4A (Expenses $ 3455578059 including grants of $ 2048176) (Revenue $ 4145370739)
SEE SCHEDULE O

NOTE: THIS SCHEDULE H CONTAINS REFERENCES TO DUKE AND DUKE HEALTH WHICH ARE
"MEANT TO ENCOMPASS FOR THE PURPOSES OF THIS SCHEDULE DUKE UNIVERSITY HEALTH SYSTEM (DUHS), DUKE UNIVERSITY SCHOOL OF MEDICINE, AND DUKE UNIVERSITY SCHOOL OF NURSING. PART V, SECTION B:GROUP A - FACILITY 1 - DUKE UNIVERSITY HOSPITALPART V, SECTION B, LINE 5: DUKE UNIVERSITY HOSPITAL (""DUH"") DUH COLLABORATES WITH THE PARTNERSHIP FOR A HEALTHY DURHAM (THE STATE CERTIFIED HEALTHY CAROLINIANS GROUP) AND THE DURHAM COUNTY HEALTH DEPARTMENT TO CONDUCT THE DURHAM COUNTY COMMUNITY HEALTH ASSESSMENT AND DEVELOPS STRATEGIES TO ADDRESS IDENTIFIED NEEDS. FACULTY AND STAFF OF THE DUKE DIVISION OF COMMUNITY HEALTH AND APPOINTED MEMBERS OF THE DUH SENIOR LEADERSHIP TEAM OFFICIALLY SERVE ON THE PARTNERSHIP FOR A HEALTHY DURHAM COMMITTEES.THE 2020 COMMUNITY HEALTH ASSESSMENT REPORT WAS PUBLISHED BY DURHAM COUNTY IN 2021. THE 2020 SURVEY WAS CONDUCTED BETWEEN MAY AND SEPTEMBER 2019, AND CARRIED OUT BY 243 COMMUNITY VOLUNTEERS, PARTNERSHIP MEMBERS, AND STAFF FROM DURHAM COUNTY DEPARTMENT OF PUBLIC HEALTH AND DUKE HEALTH. THE COUNTY WIDE SURVEY SAMPLE SIZE WAS DOUBLED IN 2019 TO ANALYZE DATA BY RACE AND ETHNICITY. THE ASSESSMENT INCLUDED 612 RESIDENT SURVEYS IN COUNTY WIDE AND HISPANIC OR LATINO NEIGHBORHOOD SAMPLES. COMMUNITY LISTENING SESSIONS WERE CONDUCTED VIA ZOOM DUE TO COVID-19 RESTRICTIONS. THE COMMUNITY HEALTH ASSESSMENT TEAM - COMPRISED OF MEMBERS REPRESENTING LOCAL GOVERNMENTS, HEALTH CARE SYSTEMS, COLLEGES & UNIVERSITIES, COMMUNITY-BASED ORGANIZATIONS AND NON-PROFITS IN SECTORS OF PHYSICAL AND MENTAL HEALTH, TRANSPORTATION, EDUCATION, HOUSING, RESEARCH, FOOD ACCESS, PLANNING ENVIRONMENT AND MORE WORKED TO DIRECT THE ACTIVITIES OF THE ASSESSMENT AND PROVIDE WRITTEN CONTENT AND EXPERTISE ON ISSUES OF INTEREST. THIS JOINT CHNA AND RELATED IMPLEMENTATION PLAN WAS ADOPTED BY THE DUHS BOARD OF DIRECTORS AND PUBLISHED ON THE DUKE HEALTH WEBSITE IN FISCAL YEAR 2022 (TAX YEAR 2021).GROUP A - FACILITY 1 - DUKE UNIVERSITY HOSPITALPART V, SECTION B, LINE 6A: DUKE REGIONAL HOSPITAL (""DRH"")GROUP A - FACILITY 1 - DUKE UNIVERSITY HOSPITALPART V, SECTION B, LINE 6B: THE PARTNERSHIP FOR A HEALTHY DURHAM AND THE DURHAM COUNTY HEALTH DEPARTMENTGROUP A - FACILITY 1 - DUKE UNIVERSITY HOSPITALPART V, SECTION B, LINE 11: THE ASSESSMENT IDENTIFIED THE SAME FIVE HEALTH PRIORITIES FOR 2021-2023 AS THOSE OF THE PREVIOUS ASSESSMENT CYCLE: 1. AFFORDABLE HOUSING 2. ACCESS TO HEALTHCARE AND HEALTH INSURANCE3. POVERTY 4. MENTAL HEALTH 5. OBESITY, DIABETES AND FOOD ACCESS ALL OF THE PROGRAMS DESCRIBED IN THE FOLLOWING IMPLEMENTATION PLAN ARE ALIGNED WITH THE FIVE HEALTH PRIORITIES WITH MANY OF THE PROGRAMS ADDRESSING COMBINATIONS OF THE FIVE HEALTH