of the 252families 117 participants attended the GEDpreparation classes with all of the participantsdemonstrating an increase in grade level onthe MAPPCASAS placement test and 11participants obtaining their GED 100 ofbabies were born full-term and 98 of babieswere born with a healthy birth weight


$652850

Identified Need Healthy People (CHNA) A lack of breastcancer outreach education or screeningprojects or mammography services inSouthwest Baltimore

Hospital Initiative American Cancer Society (ACS) WestBaltimore Breast Education andMammography Project

Primary Objective of the InitiativeMetrics To help increase awareness and improve21


that will be used to evaluate the results access to screening through both client-basedand provider-based interventions byprovidingbullTailored education for low income AfricanAmerican womenbullAddressing both the structural and clientcost barriers to getting breast cancerscreenings for this population of focus

Single or Multi-Year InitiativeTime Period Single year initiative from May 1 2013through June 1 2014


bullBon Secours Baltimore HospitalbullAmerican Cancer SocietybullSt Agnes Hospital Womenrsquos Breast CenterbullNorthwest Hospital MammographyDepartment

How were the outcomes evaluated Outcomes were evaluated based on programtargets (results listed below)


313 women received either a clinical breastexam OR mammogram547 women received Group Education27 Group Education Events were to be held562 women were to receive Reduction ofStructural Barriers assistance

Continuation of Initiative No- This was a one year project funded byACS and Lee Denim

ATotal Cost of Initiative $42742BWhat amount is Restricted GrantsDirectoffsetting revenue

$23743

Identified Need Healthy People (CHNA) Expanded PrimaryCare and capacity along with expandedaccess to casecare management servicesPreparing for the Affordable Care Act anddeveloping additional community-basedcollaborative projects that promote patientengagement in acute and preventive careservices as well as chronic diseasemanagement

Hospital Initiative Health Enterprise ZonePrimary Objective of the InitiativeMetricsthat will be used to evaluate the results

The primary disease target for the initiative iscardiovascular disease (CVD) which affectsresidents of the HEZ area at a rate twice thatof MarylandThis initiative implemented a two-partapproach 1) increased care coordinationthrough the patient-centered medical homefor patients with cardiovascular disease athigh risk of hospitalization and emergencydepartment (ED) use and 2) community-based risk factor reduction for patients at riskof developing cardiovascular disease Thesestrategies are designed to be mutuallyreinforcing to improve cardiovascularoutcomesThis project will target approximately 86000West Baltimore residents through primarycare care coordination disease management

22

education and a multi-media communityeducation campaign This includes 43000people who are obese 36000 smokers and6500 people with CVD who are excessivelyhigh users of the EDThis HEZ project offers enhancements toexisting community health resources and newprograms and services to support improvedhealth among the target population TheWest Baltimore Primary Care AccessCollaborative (WBPCAC) members whoprovide outpatient care collectively serveapproximately 51000 patients with CVD Itis anticipated that all existing CVD patientsserved by the Collaborative will experienceenhanced care coordination as well as bereferred for other HEZ project programs andservices An additional 15500 individualswho previously have not been served by theCollaborative will receive primary care andother servicesThe Evaluation Team will establish astandardized process and schedule for datacollection and reporting This data will allowHEZ to track (1) patient referral source (egED CHW outreach) (2) the number of newpatients served by Collaborative membersandor CARE (3) the number ofCollaborative membersrsquo existing patientswho receive new or enhanced services fromthe HEZ project and (4) patientsrsquo frequencyof use of primary care and CARE programsand services This data will be reported atleast twice a yearHEZ GoalWBPCAC GoalA Improved risk factor prevalence or healthoutcomes (eg SHIP or LHIP measures orothers) By 2016 reduce by 15cardiovascular disease risk factor prevalenceamong West Baltimore residentsB Expanded primary care workforce ByJune 2015 increase by 48 the number ofprimary care professionals represented onWBPCAC membersrsquo care teamsC Increased community health workforce(including public health and outreachworkers) By December 2013 increase by 11the number of community health workersserving West BaltimoreD Increased community resources for health(eg housing built environment foodaccess etc) By 2014 create a mechanism toidentify and implement interventions toincrease community resources for healthE Reduced preventable emergencydepartment visits and hospitalizationsbullE1 By 2016 reduce by 15 the number ofpreventable emergency department visits ofWest Baltimore residents with cardiovasculardiseasebullE2 By 2016 reduce by 10 the number ofpreventable hospitalizations of WestBaltimore residents with cardiovasculardisease23


F Reduced unnecessary costs in health carethat would not have incurred if preventiveservices and adequate primary care had beenprovided By 2016 reduce by 10unnecessary costs of caring for WestBaltimore residents with cardiovasculardisease

Single or Multi-Year InitiativeTime Period This is a five year initiative spanning March2013- March 2018


bullBaltimore Medical SystembullBon Secours Baltimore Health SystembullCoppin State UniversitybullEquity MattersbullLight Health and Wellness ComprehensiveServices IncbullMosaic Community ServicesbullNational Council on Alcohol and DrugDependence MarylandbullPark West Health System IncbullPeoplersquos Community Health CentersbullSaint Agnes HospitalbullSenator Verna Jones-RodwellbullSinai Hospital of BaltimorebullTotal Health Care IncbullUniversity of Maryland Medical CenterbullUniversity of Maryland Midtown CampusbullUniversity of Maryland Baltimore

How were the outcomes evaluated Currently we have an external evaluatorfrom the University of Maryland that hasestablished baseline clinical metrics relatedto CVD Improvements in metrics such ascontrolled HTN HgbA1c obesity andsmoking cessation are expected to be realizedand will result in meeting the objectives ofthe program


Year one focused on building infrastructurefor the program marketing and involvingcommunity members in their careincreasingutilization of health resources The long termobjectives listed above and are not expectedto be realized until subsequent years

Continuation of Initiative Yes this is a long term population healthbased initiative focused on addressing thesocial determinants of health


$1023324

Identified Need Healthy Economy (CHNA) 453 ofSouthwest families are living on a householdincome of $25000 or less 36 of residentshave a high school diploma equivalentldquoProviding job readiness programs andongoing adult educationrdquo

Hospital Initiative Career DevelopmentPrimary Objective of the InitiativeMetricsthat will be used to evaluate the results

For adults the Career Development Programis an intensive job placement career and

24

financial asset building program that helpsadults overcome some of the most significantbarriers to achieving long term employmentand economic self-sufficiency Graduates ofthe program are also eligible to participate inthe Clean amp Green landscaping trainingprogramFor youth YEEP is a mentoring program thathelps our youth find after-school and summerjobs as well as help them develop plans forcareers and a productive meaningful adultlife YEEPrsquos wide-ranging and life changingstrategies teach participants about civicresponsibility community awarenesspersonal growth and development Duringthe school year YEEP students and parentscomplete community service projects attendrecreational and cultural activities and attendmeeting and training sessions to raise theawareness knowledge skills andexpectations in the areas of academicachievement leadership financial literacyeconomic self-sufficiency and careerdevelopment for young people between theages of 13-17


bullBon Secours Baltimore Health SystembullHarbor Bank of MarylandbullMayorrsquos Office of EmploymentDevelopmentbullArea high schoolsbullArea employersbullBaltimore City Community College

How were the outcomes evaluated Several metrics are tracked to monitor andevaluate the effectiveness of the programincludingbull of local residences accessing CareerDevelopment Servicesbull of visits madebull of job placementsbull of community residents utilizingComputer LabJob Hub for career relatedsearchesbull of youth participants completing 60 hoursin activities to position them for economicindependencebull of vacant lots servicedbull of trainees in the Clean and GreenProgram


From September 2013 through August 2014Career Development served 269 arearesidents for a total of 578 visits 136participants accessed the community jobhubcomputer lab to assist with employmentrelated searches 26 Career Developmentparticipants obtained employment 31 youthparticipants complete 60 hours in activitiesthat will position them to obtain economicindependence and personal growth Clean ampGreen Landscaping provided 6 monthinternships to 8 adult trainees and 4 youthparticipants 52 vacant lots were also

25

improved through the programContinuation of Initiative YesATotal Cost of Initiative $510727BWhat amount is Restricted GrantsDirectoffsetting revenue

$97191

26

V1

2 Were there any primary community health needs that were identified through theCHNA that were not addressed by the hospital If so why not (Examples includeother social issues related to health status such as unemployment illiteracy the factthat another nearby hospital is focusing on an identified community need or lack ofresources related to prioritization and planning) This information may be copieddirectly from the CHNA that refers to community health needs identified but unmet

