MINUTES OF THE GROSSMONT HEALTHCARE DISTRICT BOARD … · 8/16/2016 · August 16, 2016 The Board of Directors of Grossmont Healthcare District (District) held a special joint meeting

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MINUTES OF THE GROSSMONT HEALTHCARE DISTRICT

BOARD OF DIRECTORS

Special Meeting

August 16, 2016

The Board of Directors of Grossmont Healthcare District (District) held a special

joint meeting with the Board of Directors of Grossmont Hospital Corporation (GHC)

on Tuesday, August 16, 2016, at 5:00 p.m. in the Main Auditorium of Sharp

Grossmont Hospital, 5555 Grossmont Center Drive, La Mesa, California.

District Directors Present: Robert Ayres, Gloria Chadwick, Michael Emerson

District Directors Absent: Randy Lenac, Betty Stieringer

District Staff Present: Barry Jantz, Chief Executive Officer

Tom Saiz, Chief Financial Officer

Jeff Scott, General Counsel

Rick Griffin, Public Relations Consultant

A. CALL TO ORDER

President Ayres welcomed the board members and staff members of both the

District and GHC, and called the meeting to order at 5:25 p.m.

B. PLEDGE of ALLEGIANCE:

President Ayres led in the pledge of allegiance.

C. APPROVAL OF AGENDA:

It was moved by Director Chadwick, seconded by Director Emerson, and

unanimously carried (3-0) to adopt the agenda.

D. PUBLIC COMMENT

There was no public comment.

E. ANNUAL REPORT FROM THE GROSSMONT HOSPITAL

CORPORATION

Sharp Grossmont Hospital CEO Scott Evans introduced staff members from

GHC and Sharp HealthCare to make the following presentations:

Sharp Grossmont Hospital 2016 Community Health Needs Assessment

– Jillian Barber, Program Manager, Sharp HealthCare

2

Finance and Operations – Scott Evans, CEO

Hospital/Patient Initiatives – Louise White, Chief Nursing Officer, VP of

Patient Care Services

Quality & Safety – Nancy Greengold, Chief Medical Officer

State of the Facilities/Master Plan Update – Karen Chapman, VP

Facilities and Support Services

The presentations provided are included with these minutes.

F. GROSSMONT HEALTHCARE DISTRICT PRESENTATION

President Ayres introduced CEO Jantz for a presentation on District activities.

Mr. Jantz provided a presentation on District highlights in the last year, as well

as an overview of Proposition G and how taxes are assessed and collected for

the Prop G projects.

The presentation provided is included with these minutes.

G. OPEN DISCUSSION

Both boards had a brief general discussion of the activities of the District and

Hospital. President Ayres and CEO Evans thanked everyone for attending and

for the presentations.

H. ADJOURNMENT:

There being no further business, on a motion duly made, seconded, and

unanimously carried, the Board adjourned at 7:56 p.m.

Respectfully submitted,

______________________________

Gloria Chadwick, R.N., Secretary

ATTEST:

______________________________

Robert Ayres, President

JOINT ANNUAL MEETING G R O S S M O N T H E A L T H C A R E D I S T R I C T A N D

G R O S S M O N T H O S P I T A L C O R P O R A T I O N

A U G U S T 2 0 1 6

AGENDA

Call to Order- GHC Chairman Dave Grundstrom

Action Item : Emergency Medical Professional Services and Medical Director

Agreement – Team Physicians of Northern CA ( “Team Health”)

Adjourn to Joint Board Meeting

Call to Order – GHD President Robert Ayres

Approval of Agenda

Public Comment:

Opportunity for citizens to speak on items of interest within subject matter jurisdiction

of the District. For the record, please state your name. “Request to speak”: cards

should be filled out in advance and presented to the Board President or the recording

secretary. The Board has a policy limiting any speaker to no more than five minutes.

Annual Report from the Grossmont Hospital Corporation

Grossmont Healthcare District Presentation

Open Discussion

Adjournment

CALL TO ORDER

DAVE GRUNDSTROM - GHC CHAIRMAN

ACTION ITEM

SCOTT EVANS, CEO

Emergency Medical Professional Services and Medical Director

Agreement – Team Physicians of Northern CA ( “Team Health”)

ADJOURNMENT TO JOINT BOARD MEETING

CALL TO ORDER

BOB AYRES - GHD PRESIDENT

APPROVAL OF AGENDA

PUBLIC COMMENT

Opportunity for citizens to speak on items of interest within subject matter

jurisdiction of the District. For the record, please state your name. “Request to

speak”: cards should be filled out in advance and presented to the Board

President or the recording secretary. The Board has a policy limiting any speaker

to no more than five minutes.

ANNUAL REPORT FROM THE

GROSSMONT HOSPITAL CORPORATION

Reflection

Community Health Needs Assessment Report – Jillian Barber, Program Manager

Scott Evans, CEO

Louise White – CNO, VP of Patient Care Services

Nancy Greengold – CMO

Karen Chapman, VP Facilities and Support Services

REFLECTION

I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel

Maya Angelou

SHARP GROSSMONT HOSPITAL

2016 COMMUNITY HEALTH NEEDS

ASSESSMENT

AND IMPLEMENTATION PLAN J I L L I A N B A R B E R , M P H

P R O G R A M M A N A G E R ,

C O M M U N I T Y B E N E F I T S & H E A L T H I M P R O V E M E N T

S H A R P H E A L T H C A R E

BACKGROUND: COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNA)

Previously utilized collaborative, countywide triennial CHNA

New health care reform requirements:

Individual hospital CHNAs Implementation plans

Collaborative, countywide CHNA process and Sharp-specific steps

Hospital Association of San Diego and Imperial Counties (HASD&IC)

Institute for Public Health at SDSU

2016 CHNA Committee Members:

Kaiser Foundation Hospital, San Diego Palomar Heath Scripps Health Sharp HealthCare UC San Diego Health System Tri-City Medical Center

HASD&IC 2016 CHNA PROCESS – COLLABORATION PARTNERS

HASD&IC 2013 CHNA FRAMEWORK

Source: HASD&IC 2013 CHNA

Top 15 Health Needs Based on 2013 Initial Quantitative Analysis*

Acute Respiratory Infections Asthma Back Pain Breast Cancer Cardiovascular Disease Colorectal Cancer Dementia and Alzheimer’s Diabetes (Type 2)

High Risk Pregnancy Lung Cancer Mental Health/Mental Illness Obesity Prostate Cancer Skin Cancer Unintentional Injuries

2013 SHARP GROSSMONT HOSPITAL IDENTIFIED COMMUNITY NEEDS

Priority health needs: Cardiovascular disease Diabetes (Type 2) Mental/Behavioral health Obesity Senior Health

Five themes from analysis of primary data: Access to Care or Insurance Care Management Collaboration Education Screening Services

2013 CHNA FRAMEWORK: PHASE 2

Source: HASD&IC 2013 CHNA: www.hasdic.org; Graphic adopted from IPH Toolkit.

HASD&IC 2016 CHNA PROCESS MAP

2016 CHNA: QUANTITATIVE DATA ANALYSIS

18

Secondary Data Variables

Hospital Utilization: Inpatient discharges, ED and ambulatory care encounters

Community Clinic Visits

Demographic Data (socio-economic indicators)

Mortality and Morbidity Data

Regional Program Data (childhood obesity trends and community resource referral patterns)

Social Determinants of Health and Health Behaviors (education, income, insurance, physical environment, physical activity, diet and substance abuse)

HASD&IC 2016 CHNA: COMMUNITY ENGAGEMENT

• Community Partners: Clinic Care Coordinators, Patient Navigators, Cal Fresh Outreach Coordinators

• Alignment of County CHNA processes

• Health Access and Navigation Survey (Roadmap)

SHARP GROSSMONT HOSPITAL 2016 CHNA: COMMUNITY ENGAGEMENT

• Key Informant Interviews (4)

• Facilitated Discussions (37 participants)

• Roadmap Surveys (104 completed)

2016 CHNA: HEALTH ACCESS AND NAVIGATION SURVEY (ROADMAP)

SHARP GROSSMONT HOSPITAL 2016 CHNA: COMMUNITY DEFINED

High-Need ZIP Codes based on Community Need Index (CNI) Score: 91945, 91977, 92020, 92021

Source: IDX (internal) database, Sharp HealthCare. Speedtrack, FY 2015.

ZIP Code Community

91941 La Mesa

91942 La Mesa

91945 Lemon Grove

91977 Spring Valley

92019 El Cajon

92020 El Cajon

92021 El Cajon

92040 Lakeside

92071 Santee

SGH 2016 CHNA: COMMUNITY DEFINED

Source: County of San Diego, HHSA, Community Health Statistics Unit, September 2015

2016 CHNA FINDINGS

Top Health Needs Top Social Determinants

HASD&IC 2016 CHNA: HEALTH ACCESS SURVEY (N=235)

1. Understanding health insurance

2. Getting health insurance

3. Using health insurance

4. Knowing where to go for care

5. Follow-up care and/or appointment

Five Most Troublesome Barriers to Accessing Health Care:

“Where Do You Get Stuck?”

HASD&IC 2016 CHNA: Health Access Survey (Roadmap)

~ 60% respondents confused by insurance terms

~ 69% respondents don’t know what services are

covered by their health insurance

~ 56% of respondents don’t know whether to use

the ED vs. urgent care or a clinic

~ 42% of respondents have no primary care

doctor

SGH 2016 CHNA FINDINGS: KEY INFORMANTS Behavioral Health: active recovery, comorbidities

(hypertension, diabetes); need early prevention programs;

share best practices; policy work

Cancer: knowledge and emotional challenges of providers;

access to care/language barriers; need lay

navigators/community coordinators

Cardiovascular: access to care/medications, diet,

comorbidities; transportation, care coordination

Care Transitions: behavioral health, chronic diseases;

expedited connection to community resources

SGH 2016 CHNA FINDINGS: FACILITATED DISCUSSIONS Cancer: health literacy, fear/anxiety; nutrition;

cultural/language barriers; navigation, empowerment

Diabetes: multiple chronic conditions; nutrition/food

insecurity; hospital to home discharge

Senior Health: behavioral health, hypertension, diabetes;

food insecurity; isolation

Care Transitions: behavioral health, comorbidities; substance

abuse; health literacy; food insecurity; isolation; health

coaching, community collaboration

2016 CHNA COMMUNITY RECOMMENDATIONS

SHARP GROSSMONT HOSPITAL IMPLEMENTATION PLAN

Access to care PFS: Public Resource Specialist, PointCare, CalFresh Enrollment

Behavioral health: Clinical programs through SGH Behavioral Health PET evaluations in the SGH Emergency Department

Cancer: Community education, screenings, collaboration Collaboration and deeper dive with Patient Navigators

Cardiovascular disease: Community education and screenings SD County Stroke Consortium participation

SHARP GROSSMONT HOSPITAL IMPLEMENTATION PLAN Diabetes: Community education / strategic partnerships

Feeding America San Diego Collaboration with community clinics

Family Health Centers of San Diego

Obesity: Community education/nutrition

Senior health: Community education, screenings and support for seniors and

caregivers Telephone Reassurance Calls Community collaboration – SDFB, Salvation Army

SHARP GROSSMONT HOSPITAL 2016 CHNA: NEXT STEPS 2016 CHNA Phase 2 – HASD&IC and Sharp

Ongoing collaboration with HASD&IC and San Diego hospitals Policy agenda Multi-health system implementation plan analysis Multi-health system collaboration

Annual implementation plan evaluation and updates

QUESTIONS?

Thank you! Jillian Barber at 858-499-4985.

For the full HASD&IC 2016 CHNA report, please

visit: www.hasdic.org

SCOTT EVANS CHIEF EXECUTIVE OFFICER

Actual Budget Variance %

TOTAL NET REVENUE 583,234$ 588,426$ (5,192)$ -0.9%

TOTAL OPERATING EXPENSES 539,011 535,633 (3,378) -0.6%

EBITDA FROM OPERATIONS 44,223$ 52,793$ (8,570)$ -16.2%

INCOME (LOSS) FROM OPERATIONS 18,825$ 25,342$ (6,517)$ -25.7%

Y E A R - T O - D A T E

SHARP GROSSMONT HOSPITAL

STATEMENT OF OPERATIONS

TEN MONTHS ENDING JULY 31, 2016

($ in 000's)

JULY YTD – NET REVENUE ($5.2 MILLION)

Net Revenue (Prior to the adjustments below) is under budget by ($17.9 million)

$11.0 million Contract inpatient discharges and Outpatient rates;

$7.9 million Medicare IP, Rehab, Homecare;

$750k loss related to decreased Medi-Cal inpatient volume shift to Observation

$1.75 million favorable rate offset (Capitated, Other)

Quarterly Unbudgeted Adjustments ($14.1 million pick-up):

$6.7 million settlement with Molina for a contract dispute on OP rates;

$4.7 million payout from Molina for excess Medi-Cal expansion funds;

$2.5 million additional Provider Fee Managed Care portion; and

$200k in prior year Medicare and Medi-Cal settlements.

