Implementation Strategy Reportfor Community Health Needs

License #550000810

Kaiser Foundation Hospital – MORENO VALLEY

2013

2013 KFH CHNA Implementation Strategy Report

Kaiser Foundation Hospital Moreno Valley Community Health Needs Assessment (CHNA)

Implementation Strategy Report 2013

Kaiser Foundation Hospital – Moreno Valley

License # 550000810 27300 Iris Avenue, Moreno Valley, CA 92555

I. General Information

Contact Person: Karen Roberts, Senior Director, Public Affairs & Brand Communications

Date of Written Plan: September 16, 2013

Date Written Plan Was Adopted by Authorized Governing Body: December 4, 2013

Date Written Plan Was Required to Be Adopted: December 31, 2013

Authorized Governing Body that Adopted the Written Plan: Kaiser Foundation Hospital/Health Plan Boards of Directors

Was the Written Plan Adopted by Authorized Governing Body by End of Tax Year in Which CHNA was Made Available to the Public? Yes ☒ No ☐

Date Facility's Prior Written Plan Was Adopted by Organization's Governing Body: N/A

Name and EIN of Hospital Organization Operating Hospital Facility: Kaiser Foundation Hospital- Moreno Valley, EIN 94-1105628

Address of Hospital Organization: 27300 Iris Avenue., Moreno Valley, CA 92555

II. About Kaiser Permanente

Kaiser Permanente is an integrated health care delivery system comprised of Kaiser Foundation Hospitals and Kaiser Foundation Health Plan (both California nonprofit public benefit corporations and exempt organizations under Section 501(c)(3) of the Internal Revenue Code), and a separate Permanente Medical Group in each region in which Kaiser Permanente operates. For more than 65 years, Kaiser Permanente has been dedicated to providing high-quality, affordable health care services and to improving the health of our members and the communities we serve. Today we serve more than 9 million members in eight states and the District of Columbia. Kaiser Permanente is dedicated to improving the health of our communities through broad coverage, high quality

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care and continuous quality improvement and innovation in the care we deliver, clinical research, workforce development, health education and the support of community health interventions. III. About Kaiser Permanente Community Benefit

Community Benefit is central to our mission. We believe good health is a fundamental aspiration of all people. We recognize that promotion of good health extends beyond the doctor’s office and the hospital. Like our approach to medicine, our work in the community takes a prevention-focused, evidence-based approach. To be healthy, people need access to healthy and nutritious food in their neighborhood stores, clean air, successful schools, and safe parks and playgrounds. Good health for the entire community also requires a focus on equity as well as social and economic well-being. We focus our work on three broad areas: • Providing access to high-quality care for low-income, underserved people • Creating safe, healthy communities and environments where people live, work, and play • Developing important new medical knowledge and sharing it widely with others and training a culturally

competent health care workforce of the future. Across these areas, we work to inspire and support people to be healthier in all aspects of their lives, and build stronger, healthier communities. In pursuit of our mission we go beyond traditional corporate philanthropy and grant-making to leverage our financial resources with medical research, physician expertise, and clinical practices. In addition to dedicating resources through Community Benefit, we also leverage substantial additional assets that improve community health, including our purchasing practices, our environmental stewardship efforts and workforce volunteerism. For many years, we have worked collaboratively with other organizations to address serious public health issues such as obesity, access to care, and violence. We have conducted Community Health Needs Assessments (CHNA) to better understand each community’s unique needs and resources. The CHNA process informs our community investments and helps us develop strategies aimed at making long-term, sustainable change—and it allows us to deepen the strong relationships we have with other organizations that are working to improve community health. IV. Kaiser Foundation Hospital-Moreno Valley

Kaiser Foundation Hospitals defines the communities served by a hospital as those individuals residing within its hospital service area. A hospital service area includes all residents in a defined geographic area surrounding the hospital and does not exclude low-income or underserved populations.

The KFH-Moreno Valley is one of two Kaiser Foundation Hospitals serving the Riverside County. (The other Kaiser Foundation Hospital is KFH-Riverside.) The map on the following page describes the geographic area covered by the KFH-Moreno Valley Medical Center Area (MCA).