PHYSICIANSAs required under HGsect19-303 provide a written description of gaps in the availability ofspecialist providers including outpatient specialty care to serve the uninsured cared for bythe hospital

Across the country the vast majority of specialist providers rely upon

reimbursement from Medicare Medicaid Managed Care and patients to provide

financial support for their practices However for hospitals such as Bon Secours

that serve low-income individuals without insurance urban poor areas the

opportunities for specialists to be compensated through these vehicles are

extremely low Consequently if these specialist providers were to provide the

needed health care services for these hospitals through only the support of

paying patients they would quickly be forced to close their practices or move to

a community with a far more favorable payer mix

For a hospital like Bon Secours to continue to support the community with the

varied specialist providers necessary for a full-service medicalsurgical hospital

with Emergency and Surgical Service some manner of support is required to

ensure the provision of this professional specialized medical care With

approximately 56 of the patient population presenting as charity self-pay and

Medicaid specialist physicians serving patients at Bon Secours are simply

unable to cover their costs

In particular the primary shortages in availability absent some form of financial

support come in the form of ED ICU regular physician staffing in addition to

the ldquoon call coverage necessary to support 24 hour services in these areas As a

result in Bon Secoursrsquo fiscal 2013 Annual Filing the ldquoPart Brdquo support provided

by the Hospital as indicated in the ldquoUR6rdquo Schedule totals $155 million The

fiscal year 2014 Annual Filing has not been completed at this time however

27

2

FY14 ldquoUR6rdquo schedule totals are anticipated to be comparable to FY13 To a

hospital the size of Bon Secours this is a significant outlay of support that is

necessary to provide the specialist care required to compassionately and

equitably care for our patients Therefore real and significant ldquogapsrdquo exist in the

availability of specialist providers in this community Those gaps currently are

only being filled via support from the Hospital The gaps are currently being filled

in the following specialist areas The gaps are currently being filled in the

following specialist areasIn addition to these gaps currently filled via subsidy relatively unmet specialistneeds for both the insured and uninsured within our facility include ENTSpecialist limited GI (Gastrointestinal Specialist) Neurologist Urologist andEndocrinologist

If you list Physician Subsidies in your data in category C of the CB Inventory Sheet pleaseindicate the categoryof subsidy and explain why the services would not otherwise beavailable to meet patient demand The categories include Hospital-based physicians withwhom the hospital has an exclusive contract Non-Resident house staff and hospitalistsCoverage of Emergency Department Call Physician provision of financial assistance toencourage alignment with the hospital financial assistance policies and Physicianrecruitment to meet community need

Please refer to number 1 in this section for answer

28

Appendix I - Describe FAP

Appendix II - Hospital FAP

Bon Secours HeaHh Syatem Inc System-Wide Policy Manual

TOPIc Patient Financial poucvNO DATE September 1999 Assistance Services CYC-011 FAP0025 and E5101 REVlSED July 9 2010

AREA Patient Financial Services APPROVED BY Rich Statuto

Patient Financial AssI$lance

PURPOSE

Bon Secours Heatth System Inc (BSHSI) is committed to ensuring access to needed heatth care services for all BSHSI treats an patients whether insured underinsured or uninsured with dignity respect and compassion throughout the admissions delivery of services discharge and billing and collection processes

Policy

The Bon Secours Heatth Syslem (BSHSI) exists to benefft people In the communHles served Patients and families are treated with digntty respect and compesslon during the furnishing of services and throughout the billing and coliecUon process

To provide high quality billing and collection services standard patient financial assistance services and procedures are utilized These services and procedures address the needs of patients who have limited financial means and are not able to pay in part or in full for the services provided without undue financial hardship (excluding cosmetic or self pay flat rate procedures)

The BSHSI financial assistance policy provides 100 financial assistance to uninsured peUents with annual family incomes at or below 200 of the Federal Poverty Guidelines rFPG) as adjusted by the Medicare geographic wage Index for each communfty served to reflect that communftys relative cost of living (AdjU$led FPG)_

Based on research conducted by the Tax Foundation the maximum annual famUy liability is based on a sliding scale determined by family Income and size A standard BSHSI sliding scale is adju$led by the Medicare geographic wage Index of each communtty served to refleci that communftys relative cost of living

of 11

Proeqdures

The standard patient financial assistance services and procedures are organized as follows

procedure Policy Section Communication and Education of Services

bull 1Preliminary Determination of Insurance and Financial Status bull 2

Financial CounSltlling bull 3

Prompt Pay Discounts bull 4

Billing and letter Series bull 5Payment Options bull 6

Program Enrollment Assistance bull 7Patient Financial Assistance Program bull e

Pursuit of Non Payment bull 9

Accountability and Monitoring bull 10State Requirements and Policy Revisions

bull 11

Definitions

bull Charity - the cost of free or discounted healih and heallh related services provided to indivkiuals who meet certain financial (and insurance coverage) criteria as denned the Catholic Health Association of the United States

bull Income - The total family household income includes but is not limited to earnings unemployment compensation Social Security Veteran Benefits Supplemental Security Income public assistance pension or retirement income alimony child support and other miscellaneous sources

bull Bad Debt - An account balance owed by a patient or guarantor that can afford to pay but has refused to pay whicih is written off as non-collectsble

bull Baseline - 200 of the Federal Poverty Guidelines (FPG) - utilized by all BSHSI local Systems to determine eligibility for the Patient Financial Assistance Program

bull Medical Eligibility VendorMedical Assistance Advocacy - Advocacy vendor contracted by BSHSlto screen patients for government programs and BSHSI Financial Assistance

bull Patient Financial Assistance Program - A program designed to reduce the patient balance owed provided to patients who are uninsured and underinsured and for whom payment in full or in part of the financial obligation would cause undue financial hardship

bull Prompt Pay Discount - A discount on the patient balance owed if paid within thirty (30) days of billing

bull The Tax Foundation Special Report - Guidelines for calculating the patient balanced owed for indMduals participating in the Patient Financial Assistance Program which identifies the percent income set aside for savings and medical expenses The source is A Special Report from the Tax Foundation dated November 2003 document number 125

bull Community Service Adjustment rCSA) - A reduction in total ciharges to an account which reflects an offset to the cost of healthcare to our uninsured patients and families

bull Uninsured - Patients who do not have any insurance and are not eligible for federal state or local health insurance programs

bull local System Champion (lSC) - The individual appointed by the local System CEO to assist in the educatron of staff and monitor compliance with this policy

Page20fll

bull Head of Household (Guarantor) - The individual listed on lax retum as Head of Household This will be the individual used for tracking Family Annual Liability

bull Household Family Membelts (Dependants) -Individuals residing In household which re claimed on the lax retum of the Head of Household (Guarantor)

ICommunication and Education of Services IPOLICY NO CYC-01FAP0025 Section 1

11 All BSHSI representatives that have contact with pallent regarding financial statu are responsible for advising patients of the BSHSI Patient Financial Assistance Services Program

12 Standard signs and brochures are prepared by BSHSI Palient Financial Servioes for limited ClJSlomizaton (name and logo) by each local System Signs and brochures are available in English and Spanish Each Local System is responsible for having the signs and brochures translated Into the other dominant languages spoken in the respective community in a manner that [s consistent with the English version

13 A brochure and education on its content are provided to each patiern upon registration Signs and brochures are predominantly displayed in patient registration customer service waiting and ancillary service areas

14 Brochures and education on the contenl are provided to physicians and their staff

15 Changes to the brochure or signs are prepared by BSHSI Patient Financial Services and distributed to each Local System Director of Patient Financial Service for immediate use All brochures must be approved by BSHSI Patient Finaneial Services and reviewed for Medicare and Medicaid compliance

16 The LSC is responsible to ensure that all community service agencies are provided information regarding the BSHSI Patient Financial Services practioes n is recommended that this be done in a forum that is interactive

17 Training education and resources on the Patient Financial Assistance Services Policy and Procedures is provided 10 each Local System CEO VP of Mission Director of Patient Financial Services and the Locaf System Champion and staff as needed to ensure consistency in deployment and policy administration

18 Accommodations will be made for non-English spaaking patients

Preliminary Determination of Insurance and Financial Status

POLICY NO CYC-01IFAP_0025 Section 2

21 The Patient Access Staff including Registration and Medical Eligibility VendorMedical Assistance Advocacy screen all patients to identify individuals and their families who may qualify for federal state or local health insurance programs or the Patient Financial Assistance Program (see section 8 of this Policy) Potentially eligible patients are referred to Patient Financial Services for financial counseling