Other Operating Revenue – $1.4 million below budget related to Contract Pharmacy

JULY 2016 FYTD FINANCIAL

SUMMARY July 2016 FYTD Actual Budget Variance

Total Net Revenue $583,234 $588,426 ($5,192)

Discharges 34,819 35,054 (235)

Discharge

Volume

Acute, OBS,

ICU TCU BHS Rehab

Women's

Services NICU Total

Actual 29,602 116 1,164 208 3,317 412 34,819

Budget 29,335 126 1,289 334 3,578 392 35,054

Variance 267 (10) (125) (126) (261) 20 (235)

Revenue

Acute (incl. OBS), ICU and NICU discharges are above target

Behavioral Health, Rehab and Women’s Services discharges are below target

Unfavorable shift in payor mix as well as shift from acute to observation

INPATIENT PAYOR MIX JULY YTD

INPATIENT PAYOR MIX - MEDICARE HIGHLIGHT

Payor FY16

IP Average

FY16

OP Average

July YTD

IP Discharges

July YTD

Observation Visits

IP

Variance to Budget

Observation

Variance to Budget

Medicare $13,383 $ 2,896 7,071 2,031 -5.4% 38.5%

YEAR END – NET REVENUE ENTRIES

Year End Entries ($9.0 million to be booked in September 2016):

$4.0 million in Accumen Gain-share (Lab);

$3.4 million in remaining Molina contract dispute settlement; and

$1.6 million is Disproportionate Share Hospital (DSH) Private Hospital

Supplemental Fund (PHSF) Program.

GROSSMONT CELEBRATES!

YOUNITY LEADER LAUNCH

GROSSMONT CELEBRATES

USS MIDWAY

Quality Pillar Core Winners

Jennifer Fryling

Individual

3 -East

Department

Head and Neck Cancer Quality of Life

Preservation

Team

Quality Core Award Spotlight

Scenario Improvement Results

3-East unit had the highest

number of hospital acquired

pressure ulcers at Sharp

Grossmont Hospital with an

average of 3 per month

Implemented a three step

approach to decreasing hospital

acquired pressure ulcers

(HAPU). The department

reviewed high-risk patient at the

beginning of shift, initiated T3

and provided appropriate lined

for the patient’s condition.

Decreased HAPUs from an

average of 3 per month in the

department to zero for three

consecutive months

Safety Pillar Core Winners

Diana Wallace

Individual

Endoscopy

Department

Emergency Department Security

Collaborative

Team

Safety Core Award Spotlight

0

1

2

3

4

5

6

7

Baseline Post Implementation

Reportable Injuries-Endoscopy Annual Estimated Cost of Injuries-Endoscopy

$330,965

$38,485

$0

$50,000

$100,000

$150,000

$200,000

$250,000

$300,000

$350,000

Baseline Post Implementation


Endoscopy employees have very

physically demanding jobs,.

During the baseline period, 6

reportable injuries occurred in

the department.

Customized patient mobilization

practices were implemented

and taught throughout the

department

A 66% percent decrease in

reportable injuries in the

department and a projected

$300k in savings due to the

prevention of injuries.

Service Pillar Core Winners

Linda VanFulpen

Individual

Sharp HospiceCare Volunteer Department

Department

SGH Pain Management Team

Team

Service Core Award Spotlight


Patient who received a total

knee replacement (TKNR) were

reporting, via the HCAHPS

survey, that their pain was

always controlled only 53% of

the time.

The innovative Cerner Pain

Dashboard was created to allow

the newly-formed

interdisciplinary team to assess

baseline pain trends and monitor

the Pain Initiative’s effects over

time.

Patients stated that their pain

was always controlled 86% of the

time compared to the baseline

score of 53%. A 33% point

increase over a 3 month period.

People Pillar Core Winners

Rudy Sanchez

Individual

SGH New Graduate Nurse Residency

Program

Department

Sharp Grossmont Hospital Experience

Team

Team

People Core Award Spotlight


Sharp Grossmont Hospital will

need an increase in nurses to

replace nurses who are nearing

retirement.

In July 2015 a newly redesigned

12-week Residency Program

was launched Residency

includes 130 of didactic

education and more than 220

hours of clinic training.

Residents are then enrolled in a

year long mentor program and

provided Lean Six Sigma

education.

From July 2015 to May 2016,

106 New Graduate nurses have

been hired

Finance Pillar Core Winners

Trini Perez

Individual

Sharp Grossmont Observation Unit

Department

Utilization Review Team

Team

Finance Core Award Spotlight


Utilization Review must ensure

that patients receive medically

necessary services and

appropriate care according to

established guidelines.

Successful UR departments

ensure a low number of claims

are denied.

UR RN model de-centralized and

were located to specific

geographic locations to build

trust and engagement with

clinical staff. Standard work

flows were implemented to

review patient status.

Decreased the number of

denials by almost 50%,

compared to FY15. 91%

decrease in denials in “Delay in

Service” and 73%

7036 6408 3752 0

1000

2000

3000

4000

5000

6000

7000

8000

FY14 FY15 FY16*

Nu

mb

er

of

Acc

ou

nts

Net Number of Denials

*FY 16 Q1-Q2 Annualized

$7,755.4 $6,323.1 $5,956.1

$-

$1,000.0

$2,000.0

$3,000.0

$4,000.0

$5,000.0

$6,000.0

$7,000.0

$8,000.0

$9,000.0

FY14 FY15 FY16*

Ne

t D

en

ied

Am

ou

nt

(In

Th

ou

sa

nd

s)

Net Denied $

*FY 16 Q1-Q2

Annualized

91%

73%

38%

0%

20%

40%

60%

80%

100%

Delay in Servive(Avoidable)

Medical Necessity NotDocumented or Missing

Level of Care (Incorrect)

Percent Decrease in Denials in FY16* Compared to FY 15 by Denial Type

*FY 16 Q1-Q2 Annualized

Growth Pillar Core Winners

Chris Crawford

Individual

Emergency Department

Department

Radiation Oncology

Team

Growth Core Award Spotlight


Goal to increase the number of

patients served in the Radiation

Oncology department.

Created a calming atmosphere

for the patients and family.

Engaging with the Marketing

department to advertise and

educate the community by

hosting events, lectures and

engaging in social media.

A 24% increase in the number of

visits in FY16, compared to the

same period in FY15.

Community Pillar Core Winners

Scott Musicant, M.D.

Individual

House-wide Clinical Practice Council

Department

5E Acute Stroke

Team

Community Core Award Spotlight

Scenario Results

Dr. Scott Musicant of La

Mesa is a practicing

vascular surgeon who

donates his time and

expertise to serve the

underserved in San Diego

County as a physician

volunteer for Project Access

San Diego (PASD).

Since 2009, Dr. Musicant

has helped about 20

uninsured or underinsured

East County residents who

cannot afford specialty

surgeries.

LOUISE WHITE CNO, VP OF PATIENT CARE SERVICES

Leadership

Forum

SHARP GROSSMONT HOSPITAL PEOPLE INITIATIVES MOLDING THE SHARP GROSSMONT CULTURE

1. Relocated/expanded Fast Track

2. Implemented Rapid Patient Management (RPM) to expedite time

to provider

3. Implemented Bed Czar role

4. Reduced Diversion/Bypass

5. Enhanced Lobby Management (nursing and concierge staff)

6. Established ED Navigators (HCPs doing comfort rounds on

patients/families waiting for beds)

7. Discharge phone calls

EMERGENCY DEPARTMENT INITIATIVES

EMERGENCY DEPARTMENT IMPROVEMENTS

Average Hours on Bypass in a Month

284

18

0

50

100

150

200

250

300

Jan-Jun 15 Jan-Jun 16

84% Decrease in number of

patients who bypassed

SGH

Increase in number of ALS

transports to

IMPROVING THE AVAILABILITY TO THE COMMUNITY

69

61

12

LOS < 3 hrs LOS < 4 hrs LOS > 4 hrs


IMPROVING THE EFFICIENCY OF THE DEPARTMENT

Patients discharged from the ED between: 04/2016 to 06/2016


IMPROVING THE PATIENT SATISFACTION

87.8 81

72

16

0

20

40

60

80

100

Mean Percentile Rank

Received Phone Call Did Not Receive Phone Call

Overall ED Patient Satisfaction Score

Patients discharged between: 04/2016 to 06/2016

Patients who received phone call: 129 Patients who did not receive phone call: 405

INPATIENT EXPERIENCE INITIATIVE


1. Enhanced Daily Huddles

2. Discharge Rounds/Discharge

Assistant

3. VP Rounding

4. Discharge phone calls

5. Narration of Care

6. No Pass Zone

7. Care Partners

8. Hourly Rounding

9. Signature Moments

10.Robust Reward & Recognition

INPATIENT EXPERIENCE INITIATIVE


39% 39%

45%

37% 38%

46% 48%

34%

40% 42%

78%

54%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Ra

nk

To

p B

ox

HCAHPS-Average HCAHPS-Inpatient Total

Questions

NANCY GREENGOLD, M.D. CHIEF MEDICAL OFFICER

ANNUAL PHYSICIAN SATISFACTION SURVEY

45%

58%

41%

73%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

FY13 FY14 FY15 FY16

Percentile Rank Linear (Percentile Rank)

PHYSICIAN ACTIVITIES

Quarterly “State of the Hospital” conferences

Shared Governance meetings

Monthly CEO and medical staff luncheons

Administration at supervisory committees

1:1 meetings with CEO and CMO

Active listening

Credentialing change

Med Staff services move

Cultivating physician leadership

ONGOING QUALITY ISSUES

Mortality

Focus on sepsis recognition and management

Mortality review initiative with Mayo

Focus on advanced illness management

Readmission Rates

Variety of strategies

Patient Safety Indicators

Dashboards

QUALITY THROUGH NEW LENS

Continuity of Care

Follow-up appointments with physicians

Partnering with PCPs, SNFs, FQHCs

Cost Effectiveness/Efficiency

Appropriateness of care

Setting (e.g., inpatient, outpatient, rule-out units)

Utilization (e.g., lab/radiology tests and procedures)

Value-based care (e.g., MACRA, MIPS, APMs)

DIFFERENT FOCUS

Spotlight on case management

Introducing…

Marguerite Paradis

Leader of the Year!

Questions

KAREN A. CHAPMAN VP OF FACILITIES AND SUPPORT SERVICES

MAJOR CAPITAL PROJECTS COMPLETED

Operating Rooms 1,2,3,4 & 5 Remodels

Linear Accelerator Suite Renovation

Women’s Center– First Floor Renovation

Campus Elevators: Parking Garage 2 &

Women’s Center

SUMMARY CAPITAL PROJECTS

Completed Capital Projects 2015 – 2016

Total Budget - $ 11,272,000

13 Significant Projects

5 OR’s, LINAC, Women Center first floor,

Campus Elevator Modernizations

OR 1,2,3,4 AND 5 REMODEL

Neuro Surgical OR

Robotic OR

General Surgery new technology

Next Generation of Equipment

LINEAR ACCELERATOR – CANCER CENTER

WOMEN’S CENTER OB/GYN

WOMEN’S CENTER: FURNISHINGS & ARTWORK

ELEVATOR MODERNIZATION

PARKING GARAGE 2 & WOMEN’S CENTER

WOMEN’S CENTER ELEVATOR PARKING GARAGE 2

Remodels

Pulmonary, Ultrasound Suite, & 2 Nuclear

Medical Suite

Fluoroscopy/ Radiology Suite

Women’s Center Second Floor

Cancer Center

Outpatient Infusion Center Expansion

GMP 6th Floor Ambulatory Services Center

Urgent Care Buildout

480V Substation Replacement

SPC-4D Study

MAJOR CAPITAL PROJECTS IN PROGRESS

In Progress Capital Projects for 2016 - 2017

Total Budget - $ 23,752,000

18 Significant Projects

Urgent Care, Fluoroscopy / Radiography

Suite, GMP 6th floor, Outpatient Infusion

Center Expansion, 480V Substation

replacement,

SUMMARY CAPITAL PROJECTS

ULTRASOUND REMODEL – LEVEL A

NUCLEAR MEDICINE SUITE

GMA - URGENT CARE

Schematic Floor Plan – Urgent Care

RENDERINGS FOR PROPOSED URGENT CARE

Registration and Lobby Typical Exam room

FLUOROSCOPY / RADIOGRAPHIC SUITE – LEVEL A

FLUOROSCOPY / RADIOGRAPHIC SUITE

GROSSMONT MEDICAL PLAZA – 6TH FLOOR

OSHPD 3 Code Compliant Expanding Sleep Clinic from 2 to 4 rooms Ambulatory Services Center with 8 exam rooms

(Perinatal and Wound Care)

GROSSMONT MEDICAL TERRACE

OUTPATIENT INFUSION CENTER EXPANSION

7 chair Outpatient Infusion Center

(OIC)

BSL 5 Compounding pharmacy w/

work room

Breakroom, & Nurse’s Station

Clean & Soiled Utility Room, ADA

Restroom & Storage

WOMEN’S CENTER - SECOND FLOOR Patient rooms Restroom remodel New headwalls New flooring, paint, sink / counter Exam room lights (2) Lighting, artwork, computer mount New storage / wardrobe Medical gas (2)- baby area only Construct (2) code compliant ADA

rooms Main Corridor Paint, column wrap / base, lighting New satellite work stations New nurse’s reception area – Main New nurse’s Reception desk New nurse call

WOMEN’S CENTER – SECOND FLOOR Improve Operations in LDR Rooms Install new Headwalls, Flooring, Paint, Artwork

