Mission and Community Benefit Report 2014

With our people as our foundation, we believe that health care is about delivering reliably amazing, high quality services and exceptional experiences, along with our commitment to our communities. We believe that building healthier communities extends beyond our four walls and carries an obligation to understand and address societal factors that impact health.

The social determinants of health are about going beyond the episodic moments of care people receive at our hospitals and our physician offices to those moments where health is actually impacted – in our homes, our schools, and our communities. As an organization we continue to focus increasingly on being the integrators of care for communities, not just focusing on clinical excellence and reducing costs within our hospitals. And concentrating on a strategy that creates value not just for the patient – but on programs that yield a healthy individual and a healthy community – which ultimately will achieve better outcomes, enhanced quality, greater efficiencies, and improved margins.

Mission-driven. Community-based. Not-for-profit.These are more than words. They are the principles and philosophy that drive every decision that ProMedica makes as an organization.

Toledo Public Schools

TECHS

The University of Toledo Medical School

Research

STEMM

Elementary School Nurses

Learners

The University of Toledo

Education

HEALTHY INDIVIDUALHEALTHY COMMUNITY

Shelter*

ProMedicaHealth and

Wellness Center

ProMedica Toledo

Hospital New Replacement

Tower

Clinical Service Lines

Transparency

Keep me safeHeal me

Treat me right

Clinical Excellence

Ebeid Center

Culture

Downtown Revitalization ProMedica

Downtown Move

Minority Business

Development

Innovation

Residential Support – Food

Fitness

22nd Century Committee

Cleveland Clinic Alliance

Key PartnershipsUniversity of Toledo

Incubator

Investments in Start-up

InnovationsAd Hoc

Committee

Physician Leadership

Disclosures

Rocket Fund Investment

Economic Development

Urban Entertainment

DistrictHigh-density Mixed-use

Development

Neighborhood Building

AmenitiesPublic/Private Partnership

Innovation

Artist District

Monroe Street Corridor

Providers

Paramount

Pathways

Center for Health Services

Mental Health*

Safety

Hunger*

Chronic Health*

Infant Mortality*

SocialDeterminants

Transforming Health Care | Where We Live, Learn, Work and Play

PAG

E 2

Established in 1986, ProMedica serves 27 counties in northwest Ohio and southeast Michigan and is one of the region’s leading healthcare providers. Our stewardship of resources has enabled us to wisely invest in cutting-edge technology, innovative programs and family-centered facilities that help to ensure patients and area residents have equal access to high-quality, safe care in the most appropriate setting, regardless of a patient’s ability to pay.

Based on needs that we have assessed within the communities we serve, ProMedica launched new services and programs in 2014 to help meet the growing demands of local consumers across all spectrums of life, including those individuals who are often the most vulnerable when it comes to health care: the elderly, poor and underserved.

ProMedica and its affiliates comprise 332 sites, more than 2,300 physicians and approximately 17,000 employees and volunteers. During 2014, ProMedica discharged 72,595 inpatients and served more than 1,407,416 outpatients, while handling 305,747 emergency visits system-wide.

Additionally, our physicians, leadership team members and employees individually contribute personal resources to the community in numerous ways—such as through tutoring elementary students in reading, providing monthly health lectures at local senior centers, generously contributing to community fundraising campaigns such as United Way, participating in medical missions, serving on local not-for-profit boards, and donating nonperishable goods to numerous local food pantries and churches—underscoring a key benefit of ProMedica being locally owned and operated.

What follows is a brief description of how our nearly 20,000 employees, physicians, and providers live our Mission and impact our communities each day.