Page 3 of tl

22 Although proof of income is requested for consideration of the Patient Financial Assistance Program some Local System DSH regulations may require proof of income Such regulations will be handled on a case-by-case basis

23 Automatoc charity ssessment and credit checks lor accounts greater than $5000 will be considered

IFinancial Counseling IPOLICY NO CYC-01IFAP 0025 Section 3 I 31 Patient Financial Services Staff including the Patient Access Staff is responsible for

aSSistIng patients and their families in determining eligibility and applying for federal state and local insurance programs andor for the Patient Financial Assistance Program If appiicabie referral for debt counseling is made Information will be made available at all patient access locations including 24-hour emergency departments

32 A standard financial information worksheet is used to collect and document the patients insurance and financial status The standard worksheet is reviewed as needed but at least annually by the BSHSI Dimctor of Patoent Flnancial Services Any changes Iltgt the standard work sheet are communicated to each Local System Director of Patient Financial Services and Local System Champion for immediate use

33 Patient cooperation is necessary for determination If patient does not provide the financial information needed to determine eligibility for the Patient Financial Assistance Program the patient will be given the opportunity lor a Prompt Pay Discount

34 All uninsured patients are provided a Community Service Adjustment at the time of billing

35 All BSHSllocations will have dedicated staff to assist palients in understanding charity and financial assistance policies

I Prompt Pay Discounts I POLICY No CYC-01IFAP 0025 Section 4

41 All patients am eligible for a 1OAgt Prompt Pay Discount when the patient balance owed is paid in full within thirty (30) days of the bill date Patient is msponibl for deducting the 10Agt prompt pay discount at the time of payment

42 The local System Dimctor of Palient Financial Services is msponsibl for ensuring compliance with allstate laws and regulations mgarding discounts fur heatth cam services

IBilling and Letter Series IPOLICY No CYC-01FAP 0025 Section 5

5 1 A standard letter series is used to inform the patient of the patient balance owed and the availability of the Patient Financial Assistance Program (See BSHSI Patient Financial Services Policy No C1217)

52 The BSHSI Director of Patient Financial Services or designee reviews as needed but at a minimum on an annual basis the standard letter series Any changes to the standard letter series are communicated to each Local System Director of Patient Financial Service or designee and Local System Champion for immediate use

Page 4 of 11

53 A distinct Jetter series is used for the Patient Financial Assistance Program to inform the patient of eligibility status and the patient balance owed (See BSHSI Patient Financial Services Policy No C313

5A The BSHSI Director of Patient Financial Services or designee reviews s needed but at a minimum on an annual basis the distinct letter series for Patient Financial AsSistance Program Any changes to the distinct letter series are communicated to each Local Syslem Director of Patient Financial Service or designee and Local System Champion for immediate use

55 It is the policy of BSHSI to provide nolification to a patient alleat thirty (30) days before an account is sent to collection Written notice can be ncluded with the bill

I Payment Options IPOLICY NO CYC-01fFAP0025 Section 6

61 A variety of payment options are available to all patients and their lamilies

bull Monthly Pay Plan - Patient pays the patient balance owed over an eight-month period with a minimum monthly payment of $50 In the State of New York the monthly payment shall not exceed ten percent (10) 01 the gross monthly income 01 the patient A patient may receive a monthly payment due reminder or choose an automatic check debit or cred~ card payment method

bull Loan Program ~ Assistance in obtaining a low-cost retail installment loan with an independent linance company is provided if the patient is not able to pay the patient balance awed within eight months of the billing date

bull Single Payment - Patients may choose to wait to pay the patient balance owed until after their insurance company has paid ils portion The patient balance awed i due within thirty (30) days of the billing dat

62 The Patient Financial SaNiees staff documents the payment aptian selected by the patient in the financial information system

63 Payments will be applied in the following or1ler unless otherwise directed by the LS DPFS bull In accordance with remittance advice or EOB bull As directed by the patientguarantor

In the absence of the above 1W0 pOints bull The mO$l current account

This approach mHigates issues with the handling of Family Annual liability and reduces expense to the organization

Page 5 ofl

IProgram Enrollment Assistance ] POLICY NO CYC-01FAP0025 Section 7

71 The Medical Eligibility VendorlMedical Assistance Advocacy screens referred patients lor eligibil~y for the following programs (this list is not Inclusive of all available programs) bull SSI Disability Federal Medicaid bull State Medicaid bull LocaVCounty Medical Assistance Programs bull State-Funded Charity Programs bull BSHSI Patient Financial Assistance Program

72 The Medical Eligibility VendorlMedlcal Assistance Advocacy assists the patient in completing and filing application f()mls for all programs for which the patient may be eligible including the BSHSI Patient Financial Assistance Program

73 The MedlCSl Eligibility VendorMedical Assistance Advocacy forwands the completed Patient Financial Asislance Program application form (and any documentation) to Patient Financial Services for processing

74 Patients should be encouraged to apply for financial assistance as soon as possible and in the State of New York Patients will have at least ninety (90) days from date of discharge Of date of service to apply for financial assistance and at least twenty (20) days to submit the completed application (including any state or federally requined documentation

75 Certain govemment programs may require proof of income

76 Patients without US citizenship presenting as uninsured will be eligible for the CSA however they must also be screened for available programs andor referred to an international case firm (as determined by the Local System)

77 Insured patienls without US citizenship must be referred to an international case firm (as determined by the Local System) for processing

IPatient Financi Assistance PrOjram I POLICY No CYC-OllFAP 0025 Section 8

R 1 The Patient Financial Assistance Program assists uninsured and underinsured patients who are not able to pay in part or in full the account balance not covered by their povate or government insurance plans without undue financial hardship

82 The standard minimum income level to quality for 100 charity t~rough the Patient Financial Assistance Program is an income equal to or less than 200 of the Federal Poverty Guidelines BSHSI will not include Patients assets in the application process

83 Individuals above the 200 of the Federal Poverty Guidelines can be found eligible for partial assistance Detennination of a patients maximum annual liability considers the patients income and size The patient balance owed is calculated using the formula illustrated in the Tables below

Page60fll

84 In Maryland indiViduals between 200 and 300 of the federal poverty guidelines may qualify for partial financial assistance based on the BSHSI reduced scale Individuals above 300 may also qualify for partial financial assistance based 01 the BSHSI reduced scale

85 In New York when a patient i above 200 but less than or equal to 250 of the Federal Poverty Guidelines the hosprtal shall apply a graduated scale not to exceed the maximum that Medicare Medicaid the charge from a third party payor or the charge from the aSHSI hospital as adjusted by the CSA whichever is more generous

86 In New York when a patient i equal to or above 251 of the Federal Poverty Guidelines the hospital shall collect no more than the greater of the amount that would have been paid for the same services by Medicare Medicaid or the highest volume payor or the charge from the BSHSI hospital as adjusted by the CSA whichaver is more generous

UNINSURED ONLY

Note This Table Does Not Address New York Patients

[Charges] x [Community Service Adjustment] = Adjusted ACCo1iSalance oWed

Uninsuredoatients ONLY will receive an ~accounr balance reduction I Communrty Service Adjustment (CSA) The reduction i market adjusted and will insure that patients will never pay 100 of charges The patient is till fully responsible for tneir Annual Liability after FAP (Steps II amp III below)

NOTES The Community Service Adjustment applies to the balance due on rndividual accounts

a If palient is approved for financial assistance they are responsible for each adjusted account balance owed amount until they meet their annual family liability

b) If patient is not approved for financial assistance they are responsible for each adjusted account balance owed without an annual thresholdlt

IStep II [Househokinoomel -[FEderal pmiddotoerty GuidefinesAdjusledfor Family Size] ~ i Adjusted Household Income I

Step III [Adjusted Household Incomel x1The Tax Foundation which identifies the I amount of Household Income Spsnt for Medical Expenses] = PatienUFamily Maximum Annual Liability

bull QnQ lill annualliabili is met any balances thereafter will be processed as 100 i chari ($Ie section 86 I

Step IV As applicable [Patient Balance Owed] - [10 Prompt Pay Discount] = Discounted Patient Balance Owed d

i

IAs piitients become Jigiille for FAP theCSA will be reversed and processed as ~~_ charity ad~~~tment _

Page7orl1

UNDERINSURED ONLY


Step I [Household Income] - [Federal Poverty Guidelines Adjusted for Family Size] -Adjusted Household Income

Step II [Adjusted Household Income] x [The Tax Foundation which identifies the amount of Household Income Spent for Medical Expenses] = PatientFamily Maximum Annual Liability