PRIORITIES. A BRIEF EXCERPT FROM THE COMMUNITY HEALTH NEEDS ASSESSMENT DESCRIBING EACH PRIORITY IS INCLUDED IN THIS IMPLEMENTATION PLAN. DUH CONSIDERS THIS DOCUMENT TO BE A ""WORKING PLAN"" THAT WILL CONTINUE TO EVOLVE OVER THE THREE YEAR PERIOD IN ORDER TO ENSURE THE EFFICACY OF STRATEGIES INTENDED TO MEET EXPRESSED COMMUNITY HEALTH NEEDS. THIS IMPLEMENTATION PLAN MAY NOTE, BUT DOES NOT CONTAIN DETAILED DESCRIPTIONS OF, THE COMMUNITY HEALTH IMPROVEMENT WORK CARRIED OUT BY OTHER COMPONENTS OF THE LARGER DUKE HEALTH SYSTEM OR DUKE UNIVERSITY. THIS IMPLEMENTATION PLAN IS INTENDED TO HIGHLIGHT DUKE HOSPITAL'S CONTINUALLY EVOLVING ACTIVITIES AND SUPPORT TO IMPROVE HEALTH WITH THE DURHAM COMMUNITY.TOGETHER WITH ITS PARTNERS, DUH ASKS ABOUT AND LISTENS TO CONCERNS, EXPLORES BARRIERS TO CARE, ANALYZES HEALTHCARE UTILIZATION AND COSTS, IDENTIFIES PARTNER NEEDS AND RESOURCES, PLANS/REDESIGNS SERVICES, TRACKS OUTCOMES, AND SHARES ACCOUNTABILITY IN ORDER TO DEVELOP EFFECTIVE PROGRAMS TO IMPROVE THE HEALTH OF THE DURHAM COMMUNITY. AS SUCH THIS IMPLEMENTATION PLAN INCLUDES NEW AND LONG-STANDING PROGRAMS. 1. AFFORDABLE HOUSINGAFFORDABLE HOUSING, AS DEFINED BY HUD (U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT), REQUIRES NO MORE THAN 30% OF A FAMILY'S MONTHLY INCOME. IF A FAMILY SPENDS MORE THAN 30% OF INCOME ON HOUSING, THEY ARE LESS ABLE TO PAY FOR OTHER EXPENSES, SUCH AS FOOD AND HEALTHCARE. THE INCREASED COST BURDEN OF UNAFFORDABLE HOUSING ADDS TO PSYCHOSOCIAL STRESSORS THAT CAN NEGATIVELY IMPACT A FAMILY. RENTERS MAKE UP 40% OF HOUSEHOLDS IN DURHAM, AND ALMOST HALF OF THEM ARE DEFINED AS COST-BURDENED (I.E. PAYING MORE THAN 30% OF THEIR MONTHLY INCOME FOR HOUSING).DUH HAS PARTNERED WITH HABITAT FOR HUMANITY OF DURHAM ON A NUMBER OF HOME BUILDS. ADDITIONALLY, AFFORDABLE HOUSING IS A FOCUS OF DUH AS PART OF THE LARGER DUKE UNIVERSITY. FUNDING FROM DUKE UNIVERSITY AND THE AJ FLETCHER FOUNDATION PROVIDED THE OPPORTUNITY TO DEVELOP TWO ACRES OF PRIME DOWNTOWN DURHAM LAND INTO MULTI-UNIT AFFORDABLE HOUSING. THE DEVELOPMENT BROKE GROUND IN JULY 2019, AND THE MULTI-UNIT HOUSING COMPLEX WAS FINISHED AND OCCUPIED IN 2021. DUKE'S WORK RELATED TO AFFORDABLE HOUSING IS AND WILL CONTINUE TO BE LED BY DUKE UNIVERSITY'S OFFICE OF DURHAM AND PUBLIC AFFAIRS. FOR INSIGHT INTO THIS AND OTHER WORK LED BY THE OFFICE OF DURHAM AND COMMUNITY AFFAIRS, SEE: HTTPS://COMMUNITY.DUKE.EDU/PROGRAMS-INITIATIVES/HOUSING-NEIGHBORHOODS/.2. ACCESS TO HEALTHCARE AND HEALTH INSURANCE:ACCESS TO HEALTHCARE IN A COMMUNITY REFERS TO THE ABILITY OF RESIDENTS TO FIND A CONSISTENT MEDICAL PROVIDER FOR THEIR PRIMARY CARE NEEDS, TO FIND A SPECIALTY PROVIDER WHEN NEEDED AND TO BE ABLE TO RECEIVE THAT CARE WITHOUT ENCOUNTERING SIGNIFICANT BARRIERS. ALTHOUGH THERE ARE MANY MEDICAL PROVIDERS, WHICH INCLUDE A NUMBER OF LOW COST