Community Health Needs Assessment 2019 CHNA Rpt19.pdf · Blackfoot Fire Department (free classes) and Eastern Idaho Regional Medical Center both currently offer a Diabetes Self-Management

Community Health Needs Assessment 2019

Bingham Memorial Hospital


Contents

Consultants’ Report ............................................................................................................... 1

Introduction ....................................................................................................................... 2

Summary of Community Health Needs Assessment .......................................................................... 3

General Description of the Hospital ................................................................................................... 4

Evaluation of Prior Implementation Strategy ..................................................................................... 5

Summary of Findings – 2019 Tax Year CHNA ................................................................................. 8

Community Served by the Hospital ...................................................................................... 9

Defined Community ........................................................................................................................... 9

Community Details ............................................................................................................... 10

Identification and Description of Geographical Community ........................................................... 10

Community Population and Demographics ...................................................................................... 11

Socioeconomic Characteristics of the Community .......................................................... 13

Income ............................................................................................................................................... 13

Unemployment Rate .......................................................................................................................... 14

Poverty .............................................................................................................................................. 14

Uninsured ......................................................................................................................................... 15

Education ......................................................................................................................................... 15

Physical Environment of the Community .......................................................................... 16

Grocery Store Access ....................................................................................................................... 16

Food Access/Food Deserts ............................................................................................................... 17

Recreation and Fitness Facility Access ............................................................................................ 17

Clinical Care of the Community .......................................................................................... 19

Access to Primary Care .................................................................................................................... 19

Access to Dentist .............................................................................................................................. 20

Access to Mental Health Providers .................................................................................................. 20

Health Professional Shortage Area ................................................................................................... 21

Preventable Hospital Events ............................................................................................................. 22

Health Status of the Community ......................................................................................... 23

Leading Causes of Death and Health Outcomes .............................................................. 24

Health Outcomes and Factors ............................................................................................ 25


Community Health Status Indicators ................................................................................. 28

Diabetes (Adult) ............................................................................................................................... 28

High Blood Pressure (Adult ............................................................................................................. 28

Obesity (Adult) ................................................................................................................................. 29

Low Birth Weight ............................................................................................................................. 29

Community Input – Key Stakeholder Interviews ............................................................... 30

Methodology..................................................................................................................................... 30

Key Stakeholder Profiles .................................................................................................................. 31

Key Stakeholder Interview Results .................................................................................................. 31

Health Issues of Vulnerable Populations ........................................................................... 33

Information Gaps .................................................................................................................. 34

Prioritization of Identified Health Needs ............................................................................ 34

Management’s Prioritization Process ................................................................................ 37

Resources Available to Address Significant Health Needs ............................................. 38

Health Care Resources ..................................................................................................................... 38

Hospitals ........................................................................................................................................... 38

Other Health Care Facilities ............................................................................................................. 38

Health Departments .......................................................................................................................... 39

Appendices

Acknowledgements .......................................................................................................................... 40

Appendix A: Analysis of Data ......................................................................................................... 41

Appendix B: Sources ........................................................................................................................ 44

Appendix C: Dignity Health CNI Report ......................................................................................... 45

Appendix D: County Health Rankings ............................................................................................. 46

Appendix E: Key Stakeholder Interview Questions ......................................................................... 49

Consultants’ Report

Ms. Danette Roberts Director of GME, Research, Grants, CME Bingham Memorial Hospital Blackfoot, Idaho On behalf of Bingham Memorial Hospital (BMH or the “Hospital”), we have assisted in conducting a Community Health Needs Assessment (CHNA) consistent with the scope of services outlined in our engagement letter dated June 13, 2019. The purpose of our engagement was to assist the Hospital in meeting the requirements of Internal Revenue Code §501(r)(3) and Regulations thereunder. We also relied on certain information provided by the Hospital, specifically certain utilization data, geographic HPSA information and existing community health care resources. Based upon the assessment procedures performed, it appears the Hospital is in compliance with the provisions of §501(r)(3). Please note that we were not engaged to, and did not, conduct an examination, the objective of which would be the expression of an opinion on compliance with the specified requirements. Accordingly, we do not express such an opinion. We used and relied upon information furnished by the Hospital, its employees and representatives and on information available from generally recognized public sources. We are not responsible for the accuracy and completeness of the information and are not responsible to investigate or verify it. These findings and recommendations are based on the facts as stated and existing laws and regulations as of the date of this report. Our assessment could change as a result of changes in the applicable laws and regulations. We are under no obligation to update this report if such changes occur. Regulatory authorities may interpret circumstances differently than we do. Our services do not include interpretation of legal matters.

December 20, 2019


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Introduction

Internal Revenue Code (IRC) Section 501(r) requires health care organizations to assess the health needs of their communities and adopt implementation strategies to address identified needs. Per IRC Section 501(r), a byproduct of the Affordable Care Act, to comply with federal tax-exemption requirements, a tax-exempt hospital facility must:

Conduct a Community Health Needs Assessment (CHNA) every three years.

Adopt an implementation strategy to meet the community health needs identified through the assessment.

Report how it is addressing the needs identified in the CHNA as well as a description of needs that are not being addressed with the reasons why such needs are not being addressed.

The CHNA must take into account input from persons including those with special knowledge of or expertise in public health, those who serve or interact with vulnerable populations and those who represent the broad interest of the community served by the hospital facility. The hospital facility must make the CHNA widely available to the public.

This CHNA, which describes both a process and a document, is intended to document Bingham Memorial Hospital compliance with IRC Section 501(r)(3). Health needs of the community have been identified and prioritized so that the Hospitals may adopt an implementation strategy to address specific needs of the community.

The process involved:

An evaluation of the implementation strategy for fiscal years ended December 31, 2016 through December 31, 2018, which was adopted by the Hospital’s board of directors in 2016.

Collection and analysis of a large range of data, including demographic, socioeconomic and health statistics, health care resources and hospital data.

Obtaining community input from key stakeholders through an electronic survey on health and quality of life issues impacting the CHNA community.

This document is a summary of all the available evidence collected during the CHNA conducted in tax year 2019. It will serve as a compliance document, as well as a resource, until the next assessment cycle. Both the process and document serve as the basis for prioritizing the community’s health needs and will aid in planning to meet those needs.

Implementation Strategy

Calendar Years Ending

December 31, 2016

December 31, 2017 and

December 31, 2018

CHNA

2019 Tax Year December 31, 2019

Initial CHNA

Adopted December 2016

2016 Tax Year


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Summary of Community Health Needs Assessment

The purpose of the CHNA is to understand the unique health needs of the community served by the Hospital and to document compliance with new federal laws outlined above.

The Hospital engaged BKD, LLP to conduct a formal CHNA. BKD, LLP is one of the largest CPA and advisory firms in the United States, with approximately 2,700 partners and employees in 40 offices. BKD serves more than 1,000 hospitals and health care systems across the country. The CHNA was conducted from May 2019 to November 2019.

Based on current literature and other guidance from the treasury and the IRS, the following steps were conducted as part of the Hospital’s CHNA:

An evaluation of the impact of actions taken to address the significant health needs identified in the tax year 2016 CHNA was completed to understand the effectiveness of the Hospital’s current strategies and programs.

The “community” served by the Hospital was defined by utilizing inpatient & outpatient data regarding patient origin. This process is further described in Community Served by the Hospital.

Population demographics and socioeconomic characteristics of the community were gathered and reported utilizing various third parties (see references in Appendices). The health status of the community was then reviewed. Information on the leading causes of death and morbidity information was analyzed in conjunction with health outcomes and factors reported for the community by the Center for Disease Control and Prevention (Community Health Status Indicators) as well as countyhealthrankings.org. Health factors with significant opportunity for improvement were noted.

Community input was provided through key stakeholder interviews of eight stakeholders. Results and findings are described in the Key Stakeholder section of this report.

Information gathered in the above steps was analyzed and reviewed to identify health issues of uninsured persons, low-income persons and minority groups and the community as a whole. Health needs were ranked utilizing a weighting method that weighs 1) the size of the problem, 2) the seriousness of the problem, 3) the impact of the issues on vulnerable populations, 4) the prevalence of common themes and 5) alignment with the Hospital’s resources.

An inventory of health care facilities and other community resources potentially available to address the significant health needs identified through the CHNA was prepared and collaborative efforts were identified.

Health needs were then prioritized taking into account the perceived degree of influence the Hospital has to impact the need and the health needs impact on overall health for the community. Information gaps identified during the prioritization process have been reported.


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General Description of the Hospital

Bingham Memorial Hospital is a 501(c)(3) non-profit organization located in Blackfoot, Idaho, with additional healthcare facilities in Idaho Falls, Pocatello and Shelley. The Hospital was established in 1950 with just six physicians, and today has over 140 medical providers and employs over 700 people.

Bingham Memorial offers over 100 types of patient services, including in-patient, out-patient, critical care, emergency, rehabilitation, same day surgery and transitional care services. The Hospital has become one of the leading and award-winning healthcare providers in eastern Idaho.

Mission

Advancing your healthcare experience through innovation, compassion and exceptional service

Vision

High Quality. High Compassion.

Values

Caring: I serve others with respect, empathy and compassion.

Integrity: I am accountable to myself and others and accept ownership for my actions and attitude.

Teamwork: I am a committed part of a team of individuals communicating openly to create excellence.

Honesty: I generate trust by having the inner strength to be truthful and sincere.