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The KFH-Moreno Valley service area is home to more than 500,000 residents. Approximately 61% of the population residing in the KFH-Moreno Valley service area is white, while 21.4% is Black, 10.8% is Asian, 4.1% is multi-race, and less than 1% are Native American or Alaska Native. Nearly 18% of the population lives below 100% of the Federal Poverty Level (FPL) and almost 26% of residents over the age of 25 do not have a high school diploma.

V. Purpose of Implementation Strategy

This Implementation Strategy has been prepared in order to comply with federal tax law requirements set forth in Internal Revenue Code section 501(r) requiring hospital facilities owned and operated by an organization described in Code section 501(c)(3) to conduct a community health needs assessment at least once every three years and adopt an implementation strategy to meet the community health needs identified through the community health needs assessment.

This Implementation Strategy is intended to satisfy each of the applicable requirements set forth in proposed regulations released April 2013. This implementation strategy describes KFH-Moreno Valley’s planned response to the needs identified through the 2013 Community Health Needs Assessment (CHNA) process. For information about KFH-Moreno Valley’s 2013 CHNA process and for a copy of the report please visit http://share.kaiserpermanente.org/article/community-health-needs-assessments-3/.

This Implementation Strategy also serves as a foundation for further alignment and connection of other Kaiser Permanente initiatives that may not be described herein, but which together advance KFH – Moreno Valley’s commitment to improving the health of the communities it serves. Such other initiatives include but are not limited to our Supplier Diversity Program to promote the socio-economic vitality that correlates with the health of our communities, our environmental stewardship to reduce waste and pollution, and organized matching of the altruism of our workforce with community volunteer opportunities that promote health. VI. List of Community Health Needs Identified in CHNA Report

KFH-Moreno Valley identified the following significant health need in the community it serves through the 2013 Community Health Needs Assessment process in order of community priority:

• Economic Instability • Health Care Access • Oral Health • Mental Health • Service Infrastructure • Obesity/Overweight • Community Violence • Cancer • Diabetes • Cardiovascular Disease (including hypertension, heart disease, and stroke) • Asthma

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VII. Who was Involved in the Implementation Strategy Development

The implementation strategy development team at KFH-Moreno Valley included the following stakeholders representing both Kaiser Foundation Hospital/Health Plan and the Permanente Medical Group.

• Vita Willett, Executive Director, KFH-Riverside and Moreno Valley • Jill Duplechan, Chief Executive Officer, KFH-Riverside and Moreno Valley • Richard Rajaratnam, MD, Area Medical Director, KFH-Riverside and Moreno Valley • Frank Flowers, MD, Area Medical Director Elect, KFH-Riverside and Moreno Valley • Corey Seale, Chief Operating Officer, KFH-Moreno Valley • Robin Mackenroth, Chief Operating Officer, KFH- Riverside • Lorna Curtis, Area Chief Financial Officer, KFH-Riverside and Moreno Valley • Karen Sirski-Martin, Assistant Medical Group Administrator, Southern California Permanente Medical

Group • Karen Roberts, Senior Director, Public Affairs & Brand Communications, KFH-Riverside and Moreno Valley • Cecilia Arias, Community Benefit Health Manager, KFH-Riverside and Moreno Valley

The process was led by staff from KFH-Moreno Valley Community Benefit and technical assistance for the IS Development process was provided by Regional Community Benefit, Advancement Project: Healthy City and Special Service for Group (SSG).

• Mehrnaz Davoudi, Senior Program Evaluation Manager, Community Benefit, Kaiser Permanente, Southern California Region

• Jonathan Nomachi, Manager of Collaborative Initiatives, Advancement Project • Angela Beltrán, Research Analyst, SSG consultant • Victoria Perera, Research Analyst, SSG consultant

VIII. Health Needs that KFH-Moreno Valley Plans to Address

a. Process and Criteria Used In order to select the health needs that KFH-Moreno Valley will address, the team used the criteria listed below, with a particular focus on choosing needs that Kaiser Permanente would have the ability to have a significant and meaningful impact on given our expertise, our resources and the evidence. In addition, KFH-Moreno Valley limited the number of needs selected to only a few in order to maximize the hospital's ability to have an impact and not spread resources too thinly across many needs. From the broader list of community health needs identified during the 2013 CHNA, the Implementation Strategy Development team applied criteria based on two categories: Need and Feasibility. The need criteria used were:

• Magnitude/Scale of the Problem: the health need affects a large number of people within the community • Severity of Problem: the health need has serious consequences (morbidity, mortality, and/or economic

burden) for those affected • Health Disparities: the health need disproportionately impacts the health status of one or more

vulnerable population groups

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The feasibility criteria used were: • Kaiser Permanente Assets: KP has relevant expertise and/or unique assets as an integrated health system

to make a meaningful contribution • Ability to leverage: opportunity to collaborate with existing community partners working to address the

need, or to build on current programs, emerging opportunities, or other assets. The criteria were applied to each health need and scored using a 5-point rating. The health needs receiving the highest overall scores were selected as needs that KFH-Moreno Valley would address. The team limited the selected health needs to three given the mix of resources and assets available and the health needs that rose to the top. b. Health Needs that KFH-Moreno Valley Plans to Address

1. Access to Health Care Health Care Access includes access to primary and specialty care services, mental health, oral health, for the uninsured or underinsured population, including safety net infrastructure, and health care workforce development. Access to health care impacts an individual’s overall physical, social, and mental health status, prevention of disease and disability, detection and treatment of health conditions, quality of life, and life expectancy. Limited access to health care impacts a person’s ability to reach full potential, negatively affecting quality of life. Barriers include lack of availability, high cost, and health professional shortage of primary, specialty, dental and mental care providers. In the KFH-Moreno Valley MCA the uninsured rate is 20.99%, which is higher than the rate in California overall (17.92%). There are about half as many primary care providers in the MCA (42.2 per 100,000 people) than in the state (83.2 per 100,000 in California). Hispanic/ Latino, Black and white populations have the highest percentages of being uninsured. The rates of uninsured are highest in Perris and the southernmost part of the KFH-Moreno Valley MCA.

Increasing access to appropriate and effective health care services addresses a wide range of specific health needs. Achieving the goal of increased access to care requires reducing barriers to preventive screening, primary care, and specialty care through deploying a wide range of strategies encompassing programs, outreach, training, and policies.

2. Diabetes Diabetes includes the prevention, detection, treatment and management of Type 1 and Type 2 among vulnerable populations in Riverside County, including service infrastructure for improved collaboration among community partners. The diabetes prevalence rate for adults has increased in Riverside County compared to the state of California. Diabetes contributes to heart disease, stroke, hypertension, kidney disease, blindness, nervous system disease, amputation, decreased quality of life, and early death. According to state data, in Riverside County the age-adjusted death rate due to diabetes increased from 2002 to 2007 (17.5 in 2002-2004 to 22.7 in 2005 -2007) and then dropped slightly in 2008-2010 to 20.7 per 100,000 people. Diabetes hospitalization rate for adults is higher in KFH-Moreno Valley MCA (13.02 per 10,000 total population) than in California (10.40 per 10,000 total population).

3. Obesity and Overweight Obesity and overweight includes the availability of healthy foods, opportunities for physical activity, behavior change for weight management, service infrastructure for improved community collaboration

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and the impact of the built environment. The health implications of overweight and obesity in the community includes heart disease, high blood pressure, diabetes, depression, and certain cancers. Low-income communities in Riverside County are disproportionately affected by obesity, especially youth. According to CDC data nearly two-thirds of adults in the KFH-Moreno Valley MCA are overweight (37.5%) or obese (27.5%). Youth obesity rates are also high with 34.3% of youth categorized as obese in KFH-Moreno Valley MCA compared to 29.8% in California. The highest disparities in youth obesity are among Hispanic/Latino, Multi-Race, and Black sub-populations. Economic instability, poor nutrition, physical inactivity, and lack of health care access contribute to obesity and overweight.

4. Broader Health Care Delivery System Needs in Our Communities

Kaiser Foundation Hospitals, which includes 37 licensed hospital facilities as of 2013, has identified a number of significant needs in addition to those identified above through the CHNA process which we are committed to addressing as part of an integrated healthcare delivery system. These needs, which are manifest in each of the communities we serve, include: 1) health care workforce shortages and the need to increase linguistic and cultural diversity in the health care workforce, and 2) access to and availability of robust public health and clinical care data and research.

Supporting a well-trained, culturally competent and diverse health care workforce helps ensure access to high quality care; this activity is also essential to making progress in the reduction of healthcare disparities which persist in most of our communities. Individuals trained through these workforce training programs are able to seek employment through Kaiser entities or at other health care providers in our communities.