AND FREE CLINICS IN DURHAM COUNTY, THERE ARE STILL MANY DURHAM RESIDENTS WHO HAVE TROUBLE ACCESSING CARE WHEN THEY NEED IT. BARRIERS TO OBTAINING HEALTHCARE INCLUDE ISSUES WITH TRANSPORTATION, LANGUAGE BARRIERS, OR DISTRUST OF THE HEALTHCARE SYSTEM. ACCORDING TO THE COMMUNITY HEALTH ASSESSMENT SURVEY, THE TOP REASONS IDENTIFIED BY DURHAM COUNTY RESIDENTS FOR WHY THEY OR SOMEONE IN THEIR HOUSEHOLD COULD NOT ACCESS NECESSARY HEALTHCARE INCLUDED INSURANCE DIDN'T COVER SERVICE, COPAY WAS TOO HIGH, LACK OF INSURANCE, COULDN'T GET AN APPOINTMENT, DIDN'T KNOW WHERE TO GO OR PROVIDER DIDN'T TAKE THEIR INSURANCE.A NUMBER OF LONG-STANDING PROGRAMS SUPPORTED BY DUH SEEK TO INCREASE ACCESS TO CARE FOR UNINSURED, UNDERINSURED, AND/OR VULNERABLE INDIVIDUALS AND FAMILIES. THOSE PROGRAMS INCLUDE:PROJECT ACCESS OF DURHAM COUNTY (PADC): LINKS ELIGIBLE LOW-INCOME, UNINSURED DURHAM COUNTY RESIDENTS TO SPECIALTY MEDICAL CARE FULLY DONATED TO THE PATIENTS BY THE PHYSICIANS, HOSPITALS INCLUDING DUH, LABS, CLINICS AND OTHER PROVIDERS PARTICIPATING IN THE PADC NETWORK.PLANS FOR FY2022: CONTINUE COVID-19 RESPONSE EFFORTS AND NAVIGATE DISRUPTION/DELAYS IN SPECIALTY SERVICES THAT MAY OCCUR DUE TO COVID-19.PROGRESS IN FY2022: PADC CONTINUED TO SUPPORT SPECIFIC COVID-19 EFFORTS THROUGH THE NC COVID-19 COMMUNITY HEALTH WORKERS INITIATIVE AND THE DURHAM VACCINE EQUITY COALITION. PADC PROVIDED SPECIALTY SERVICES TO 2,067 PATIENTS.LOCAL ACCESS TO COORDINATED HEALTHCARE (LATCH): WAS INITIATED IN 2002 WITH HEALTHY COMMUNITIES ACCESS PROGRAM (HCAP) FUNDING FROM THE US HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) TO DUKE'S DIVISION OF COMMUNITY HEALTH, DEPARTMENT OF COMMUNITY AND FAMILY MEDICINE. THE FOUNDING AND SUSTAINING LATCH PARTNERSHIP INCLUDES DUH (WHICH NOW PROVIDES THE MAJORITY OF OPERATING FUNDS), LINCOLN COMMUNITY HEALTH CENTER, THE DURHAM COUNTY DEPARTMENTS OF HEALTH AND SOCIAL SERVICES, EL CENTRO HISPANO, AND A NUMBER OF COMMUNITY-BASED ORGANIZATIONS (CBOS). THROUGH COMMUNITY-BASED, LINGUISTICALLY AND CULTURALLY-RELEVANT CARE MANAGEMENT, LATCH AIMS TO IMPROVE HEALTH KNOWLEDGE AND SELF-CARE, ACCESS TO HEALTH CARE AND HEALTH SERVICES UTILIZATION OUTCOMES AMONG DURHAM COUNTY'S UNINSURED. CARE MANAGEMENT SERVICES INCLUDE: HEALTH SERVICES COORDINATION AND NAVIGATION (MEDICAL, SOCIAL, BEHAVIORAL); POST-HOSPITALIZATION FOLLOW-UP; PATIENT EDUCATION; CHRONIC DISEASE MANAGEMENT; PSYCHO-SOCIAL SUPPORT; ACCESS TO BENEFITS (MEDICAID/SSI/SSDI); BILLS ASSISTANCE; INTERPRETATION/TRANSLATION; AND, TRANSPORTATION COORDINATION. IN PARTNERSHIP WITH OTHER COMMUNITY STAKEHOLDERS-HEALTHCARE AND SOCIAL SERVICE PROVIDERS, LOCAL GOVERNMENT AND COMMUNITY-BASED ORGANIZATIONS-LATCH MONITORS HEALTHCARE TRENDS, IDENTIFIES BARRIERS FACING UNINSURED PATIENTS, AND, WORKING AS A CONSORTIUM, ADDRESSES AND ELIMINATES BARRIERS."

