Prepared with consulting assistance from: Summit Healthcare Regional Medical Center Community Health...

Prepared with consulting assistance from:

Summit Healthcare Regional Medical CenterCommunity Health Needs Assessment

May 10, 2013

May 10, 2013

Dear Residents of our White Mountain communities,

I am pleased to share with you the results from the hospital’s first Community Health Needs Assessment, which was completed in May of this year. Undertaken in part to make sure we meet new IRS requirements for maintaining our tax exempt status, this project has also helped us to better understand the people that we serve – how healthy is our population, and how well are your health needs being met?

Based on our data findings, plus results from a community survey and input from community leaders, we have identified mental health and substance abuse services as the leading area of unmet health needs in our region.

Summit Healthcare leaders are committed to helping to address the issues that have been identified. During this process we learned that other groups and organizations in our area are also concerned about gaps in mental health and substance abuse services and want to work with us to find effective and sustainable solutions. By pooling our ideas and resources, we believe that we can make real progress that has a positive impact in our local communities.

We are in the early stages of working with our community partners to develop action plans going forward. If you would like more information about the status of these projects or would like to be involved as a community partner, please feel free to contact me.

Best regards,

Ron McArthur, FACHEChief Executive Officer

Table of ContentsIntroduction & Project Overview 4

Needs Assessment Methodology 10

Needs Assessment Key Findings 16

Process to Establish Health Improvement Priorities 30

Appendices 35

Appendix A: Community Definition and Profile 36

Appendix B: County Health Rankings 41

Appendix C: Mortality and Morbidity 47

Appendix D: Personal Health Behaviors 56

Appendix E: Clinical Care 59

Appendix F: Physical Environment and Public Safety 62

Appendix G: Community Survey Results 65

Appendix H: Community Leader Meeting Attendees 74

Appendix I: Additional Information77

Introduction and Project Overview

4

The Community Health Needs Assessment project completed by Summit Healthcare Regional Medical Center (“Summit”) in early 2013 was designed to meet five major goals:

1. Better understand the community we serve – how healthy is our population, and how well are their health needs being met?

2. Gain focus for the hospital’s community health outreach efforts – how can we best use our resources to address the most pressing needs?

3. Strengthen the community health component of the hospital’s strategic plan – how can we better align our community health activities with the overall goals and priorities of the organization?

4. Create synergies with other organizations working to address health issues – what are the opportunities to work with other groups in the community to achieve shared goals?

5. Comply with requirements outlined in the Affordable Care Act (ACA) for non-profit 501(c)(3) hospitals to conduct a community health needs assessment and implement strategies to address identified needs. Additional information about ACA requirements can be found in Appendix I.

Consulting Assistance

Summit engaged Strategy Connections, a health care consulting company based in Fort Collins, Colorado, to provide consulting assistance for completing the CHNA project. Carol Davis, Owner and Principal Consultant, served as project leader and primary consultant throughout the project. A summary of Ms. Davis’ qualifications and experience is included in Appendix I.

5

Introduction & Project Overview

Project Goals

Summit’s model for community health improvement as shown below considers health status data, community survey results and community leader perspectives in determining priority health needs that the hospital will help to address over the next three years. On an annual basis as part of the budget development process, Summit Healthcare will identify specific initiatives to be undertaken during the year that will help to address highest priority community health needs.

6


Community Health Improvement Model

Priority Needs for Summit

Healthcare to

Address

Health Status Data

Community Survey

Leader Perspectives

Action Plan & Implementation

The CHNA project kicked off in May 2012 and concluded in May 2013, with timing of the various components as follows:

7


Project Timeline

Project Kick Off Meetings

Jun-Aug 2012

May2012

Sep-Oct 2012

Dec 2012-Jan

2013

Feb 2013

Community Survey

Health Status Data Collection

& Analysis

Survey Analysis; Prliminary

Health Needs Development

Planning Meeting with Community Leaders

May 2013

Board Approval of Community

Health Priorities

8

Area A: 85901 Show Low 85902 Show Low 85912 White Mountain Lake 85923 Clay Springs 85928 Heber 85929 Lakeside 85933 Overgaard 85934 Pinedale 85935 Pinetop 85937 Snowflake 85939 Taylor 85924 Concho 85940 Vernon

Area B: 85911 Cibecue 85930 McNary 85926 Fort Apache 85941 Whiteriver


Definition of Community


Demographic Overview

Area A Area B

Population Size 51,676 11,250

Median Age 43.0 24.8

Percent of Population 0-17 25.1% 36.9%



Percent of Population 65+ 19.9% 6.1%

Median Household Income $46,845 $31,806

Racial & Ethnic Diversity• White Non-Hispanic• Hispanic of Any Race• American Indian Non-Hispanic• Asian Non-Hispanic• African American Non-Hispanic• Other or Multi-Racial

81.8%12.8%

2.9%0.5%0.3%1.6%

1.5%2.4%

94.2%0.8%0.1%1.1%

9

Source: The Nielsen Company (data retrieved 10/31/2012)

Needs Assessment Methodology

10

Summit analyzed both secondary and primary data in the CHNA process .

Secondary data analysis uses data that was collected by others and is already in existence. A reference list of secondary data sources used in the needs assessment can be found on page 12. In addition, all statistics used in the report are fully referenced.

The availability of credible and objective measures of health status is essential to understanding overall health of the population. Without such data, the ability to prioritize health needs would be severely limited and based solely on small scale observations, anecdotal information, and personal opinions and agendas. This data, although critical to the integrity of the process, has important limitations that need to be acknowledged:

Most health status data is collected and reported only at the county level. Summit’s primary service area encompasses only the southern half of Navajo County. The characteristics of the population served by Summit could be quite different from the overall county profile.

Data is not current. Most of the data used in this report is based on 2010 statistics. Although changes in specific indicators tend to be small from year to year, the lag time makes it especially difficult to identify potential trends in a timely manner or to determine whether targeted interventions are having the intended impact and should be continued, modified or discontinued.

11


Secondary Data

County Health Rankings 2012 Arizona Health Status & Vital Statistics 2010 Behavioral Risk Factor Surveys 2009, 2010 Dartmouth Atlas

Arizona Cancer Registry Centers for Disease Control Crime in Arizona Report 2010 The Nielsen Company

Data from above-listed sources allowed for easy comparison of Navajo County with other counties in Arizona.Additional sources of data


Secondary Data Sources

12

Primary data is new data that was collected by Summit via a community survey to gain additional insight into health status and perception of health needs.

The survey, designed and tabulated by Strategy Connections, utilized a convenience sampling methodology, which means that respondents self-selected to participate. It was available both on-line and in hard copy. The survey was advertised via e-mail distribution lists and newsletters of a wide variety of local organizations, including school districts, businesses, public health, health care organizations and county/city/town governments.

The survey was completed by 164 individuals. A profile of survey respondents is depicted on page 14, and detailed survey results can be reviewed in Appendix G.

Community input received from the survey was invaluable to the needs assessment process, and Summit appreciates those who took the time to share their opinions. It is, however, important to be cautious in reviewing and interpreting the results due to these limitations:

Convenience sampling, while economical and helpful, does not produce statistically valid results that can be generalized to the overall target population. In other words, we can’t say that results from this survey are representative of the entire population of the community, only that the findings are representative of those individuals who chose to participate.