Deploying a wide range of research methods contribute to building general knowledge for improving health and health care services, including clinical research, health care services research, and epidemiological and translational studies on health care that are generalizable and broadly shared. Conducting high-quality health research, and disseminating findings from it, increases awareness of the changing health needs of diverse communities, addresses health disparities and improves effective health care delivery and health outcomes.

IX. KFH-Moreno Valley’s Implementation Strategies

As part of the Kaiser Permanente integrated health system, KFH-Moreno Valley has a long history of working with Kaiser Foundation Health Plan, The Permanente Medical Group, and other Kaiser Foundation Hospitals, as well as external stakeholders , to identify, develop and implement strategies to address the health needs in the community. These strategies are developed so that they: Are available broadly to the public and serve low-income consumers. Reduce geographic, financial, or cultural barriers to accessing health services, and if they ceased would result

in access problems. Address federal, state, or local public health priorities Leverage or enhance public health department activities Advance increased general knowledge through education or research that benefits the public Address needs that would otherwise become the responsibility of government or another tax-exempt

organization

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KFH-Moreno Valley is committed to enhancing its understanding about how best to develop and implement effective strategies to address community health needs and recognizes that good health outcomes cannot be achieved without joint planning and partnerships with community stakeholders and leaders. As such, KFH-Moreno Valley will continue to work in partnership to refine its goals and strategies over time so that they most effectively address the needs identified. Access to Health Care Kaiser Permanente aims to increase the number of people who will have access to appropriate health care in the Moreno Valley service area by aligning our strategies with the following goals: Increase health care coverage for uninsured, underinsured, and low income residents Improve service infrastructure of safety net providers for improved capacity to serve the uninsured and

underinsured Increase access to primary care services Increase access to specialty care services including mental health Improve health care capacity through workforce development Increase access to oral health care There are several strategies Moreno Valley service area will implement to address these goals: Participate in government- sponsored programs for low-income individuals (Medi-Cal Managed Care and

Medi-Cal Fee-for-Services) Provide care to low income children under 19 in families at or below 300% of FPL who lack access to

employer-subsidized coverage and do not qualify for public programs pursuant to a program that provides these children with heavily subsidized health care cover

Provide Medical Financial Assistance (i.e., charity care) Leverage ACA communications for increased participation in Health Care Reform. Provide technical assistance and convening coordination for safety net providers to network and identify

collaborative opportunities Provide grant and in-kind donations to advance the collaborative structure among safety net providers Provide grants and in-kind donations to community clinics to provide primary care, care

management/coordination, engaging health promoters for patient navigation Partner with participating community clinics to provide technical assistance with implementing Proactive

Office Encounter (POE) to systematically identify and address primary care delivery, including preventive screening, and chronic care management and leverage Community Benefit Clinical Quality Consultant to provide technical assistance

Promote safety net collaboration for specialty care referral workflow to improve access for the uninsured. Conduct Community Surgery Day and Colonoscopy Screening annual event in partnership with safety net

providers Provide grants in support of mental health interventions to prevent/treat domestic violence, substance

abuse, depression, and suicide Explore collaborative opportunities among oral health providers for low-income populations Provide grants and in-kind donation in support of dental education, prevention of dental caries among the

uninsured population and at-risk children, including dental services Leverage the partnership with UCR School of Medicine, Riverside County Medical Association, local nursing

and allied health training programs Support youth pipeline programs (Hippocrates Circle, Summer Youth, and INROADS), and increase awareness

of Science, Technology, Engineering, and Math (STEM) careers

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We anticipate that our strategies will have the following outcomes, which can contribute toward achieving our overall goal(s) for access to health care: Increase number of eligible individuals enrolled in government-sponsored and/or subsidized health care

coverage programs Improve relationships and develop a safety net collaboration Improve the medical home model of health care delivery for the uninsured and underinsured Improve collaboration for specialty care referrals throughout Riverside County Improve access to mental health interventions for at-risk populations Improve access to preventive dental services Increase diverse health care professionals practicing in Riverside County Diabetes Kaiser Permanente aims to reduce morbidity and mortality of Type 1 and Type 2 Diabetes among high-risk population in the Moreno Valley service area by aligning our strategies with the following goals: Improve healthy eating and active living among high-risk population Promote early detection of diabetes and prevention of Type 2 diabetes among high-risk population Improve clinical care for and management of high risk populations Improve capacity of safety net providers and CBOs addressing diabetes care management Improve diabetes self-management skills There are several strategies Moreno Valley service area will implement to address these goals: Collaborate with schools, worksites, and CBOs to improve environmental and education policies for healthy