PLANS FOR FY2022: CONTINUE CARE MANAGEMENT SERVICES AND
"COVID-19 RESPONSE EFFORTS TO ADDRESS THE NEEDS OF ITS PATIENT POPULATION GIVEN THE RESOURCES AVAILABLE.PROGRESS IN FY2022: LATCH EXPERIENCED SIGNIFICANT STAFFING ISSUES IN 2022, BUT CONTINUED TO SUPPORT COVID-19 EFFORTS ACROSS THE COMMUNITY.THE COMPLEX CHILD PROGRAM (CCP): PROVIDES THE COORDINATION OF MEDICAL AND CO-MANAGEMENT OF MEDICAL CARE FOR CHILDREN WITH MULTIPLE MEDICALLY COMPLEX ISSUES THAT REQUIRE THE INTERACTION WITH MULTIPLE SPECIALISTS. ON AVERAGE THESE CHILDREN WORK WITH 13 SPECIALISTS. BEFORE THE COMPLEX CHILD PROGRAM, CARE COULD SEEM FRAGMENTED AS PATIENTS/FAMILIES HAD NO CENTRAL ""QUARTERBACK"" HELPING TO OVERSEE THE BIG PICTURE.THROUGH THE CCP PARENTS NOW HAVE DIRECT PHONE ACCESS TO A COMPLEX CARE SERVICE (CCS) PROVIDER OR RN 24/7. THE CCP TEAM WORKS WITH PARENTS TO CREATE A COMPREHENSIVE ""COMPLEX CARE PLAN"" THAT IS PLACED IN THE CHILD'S MEDICAL RECORD AND GIVEN TO THE PARENTS. IN ADDITION, THE CCP TEAM COORDINATES INPATIENT INTENSIVE CARE TRANSITIONS PRIOR TO DISCHARGE AND CONDUCTS INTENSIVE OUTPATIENT ""BETWEEN-VISIT"" CONTACTS (PHONE, CLINIC VISITS, AND IN SOME CASES, HOME VISITS). PLANS FOR FY2022: CONTINUE THE CCP SERVING CHILDREN WITH MULTIPLE MEDICALLY COMPLEX ISSUES AND THEIR FAMILIES.PROGRESS IN FY2022: AS IN FY2021, CCP CONTINUED TO MAXIMIZE SERVICES TO CHILDREN WITH MULTIPLE MEDICALLY COMPLEX ISSUES AND THEIR FAMILIES.SOUTHERN HIGH SCHOOL (SHS) WELLNESS CENTER: PROVIDES COMPREHENSIVE PRIMARY CARE AND MENTAL HEALTH SERVICES AT SHS TO STUDENTS AT THE SCHOOL AND IS OPEN TO ALL STUDENTS AND STAFF OF DURHAM PUBLIC SCHOOLS. IT IS OPERATED BY DUKE'S DIVISION OF COMMUNITY HEALTH ON BEHALF OF DUH. DURHAM PUBLIC SCHOOLS CLOSED TO IN-PERSON LEARNING IN MARCH 2020 AS A RESULT OF COVID-19. THE SOUTHERN HIGH SCHOOL WELLNESS CENTER PIVOTED TO PROVIDING TELEHEALTH SERVICES (VIA PHONE AND VIDEO VISITS) IN 2021."

JUST FOR US (JFU): PROVIDES AN IN-HOME CARE PROGRAM FOR LOW-INCOME,
FRAIL ELDERLY AND DISABLED. JFU WAS LAUNCHED IN 2002 AS A COLLABORATION OF DUKE, LINCOLN COMMUNITY HEALTH CENTER, DURHAM DEPARTMENT OF SOCIAL SERVICES (DSS), THE LOCAL AREA MENTAL HEALTH ENTITY, AND THE DURHAM HOUSING AUTHORITY. DUH PROVIDES THE MAJORITY OF ONGOING SUPPORT FOR THE PROGRAM. THROUGH JFU, AN INTERDISCIPLINARY TEAM OF PROVIDERS SERVES CLIENTS IN THEIR HOMES, PROVIDING MEDICAL CARE, MANAGEMENT OF CHRONIC ILLNESSES, AND CASE MANAGEMENT. EACH PARTICIPANT RECEIVES A HOME VISIT EVERY 5 WEEKS UNLESS THERE IS AN ACUTE EPISODE OR A HOSPITAL DISCHARGE, FOR WHICH A VISIT IS SCHEDULED IMMEDIATELY. VISITS INCLUDE MEDICATION RECONCILIATION, SOCIAL ISSUES, SUPPORT SERVICES, CHRONIC DISEASE MANAGEMENT, AND POST-HOSPITAL CARE. THE HEALTH CARE TEAM CONSISTS OF A CLINICAL PROVIDER (PA, NP OR MD), OCCUPATIONAL THERAPIST, REGISTERED DIETITIAN, SOCIAL WORKER, PHLEBOTOMIST, AND COMMUNITY HEALTH WORKER. ALMOST ALL OF THE JFU IN HOME VISITS CEASED IN MARCH 2020 AS A RESULT OF COVID-19. AS A RESULT, THE JFU TEAM CONDUCTED FREQUENT WELL-CHECK CALLS AND PROVIDED TELEHEALTH SERVICES (VIA PHONE/VIDEO VISITS).NEIGHBORHOOD/COMMUNITY CLINICS: DUH IN PARTNERSHIP WITH LINCOLN COMMUNITY HEALTH CENTER COLLABORATIVELY OPERATES THREE COMMUNITY HEALTH CLINICS: THE LYON PARK COMMUNITY CLINIC, THE WALLTOWN NEIGHBORHOOD CLINIC AND THE HOLTON WELLNESS CENTER. THE CLINICS WERE DESIGNED TO PROVIDE PRIMARY CARE, HEALTH EDUCATION, AND DISEASE PREVENTION TO THE UNDERSERVED POPULATIONS OF DURHAM. THE CLINICS PROVIDE MEDICAL CARE FOR PERSONS WITH AND WITHOUT HEALTH INSURANCE. THOSE WITHOUT INSURANCE ARE SEEN BASED ON A SLIDING FEE SCALE. NO PATIENT IS DENIED CARE BASED ON INABILITY TO PAY FOR SERVICES. THE LYON PARK CLINIC WAS THE FIRST OF THE COLLABORATIVE NEIGHBORHOOD CLINICS, OPENING ITS DOORS FOR PATIENT CARE IN APRIL 2003. THE WALLTOWN CLINIC OPENED IN JANUARY 2005 AND THE HOLTON CLINIC OPENED IN AUGUST 2009. EACH CLINIC RECEIVED START-UP FUNDS THROUGH A DUKE ENDOWMENT GRANT. CLINICS GENERATE REVENUE THROUGH A CONTRACT WITH LINCOLN COMMUNITY HEALTH CENTER AND RECEIVE SIGNIFICANT SUPPORT FROM DUH. THE CLINICS OPERATE AS FAMILY MEDICINE PRACTICES AND ARE OPEN 5 DAYS A WEEK. STAFFING INCLUDES PHYSICIAN ASSISTANTS, NURSE PRACTITIONERS AND FAMILY PHYSICIANS, WHO SERVE AS SUPERVISING DOCTORS. EACH CLINIC IS SUPPORTED BY NURSING STAFF: CERTIFIED NURSING ASSISTANTS, LICENSED PRACTICAL NURSES, OR CERTIFIED MEDICAL ASSISTANTS AND A STAFF ASSISTANT. THE STAFF ASSISTANT PERFORMS ALL ADMINISTRATIVE TASKS FOR THE CLINIC INCLUDING ANSWERING INCOMING PHONE CALLS, REGISTRATION, SCHEDULING, ETC. PLANS FOR FY2022: UTILIZING LESSONS LEARNED DURING COVID-19, THE SOUTHERN HIGH SCHOOL WELLNESS CENTER, JUST FOR US, AND THE NEIGHBORHOOD/COMMUNITY CLINICS WILL CONTINUE TO FIND WAYS TO IMPROVE AND EXPAND VIDEO/TELEHEALTH PATIENT VISITS AS THE COVID-19 PANDEMIC CONTINUES.