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Evaluation of Prior Implementation Strategy

High Cost of Care Offered in 2016 BMH participates in health fairs, offers reduced-cost flu shots, provides access to

emergency care and offers charity care. In addition, BMH offers a low income/sliding fee scale for rural clinics including the Shelley Clinic, the First Choice Clinic and the Idaho’s Physician’s Clinic.

Proposed Community calendar mailed to community and available in Doctor’s offices as well as with the front office staff/nurse managers.

Met elsewhere Health West, Community Family Clinic, Ft. Hall Clinic, Idaho State University, Eastern Idaho Regional Medical Center.

Actions taken Negotiating with pharmaceutical companies to lower the cost of prescription drugs.

Uninsured/Underinsured Offered in 2016 Partnership with Riverside Benefits Proposed Insurance benefits community class Met elsewhere Idaho health exchange Action taken BMH developed a Community Resource Booklet to connect patients with low-cost

or free services when possible. The launch of this booklet was paired with a new series of physician education initiatives designed to enhance access to low-cost community services in order to promote increased knowledge of and access to essential health services. Accountable care status to serve more Medicaid patients, expansion of PCMH. (Medicaid expansion)

Diabetes Offered in 2016 Diabetes and Osteoporosis Center in Pocatello, hyperbaric, and wound ostomy

treatment. Diabetes Prevention Program- focus on prevention (instructor is a certified Center for Disease Control (CDC) Lifestyle Coach).

Proposed Community calendar, *Diabetes Health Campaign Certified Diabetes Education (CDE) program in development - within the next three years at BMH which will result in a Diabetes Self-Management Program (DSME). Transitioning program to Patient Centered Medical Home (PCMH), community calendar.

Met elsewhere Portneuf Medical Center, Health West offer diabetes care in their clinics. Blackfoot Fire Department (free classes) and Eastern Idaho Regional Medical Center both currently offer a Diabetes Self-Management Program (DSME). Physicians Immediate Care – Pocatello (weight loss program)-future location at IPC Fall 2017.

Action taken In 2017, 2018 and 2019 BMH applied for and received grants to expand the Diabetes Prevention Program (DPP) and provide access to DPP through Medicaid. BMH also offers an Exercise and Nutrition Class. In partnership with the PCMH, BMH’s Grants Department applied for funding to support the purchase of eye cameras that will allow BMH clinics to screen for diabetic retinopathy. BMH is also leveraging its PCMH and Grants Department to improve access to health screenings for hypertension, cholesterol, pre-diabetes and diabetes.


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Healthy Lifestyle Choices Offered in 2016 Tobacco cessation class Proposed Community calendar Met elsewhere Action taken The Bingham Health Care Foundation also offers scholarships for all BMH classes

(while funding lasts) and BMH offers an Exercise and Nutrition Class.

Obesity Offered in 2016 Diabetes Prevention Program, weight loss seminars Proposed Idaho Food bank- Cooking Matters class, PCMH, community calendar Met elsewhere Physicians Immediate Care, Portneuf Medical Center, Eastern Idaho Regional

Medical Center all offer classes Action taken Grants to expand DPP and provide access to DPP through Medicaid. BMH also

offers an Exercise and Nutrition Class. In 2017, BMH applied for a grant to purchase two now bariatric beds and to redesign the educational materials used within its Bariatric Center of Excellence. The Bariatric Center of Excellence is also undergoing expansions and introducing new services to further improve patients’ abilities to maintain their weight loss. This includes a new treatment model called, “Enhanced Recovery After Surgery.” BMH is also leveraging its PCMH and Grants Department to improve access to health screenings for hypertension, cholesterol, pre-diabetes and and diabetes.

Mental Health Services Offered in 2016 Anger Management, Love and Logic classes and counseling services Proposed PCMH, local mental health specialists, community calendar Met elsewhere Blackfoot South, Health West offer mental health services/counseling Action taken Community resource booklet to connect patients with low-cost and free mental

health services in the community as well as physician/provider education about how best to use these resources to help patients. In 2018 BMH also open a geriatric psychiatric unit with 10 beds to provide acute mental health care. As part of that process, BMH hired a psychiatric nurse and a psychiatrist.

Heart Disease Offered in 2016 Cardiology services Proposed None Met elsewhere Portneuf Medical Center, Eastern Idaho Regional Medical Center, Health West

offer cardiology services Action taken Grants to expand DPP and provide access to DPP through Medicaid. BMH also

offers an Exercise and Nutrition Class. In addition, BMH is leveraging its PCMH and Grants Department to apply for grants that will allow it to improve access to health screenings for hypertension, cholesterol, pre-diabetes and diabetes.


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Limited Health Knowledge Offered in 2016 Heart Health Screenings, Diabetes Prevention Program, Bumps and Bruises

clinics, Spanish interpreters for the Latino population, health fairs, weight loss seminars and Diabetes Prevention Program.

Proposed Community calendar. Diabetes Self-Management Education Program (DSME). Met elsewhere Southeast Idaho Public Health, Idaho Department of Health and Welfare, Chronic

Disease Coalition, Health West, Portneuf Medical Center, Eastern Idaho Regional Medical Center offer a variety of health classes.

Action taken In 2019 BMH released a community resource booklet that provides information about wellness and information about where to find free and low-cost services throughout eastern Idaho. BMH also offers an Exercise and Nutrition Class.

Drug/Alcohol Abuse Offered in 2016 Proposed PCMH, community calendar Met elsewhere Churches, Pocatello Recovery Center, Blackfoot South offer AA classes, Pocatello

Health Department Action taken In 2019 BMH released a Community Resource Booklet to connect patients with

low-cost and free addiction services in the community as well as physician/provider education about how best to use these resources to help patients. Grants to provide drug disposal resources to the community through partnerships with the BHCF, the Shoshone Bannock Community Clinic and the Bingham sheriff’s Department. Grant to allow BMH to purchase drug disposal bins and increase BMH’s participation in National Drug Take Back Day. BMH also offers a drug abuse and addiction class.

Health Screenings Offered in 2016 Free Wellness screenings, Bumps and Bruises clinics, health fairs, weight loss

seminars. Proposed Community calendar Met elsewhere All free screenings available at Health Department, ISU, Eastern Idaho Regional

Medical Center, Health West. Action taken Expansion of PCMH. In partnership with the PCMH, BMH’s Grants Department

applied for funding to support the purchase of eye cameras that will allow BMH clinics to screen for diabetic retinopathy. BMH is also leveraging its PCMH and Grants Department to improve access to health screenings for hypertension, cholesterol, pre-diabetes and diabetes.


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Summary of Findings – 2019 Tax Year CHNA

Health needs were identified based on information gathered and analyzed through the 2019 CHNA conducted by the Hospital. These identified community health needs are discussed in greater detail later in this report and the prioritized listing is available at Exhibit 24.

Based on the prioritization process, the following significant needs were identified:

Mental health services

Substance abuse

Adult obesity

Access to primary care providers

These needs have been prioritized based on information gathered through the CHNA. The prioritization process is discussed in greater detail later in this report.


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Community Served by the Hospital

Bingham Memorial Hospital is located in Blackfoot, Idaho, which is the county seat of Bingham County.

Defined Community

A community is defined as the geographic area from which a significant number of the patients utilizing Hospital services reside. While the CHNA considers other types of health care providers, the Hospital is the single largest provider of acute care services. For this reason, the utilization of Hospital services provides the clearest definition of the community.

Based on the patient origin of acute care discharges from January 1, 2018 through December 31, 2018, management has identified the community to include the corresponding counties listed in Exhibit 1.

Number of Percent of

Zip Code City Discharges Total Discharges

Bingham County

83221 Blackfoot 110,799 39.0%

83274 Shelley 7,230 2.6%

83236 Firth 4,084 1.5%

83262 Pingree 3,899 1.4%

83210 Aberdeen 3,020 1.1%

83256 Moreland 2,181 0.8%

83277 Springfield 577 0.3%

83218 Basalt 535 0.2%

83215 Atomic City 137 0.1%

Bannock County

83202 Pocatello 83,863 29.6%

83245 Inkom 3,026 1.1%

83203 Fort Hall 2,092 0.8%

83250 Mccammon 1,762 0.7%

83246 Lava Hot Springs 1,023 0.4%

83234 Downey 635 0.3%

83214 Arimo 465 0.2%

83281 Swanlake 27 0.1%

Bonneville County

83405 Idaho Falls 28,928 10.2%

83427 Iona 507 0.2%

83443 Ririe 314 0.2%

83428 Irwin 126 0.1%

83454 Ucon 76 0.1%

83449 Swan Valley 45 0.1%

Total Community 255,351 89.9%

Total Other Counties 28,919 10.1%

Total 284,270 100.0%

Source: Bingham Memorial Hospital

Exhibit 1Summary of Inpatient and Outpatient Discharges by Zip Code

01/01/2018 to 12/31/2018


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Community Details

Identification and Description of Geographical Community

The following map geographically illustrates the Hospital’s community by showing the community zip codes shaded by number of inpatient discharges. The map below displays the Hospital’s geographic relationship to the community, as well as significant roads and highways.


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Community Population and Demographics

The U.S. Bureau of Census has compiled population and demographic data. Exhibit 2 below shows the total population of the CHNA community. It also provides the breakout of the CHNA community between the male and female population, age distribution, race/ethnicity and the Hispanic population.