Furniture, lighting, Millwork, Window Treatments, Restroom & Sink area Remodel

Typical LDR Room Part of Exam lighting Study

CANCER CENTER REMODEL

Improved patient flow and monitoring

Improved functional adjacencies

Improved lobby and waiting area

Differentiate between day treatment and Radiation Oncology

Replacement of old finishes

MECHANICAL EQUIPMENT ROOM (MER) 8

SUBSTATION REPLACEMENT – LEVEL A

Scope

Replace (3) old Substations with one newer technology

for improved performance & growth

Phases of Work

Make ready – Communication Room Remodel

Phases 1-3: Replace three substations

Phase 4 – Install new Transformer, Distribution board

and Pad for growth

SPC - 4D PROVISIONS & IMPACT TO SGH

NONCONFORMING BUILDINGS CAN BE UPGRADED TO SPD-4D TO PROVIDE

SERVICES BEYOND 2030

THE CBC 1980 CAN BE USED TO UPGRADE A BUILDING TO SPC-4D

ASCE 41-13 DAMAGE CONTROL STRUCTURAL PERFORMANCE LEVEL CAN BE

USED FOR SPC-4D ANALYSIS OR RETROFIT

NO SEISMIC EVALUATION CHECKLIST, MUCH SIMPLER ENFORCEMENT

NPC-4 REQUIREMENTS REMAIN IN FORCE

SPC-2 SPC-4 SPC-5

PRE 1973 1973 -1989 1989

Applicable Design Build Codes

1973,1976,1979,1982,1985,1988

Seismic Compliance

Deadline

Beyond 2013

2030

South Tower

Was: West Tower: West Now: “North Tower”

Was: West Tower: North Now: “North Tower”

Was: North Tower Now: “North Tower”

Was: West Tower: East Now: “North Tower”

Administration Building

SGH SPC-4D BUILDINGS REVIEWED FOR SEISMIC UPGRADE

SPC - 4D PROVISIONS & IMPACT TO SGH

Questions

GROSSMONT HEALTHCARE DISTRICT

PRESENTATION

OPEN DISCUSSION

ADJOURNMENT

Sharp Grossmont Hospital

2016 Community Health Needs Assessment

and Implementation Plan

Jillian Barber, MPH

Program Manager, Community Benefits and Health Improvement

Sharp HealthCare

Background: Community Health Needs Assessments (CHNA)

• Previously utilized collaborative, countywide triennial CHNA

• New health care reform requirements:

• Individual hospital CHNAs • Implementation plans

• Collaborative, countywide CHNA process and Sharp-specific steps

• Hospital Association of San Diego and Imperial Counties (HASD&IC)

• Institute for Public Health at SDSU

• 2016 CHNA Committee Members:

• Kaiser Foundation Hospital, San Diego • Palomar Heath • Scripps Health • Sharp HealthCare • UC San Diego Health System • Tri-City Medical Center

HASD&IC 2016 CHNA Process – Collaboration Partners

HASD&IC 2013 CHNA Framework

Source: HASD&IC 2013 CHNA




2013 Sharp Grossmont Hospital Identified Community Needs

Priority health needs: • Cardiovascular disease • Diabetes (Type 2) • Mental/Behavioral health • Obesity • Senior Health

Five themes from analysis of primary data: • Access to Care or Insurance • Care Management • Collaboration • Education • Screening Services

2013 CHNA Framework: Phase 2

Source: HASD&IC 2013 CHNA: www.hasdic.org; Graphic adopted from IPH Toolkit.

HASD&IC

2016 CHNA Process

Map

2016 CHNA: Quantitative Data Analysis

8


Hospital Utilization: Inpatient discharges, ED and ambulatory care encounters

Community Clinic Visits

Demographic Data (socio-economic indicators)




HASD&IC 2016 CHNA: Community Engagement

9

• Community Partners: Clinic Care Coordinators, Patient Navigators, Cal Fresh Outreach Coordinators

• Alignment of County CHNA processes

• Health Access and Navigation Survey (Roadmap)

Sharp Grossmont Hospital 2016 CHNA: Community Engagement

10

• Key Informant Interviews (4)

• Facilitated Discussions (37 participants)

• Roadmap Surveys (104 completed)

2016 CHNA: Health Access and Navigation Survey (Roadmap)

11

Sharp Grossmont Hospital 2016 CHNA: Community Defined

12

High-Need ZIP Codes based on Community Need Index (CNI) Score: 91945, 91977, 92020, 92021

Source: IDX (internal) database, Sharp HealthCare. Speedtrack, FY 2015.

ZIP Code Community

91941 La Mesa

91942 La Mesa

91945 Lemon Grove

91977 Spring Valley

92019 El Cajon

92020 El Cajon

92021 El Cajon

92040 Lakeside

92071 Santee

13

SGH 2016 CHNA: Community Defined

14

Source: County of San Diego, HHSA, Community Health Statistics Unit, September 2015

2016 CHNA FINDINGS

Top Health Needs Top Social Determinants

HASD&IC 2016 CHNA: Health Access Survey (n=235)

1. Understanding health insurance

2. Getting health insurance

3. Using health insurance

4. Knowing where to go for care

5. Follow-up care and/or appointment

Five Most Troublesome Barriers to Accessing Health Care:

“Where Do You Get Stuck?”

17

HASD&IC 2016 CHNA: Health Access Survey (Roadmap)

• ~ 60% respondents confused by insurance terms

• ~ 69% respondents don’t know what services

are covered by their health insurance

• ~ 56% of respondents don’t know whether to use

the ED vs. urgent care or a clinic

• ~ 42% of respondents have no primary care

doctor

SGH 2016 CHNA Findings: Key Informants

18

• Behavioral Health: active recovery, comorbidities

(hypertension, diabetes); need early prevention

programs; share best practices; policy work

• Cancer: knowledge and emotional challenges of

providers; access to care/language barriers; need lay

navigators/community coordinators

• Cardiovascular: access to care/medications, diet,

comorbidities; transportation, care coordination

• Care Transitions: behavioral health, chronic diseases;

expedited connection to community resources

SGH 2016 CHNA Findings: Facilitated Discussions

19

• Cancer: health literacy, fear/anxiety; nutrition;

cultural/language barriers; navigation, empowerment

• Diabetes: multiple chronic conditions; nutrition/food

insecurity; hospital to home discharge

• Senior Health: behavioral health, hypertension,

diabetes; food insecurity; isolation

• Care Transitions: behavioral health, comorbidities;

substance abuse; health literacy; food insecurity;

isolation; health coaching, community collaboration

2016 CHNA Community Recommendations

Sharp Grossmont Hospital Implementation Plan

21

Access to care • PFS: Public Resource Specialist, PointCare, CalFresh

Enrollment

Behavioral health: • Clinical programs through SGH Behavioral Health • PET evaluations in the SGH Emergency Department

Cancer: • Community education, screenings, collaboration • Collaboration and deeper dive with Patient Navigators

Cardiovascular disease: • Community education and screenings • SD County Stroke Consortium participation

Sharp Grossmont Hospital Implementation Plan

22

Diabetes: • Community education / strategic partnerships

• Feeding America San Diego • Collaboration with community clinics

• Family Health Centers of San Diego

Obesity: • Community education/nutrition

Senior health: • Community education, screenings and support for

seniors and caregivers • Telephone Reassurance Calls • Community collaboration – SDFB, Salvation Army

Sharp Grossmont Hospital 2016 CHNA: Next Steps

23

• 2016 CHNA Phase 2 – HASD&IC and Sharp

• Ongoing collaboration with HASD&IC and San Diego hospitals

• Policy agenda • Multi-health system implementation plan

analysis • Multi-health system collaboration

• Annual implementation plan evaluation and updates

Questions?

Thank you! Jillian Barber at 858-499-4985.

For the full HASD&IC 2016 CHNA report, please

visit: www.hasdic.org

Sharp Grossmont Hospital Community Health Needs Assessment – Implementation Plan

Fiscal Year 2017-2020

Current as of: 8/17/2016 Page 1 of 46

Identified Community Health Need: Access to Care

Objectives/Anticipated Impact Action Items

Target Completion

Date

Responsible Party/ies

Identified Themes in 2016 CHNA

Evaluation Methods, Measurable Targets, and Other Comments

1. Increase coverage for patients seen in the Emergency Room by providing assistance to secure health coverage for all individuals entitled to the benefit; also provide payment options for individuals that chose not to secure coverage or are not currently eligible for health benefits. Secure benefit concurrent with stay when Medi-Cal Presumptive Eligibility rules apply.

a. Continue to provide services to help every unfunded patient received in the Emergency Department find coverage options - including PointCare questionnaire to generate personalized coverage options that are filed in patients' accounts for future reference and accessibility.

In addition, Sharp staff use the PointCare on-line survey to direct patients to the Covered California website for health coverage or Medi-Cal enrollment as Presumptively Eligible and/or full scope benefits.

Ongoing(evaluated annually)

NavigatorsPatient Access

Service

RepresentativesPatient Access

Services

Public Resource Specialist

Patient Access Service

Self-Pay Team Manager

Access to CareEducation

The PointCare program continues to collect metrics on number of individuals served and cost savings. Via this program, Sharp served 9,384 self-pay patients since October 01, 2015 through 07/31/2016.

PointCare has expanded its website to also provide linkage to Covered CA as appropriate. The tool interfaces patient screening information in the GE record.

Sharp Healthcare’s Patient Access Services department has processed real-time Medi-Cal eligibility determinations under the Hospital Presumptive Eligibility Program for 234 unfunded patients, YTD FY 2016.

Thus far in FY 2016, Sharp Healthcare’s Patient Access Services department has assisted 309 recipients in maintaining Medi-Cal eligibility after the HPE period lapse via advanced advocacy efforts.

Continued unknowns in understanding the efficacy of our efforts are the increase in the patient out of pocket responsibility resulting from health plan coverage purchased off the exchange and the transition of qualified unfunded patients directly to Medi-Cal.






Target Completion

Date




Sharp has initiated a process of trending straight self-pay collections separate from balance after insurance collections in an effort to closely monitor these two distinct populations.

2. Provide payment options and support high-risk, uninsured, underinsured, and patients admitted to hospital facilities with an inability to pay their financial responsibility after health insurance.

a. Provide the Maximum Out of Pocket Program to patients who express an inability to pay their financial responsibility after health insurance.

Ongoing Financial Counselor

Access to careFinancial

assistanceProvide

education on patient financial

services

The Maximum Out of Pocket Program was launched in October 2014. Sharp provides one-on-one interviews during the hospital stay focusing on educating the patient regarding their health insurance benefits, accessing care, and payments options with a compassionate approach while promoting healing.

b. Provide a Public Resource Specialist for uninsured and underinsured patients, to offer support patients needing advanced guidance on available funding options.

Ongoing Patient Access Services;





assistanceProvide


services

In 2015, a new position was created – the Public Resource Specialist – to support to patients needing extra guidance on available funding options. These individuals will also perform what is traditionally called “field calls” (home visits) to patients who have left the hospital and require assistance in completing a process to facilitate coverage. These positions were deployed in fiscal year 2016.






Target Completion

Date




c. Provide specialized financial assistance and support program to families with children in a Sharp NICU.

Ongoing Patient Access Services





assistance

In Summer 2015, a pilot program was launched at Sharp Mary Birch Hospital for Women & Newborns in support of Sharp’s NICU babies. This process includes a meeting with families where a newborn that has been diagnosed with a devastating medical condition or extremely low birth weight is evaluated for eligibility for Supplemental Security Income (SSI).

d. Patient Assistance Team will continue to assist patients in need of assistance gain access to free or low-cost medications. Patients are identified through usage reports, or referred through case management, nursing, physicians or even other patients. If eligible, uninsured patients are offered assistance, which can help decrease readmissions due to lack of medication access. The team members research all options available including programs offered by drug manufacturers,

Ongoing Supervisor, Patient

Assistance Navigators

Manager Patient Financial

Services, Self-Pay Patients

Access to careProvide


services

Cost savings for replacement drugs is monitored through pharmacy and supply chain. The patient accounting staff remove the charges from the patient statement.

Sharp was the first hospital in San Diego to gain Certification through the Covered CA program, training over 20 employees to become Certified Enrollment Counselors for Covered CA. This, along with Hospital Presumptive Eligibility, has reduced the unfunded population at our hospitals significantly. With the ending of the In-Person assistance program in July 2015, entity counselors will be transitioned to the Certified Application Assistance Program.

Sharp also tracks each individual that has applied for






Target Completion

Date




grant-based programs offered by foundations, copay assistance, low-cost alternatives, or research where the patient might find their medication at a lower cost.

financial assistance. The patient account is noted with the findings, and a specific adjustment code is used to track the dollars associated with these reviews.

e. Continue to offer ClearBalance – a specialized loan program for patients facing high medical bills. Through this collaboration with San Diego-based CSI Financial Services, both insured and uninsured patients have the opportunity to secure small bank loans in order to pay off their medical bills in low monthly payments.

Ongoing Supervisor, Patient

Assistance Navigators

Manager Patient Financial

Services, Self-Pay Patients

Access to Care To date in FY16, more than 1,830 Sharp patients been assisted through the ClearBalance loan program.

f. Continue to provide Project HELP funds for pharmaceuticals, transportation vouchers and other needs for economically disadvantaged patients.

Ongoing Sharp Grossmont

Hospital (SGH) Chief Financial

Officer

Access to Care Project HELP funds are tracked though an internal database. From FY10-FY15, Project HELP funds totaled ~$792.8 K, and increased 58.4%.