PROGRESS IN FY2022: IN SPITE OF VARYING COVID-19 RATES THROUGHOUT 2022,
THE SOUTHERN HIGH SCHOOL WELLNESS CENTER, THE MICRO-CLINICS AND JUST FOR US MANAGED TO MAINTAIN THE UTILIZATION OF 2021 WITH A TOTAL OF 10,250 IN-PERSON AND VIDEO/TELEHEALTH PATIENT VISITS.3. POVERTYPOVERTY HAS A STRONG IMPACT ON HEALTH AND IS AN IMPORTANT CONCERN FOR DURHAM RESIDENTS. RESEARCH NOW SHOWS THAT EVEN THE RISK OF AN ADVERSE CHANGE IN MATERIAL CONDITIONS, ECONOMIC AND HOUSING INSECURITY, AS WELL AS UNINSURED OR UNDERINSURED HEALTH INSURANCE COVERAGE, AFFECT HEALTH OUTCOMES. REASONS FOR THE ASSOCIATION BETWEEN ECONOMIC INSECURITY AND HEALTH INCLUDE THE HEALTH EFFECTS OF STRESS RESULTING FROM ECONOMIC INSECURITY, EFFECTS OF STRESS AND SPENDING LIMITATIONS ON FOOD CONSUMPTION, AND RESTRICTED USE OF HEALTH SERVICES.EFFECTIVE 7/1/2019, DU AND DUHS INCREASED THE MINIMUM WAGE TO $15 PER HOUR FOR ALL EMPLOYEES. ON JULY 1, 2022, DUKE UNIVERSITY, INCLUDING DUKE UNIVERSITY HEALTH SYSTEM, INCREASED THE MINIMUM WAGE TO $17 PER HOUR FOR ALL EMPLOYEES WORKING AT LEAST 20 HOURS PER WEEK AND 36 WEEKS PER YEAR.SECOND CHANCES: SINCE SEPTEMBER 2018, DUKE NO LONGER REQUIRES JOB APPLICANTS TO DISCLOSE CRIMINAL HISTORY DURING THE APPLICATION PROCESS. SSI/SSDI OUTREACH, ACCESS AND RECOVERY (SOAR): HELPS PATIENTS WHO ARE CHRONICALLY HOMELESS, OR AT RISK OF HOMELESSNESS ACCESS HEALTH INSURANCE, A STABLE INCOME, AND MEDICAL CARE BY ASSISTING THESE INDIVIDUALS IN APPLYING FOR SUPPLEMENTAL SECURITY INCOME (SSI) AND SOCIAL SECURITY DISABILITY INSURANCE (SSDI). THE HOMELESS POPULATION AND THOSE REENTERING THE COMMUNITY FROM AN INSTITUTION FACE NUMEROUS CHALLENGES IN ACCESSING SERVICES. APPROVAL ON INITIAL SSI AND SSDI APPLICATIONS FOR THESE AT-RISK POPULATIONS, WHO HAVE NO ONE TO ASSIST, IS ABOUT 10-15 PERCENT. FOR THOSE WITH MENTAL ILLNESS, SUBSTANCE ABUSE ISSUES, AND/OR CO-COGNITIVE IMPAIRMENT, THE APPLICATION PROCESS IS EVEN MORE DIFFICULT. EVEN WITH ASSISTANCE, THE APPLICATION PROCESS CAN TAKE UP TO SIX MONTHS. THROUGH SOAR, THESE INDIVIDUALS WITH COMPLEX NEEDS ARE PROVIDED CASE MANAGEMENT FOR HOME, HOSPITAL, AND CLINIC VISITS; ARE PROVIDED WITH A STEP BY STEP EXPLANATION AND COMPLETION OF ALL APPLICATIONS FOR FEDERAL DISABILITY BENEFITS; RECEIVE EXPEDITED APPLICATIONS FOR MONTHLY INCOME AND MEDICAID/MEDICARE; AND ARE LINKED TO COMMUNITY RESOURCES. DUH CURRENTLY FUNDS TWO SOAR CASE MANAGERS WHO HAVE SUCCESSFULLY HELPED MORE THAN 100 PATIENTS IN THE LAST 3 YEARS. PLANS FOR FY2022: CONTINUE TO ADJUST TO COVID-19 DISRUPTIONS AND MAINTAIN A MINIMUM OF 20 CASES.