While the relative age of the community population can impact community health needs, so can the ethnicity and race of a population. The population of the CHNA community by race and ethnicity illustrates different categories of race such as, white, black, Asian, other and multiple races.

County Population County Male Female

Bingham County 45,369 Bingham County 22,732 22,637

Bannock County 84,113 Bannock County 41,867 42,246

Bonneville County 110,404 Bonneville County 55,082 55,322

Total Community 239,886 Total Community 119,681 120,205

Idaho Idaho 830,627 826,748

United States United States

Bingham Banncock Bonneville

Age Group County % of Total County % of Total County % of Total Idaho % of Total United States % of Total

0 ‐ 4 3,667 8.1% 6,336 7.5% 9,638 7.5% 114,112 6.9% 6.2%

5 ‐ 17 10,704 23.6% 16,226 19.3% 24,906 19.3% 320,499 19.3% 16.7%

18‐24 3,846 8.5% 8,952 10.6% 9,371 10.6% 157,451 9.5% 9.7%

25 ‐ 34 5,397 11.9% 12,804 15.2% 15,361 15.2% 216,102 13.0% 13.7%

35 ‐ 44 5,347 11.8% 10,348 12.3% 13,461 12.3% 204,514 12.3% 12.7%

45 ‐ 54 5,095 11.2% 8,690 10.3% 12,054 10.3% 198,911 12.0% 13.4%

55 ‐ 64 5,306 11.7% 9,801 11.7% 11,941 11.7% 203,337 12.3% 12.7%

65+ 6,007 13.2% 10,956 13.0% 13,672 12.9% 242,449 14.6% 14.9%

Total 45,369 100.0% 100.0% 110,404 100.0% 100.0% 100.0%

County White Black Asian

American

Indian &

Alaska All Other

Total Non‐

Hispanic Hispanic

Bingham County 37,735 142 427 2,790 4,275 8,121

Bannock County 75,606 533 1,145 2,618 4,211 6,954

Bonneville County 98,578 550 966 401 9,909 13,987

Total Community 211,919 1,225 2,538 5,809 18,395 29,062

Percentage 88.34% 0.51% 1.06% 2.42% 7.67% 12.11%

Idaho 1,507,880 11,231 22,720 21,323 201,978

Percentage 90.98% 0.68% 1.37% 1.29% 5.68% 12.19%

United States 40,610,815 2,632,102 26,204,968 55,510,571

Percentage 73.01% 12.65% 5.35% 0.82% 8.16% 17.29%

Data Source: US Census Bureau, American Community Survey. 2013-17. * May not total due to rounding

158,018,753

1,657,375

82.71%

1,455,397

87.81%

37,248

77,159

96,417

210,824

87.89%

47,732,389

321,004,407

94,221

234,370,202 17,186,320 265,493,836

Age Distribution

162,985,654

84,113

19,853,515

53,747,764

31,131,484

44,044,173

40,656,419

43,091,143

40,747,520

Population by GenderTotal Population

321,004,407

1,657,375

Race/Ethnicity

Exhibit 2Demographic Snapshot

DEMOGRAPHIC CHARACTERISTICS (as of 2017)


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Exhibit 3 reports the percentage of population living in urban and rural areas. Urban areas are identified using population density, count and size thresholds. Urban areas also include territory with a high degree of impervious surface (development). Rural areas are all areas that are not urban. This table could help to understand why transportation may or may not be considered a need within the community, especially within the rural and outlying populations.

Exhibit 3

Urban/Rural Population

County Urban Population Rural Population Percent Urban Percent Rural

Bingham County 20,053 25,554 44.0% 56.0%

Bannock County 69,809 13,030 84.3% 15.7%

Bonneville County 90,734 13,500 87.0% 13.0%

Total Community 180,596 52,084 77.6% 22.4%

Idaho 1,106,370 461,212 70.6% 29.4%

United States 252,746,527 59,724,800 80.9% 19.1%

Data Source: US Census Bureau, Decennial Census. 2010.


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Socioeconomic Characteristics of the Community

The socioeconomic characteristics of a geographic area influence the way residents access health care services and perceive the need for health care services within society. The economic status of an area may be assessed by examining multiple variables within the CHNA community. The following exhibits are a compilation of data that includes median household income, unemployment rates, poverty, uninsured population and educational attainment for the CHNA community. These standard measures will be used to compare the socioeconomic status of the community to the state of Idaho and the United States.

Income

Exhibit 4 presents the per capita income for the community. This includes all reported income from wages and salaries as well as income from self-employment, interest or dividends, public assistance, retirement and other sources. The per capita income in this exhibit is the average (mean) income computed for every man, woman and child in the specified area. On average, the counties in the CHNA community have a per capita income below Idaho and United States amounts.

Exhibit 4

Per Capita Income

Per Capita

County Income ($)

Bingham County 20,720$

Bannock County 23,872$

Bonneville County 25,706$

23,433$

Idaho 25,471$

United States 31,177$

Data Source: US Census Bureau, American Community Survey. 2013-17.


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Unemployment Rate

Exhibit 5 presents the average annual unemployment rate from 2006 through 2017 for the counties in the CHNA community, as well as the trend for Idaho and the United States. On average, the unemployment rates for the community are lower than both the United States and the state of Idaho. A decrease in the unemployment rate has been the trend since reaching its highest point of 7.4 in 2010.

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

10.0

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Exhibit 5Average Annual Unemployment Rate

Idaho United States CHNA Community

Poverty

Exhibit 6 presents the percentage of total population below 100 percent Federal Poverty Level (FPL). Poverty is a key driver of health status and is relevant because poverty creates barriers to access, including health services, healthy food choices and other factors that contribute to poor health. The community’s poverty rate is lower than the state and national poverty rate.

Exhibit 6

Population Below 100% FPL

Population (for Whom Poverty

Status is Determined)

Bingham County 44,920 5,905 13.15%

Bannock County 81,871 14,445 17.64%

Bonneville County 108,951 12,919 11.86%

Total Community 235,742 33,269 14.11%

Idaho 1,626,557 236,000 14.51%

United States 313,048,563 45,650,345 14.58%


CountyPopulation in

Poverty

Percent in

Poverty


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Uninsured

Exhibit 7 reports the percentage of the total civilian noninstitutionalized population without health insurance coverage for the counties in the community, the state of Idaho and the United States. This indicator is relevant because lack of insurance is a primary barrier to health care access, including regular primary care, specialty care and other health services that contribute to poor health status. Lack of health insurance is considered a key driver of health status.

Education

Exhibit 8 presents the population with a Bachelor’s degree or higher in the CHNA community versus the state of Idaho and the United States.

Education levels obtained by community residents may impact the local economy. Higher levels of education generally lead to higher wages, less unemployment and job stability. These factors may indirectly influence community health. As noted in Exhibit 8, the percent of residents within the CHNA community obtaining a Bachelor’s degree or higher is slightly above the state percentage.

Exhibit 8

Educational Attainment of Population Age 25 and Older

Bingham County 27,152 5,232 19.27%

Bannock County 52,599 14,756 28.05%


Total Community 146,240 39,461 26.98%

Idaho 1,065,313 285,141 26.77%

United States 216,271,644 66,887,603 30.93%


County Total Population Age

25 and Older

Population with

Bachelor's Degree or

Higher

Percent with

Bachelor's Degree or

Higher

Exhibit 7

Uninsured Status

Population Total Percent

(Civilian Noninstitutionalized) Uninsured Insured

Bingham County 45,076 5,773 12.81%

Bannock County 82,996 7,908 9.53%


Total Community 237,221 24,498 10.33%

Idaho 1,636,345 197,418 12.06%

United States 316,027,641 33,177,146 10.50%


County


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Physical Environment of the Community

A community’s health is also affected by the physical environment. A safe, clean environment that provides access to healthy food and recreational opportunities is important to maintaining and improving community health. This section will touch on a few of the elements that relate to needs mentioned throughout the report.

Grocery Store Access

Exhibit 9 reports the number of grocery stores per 100,000 population. Grocery stores are defined as supermarkets and smaller grocery stores primarily engaged in retailing a general line of food, such as canned and frozen foods, fresh fruits and vegetables and fresh and prepared meats, fish and poultry. Included are delicatessen-type establishments. Convenience stores and large general merchandise stores that also retail food, such as supercenters and warehouse club stores, are excluded. This indicator is relevant because it provides a measure of healthy food access and environmental influences on dietary behaviors.

Exhibit 9

Grocery Store Access

Total Number of Establishments

Population Establishments Rate per 100,000

Bingham County 45,607 6 13.16

Bannock County 82,839 11 13.28

Bonneville County 104,234 10 9.59

Total Community 232,680 27 11.60

Idaho 1,567,582 264 16.84

United States 308,745,538 65,399 21.18

Data Source: US Census Bureau, County Business Patterns

Additional data analysis by CARES. 2016.

County


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Food Access/Food Deserts

This indicator reports the percentage of the population living in census tracts designated as food deserts. A food desert is defined as a low-income census tract where a substantial number or share of residents has low access to a supermarket or large grocery stores. The information in Exhibit 10 below is relevant because it highlights populations and geographies facing food insecurity. The CHNA community has a higher population with low food access when compared to the state of Idaho and the United States.