The profile of those who responded to the survey does not reflect overall demographics of the community. Most respondents were Caucasian females from the Show Low–Pinetop–Lakeside area. Elderly individuals, males and minority populations, especially American Indians, were underrepresented in survey participation.

Community survey: convenience sampling design, how advertised, when conducted, profile of respondents

Information limitations and gaps

13


Primary Data

Age

65+: 7%

No Answer: 22%

45-64: 44%

18-44: 27%

# in House...

3-4: 26%

No Answer: 21%

2: 34%

1: 7%

>4: 12%

Sex

Female: 59%

Male: 20%

No Answer: 21%

Zip Code

No Answer: 22%

Show Low: 27%

Other Apache: 5%

Snowflake/Taylor: 10%

Other Navajo: 9%

Lakeside/Pinetop: 23%

Vernon: 4%

Residency

Don’t Live Here: 4%No Answer: 22%

Part Time/Seasonal: 0%

Full Time: 74%

Diversity

American Indian: 3%

No Answer: 22%

Hispanic: 6%

White: 69%

Asian: <1%


Community Survey:164 Respondents

14

For purposes of the health needs assessment, Summit Healthcare defined its community as the southern 1/3 of Navajo County, which corresponds to the geographic area where 80% of the hospital’s inpatients reside. Due to significant differences in demographics and governance, this large area was subdivided into two regions – Area A and Area B as shown on the map on page 8.

The process of identifying health needs described in this report pertains primarily to Area A, although county-wide health status data includes Area B as well. With significantly different demographic characteristics (summarized on page 9 – younger, less household income, 94% American Indian, higher unemployment), the Area B population likely has unique community health needs as well.

Area B lies within the Fort Apache Indian Reservation, which is governed by the White Mountain Apache Tribe. The Indian Health Service (IHA) is responsible for providing health care services to this population. Summit leaders work closely with IHS leaders to identify health needs on an ongoing basis and provide certain specialty services not available through local IHS providers, including high risk obstetrics, surgery, oncology, urology and wound care. In addition, Summit has a mutual aid agreement with Whiteriver Indian Hospital for supplies and disaster-planning. Summit is currently working with IHS leaders on ways to address the need for transportation when residents require health care services at Summit. Summit leaders also meet periodically with tribal leaders to discuss specific programs (e.g. First Things First) and other topics of mutual interest.

Summit Healthcare is committed to working collaboratively with tribal and IHS leaders to address community health needs for residents of the Fort Apache Reservation. We support their ongoing processes to identify and prioritize the issues and will continue to assist with providing solutions whenever possible.

15Needs Assessment Methodology

Health Needs Assessment Process for Area B – Fort Apache Reservation

Needs Assessment Key Findings

16

Top 10 Highest Scores for Needs Being Met

1. Chiropractic care

2. Prescription drugs

3. Medical equipment

4. Ambulance & emergency transport services

5. Hospice care

6. Outpatient testing services

7. Dental care

8. Hospital care – ER & inpatient

9. Kidney dialysis

10. Assisted living


10 Highest Survey Scores for Needs Being Met

17

Six Lowest Scores for Needs Being Met

1. Mental health services

2. Substance abuse treatment

3. Obesity treatment

4. Specialty physicians

5. Services for people without health insurance

6. Alzheimer’s disease & other dementias


6 Lowest Survey Scores for Needs Being Met (“Poor” or “Fair”)

18

Ten Highest Scores for Improving Health

1. Get prenatal care

2. Decrease substance abuse

3. Increase exercise & physical fitness

4. Get recommended screening exams

5. Achieve a healthy weight

6. Decrease tobacco use

7. Improve diet & nutrition

8. Get routine physicals & lab work

9. Get recommended immunizations

10.Get regular dental checkups


10 Highest Survey Scores for Importance in Improving Overall Community Health

19

Category Potential Area for Improvement

Availability of Services • Mental health and substance abuse services

• Specialty physicians

• Obesity treatment

• Services for individuals without health insurance

Compliance with Prevention & Treatment Guidelines

• Cancer screening exams

• Management of chronic diseases

• Prenatal care

Healthy Lifestyle • Exercise and physical fitness


8 Areas of Potential Community Need (Data + Survey Results

20

How well are needs being met?

Excellent

Poor

Very Good

Good

Fair

10

9

8

7

6

5

4

3

2

1

0

X Mental health services

Very Important

Moderately Important

Somewhat Important

Not At All Important

10

9

8

7

6

5

4

3

2

1

0

How important for improving health of

community?

XDecreasing substance abuse XDecreasing suicides

XImproving stress management skills

3349

17

Navajo County Deaths (2010) Additional Data Findings County Rank

3.6 poor mental health days (per person average) past 30 days

#10

11.3% binge drinking (adults) past 30 days #2

9.8 mental health providers per 100,000 population

#8


Mental Health & Substance Abuse Services21

X Substance abuse services

Note: Arizona counties ranked from #1 (best) to #15 (worst)


Specialty Physicians

22

Survey Comments – Perceived Specialty Needs

# Mention

s

Neurology 22

Pediatric specialties 12

Psychiatry/other mental health

11

Endocrinology 6

Rheumatology 6

Cardiology 4


Excellent

Poor

Very Good

Good

Fair

10

9

8

7

6

5

4

3

2

1

0

X Specialty physicians


Excellent

Poor

Very Good

Good

Fair

10

9

8

7

6

5

4

3

2

1

0

X Obesity treatment services

Very Important


Somewhat Important


10

9

8

7

6

5

4

3

2

1

0


community?

XAchieving a healthy weight

Data FindingsCounty Rank

29% obese (adults) #8


Obesity Treatment

23



Excellent

Poor

Very Good

Good

Fair

10

9

8

7

6

5

4

3

2

1

0

X No health insurance

CHR Data FindingsCounty Rank

22% lack health insurance #12

17% couldn’t afford to see doctor past year

#12


No Health Insurance

24

Community Survey Findings

Of the 32% who did not received needed services in past 12 months:

• 35% could not afford to pay for care• 25% had no health insurance

Respondents could select multiple answers.


Very Important


Somewhat Important


10

9

8

7

6

5

4

3

2

1

0


community?

XGetting recommended

screening exams


90% ever had mammogram (women 40+)

#11

86% ever had Pap test (women 18+)

#15

84% ever had PSA test (men 40+) #1

50% ever had colonoscopy (50+) #13

Lung Colorectal Lymph/blood Breast Prostate Kidney/renal

24 2219

1310 10

Cancer Deaths – Navajo County (2010)

Breast Prostate Lung Colorectal Kidney/renal Melanoma Urinary/bladder

58 5546

34

20 1914

New Cancer Cases – Navajo County (2009)

148 total deaths - #2 cause of death

394 total new cancer cases


Cancer Screening Exams

25



Excellent

Poor

Very Good

Good

Fair

10

9

8

7

6

5

4

3

2

1

0

X

Additional Data Findings (adults)

County

Rank

34% high cholesterol #5

21% high blood pressure #1

13% asthma #5

11% diabetes #10

4% heart attack#4 (tie)

4% stroke #8

43% blood sugar tests (Medicare patients with diabetes)

#14

X

XX

X

Cardiovascular (#1 cause of death)

Lower respiratory (#4 cause of death)

Diabetes (#5 cause of death)

Stroke (#8 cause of death)

Renal failure (#12 cause of death)

182

41 41 31 12

Navajo County Deaths (2010)


Management of Chronic Diseases

26

XHeart disease

Asthma/COPD/respiratory

Stroke/neurologicalChronic painDiabetes

Dialysis



Excellent

Poor

Very Good

Good

Fair

10

9

8

7

6

5

4

3

2

1

0

X Pregnancy-related care

Very Important


Somewhat Important


10

9

8

7

6

5

4

3

2

1

0


community?XGetting prenatal care


68% of women giving birth received prenatal care in 1st trimester

#12


Prenatal Care

27


Very Important


Somewhat Important


10

9

8

7

6

5

4

3

2

1

0


community?