PROGRESS IN FY2022: UNFORTUNATELY, COVID-19 CONTINUED TO DISRUPT
THE SOAR PROGRAM. CHANGES IN THE REPORTING SYSTEM ALSO DISRUPTED THE ABILITY TO OBTAIN A COMPLETE CASE COUNT FOR THE YEAR.BENEFITS ENROLLMENT COUNSELING (BEC): IN FY 16 THE DUKE DIVISION OF COMMUNITY HEALTH LAUNCHED THE BENEFITS ENROLLMENT COUNSELING PROGRAM (BEC) WITH GRANT FUNDING THROUGH THE NATIONAL COUNCIL ON AGING TO HELP SENIORS AND THOSE WITH DISABILITIES AND A LIMITED INCOME FIND AND ENROLL IN ALL THE BENEFIT PROGRAMS FOR WHICH THEY ARE ELIGIBLE. THE GOAL OF THE SERVICE IS TO ENABLE OLDER ADULTS TO ENJOY LIFE AND LIVE INDEPENDENTLY IN THEIR HOMES AND COMMUNITIES FOR AS LONG AS POSSIBLE. FOR THOSE WITH LIMITED INCOME AND RESOURCES, ADDITIONAL SUPPORT CAN BE CRITICAL IN MAINTAINING THEIR HEALTH AND AVOIDING COSTLY HOSPITALIZATIONS. THE BENEFITS PROVIDE CLIENTS SERVED WITH ACCESS TO HEALTHY FOOD, NEEDED MEDICAL CARE AND PRESCRIPTIONS, AS WELL AS OTHER SUPPORTIVE SERVICES. THE BENEFITS ALSO PROVIDE A COMMUNITY ECONOMIC STIMULUS, AS BENEFITS ARE SPENT LOCALLY IN PHARMACIES, GROCERY STORES, UTILITY COMPANIES, AND HEALTH CARE PROVIDERS. TO INCREASE THE REACH OF THE PROGRAM BEYOND GRANT FUNDING, BEC STAFF TRAIN VOLUNTEERS (FROM PARTNER COMMUNITY BASED ORGANIZATIONS AND DUKE) TO ASSIST CLIENTS IN DURHAM, GRANVILLE, AND PERSON COUNTIES. BEC CURRENTLY WORKS WITH 26 DUKE UNDERGRADUATES AND MEDICAL STUDENTS. THESE STUDENTS ENGAGE IN SERVICE, OUTREACH, AND ADVOCACY EFFORTS AS WELL AS BUILD MEANINGFUL INTERGENERATIONAL RELATIONSHIPS.IN 2019 BEC LAUNCHED THE COPE INITIATIVE (COMMUNITY OUTREACH, PREVENTION AND EDUCATION), WHICH OFFERS HEALTH SCREENING AND EDUCATION IN THE COMMUNITY, AND INITIATIVES THAT DIRECTLY ADDRESS GAPS IN SENIOR HUNGER PREVENTION THROUGH TEACHING SELF-SUFFICIENT, SUSTAINABLE GARDENING PRACTICES, AND THE PROVISION OF COOKING CLASSES AT SENIOR CENTERS.PLANS FOR FY2022: CONTINUE COVID-19 RESPONSE ASSISTANCE AND BEC. RETURN TO THE COMMUNITY GARDEN WORK WHEN ALLOWED. PROGRESS IN FY2022: THE BEC CONTINUES ITS COMMITMENT TO SERVING MEDICARE POPULATIONS IN THE PIEDMONT REGION. THE BEC EXPANDED ITS REACH AMONG DUKE HEALTH PROVIDERS, ACCEPTING REFERRALS FROM 20 UNIQUE PRIMARY CARE LOCATIONS, IN ADDITION TO VARIOUS OTHER CLINICAL SETTINGS INCLUDING ADULT ORGAN TRANSPLANT, ONCOLOGY, ENDOCRINOLOGY, AND DUKE HOME CARE AND HOSPICE. USAGE OF NCCARE360 HAS GROWN OVER THE YEAR AND EXPANDED THE BEC'S REFERRAL NETWORK, ACCOUNTING FOR 4% OF ALL REFERRALS. BEC'S PRESENCE AS A TRUSTED ORGANIZATION IN THE COMMUNITY IS REFLECTED IN 20% OF ALL REFERRALS BEING INITIATED BY THE CLIENTS THEMSELVES THROUGH SELF-REFERRAL.THANKS TO SECURE COMMUNICATION ESTABLISHED IN FY2022 BY DUKE AND THE SOCIAL SECURITY