Recreation and Fitness Facility Access

This indicator reports the number per 100,000 population of recreation and fitness facilities as defined by North American Industry Classification System (NAICS) Code 713940. It is relevant because access to recreation and fitness facilities encourages physical activity and other healthy behaviors. Exhibit 11 shows that the CHNA community has less fitness establishments available to the residents of the community (per 100,000 population) than Idaho as a whole.

Exhibit 10

Population with Low Food Access

Population with Percent with

Low Food Access Low Food Access

Bingham County 45,607 14,711 32.26%

Bannock County 82,839 27,368 33.04%


Total Community 232,680 83,499 35.89%

Idaho 1,567,582 412,452 26.31%

United States 308,745,538 69,266,771 22.43%

Data Source: US Department of Agriculture, Economic Research Service,

USDA - Food Access Research Atlas. 2015.

Total PopulationCounty

Exhibit 11

Recreation and Fitness Facility Access

Total Number of Establishments

Population Establishments Rate per 100,000





Idaho 1,567,582 158 10.08

United States 308,745,538 33,980 11.01

Data Source: US Census Bureau, County Business Patterns

Additional data analysis by CARES. 2016.

County


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The trend graph below (Exhibit 12) shows the percentage of adults who are physically inactive by year for the community and compared to the state of Idaho and the United States.

18.00%

19.00%

20.00%

21.00%

22.00%

23.00%

24.00%

25.00%

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Exhibit 12Percent Adults Physically Inactive by Year, 2004 ‐ 2015

CHNA Community Idaho United States


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Clinical Care of the Community

A lack of access to care presents barriers to good health. The supply and accessibility of facilities and physicians, the rate of uninsured, financial hardship, transportation barriers, cultural competency and coverage limitations affect access.

Rates of morbidity, mortality and emergency hospitalizations can be reduced if community residents access services such as health screenings, routine tests and vaccinations. Prevention indicators can call attention to a lack of access or knowledge regarding one or more health issues and can inform program interventions.

Access to Primary Care

Exhibit 13 shows the number of primary care physicians per 100,000 population. Doctors classified as “primary care physicians” by the American Medical Association include general family medicine MDs and DOs, general practice MDs and DOs, general internal medicine MDs and general pediatrics MDs. Physicians age 75 and over and physicians practicing sub-specialties within the listed specialties are excluded. This indicator is relevant because a shortage of health professionals contributes to access and health status issues.

Exhibit 13

Access to Primary Care

Total Population Primary Care Physicians Primary Care Physicians

2014 2014 Rate per 100,000




Total Community 237,239 147 62

Idaho 1,634,464 1,153 70.50

United States 318,857,056 279,871 87.80

Data Source: US Department of Health & Human Services, Health Resources and

Services Administration, Area Health Resource File. 2014.

County


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Access to Dentists

Exhibit 14 shows the number of dentists per 100,000 population. This indicator includes all dentists ‐ qualified as having a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), who are licensed by the state to practice dentistry and who are practicing within the scope of that license.

Access to Mental Health Providers

Exhibit 15 shows the rate of the county population to the number of mental health providers including psychiatrists, psychologists, clinical social workers and counselors that specialize in mental health care.

Exhibit 14

Access to Dentist

Total Population Primary Care Physicians Dentists

2015 2015 Rate per 100,000




Total Community 238,823 191 80

Idaho 1,654,930 1,062 64.2

United States 321,418,820 210,832 65.6



County

Exhibit 15

Access to Mental Health Providers

Estimated Number of Mental Mental Health Care

Population Health Providers Providers Rate per 100,000





Idaho 1,710,796 3,393 198.3

United States 317,105,555 643,219 202.8



County


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Health Professional Shortage Area

This indicator reports the geographic areas or populations with a deficit in primary care services. This indicator is relevant because a shortage of health professionals contributes to access and health status issues. As the map below shows, Bingham and Bannock County are designated population group HPSAs and Bonneville County is a designated geographic HPSA.


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Preventable Hospital Events

Exhibit 16 reports the discharge rate (per 1,000 Medicare enrollees) for conditions that are ambulatory care sensitive (ACS). ACS conditions include pneumonia, dehydration, asthma, diabetes and other conditions which could have been prevented if adequate primary care resources were available and accessed by those patients. This indicator is relevant because analysis of ACS discharges allows demonstrating a possible “return on investment” from interventions that reduce admissions (for example, for uninsured or Medicaid patients) through better access to primary care resources.

Preventable Hospital Events


Bannock County 5,442 152 28



Idaho 115,756 3,744 32.3

United States 22,488,201 1,112,019 49.4

Data Source: Dartmouth College Institute for Health Policy & Clinical Practice,

Dartmouth Atlas of Health Care. 2015.

Exhibit 16

CountyTotal Medicare Part A

Enrollees

Ambulatory Care Sensitive

Condition Hospital

Discharges

Ambulatory Care

Sensitive Condition

Discharge Rate


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Health Status of the Community

This section of the assessment reviews the health status of the CHNA community and its residents. As in the previous section, comparisons are provided with the state of Idaho and the United States. This in-depth assessment of the mortality and morbidity data, health outcomes, health factors and mental health indicators of the county residents that make up the CHNA community will enable the Hospital to identify priority health issues related to the health status of its residents.

Good health can be defined as a state of physical, mental and social well-being, rather than the absence of disease or infirmity. According to Healthy People 2020, the national health objectives released by the U.S. Department of Health and Human Services, individual health is closely linked to community health. Community health, which includes both the physical and social environment in which individuals live, work and play, is profoundly affected by the collective behaviors, attitudes and beliefs of everyone who lives in the community. Healthy people are among a community’s most essential resources.

Numerous factors have a significant impact on an individual’s health status: lifestyle and behavior, human biology, environmental and socioeconomic conditions, as well as access to adequate and appropriate health care and medical services.

Studies by the American Society of Internal Medicine conclude that up to 70 percent of an individual’s health status is directly attributable to personal lifestyle decisions and attitudes. Persons who do not smoke, drink in moderation (if at all), use automobile seat belts (car seats for infants and small children), maintain a nutritious low-fat, high-fiber diet, reduce excess stress in daily living and exercise regularly have a significantly greater potential of avoiding debilitating diseases, infirmities and premature death.

The interrelationship among lifestyle/behavior, personal health attitude and poor health status is gaining recognition and acceptance by both the general public and health care providers. Some examples of lifestyle/behavior and related health care problems include the following:

Lifestyle

Lung cancer Emphysema

Cardiovascular disease Chronic bronchitis

Cirrhosis of liver Suicide

Motor vehicle crashes Homicide

Unintentional injuries Mental illness

Malnutrition

Obesity Depression

Digestive disease

Trauma

Motor vehicle crashes

Cardiovascular disease

Depression

Mental illness Cardiovascular disease

Alcohol/drug abuse

Primary Disease Factor

Smoking

Alcohol/drug abuse

Poor nutrition

Lack of exercise

Overstressed

Driving at excessive speeds


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Health problems should be examined in terms of morbidity as well as mortality. Morbidity is defined as the incidence of illness or injury, and mortality is defined as the incidence of death. Such information provides useful indicators of health status trends and permits an assessment of the impact of changes in health services on a resident population during an established period of time. Community attention and health care resources may then be directed to those areas of greatest impact and concern.

Leading Causes of Death and Health Outcomes

Exhibit 17 reflects the leading causes of death for the community and compares the age-adjusted rates to the state of Idaho and the United States.

The table above shows leading causes of death within the CHNA community as compared to the state of Idaho and also to the United States. The age-adjusted rate is shown per 100,000 residents. The rates in red represent the CHNA community and corresponding leading causes of death that are greater than the state rates.

Bingham Bannock Bonneville Total United

County County County Community Idaho States

Cancer 147.1 143 134.3 139.8 153.8 158.1 Coronary Heart Disease 99.4 66.6 91.2 84.1 83.8 97.1 Lung Disease 51.2 50.4 52.8 51.6 46.3 41.1 Stroke 41.8 43.6 34.0 38.8 36.9 37.1

Unintentional Injury 65.4 55.1 58.7 58.7 47.7 44.0

Age‐Adjusted Death Rate per 100,000 Population

Data Source: Centers for Disease Control and Prevention, National Vital Statistics System. Accessed via CDC WONDER. 2013‐17.

Selected Causes of

Resident Deaths

Exhibit 17

Age-Adjusted Rates


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Health Outcomes and Factors

An analysis of various health outcomes and factors for a particular community can, if improved, help make the community a healthier place to live, learn, work and play. A better understanding of the factors that affect the health of the community will assist with how to improve the community’s habits, culture and environment. This portion of the community health needs assessment utilizes information from County Health Rankings, a key component of the Mobilizing Action Toward Community Health (MATCH) project, a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

The County Health Rankings model is grounded in the belief that programs and policies implemented at the local, state and federal levels have an impact on the variety of factors that, in turn, determine the health outcomes for communities across the nation. The model provides a ranking method that ranks all 50 states and the counties within each state, based on the measurement of two types of health outcomes for each county: how long people live (mortality) and how healthy people feel (morbidity). These outcomes are the result of a collection of health factors and are influenced by programs and policies at the local, state and federal levels.

Counties in each of the 50 states are ranked according to summaries of a variety of health measures. Those having high ranks, e.g. 1 or 2, are considered to be the “healthiest”. Counties are ranked relative to the health of other counties in the same state on the following summary measures:

Health Outcomes - rankings are based on an equal weighting of one length of life (mortality)measure and four quality of life (morbidity) measures.