PAG

E 3

Community Health Improvement Services and Community Benefit Operations $6,296

Health Professions Education $13,822

Subsidized Health Services $25,216

Research $53

Cash and In-kind Contributions $5,631

Financial Assistance $20,165

Medicaid and Means-Tested Shortfalls $77,544

Total Community Benefit $148,727

2014 Community Benefit

52.14% Medicaid and Means-Tested

Shortfalls

16.95% Subsidized Health

Services

9.29% Health

ProfessionsEducation

13.56% Financial

Assistance

4.23% Community Health

Improvement aned Community Benefit Operations

4.23% Cash and

In-kind Contributions

(000’s eliminated)

In 2014, ProMedica contributed $148,727,000 in community benefit through community benefit expenditures, financial assistance and government-sponsored, means-tested health care. These numbers not only indicate ProMedica’s long-standing commitment to the community, but also fulfill our not-for-profit status by improving the health and well-being of residents in the communities we serve.

As part of this total, ProMedica contributed more than $50 million through community health improvement services, health professions education, subsidized health services, research, cash and in-kind contributions, community building activities, and other community benefit operations. These programs included free community health screenings, such as diabetes testing, blood pressure, bone density, body mass, and cancer checkups; mammogram screenings for low-income and uninsured women; childhood immunizations; reduced-cost school-athletic physicals; first-aid coverage at community events; volunteer elementary school mentors; public health education lectures and seminars; a childhood obesity program; college scholarships for students entering healthcare careers; and many other community-based initiatives.

ProMedica also contributed $20,165,000 in financial assistance for patients who did not have the financial resources to pay for hospital services. This amount represents the cost to provide service and does not include the costs for accounts that are written off to bad debt for patients who do not pay their bills. In addition, ProMedica’s cost of bad debt for 2014 was $24,864,000. This amount is not included in the community benefit amount of $148,727,000noted above.

PAG

E 4

Further, ProMedica continues to be a leading participant in the Lucas County CareNet initiative—a collaborative effort among ProMedica, Mercy Health Partners, The University of Toledo Medical Center, the City of Toledo, and others. CareNet was created to provide free or lower-cost health care for low-income Lucas County residents. Established in 2003, CareNet bridges the gap between adults without health insurance and needed healthcare services. While some individuals may qualify for governmental insurance programs such as Medicaid, others do not; it is for these individuals that CareNet was established.

Additionally during 2014, ProMedica provided $77,544,000 of community benefit through the cost—not reimbursed by the government—for treating Medicaid patients. ProMedica’s total cost—not reimbursed by the government—for treating Medicare patients during 2014 was $150,918,000 and is not reflected in the community benefit amount of $148,515,000 noted above.

Indeed, ProMedica goes beyond industry standards in meeting the goal of providing care to everyone, regardless of their ability to pay. We provide hospital care free-of-charge to all families without insurance with incomes at or below 200% of the federal poverty level. In addition to free care for those families under this federal poverty level, ProMedica hospitals provide significant discounts to families with incomes of up to 400% of the federal poverty level.

In addition to being a strong advocate for the health and well-being of others, ProMedica provides and promotes community wellness, collaborating with more than 300 local nonprofit agencies and organizations in 2014 that had values and missions similar to our own.

PAG

E 5

Making a Difference Where we Work, Live, Learn, and Play• The ProMedica Advocacy Fund awarded $369,390.00 to 22 different organizations. Our

supported was for things like providing housing and shelter services for families, providing kitchen equipment to prepare healthy food for children and families receiving child care and other services, providing education on healthy food preparation techniques and produce preservation, providing summer meals and enrichment activities for children in the community, supporting emergency shelter and supportive services for homeless young people, purchasing a new box truck to transport donated foods, establishing community gardens, renovations of facilities and family care homes, providing emergency basic needs assistance and more.

• ProMedica staff dedicate many hours in serving the community. Our management team logged over 4,000 hours in 2014, serving in various community sectors including first aid, Habitat, United Way, Days of Caring, and many community fundraising events, to name a few. In addition, over 100 management team members reported that they serve on board and community committees on behalf of ProMedica, with many serving with multiple organizations.

• As part of the One Million Healthy Steps initiative with the Toledo Lucas County Minority Health Commission, ProMedica sponsored nine monthly Walk with a Doc programs at The Flower Market Garden Grocer. These monthly programs included a registered dietitian providing a healthy food item and recipes, health screenings and information on other community resources, including SNAP. A ProMedica physician was available to walk and talk to participants.