Once the annual liabilitv is met ani balances thereafter will be ~rocessed as 100 charity (see section B6)

Step III

Step IV

As applicable [Patient Balance Owed] - [10 Prompt Pay Discount] - Discounted Patient Balance Owed

As patients become eligible for FAP the eSA will be reversed and processed as a charity adjustment

87 The BSHSI Director of Patient Financial Services prepares and distributes updates to the Federal Poverty Guidelines The Tax Foundation Average and the respective Local System Cost of Service Adjustment as a part of the annual Strategic Quality Plan and Budget Guidelines process The Local System Champion is responsible to ensure Guidelines are followed

B8 Patient Financial Services determines and documents the patients eligibility for the Patient Financial Assistance Program and notifies the patient The letter of approvaldenial is mailed to the patient after receipt of the application and supporting documentation

B9 Patients determined to be eligible for Patient Financial Assistance Program retain eligibility for a period of twelve (12) months from the date of approval At the end of those twelve (12) months the patient is responsible for reapplying for eligibility for the Patient Financial Assistance Program

B10 Services provided as a result of an accident are subject to all legal instruments required to ensure third party liability payment even if these instruments are filed after the initial eligibility for the Patient Financial Assistance Program has been approved If third party coverage exists BSHSI will collect the balance owed from the third party payer

811 Application can be made on behalf of the patient by the following parties including but not limited to

bull Patient or guarantor bull Faith community leader or representative bull Physician or other health care professionals bull Member of the Administration

Page80fll

89 Validated denial of coverage will be considered as uninsured and will be provided CSA

IPursuit of Non-Payment IPolicy No CYC-OllFAP 0025 Section 9

91 No collection efforts are pursued on any pending Patient Financial Assistance Program account

92 Any collection attorneys working on behaW of BSHSI are NOT authorized to attach bank accounts and in no case file body attachments BSHSI collection attorneys follow BSHSls value-based procedures in the pursu~ of estates garnishments and judgments for non-payment of debts In no event Will BSHSI ever put a lien on a patient guarantors primary residence

93 In New York BSHSI payment plans will not contain an accelerator or similar clause under which a higher rate of interest is triggered by a missed payment

94 Each Local System uses a reputable collections attorney for the processing of legal accounts

95 The Local System Director of Patient Financial Services is responsible lor reviewing balances of $5000 and greater to confirm that all appropriate actions have been taken prior to he patient balance being written off to Bad Debt or sent for su~ Policy allows for the Local Systems to be more stringent in their practices with respect to authorization levels

96 As State requirements permtt deceased patienlS wah no estate or patients that have been discharged through a Chapter 7 bankruptcy are automatically qualified for 100 charity wnte off

97 All collection-type vendors are required to comply with the BSHSI Code of Conduct

IAccountability and Monoring IPolicy No CYC-01FAP0025 Seeben 10

101 Reports on the program status are issued monthly as part of current patient financial services revenue cycle reporting to each Local System CEO CFO VP of Mission Director of Patient Financial Services Local System Champon and staff and ohers as defined

102 The indicators used to monitor the program are bull Main Indicators

o Bad Debt as of Gross Revenue o Charity Care as of Gross Revenue

bull Monitoring lndicator o Reduction to of accountsdollars in bad debt that have been

reclassified to charity

103 The Local System CEO is the responsible person to insure applicable standardization of implementation and compUance with the integrity of the program on an ongoing basis

Page90fll

IState Requirements and Policy Revisions IPolicy No CYC-01IFAP0025 Section 11

111 Due to the ever-changing environment and current proposed legislation it will be necessary to revise this policy as appropriate

112 It may be necessary to address certain State requirements within this policy to insure compliance w~h applicable laws and regulations

113 Maryland State Only Regulations

bull The Maryland HSCRC (Hea~ Service Cost Review Commission) requires all Maryland hosp~ls to use the Un~orm Financial Assistanoe Applicalion form beginning January 1 2006

bull To maintain compliance ~ applicable Malyland laWs Bon Seeours Maryland will not sell bad debt accounts to any Ihird parties Bon Secours may use third party vendors 10 assist in the coUection of bad debt and charity accounts

bull 114 New Yolk Slate Only Requirements

bull Appeals Process for Re-Consideration of a Denied Application - All partenls thai hve been denied have the right 10 appeal by contacting the New York Dusiness office at 800shy474-3900

bull The followng are the reporting requirements by the hospital o A report on hospital costs incurred and uncollected amounts in providing services

to the uninsured and under insured including uncollected co insurance and deductible amounts

o The number of patients organized by zip code who applied for financial assistance and the number of patients by zip code whose applications were approved and whose applications were denied

o The amount reImbursement receIved from the Hospital Indigent Care Pool o The amount spent from charitable funds trusts or bequests established for the

purpose of providing financial assistance to eligible patients as defined by such trusts or bequests

Q ff local social selVioes district in which the hosp~al is located permits the hospital to assist patients with Medicaid applications the number of Madicaid applications the hospital helped patients complete and the number approved and denied

Q The hospitals losses resulUng from providing services under Madicaid

Page o of 11

---

--- ---

Prepared byfTitle Nlck Da_on Director Revenue CyclesecteIclIs___

SignatureDale -__-__ -shy

Rampviewed byfTitle ~4lIoIo1lt1dP Illttgtjjatlon Revn CyclesectetV~icea~_______

SignaturelDate j~~L7ItYL2_ __

Approved byfTitIe VP In~ration Revenu~ Cycle ~rviC~___ M _____bull ______

SignatureDate -p~-_--VIL2Ltp___ _ __ --_shy

Related Policies amp P~ Noles Controls

-_ _-_ _-_ _ shy

Revision Date (Use if ReVised)

NlckllaWson -- shy

Nick Dawson

Nick Dawson

Nick Dawson

Nick Dawson

- ---- shy

Filename Be

Dale September 1999

Additions for New York State

Additions for Maryland Stale

Inclusions of board approved language

Addition of section 84 for Maryland HSCRC regulations

Rampvised section 88

Review Date (Use if Reviewed

No Changes)

-April 18 2008

middotmiddotprIl24 2008----shy

June 4 2008

January 6 2010

April 20 2010

JUly 9 2010

15101

Page 11 ofl

Appendix III - Patient Information Sheet

Appendix VI - Mission Vision Value Statement

Description of Mission Vision and Values

While in many ways the Mission of Bon Secours speaks for itself an outside observer would

benefit from the knowledge that the Mission is driven by and sustained through the Eight Core

Values of the system They are Respect Justice Integrity Stewardship Innovation

Compassion Quality and Growth

It is part of the culture of Bon Secours to live these values on a day to day basis They drive the Systemrsquos desire to treat patients in a holistic way by treating mind body and spirit Our community benefits program reflect the Systemrsquos desire to help the people of West Baltimore attain and maintain good health by helping in the areas of housing career development and health awareness It is through the values of Respect and Justice that we strive to provide adequate housing It is because of the values of Integrity and Stewardship that we seek to use the resources available in the most effective manner Compassion and Quality compel us to treat all patients in a caring way And Innovation and Growth drives our desire to continue to serve the community for many years into the future

The policy is attached

Nursing Administration Policy

Policy Number 01-6010-SC000000doc

Title Bon Secours Mission Vision Values

Effective Date

Reviewed Date 122006 012010 0711

0912

- 2 -

MISSION

The mission of Bon Secours Health System is to bring compassion to health care and to be Good

Help to Those in Needreg especially those who are poor and dying As a system of caregivers we

commit ourselves to help bring people and communities to health and wholeness as a part of the

healing ministry of Jesus Christ and the Catholic Church

As a system of caregivers we commit ourselves to help bring people and communities to health

and wholeness as part of the healing ministry of Jesus Christ and the Catholic Church

VISION

Inspired by the healing ministry of Jesus Christ and the Charism of Bon SecourshellipAs a

prophetic Catholic health ministry we will partner with our communities to create a more

humane world build health and social justice for all and provide exceptional value for those we

serve

VALUES

RESPECT

JUSTICE

INTEGRITY

STEWARDSHIP

INNOVATION

COMPASSION

QUALITY

GROWTH

I1

BACKGROUND The Health Services Cost Review Commissionrsquos (HSCRC or Commission) Community BenefitReport required under sect19-303 of the Health General Article Maryland Annotated Code is theCommissionrsquos method of implementing a law that addresses the growing interest inunderstanding the types and scope of community benefit activities conducted by Marylandrsquosnonprofit hospitals The Commissionrsquos response to its mandate to oversee the legislation was to establish a reportingsystem for hospitals to report their community benefits activities The guidelines and inventoryspreadsheet were guided in part by the VHA CHA and othersrsquo community benefit reportingexperience and was then tailored to fit Marylandrsquos unique regulated environment The narrativerequirement is intended to strengthen and supplement the qualitative and quantitative informationthat hospitals have reported in the past The narrative is focused on (1) the general demographicsof the hospital community (2) how hospitals determined the needs of the communities theyserve and (3) hospital community benefit administration