Health Factors - rankings are based on weighted scores of four types of factors:

o Health behaviors (six measures)

o Clinical care (five measures)

o Social and economic (seven measures)

o Physical environment (four measures)

A more detailed discussion about the ranking system, data sources and measures, data quality and calculating scores and ranks can be found at the website for County Health Rankings (www.countyhealthrankings.org).

As part of the analysis of the needs assessment for the community, the three counties that comprise the community will be used to compare the relative health status of each county to Idaho as well as to a national benchmark as seen in Exhibits 18. The current year information is compared to the health outcomes reported on the prior community health needs assessment and the change in measures is indicated. A better understanding of the factors that affect the health of the community will assist with how to improve the community’s habits, culture and environment.

Health Outcomes - rankings are based on an equal weighting of one length of life (mortality) measure and four quality of life (morbidity) measures.


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Exhibit 18.1County Health Rankings - Health Outcomes

Bingham Bingham Top US

County County Performers

2015 2018 2018

Mortality * 29 33

Premature death ‐ Years of potential life lost before age 75 per

100,000 population (age‐adjusted) 7,114 8,300 6,300 5,300

Morbidity * 31 39

Poor or fair health ‐ Percent of adults reporting fair or poor health

(age‐adjusted) 17% 19% 15% 12%

Poor physical health days ‐ Average number of physically unhealthy

days reported in past 30 days (age‐adjusted) 3.5 4.1 3.7 3.0

Poor mental health days ‐ Average number of mentally unhealthy


Low birth weight ‐ Percent of live births with low birth weight (<2500

grams) 8.2% 8.0% 7.0% 6.0%

*Rank out of 42 Idaho countiesSource: Countyhealthrankings.org

Idaho

2018


Bonneville Bonneville Top US


2015 2018 2018

Mortality * 19 24



Morbidity * 21 14


(age‐adjusted) 14% 15% 15% 12%






grams) 7.1% 7.0% 7.0% 6.0%


Idaho

2018


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Bannock Bannock Top US


2015 2018 2018

Mortality * 33 31



Morbidity * 30 38


(age‐adjusted) 15% 17% 15% 12%






grams) 7.3% 7.0% 7.0% 6.0%


Idaho

2018


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Community Health Status Indicators

The following exhibits show a more detailed view of certain health outcomes and factors. The percentages for the CHNA community are compared to the state of Idaho and the United States.

Diabetes (Adult)

Exhibit 19 reports the percentage of adults aged 20 and older who have ever been told by a doctor that they have diabetes. This indicator is relevant because diabetes is a prevalent problem in the U.S.; it may indicate an unhealthy lifestyle and puts individuals at risk for further health issues.

.

High Blood Pressure (Adult)

Per Exhibit 20 below, 40,568 or 25.3 percent of adults aged 18 and older who have ever been told by a doctor that they have high blood pressure or hypertension. The community percentage of high blood pressure among adults is less than the percentage of Idaho and the United States.

Exhibit 19

Population with Diagnosed Diabetes

Total Population Percent*

Population with Diagnosed with Diagnosed

Age 20 and Older Diabetes Diabetes

Bingham County 29,768 3,215 9.8%

Bannock County 58,831 5,589 9.1%


Total Community 162,158 14,983 8.7%

Idaho 1,177,284 100,439 7.66%

United States 241,492,750 24,722,757 9.28%

* Age-adjusted Rate

Data Source: Centers for Disease Control and Prevention, National Center for

Chronic Disease Prevention and Health Promotion. 2015.

County

Exhibit 20

Population with High Blood Pressure

Total Population Percent

Population with High with High

Age 18 and Older Blood Pressure Blood Pressure

Bingham County 30,235 7,891 26.1%

Bannock County 59,487 15,586 26.2%


Total Community 160,055 40,568 25.3%

Idaho 1,126,153 296,178 26.3%

United States 232,556,016 65,476,522 28.2%

Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor

Surveillance System. Additional data analysis by CARES. 2006-12.

County


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Obesity (Adult)

Exhibit 21 reports the percentage of adults aged 20 and older who self-report that they have a Body Mass Index (BMI) greater than 30.0 (obese). Excess weight may indicate an unhealthy lifestyle and puts individuals at risk for further health issues.

Exhibit 21

Population with Obesity

Total Population Percent*

Population with BMI > 30.0 with BMI > 30.0

Age 20 and Older (Obese) (Obese)

Bingham County 29,650 9,073 30.4%

Bannock County 58,889 18,138 30.7%


Total Community 161,598 48,179 29.7%

Idaho 1,175,731 333,288 28.2%

United States 238,842,519 67,983,276 28.3%

* Age-adjusted Rate

Data Source: Centers for Disease Control and Prevention, National Center for

Chronic Disease Prevention and Health Promotion. 2015.

County

Low Birth Weight

Exhibit 22 reports the percentage of total births that are low birth weight (under 2500g). This indicator is relevant because low birth weight infants are at high risk for health problems. This indicator can also highlight the existence of health disparities.

Exhibit 22

Births with Low Birth Weight

Total Low Weight Percent

Live Births Low Weight

Births (Under 2500g) Births

Bingham County 5,684 749 13.2%

Bannock County 10,255 466 4.5%

Bonneville County 13,062 927 7.1%

Total Community 29,001 2,142 7.4%

Idaho 165,480 10,756 6.5%

United States 29,300,495 2,402,641 8.2%

Data Source: US Department of Health & Human Services, Health Indicators Warehouse.

Centers for Disease Control and Prevention, National Vital Statistics System.

Accessed via CDC WONDER. 2006-12

County


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Community Input - Key Stakeholder Interviews

Interviewing key stakeholders is a technique employed to assess public perceptions of the county’s health status and unmet needs. These interviews are intended to ascertain opinions among individuals likely to be knowledgeable about the community and influential over the opinions of others about health concerns in the community.

Methodology

Eight key stakeholder interviews were conducted. Interviewees were determined based on their a) specialized knowledge or expertise in public health, b) their affiliation with local government, schools and industry or c) their involvement with underserved and minority populations.

A representative from the Hospital contacted all individuals nominated for interviewing. Their knowledge of the community and personal relationships with the interviewees added validity to the data collection process. The interviews were conducted either by a representative of the Hospital or by BKD personnel.

All interviews were conducted using a standard questionnaire. A copy of the interview is included in the Appendices. A summary of the opinions is reported without judging the truthfulness or accuracy of their remarks. Leaders provided comments on various issues, including:

Health and quality of life for residents of the primary community

Barriers to improving health and quality of life for residents of the primary community

Opinions regarding the important health issues that affect Bingham, Bannock and Bonneville County residents and the types of services that are important for addressing these issues

Delineation of the most important health care issues or services discussed and actions necessary for addressing those issues

Themes in the data were identified and representative quotes have been drawn from the data to illustrate the themes. Interviewees were assured that personal identifiers such as name or organizational affiliations would not be connected in any way to the information presented in this report. Therefore, quotes included in the report may have been altered to preserve confidentiality.

This technique does not provide a quantitative analysis of the leaders’ opinions, but reveals some of the factors affecting the views and sentiments about overall health and quality of life within the community.


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Key Stakeholder Profiles

Key stakeholders from the community (see the Appendices for a list of key stakeholders) worked for the following types of organizations and agencies:

Social service agencies

Local school system and community college

Local city and county government

Public health agencies

Industry

Medical providers

Key Stakeholder Interview Results

The questions on the interview instrument are grouped into four major categories for discussion. The interview questions for each key stakeholder were identical. A summary of the stakeholders’ responses by each of the categories follows.

This section of the report summarizes what the key stakeholders said without assessing the credibility of their comments.

1. General opinions regarding health and quality of life in the community

The key stakeholders were asked to rate the health and quality of life on a scale of 1 to 10, with 10 being perfect health. They were also asked to provide their opinion whether the health and quality of life had improved, declined or stayed the same over the past few years. Lastly, key stakeholders were asked to provide support for their answers.

Six of the key stakeholders rated the health and quality of life in their communities between 7 and 9. Two key stakeholders rated their communities between a 3 and 4.5. The average rating assessed by the key stakeholders was 7.

When asked whether the health and quality of life had improved, declined, or stayed the same, all key stakeholders, except one, expressed it had stayed the same or improved. They attributed the improvement to the increase in available providers and new developments and recreation options in the community. The stakeholder that perceived a decline in the health and quality of life in the community attributed it to the increased issues surrounding drug addiction that the community is currently experiencing.

2. Underserved populations and communities of need

Key stakeholders were asked to provide their opinions regarding specific populations or groups of people whose health or quality of life may not be as good as others. The key stakeholders were also asked to provide their opinions as to why they thought these populations were underserved or in need.

Respondents noted that persons living with low-incomes or in poverty are most likely to be underserved due to lack of financial resources and lack of insurance. Lack of financial resources prevents persons with low-income from seeking and being able to afford medical care. The


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working poor do not have enough money to take a day off work to seek medical care for themselves and/or their children. This population may live a lifestyle that makes them more prone to disease from behaviors such as smoking, poor diets and inactivity.

The Native American population and the elderly were also identified as populations that face challenges with access to care. Stakeholders believed that factors contributing to the inadequate access to care included lack of transportation and lack of awareness of available options. In addition, members of the Native American community may face cultural barriers.