ADMINSTRATION, THE BEC IS NOT ONLY ABLE TO MAKE DIRECT REFERRALS FOR SUPPLEMENTAL SECURITY INCOME AND SOCIAL SECURITY DISABILITY INSURANCE EVALUATIONS, BUT TO FOLLOW UP ON CLIENT CASE PROGRESS AND OUTCOMES. THE BEC DIRECTOR ALSO COMPLETED THE NC SHIIP (SENIOR HEALTH INSURANCE INFORMATION PROGRAM) TRAINING AND IS NOW A CERTIFIED SHIIP COUNSELOR THROUGH THE NC DEPARTMENT OF INSURANCE, IN PARTNERSHIP WITH LOCAL SHIIP COORDINATING SITE; SENIOR PHARMASSIST. THE BEC CONTINUES TO EDUCATE STUDENT VOLUNTEERS, PROVIDING OPPORTUNITY FOR CLIENT ENGAGEMENT IN LOGITUDINAL RELATIONSHIPS, WITH TRAINING AROUND MEDICARE, SOCIAL SECURITY AND BENEFIT PROGRAMS TO UNDERGRADUATE AND GRADUATE STUDENTS ALIKE. BEC VOLUNTEERS COME FROM DIVERSE EDUCATIONAL BACKGROUNDS INCLUDING PUBLIC HEALTH, GLOBAL POLICY, NURSING, DOCTORAL PROGRAMS AND MORE. THANKFULLY, DIRECT SUPPORT BY THE BEC FOR COVID-19 INITIATIVES WAS NOT NECESSARY FOR MOST OF FY2022. IN FY2022, THE BEC ASSISTED 350 INDIVIDUALS WITH AN AVERAGE OF 1.46 APPLICATIONS PER PERSON FOR BENEFIT PROGRAMS. THE TOTAL VALUE OF BENEFITS WAS $1,184,186.4. MENTAL HEALTHMENTAL HEALTH AND SUBSTANCE USE DISORDERS HAVE DIRECT COSTS SUCH AS PREVENTION, TREATMENT, AND RECOVERY SUPPORTS. BUT, THERE ARE ALSO INDIRECT COSTS SUCH AS MOTOR VEHICLE ACCIDENTS, PREMATURE DEATH, COMORBID HEALTH CONDITIONS, DISABILITY, LOST PRODUCTIVITY, UNEMPLOYMENT, POVERTY, SCHOOL DIFFICULTIES, ENGAGEMENT WITH SOCIAL SERVICE, JUVENILE JUSTICE, CRIMINAL JUSTICE SYSTEMS, AND HOMELESSNESS, AMONG OTHER PROBLEMS. DUH PARTNERS WITH AND SUPPORTS A NUMBER OF COLLABORATIVE INITIATIVES TO IMPROVE ACCESS TO MENTAL HEALTH SERVICES AND REDUCE SUBSTANCE ABUSE. DUH CONTINUES TO SERVE AS A KEY PARTNER IN THE FOLLOWING ACTIVITES:* COMMUNITY COALITIONS: DURHAM CRISIS COLLABORATIVE; PARTNERSHIP FOR A HEALTHY DURHAM MENTAL HEALTH COMMITTEE AND DURHAM TOGETHER FOR RESILIENT YOUTH; DURHAM COUNTY LEADERSHIP FORUM ON SUBSTANCE ABUSE AND MENTAL HEALTH.* NALOXONE OUTREACH: PHARMACIES (DUKE SOUTH CLINIC PHARMACY, MAIN STREET, GURLEY'S, JOSEF'S, & DUKE CANCER SPECIALTY); DURHAM COUNTY DEPARTMENT OF PUBLIC HEALTH; DURHAM MOBILE CRISIS UNIT.* PROVIDER EDUCATION: PROVIDER TOOLKITS AND CME EDUCATION; USE OF PAIN AGREEMENTS; USE OF CONTROLLED SUBSTANCE REPORTING SYSTEM (CSRS); CHRONIC PAIN PROVIDER CONSULTATION CALLS.* DIVERSION CONTROL: PERMANENT DROP BOXES IN 5 OF 6 COUNTIES (DURHAM, FRANKLIN, PERSON, GRANVILLE, & VANCE).* CHRONIC PAIN PATIENT SUPPORT: CHRONIC PAIN SELF-MANAGEMENT WORKSHOPS AT LINCOLN COMMUNITY HEALTH CENTER; CHRONIC PAIN MANAGEMENT RESOURCES; KEY COMMUNITY PRESENTATIONS.* COUNTY-WIDE ADVERSE CHILDHOOD EXPERIENCES (ACES) AND COMMUNITY RESILIENCY MODEL (CRM): ACTIVITIES AND TRAINING.