Target Completion

Date




a. Provide data to St. Vincent de Paul for Permanent Supportive Housing Cost Effectiveness Study– which provides housing and social services San Diego’s chronically homeless community members.

July 2015Concluded.

Vice President, Sharp

HealthCare (SHC)

Government Relations

Access to CareCollaboration

Care Management

This effort concluded in 2015, and has led to the state’s adoption of the model for distribution in other regions, via the Whole Person Care program funded by the Medicaid Waiver; and continuation (via the City/County Project One for All which will include wraparound services for defined population of homeless.

b. Participate in collaboration with the San Diego Organizing Project and Multicultural Primary Group to provide follow-up medical and case management services to high-risk patients (homeless, etc.)

2016Concluded.

Vice President, SHC


Care Transitions Program Manager


Care Management

This project concluded in 2016.

This project tracks hospital service utilization and cost savings. Currently (as of July, 2015) Sharp is tracking service utilization for 50 individuals. Program began in spring, 2013.

3. Improve access and health outcomes for high-risk community members, particularly San Diego’s homeless population.

c. Continue to collaborate with the San Diego Rescue Mission to discharge chronically homeless patients to the Rescue Mission’s Recuperative Care Unit. These patients receive follow-up care through SGH in a safe space, in addition to psychiatric care, substance abuse counseling and

Ongoing Care Transitions Program Manager

Access to CareCare

ManagementCollaboration

Program tracks the number of referrals made to the Rescue Mission as well as cost data for patients for whom Sharp covers the cost of post-discharge treatment (at a Sharp facility). Data for the latter are tracked via Sharp’s Case Management Department’s cost reports.






Target Completion

Date




other services through the San Diego Rescue Mission.

d. Continue to partner with Father Joe’s Villages to support Project SOAR - designed to facilitate and expedite the processing of social security and disability applications for homeless individuals with urgent health care needs.

Ongoing Care Transitions Program Manager


Care Management

Eligibility for Project SOAR’s programming is incorporated into Sharp’s current eligibility review process for all patients; patient files are assessed for Project SOAR eligibility and then referrals are conducted for qualified patients.

Currently there are no mechanisms in place to track cost or volume on this program, as it is a cooperative with no direct costs for Sharp. Thus, it is difficult to measure any savings that Sharp might experience.

e. Continue to explore opportunities for collaboration with community organizations to provide medical care, financial assistance, psychiatric and social services to high-risk, chronically ill, and/or

Ongoing Vice President, SHC


Care Transitions


Care Management

With the success of Sharp Grossmont Hospital’s Care Transitions Intervention (CTI) pilot (see line item below), Sharp is exploring the concept of expanding this model of care (connection to resources for food insecurity, transportation, and other social supports) to other high-risk patient populations at Sharp’s hospital entities. In






Target Completion

Date




chronically homeless patients Program Manager

Program Manager,

Community Benefits and

Health Improvement

progress.

f. Continue to offer high-risk, vulnerable SGH patients (Self-Pay, Medi-Cal, Medi-Cal Presumptive, with complex chronic health conditions and limited social support) health coaching and resources (through multiple community partnerships) upon discharge to help ensure safe transition from hospital to home, and improve their quality of life; a Care Transitions Intervention (CTI) model pilot.

TBD – start date was July,

2014

Care Transitions Program Manager

Program Manager,


Health Improvement

Access to CareCare

ManagementCollaboration

The CTI© program focuses on transitioning patient home safely by reviewing Medications, early recognition of symptoms, establishing a Medical Home, providing Advanced Care Planning choices and ensuring the patient has a plan for managing their care across the care continuum. Part of this is accomplished by connecting to patients to community resources (e.g., the San Diego Food Bank, 2-1-1 San Diego, Feeding America) that help them maintain their health and safety, including: food (directly), hunger relief organizations, transportation resources, access to a primary care physician for follow up care, medical equipment, and other social supports. In FY 2015, connections with Feeding America, San Diego and 211 San Diego were established with success.






Target Completion

Date




With support for SGH Foundation, Wal Mart, SDGE and individual donors, the program has been able to support these patients with food, blood pressure cuffs, diabetes kits, pulse oximeters and pill boxes. The program is also able to assist with co-pays for medications should the need arise.

Metrics since the inception of CTI (June, 2014): 950 patients served 457 (48%) required social support 82 required food support (since Sept., 2014) 55 received emergency food boxes

(since March, 2015) 25 received diabetes kits (since 2015) 92 assist with PCP appt

o 75% patients made appts.o 85% kept PCP appt.

74 community clinic referrals 83 Pharmacy support 351 community resource information 30 referral to 2-1-1 Readmission rates (30-day):

o Inpatient: 13.4 % averageo ED, post-discharge: 10.02%






Target Completion

Date




o IP for those referred to 2-1-1: 4.7%

For 2-1-1 partnership, also collecting metrics on social determinants of health and self-efficacy. Data forthcoming.

A goal for the program is to integrate more Behavioral Health support as these are the patients that so often cannot be coached and need a specific Care Pathway.




Identified Community Health Need: Behavioral Health


Target Completion

Date




1. Provide comprehensive behavioral health programs to adults and older adults in East County with acute or persistent psychiatric disorders. Programs will help individuals in crisis regain their optimal level of functioning and achieve a renewed sense of emotional stability and wellness.

a. Continue to provide a dedicated psychiatric assessment team in the Emergency Department (ED) and acute care.

Ongoing Director, SGH Behavioral

Health Services

Chief Medical Officer, SHC Behavioral

Health

Behavioral Health

ScreeningAccess to CareCo-occurring

disordersSenior Health

SGH is the only hospital in East County to provide this assessment to patients in the ED. Psychiatric consultations in the ED have increased approximately 117% from 2007 (294 consults) to mid-2016 (637 consults).

Although Behavioral Health is identified as a health need in the communities served by SGH, beyond clinical services, the facility does not have the resources to comprehensively address the elements of community education and support around this health need. Consequently, the community education and support elements of behavioral health care are addressed through the programs/services provided through Sharp Mesa Vista Hospital and Sharp McDonald Center, which are the major providers of behavioral health and chemical dependency services in San Diego County.

b. Continue to provide hospital-based outpatient programs that serve individuals dealing with a variety of behavioral health issues, including schizophrenia, depression and bipolar or anxiety disorders.


Health Services


Health

Behavioral Health



Current outpatient programs include: Adult Mental Health Program for adults with acute and chronic disorders such as schizophrenia and bipolar disease; Bridges Program, based on the Recovery Model for adults diagnosed with schizophrenia and bipolar disorder; Dual Recovery Program, for adults with co-existing mental illness and chemical-use/addictive behavior disorder; Older Adults (Senior) Mental Health Program, for adults age 60 and






Target Completion

Date




older experiencing anxiety, depression and other behavioral health issues often associated with challenging, age-related life transitions; Outpatient Electroconvulsive Therapy (ECT) Program.

c. Continue to offer specialized inpatient treatment programs designed to address the specific needs and conditions of patients.


Health Services


Health

Behavioral Health



Current inpatient programs include: FOCUS program for adults suffering from psychiatric illness such as psychosis, delusions, depression, grief, anxiety, panic, obsessive-compulsive disorder, and traumatic stress syndromes; Intensive treatment programs for short-term crisis intervention, rapid recovery and return home; Medical Psychiatric Program and an Older Adult Program specifically for individuals age 60 and over.

d. Explore collaboration with MHA’s Mental Health First Aid Training to provide training to front-line SGH staff for improved management

January, 2016Completed.

SGH Chief Nursing Officer

Program Manager,


Health Improvement

Behavioral Health

EducationStigma Reduction

Workforce Development

In Fall 2015, Sharp Grossmont Hospital staff attended a Sharp-hosted training with Mental Health First Aid– an internationally-renowned program that teaches front-line staff the signs and impacts of addiction and mental illness, including a 5-step action plan to assess and de-escalate situations, and local resources. This is a peer-reviewed, proven-effective program and is listed in the Substance Abuse and Mental Health Services Administration’s National Registry of Evidence-based Programs and Practices. Sharp HealthCare is the first hospital/health system to participate in this training, currently funded by the County of San Diego.






Target Completion

Date







Identified Community Health Need: Cancer


Target Completion

Date




1. Improve navigation of the health care system for cancer patients in San Diego’s east region through patient navigation services.

a. Continue to offer the cancer patient navigator program to SGH cancer patients; facilitate connection to community resources via the navigator program.

Ongoing SGH Cancer Patient

Navigator Coordinator

Access to CareCare

Management

In FY 2015, the Breast CPN facilitated access to care for more than 180 breast cancer patients in need — many with late-stage cancer diagnoses — through the provision of referrals to various community and national organizations.

Navigation Resources: In FY 2016, due to a vacancy in Sharp’s cancer navigator position, it was decided to replace the position with a navigator who was a social worker to better address patient needs. The position was filled with an LCSW in January, 2016. Later in 2016 with growing clinical needs, approval was secured to hire an RN to meet both Navigator and Radiation Oncology needs. That position will start in August, 2016. This team will cover all cancer sites, but will focus on those patients receiving radiation therapy. Metric: Navigation FTEs.

Identification and Prioritization of Needs: Distress Screening to assess practical and emotional issues contributing to cancer patient distress has been conducted at Sharp Chula Vista Medical Center over the past few years. A recent effort was initiated by Sharp Cancer Outpatient social workers to develop a consistent tool across the Sharp system that would evaluate these needs in greater detail in order to make them actionable and rate them by intensity so that they may be prioritized






Target Completion

Date




and addressed appropriately. Metrics: Routine reports including number of patients screened, information on the issues that are most challenging for patients and the percentage of patients rated in high distress will be provided to the Integrated Network Cancer Program and to individual entities. The information will drive efforts to target and provide additional support and resources to better meet our patient needs.

Navigation Communication: Currently patient navigation is not consistently documented and easily accessible to all care team members. Often patients share valuable information with Navigators that can be useful to other team members for care coordination as well as identifying concerns about treatments and side effects that can be addressed by physicians and other staff for a more personalized approach to care and presenting options that may be more acceptable for cultural or personal beliefs. A project is planned for integrating Navigator care documentation in Cerner EMR to provide improved communication among all cancer team members. Metric: Implementation of Navigator documentation in Cerner.

Timely Access to Care: Navigators have identified that timely access to specialist appointments and imaging






Target Completion

Date




studies is a consistent issue among our cancer patients with delays that feed patient anxiety and is a clinical concern for impacting maximum effectiveness of cancer treatment. This will be a focus for our cancer navigators and the cancer program in identifying performance improvement initiatives to reduce the time from diagnosis to treatment for our cancer patients. Metrics: Calculation of the time from diagnosis to treatment for key sites that will capture the predominant issues and annual evaluation of the change in number of days to treatment at least annually. Also measured will metrics specific to focused projects on key processes identified that are contributing to delays in care.

The Breast CPN is an RN certified in breast health who personally assists breast cancer patients and their families in their navigation of the health care system. The Breast CPN offers support, guidance, financial assistance referrals and connection to community resources. Through collaboration with community clinics — including FHCSD, Neighborhood Healthcare and Borrego Health — the Breast CPN refers unfunded or underfunded women for a covered diagnostic mammogram or immediate Medi-Cal insurance should their biopsy prove positive and require treatment. The Breast CPN also identifies patients who may benefit from the Breast and Cervical Cancer






Target Completion

Date




Treatment Program, a program offered through the California Department of Health Care Services to provide urgently needed cancer treatment coverage, including referring patients to local clinics who help complete the enrollment process. Patients needing psychosocial support may be referred to various local or national support groups, the Jewish Family Service of San Diego’s Breast Cancer Case Management program or the SGH Cancer Center Radiation Oncology Department’s LCSW.

Since 2014, a CPN at SGH has been designated for patients with cancers other than breast. The CPN primarily serves patients with head and neck cancers and lung cancer, but also assists those with anal and esophageal cancers as well as any cancer patient with complex care needs. The CPN supports patients and their family members through care coordination and connection to needed resources, including transportation, translation needs, financial assistance, speech therapy, nutritional support, feeding tube support, social work services and more. In addition, the CPN offers psychosocial support and education about the side effects of radiation therapy. The CPN has assisted nearly 160 patients and their families since the inception of the program.






Target Completion

Date




b. Seek funding for the cancer patient navigator program and expand navigator services to all cancers.

Ongoing SGH Patient Navigator

Access to CareCare

Management

No current updates.

2. Increase cancer education and support for community members in the east region with cancer diagnoses.

a. Continue to provide free support programs for community members with cancer diagnoses.



Cancer Education

Care Management

In FY 2015, a variety of free support groups reached approximately 1,000 community members In SDC’s east region impacted by cancer, including: bi-monthly breast cancer support group; monthly lung cancer support group; monthly brain cancer support group. In addition, beginning in the spring of 2015, the weekly Art and Chat support group offered cancer patients, survivors and their loved ones a combination of chat and relaxing drawing methods to increase focus, creativity, self-confidence and personal well-being. The SGH Cancer Center also offered the weekly chaplain-led Sacred Circle: Spirituality and Cancer support group, through which cancer patients used a mixture of expressive arts modalities, prayer, and discussion of personal and spiritual topics to restore their spirits.