3. Barriers

The key stakeholders were asked what barriers or problems keep community residents from obtaining necessary health services and improving health in their community. Responses from all the key stakeholders noted consistent themes. They noted financial barriers, lack of funding and the cost of health care. Other barriers noted by the key stakeholders include the absence of basic knowledge of health issues, and unwillingness of individual community members to be accountable for their health and to part take in a healthy lifestyle.

Language and culture were also mentioned as barriers by key stakeholders. Stakeholders noted that cultural differences can influence community members preferences on healthcare services and the ways in which they are willing and able to access these services.

4. Most important health and quality of life issues

Key stakeholders were asked to provide their opinion as to the most critical health and quality of life issues facing the communities. The responses were varied between all the key stakeholders. Some of the responses included mental health issues, illegal drug use and access and affordability of health care.

The key stakeholders were also asked to identify the most critical issues the Hospital should address over the next three to five years. Responses included:

Increase outreach programs

Increase programs for substance abuse

Increase health education in the community and in the schools

Key Findings

A summary of themes and key findings provided by the key stakeholders follows:

Overall, the stakeholders were extremely grateful to live in a strong community with opportunities for access to health care.

Mental health needs are currently underserved and should be made a priority in the community.

There is an ongoing need for community outreach programs aimed to educate patients and those within and around the community.

Substance abuse has been an increasing issue that needs to be a priority for the community.


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The inability to afford care is perceived to be one of the main reasons people do not access health services and preventative care.

Numerous stakeholders spoke highly of the services offered by the Hospital and the leadership at the Hospital.

“Bingham has been very proactive in the last 10 years in addressing needs. State hospitals send many patients to Bingham and BMH has been very responsive.”

“BMH is well respected as low-cost, high-quality provider. They seem to be focused on

helping the population to be healthy.”

Health Issues of Vulnerable Populations

According to Dignity Health’s Community Need Index (See Appendices), the Hospital’s community has a moderate-level of need. The CNI score is an average of five different barrier scores that measure socioeconomic indicators of each community (income, cultural, education, insurance and housing). The zip codes in the community that have the highest need in the community are listed in Exhibit 23.

Exhibit 23

Zip Codes with Highest Community Need Index

Zip Code CNI Score* City County

83210 4.2 Aberdeen Bingham

83236 4.2 Firth Bingham

83402 4.2 Idaho Falls Bonneville

83201 4.0 Pocatello Bannock

83204 4.0 Arbon Valley Bannock

83202 3.8 Bannock County Bannock

83277 3.8 Springfield Bingham

83221 3.8 Blackfoot Bingham

83262 3.6 Pingree Bingham

83246 3.4 Lava Hot Springs Bannock


83215 3.0 Atomic City Bingham


83234 2.8 Downey Bannock

83274 2.8 Shelley Bingham


83250 2.6 McCammon Bannock

83285 2.6 Wayan Bonneville

83214 2.4 Arimo Bannock

83427 2.4 Iona Bonneville

83428 2.2 Irwin Bonneville

83449 2.2 Swan Valley Bonneville

83443 2.2 Ririe Bonneville

83245 2.0 Bannock County Bannock

* Scale of 1 (Lowest Need) to 5 (Highest Need)

Source: Dignity Health Community Need Index


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Information Gaps

This assessment was designed to provide a comprehensive and broad picture of the health in the overall community served by the Hospital; however, there may be a number of medical conditions that are not specifically addressed in this report due to various factors, including but not limited to, publicly available information or limited community input.

In addition, certain population groups might not be identifiable or might not be represented in numbers sufficient for independent analysis. Examples include homeless, institutionalized persons, undocumented residents and members of certain ethnic groups who do not speak English or Spanish. Efforts were made to obtain input from these specific populations through key stakeholder interviews.

Prioritization of Identified Health Needs

Priority setting is a required step in the community benefit planning process. The IRS regulations indicate that the CHNA must provide a prioritized description of the community health needs identified through the CHNA and include a description of the process and criteria used in prioritizing the health needs.

Using findings obtained through the collection of primary and secondary data, the Hospital completed an analysis of these inputs (see Appendices) to identify community health needs. The following data was analyzed to identify health needs for the community:

Leading Causes of Death

Leading causes of death for the community and the death rates for the leading causes of death for each county within the Hospital’s CHNA community were compared to U.S. adjusted death rates. Causes of death in which the county rate compared unfavorably to the U.S. adjusted death rate resulted in a health need for the Hospital CHNA community.

Health Outcomes and Factors

An analysis of the County Health Rankings health outcomes and factors data was prepared for Bingham Memorial Hospital’s CHNA community. County rates and measurements for health behaviors, clinical care, social and economic factors and the physical environment were compared to state benchmarks. County rankings in which the county rate compared unfavorably (by greater than 30 percent of the national benchmark) resulted in an identified health need.

The indicators falling within the least favorable quartile from the Community Health Status Indicators (CHSI) resulted in an identified health need.

Primary Data

Health needs identified through the key stakeholder survey were included as health needs. Needs for vulnerable populations were separately reported on the analysis in order to facilitate the prioritization process.

Health Needs of Vulnerable Populations

Health needs of vulnerable populations were included for ranking purposes.


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To facilitate prioritization of identified health needs, a ranking process was used. Health needs were ranked based on the following five factors. Each factor received a score between 0 and 5, with a total maximum score of 25 (indicating the greatest health need).

1) How many people are affected by the issue or size of the issue? For this factor, ratings were based on the percentage of the community who are impacted by the identified need. The following scale was utilized: >25% of the community= 5; >15% and <25%=4; >10% and <15%=3; >5% and <10%=2 and <5%=1.

2) What are the consequences of not addressing this problem? Identified health needs, which have a high death rate or have a high impact on chronic diseases, received a higher rating.

3) What is the impact on vulnerable populations? This rating factor used information obtained from key stakeholder interviews to identify vulnerable populations and determine the impact of the health need on these populations.

4) Prevalence of common themes. The rating for this factor was determined by how many sources of data (Leading Causes of Death, Primary Causes for Inpatient Hospitalization, Health Outcomes and Factors and Primary Data) identified the need.

5) Alignment with Hospital’s resources. The rating for this factor was determined by whether or not the need fits within the Hospital’s strategic plan, as well as the Hospital’s ability to address the need. Rating of one (least) through five (greatest) was given to each need, based on management assessment.


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Each need was ranked based on the five-prioritization metrics. As a result, the following summary list of needs was identified:

Exhibit 24

Ranking of Community Health Needs

Health Problem

How many people are

affected by the issue?

What are the consequences of not addressing this problem?

What is the impact on vulnerable

populations?

Prevalence of common themes

Alignment with Hospital's Resources Total Score

Mental Health Services 3 4 3 5 5 20

Substance Abuse 4 3 3 5 5 20

Adult Obesity 5 4 2 3 5 19

Access to Primary Care Providers 2 3 3 5 5 18

High Cost of Care 3 4 5 3 2 17

Uninsured/Underinsured 3 4 5 3 2 17

Diabetes 3 3 3 3 4 16

Lack of Health Knowledge/Education 4 2 3 3 4 16

Heart Disease 4 4 1 3 3 15

Adult Smoking 2 4 1 3 3 13

Children in Poverty 2 2 3 3 2 12

Cancer 3 4 1 1 3 12

Excessive Drinking 2 2 1 3 2 10

Lung Disease 3 2 1 1 3 10

Children in Single-Parent Households 2 2 2 1 2 9

Stroke 2 2 1 1 3 9

Violent Crime Rate 1 1 4 1 1 8

Alcohol-Impaired Driving Deaths 1 2 1 1 2 7

Dentists 1 1 1 1 2 6


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Management’s Prioritization Process

For the health needs prioritization process, the Hospital engaged a leadership team to review the most significant health needs reported on the prior needs assessment, as well as in Exhibit 24 using the following criteria:

Current area of Hospital focus

Established relationships with community partners to address the health need

Organizational capacity and existing infrastructure to address the health need

As a result of the analysis described, Hospital management identified the following health needs as the most significant health needs for the community. Based on the criteria outlined above, the health needs that scored an 18 or more (out of a possible 25) were identified as a priority area that will be addressed through Bingham Memorial Hospital’s Implementation Strategy for years 2020 - 2022.

Mental Health Services

Substance Abuse

Adult Obesity

Access to Primary Care Providers


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Resources Available to Address Significant Health Needs

Health Care Resources

The availability of health care resources is a critical component to the health of a county’s residents and a measure of the soundness of the area’s health care delivery system. An adequate number of health care facilities and health care providers are vital for sustaining a community’s health status. Fewer health care facilities and health care providers can impact the timely delivery of services. A limited supply of health resources, especially providers, results in the limited capacity of the health care delivery system to absorb charity and indigent care as there are fewer providers upon which to distribute the burden of indigent care.

Hospitals

Bingham Memorial Hospital is a state-of-the-art, critical access hospital that has a medical staff of over 150 physicians. Residents of the community can also take advantage of services provided by Bingham healthcare facilities in Idaho Falls, Pocatello and Shelly, Idaho, as well as services offered by other facilities and providers. Exhibit 25 summarizes hospitals available to the residents of CHNA Community. Those hospitals marked with an asterisk (*) are within 30 miles of the Hospital.

Other Health Care Facilities

Short-term acute care hospital services are not the only health services available to members of the Hospital’s community. Exhibit 26 provides a listing of community health centers and rural health clinics in the Hospital’s community.