nutrition and physical activity to prevent and control diabetes Provide grants and in-kind donations to community organizations that reduce health disparities Leverage KP Symposiums for professional development of community providers, practitioners, educators, and

outreach workers/health promoters Provide grants and in-kind donations to community organizations that implement culturally and linguistically

appropriate diabetes awareness and education campaigns which improve diabetes screening in high-risk populations

Leverage Project ALL HEART’s technical assistance to safety net providers Partner with safety net providers to provide technical assistance with implementing Proactive Office

Encounter (POE) to systematically identify and address preventive, screening, and chronic care needs of diabetes patients

Provide grants and in-kind donations to community organizations to improve diabetes clinical care through process and workflow improvement, and care management

Partner with local collaborations and existing community campaigns and leverage to provide technical assistance

Share best practices in diabetes care management, leverage safety net collaboration, KP Family Medicine Residents rotating in the community clinic settings and pharmacy interns

Promote the Healthier Living Series- Chronic Disease Management classes (English and Spanish), increase the awareness and benefits of a mostly plant-based diet, and utilize health promoters for community engagement

Provide grants and in-kind donations to community organizations that provide diabetes prevention, treatment, and management education in community settings

Partner with Regional Health Education for sharing of diabetes management best practices, curriculum, educational materials, and technical assistance for CBOs to implement programs

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We anticipate that our strategies will have the following outcomes, which can contribute toward achieving our overall goal(s) for diabetes: Increase awareness, knowledge, skills, motivation and utilization around healthy eating and active living. Increase screenings, testing, early detection and prevention for diabetes Promote the medical home model and coordinated team approach for diabetes prevention and care delivery Facilitate the incorporation of evidenced-based research findings into community clinic practices Increase knowledge of meal planning and food preparation to manage diabetes

Obesity and Overweight Kaiser Permanente aims to reduce prevalence of obesity and overweight In the Moreno Valley service area by aligning our strategies with the following goals: Increase healthy eating among families, including youth and seniors in low income communities Increase active living Improve weight management skills for overweight / obese

There are several strategies Moreno Valley service area will implement to address these goals: Promote a multi-disciplinary collaborative effort for healthy food and beverage availability Provide grants and in-kind donations to community based organizations (CBOs) to address availability of

healthy foods and beverages Partner with Educational Theatre Programs, to Riverside County students to address knowledge gaps related

to healthy eating Foster coalitions and community networks Promote community-wide campaigns Provide grants to community organizations to provide physical activity opportunities in school and

communities settings Participate in Healthy Eating Active Living (HEAL) collaborative efforts across Riverside County in partnership

with Riverside Department of Public Health, cities, and CBOs to adopt health policies, including a Healthy City Resolution which leverages the County of Riverside’s Healthy Counties Element in the General Plan

Leverage HEAL Cities Campaign technical assistance and toolkits Continue to offer our Farmer’s Market program on the hospital campus to provide access to largely locally

produced fresh fruits and vegetable and to educate the public on the benefits of healthy eating and active living

Provide grants and in-kind donations to community organizations that adopt policies that enhance the built environment for healthy eating and provide physical activity opportunities in school and communities settings

Partner with Regional Health Education for sharing of weight management best practices, curriculum, educational materials, and technical assistance for CBOs to implement programs

Partner with community clinics to provide technical assistance with implementing Proactive Office Encounter (POE) to systematically identify and address preventive, screening, and chronic care needs of overweight/obese patients (e.g. screening for BMI and providing counseling for PA, nutrition, and screen time during visits)

Promote the Healthier Living Series- Chronic Disease Management classes (English and Spanish) and increase the awareness and benefits of a mostly plant-based diet

We anticipate that our strategies will have the following outcomes, which can contribute toward achieving our overall goal(s) for obesity and overweight: Increase accessibility, availability, affordability and identification of healthy foods in communities Increase awareness about healthy eating