Development of programs and services driven by Distress Screening (see action item “Cancer: a” above) and feedback from navigators, social workers and other staff will be ongoing.






Target Completion

Date




Expansion of Sharp partnership with the American Cancer Society to provide education and support materials and community support connections to ACS Patient Organizers. This will be in conjunction with Sharp information for patient education, services offered, information specific to care at SGH and additional connections to community and national organizations that provide assistance to cancer patients. A specific portion of Sharp’s website (sharp.com) is planned for cancer patients to provide information and tools that will be helpful to patients during the course of their cancer journey.

Metrics (forthcoming): Number of Patient Organizers delivered (?); initiation of patient information website section; number of hits on the patient website indicating use.

b. Continue to provide Look Good… Feel Better classes to community members with cancer diagnoses.



Cancer Education

Care ManagementCollaboration

In FY 2015, six Look Good…Feel Better classes taught approximately 30 women techniques to manage appearance-related side effects of cancer treatment and boost self-confidence. Offered through the ACS, the Look Good…Feel Better classes included a complimentary makeup kit for attendees and instruction from a licensed beauty professional on makeup application, skin care, and wearing wigs and headwear.






Target Completion

Date




c. Continue to provide ongoing social and psychosocial supports to community member with cancer diagnoses.

Ongoing SGH Cancer Licensed Clinical

Social Worker

Cancer Education

Care Management

In FY 2015, SGH’s Cancer LCSW offered psychosocial services (assessments, crisis intervention, counseling and stress management), support group leadership, and advocacy and resources for transportation, palliative care and hospice, food and financial assistance. In FY 2015 this included improving patient and family connections to community services such as ACS, San Diego Brain Tumor Foundation, Leukemia and Lymphoma Society, Lung Cancer Alliance, Mama’s Kitchen, 2-1-1 San Diego, Feeding America San Diego, SDFB and Jewish Family Service of San Diego’s Breast Cancer Case Management program, and other food and financial assistance programs.

The LCSW served approximately 230 patients and family members in FY 2015, and an additional 25 community members contacted the LCSW for consultation regarding support groups and other SGH Cancer Center services and community resources.

3. Increase community education on the signs and symptoms of cancer through education and screening events.

a. Continue to conduct comprehensive community cancer health seminars with screenings.

Ongoing(evaluated annually)

Manager, SGH Radiation Oncology HBO/WHC

SGH Cancer

Cancer EducationCollaboration

Screenings

In FY 2015, the SGH Cancer Center provided breast self-examinations and cancer education and resources from the ACS and National Cancer Institute (NCI) to more than 500 individuals at community events, including the Cuyamaca College Health & Wellness Fair, East County Senior Service Providers 16th annual Senior Health Fair at Santee Trolley Square, the Southern Indian Health Council,






Target Completion

Date




Patient Navigator

Coordinator

Inc. Women’s Wellness Health Fair, Sharp’s annual Women’s Health Conference, Sharp HospiceCare Resource & Education Expo and the Waterford Terrace Retirement Community Health Fair. In addition, SGH Cancer Center staff walked alongside cancer patients and families in the ACS Making Strides Against Breast Cancer Walk in October.

The SGH Cancer Center also hosted educational classes at no cost for patients and community members facing cancer. Offered monthly between June and September, the Chair Yoga and Relaxation class taught individuals in all stages of cancer yoga postures, breathing and meditation techniques to help lower stress and calm the nervous system. The SGH Cancer Center also offered a 12-month Survivorship Lunch and Learn series in FY 2015, reaching approximately 10 individuals per session. Once a month, community members, patients and families were invited to hear local experts speak about a unique cancer-related topic — such as coping with the holidays, approaching survivorship with confidence, and complementary therapies – and participate in a Q&A session.




Identified Community Health Need: Cardiovascular Disease


Target Completion

Date




a. Continue to provide free bimonthly cardiac education classes.

Ongoing (evaluated annually)

Manager, SGH 5 West, Cardiac Rehabilitation

Director, SGH Cardiac/

Vascular Services

Director, SGH Marketing and

Communication

Cardiovascular Disease

Education

A free Heart and Vascular Risk Factors Education class was offered twice a month to individuals who were hospitalized within the last six months due to select heart conditions, reaching nearly 180 individuals in FY 2015.

SGH educational programs are evaluated by participants through survey.

1. Empower community members with cardiovascular and cerebrovascular disease through education, screening and support; promote accountability and behavioral change through education on chronic disease self-management.

b. Continue to provide free congestive heart failure education classes and support groups.

Ongoing Manager, SGH 5 West, Cardiac Rehabilitation


Vascular Services


Communication


Education

In FY15, a free, monthly CHF class and support group, held at the Grossmont Healthcare District Herrick Community Health Care Library, provided approximately 45 community members with a supportive environment to discuss various topics about living well with CHF, covering topics such as exercise, nutrition, treatment plans and symptoms.







Target Completion

Date




c. Educational sessions focused on heart disease and cardiovascular health for the east region communities.


Manager, SGH 5 West, Cardiac Rehabilitation


Vascular Services


Communication


Education

Target is at least one to two community events per year – including health fairs and lectures. Past event have included: December Nights, Sharp Women’s Health Conference and Celebrando. SGH educational programs are evaluated by participants through survey.

In FY 2015, SGH’s Cardiac Training and Cardiac Rehabilitation Departments provided education and free cardiovascular screenings at various community events throughout San Diego. Events included cardiopulmonary resuscitation (CPR) demonstrations and education and resources on cardiac health, including prevention, evaluation and treatment. Locations included the Summer Healthcare Saturday Health Fair at Grossmont Center, the SGH Women’s Heart Health Expo, Celebrando Latinas Conference at the Hilton San Diego Bayfront, December Nights, the Sharp Women’s Health Conference, and the American Heart Association (AHA) Heart & Stroke Walk.

The team also collaborated with the SGH Senior Resource Center to educate 20 seniors at the Herrick Community Health Care Library about the importance of exercise and nutrition to maintain a healthy heart.






Target Completion

Date





d. Continue to provide educational resources on cardiac health at community events throughout San Diego.


Director, SGH Cardiac/Vascular Services


Education

In FY 2014, SGH’s Cardiac Training and Cardiac Rehabilitation Departments provided education and free cardiovascular screenings at various community events throughout San Diego (see item 1c above).

Preventive cardiovascular screenings (fee-based) are comprehensive, include ultrasound, lab tests, and calcium scoring as well as assessing and educating the patient on his or her risk of a heart attack or stroke. SGH has screened approximately 800 individuals to date.

From FY 2008 to FY 2012, 634 individuals received these vascular screenings and 92 were referred for follow-up care, resulting in 869 outpatient visits.

e. Continue to provide preventative cardiovascular screenings to community members in San Diego’s east region.


Director, SGH Cardiac/Vascular Services



Screenings

Preventive cardiovascular screenings (fee-based) are comprehensive, include ultrasound, lab tests, and calcium scoring as well as assessing and educating the patient on his or her risk of a heart attack or stroke.

From FY 2008 to FY 2012, 634 individuals received these vascular screenings and 92 were referred for follow-up






Target Completion

Date




Communications

care, resulting in 869 outpatient visits.

f. Continue to participate in stroke screening & education events in San Diego, including events targeting seniors & high-risk adults as well as individuals with identified risk factors.


Ortho/Neuro Service Line

Program Coordinator, Sharp Senior

Resource Center


EducationScreening

Collaboration

Educational events conducted in collaboration with the Sharp Senior Resource Center collect evaluation forms to assess the quality of education/screening events. Feedback from these evaluations is incorporated for future planning.

In addition, Sharp’s Senior Resource Centers track attendance for each educational event and screening. Metrics on community members referred for follow-up are also tracked, and often participant’s name and phone number are collected in order to facilitate follow-up. Often the community member talks to the department directly, or their provider (if a Sharp provider) is forwarded the information directly. Community members receive their results and feedback to take to their doctor on their own time.

2. Collaborate with other health care organizations in San Diego on stroke education and prevention

a. Continue participation in San Diego County Stroke Consortium


Ortho/Neuro Service Line


EducationCollaboration

Sharp team members continue to serve as part of the San Diego County Stroke Consortium and the Sharp HealthCare Stroke service line team once again participated in the “Strike Out Stroke” event at the Padres






Target Completion

Date




efforts. in June 2016, with more than 25,000 attendees.




Identified Community Health Need: Diabetes


Target Completion

Date




1. Increase education of signs and symptoms of diabetes in East County.

a. Participate in educational forums, health fairs and events in San Diego’s east region.


SHC Diabetes Leadership

Team

Diabetes Education

Collaboration

In FY 2015, the SGH Diabetes Education Program reached more than 1,770 community members through educational lectures and blood glucose screenings at hospital and off-site locations. Diabetes lectures were held at libraries, community centers, educational institutions and national conferences. Blood glucose screenings wereprovided at six community events including the Health & Wellness Fair at College Avenue Center, the Santee Cameron Family Health Fair at the Cameron Family YMCA,the Healthy Food Choices & Diabetes screening and lecture at the Dr. William C. Herrick Community Health Care Library, the Cuyamaca College Health Fair, theWaterford Terrace Health Fair and the 16th annual Senior Health Fair at the Santee Trolley Square.

Collect feedback from community members on educational courses provided, in order to improve and refine educational resources tailored to community member needs. In addition, the SHC Diabetes Leadership team meets annually to evaluate the programs over the previous year.






Target Completion

Date




b. Explore opportunities with new venues/ community groups to provide additional resources. E.g. churches, YMCA’s and schools.

9/30/2017(Currently evaluated annually)


Team

SHC Program Manager,


Health Improvement

Diabetes Education


SHC Program Manager, Community Benefits and Health Improvement meets with SHC Diabetes Leadership Team regularly to assess, grow and support additional opportunities for outreach and education.

c. Utilize findings in the FY 2016 CHNA to assess existing community resources and explore areas where additional diabetes education and resources may be needed in SDC’s east region.

9/30/2017(Ongoing, evaluated annually)



Health Improvement


Team

DiabetesFood Insecurity

EducationAccess to Care

SHC Program Manager, Community Benefits and Health Improvement meets with SHC Diabetes Leadership Team regularly to assess, grow and support additional opportunities for outreach and education.

Current discussions focus on clinic collaborations (Family Health Centers Partnership continuance) and exploring partnerships to address food insecurity as part of nutrition education, similar to Feeding America San Diego Partnership (see action item “Diabetes, d” below).

d. Provide diabetes education to food-insecure adults enrolled in Feeding America San Diego’s

12/31/16Study

concluded in


Team

Uncontrolled Diabetes

Education

New in FY15-FY16, the SHC Diabetes Education Program provided diabetes education to food insecure adults enrolled in Feeding America San Diego’s (FASD) Diabetes






Target Completion

Date




Diabetes Wellness Project – a collaboration including UCSD’s Student Run Health Clinic.

Spring 2016.SHC Program

Manager, Community Benefits and

Health Improvement


Food Insecurity

Wellness Project, a randomized, controlled trial and collaboration between UCSD’s Student-Run Free Clinic Project, the Third Avenue Charitable Organization (TACO) and Baker Elementary School in Southeast San Diego. The Diabetes Wellness Project screens adult clinic patients with Type 2 diabetes for food insecurity, and provides them with ongoing medical treatment and diabetes management through the clinic. In addition, FASD provides Diabetes Wellness Food Boxes to project participants, in conjunction with a monthly diabetes and nutrition education course. Provided by an SHC Diabetes Educator - as well as CalFresh outreach. Approximately 200 participants enrolled in the one-year Diabetes Wellness Project.

Data forthcoming, results to be published in Fall, 2016. However initial results reveal correlation of food insecurity with increased depression and decreased fruit/vegetable intake, with program participants at baseline. In addition, statistically significant positive impacts on food insecurity, depression, and HbA1c levels of uncontrolled diabetics enrolled in the program were observed.

2. Reduce incidence of Type 2 diabetes through education

a. Provide free prediabetes classes to community members in SDC’s

9/30/17 (Evaluate


DiabetesUncontrolled

New in August, 2016, the SGH Diabetes team began offering prediabetes classes to patients and community






Target Completion

Date




and resources provided to individuals in SDC’s east region with prediabetes.

east region. Annually) Team DiabetesEducation

Care Management

members in the east region who are either diagnosed with or at-risk for prediabetes. Metrics forthcoming.

Sharp Program Manager, Community Benefits and Health Improvement to work with Diabetes Education Team on expanding prediabetes classes out to community organizations and clinics.

a. Continue to coordinate and implement blood glucose screenings at community and hospital sites in SDC’s east region.

Screenings discontinued in FY 2016, (See

“Other Comments”)


Team

Uncontrolled Diabetes Screening

Access to Care

In FY 2015, the SGH Diabetes Education Program reached more than 1,770 community members through educational lectures and blood glucose screenings at hospital and off-site locations. More than 250 community members were screened during these events and, as a result, more than 30 community members were identified with elevated blood glucose levels and were provided with follow-up resources. Of these individuals, more than 50 did not have a preexisting diagnosis of diabetes.