Reporting Requirements

GENERAL HOSPITAL DEMOGRAPHICS AND CHARACTERISTICSPlease list the following information in Table I below For the purposes of thissection ldquoprimary services areardquo means the Maryland postal ZIP code areas fromwhich the first 60 percent of a hospitalrsquos patient discharges originate during the mostrecent 12 month period available where the discharges from each ZIP code areordered from largest to smallest number of discharges This information will beprovided to all hospitals by the HSCRC

Table I

BedDesignation

InpatientAdmissions

PrimaryService AreaZip Codes

All OtherMarylandHospitalsSharingPrimaryService Area

Percentage ofUninsuredPatients byCounty

Percentage ofPatients whoare MedicaidRecipientsby County

107 4681 21223212162121721229212022123021201

St AgnesHospital(21229)

BaltimoreCity- 86BaltimoreCounty- 8HowardCounty- 2Anne ArundelCounty- 1

BaltimoreCity- 92BaltimoreCounty- 5Anne ArundelCounty- 1Others- 1

2

2

a

-

-

-

-

-




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8

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1

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9

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h

i


10

























$120635

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$90218

13













$139034











16





$2256562










$137412

17












$97573

18













$66686















$652850














$23743




22












$1023324




24







25


$97191

26

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27

2











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Dale September 1999







No Changes)

-April 18 2008


June 4 2008

January 6 2010

April 20 2010

JUly 9 2010

15101

Page 11 ofl













Effective Date

Reviewed Date 122006 012010 0711

0912

- 2 -

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VISION




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VALUES

RESPECT

JUSTICE

INTEGRITY

STEWARDSHIP

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COMPASSION

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a

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Table II





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d

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1

a












9

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d

e

fg

h

i


10

























$120635

12












$90218

13













$139034











16





$2256562










$137412

17












$97573

18













$66686















$652850














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25


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Filename Be

Dale September 1999







No Changes)

-April 18 2008


June 4 2008

January 6 2010

April 20 2010

JUly 9 2010

15101

Page 11 ofl













Effective Date

Reviewed Date 122006 012010 0711

0912

- 2 -

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VISION




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VALUES

RESPECT

JUSTICE

INTEGRITY

STEWARDSHIP

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COMPASSION

QUALITY

GROWTH



291




31





































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1

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fg

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i


10

























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12












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13













$139034











16





$2256562










$137412

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of 11













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---

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Nick Dawson

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Dale September 1999







No Changes)

-April 18 2008


June 4 2008

January 6 2010

April 20 2010

JUly 9 2010

15101

Page 11 ofl













Effective Date

Reviewed Date 122006 012010 0711

0912

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VISION




serve

VALUES

RESPECT

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INTEGRITY

STEWARDSHIP

INNOVATION

COMPASSION

QUALITY

GROWTH































5
















need

6

II1

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3


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8

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1

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9

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fg

h

i


10

























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12












$90218

13













$139034











16





$2256562










$137412

17












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$66686















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25


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26

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Nick Dawson

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Filename Be

Dale September 1999







No Changes)

-April 18 2008


June 4 2008

January 6 2010

April 20 2010

JUly 9 2010

15101

Page 11 ofl













Effective Date

Reviewed Date 122006 012010 0711

0912

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MISSION







VISION




serve

VALUES

RESPECT

JUSTICE

INTEGRITY

STEWARDSHIP

INNOVATION

COMPASSION

QUALITY

GROWTH
















need

6

II1

2

III1


X Yes_ No






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3


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8

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1

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9

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h

i


10

























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12












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13













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16





$2256562










$137412

17












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18













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$652850














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22












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24







25


$97191

26

V1

























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PURPOSE


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Page 1of 11

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Page 5 ofl













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Step III

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Page80fll

















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Page o of 11

---

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Filename Be

Dale September 1999







No Changes)

-April 18 2008


June 4 2008

January 6 2010

April 20 2010

JUly 9 2010

15101

Page 11 ofl













Effective Date

Reviewed Date 122006 012010 0711

0912

- 2 -

MISSION







VISION




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VALUES

RESPECT

JUSTICE

INTEGRITY

STEWARDSHIP

INNOVATION

COMPASSION

QUALITY

GROWTH

II1

2

III1


X Yes_ No






X Yes_ No






7

a

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i123

ii1234

iii12

3


X Yes_ No






8

c

d

IV

1

a












9

bc

d

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fg

h

i


10

























$120635

12












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13













$139034











16





$2256562










$137412

17












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18













$66686















$652850














$23743




22












$1023324




24







25


$97191

26

V1

























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2











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PURPOSE


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Page 1of 11

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Page 5 ofl













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UNINSURED ONLY











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Step III

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Page80fll

















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Page o of 11

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Nick Dawson

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Filename Be

Dale September 1999







No Changes)

-April 18 2008


June 4 2008

January 6 2010

April 20 2010

JUly 9 2010

15101

Page 11 ofl













Effective Date

Reviewed Date 122006 012010 0711

0912

- 2 -

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VISION




serve

VALUES

RESPECT

JUSTICE

INTEGRITY

STEWARDSHIP

INNOVATION

COMPASSION

QUALITY

GROWTH

a

b

i123

ii1234

iii12

3


X Yes_ No






8

c

d

IV

1

a












9

bc

d

e

fg

h

i


10

























$120635

12












$90218

13













$139034











16





$2256562










$137412

17












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18













$66686















$652850














$23743




22












$1023324




24







25


$97191

26

V1

























27

2











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PURPOSE


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Page 1of 11

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Page 3 of tl















Page 4 of 11













Page 5 ofl













Page60fll




UNINSURED ONLY











i


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Step III

Step IV









Page80fll

















Page90fll
















Page o of 11

---

--- ---








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NlckllaWson -- shy

Nick Dawson

Nick Dawson

Nick Dawson

Nick Dawson

- ---- shy

Filename Be

Dale September 1999







No Changes)

-April 18 2008


June 4 2008

January 6 2010

April 20 2010

JUly 9 2010

15101

Page 11 ofl













Effective Date

Reviewed Date 122006 012010 0711

0912

- 2 -

MISSION







VISION




serve

VALUES

RESPECT

JUSTICE

INTEGRITY

STEWARDSHIP

INNOVATION

COMPASSION

QUALITY

GROWTH

c

d

IV

1

a












9

bc

d

e

fg

h

i


10

























$120635

12












$90218

13













$139034











16





$2256562










$137412

17












$97573

18













$66686















$652850














$23743




22












$1023324




24







25


$97191

26

V1

























27

2











28







PURPOSE


Policy





Page 1of 11

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Page 3 of tl















Page 4 of 11













Page 5 ofl













Page60fll




UNINSURED ONLY











i


Page7orl1

UNDERINSURED ONLY





Step III

Step IV









Page80fll

















Page90fll
















Page o of 11

---

--- ---








-_ _-_ _-_ _ shy


NlckllaWson -- shy

Nick Dawson

Nick Dawson

Nick Dawson

Nick Dawson

- ---- shy

Filename Be

Dale September 1999







No Changes)

-April 18 2008


June 4 2008

January 6 2010

April 20 2010

JUly 9 2010

15101

Page 11 ofl













Effective Date

Reviewed Date 122006 012010 0711

0912

- 2 -

MISSION







VISION




serve

VALUES

RESPECT

JUSTICE

INTEGRITY

STEWARDSHIP

INNOVATION

COMPASSION

QUALITY

GROWTH

bc

d

e

fg

h

i


10

























$120635

12












$90218

13













$139034











16





$2256562










$137412

17












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$66686















$652850














$23743




22












$1023324




24







25


$97191

26

V1

























27

2











28







PURPOSE


Policy





Page 1of 11

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bull 11

Definitions












Page20fll















Page 3 of tl















Page 4 of 11













Page 5 ofl













Page60fll




UNINSURED ONLY











i


Page7orl1

UNDERINSURED ONLY





Step III

Step IV









Page80fll

















Page90fll
















Page o of 11

---

--- ---








-_ _-_ _-_ _ shy


NlckllaWson -- shy

Nick Dawson

Nick Dawson

Nick Dawson

Nick Dawson

- ---- shy

Filename Be

Dale September 1999







No Changes)