XIncrease exercise & physical fitness


56% with moderate/vigorous exercise past 30 days

#12

2.7 fitness/recreational facilities per 100,000 population

#12


Exercise & Physical Fitness

28


Topic # of Mentions

1. More community education & personal responsibility for health

17

2. More exercise 10

3. Better access to medical care 8

4. More affordable care 6

5. More trails for safe walking/bicycling 6

6. Better access to healthy food – restaurants & grocery stores

5

7. Better diet/nutrition 5


Survey Results: One Thing to Most Improve Health?

29

Process to Establish Health Improvement Priorities

30

Summit Healthcare leaders hosted a meeting of invited community representatives to share key findings from the health needs assessment and to seek input on which health needs are the most important to address. The priority-setting meeting was held on Wednesday, February 6, 2013 from 6:00-7:30 p.m. at a local restaurant.

Thirty-five individuals representing 18 organizations participated in the meeting. A complete list of attendees, including job title and organization, is located in Appendix H.

The agenda consisted of the following segments:

• Welcome and introductory remarks by Ron McArthur, CEO of Summit Healthcare• Presentation of key findings from health needs assessment• Audience discussion and voting on perceived priority of eight community health needs• Additional discussion• Next steps and concluding remarks


Community Leader Meeting

31

Availability of Services• Mental health and substance abuse services• Specialty physicians• Obesity treatment• Services for individuals without health insurance

Compliance with Prevention and Treatment Guidelines• Cancer screening exams• Management of chronic diseases• Prenatal care

Healthy Lifestyle• Exercise and physical fitness

32Process to Establish Health Improvement Priorities

Health Needs Presented for Community Leader Input


Results of Community Leader VotingAfter the list of 8 community health needs was presented, attendees had an opportunity for questions and large group discussion. Then 26 voting participants (Summit representatives did not vote) were asked to rate the importance of each issue on a scale from 1 (“less important”) to 5 (“very important) using Turning Point audience response technology and based on the following criteria:

Does this issue affect a large number of individuals and families? Does the community have (or can we acquire) the necessary skills and resources to make

a difference?

Results from the voting exercise were as follows:

33

Topic Mean Score Frequency Distribution

5 4 3 2 1

1. Mental health and substance abuse services 4.46 15 8 3 0 0

2. Prenatal care 4.00 12 6 4 4 0

3. Services for individuals without health insurance 3.85 11 6 4 4 1

4. Exercise and physical fitness 3.81 11 5 6 2 2

5. Cancer screening exams 3.80 9 4 11 0 1

6. Management of chronic diseases 3.65 6 8 10 1 1

7. Specialty physicians 3.35 3 9 9 4 1

8. Obesity treatment services 3.15 4 5 10 5 2


Summit Healthcare Board Decision and Next Steps

34

At its monthly meeting on May 10, 2013, the Summit Healthcare Board of Directors reviewed key findings from the health needs assessment process, including results from the community leader meeting that was held on February 6. The Board then considered and passed the following motion:

a) To adopt mental health and substance abuse services as the leading community health need that Summit will help to address by working with other community groups to find collaborative and sustainable solutions, and b) to adopt the seven other improvement areas as priorities to consider for Summit’s various community outreach programs and services.

Initial implementation activities include the following projects to be completed by December 31, 2013:

Mental health and substance abusei. Continue efforts to recruit a psychiatrist and/or develop a telemedicine option for psychiatry.ii. Convene community partners to more clearly identify and prioritize gaps in services.

Seven other improvement areasi. Review current services provided by Summit that focus on these areas (listed on page 33), and identify

opportunities to improve effectiveness or potentially expand services to address unmet needs.

Implementation plans with specific projects and resource requirements for subsequent years will be developed annually during Summit’s budget planning process for the next fiscal year. An action plan for FY2014 will be adopted by the board no later than December 31, 2013.

Appendices

35

Appendix A:Community Definition and Profile

36

Community Definition and Profile

Map of Defined Community

Sources: Intellimed for patient origin, Microsoft MapPoint 2011 for map boundaries

37

For purposes of the community health needs assessment, Summit Healthcare defined its community as the southern 1/3 of Navajo County, which corresponds to the geographic area where 80% of the hospital’s inpatients reside. Due to significant differences in demographics and governance, this large area was subdivided into two regions as follows:

Residents of Area A accounted for 69.7% of Summit’s inpatient discharges between July 1, 2011 and June 30, 2012. Area A encompasses 11 zip codes:

• 85901 Show Low• 85902 Show Low• 85912 White Mountain Lake• 85923 Clay Springs• 85924 Concho• 85928 Heber• 85929 Lakeside• 85933 Overgaard• 85934 Pinedale• 85935 Pinetop• 85937 Snowflake• 85939 Taylor• 85940 Vernon

Area B lies within the Fort Apache Indian Reservation. Residents of Area B accounted for 10.3% of Summit’s inpatient discharges during the same 12-month period. Area B includes 4 zip codes:

• 85911 Cibecue• 85930 McNary• 85926 Fort Apache• 85941 Whiteriver


Summit Healthcare Inpatient Origin (7/1/2011-6/30/2012)

Source: Intellimed; excludes newborns

38

Inpatient Discharges As % of Total Summit Inpatient Discharges

Show Low 974 27.65%

Lakeside 405 11.08%

Snowflake 347 9.49%

Whiteriver 264 7.22%

Pinetop 204 5.58%

Taylor 195 5.34%

Concho 129 3.53%

Saint Johns 116 3.17%

Overgaard 104 2.85%

Eagar 97 2.65%

Holbrook 78 2.13%

Vernon 69 1.89%

Springerville 62 1.70%

Heber 57 1.56%

Cibecue 53 1.45%

Fort Apache 39 1.07%

Clay Springs 29 0.79%

McNary 20 0.55%

White Mountain Lake 20 0.55%

Pinedale 16 0.44%

All Others 378 10.34%

Total Discharges 3,655 100.00%


Demographic Overview: Area A

2013 Estimated

2018 Projected

5 Year Change

5 Year Change %

Population Size 51,676 54,127 +2,451 +4.7%

Median Age 43.0 41.3 -1.7 -4.0%

Percent of Population 0-17 25.1% 25.1% +619 +4.8%

Percent of Population 18-44 26.5% 28.0% +1,503 +11.0%

Percent of Population 45-64 28.6% 25.0% -1,285 -8.7%

Percent of Population 65+ 19.9% 21.9% +1,614 +15.7%

Median Household Income $46,845 $49,584 +$739 +5.9%


81.8%12.8%2.9%0.5%0.3%1.6%

81.9%13.3%2.5%0.5%0.3%1.5%

+2,067+594-188+14-17-19

+4.9%+9.0%-12.4%+5.0%-11.0%-2.3%


39


Demographic Overview: Area B

2013 Estimated

2018 Projected

5 Year Change

5 Year Change %

Population Size 11,250 11,528 +278 +2.5%

Median Age 24.8 26.1 +1.3 +5.2%

Percent of Population 0-17 36.9% 35.7% -34 -0.8%



Percent of Population 65+ 6.1% 7.2% +148 +21.7%

Median Household Income $31,806 $34,031 +$2,225 +7.0%


1.5%2.4%94.2%0.8%0.1%1.1%

1.5%2.8%93.3%1.1%0.1%1.2%

+11+54+153+42+3+15

+6.7%+20.4%+1.4%+48.8%+37.5%+12.1%


40

Appendix B:County Health Rankings

41

County Health Rankings is a collaboration between the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation. The project publishes an annual report that assesses the overall health of nearly every county in all 50 states, using a standard way to measure how healthy people are and how long they live.