3. Improve identification of pre-diabetes and diabetes in community members through screening.

b. Explore potential partnerships with the community clinics in order to offer diabetes classes at their clinic locations

9/30/2017(Ongoing, evaluate annually)


Team


Community

Access to CareCollaborationCommunity

Clinics

This past year, the SHC Diabetes Education Program collaborated with Family Health Centers of San Diego (FHCSD) to conduct outreach and education to vulnerable community members in SDC’s east region, specifically the FHCSD site in Lemon Grove. Sharp Diabetes educators supported the expansion of FHCSD’s Diabetes Management Care Coordination Project (DMCCP), which






Target Completion

Date




Benefits and Health

Improvement

provides FHCSD patients with group diabetes education and encourages peer support and education from project “graduates” to current patients/project enrollees. In 2016:

4 sessions held in Lemon Grove 61 attendees

Overall through the partnership, Sharp Diabetes Educators have provided 12 lectures from Jan through June 2016, including classes in English and Spanish. Classes have served 92 attendees at the Lemon Grove, North Park, Chula Vista and Logan Heights FHCSD sites. Classes briefly paused in June, 2016 and will resume in August, 2016.

The project monitors enrollees’ A1C levels, and has proven successful outcomes in lowering and maintaining these levels through education and peer support. The SHC Diabetes Education Program supports the project through the provision of diabetes lectures at multiple FHCSD sites. In SDC’s east region, the SHC Diabetes Education Program provided a diabetes lecture to nearly 15 attendees at the FHCSD Lemon Grove site. Topics included nutrition, physical activity, diabetes mellitus, self-management and goal setting. Outcomes data forthcoming.






Target Completion

Date




In Summer, 2016 Sharp Program Manager, Community Benefits and Health Improvement to work with Diabetes Education Team to support FHCSD partnership. In addition, the SHC Diabetes Leadership team meets annually to evaluate the programs over the previous year.

4. Improve access to diabetes educational resources for underserved populations in SDC’s east region.

a. Create language-appropriate and culturally sensitive diabetes educational materials.

9/30/2017Ongoing (evaluate annually)


Team

Diabetes Education

Care ManagementCollaboration

Materials have been updated for both Type 1 and 2 Diabetes, as well as Gestational Diabetes Mellitus post- discharge. Materials are designed to assist mothers after delivery as well as to advise on how to manage blood sugars while breast feeding.

Materials have also been completed for the Chaldean and Vietnamese populations in San Diego. Materials for Vietnamese populations include gestational diabetes, as well as a culturally-appropriate 7-day meal plan.

Also exploring new opportunities for more effective methods and resources for properly translated educational materials (e.g. multi-lingual interns, etc.).




Identified Community Health Need: Obesity


Target Completion

Date




1. Provide free biometric screenings for community members that address risk factors for obesity.

a. In 2013, Sharp HealthCare began a community-wide effort to increase the early identification of health issues in the San Diego community through the provision of free health screenings for: cholesterol, blood sugar, body mass index (BMI), blood pressure and tobacco use. Locations in San Diego’s east region included: El Cajon Jamboree, East County YMCA, Grossmont College Health Fair, East county Chamber Health Fair, Hatfield Park (Spring Valley), Santee Library, and the Westfield Parkway Shopping Center (El Cajon).

This program ended in

2016.

Sharp HealthCare Chief Experience

Officer

ObesityScreeningEducation

Collaboration

In FY 2015, Sharp HealthCare hosted 75 community health screening events throughout SDC, including the east region, screening more than 5,200 San Diegans and providing more than 110,000 hours in support of the effort.

From the inception of the screenings Sharp HealthCare participated in nearly 200 community health screenings events across San Diego – ultimately screening more than 14,000 San Diegans.

The screening program concluded in early 2016.

Screenings provided personalized health information at no charge to community members over the age of 18. Participants were not asked to provide personal information, nor were they required to show proof of insurance or have any relationship with Sharp to be eligible for the screening. To encourage participation, identifying and follow-up information was not collected. Appointments were not required, and community members retained the only copy of their results. Community members also received personalized strategies to improve their overall health and well-being.

Though Sharp’s hospitals, including Sharp Grossmont






Target Completion

Date




provide various nutrition education opportunities for the community, i general, resource limitations restrict growth beyond current programs and services that specifically address obesity at this time.

b. Coordinate and provide various health screenings, including BMI and blood pressure screenings at community events.

Ongoing Manager, SGH Community

Relations

ScreeningsCollaboration

In FY 2015 SGH participated in a variety of community events and provided education and health screenings for diabetes, stroke and heart health. Education and screenings include nutrition, and exercise education, as well as emphasis on maintaining a healthy weight and lifestyle. SGH also provides educational resources on risk factors for obesity and resulting chronic diseases.

Education and programs provided by SGH are evaluated by participants through survey.

Community screening participants receive their screening results, however additional follow-up, feedback and tracking is not conducted at this time.






Target Completion

Date




2. Provide care management in support of weight loss and healthy life style choices for San Diego community members.

a. NA NA NA ObesityCardiovascularHypertension

DiabetesChronic Disease

Care Management

In general, resource limitations restrict growth beyond current programs and services provided at Sharp Grossmont Hospital that specifically address obesity at this time.

However, free, Healthier Living Workshops are provided to community members through Sharp HealthCare’s medical group, Sharp Rees-Stealy, including sites in SDC’s east region. The six-week class teaches how to manage the challenges of living with a chronic disease, including diabetes, high blood pressure, asthma, arthritis and other conditions. Topics include: appropriate exercise for maintaining and improving strength, flexibility and endurance; appropriate use of medications; communicating effectively with family, friends and health professionals; nutrition to improve well-being; techniques to deal with frustration, fatigue, pain and isolation often associated with chronic disease. Family members or friends of someone with an ongoing health condition, as well as community members interested in becoming more physically and socially active, are welcome to attend.




Identified Community Health Need: Senior Health


Target Completion

Date




1. Increase access for seniors and other high-risk populations to flu vaccines.

a. Continue to provide seasonal flu vaccinations at community sites for seniors with limited mobility and access to transportation, as well as for high-risk adults, including low-income, minority, chronically ill and refugee populations.


Program Coordinator, SGH Senior

Resource Center

Senior HealthAccess to CareTransportation

In FY 2016, the SGH Senior Resource Center (SRC) provided 588 flu shots to seniors and high risk adults at 11 different sites including senior centers and three food banks. Because of increased availability of flu vaccine at grocery stores and pharmacies, numbers served by the SRC have decreased. However, the SRC is investing additional effort to reach the uninsured.

For FY17: provide flu vaccinations to at least ten community sites. Provide flu clinics to at least three food bank sites. Track and evaluate trends in flu clinic attendance.

b. Continue to coordinate the notification of seniors regarding the availability of seasonal flu vaccines and the provision of flu vaccines to high-risk individuals in selected community settings. Publicize flu clinics through media and community partners.



Resource Center

Senior HealthAccess to Care

Seniors were alerted through activity reminders, collaborative outreach conducted by the flu clinic site, Sharp.com and both paper and electronic newspaper notices.

The flu clinic sites assisted in distributing flu clinic information and encouraged their clients to get vaccinated.






Target Completion

Date




c. Continue to direct seniors and other chronically ill adults to available seasonal flu clinics, including physicians’ offices, pharmacies and public health centers.



Resource Center

Senior HealthAccess to Care

Provided reminders to seniors who attend the SRC programs that flu vaccination is important for themselves and their families.

2. Support the safety net for seniors living alone in East County.

a. Maintain daily contact through phone calls with East County individuals (often elderly and home-bound) in rural and suburban settings who are at risk for injury or illness, and continue supporting telephone reassurance call services for East County residents.



Resource Center

Senior HealthCare

ManagementAccess to Care

For FY 2016, through July 2016, 4,246 calls were made through the daily telephone reassurance call program with 42 alerts. In FY2016, 2 seniors were found on the floor and paramedics transferred them to area hospitals. One had fallen and the other fainted after not managing her diabetes well.

Telephone reassurance call data are tracked internally by the Program Coordinator for the Sharp Senior Resource Center.

3. Continue to host a variety of senior health education and screening programs, in

a. Provide information on various senior issues such as senior mental health, memory loss,



Senior HealthEducationScreenings

In FY 2016 through July 2016, the SGH Senior Resource Center provided 45 free health education programs to nearly 988 community members. Nine screening events






Target Completion

Date




order to raise awareness, identify risk factors, and connect seniors to helpful resources.

hospice, senior services, nutrition, healthy aging and balance and fall prevention.

Resource Center Collaboration were provided in FY 2016 through July 2016 to 153 seniors and as a result 14 attendees were referred to physicians for follow-up on their screening results.

Each education program provided by or in collaboration with the Senior Resource Center is evaluated by participants. Evaluations include point scores and average evaluation scores, as well as open-ended questions such as: what was the most important thing participants learned, what other programs seniors (participants) would like. This feedback is provided to speakers so that they may refine future educational offerings.

In addition, Sharp’s Senior Resource Centers track attendance and for each educational event, flu vaccination event and screening held throughout the year. Metrics on community members referred for follow-up are also tracked, and often participants’ names and phone numbers are collected in order to facilitate follow-up. Often the community member talks to the department directly, or their provider (if a Sharp provider) is forwarded the information directly. In addition, community members receive their results and feedback to take to their doctor on their own time.






Target Completion

Date




b. Continue to participate in community health fairs for seniors



Resource Center

Senior HealthEducation

Collaboration

In FY 2016 through July 2016, the SGH Senior Resource Center participated in health fairs in El Cajon, Rancho San Diego, Lakeside, Santee, La Mesa, Lemon Grove, the College Area and San Diego. Populations served at these fairs included seniors and caregivers; Parkinson’s patients and caregivers, Dementia patients and caregivers, veterans and those caring for veterans, and Lesbian, Gay, Bisexual and Transgender (LGBT) seniors. In addition, the SGH Senior Resource Center event provided blood pressure screenings as well as educational resources on senior and caregiver services. Through participation in these events, the SGH Senior Resource Center provided education and resources to more than 1,813 community members through July 2016.

c. Coordinate two conferences – one dedicated to family caregiver issues in collaboration with the Caregiver Coalition of San Diego and one focused on chronic care and advanced illness management in collaboration with Sharp HospiceCare.



Resource Center


Collaboration

In collaboration with the Caregiver Coalition of San Diego, the SGH Senior Resource Center provided two conferences to more than 100 family caregivers: one focused on caring for veterans; and the other focused on caring for dementia. Conferences provided education on emotional issues, resources available in the community and legal issues.

The SGH Senior Resource Center also partnered with Sharp HospiceCare and provided a conference to seniors and their families titled Life’s Transitions: Changing Health






Target Completion

Date




Care Needs through the Years. Held at the La Mesa Community Center the conference reached more than 80 community members and provided education on: Miscommunications in Health Care, Quality of Life Conversations, Legacy Planning and Coping with Life’s Challenges.

4. Engage and partner with local community organizations that address senior health issues in order to foster future opportunities for collaboration in provision of education, screening, and other resources to seniors and high-risk populations.

a. Maintain active relationships with community organizations serving seniors throughout San Diego. Organizations include: East County Senior Service Providers, Meals on Wheels, Caregiver Coalition, and the Caregiver Education Committee.



Resource Center

Senior HealthCollaboration

As the Senior Resource Center increases the number of community partners it collaborates with, it is expected that additional opportunities will arise.

In FY2016, the SGH Senior Resource Center attended meetings for East County Senior Service Providers, Aging Disability Resource Connection (ADRC) Advisory Board, Project CARE, Meals on Wheels Greater San Diego East County Advisory Board, Caregiver Coalition, and the Caregiver Education Committee throughout the year.

5. Provide coordinated care to patients with advancing progressive chronic disease, in order to improve the individual experience as they near end-of-life.

a. Continue collaboration with Sharp HospiceCare to offer Sharp patients the Transitions program: a "pre-hospice" program designed to provide home-based palliative care and management for patients with advanced



HospiceCare;

Utilization Review, Sharp HospiceCare

Senior HealthCare

Management

Patient and Family Satisfaction Surveys provided to all Transition participants at the end of the program’s “Active Phase” (six weeks).

Performance Target: 200 admissions across the system each year. In FY 2015, 300 admissions across the system; YTD FY 2016, 178 admissions.






Target Completion

Date




progressive chronic illness. The program is adapted to match each patient’s unique physical, emotional and spiritual needs.

6. Increase the availability of education, resources and support to community members with life-limiting illness and their loved ones.

a. Provide 13 mailings of bereavement support newsletters

9/30/2017Ongoing

(evaluated annually)

Bereavement Dept., Sharp HospiceCare;


Track number of mailings annually through internal Access/Excel database. In FY 2015, approximately 1,300 community members received bereavement support newsletters.

b. Support the unique advanced illness management and end-of-life care needs of military veterans and their families through participation in veteran-oriented community events and services, and

9/30/17Ongoing


Bereavement Dept., Sharp HospiceCare;

Senior HealthVeteransEducation

In June, participated in the Operation Engage America Resource Fair, hosted by Operation Engage America, at Liberty Station, providing resources to nearly 200 veterans, families, caregivers and other community members.

Provided end-of-life care resources to ~ 100 attendees at the SCRC’s Operation Family Caregiver conference at Camp Pendleton in October.

In August and October, provided education and resources at the Veterans, Military and Families Expos at the War Memorial Building at Balboa Park, to ~ 240 community members.

In November, provided education on ACP and






Target Completion

Date




integrative therapies to ~ 50 veterans /families members at the VA San Diego Healthcare System’s health fair

Since 2010, member of the San Diego County Hospice Veterans Partnership - a coalition of VA facilities and community hospices working together to ensure excellent end-of-life care for veterans and their families.