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Increase collaboration with community-based organizations, local government and schools for healthy eating Increase opportunities for physical activity in communities and workplaces Promote an understanding of the connections between the built environment and the on-going health

challenges in Riverside County Increase availability of weight management services for overweight/obese residents Broader Health Care Delivery System Needs in Our Communities Workforce Long-term Goals To address health care workforce shortages and cultural and linguistic disparities in the health care workforce Intermediate Goals Increase the number of skilled, culturally competent, diverse professionals working in and entering the health

care workforce to provide access to quality culturally relevant care Strategies Implement health care workforce pipeline programs to introduce diverse, underrepresented school age youth

and college students to health careers Provide workforce training programs to train current and future health care providers with the skills,

linguistic, and cultural competence to meet the health care needs of diverse communities Disseminate knowledge to educational and community partners to inform curricula, training and health

career ladder/pipeline programs To leverage CB funded programs to develop strategies to increase access to allied health, clinical training and

residency programs for linguistic and culturally diverse candidates Increase capacity in allied health, clinical training and residency programs to address health care workforce

shortages through the provision of clinical training and residency programs Leverage KP resources to support organizations and research institutions to collect, standardize and improve

access to workforce data to enhance planning and coordination of workforce training and residency training programs

Expected Outcomes Increase the number of diverse youth entering health care workforce educational, training programs and

health careers Increase the number of culturally and linguistically competent and skilled providers Increase awareness among academia of what is required to adequately train current and future allied health,

clinical and physician residents on how to address the health care needs of our diverse communities Increase the participation of diverse professionals in allied health, clinical training and residency programs Improve access to relevant workforce data to inform health care workforce planning and academic curricula Research Long-term Goals To increase awareness of the changing health needs of diverse communities Intermediate Goals Increase access to, and the availability of, relevant public health and clinical care data and research

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Strategies Disseminate knowledge and expertise to providers to increase awareness of the changing health needs of

diverse communities to improve health outcomes and care delivery models Translate clinical data and practices to disseminate findings to safety net providers to increase quality in care

delivery and to improve health outcomes Conduct, publish and disseminate high-quality health services research to the broader community to address

health disparities, and to improve effective health care delivery and health outcomes Leverage KP resources to support organizations and research institutions to collect, analyze and publish data

to inform public and clinical health policy, organizational practices and community health interventions to improve health outcomes and to address health disparities

Expected Outcomes Improve health care delivery in community clinics and public hospitals Improve health outcomes in diverse populations disproportionally impacted by heath disparities Increase the availability of research and publications to inform clinical practices and guidelines X. Evaluation Plans

KFH-Moreno Valley will monitor and evaluate the strategies listed above for the purpose of tracking the implementation of those strategies as well as to document the anticipated impact. Plans to monitor will be tailored to each strategy and will include the collection and documentation of tracking measures, such as the number of grants made, number of dollars spent, number of people reached/served, number and role of volunteers, and health outcomes. In addition, KFH-Moreno Valley will require grantees to propose, track and report outcomes, including behavior and health outcomes as appropriate. For example, outcome measures for a strategy that addresses obesity/overweight by increasing access to physical activity and healthy eating options might include number of students walking or biking to school, access to fresh locally grown fruits and vegetables at schools, or number of weekly physical activity minutes.

XI. Health Needs Facility Does Not Intend to Address

The remaining prioritized health needs for Moreno Valley will not be addressed by KFH-Moreno Valley because, using the criteria described previously, they were not ranked as highly as Access to Care, which includes Mental Health, Oral Health, and Service Infrastructure, Obesity and Overweight, and Diabetes, which also includes Service Infrastructure. KFH-Moreno Valley has unique resources and capacity to dedicate to the three chosen health needs. In addition, there are other strong community partners who are currently addressing the needs below. The needs that will not be addressed are:

1. Asthma 2. Cancer 3. Cardiovascular Disease (including hypertension, heart disease, and stroke) 4. Community Violence 5. Economic Instability

While this Implementation Strategy Report responds to the CHNA and Implementation Strategy requirements in the Affordable Care Act and IRS Notices, it is not exhaustive of everything we do to enhance the health of our

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communities. KFH-Moreno Valley will look for collaboration opportunities that address needs not selected where it can appropriately contribute to addressing those needs.

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