Results are aggregated into two overall categories: 1) health outcomes, and 2) health factors.

• Ranking for health outcomes is based on mortality and morbidity data.

• Ranking for health factors considers data on health behaviors, clinical care, social and economic factors, and physical environment.

42

County Health Rankings

Introduction to County Health Rankings


Arizona Maps for Health Outcomes and Health Factors

43

Source: County Health Rankings; data retrieved from www.countyhealthrankings.org on 4/10/2012.


Navajo County Data

44

Notes: National benchmark reflects 90th percentile; i.e., only 10% are better. Blank values reflect unreliable or missing data.Source: County Health Rankings; data retrieved from www.countyhealthrankings.org on 6/11/2012.

Navajo County Error Margin National

Benchmark Arizona

Navajo County Rank 1-15(1=most

favorable)

Health Outcomes 12

Mortality 13

Premature death (years of potential life lost per 100,000 population) 11,875 11,125-12,625 5,466 7,213

Morbidity 11

Poor or fair health (percent of adults) 17% 14-19% 10% 15%

Poor physical health days in past month 3.4 2.9-3.9 2.6 3.4

Poor mental health days in past month 3.6 3.0-4.1 2.3 3.3

Low birthweight babies (percent of total live births) 7.9% 7.4-8.3% 6.0% 7.0%

Health Factors 13

Health Behaviors 10

Smoking (percent of total adults) 18% 15-21% 14% 18%

Obesity (percent of total adults) 32% 28-35% 25% 25%

Physical inactivity (percent of total adults) 25% 22-29% 21% 20%

Excessive drinking (percent of total adults) 12% 10-15% 8% 17%

Motor vehicle crash death rate per 100,000 population 53 48-58 12 19

Sexually transmitted infections per 100,000 population (chlamydia) 572 84 400

Teen births per 1,000 females ages 15-19 63 61-66 22 60


Navajo County Data

45



Benchmark Arizona


favorable)

Clinical Care 10

Uninsured (% of total population) 20% 18-21% 11% 20%

Population per primary care physician 1,170:1 631:1 1,118:1

Preventable hospital stays per 1,000 Medicare enrollees 66 60-71 49 52

Diabetic testing of blood sugar levels (% of people with diabetes) 43% 40-46% 89% 76%

Mammography screening (% of women ages 40+) 47% 42-51% 74% 68%

Social & Economic Factors 13

High school graduation (% of population ages 25+) 72% 76%

Some college (% of population ages 25+) 49% 45-53% 68% 60%

Unemployment (% of total workforce) 15.7% 5.4% 10.0%

Children in poverty (% of total children) 36% 29-44% 13% 25%

Inadequate social support (% of total adults) 24% 20-27% 14% 20%

Children in single-parent households (% of total children) 39% 35-43% 20% 33%

Violent crimes per 100,000 population 354 73 466


Navajo County Data

46



Benchmark Arizona


favorable)

Physical Environment 9

Air pollution – particulate matter days in a year 0 0 1

Air pollution – ozone days in a year 1 0 29

Recreational facilities (total number) 3 16 7

Limited access to healthy foods (% of population based on formula that considers poverty level and geographic isolation) 22% 0% 9%

Fast food restaurants (% of total restaurants) 42% 25% 52%

Appendix C:Mortality and Morbidity

47

County number is FAVORABLE (>10% positive variation from state number) but not necessarily statistically significant

County number is UNFAVORABLE (>10% negative variation from state number) but not necessarily statistically significant

Mortality and Morbidity

Age-Adjusted Mortality Rates for 10 Leading Causes of Death

Navajo County ArizonaNavajo County

Rank 1-15(1=most favorable)

1. Cardiovascular disease 202.8 188.6 12

2. Malignant neoplasms (cancer) 134.6 150.5 6

3. Unintentional injury 78.1 43.8 13

4. Chronic lower respiratory diseases 41.7 42.6 6

5. Diabetes 38.7 20.1 13

6. Chronic liver disease & cirrhosis 37.1 12.3 14

7. Suicide 33.1 16.7 14

8. Cerebrovascular disease (stroke) 32.0 30.7 8

9. Influenza & pneumonia 18.3 10.9 12

10. Alzheimer’s disease 17.8 35.1 6

11. Total, all causes 808.9 679.9 12

Note: All rates per 100,000 population and age-adjusted.Source: Arizona Health Status and Vital Statistics 2010; Arizona Department of Health Services; data retrieved from www.azdhs.gov on 6/11/2012.

48


Additional Mortality Measures

Navajo County ArizonaNavajo County Rank

1-15(1=most favorable)

1. Perinatal deaths (per 1,000 live births + fetal losses at 28+ weeks gestation) 4.6 5.5 5

2. Drug-induced deaths (per 100,000 population) 16.3 17.6 8

3. Alcohol-induced deaths (per 100,000 population) 51.5 14.1 13

4. Average age at death 64.3 72.1 14

5. Median age at death 69.0 77.0 14

6. Years of potential life lost due to premature death (per 100,000 population)

11,875 7,213 13

Source for #1, 2, 3, 4, 5: Arizona Health Status and Vital Statistics 2010; Arizona Department of Health Services; data retrieved from www.azdhs.gov on 6/11/2012.Source for #6: County Health Rankings; data retrieved from www.countyhealthrankings.org on 6/11/2012.

49




Overall Health Status and Limitations



1. Percent of adults satisfied or very satisfied with life 93.2% 93.7% 12 (tie)

2. Percent of adults reporting fair to poor general health 16.5% 15.4% 5 (out of 14)

3. Poor physical health days in past 30 days 3.4 3.4 4

4. Poor mental health days in past 30 days 3.6 3.3 9

5. Percent of adults with activity limitations due to health issues 20.9% 20.4% 6

6. Percent of adults who need special equipment for health reasons 8.6% 7.1% 8

7. Percent of live births with low birthweight (<2,500 grams) 7.9% 7.0% 13

Source for #1, 5, 6: Behavioral Risk Factor Surveys 2009 and 2010; Arizona Department of Health Services; data retrieved from www.azdhs.gov on 6/11/2012.Source for #2, 3, 4, 7: County Health Rankings; data retrieved from www.countyhealthrankings.org on 6/11/2012..