Participation on the advisory board for the SCRC’s Operation Family Caregiver.

Currently a Level 1 Partner (4 levels available) in We Honor Veterans (WHV), a national program developed by the NHPCO in collaboration with the U.S. Department of Veterans Affairs (VA) to empower hospice professionals to meet the unique end-of-life needs of veterans and their families. As WHV partners, hospice organizations can achieve up to four levels of commitment in serving veterans. Level 1 partners are equipped to provide veteran-centric education to its staff and volunteers, including training them to identify patients with military experience.






Target Completion

Date




c. Continue to provide community education and resource services throughout San Diego

9/30/2017Ongoing


Business Development,

Sharp HospiceCare


Collaboration

Track number of community education events through internal database.

In FY 2015, Sharp HospiceCare collaborated with community organizations to provide more than 2,400 community members with end-of-life education and outreach at a variety of churches, senior living centers, and community health agencies and organizations throughout SDC, as well as through participation in community health fairs and events.

d. Continue to offer individual and family bereavement counseling and support groups

9/30/2017Ongoing


Bereavement Dept., Sharp HospiceCare

Senior HealthCare

Management

Track number of individual and group counseling sessions through internal database.

In FY 2015, the Healing After Loss and the Widow’s and Widower’s ongoing bereavement support groups served approximately 200 community members.

e. Provide Advance Care Planning (ACP) for community groups as well as individual consultations

9/30/2017Ongoing


Advance Care Planning Dept.,

Sharp HospiceCare


Care Management

Track number of sessions and individual consultations through Allscripts Business Unit, Excel spreadsheet and participant evaluations. Quarterly community presentations offered throughout San Diego County.

In FY 2015, the program engaged approximately 2,500 community members in free ACP and POLST (Physician Orders for Life-Sustaining Treatment) education at a






Target Completion

Date




variety of community sites, including health fairs, senior centers, homecare agencies, churches and seminars.

f. Continue to conduct outreach activities and provide professional education on hospice-related topics to community agencies, health care facilities, colleges and universities on hospice and palliative care.


Medical Director, Sharp

HospiceCare


Sharp HospiceCare


Resource Center


Collaboration

Presentations provided to the health care community are evaluated through survey and tracked through an internal Excel database. Survey and data tracking serve to evaluate effectiveness and to document activities for Sharp’s annual Community Benefit Plan and Report. In FY 2015, Sharp HospiceCare provided:

Introductory education on hospice, bioethics and ACP to 36 advanced psychology students at Valhalla High School

Lectures on hospice, bioethics, ACP and advance directives to ~ 180 nursing students from Azusa Pacific University

Lectures on spiritual care in hospice to ~ 50 students in the Certified Hospice and Palliative Nursing Assistant training program through the HPNA.

Education to ~ 500 local, state and national health professionals on ACP and POLST, including, but not limited to case managers from the San Diego Care Transitions Partnership, Senior Care Action Network (SCAN) Health Plan, the Center to






Target Completion

Date




Advance Palliative Care (CAPC) National Conference, Caregiver Coalition of San Diego, etc.

A POLST Train-the-Trainer workshop to community health care providers

Educational outreach to local and national organizations (e.g., Good Samaritan Medical Center, Saddleback Memorial Medical Center, Highmark Health, Baylor Scott and White Health, Family Medicine Education Consortium, American Hospital Association (AHA) Leadership Summit, West Health Institute, etc.). Topics ranged from successful aging to ACP.

Sixth annual Resource and Education Expo titled Advanced Illness Management: Preserving Quality of Life for ~200 community health professionals.






Target Completion

Date




7. Provide education and outreach to the San Diego health care community concerning hospice and palliative services within the care continuum, in order to raise awareness of the choices available towards the end of life and empower community members so that they and their family members may take an active role in their treatment.

a. Provide Advance Care Planning (ACP) Training to physicians, case managers and other health care professionals


Advance Care Planning

Coordinator


In FY 2015, HospiceCare educated more than 500 local, state and national health professionals on ACP and POLST, including, but not limited to case managers from the San Diego Care Transitions Partnership, Grossmont Post Acute Care, Continuum Healthcare, Senior Care Action Network (SCAN) Health Plan, the Center to Advance Palliative Care (CAPC) National Conference, SDRHCC, Caregiver Coalition of San Diego, SDCCEOLC, San Diego Dementia Consortium, the Sharp HospiceCare Resource & Education Expo, Greater San Diego Business Association and the County of San Diego Ombudsmen Program. In collaboration with the Coalition for Compassionate Care of California (CCCC), the Sharp ACP team also offered a POLST Train-the-Trainer workshop to train community health care providers on POLST.

b. Continue active involvement with and participation on state and national hospice organizations (California hospice and Palliative Care Association (CHAPCA) the NHPCO Leadership etc.) included presentations on understanding late-stage illness, changing our culture of Care to one of partnership and a continuum of



HospiceCare

Medical Director,

Sharp HospiceCare


Collaboration

Sharp HospiceCare provides approximately six presentations provided each year in collaboration with state and national organizations.

Sharp HospiceCare leadership continues to serve as part of the CHCF Palliative Care Action Community, as well as the board, and as a state hospice representative, for NHPCO and CHAPCA.

Community presentations provided through Sharp






Target Completion

Date




Care perspective, advanced Care planning, etc.

HospiceCare– including those to professional organizations – are evaluated through survey to evaluate effectiveness and revise program content.

8. Collaborate with community, state and national organizations to develop and implement appropriate services for the needs of the aging population.

a. Explore partnership with community organizations designed specifically to meet the needs of caregivers.

9/30/17Ongoing


Business Development Dept., Sharp HospiceCare

Senior HealthCollaboration

New community partnership: Lantern Crest in Santee; Elmcroft of San Diego (throughout the County as well as additional home care facilities.

b. Continue to collaborate with a variety of local networking groups and community-oriented agencies to provide caregiver classes, end-of-life programs, Advance Care Planning seminars and web presentations for consumers and health care professionals



Sharp HospiceCare


Collaboration

Sharp Grossmont Hospital 2016 CHNA Executive Summary Page 1

Sharp Grossmont Hospital 2016 CHNA Executive Summary

Overview and Background Sharp HealthCare (Sharp) has been a long-time partner in the process of identifying and responding to the health needs of the San Diego community. This partnership includes a broad range of hospitals, health care organizations, and community agencies that have worked together to conduct triennial community health needs assessments (CHNAs) over the past 20 years. Previous collaborations among not-for-profit hospitals and other community partners have resulted in numerous well-regarded CHNA reports. Sharp hospitals, including Sharp Grossmont Hospital (SGH), base their community benefit and community health programs on both the findings of these CHNAs and the combination of expertise in programs and services offered and the knowledge of the populations and communities served by each Sharp hospital. The Sharp Grossmont Hospital 2016 Community Health Needs Assessment (CHNA) examines the health needs of the community members it serves in the east region of San Diego County (SDC). SGH’S 2016 CHNA process and findings are based on the collaborative Hospital Association of San Diego and Imperial Counties (HASD&IC) 2016 Community Health Needs Assessment process and findings for SDC. This collaborative process was conducted under the auspices of HASD&IC, and in contract with the Institute for Public Health (IPH) at San Diego State University (SDSU). The HASD&IC Board of Directors convened a CHNA Committee to plan and implement the collaborative 2016 CHNA process. The CHNA Committee is comprised of representatives from all seven participating hospitals and health care systems: Kaiser Foundation Hospital – San Diego Palomar Health Rady Children's Hospital – San Diego Scripps Health (Chair) Sharp HealthCare (Vice Chair) Tri-City Medical Center University of California San Diego Health SGH prepared this CHNA for Fiscal Year 2016 (FY 2016) in accordance with the requirements of Section 501(r)(3) within Section 9007 of the Patient Protection and Affordable Care Act (“Affordable Care Act”), and IRS Form 990, Schedule H for not-for-profit hospitals.1 Under the Affordable Care Act enacted in March, 2010, IRS Code Section 501(r)(3) requires not-for-profit hospitals to conduct a triennial assessment of prioritized health 1 See Section 9007(a) of the Patient Protection and Affordable Care Act (“Affordable Care Act”), Pub. L. No. 111-148, 124 Stat.119, enacted March 23, 2010. Notice 2011-52.


needs for the communities served by its hospital facilities, as well as adopt an implementation plan – a written strategy to address the health needs identified as a result of the CHNA. The CHNA is considered adopted once it has been made widely available to the public. In addition, the CHNA and the implementation plan must be approved by an authorized governing body of the hospital facility. CHNA Objectives In recognition of the challenges that health providers, community organizations and residents face in their efforts to prevent, diagnose and manage chronic conditions, the HASD&IC 2016 CHNA process focused on gaining deeper insight into the top health needs identified for SDC through the 2013 CHNA process. Figure 1 below presents the 2013 CHNA methodology and findings.

Figure 1: 2013 CHNA Methodology

In 2013, Sharp HealthCare based its individual hospital CHNAs on this collaborative model, and through further outreach and analyses, identified additional health needs for its hospitals. For SGH, the additional identified need was senior health. Following the collaborative, HASD&IC 2016 CHNA model, SGH’s 2016 CHNA processes dove deeper into the priority health needs identified in 2013 (behavioral health, cardiovascular disease, diabetes, obesity and senior health). In addition, SGH included cancer in its CHNA analyses in 2016, given the significance of various forms of cancer identified in 2013 (see Figure 1 above) as well as input from Sharp providers and patients. Specific objectives of the 2016 CHNA process included:

Gather in-depth feedback to aid in the understanding of the most significant health needs impacting community members in SDC, particularly Sharp patients.

Connect the identified health needs with associated social determinants of health to further understand the challenges that community members and




2013 Top Health Needs:

Behavioral HealthCardiovascular

Diabetes (Type 2)Obesity

Quantitative Data Analysis

Key Informant Interviews

Community Forums

Health Expert & Community Leader Survey


Sharp patients – particularly those in communities of high need – face in their attempts to access health care and maintain health and well-being.

Identify currently available community resources that support identified health conditions and health challenges.

Provide a foundation of information to begin discussions of opportunities for programs, services and collaborations that could further address the identified health needs and challenges for the community.

Study Area Defined For the purposes of the collaborative, HASD&IC 2016 CHNA, the study area is the entire County of San Diego due to a broad representation of hospitals in the area. More than three million people live in socially and ethnically diverse SDC. Information on key demographics, socioeconomic factors, access to care, health behaviors, and the physical environment can be found in the full HASD&IC 2016 CHNA report at: http://hasdic.org. For the SGH 2016 CHNA, the community served includes the entire east region of SDC, including the sub-regional areas of Jamul, Spring Valley, Lemon Grove, La Mesa, El Cajon, Santee, Lakeside, Harbison Canyon, Crest, Alpine, Laguna-Pine Valley and Mountain Empire. Approximately five percent of the population lives in remote or rural areas of this region. Table 1 below lists ZIP codes where the majority of SGH patients reside. Figure 2 presents key demographics for SDC’s east region served by SGH. Table 1: Primary Communities Served by SGH

ZIP Code Community

91941 La Mesa

91942 La Mesa

91945 Lemon Grove

91977 Spring Valley

92019 El Cajon

92020 El Cajon

92021 El Cajon

92040 Lakeside

92071 Santee Source: IDX (internal) database, Sharp HealthCare. FY 2015.


Figure 2: Selected Community Health Statistics, SDC’s East Region2

*Federal Poverty Level (FPL) is a measure of income issued every year by the Department of Health and Human Services. In 2016, the FPL for a family of four was $24,300.

Recognizing that health needs differ across the region and that socioeconomic factors impact health outcomes, both HASD&IC’s and SGH’s 2016 CHNA processes utilized the Dignity Health Community Need Index (CNI) to identify communities with the highest level of health disparities and needs. Table 2 below presents primary communities (by ZIP code) served by SGH that have especially high need based on their CNI score (> 4.2). Table 2: High-Need Primary Communities Served by SGH, CNI Score > 4.2

ZIP Code Community

92020,92021 El Cajon

91945 Lemon Grove

91977 Spring Valley Source: Dignity Health Community Need Index. 2013.

Data Collection and Analysis The HASD&IC 2016 CHNA process and findings significantly informed the SGH 2016 CHNA process and as such are described as applicable throughout this report. For complete details on the HASD&IC 2016 CHNA process, please visit the HASD&IC website at: www.hasdic.org or contact Lindsey Wade at [email protected]. For the collaborative HASD&IC 2016 CHNA process, the IPH employed a rigorous methodology using both community input and quantitative analysis to provide a deeper understanding of barriers to health improvement in SDC. Figure 3 below provides an overview of the process used to identify and prioritize the health needs for the HASD&IC 2016 CHNA.

2

More than 15% of East County residents live in households with income below 100% of the Federal

Poverty Level.*

An estimated 11% of East County residents are

unemployed (compared to 9.5% of SDC overall).

Approximately 1 in 7 San Diegans are food insecure.

8% of East County households are on Food

Stamps, but 20% ‐ 35% are eligible for Food Stamps.

Almost 14% of East County residents ages 25 and older have no high school diploma

or equivalency.

Approximately 50% of households in East County have housing costs that

exceed 30% of their income.

Approximately 10 % of East County residents primarily speak a lanugage other than

English at home.