Hospital Address County

*State Hospital South 700 East Alice Street, Blackfoot, ID 83221-0400 Bingham*Portneuf Medical Center 651 Memorial Drive, Pocatello, ID 83201-4004 Bingham*Eastern Idaho Regional Med Ctr 3100 Channing Way, Idaho Falls, ID 83404-7533 Bonneville*Mountain View Hospital 2325 Coronado Street, Idaho Falls, ID 83404 Bonneville*Idaho Falls Recovery Center 1957 East 17th Street, Idaho Falls, ID 83404-6429 Bonneville

Source: Ushositalfinder.com

Exhibit 25

Summary of Acute Care Hospitals

Facility Facility Type Address County

Blackfoot Medical Center Rural Health Clinic 1441 Parkway Dr, Blackfoot, ID 83221 BinghamFirst Choice Urgent Care and Medical Clinic Rural Health Clinic 1350 Parkway Dr, Blackfoot, ID 83221 BinghamIdaho Physicians Clinic Rural Health Clinic 98 Poplar St, Blackfoot ID, 83221 BinghamShelley Family Medical Center Rural Health Clinic 210 S Emerson, Shelley, ID 83274 BinghamPhysicians & Surgeons Clinic of Shelley Rural Health Clinic 275 W Locust St, Shelley, ID 83274 Bingham

Source: Bureau of Facility Standard, Division of Licensing and Certification, Idaho Department of Health and Welfare (Sept 2018)

Exhibit 26

Summary of Other Health Care Facilities


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Health Departments

Within the Hospital’s CHNA community resides two Health Department locations. Idaho Public Health District 6 – Southeastern Idaho Public Health is located in Pocatello and provides services to residents of Bannock County and Bingham County. Idaho Public Health District 7 – Eastern Idaho Public Health is located in Idaho Falls and provides services to residents of Bonneville County.

The Health Department locations offer a wide array of services to residents, including assessments and screenings, as well as education and wellness resources. These services include clinical services, community health initiatives, environmental health services, WIC and public health preparedness services.


APPENDICES


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Acknowledgements

The CHNA Committee was the convening body for this project. Many other individuals including community residents, key stakeholders and community-based organizations contributed to this community health needs assessment.

APPENDIX A

ANALYSIS OF DATA


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(A) (B)

Idaho Crude

Rates

County

Rate

10% Increase of

Idaho Crude Rate

If (A)>(B), then

"Health Need"

Bingham County 185.81Cancer 158.1 153.8 147.1 169.2Coronary Heart Disease 97.1 83.8 99.4 92.2 Health NeedLung Disease 41.1 46.3 51.2 50.9 Health NeedStroke 37.1 36.9 41.8 40.6 Health NeedUnintentional Injury 44.0 47.7 65.4 52.5 Health Need

Bannock CountyCancer 158.1 153.8 143.0 169.2Coronary Heart Disease 97.1 83.8 66.6 92.2Lung Disease 41.1 46.3 50.4 50.9Stroke 37.1 36.9 43.6 40.6 Health NeedUnintentional Injury 44.0 47.7 55.1 52.5 Health Need

Bonneville CountyCancer 158.1 153.8 134.3 169.2Coronary Heart Disease 97.1 83.8 91.2 92.2Lung Disease 41.1 46.3 52.8 50.9 Health NeedStroke 37.1 36.9 34.0 40.6Unintentional Injury 44.0 47.7 58.7 52.5 Health Need

The crude rate is shown per 100,000 residents. Please refer to Exhibit 19 for more information

Analysis of CHNA DataAnalysis of Health Status-Leading Causes of Death

U.S. Crude

Rates


42

(A) (B)

National

Benchmark

30% of

National

Benchmark

County

Rate

County Rate Less

National Benchmark

If (B)>(A), then

"Health Need"

Bingham County:Adult Smoking 14.0% 4.2% 16.0% 2.0%Adult Obesity 26.0% 7.8% 32.0% 6.0%Food Environment Index 8.6 3 8.0 1Physical Inactivity 20.0% 6.0% 27.0% 7.0% Health NeedAccess to Exercise Opportunities 91.0% 27.3% 45.0% 46.0% Health NeedExcessive Drinking 13.0% 3.9% 16.0% 3.0%Alcohol-Impaired Driving Deaths 13.0% 3.9% 39.0% 26% Health NeedSexually Transmitted Infections 145 44 261 116 Health NeedTeen Birth Rate 15 5 34 19 Health NeedUninsured 6.0% 1.8% 16.0% 10.0% Health NeedPrimary Care Physicians 1030 309 2650 1620 Health NeedDentists 1280 384 2650 1370 Health NeedMental Health Providers 330 99 810 480 Health NeedPreventable Hospital Stays 35 11 33 -2Diabetic Screen Rate 91.0% 27.3% 74.0% 17.0%Mammography Screening 71.0% 21.3% 52.0% 19.0%Violent Crime Rate 62 18.6 128 66 Health NeedChildren in Poverty 12.0% 3.6% 18.0% 6.0% Health NeedChildren in Single-Parent Households 20.0% 6.0% 21.0% 1.0%

Bannock CountyAdult Smoking 14.0% 4.2% 16.0% 2.0%Adult Obesity 26.0% 7.8% 28.0% 2.0%Food Environment Index 8.6 3 7 1Physical Inactivity 20.0% 6.0% 19.0% -1.0%Access to Exercise Opportunities 91.0% 27.3% 75.0% 16.0%Excessive Drinking 13.0% 3.9% 18.0% 5.0% Health NeedAlcohol-Impaired Driving Deaths 13.0% 3.9% 36.0% 23% Health NeedSexually Transmitted Infections 145 44 412.7 268 Health NeedTeen Birth Rate 15 5 25 10 Health NeedUninsured 6.0% 1.8% 11.0% 5.0% Health NeedPrimary Care Physicians 1030 309 1400 370 Health NeedDentists 1280 384 1100 -180Mental Health Providers 330 99 260 -70Preventable Hospital Stays 35 11 28 -7Diabetic Screen Rate 91.0% 27.3% 75.0% 16.0%Mammography Screening 71.0% 21.3% 57.0% 14.0%Violent Crime Rate 62 18.6 247 185 Health NeedChildren in Poverty 12.0% 3.6% 19.0% 7.0% Health NeedChildren in Single-Parent Households 20.0% 6.0% 25.0% 5.0%

Analysis of Health Outcomes and Factors


43

(A) (B)

National

Benchmark

30% of

National

Benchmark

County

Rate

County Rate Less

National Benchmark

If (B)>(A), then

"Health Need"

Analysis of Health Outcomes and Factors

Bonneville County:Adult Smoking 14.0% 4.2% 14.0% 0.0%Adult Obesity 26.0% 7.8% 30.0% 4.0%Food Environment Index 8.6 3 7.9 -0.7Physical Inactivity 20.0% 6.0% 20.0% 0.0%Access to Exercise Opportunities 91.0% 27.3% 84.0% -7.0%Excessive Drinking 13.0% 3.9% 16.0% 3.0%Alcohol-Impaired Driving Deaths 13.0% 3.9% 25.0% 12.0% Health NeedSexually Transmitted Infections 145 44 282 137 Health NeedTeen Birth Rate 15 5 33 18 Health NeedUninsured 6.0% 1.8% 12.0% 6.0% Health NeedPrimary Care Physicians 1030 309 2340 1310 Health NeedDentists 1280 384 1150 -130Mental Health Providers 330 99 370 40Preventable Hospital Stays 35 11 34 -1Diabetic Screen Rate 91.0% 27.3% 83.0% -8.0%Mammography Screening 71.0% 21.3% 60.0% -11.0%Violent Crime Rate 62 18.6 184 122 Health NeedChildren in Poverty 12.0% 3.6% 15.0% 3.0%Children in Single-Parent Households 20.0% 6.0% 19.0% -1.0%

*From County Health Rankings

APPENDIX B

SOURCES


44

Discharges by Zip Code Hospital FY 2018

Community Details:

Population & DemographicsCommunity Commons via American Community Survey

https://factfinder.census.gov/2013‐2017

Community Details:

Urban/Rural PopulationCommunity Commons via US Census Bureau

https://factfinder.census.gov/2010

Socioeconomic Characteristics:

IncomeCommunity Commons via American Community Survey



UnemploymentCommunity Commons via US Department of Labor

http://www.communitycommons.org/2018


PovertyCommunity Commons via American Community Survey

http://www.communitycommons.org/2013‐2017


UninsuredCommunity Commons via American Community Survey



MedicaidCommunity Commons via American Community Survey



EducationCommunity Commons via US Census Bureau


Physical Environment:

Grocery Store AccessCommunity Commons via US Department of Agriculture



Food Access/Food DesertsCommunity Commons via US Census Bureau



Recreation/Fitness AccessCommunity Commons via US Department of Health & Human Services


Clinical Care:

Access to Primary CareCommunity Commons via Centers for Disease Control & Prevention


Clinical Care:

Access to DentistsCommunity Commons via US Department of Health & Human Services


Clinical Care:

Access to Mental Health ProvidersCommunity Commons via US Department of Health & Human Services


Clinical Care:

Professional Shortage AreaRural Health Information Hub

https://www.ruralhealthinfo.org/states/idaho/resources2018

Critical Care:

Preventable Hospital EventsCommunity Commons via Dartmouth College Institute for Health Policy


Leading Causes of DeathCommunity Commons via Centers for Disease Control and Prevention