50




Health Conditions



1. Percent of adults diagnosed with asthma 12.8% 15.6% 5

2. Percent of adults who have had a heart attack 4.0% 4.5% 4 (tie)

3. Percent of adults who have high blood pressure 21.2% 26.6% 1

4. Percent of adults who have high cholesterol 34.0% 40.9% 5

5. Percent of adults who are obese 29.3% 25.1% 8

6. Percent of adults diagnosed with diabetes 10.7% 8.9% 10

7. Percent of adults who have had a stroke 3.8% 2.9% 8

51

Source for #1, 2, 5, 6, 7: Behavioral Risk Factor Surveys 2009 and 2010; Arizona Department of Health Services; data retrieved from www.azdhs.gov on 6/11/2012. Source for #3, 4: Behavioral Risk Factor Survey 2009; Arizona Department of Health Services; data retrieved from www.azdhs.gov on 6/11/2012.




Age-Adjusted Rates of New Cancer Cases

Navajo County Arizona

All Invasive Cancers 388.7 391.2

Female Breast 90.2 (females only) 109.6 (females only)

Lung and Bronchus 40.0 54.1

Colorectal 17.2 35.5

Corpus and Uterus, Not Otherwise Specified 16.9 (females only) 21.1

Urinary Bladder 11.4 17.8

Ovary 10.5 (females only) 21.1 (females only)

Thyroid 12.9 14.5

Prostate 100.5 (males only) 99.5 (males only)

Kidney and Renal Pelvis 15.4 14.5

Melanomas of the Skin 14.6 14.0

Stomach 13.3 5.1

Testis 12.6 (males only) 5.2 (males only)

52

Note: All rates per 100,000 population and age-adjusted based on new cancer cases reported for 2009.Source: Arizona Cancer Registry Query Module; data retrieved from http://healthdata.azgov on 8/17/2012.





Gonorrhea 33.5 50.8 10

Coccidioidomycosis (Valley Fever) 29.8 175.9 5

Genital herpes 21.4 29.0 9

Methicillin resistant S. aureus (invasive) 11.2 17.6 7

Pertussis 4.7 6.4 11 (tie)

Syphilis (total) 1.9 14.1 2 (tie)

Hepatitis B (acute) 1.9 2.3 7 (tie)

Giardiasis 1.9 2.4 9

Aseptic meningitis 0.9 9.0 6

West Nile virus 0.9 2.6 7

E. Coli 0157:H7 0.9 1.5 6

Hepatitis A 0.9 1.1 5 (tie)

Tuberculosis (total) 4.7 4.4 9

Chlamydia 559.3 420.2 14

Campylobacteriosis 42.8 14.7 14

Salmonellosis 31.6 14.3 15

Streptococcus pneumoniae (invasive) 29.8 11.9 14

Shigellosis 16.8 6.8 13

Streptococcal Group A (invasive) 10.2 2.8 15


Rates of Reported Cases of Selected Notifiable Diseases

53

Note: All rates per 100,000 population.Source: Arizona Health Status and Vital Statistics 2010; Arizona Department of Health Services; data retrieved from www.azdhs.gov on 8/17/2012.



2010Discharges

% of Total Navajo County

% of Total Arizona

Total hospital discharges 9,657

Circulatory system 1,268 13.1% 14.5%

Digestive system 1,170 12.1% 11.3%

Injury and poisoning 1,148 11.9% 9.9%

Respiratory system 1,103 11.4% 9.0%

Musculoskeletal system 624 6.5% 6.3%

Genitourinary system 469 4.9% 5.7%

Infectious and parasitic diseases 442 4.6% 4.1%

Endocrine/nutritional/metabolic/immunity disorders 374 3.9% 3.8%

Symptoms/signs/ill-defined conditions 351 3.6% 5.3%

Neoplasms (cancer) 319 3.3% 4.0%

Skin and subcutaneous tissue 242 2.5% 2.5%

Mental disorders 195 2.0% 2.8%

Nervous system 188 1.9% 2.3%

Conditions originating in perinatal period 110 1.1% 0.5%

Blood and blood-forming organs 83 0.9% 1.0%

Certain congenital anomalies 61 0.6% 0.4%

All other diagnoses 1,510 15.6% 16.7%


Leading Reasons for Hospitalization among Navajo County Residents

54

Source: Arizona Health Status and Vital Statistics 2010; Arizona Department of Health Services; data retrieved from www.azdhs.gov on 6/11/2012.



2010Visits

% of Total Navajo County

% of Total Arizona

Total ER visits 26,859

Injury and poisoning 6,998 26.1% 22.7%

Symptoms/signs/ill-defined conditions 4,877 18.2% 23.8%

Respiratory system 2,686 10.0% 9.9%

Musculoskeletal system 1,351 5.0% 6.9%

Genitourinary system 1,424 5.3% 6.1%

Digestive system 1,751 6.5% 5.8%

Nervous system 1,448 5.4% 6.0%

Skin and subcutaneous tissue 1,162 4.3% 3.8%

Mental disorders 1,272 4.7% 3.5%

Circulatory system 865 3.2% 2.3%

Infectious and parasitic diseases 760 2.8% 2.1%

Endocrine/nutritional/metabolic/immunity disorders 573 2.1% 1.4%

Neoplasms (cancer) 54 0.2% 0.1%

All other diagnoses 1,638 6.1% 5.5%


Leading Reasons for ER Visits among Navajo County Residents

55

Source: Arizona Health Status and Vital Statistics 2010; Arizona Department of Health Services; data retrieved from www.azdhs.gov on 6/11/2012.



Appendix D:Personal Health Behaviors

56

Personal Health Behaviors

Lifestyle Measures

57



1. Binge drinking (5 or more drinks on a single occasion) in past 30 days 11.3% 14.5% 2

2. Consume 5+ fruits and vegetables daily 30.5% 24.7% 3

3. Always use seat belts 80.5% 87.0% 7

4. Moderate/vigorous exercise in past 30 days 55.7% 52.3% 6

5. Teen birth rate (per 1,000 females ages 15-19) 63.1 59.9 8

6. Currently smoke 19.2% 15.6% 9

Source for #1, 2, 4, 6: Behavioral Risk Factor Surveys 2009 and 2010; Arizona Department of Health Services; data retrieved from www.azdhs.gov on 6/11/2012.Source for #3: Behavioral Risk Factor Survey 2010; Arizona Department of Health Services; data retrieved from www.azdhs.gov on 6/11/2012.Source for #5: County Health Rankings; data retrieved from www.countyhealthrankings.org on 6/11/2012.



Personal Health Behaviors

Prevention and Wellness Measures

58



1. Ever had a mammogram (women ages 40+) 89.8% 91.3% 11

2. Ever had a PSA test (men ages 40+) 83.9% 76.8% 1

3. Flu shot in past year (ages 65+) 70.4% 67.0% 2

4. Checkup in past year 69.0% 65.8% 4

5. Ever had a Pap test (women ages 18+) 85.6% 95.3% 15

6. Ever had a colonoscopy (ages 50+) 50.0% 61.0% 13

7. HbA1c screening for Medicare enrollees with diabetes 43.0% 75.6% 14

8. Shingles vaccination in past 5 years (ages 50+) 6.0% 9.1% 12

9. Awareness of folic acid to prevent birth defects (women ages 18-44) 24.1% 57.3% 15

Source for #1, 4, 8: Behavioral Risk Factor Surveys 2009 and 2010; Arizona Department of Health Services; data retrieved from www.azdhs.gov on 6/11/2012.Source for #2, 3, 5, 6, 9: Behavioral Risk Factor Survey 2010; Arizona Department of Health Services; data retrieved from www.azdhs.gov on 6/11/2012.Source for #7: County Health Rankings; data retrieved from www.countyhealthrankings.org on 6/11/2012.