• The ProMedica Speaker’s Bureau provides experts on various health and health related topics upon request. In 2014, over 1,000 elementary age students were provided healthy living education through ProMedica’s Health Conversation Map programs. In addition to eight annual healthcare speakers provided for the healthcare core students at Toledo Early College High School in Toledo, 44 additional requests for speakers were coordinated through this ProMedica office, serving counties in northwest Ohio and southeast Michigan.

• For ProMedica’s Summer Youth Employment Program in 2014, 74 youth were hired, and 66 youth (89%) maintained employment through the summer. ProMedica has provided funding for this program each year and the United Way provided matching dollars in 2013 and 2014. At the end of each summer, 2 – 3 youth are typically employed permanently.

• Each year, ProMedica employees pledge to donate thousands of dollars in support of the Circle of Care campaign for ProMedica foundations and the United Way campaign. 2014 was no different. In 2014, ProMedica employees donated more the $750,000 to support ProMedica programs, services and employees, and to meet the needs of our communities. Of that amount, more than $100,000 was donated to the ProMedica Family Fund, which provides emergency funds to ProMedica employees facing financial hardship due to accidents, fires and natural disasters such as flooding or tornadoes.

• ProMedica Cancer Institute’s community outreach included screenings for skin cancer; education sessions on colon cancer; the fifth annual survivor celebrations for cancer survivors, friends and caregivers; and sponsorship of the annual Susan G. Komen® Race for the Cure in support of breast cancer research.

PAG

E 6

Hunger as a Health Issue• Through partnership with Russell Ebeid and ProMedica, the Ebeid Institute has been established and

is dedicated to improving the health and well-being of our community by engaging local and national organizations to address the social determinants of health with an intense focus on hunger and nutrition, education; and by promoting a sense of personal responsibility for one’s health. The first initiative of the Ebeid Institute will be working to establish a full-service food market and community hub in central Toledo. Plans for the four-story facility include a food market, kitchens and education workstations for nutrition classes, and basic health information and community navigation.

• In 2014, ProMedica hosted three National Hunger Summits in partnership with the Alliance to End Hunger (in Washington DC, Chicago, IL and Atlanta, GA). The summits are designed to bring together local and national experts and share information about hunger as a health issue. By broadening the dialogue to include the healthcare industry, hospitals and health systems can have a measurable impact on their communities. Food insecurity has a marked effect on the health and well-being of our patients and as such, healthcare has a role to play in ending the problem. These half day summits provide venues for community agencies to learn how they can more effectively interface with the hospital or health system in their own community to find local solutions.

• ProMedica’s food reclamation program collected more than 100,000 pounds of prepared, but unserved food in 2014. The food was then donated to local homeless shelters and communal feeding sites, equating to nearly 75,000 meals.

• In 2014, ProMedica began planning for a food pharmacy modeled after the one at Boston Medical Center. Two evidence-based questions to identify patients at risk of food insecurity were built into the electronic health record and physician training materials for the referral process were developed. A location for the food pharmacy was identified and plans for a 2015 opening were made. The food pharmacy provides several days of food for patients who are referred and patients can visit the food pharmacy once per month for up to six months before needing a new referral.

• ProMedica began planning for an in-patient food insecurity screening program in 2014. Using the same food insecurity screening questions as the food pharmacy, admitting nurses screen patients and those who are identified as at risk are visited by a social worker or discharge planner who confirms their need. Those who are in need of assistance are provided a care package containing three meals upon discharge from the hospital anda community resource guide so they can connect to more ongoing resources in their community. The program began at Bixby and Herrick Hospitals followed by Fostoria and Defiance with the remainder of the system scheduled to be live by the end of 2015.