Figure 3: HASD&IC 2016 Community Health Needs Assessment Process Map


The 2016 CHNA process began with a comprehensive scan of recent community health statistics in order to validate the regional significance of the top four health needs originally identified in the HASD&IC 2013 CHNA. Quantitative data for both the HASD&IC 2016 CHNA and SGH 2016 CHNA included 2013 Office of Statewide Health Planning and Development (OSHPD) demographic data for hospital inpatient, emergency department, and ambulatory care encounters to understand the hospital patient population. Clinic data was also gathered from OSHPD’s website and incorporated in order to provide a more holistic view of health care utilization in SDC. Additional variables analyzed in the 2016 CHNA processes are included in Table 3 below and were analyzed at the ZIP code level wherever possible. Table 3: Variables Analyzed in the HASD&IC and SGH 2016 CHNA


Hospital Utilization: Inpatient discharges, ED and ambulatory care encounters (both countywide and for SGH specifically)

Community Clinic Visits Demographic Data (socio‐economic indicators)




Based on the results of the community health statistics scan and feedback from community partners received during the 2016 CHNA planning process, a number of community engagement activities were conducted across SDC, as well as specific to SGH, in order to provide a more comprehensive understanding of the identified health needs, including their associated social determinants of health and potential system and policy changes that may positively impact them. In addition, a detailed analysis of how the top health needs impact the health of San Diego residents was conducted. Figure 4 below outlines the number and type of community engagement activities conducted as part of the collaborative, HASD&IC 2016 CHNA, including: key informant interviews, facilitated discussions with care coordinators (community partnership discussions), and community resident input through a Health Access and Navigation (“Roadmap”) Survey.

Figure 4: HASD&IC 2016 CHNA Community Engagement Activities


For the SGH 2016 CHNA, Sharp contracted with IPH to collect additional community input through three primary methods: facilitated discussions, key informant interviews, and the Health Access and Navigation Survey (or, “Roadmap”) with patients and community members. This input focused on cardiovascular health, cancer, diabetes, senior health and the needs of highly vulnerable patients and community members. Figure 5 below outlines the engagement activities specific to SGH’s 2016 CHNA. More than 40 Sharp providers and more than 100 patients / community members were reached through these efforts.

Figure 5: SGH 2016 CHNA Community Engagement Activities

Findings The collaborative, HASD&IC 2016 CHNA prioritized the top health needs for SDC through application of the following five criteria: 1. Magnitude or Prevalence 2. Severity 3. Health Disparities 4. Trends 5. Community Concern Using these criteria, a summary matrix translating the 2016 CHNA findings was created for review by the CHNA Committee. As a result, the CHNA Committee identified behavioral health as the number one health need in SDC. In addition, cardiovascular disease, diabetes, and obesity were identified as having equal importance due to their interrelatedness. Health needs were further broken down into priority areas due to the overwhelming agreement among all data sources and in recognition of the complexities within each health need. Figure 6 below illustrates the prioritization of the top health needs for SDC.


Figure 6: HASD&IC 2016 CHNA Top Health Needs

These findings were well-aligned with findings from both the quantitative analysis and community engagement activities conducted by SGH. As the HASD&IC 2016 CHNA process included robust representation from the communities served by SGH, the findings of the prioritization process apply to the same four priority health needs identified for SGH (behavioral health, cardiovascular, diabetes, obesity). Findings from SGH’s 2016 CHNA continued to prioritize senior health among the top health needs for the community members it serves, and, in recognition of the significance of various forms of cancer prioritized in the 2013 CHNA process (See Figure 1), as well as discussion with Sharp team members and the priorities they observe in their patient population, SGH also identified cancer as a priority health need to address in its community. Further, the IPH conducted a content analysis of the input collected by the community engagement activities of the HASD&IC 2016 CHNA process, and found that social determinants of health were a key theme. Ten social determinants were consistently referenced across the different community engagement activities. The importance of these social determinants was also confirmed by quantitative data. Hospital programs and community collaborations have the potential to impact these social determinants, which Figure 7 lists below in order of priority.


Feedback collected from SGH’s community engagement activities also highlighted the inextricable connection of these social determinants to the health of SGH’s patients and community members.

Figure 7: Social Determinants of Health, HASD&IC 2016 CHNA


Implementation Plan SGH developed its FY17-FY20 implementation plan to address the needs identified through the 2016 CHNA process for the community it serves. Many of the programs included in the implementation plan have been in place at SGH for several years. In addition, SGH leadership, Sharp Community Benefit and team members across Sharp are committed to an ongoing evaluation of the programs provided to address the needs of SGH’s community members. The FY17-FY20 SGH implementation plan is submitted along with the IRS Form 990, Schedule H, and will be publicly available on Guidestar (http://www.guidestar.org/) in the coming months. Categories of programs and activities included in the Sharp Grossmont Hospital FY17-FY20 implementation plan are summarized below:

Identified Community Need: Access to Care o Patient Financial Services – PointCare assistance, Public Resource

Specialist, CalFresh Enrollment o Care Transitions Intervention Program

Identified Community Need: Behavioral Health

o Clinical programs for adults, adolescents and older adults through Sharp Grossmont Behavioral Health

o Psychiatric Evaluation Team (PET) evaluations in the SGH Emergency Department

Identified Community Need: Cancer o Community education and screening programs o Analyze and refine patient navigation services o Collaboration with community organizations

Identified Community Need: Cardiovascular Disease o Community education and screening programs o Community organization collaboration o Care Transitions Intervention Program

Identified Community Need: Diabetes o Community education programs; food-insecure, vulnerable populations o Collaboration with community clinics o Care Transitions Intervention Program

Identified Community Need: Obesity

o Community education programs

Identified Community Need: Senior Health o Community education, screenings and support for seniors and caregivers; o Support for older adults living alone in East County through telephone

reassurance calls o Collaboration with community organizations


Conclusion / Next Steps SGH is committed to the health and well-being of its community, and the findings of SGH’s 2016 CHNA will help inform the activities and services provided by SGH to improve the health of its community members. These programs are detailed in SGH’s FY17-FY 20 implementation plan, which will be made available online to the community at: http://www.sharp.com/about/community/health-needs-assessments.cfm. The 2016 CHNA process generated a list of currently existing resources in SDC that address the health needs identified through the CHNA process. While not an exhaustive list of San Diego’s available resources, this information serves as a resource for SGH to help continue, refine and create programs that meet the needs of its community. Sharp will continue to work with HASD&IC and IPH as part of the CHNA Committee to develop and implement Phase 2 of the 2016 CHNA. Phase 2 will focus on continued engagement of community partners to analyze and improve the CHNA process, as well as the hospital programs provided to address the 2016 CHNA findings. In this way, our CHNA work will continue to evolve to meet the needs of our ever-changing community. In addition, Phase 2 of the CHNA will focus on the development of a multi-hospital and health system collaborative effort to address priority health needs, including a policy agenda to focus and strengthen the role of hospitals as advocates for community health. The health needs and social determinants of health identified in this CHNA will not be resolved with a “quick fix.” Rather, these resolutions require time, persistence, collaboration and innovation. It is a journey that SGH and the entire Sharp system are committed to, and Sharp remains steadfastly dedicated to the care and improvement of health and well-being for all San Diegans. The complete Sharp Grossmont Hospital 2016 Community Health Needs Assessment is available online at: http://www.sharp.com/about/community/health-needs-assessments.cfm or by contacting Sharp HealthCare Community Benefit at: [email protected].

Grossmont Healthcare District Joint Meeting: GHD and GHC Boards

August 16, 2016

Mission Statement As stewards of the public trust, your Grossmont Healthcare District will preserve and protect those resources entrusted to its care.

To maintain and improve the physical and behavioral health of its constituents, we will:

Monitor the health care services provided at Grossmont Hospital.

Anticipate and recognize the unmet health care needs of the communities we serve and support suitable services to the greatest extent possible consistent with available resources.

2

Health and Safety Code 32121.9

“A district that leases or transfers its assets to a corporation…shall act as an advocate for the community to the operating corporation…and report to the community on the progress made in meeting the community’s health needs.”

GHD Designees to the GHC Board Monthly/Annual Reports from GHC to the Board Annual Sharp Grossmont Community Benefits Report Independent Citizens’ Bond Oversight Committee Annual

Report to the Community Quarterly Facilities Inspections / State of the Facilities

3

District Tax Rate for Proposition G Bond Debt Service Fiscal Year 2007-2016

DRAFT

4

0

0.005

0.01

0.015

0.02

0.025

2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16

0.01315 0.01315 0.01315 0.01315 0.01315

0.02005 0.02005 0.02005 0.02005

0.02352

DRAFT

5

Largest Local Secured Property Taxpayers FY 2016-17

Source: California Municipal Statistics, Inc.

DRAFT

Assessed Valuations Fiscal Years 1998-2017

Compound Annual % Change

$19,149,478,411

$20,008,904,479

$21,480,147,755

$22,917,936,980

$24,502,781,755

$26,201,050,983

$28,353,352,149

$30,996,502,673

$34,725,373,707

$38,663,069,842

$41,726,773,703

$42,819,398,197

$40,685,373,313

$40,094,695,319

$40,267,277,314

$40,333,211,458

$41,470,184,605

$43,461,644,479

$45,801,719,181

$-

$10,000,000,000

$20,000,000,000

$30,000,000,000

$40,000,000,000

$50,000,000,000

$60,000,000,000

4.5% 7.4%

6.7% 6.9%

6.9% 8.2%

9.3%

12.0%

11.3%

7.9% 2.6% -5.0% -1.5% 0.4% 0.2% 2.8%

4.8% 5.4%

5.1%

4.5% 5.9%

6.2% 6.4%

6.5% 6.8%

7.1%

7.7%

8.1%

8.1% 7.6% 6.5% 5.8% 5.5% 5.1% 4.9%

4.9% 5.0%

5.0%

$48,115,213,301

6

Prop G Highlights: 2015-16 Oct 2015 – Another “clean” audit on all Prop G & Co-Gen funds Nov 2015 – East Tower Fifth Floor Complete and Occupied Feb 2016 – Beneficial Occupancy of New Lab and Pharmacy April 2016 – Beneficial Occupancy of Central Energy Plant April 2016 – Co-Gen successfully supplying power to the campus:

Hospital is “off the grid” May 2016: Beneficial Occupancy of H&V Level B (Main Dock) May 2016 – Approval of Completion Agreement for Prop G Projects

and Related Master Budget Realignment CEP and H&V – Both 98% complete Settlements with contractors on three major projects FY 2015-16: $29.2 million in Building Fund expenditures ($41.5 million

in FY 14-15 and $44.6 million in FY 13-14) Bids due in September, H&V Surgery Floor Build-Out

7

8

New 13,000 S.F. Clinical Testing Lab

9

New 13,000 S.F. Clinical Testing Lab

In Progress: New Oxygen Farm (left), Steam Line Fixes (below left), Cart Wash Area (below right)

10

Remaining Prop G Schedule Updated 5-19-2016

Projects Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4CEP & Co-Generation By AugustFinal site work & O2 Tank By September

Heart & Vascular BuildingHeart & Vascular Site Work

H&V - Surgery Build Out Oct

Boa

rd

CDPH

Prop G Scope July

Boa

rd

CDPH

Sharp ScopeConstruction

Construction

2016 2017 2018 2019

11

Available Funds vs. Worst Case Forecast

Category Project NameProjected Cost At Completion

(7/21/2016)

Funds Available Total Prop G Building Fund (Bond Proceeds, Interest Earned, Grants, Etc.) 256,809,326$ E Tower Phase 1 249,566$ Early Utilities and North Dock 13,313,098$ ED-CCU 40,514,579$ CEQA 104,211$ Central Energy Plant 57,396,138$ Heart and Vascular 62,237,283$ East Tower Renovation 39,962,314$ South Dock / Level B Seismic Upgrades 11,998,902$ Bond Issuance Costs (Current Projection) 498,613$ Total Worst Case Scenario for Projects Completed or Under Construction 226,274,704$ Remaining Prop G Building Funds before H&V Level 1 Surgery Floor Build Out Project 30,534,622$

Projects Not Under Construction H&V Level 1 Surgery Floor Build Out (Current Estimate, Bid and Board Award Pending) 28,798,214$ Potential Surplus 1,736,408$

Worst Case Forecast for Projects Completed or Under Construction

12

Looking Ahead A focus on completing the Prop G projects – the highest priority! Property Taxes – Property tax revenues continue to increase

after a decline a few years ago. State of CA – The Legislature and Little Hoover Commission will

be holding hearings, with a focus on special districts in general and healthcare districts specifically (view of local governments as a potential source of tax dollars).

Community Needs – The District continues to see an increase in needs for community non-profits and safety net providers, impacted by recent state cuts and economic declines.

November Election – Three GHD Board seats will appear on the November ballot for four-year terms.

13

Input and Discussion

14

Question 1

One or two commonly heard misperceptions or confusions about the District/Sharp partnership.

15

Question 2

Suggestions for helping the public better understand the partnership between the District and Sharp Grossmont Hospital.

16

Question 3

One or two things the District, Sharp or the two of us mutually can do to improve healthcare in the East Region?

17

Questions?

Documents

MINUTES OF THE GROSSMONT HEALTHCARE DISTRICT BOARD … · 8/16/2016 · August 16, 2016 The Board of Directors of Grossmont Healthcare District (District) held a special joint meeting