Appendix E:Clinical Care

59

Clinical Care

Availability and Accessibility of Care

60



1. Primary care physicians per 100,000 population 85.4 89.4 5

2. Has a personal doctor or health care provider 74.1% 79.2% 9

3. Mental health providers per 100,000 population 9.8 28.7 8

4. Dentists per 100,000 population 32.7 42.9 6

5. Doesn’t have health insurance 21.6% 14.2% 12

6. Needed to see a doctor but couldn’t afford it during past year 16.7% 13.2% 12

Source for #1, 3, 4: Behavioral Risk Factor Surveys 2009 and 2010; Arizona Department of Health Services; data retrieved from www.azdhs.gov on 6/11/2012.Source for #2, 5, 6: County Health Rankings; data retrieved from www.countyhealthrankings.org on 6/11/2012.



Clinical Care

Effectiveness of Care

61



1. Total health care spending per Medicare enrollee $7,438 $8,413 4

2. Medical patients readmitted to hospital within 30 days of discharge (Medicare only) 14.7% 15.8% 4 (out of 14)

3. Surgical patients readmitted to hospital within 30 days of discharge (Medicare only) 14.2% 12.2% 12 (out of 13)

4. Preventable hospital admissions per 1,000 Medicare enrollees 65.7 51.7 9

Source for #1, 2, 3: Dartmouth Atlas; data retrieved from www.dartmouthatlas.org on 6/11/2012.Source for #4: County Health Rankings; data retrieved from www.countyhealthrankings.org on 6/11/2012.



Appendix F:Physical Environment and Public Safety

62

Physical Environment and Public Safety

Physical Environment

63



1. Percent of all restaurants that are fast food 41.7% 51.7% 7

2. Air pollution: average number of days per year of unhealthy air due to ozone 1 29 7 (tie)

3. Air pollution: average number of days per year of unhealthy air due to particulates 0 1 N/A

4. Percent of population with limited access to healthy foods 22.2% 8.8% 12

5. Number of fitness and recreational facilities per 100,000 population 2.7 7.3 12

Source: County Health Rankings; data retrieved from www.countyhealthrankings.org on 6/11/2012.



Physical Environment and Public Safety

Crime Rates

64



1. Violent crimes per 100,000 population 353.7 466.4 6

2. Larceny – thefts per 1,000 population 13.5 24.5 N/A

3. Burglaries per 1,000 population 8.0 7.5 N/A

4. Aggravated assaults per 1,000 population 3.5 2.4 N/A

5. Motor vehicle thefts per 1,000 population 1.3 3.2 N/A

6. Robberies per 1,000 population 0.3 1.1 N/A

7. Forcible rapes per 1,000 population 0.1 0.2 N/A

8. Arsons per 1,000 population 0.1 0.2 N/A

9. Murders per 1,000 population 0.06 0.10 N/A

Source for #1: County Health Rankings; data retrieved from www.countyhealthrankings.org on 6/11/2012.Source for #2-9: Crime in Arizona Report 2010; Arizona Department of Public Safety; data retrieved from www.azdps.gov on 8/17/2012.



Appendix G:Community Survey Results

65

Community Survey Results

How well are needs for health care services being met in White Mountains?

66

Excellent Very Good

Score (0=low,

10=high)Good

Score (0=low,

10=high)Fair

Score (0=low, 10=high

)

Poor

None Chiropractic 6.51 Dialysis 5.71Specialty physicians

3.62 None

Prescription drugs 6.43 Assisted living 5.55Substance abuse

2.77

Medical equipment 6.38 Outpatient rehabilitation 5.53 Mental health 2.37

Ambulance/emergency transport

6.33 Home health care 5.12

Hospice 6.23 Urgent care 4.98

Outpatient testing 6.20 Primary care 4.89

Dental 6.15 Alternative medicine 4.79

Hospital care - ER & inpatient

6.03 Nursing home 4.67

Communication & coordination

4.59

Note: Excludes “no opinion” responses.Source: Based on results from online and paper survey advertised by Summit Healthcare and completed by 164 respondents between 9/1/2012 and 11/7/2012. Survey administered by Strategy Connections.


How well are health care needs being met for specific populations?

67

Excellent Very Good GoodScore (0=low,

10=high)Fair

Score (0=low,

10=high)Poor

None None Visitors & seasonal residents 5.87 People without health insurance 3.45 None

Racial & ethnic minorities 5.74

Children 5.29

Young families 5.29

Seniors 5.24

Persons with disabilities 4.91

Low income 4.66



How well are health care needs being met for patients & families with specific health conditions?

68

Excellent Very Good

Score (0=low, 10=high

)

GoodScore (0=low, 10=high

)

FairScore (0=low, 10=high

)

Poor

None Pregnancy 6.71Asthma, COPD, respiratory diseases

5.85Alzheimer's disease & other dementias

3.87 None

Cancer 5.44 Obesity 3.58

Heart disease 5.21Mental health conditions

3.11

Diabetes 5.11 Substance abuse & addictions

2.95

Chronic pain 4.19

Stroke & other neurological disorders

4.04



Health Care Obstacles

69

# of Responses % of TotalYes 52 31.7%No 91 55.5%Did Not Answer 21 12.8%Total 164 100.0%

A. In the past 12 months, did anyone in your household go without health care services that they needed?

B. Please identify the issues that caused you or a member of your household NOT to get the care they needed during the past 12 months. (Respondents could select more than one answer.)

# of Responses % of Total

Too expensive 35 35%

Didn’t have health insurance 25 25%

Not satisfied with choice of providers 12 12%

Service wasn’t available locally 11 11%

Couldn’t get a convenient appointment time 5 5%

Didn’t know who to call 3 3%

Didn’t have transportation 1 1%

Language barriers 1 1%

Other 7 7%

Total 100 100.0%

Source: Based on results from online and paper survey advertised by Summit Healthcare and completed by 164 respondents between 9/1/2012 and 11/7/2012. Survey administered by Strategy Connections.


Health Care Obstacles (continued)

70

C. What types of health care services were needed but not obtained?

# of Responses

Primary care 20

Specialty care 10

Dental care 8

Diagnostic testing 6

Vision care 2

Prescriptions 2

Surgery/other treatment 2

Mental health services 2

Emergency services 1

Source: Based on results from online and paper survey advertised by Summit Healthcare and completed by 164 respondents between 9/1/2012 and 11/7/2012. Survey administered by Strategy Connections.


How important are these goals & activities to improving overall health of the population?