-April 18 2008


June 4 2008

January 6 2010

April 20 2010

JUly 9 2010

15101

Page 11 ofl













Effective Date

Reviewed Date 122006 012010 0711

0912

- 2 -

MISSION







VISION




serve

VALUES

RESPECT

JUSTICE

INTEGRITY

STEWARDSHIP

INNOVATION

COMPASSION

QUALITY

GROWTH

























$120635

12












$90218

13













$139034











16





$2256562










$137412

17












$97573

18













$66686















$652850














$23743




22












$1023324




24







25


$97191

26

V1

























27

2











28







PURPOSE


Policy





Page 1of 11

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bull 11

Definitions












Page20fll















Page 3 of tl















Page 4 of 11













Page 5 ofl













Page60fll




UNINSURED ONLY











i


Page7orl1

UNDERINSURED ONLY





Step III

Step IV









Page80fll

















Page90fll
















Page o of 11

---

--- ---








-_ _-_ _-_ _ shy


NlckllaWson -- shy

Nick Dawson

Nick Dawson

Nick Dawson

Nick Dawson

- ---- shy

Filename Be

Dale September 1999







No Changes)

-April 18 2008


June 4 2008

January 6 2010

April 20 2010

JUly 9 2010

15101

ofl













Effective Date

Reviewed Date 122006 012010 0711

0912

- 2 -

MISSION







VISION




serve

VALUES

RESPECT

JUSTICE

INTEGRITY

STEWARDSHIP

INNOVATION

COMPASSION

QUALITY

GROWTH









$120635

12












$90218

13













$139034











16





$2256562










$137412

17












$97573

18













$66686















$652850














$23743




22












$1023324




24







25


$97191

26

V1

























27

2











28







PURPOSE


Policy





Page 1of 11

Proeqdures










bull 11

Definitions












Page20fll















Page 3 of tl















Page 4 of 11













Page 5 ofl













Page60fll




UNINSURED ONLY











i


Page7orl1

UNDERINSURED ONLY





Step III

Step IV









Page80fll

















Page90fll
















Page o of 11

---

--- ---








-_ _-_ _-_ _ shy


NlckllaWson -- shy

Nick Dawson

Nick Dawson

Nick Dawson

Nick Dawson

- ---- shy

Filename Be

Dale September 1999







No Changes)

-April 18 2008


June 4 2008

January 6 2010

April 20 2010

JUly 9 2010

15101

Page 11 ofl













Effective Date

Reviewed Date 122006 012010 0711

0912

- 2 -

MISSION







VISION




serve

VALUES

RESPECT

JUSTICE

INTEGRITY

STEWARDSHIP

INNOVATION

COMPASSION

QUALITY

GROWTH












$90218

13













$139034











16





$2256562










$137412

17












$97573

18













$66686















$652850














$23743




22












$1023324




24







25


$97191

26

V1

























27

2











28







PURPOSE


Policy





Page 1of 11

Proeqdures










bull 11

Definitions












Page20fll















Page 3 of tl















Page 4 of 11













Page 5 ofl













Page60fll




UNINSURED ONLY











i


Page7orl1

UNDERINSURED ONLY





Step III

Step IV









Page80fll

















Page90fll
















Page o of 11

---

--- ---








-_ _-_ _-_ _ shy


NlckllaWson -- shy

Nick Dawson

Nick Dawson

Nick Dawson

Nick Dawson

- ---- shy

Filename Be

Dale September 1999







No Changes)

-April 18 2008


June 4 2008

January 6 2010

April 20 2010

JUly 9 2010

15101

Page 11 ofl













Effective Date

Reviewed Date 122006 012010 0711

0912

- 2 -

MISSION







VISION




serve

VALUES

RESPECT

JUSTICE

INTEGRITY

STEWARDSHIP

INNOVATION

COMPASSION

QUALITY

GROWTH













$139034











16





$2256562










$137412

17












$97573

18













$66686















$652850














$23743




22












$1023324




24







25


$97191

26

V1

























27

2











28







PURPOSE


Policy





Page 1of 11

Proeqdures










bull 11

Definitions












Page20fll















Page 3 of tl















Page 4 of 11













Page 5 ofl













Page60fll




UNINSURED ONLY











i


Page7orl1

UNDERINSURED ONLY





Step III

Step IV









Page80fll

















Page90fll
















Page o of 11

---

--- ---








-_ _-_ _-_ _ shy


NlckllaWson -- shy

Nick Dawson

Nick Dawson

Nick Dawson

Nick Dawson

- ---- shy

Filename Be

Dale September 1999







No Changes)

-April 18 2008


June 4 2008

January 6 2010

April 20 2010

JUly 9 2010

15101

Page 11 ofl













Effective Date

Reviewed Date 122006 012010 0711

0912

- 2 -

MISSION







VISION




serve

VALUES

RESPECT

JUSTICE

INTEGRITY

STEWARDSHIP

INNOVATION

COMPASSION

QUALITY

GROWTH







16





$2256562










$137412

17












$97573

18













$66686















$652850














$23743




22












$1023324




24







25


$97191

26

V1

























27

2











28







PURPOSE


Policy





Page 1of 11

Proeqdures










bull 11

Definitions












Page20fll















Page 3 of tl















Page 4 of 11













Page 5 ofl













Page60fll




UNINSURED ONLY











i


Page7orl1

UNDERINSURED ONLY





Step III

Step IV









Page80fll

















Page90fll
















Page o of 11

---

--- ---








-_ _-_ _-_ _ shy


NlckllaWson -- shy

Nick Dawson

Nick Dawson

Nick Dawson

Nick Dawson

- ---- shy

Filename Be

Dale September 1999







No Changes)

-April 18 2008


June 4 2008

January 6 2010

April 20 2010

JUly 9 2010

15101

Page 11 ofl













Effective Date

Reviewed Date 122006 012010 0711

0912

- 2 -

MISSION







VISION




serve

VALUES

RESPECT

JUSTICE

INTEGRITY

STEWARDSHIP

INNOVATION

COMPASSION

QUALITY

GROWTH





$2256562










$137412

17












$97573

18













$66686















$652850














$23743




22












$1023324




24







25


$97191

26

V1

























27

2











28







PURPOSE


Policy





Page 1of 11

Proeqdures










bull 11

Definitions












Page20fll















Page 3 of tl















Page 4 of 11













Page 5 ofl













Page60fll




UNINSURED ONLY











i


Page7orl1

UNDERINSURED ONLY





Step III

Step IV









Page80fll

















Page90fll
















Page o of 11

---

--- ---








-_ _-_ _-_ _ shy


NlckllaWson -- shy

Nick Dawson

Nick Dawson

Nick Dawson

Nick Dawson

- ---- shy

Filename Be

Dale September 1999







No Changes)

-April 18 2008


June 4 2008

January 6 2010

April 20 2010

JUly 9 2010

15101

Page 11 ofl













Effective Date

Reviewed Date 122006 012010 0711

0912

- 2 -

MISSION







VISION




serve

VALUES

RESPECT

JUSTICE

INTEGRITY

STEWARDSHIP

INNOVATION

COMPASSION

QUALITY

GROWTH












$97573

18













$66686















$652850














$23743




22












$1023324




24







25


$97191

26

V1

























27

2











28







PURPOSE


Policy





Page 1of 11

Proeqdures










bull 11

Definitions












Page20fll















Page 3 of tl















Page 4 of 11













Page 5 ofl













Page60fll




UNINSURED ONLY











i


Page7orl1

UNDERINSURED ONLY





Step III

Step IV









Page80fll

















Page90fll
















Page o of 11

---

--- ---








-_ _-_ _-_ _ shy


NlckllaWson -- shy

Nick Dawson

Nick Dawson

Nick Dawson

Nick Dawson

- ---- shy

Filename Be

Dale September 1999







No Changes)