Health Outcomes and FactorsCounty Health Rankings

http://www.countyhealthrankings.org/2015 & 2018

Health Outcome DetailsCommunity Commons


Health Care Resources:

HospitalsUS Hospital Finder

http://www.ushospitalfinder.com/2018

Health Care Resources:

Community Health CentersRural Health Information Hub

https://www.ruralhealthinfo.org/states/idaho/resources2018

Zip Codes with Highest CNIDignity Health Community Needs Index

http://cni.chw‐interactive.org/2018

DATA TYPE SOURCE YEAR(S)

APPENDIX C

DIGNITY HEALTH COMMUNITY NEED INDEX

(CNI) REPORT


45

Bingham, Bonneville, and Bannock County

46

APPENDIX D

COUNTY HEALTH RANKINGS


46

Exhibit 20.2County Health Rankings - Health Factors

Bingham Bingham Top US

County County Idaho Performers

2015 2018 2018 2018

Health Behaviors * 31 31

Adult smoking ‐ Percent of adults that report smoking at least 100

cigarettes and that they currently smoke 16.0% 16.0% 14.0% 14.0%

Adult obesity ‐ Percent of adults that report a BMI >= 30

35.0% 32.0% 29.0% 26.0%

Food environment index^ ‐ Index of factors that contribute to a healthy

food environment, 0 (worst) to 10 (best) 7.5 8.0 7.1 8.6

Physical inactivity ‐ Percent of adults aged 20 and over reporting no leisure

time physical activity 23.0% 27.0% 20.0% 20.0%

Access to exercise opportunities^ ‐ % of population with adequate access

to locations for physical activity 62.0% 45.0% 80.0% 91.0%

Excessive drinking ‐ Percent of adults that report excessive drinking in the

past 30 days 10.0% 16.0% 17.0% 13.0%

Alcohol‐impaired driving deaths ‐ Percent of motor vehicle crash deaths

with alcohol involvement 44.0% 39.0% 32.0% 13.0%

Sexually transmitted infections ‐ Chlamydia rate per 100K

population 202.0 260.7 344.5 145.1

Teen births ‐ Female population, ages 15‐19

43.0 34.0 26.0 15.0

Clinical Care * 28 27

Uninsured adults ‐ Percent of population under age 65 without health

insurance 21.0% 16.0% 13.0% 6.0%

Primary care physicians ‐ Number of population for every one primary care

physician 2,842 2,650 1,560 1,030

Dentists ‐ Number of population for every one dentist

1,969 2,260 1,540 1,280

Mental health providers ‐ Number of population for every one mental

health provider 1,029 810 520 330

Preventable hospital stays ‐ Hospitalization rate for ambulatory‐care

sensitive conditions per 1,000 Medicare enrollees 38.0 33.0 32.0 35.0

Diabetic screening^ ‐ Percent of diabetic Medicare enrollees that receive

HbA1c screening 75.0% 74.0% 82.0% 91.0%

Mammography screening^ ‐ Percent of female Medicare enrollees that

receive mammography screening 55.7% 52.0% 58.0% 71.0%

Social & Economic Factors * 13 15

High school graduation^ ‐ Percent of ninth grade cohort that graduates in 4

years 80.0% 81.0% 79.0% 95.0%

Some college^ ‐ Percent of adults aged 25‐44 years with some post‐

secondary education 59.2% 62.0% 64.0% 72.0%

Unemployment ‐ Percent of population age 16+ unemployed but seeking

work 5.9% 3.6% 3.8% 3.2%

Children in poverty ‐ Percent of children under age 18 in poverty

19.0% 18.0% 17.0% 12.0%

Income inequality ‐ Ratio of household income at the 80th percentile to

income at the 20th percentile 4.1 3.9 4.2 3.7

Children in single‐parent households ‐ Percent of children that live in

household headed by single parent 22.0% 21.0% 25.0% 20.0%

Social associations^ ‐ Number of membership associations per 10,000

population 3.5 3.8 7.4 22.1

Violent Crime Rate ‐ Violent crime rate per 100,000 population (age‐

adjusted) 131.0 128.0 212.0 62.0

Injury deaths ‐ Number of deaths due to injury per 100,000

population 67.0 88.0 71.0 55.0

Physical Environment * 38 16

Air pollution‐particulate matter days ‐ Average daily measure of fine

particulate matter in micrograms per cubic meter 9.9 7.8 7.2 6.7

Drinking Water Violations ‐ Percentage of population getting water from a

public water system with at least on health‐based violation 65.0% N/A N/A N/A

Severe housing problems ‐ Percentage of household with at least 1 of 4

housing problems: overcrowding, high housing costs or lack of kitchen or

plumbing facilities 14.0% 14.0% 16.0% 9.0%

Driving alone to work ‐ Percentage of the workforce that drives alone to

work 80.0% 79.0% 78.0% 72.0%

Long commute, driving alone ‐ Among workers who commute in their car

alone, the % that commute more than 30 mins21.0% 23.0% 22.0% 15.0%

* Rank out of 42 Idaho counties^ Opposite Indicator signifying that an increase is a positive outcome and a decrease is a negative.Note: N/A indicates unreliable or missing dataSource: Countyhealthrankings.org


47


Bannock Bannock Top US


2015 2018 2018 2018





29.0% 28.0% 29.0% 26.0%

Food environment index^ ‐ Index of factors that contribute to a

healthy food environment, 0 (worst) to 10 (best) 7.0 7.2 7.1 8.6



Access to exercise opportunities^ ‐ % of population with adequate access

to locations for physical activity 81.0% 75.0% 80.0% 91.0%


past 30 days 13.0% 18.0% 17.0% 13.0%




population 389.0 412.7 344.5 145.1

Teen births ‐ Female population, ages 15‐19

32.0 25.0 26.0 15.0

Clinical Care * 4 7


insurance 17.0% 11.0% 13.0% 6.0%


physician 1,445 1,400 1,560 1,030


1,125 1,110 1,540 1,280


health provider 295 260 520 330




HbA1c screening 81.0% 75.0% 82.0% 91.0%





years 91.0% 89.0% 79.0% 95.0%



Unemployment ‐ Percent of population age 16+ unemployed but seeking

work 6.3% 3.5% 3.8% 3.2%


21.0% 19.0% 17.0% 12.0%






population 7.4 7.2 7.4 22.1


adjusted) 226.0 247.0 212.0 62.0


population 77.0 90.0 71.0 55.0







housing problems: overcrowding, high housing costs or lack of kitchen or

plumbing facilities 14.0% 15.0% 16.0% 9.0%


work 78.0% 77.0% 78.0% 72.0%

Long commute, driving alone ‐ Among workers who commute in their car

alone, the % that commute more than 30 mins

11.0% 10.0% 22.0% 15.0%



48


Bonneville Bonneville Top US


2015 2018 2018 2018





30.0% 30.0% 29.0% 26.0%

Food environment index^ ‐ Index of factors that contribute to a

healthy food environment, 0 (worst) to 10 (best) 7.6 7.9 7.1 8.6



Access to exercise opportunities^ ‐ Percentage of population with

adequate access to locations for physical activity 79.0% 84.0% 80.0% 91.0%


past 30 days 9.0% 16.0% 17.0% 13.0%




population 235.0 281.7 344.5 145.1

Teen births ‐ Female population, ages 15‐19 43.0 33.0 26.0 15.0

Clinical Care * 9 8


insurance 17.0% 12.0% 13.0% 6.0%


physician 2,223 2,340 1,560 1,030


1,097 1,150 1,540 1,280


health provider 459 370 520 330




HbA1c screening 81.0% 83.0% 82.0% 91.0%





years 87.0% 74.0% 79.0% 95.0%



Unemployment ‐ Percent of population age 16+ unemployed but

seeking work 5.4% 3.2% 3.8% 3.2%


16.0% 15.0% 17.0% 12.0%






population 5.0 4.6 7.4 22.1


adjusted) 223.0 184.0 212.0 62.0


population 72.0 76.0 71.0 55.0







housing problems: overcrowding, high housing costs or lack of kitchen or 12.0% 12.0% 16.0% 9.0%


work78.0% 79.0% 78.0% 72.0%

Long commute, driving alone ‐ Among workers who commute in

their car alone, the % that commute more than 30 minutes 12.0% 12.0% 22.0% 15.0%


APPENDIX E

KEY STAKEHOLDER INTERVIEW QUESTIONS


49

1. In general, how would you rate health and quality of life in southeast Idaho on a scale of 1 to10, with 10 being the highest?

2. In your opinion, has health and quality of life in southeast Idaho improved/declined/stayed thesame over the past few years?

3. Why do you think it has (based on answer from previous question):Improved/declined/stayed the same?

4. What barriers, if any, exist to improving health and quality of life in southeast Idaho?

5. In your opinion, what are the most critical health and quality of life issues in southeast Idaho?

6. What needs to be done to address these issues?

7. Please describe your familiarity and/or perceptions regarding available local health resourcesand services?

8. Are there any specialists (physicians) which are needed in the community? If so, whatspecialties are needed?

9. What groups of people in the community do you believe have the most serious unmet healthcare needs?

10. What is the most important issue that the hospital should address in the next 3-5 years?

Documents

Community Health Needs Assessment 2019 CHNA Rpt19.pdf · Blackfoot Fire Department (free classes) and Eastern Idaho Regional Medical Center both currently offer a Diabetes Self-Management