71

Top QuartileScore (0=low, 10=hig

h)

2nd QuartileScore (0=low, 10=hig

h)

3rd QuartileScore (0=low, 10=hig

h

4th QuartileScore (0=low, 10=hig

h)

Get prenatal care 9.60 Decrease tobacco use 9.05 Decrease teen pregnancy 8.80Develop streets & trails to promote walking/bicycling

8.04

Decrease substance abuse 9.38 Improve diet & nutrition 9.04 Get regular eye exams 8.46 Improve access to

healthy foods 7.87

Increase exercise & physical fitness 9.17 Get routine physicals &

lab work 8.95 Use seat belts & car seats 8.33 Improve access to

recreational facilities 7.67

Get recommended screening exams 9.15 Get recommended

immunizations 8.89 Improve stress management skills 8.13 Improve connections

with spiritual care 7.59

Achieve a healthy weight 9.14 Get regular dental checkups 8.84 Decrease motor vehicle

accidents 8.11 Improve water quality 6.48

Decrease suicides 8.81 Improve community safety 8.10 Improve air quality 6.08



Demographic Profile of Survey Respondents (n=164)

72

Sex # of Responses % of Total

Male 32 19.5%

Female 97 59.2%

Did Not Answer 35 21.3%

Total 164 100.0%

Age # of Responses % of Total

Under 18 0 0.0%

18-44 45 27.4%

45-64 72 43.9%

65+ 11 6.7%


Total 164 100.0%

# in Household # of Responses % of Total

1 11 6.7%

2 56 34.2%

3-4 43 26.2%

More than 4 19 11.6%


Total 164 100.0%

Zip Code # of Responses % of Total

Show Low 44 26.8%

Lakeside 22 13.4%

Pinetop 15 9.2%

Snowflake 11 6.7%

Vernon 7 4.3%

Taylor 6 3.7%

Other Navajo County 14 8.5%

Other Apache County 8 4.9%


Total 164 100.0%

Residency # of Responses % of Total

Full Time Resident 121 73.8%

Part Time or Seasonal Resident 0 0%

Don’t Live Here At All 7 4.3%


Total 164 100.0%


Demographic Profile of Survey Respondents (n=164)

73

Diversity # of Responses % of Total

White non-Hispanic 113 68.9%

Hispanic of any race 10 6.1%

American Indian/Alaska Native non-Hispanic

4 2.4%

Asian non-Hispanic 1 0.6%

Black non-Hispanic 0 0%

Multi-racial 0 0%


Total 164 100.0%

Health Plans # of Responses % of Total

Group insurance 108 57.8%

No coverage 18 9.6%

Individual insurance 8 4.3%

Medicare HMO/PPO 5 2.7%

Traditional Medicare 3 1.6%

AHCCCS/Medicaid 3 1.6%

Indian Health Service 2 1.1%

KidsCare 0 0%

Other coverage 5 2.7%


Total 187 100.0%

Note: Respondents could select multiple answers.

Appendix H:Community Leader Meeting Attendees

74

Appendix H: Community Leader Meeting Attendees

Participant List

75

Name Title Organization

Bowman, Greg Pastor Life Church

Bowman, Kassie Pastor Life Church

Bradley, Bart Director of Nursing Tall Pines Care and Rehab

Bruce, Barbara President Summit Healthcare Foundation/White Mountain Radio

Carlyon, Brad Attorney Navajo County

Ebert, Thia Chief Nursing Officer Summit Healthcare

Forney, Julie Director Summit Healthcare Cancer Center

Garrett, Steve Member Summit Healthcare Governing Board

Grugel, Kirk Director CASA of Navajo County

Head, Brad Director of Special Operations Community Counseling Centers

Jacobs, Carolyn Chief Quality Officer Summit Healthcare

Jeffries, Nadine Community Member

Jeffries, Mark Director Frontier Communications

Kartchner, Wade Director Navajo County Public Health

Kolling, Angie Chief Marketing & Communications Officer Summit Healthcare

Lanner, Mary Anne Branch Manager Pioneer Title Agency

Lewis, Sandra Executive Director Tall Pines Care and Rehab

Loveless, Kurt Chief Financial Officer Summit Healthcare

Macedo, Sharon Community Development Specialist

Matyas, Samuel Chief Operating Officer Snowflake Carriage House

Appendix H: Community Leader Meeting Attendees

Participant List (continued)

76

Name Title Organization

McArthur, Ron Chief Executive Officer Summit Healthcare

Moore, Hunter Government Relations Administrator Navajo County

Nicks, Laura Director of Care Resources Summit Healthcare

Northup, Jeff Chief Medical Officer Summit Healthcare

Oakes, Jeffrey Chief Executive Officer Community Counseling Center

O’Donnell, Crystal Executive Director Pinetop-Lakeside Chamber of Commerce

Orth, Susan Office Manager Silversword Asset Management

Sandoval, Kathy Bank Manager National Bank of Arizona

Smith, Carol Owner Bannon Springs Assisted Living Center

Stoner, Julie Administrative Assistant Summit Healthcare

Szoke, Jana Program Manager NCOG

Tegmeyer, Susan Executive Director Show Low Chamber of Commerce

Thompson, Neal Chairman Summit Healthcare Governing Board

Tyler, Mary Assistant Health Director Navajo County Public Health

Wright, Doug ER Physician, Chief of Staff Summit Healthcare

Appendix I:Additional Information

77

78Appendix I: Additional Information

Health Care Services Available to Meet Community Health Needs (Area A)

Type of Service(s)# of Facilities or

ProvidersAdditional Information

Acute Care Hospital w/ 24 hour ER 1 • Summit Healthcare Regional Medical Center

Physicians – Primary CareSource: Summit Healthcare (3/13/2013)

16+ • 16 primary care physicians have active staff privileges at Summit – family medicine, general internal medicine & pediatrics.

• There are additional primary care physicians (and non-physicians) who practice in the area but don’t have active staff privileges at Summit.

Physicians – Medical SubspecialtiesSource: Summit Healthcare (3/13/2013)

15+ • 15 medical subspecialists have active staff privileges at Summit, including cardiology, oncology, pulmonary medicine and nephrology.

• There may be additional medical subspecialists who practice in the area but don’t have active staff privileges at Summit.

Physicians – Surgery Source: Summit Healthcare (3/13/2013)

20+ • 20 surgeons have active staff privileges at Summit, including obstetrics & gynecology, general surgery, orthopedics, urology, vascular surgery, plastic surgery, ENT & pain management.

• There may be additional surgeons who practice in the area but don’t have active staff privileges at Summit.

Federally Qualified Health CenterSource: www.northcountryhealthcare.org

1 clinic location (Show Low) in

Area A

• North Country HealthCare

VA Outpatient ClinicSource: www.phoenix.va.gov

1 • Show Low VA Health Care Clinic


Health Care Services Available to Meet Community Health Needs (Area A)

Type of Service(s)# of Facilities or Providers

Additional Information

Public Health ServicesSource: www.navajocountyaz.gov/pubhealth

Satellites in Show Low & Snowflake

• Navajo County Public Health Services District

Urgent Care CentersSource: Google search

1 • StatClinix

Home Health Agencies – Medicare CertifiedSource: www.medicare.gov

3 • Summit Healthcare Home Health• KC’s Home Health Care, LLC• Focus Care of Arizona, LLC

DialysisSource: www.medicare.gov

1 • Show Low Dialysis

Nursing HomesSource: Navajo County Health Assessment (2012)

2 • Tall Pines Care and Rehab• Sierra Blanca

Hospice and Palliative CareSource: Navajo County Health Assessment (2012)

1 • Hospice Compassus

DentistsSource: Navajo County Health Assessment (2010)

≈11 • Several dental clinics in Show Low area

Mental Health & Substance AbuseSource: www.samhsa.org

2 • Community Counseling Centers Outpatient Unit

• Community Counseling Centers at PineView Psychiatric Hospital

During the next three years, Summit will focus on helping to address the top health needs as identified by community leaders – mental health and substance abuse services. This effort will require a significant commitment of time and resources to be successful. For the other seven areas listed above, Summit will continue to collaborate with local physicians as well as other groups and organizations to monitor the issues and assist with resources when it is consistent with our mission and within our capabilities to do so. We will also consider these community health needs as we plan various community outreach programs and services.