-April 18 2008


June 4 2008

January 6 2010

April 20 2010

JUly 9 2010

15101

Page 11 ofl













Effective Date

Reviewed Date 122006 012010 0711

0912

- 2 -

MISSION







VISION




serve

VALUES

RESPECT

JUSTICE

INTEGRITY

STEWARDSHIP

INNOVATION

COMPASSION

QUALITY

GROWTH













$66686















$652850














$23743




22












$1023324




24







25


$97191

26

V1

























27

2











28







PURPOSE


Policy





Page 1of 11

Proeqdures










bull 11

Definitions












Page20fll















Page 3 of tl















Page 4 of 11













Page 5 ofl













Page60fll




UNINSURED ONLY











i


Page7orl1

UNDERINSURED ONLY





Step III

Step IV









Page80fll

















Page90fll
















Page o of 11

---

--- ---








-_ _-_ _-_ _ shy


NlckllaWson -- shy

Nick Dawson

Nick Dawson

Nick Dawson

Nick Dawson

- ---- shy

Filename Be

Dale September 1999







No Changes)

-April 18 2008


June 4 2008

January 6 2010

April 20 2010

JUly 9 2010

15101

Page 11 ofl













Effective Date

Reviewed Date 122006 012010 0711

0912

- 2 -

MISSION







VISION




serve

VALUES

RESPECT

JUSTICE

INTEGRITY

STEWARDSHIP

INNOVATION

COMPASSION

QUALITY

GROWTH










$652850














$23743




22












$1023324




24







25


$97191

26

V1

























27

2











28







PURPOSE


Policy





Page 1of 11

Proeqdures










bull 11

Definitions












Page20fll















Page 3 of tl















Page 4 of 11













Page 5 ofl













Page60fll




UNINSURED ONLY











i


Page7orl1

UNDERINSURED ONLY





Step III

Step IV









Page80fll

















Page90fll
















Page o of 11

---

--- ---








-_ _-_ _-_ _ shy


NlckllaWson -- shy

Nick Dawson

Nick Dawson

Nick Dawson

Nick Dawson

- ---- shy

Filename Be

Dale September 1999







No Changes)

-April 18 2008


June 4 2008

January 6 2010

April 20 2010

JUly 9 2010

15101

Page 11 ofl













Effective Date

Reviewed Date 122006 012010 0711

0912

- 2 -

MISSION







VISION




serve

VALUES

RESPECT

JUSTICE

INTEGRITY

STEWARDSHIP

INNOVATION

COMPASSION

QUALITY

GROWTH











$23743




22












$1023324




24







25


$97191

26

V1

























27

2











28







PURPOSE


Policy





Page 1of 11

Proeqdures










bull 11

Definitions












Page20fll















Page 3 of tl















Page 4 of 11













Page 5 ofl













Page60fll




UNINSURED ONLY











i


Page7orl1

UNDERINSURED ONLY





Step III

Step IV









Page80fll

















Page90fll
















Page o of 11

---

--- ---








-_ _-_ _-_ _ shy


NlckllaWson -- shy

Nick Dawson

Nick Dawson

Nick Dawson

Nick Dawson

- ---- shy

Filename Be

Dale September 1999







No Changes)

-April 18 2008


June 4 2008

January 6 2010

April 20 2010

JUly 9 2010

15101

Page 11 ofl













Effective Date

Reviewed Date 122006 012010 0711

0912

- 2 -

MISSION







VISION




serve

VALUES

RESPECT

JUSTICE

INTEGRITY

STEWARDSHIP

INNOVATION

COMPASSION

QUALITY

GROWTH












$1023324




24







25


$97191

26

V1

























27

2











28







PURPOSE


Policy





Page 1of 11

Proeqdures










bull 11

Definitions












Page20fll















Page 3 of tl















Page 4 of 11













Page 5 ofl













Page60fll




UNINSURED ONLY











i


Page7orl1

UNDERINSURED ONLY





Step III

Step IV









Page80fll

















Page90fll
















Page o of 11

---

--- ---








-_ _-_ _-_ _ shy


NlckllaWson -- shy

Nick Dawson

Nick Dawson

Nick Dawson

Nick Dawson

- ---- shy

Filename Be

Dale September 1999







No Changes)

-April 18 2008


June 4 2008

January 6 2010

April 20 2010

JUly 9 2010

15101

Page 11 ofl













Effective Date

Reviewed Date 122006 012010 0711

0912

- 2 -

MISSION







VISION




serve

VALUES

RESPECT

JUSTICE

INTEGRITY

STEWARDSHIP

INNOVATION

COMPASSION

QUALITY

GROWTH







25


$97191

26

V1

























27

2











28







PURPOSE


Policy





Page 1of 11

Proeqdures










bull 11

Definitions












Page20fll















Page 3 of tl















Page 4 of 11













Page 5 ofl













Page60fll




UNINSURED ONLY











i


Page7orl1

UNDERINSURED ONLY





Step III

Step IV









Page80fll

















Page90fll
















Page o of 11

---

--- ---








-_ _-_ _-_ _ shy


NlckllaWson -- shy

Nick Dawson

Nick Dawson

Nick Dawson

Nick Dawson

- ---- shy

Filename Be

Dale September 1999







No Changes)

-April 18 2008


June 4 2008

January 6 2010

April 20 2010

JUly 9 2010

15101

Page 11 ofl













Effective Date

Reviewed Date 122006 012010 0711

0912

- 2 -

MISSION







VISION




serve

VALUES

RESPECT

JUSTICE

INTEGRITY

STEWARDSHIP

INNOVATION

COMPASSION

QUALITY

GROWTH


$97191

26

V1

























27

2











28







PURPOSE


Policy





Page 1of 11

Proeqdures










bull 11

Definitions












Page20fll















Page 3 of tl















Page 4 of 11













Page 5 ofl













Page60fll




UNINSURED ONLY











i


Page7orl1

UNDERINSURED ONLY





Step III

Step IV









Page80fll

















Page90fll
















Page o of 11

---

--- ---








-_ _-_ _-_ _ shy


NlckllaWson -- shy

Nick Dawson

Nick Dawson

Nick Dawson

Nick Dawson

- ---- shy

Filename Be

Dale September 1999







No Changes)

-April 18 2008


June 4 2008

January 6 2010

April 20 2010

JUly 9 2010

15101

Page 11 ofl













Effective Date

Reviewed Date 122006 012010 0711

0912

- 2 -

MISSION







VISION




serve

VALUES

RESPECT

JUSTICE

INTEGRITY

STEWARDSHIP

INNOVATION

COMPASSION

QUALITY

GROWTH

V1

























27

2











28







PURPOSE


Policy





Page 1of 11

Proeqdures










bull 11

Definitions












Page20fll















Page 3 of tl















Page 4 of 11













Page 5 ofl













Page60fll




UNINSURED ONLY











i


Page7orl1

UNDERINSURED ONLY





Step III

Step IV









Page80fll

















Page90fll
















Page o of 11

---

--- ---








-_ _-_ _-_ _ shy


NlckllaWson -- shy

Nick Dawson

Nick Dawson

Nick Dawson

Nick Dawson

- ---- shy

Filename Be

Dale September 1999







No Changes)

-April 18 2008


June 4 2008

January 6 2010

April 20 2010

JUly 9 2010

15101

Page 11 ofl













Effective Date

Reviewed Date 122006 012010 0711

0912

- 2 -

MISSION







VISION




serve

VALUES

RESPECT

JUSTICE

INTEGRITY

STEWARDSHIP

INNOVATION

COMPASSION

QUALITY

GROWTH

2











28







PURPOSE


Policy





Page 1of 11

Proeqdures










bull 11

Definitions












Page20fll















Page 3 of tl















Page 4 of 11













Page 5 ofl













Page60fll




UNINSURED ONLY











i


Page7orl1

UNDERINSURED ONLY





Step III

Step IV









Page80fll

















Page90fll
















Page o of 11

---

--- ---








-_ _-_ _-_ _ shy


NlckllaWson -- shy

Nick Dawson

Nick Dawson

Nick Dawson

Nick Dawson

- ---- shy

Filename Be

Dale September 1999







No Changes)

-April 18 2008


June 4 2008

January 6 2010

April 20 2010

JUly 9 2010

15101

Page 11 ofl













Effective Date

Reviewed Date 122006 012010 0711

0912

- 2 -

MISSION







VISION




serve

VALUES

RESPECT

JUSTICE

INTEGRITY

STEWARDSHIP

INNOVATION

COMPASSION

QUALITY

GROWTH







PURPOSE


Policy





Page 1of 11

Proeqdures










bull 11

Definitions












Page20fll















Page 3 of tl















Page 4 of 11













Page 5 ofl













Page60fll




UNINSURED ONLY











i


Page7orl1

UNDERINSURED ONLY





Step III

Step IV









Page80fll

















Page90fll
















Page o of 11

---

--- ---








-_ _-_ _-_ _ shy


NlckllaWson -- shy

Nick Dawson

Nick Dawson

Nick Dawson

Nick Dawson

- ---- shy

Filename Be

Dale September 1999







No Changes)