• Nutrexity is a board game developed by ProMedica with the help of a professional learning company, and reinforces learning about NUTRition, EXercise and serving the communITY. Nutrexity was donated to schools and other community organizations to help grade 2 – 4 students learn this important information in a fun and memorable way! The object of the game is to earn points by correctly answering questions about healthy food choices, exercise and serving others.

PAG

E 7

Behavioral Health• ProMedica formed a joint operating company (JOC) with local behavioral health provider Harbor to

address a growing community need for mental health services in northwest Ohio and southeast Michigan. The JOC will help increase access to behavioral health services and enhance care through a more integrated, coordinated model.

• Award of Agreements to Harbor and Pathway for FFY15/16 TANF-Funded Work Experience Program (WEP) Services for Lucas County Department of Job & Family Services.

• The Substance Abuse and Mental Health Services Administration awarded Harbor Behavioral Health and Behavioral Connections of Wood County a $1.5 million, three-year grant to expand the availability of comprehensive, residential substance abuse treatment, prevention and recovery support services for pregnant and postpartum women and their minor children. Behavioral Connections, Harbor and ProMedica will collaborate to open a 15-bed residential treatment center in northwest Ohio by September 30, 2015. The center will house pregnant and postpartum women who have limited access to quality health services.

• Harbor provides Community Employment Services (Career Connections) for both youth and adult populations to promote recovery and secure/maintain employment by providing training and skill development that is goal oriented, ability based and incorporates individual choice.

• Harbor operates a Partial Hospitalization/Day Treatment program in partnership with Toledo Public Schools at Robinson Elementary School and Westfield High School, Toledo, and at the Quest Program, Monroe Street, Toledo. The goal for this program is to help youth function successfully in a less-restrictive environment in unison with the resiliency philosophy. This program is also a collaboration between Harbor and Toledo Public Schools.

• The Developmental Pediatrics Service is designed to specifically serve children with developmental delays or handicaps and co-occurring mental health disorders.

• Medicaid Health Home is a Medicaid benefit for Ohio’s Medicaid enrollees with serious and persistent mental illness which includes adults with serious mental illness and children/adolescents with serious emotional disturbance. The Medicaid Health Home service model is designed to bridge the gap between traditional silo health care services by focusing on the whole person. The model focuses on integration and coordination of behavioral, medical, long-term care and social supportive services in order to maximize and improve the individual’s overall health and the value of service delivery.

Infant Mortality• ProMedica is focused on preventing pre-term births, and is working to connect more women

to the Lucas County Initiative to Improve Birth Outcomes, which is a collaboration of Toledo-area health systems and social service agencies spearheaded by the Northwest Ohio Pathways HUB. ProMedica formed a steering committee to begin to address the rising infant mortality numbers and quickly determined the need to get more patients into the HUB program, and need to better educate obstetricians and other providers about the HUB program. A new initiative is asking pregnant women to fill out a questionnaire that helps identify their social and health needs to assess potential risk that can contribute to a baby not making it past the first year of life. Patients with needs identified through the questionnaire will be referred to the HUB which will connect them to the appropriate services.

PAG

E 8

PAG

E 9

Clinical Excellence – High Performance … High Reliability• ProMedica continued its Childhood Obesity Pilot Program, which focused on children and

adolescents with a body mass index (BMI) that classifies them as obese. Families met quarterly over a 12-month period with a dietitian in a physician’s office or outpatient clinic to receive nutrition counseling and ask questions. Each child’s BMI and responses to a health questionnaire were collected before, during and after the 12-month period to determine the program’s effectiveness.

• ProMedica opened its 55,000 square foot Mary Ellen Falzone Diabetes Center in February 2014. The facility is named for a young girl who died from juvenile diabetes before her family even knew she had the disease. Located on the campus of Toledo Hospital, the center offers diabetes programs, services and physicians together in one convenient location to serve all community members working to manage their diabetes.

• Flower Hospital completed expansion of its psychiatric care unit in March. The addition includes 18 inpatient rooms, a common space for patients and special security measures to provide added protection for this patient population. ProMedica is committed to expanding behavioral health services system-wide to meet the needs of our communities.