Summit already plays an active role in monitoring community needs for primary and specialty medical care and in helping to address gaps as appropriate. We provide discounted care for individuals who qualify. We work with our physicians and other community organizations to provide and promote screening exams for cancer. We provide community outreach programs to help people better manage chronic health conditions and maintain a healthy lifestyle. Can we do more? No doubt. During the next three years, we will continue to evaluate our activities related to these community health needs and identify opportunities to improve and expand our efforts.


Summit’s Role in Addressing Other Identified Needs

Other Community Health NeedsMean Score (see p. 33

for details)

1. Prenatal care2. Services for individuals without health insurance3. Exercise and physical fitness4. Cancer screening exams5. Management of chronic diseases6. Specialty physicians7. Obesity treatment services

4.003.853.813.803.653.353.15

Carol Davis offers 22 years of health care consulting and management experience. She engages clients in understanding their critical strategic issues and implementing collaborative solutions with measurable results. Carol has been recognized by clients for excellence in customer service, group facilitation, physician relations, board development and project management.

Community Health Experience

Carol has assisted a number of hospitals with conducting a community health needs assessment and developing a strategic plan to address identified needs as required for 501(c)(3) hospitals under national health care reform legislation passed in March 2010. These projects require strong analytic as well as group facilitation skills, along with the ability to customize each engagement to reflect the organization’s unique mission, capabilities and resources.

Carol’s interest and experience with community health projects is long standing. As a health system executive in 1992, she persuaded the organization to designate community health improvement as a strategic priority. She championed community health initiatives both internally as well as across the community to address pressing needs. In 1998, she was recognized as a Public Health Hero for “efforts to assure primary health care access to low income and uninsured members of the community.”

Selected community health activities: Member of Leadership Council for community-wide initiative for prevention of substance abuse Co-founder and President of non-profit organization that successfully expanded access to primary care services Co-founder of coalition that completed inaugural community health assessment and improvement plan Member of Community Benefit Steering Committee for VHA regional initiative

Strategy Consulting Experience

With experience as an independent consultant as well as with a national health care consulting company, Carol has served as project leader for over 250 strategy engagements with 85 hospitals and health systems located in 23 states. Areas of expertise include organizational strategy, hospital-physician integration strategy and community health strategy.

81

Appendix I: Additional Information


Selected consulting engagements: Led efforts by a community hospital to implement an integration strategy with independent physicians Assessed market potential of building an acute care hospital in an underserved community Evaluated market potential of reopening an acute care hospital that had closed due to bankruptcy Developed patient volume projections to support building replacement hospitals in rural markets Worked with two competing hospitals to explore a potential merger Worked with an American Indian tribe to resolve funding issues with the Indian Health Service under a Self-

Governance Compact

Health System Experience

As executive leader for strategic services in a 220 bed regional referral hospital for seven years, Carol was responsible for strategic planning, business development, marketing, community health improvement and information technology.

Education

Carol earned an M.S. in Health Administration from the University of Colorado at Denver, and a B.M.E. in Music Therapy from the University of Kansas.

Professional Memberships American College of Healthcare Executives Society for Healthcare Strategy and Market Development Healthcare Financial Management Association Association for Community Health Improvement Colorado Health Administration Alumni Association

Additional Information Company website: www.strategy-connect.com Linked In profile: www.linkedin.com/pub/carol-davis/6/76a/78a/

82



http://www.strategy-connect.com/

http://www.linkedin.com/pub/carol-davis/6/76a/78a/

http://www.linkedin.com/pub/carol-davis/6/76a/78a/

IRS Schedule H, Form 990 Reference Topic Report Location and/or Suggested Response

Part V, Sec B, Line 1a Definition of community served by hospital • Pages 8, 15, 37-38

Part V, Sec B, Line 1b Demographics of the community • Pages 9, 39-40

Part V, Sec B, Line 1c Existing health care facilities and resources within the community that are available to respond to the health needs of the community

• Pages 78-79

Part V, Sec B, Line 1d How data was obtained • Pages 11-15

Part V, Sec B, Line 1e Health needs of the community • Health needs identified in community survey page 18• Health needs identified from survey + data pages 20, 32• Health needs prioritized by community leaders page 33

Part V, Sec B, Line 1f Primary and chronic disease needs and other health issues of uninsured persons, low income persons and minority groups

• Health needs identified in community survey page 18• Health needs identified from survey + data pages 20, 32• Health needs prioritized by community leaders page 33

Part V, Sec B, Line 1g Process for identifying and prioritizing community health needs and services to meet the community health needs

• Pages 31-34


Schedule H ReferencesThe Affordable Care Act was passed by Congress and signed into law in March 2010. The legislation contains a new community health needs assessment (CHNA) standard that a non-profit hospital must meet in order to retain its status as a tax-exempt charitable organization under Section 501(c)(3) of the Internal Revenue Code. Final regulations for complying with the CHNA requirement have not yet been issued; the IRS, however, issued draft reporting regulations in December 2011.

83

IRS Schedule H, Form 990 Reference Topic Report Location and/or Suggested Response

Part V, Sec B, Line 1h Process for consulting with persons representing the community’s interests

• Community survey page 13• Community leader meeting page 31

Part V, Sec B, Line 1i Information gaps that limit the hospital facility’s ability to assess the community’s health needs

• Secondary data limitations page 11• Primary data limitations page 13• Information gaps Area B page 15

Part V, Sec B, Line 2 Tax year the hospital facility last conducted a Needs Assessment

• FYE December 31, 2013

Part V, Sec B, Line 3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from public health experts and persons who represent the community served by the hospital facility? If yes, describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted.

• Consulted with Mary Tyler, Assistant Director, Navajo County Public Health Services District in May 2012 during project kick-off meetings and again in January 2013 to share findings. Ms. Tyler also participated in community leader meeting in February 2013, along with Dr. Wade Kartchner, Director of Navajo County Public Health Services District.

• Invited broad cross-section of community leaders to participate in a priority-setting meeting in February 2013.

• Thirty-five people representing 18 organizations participated in the February 2013 priority-setting meeting. Individuals are listed by name, title and organization on pages 75-76..

Part V, Sec B, Line 4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities?

• No

Part V, Sec B, Line 5 Did the hospital facility make its Needs Assessment widely available to the public? If yes, indicate how.

• Available on hospital website: www.summithealthcare.net• Available by request from Summit Healthcare administration:

928.537.6399


Schedule H References

IRS Schedule H, Form 990 Reference

Topic Report Location and/or Suggested Response

Part V, Sec B, Line 6a Adoption of an implementation strategy to address the health needs of the hospital facility’s community

• Implementation plan for FY2014 to be developed and adopted by the end of FY2013 (December 31, 2013)

Part V, Sec B, Line 6f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment

• Budget to support implementation plan for FY2014 to be developed and adopted by the end of FY2013 (December 31, 2013)

Part V, Sec B, Line 6g Prioritization of health needs in community • Pages 31-34

Part V, Sec B, Line 7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If no, explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs.

• Page 80


Schedule H References

Date post:	17-Dec-2015
Category:	Documents
Upload:	dwight-barber
View:	215 times
Download:	0 times

Prepared with consulting assistance from: Summit Healthcare Regional Medical Center Community Health...

Documents