-April 18 2008


June 4 2008

January 6 2010

April 20 2010

JUly 9 2010

15101

Page 11 ofl













Effective Date

Reviewed Date 122006 012010 0711

0912

- 2 -

MISSION







VISION




serve

VALUES

RESPECT

JUSTICE

INTEGRITY

STEWARDSHIP

INNOVATION

COMPASSION

QUALITY

GROWTH

Proeqdures










bull 11

Definitions












Page20fll















Page 3 of tl















Page 4 of 11













Page 5 ofl













Page60fll




UNINSURED ONLY











i


Page7orl1

UNDERINSURED ONLY





Step III

Step IV









Page80fll

















Page90fll
















Page o of 11

---

--- ---








-_ _-_ _-_ _ shy


NlckllaWson -- shy

Nick Dawson

Nick Dawson

Nick Dawson

Nick Dawson

- ---- shy

Filename Be

Dale September 1999







No Changes)

-April 18 2008


June 4 2008

January 6 2010

April 20 2010

JUly 9 2010

15101

Page 11 ofl













Effective Date

Reviewed Date 122006 012010 0711

0912

- 2 -

MISSION







VISION




serve

VALUES

RESPECT

JUSTICE

INTEGRITY

STEWARDSHIP

INNOVATION

COMPASSION

QUALITY

GROWTH















Page 3 of tl















Page 4 of 11













Page 5 ofl













Page60fll




UNINSURED ONLY











i


Page7orl1

UNDERINSURED ONLY





Step III

Step IV









Page80fll

















Page90fll
















Page o of 11

---

--- ---








-_ _-_ _-_ _ shy


NlckllaWson -- shy

Nick Dawson

Nick Dawson

Nick Dawson

Nick Dawson

- ---- shy

Filename Be

Dale September 1999







No Changes)

-April 18 2008


June 4 2008

January 6 2010

April 20 2010

JUly 9 2010

15101

Page 11 ofl













Effective Date

Reviewed Date 122006 012010 0711

0912

- 2 -

MISSION







VISION




serve

VALUES

RESPECT

JUSTICE

INTEGRITY

STEWARDSHIP

INNOVATION

COMPASSION

QUALITY

GROWTH















Page 4 of 11













Page 5 ofl













Page60fll




UNINSURED ONLY











i


Page7orl1

UNDERINSURED ONLY





Step III

Step IV









Page80fll

















Page90fll
















Page o of 11

---

--- ---








-_ _-_ _-_ _ shy


NlckllaWson -- shy

Nick Dawson

Nick Dawson

Nick Dawson

Nick Dawson

- ---- shy

Filename Be

Dale September 1999







No Changes)

-April 18 2008


June 4 2008

January 6 2010

April 20 2010

JUly 9 2010

15101

Page 11 ofl













Effective Date

Reviewed Date 122006 012010 0711

0912

- 2 -

MISSION







VISION




serve

VALUES

RESPECT

JUSTICE

INTEGRITY

STEWARDSHIP

INNOVATION

COMPASSION

QUALITY

GROWTH













Page 5 ofl













Page60fll




UNINSURED ONLY











i


Page7orl1

UNDERINSURED ONLY





Step III

Step IV









Page80fll

















Page90fll
















Page o of 11

---

--- ---








-_ _-_ _-_ _ shy


NlckllaWson -- shy

Nick Dawson

Nick Dawson

Nick Dawson

Nick Dawson

- ---- shy

Filename Be

Dale September 1999







No Changes)

-April 18 2008


June 4 2008

January 6 2010

April 20 2010

JUly 9 2010

15101

Page 11 ofl













Effective Date

Reviewed Date 122006 012010 0711

0912

- 2 -

MISSION







VISION




serve

VALUES

RESPECT

JUSTICE

INTEGRITY

STEWARDSHIP

INNOVATION

COMPASSION

QUALITY

GROWTH













Page60fll




UNINSURED ONLY











i


Page7orl1

UNDERINSURED ONLY





Step III

Step IV









Page80fll

















Page90fll
















Page o of 11

---

--- ---








-_ _-_ _-_ _ shy


NlckllaWson -- shy

Nick Dawson

Nick Dawson

Nick Dawson

Nick Dawson

- ---- shy

Filename Be

Dale September 1999







No Changes)

-April 18 2008


June 4 2008

January 6 2010

April 20 2010

JUly 9 2010

15101

Page 11 ofl













Effective Date

Reviewed Date 122006 012010 0711

0912

- 2 -

MISSION







VISION




serve

VALUES

RESPECT

JUSTICE

INTEGRITY

STEWARDSHIP

INNOVATION

COMPASSION

QUALITY

GROWTH




UNINSURED ONLY











i


Page7orl1

UNDERINSURED ONLY





Step III

Step IV









Page80fll

















Page90fll
















Page o of 11

---

--- ---








-_ _-_ _-_ _ shy


NlckllaWson -- shy

Nick Dawson

Nick Dawson

Nick Dawson

Nick Dawson

- ---- shy

Filename Be

Dale September 1999







No Changes)

-April 18 2008


June 4 2008

January 6 2010

April 20 2010

JUly 9 2010

15101

Page 11 ofl













Effective Date

Reviewed Date 122006 012010 0711

0912

- 2 -

MISSION







VISION




serve

VALUES

RESPECT

JUSTICE

INTEGRITY

STEWARDSHIP

INNOVATION

COMPASSION

QUALITY

GROWTH

UNDERINSURED ONLY





Step III

Step IV









Page80fll

















Page90fll
















Page o of 11

---

--- ---








-_ _-_ _-_ _ shy


NlckllaWson -- shy

Nick Dawson

Nick Dawson

Nick Dawson

Nick Dawson

- ---- shy

Filename Be

Dale September 1999







No Changes)

-April 18 2008


June 4 2008

January 6 2010

April 20 2010

JUly 9 2010

15101

Page 11 ofl













Effective Date

Reviewed Date 122006 012010 0711

0912

- 2 -

MISSION







VISION




serve

VALUES

RESPECT

JUSTICE

INTEGRITY

STEWARDSHIP

INNOVATION

COMPASSION

QUALITY

GROWTH

















Page90fll
















Page o of 11

---

--- ---








-_ _-_ _-_ _ shy


NlckllaWson -- shy

Nick Dawson

Nick Dawson

Nick Dawson

Nick Dawson

- ---- shy

Filename Be

Dale September 1999







No Changes)

-April 18 2008


June 4 2008

January 6 2010

April 20 2010

JUly 9 2010

15101

Page 11 ofl













Effective Date

Reviewed Date 122006 012010 0711

0912

- 2 -

MISSION







VISION




serve

VALUES

RESPECT

JUSTICE

INTEGRITY

STEWARDSHIP

INNOVATION

COMPASSION

QUALITY

GROWTH
















Page o of 11

---

--- ---








-_ _-_ _-_ _ shy


NlckllaWson -- shy

Nick Dawson

Nick Dawson

Nick Dawson

Nick Dawson

- ---- shy

Filename Be

Dale September 1999







No Changes)

-April 18 2008


June 4 2008

January 6 2010

April 20 2010

JUly 9 2010

15101

Page 11 ofl













Effective Date

Reviewed Date 122006 012010 0711

0912

- 2 -

MISSION







VISION




serve

VALUES

RESPECT

JUSTICE

INTEGRITY

STEWARDSHIP

INNOVATION

COMPASSION

QUALITY

GROWTH

---

--- ---








-_ _-_ _-_ _ shy


NlckllaWson -- shy

Nick Dawson

Nick Dawson

Nick Dawson

Nick Dawson

- ---- shy

Filename Be

Dale September 1999







No Changes)

-April 18 2008


June 4 2008

January 6 2010

April 20 2010

JUly 9 2010

15101

Page 11 ofl













Effective Date

Reviewed Date 122006 012010 0711

0912

- 2 -

MISSION







VISION




serve

VALUES

RESPECT

JUSTICE

INTEGRITY

STEWARDSHIP

INNOVATION

COMPASSION

QUALITY

GROWTH













Effective Date

Reviewed Date 122006 012010 0711

0912

- 2 -

MISSION







VISION




serve

VALUES

RESPECT

JUSTICE

INTEGRITY

STEWARDSHIP

INNOVATION

COMPASSION

QUALITY

GROWTH

COMMUNITY BENEFIT NARRATIVE REPORT FY2014 BON...

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Transcript of COMMUNITY BENEFIT NARRATIVE REPORT FY2014 BON...