• Toledo and Toledo Children’s Hospitals completed construction of new imaging and inpatient pharmacy centers in the existing Renaissance Tower. Located on the first level, the new radiology space provides a centralized location for all radiology services, excluding breast care. The space also features a lab draw site, while a new inpatient pharmacy location provides operational efficiencies and improved workflow to better serve our patients and caregivers.

• St. Luke’s Hospital’s emergency department renovation was completed, enhancing patient privacy and comfort while improving department workflow for caregivers and patients alike.

• ProMedica Home Health Care’s ER2Home program launched at Flower Hospital is designed to avoid hospital readmissions for high-risk, high-cost patients who come to the emergency center. Through ER2Home, patients receive a 30-day intensive skilled nursing and telehealth monitoring program to help them better manage their health condition.

• ProMedica signed a multi-year contract to implement Epic Enterprise Solutions system-wide. The new contract will move ProMedica to a more integrated electronic health record (EHR) platform that will further enable one patient, one record, and one bill for patients regardless of service provided or the location of the service.

• ProMedica Physicians opened a second ProMedica AfterHours location in Oregon, Ohio providing residents with diagnosis and treatment for non-emergency medical issues as well as prescription services. Providing new options for medical care when physician offices normally are closed, AfterHours is staffed by ProMedica Physicians certified nurse practitioners and is open nights, weekends and holidays – 365 days a year.

• ProMedica’s Culture of Safety program was expanded through implementation of error prevention training for employees system-wide. By year end, more than 90 percent of physicians and more than 13,000 acute care employees had completed error prevention training. The path to safe, patient-centered care and service is designed to engage patients and families and improve care coordination to deliver better outcomes and services across the system.

PAG

E 1

0

Education• ProMedica has invested in the next generation of healthcare workers by helping to develop an annual

ancillary curriculum for healthcare core students at Toledo Early College High School. Freshman students receive monthly lectures about specific healthcare careers by ProMedica staff directly involved in those areas of care. Sophomore students are required to volunteer a specific number of hours at a hospital, and junior students then spend more time shadowing various hospital staff to see what the day in a life of that career may look like. A rising senior is provided with a paid summer research position with Jobst Vascular Institute, and paid co-op positions will be piloted for two seniors in the 2015-16 school year. An annual symposium caps off the year, with many speakers from ProMedica, based on the topic of the symposium.

Economic Development• Planning has been underway for the new ProMedica Headquarters in downtown Toledo. In early July the

project was awarded $5 million dollars in historic tax credits from the State Historic Preservation Office. The current schedule plans to move over 1,000 employees to the new downtown facility in early 2017. Second and third phases of this move will eventually bring the total number of ProMedica employee’s downtown to over 2,000.

• ProMedica has been leading discussion about the future of Promenade Park. The group of about 20 community stakeholders has been moving forward with technical, design and programming plans for the park. Important aspects of these plans include the continued effort of revitalizing downtown Toledo, promoting healthy lifestyles and outdoor activities and integrating the arts and cultural groups deeper into the community.

• Among the region’s largest employers, ProMedica plays a significant role in economic development and stability in our region. During 2014, for every one dollar of revenue, another 34 cents was created in our service-area economy, with a total economic output of $3.7 billion. We also create a direct economic impact with our revenue, payroll and employment. Additionally, spending on services and materials with vendors in our region creates an indirect economic benefit.

At ProMedica, we are passionate about health care – and about our communities. We recognize that healthcare must take the broader view and take a greater role in our communities. And we are dedicated to our vision of building healthier communities – one life at a time.

PAG

E 11

Randy Oostra, DM, FACHE President and CEO randy.oostra@promedica.org 419-469-3824

Main Offices 1801 Richards Rd. Toledo, Ohio 43607 419-469-3801

Web site promedica.org

Social Media Caring Bridge Facebook LinkedIn Pinterest Twitter YouTube

1.1479.072815.BJ © 2015 ProMedica