PLANS FOR FY2022: MENTAL HEALTH TREATMENT COMMITTEE WILL CONTINUE TO
"WORK AND IDENTIFY SUBSTANCE USE DISORDER (""SUD"") HOUSING RESOURCES FOR INDIVIDUALS IN ACTIVE MEDICATION-ASSISTED TREATMENT (""MAT"") TREATMENT PROGRAMS. ALLIANCE PROVIDED ADDITIONAL FUNDING TO SUPPORT EFFORTS. A CURRENT LISTING FOR MAT HOUSING RESOURCES IS ON THE DURHAM PUBLIC HEALTH WEBSITE UNDER THE DURHAM JOINS TOGETHER (""DJT"") SECTION TASK FORCE SELECTION. THE DURHAM RECOVERY RESPONSE CENTER (""DRRC"") WILL PROVIDE A PEER SUPPORT SPECIALIST TO BEGIN SUPPORTING INPATIENT SERVICES IN DUKE UNIVERSITY HOSPITAL AND DUKE REGIONAL HOSPITAL. THE HOSPITALS WILL USE TECHNOLOGY RESOURCES TO PROMOTE DRRC SERVICES FOR PATIENTS. DURHAM PUBLIC HEALTH PLANS TO TRANSLATE THE SUD RESOURCE GUIDE INTO SPANISH.PROGRESS IN FY2022: THE SUD RESOURCE GUIDE WAS TRANSLATED INTO SPANISH. DURHAM COUNTY CONTINUES TO BE THE MODEL FOR ADDRESSING SUD THROUGH MAT SERVICES. THE OUTPATIENT SERVICES FROM RECOVERY INNOVATIONS (RI)/DURHAM RECOVERY RESPONSE CENTER (DRRC) HAVE EXPANDED THEIR SERVICES TO INCLUDE MORE MENTAL HEALTH-SPECIFIC SERVICES THAT PROVIDE GREATER ASSISTANCE TO INDIVIDUALS WITH CO-OCCURRING DIAGNOSES. RI PRODUCED A VIDEO HIGHLIGHTING THE PEER NAVIGATION COMMUNITY LINKAGES TO CARE (CLC) SERVICES, MAT/OBOT (OFFICE-BASED OPIOID TREATMENT), AND OUTPATIENT CLINIC TO USE TO EXPLAIN SERVICES TO INDIVIDUALS AT RI.ALLIANCE SECURED A CONTRACT WITH OXFORD HOUSE TO SUPPORT INDIVIDUALS WITH SUD THAT WILL BE A RESOURCE AVAILABLE IN DURHAM. ALLIANCE ALSO HAS A NEW CONTRACT WITH MORSE CLINIC-DURHAM THAT SERVES INDIVIDUALS WITH MEDICAID AS WELL AS THE UNINSURED. THE MORSE CLINIC OF DURHAM WAS FULLY LICENSED IN SEPTEMBER 2022.THE DURHAM COUNTY HEALTH DEPARTMENT UPDATED THE LISTING OF HOUSING OPTIONS FOR INDIVIDUALS LIVING WITH SUD AND MADE THE LISTING AVAILABLE ON THE DURHAM COUNTY PUBLIC HEALTH WEBSITE."

DUHS SAFE OPIOID TASK FORCE: WAS CREATED TO IMPROVE THE SAFETY OF PAIN
MANAGEMENT BY ENCOURAGING CLINICAL PRACTICE STANDARDIZATION, WHERE CLINICALLY APPROPRIATE, WHEN OPIOID THERAPY IS DESIGNATED FOR TREATMENT. THE OPIOID SAFETY TASK FORCE PROVIDES RECOMMENDATIONS FOR THE INITIATION AND MANAGEMENT OF OPIOID THERAPY ACROSS DUKE UNIVERSITY HEALTH SYSTEM (DUHS) TO IMPROVE PERSONAL AND COMMUNITY SAFETY AND REDUCE HARM ASSOCIATED WITH THE HIGH RISK TREATMENTS WHILE ENGAGING PATIENTS IN THEIR OWN CARE. DUH ALONG WITH DUKE REGIONAL AND DUKE RALEIGH HOSPITALS SERVES AS A PIVOTAL PLAYER IN ALL ASPECTS OF THE WORK OF THE TASK FORCE.PLANS FOR FY2022: CONTINUE EFFORTS TO SUPPORT TREATMENT OPTIONS FOR INDIVIDUALS LIVING WITH OUD/SUD.PROGRESS IN FY2022: DUKE CONTINUED TO PARTNER WITH COMMUNITY-WIDE EFFORTS TO SUPPORT TREATMENT OPTIONS FOR INDIVIDUALS LIVING WITH OUD/SUD. THE MHSUD TREATMENT COMMITTEE AND THE DATA TEAM OF THE DURHAM JOINS TOGETHER TASK FORCE DEVELOPED THE COMMUNITY LINKAGES TO CARE (CLC) PROGRAM WHICH FUNDS PEER SUPPORT SERVICES. DURHAM EMS COMMUNITY PARAMEDICS RECEIVED 2 GRANTS FROM SAMHSA. THROUGH THIS FUNDING, EMS WILL OFFER A FIELD INDUCTED MAT PROGRAM, AND THE PEER SUPPORT SPECIALIST WILL GO OUT WITH THE COMMUNITY PARAMEDICS TO START MAT. IN ADDITION, SEVERAL DUKE PRIMARY CARE PRACTICES ARE DEVELOPING OPTIONS FOR EXPANDING MAT SERVICES.5. OBESITY, DIABETES, AND FOOD ACCESSAS OF 2016, 65% OF ADULTS IN THE PIEDMONT REGION, WHICH INCLUDES DURHAM, WERE OVERWEIGHT OR OBESE. ADDITIONALLY, 12% OF DURHAM HIGH SCHOOLERS WERE OBESE AS OF 2014. OBESITY IS A STRONG CONTRIBUTOR TO DIABETES. IN 2015, 14.1% OF DURHAM COUNTY RESIDENTS AGED 18 YEARS OR OLDER WHO RECEIVED SOME LEVEL OF CARE FROM DUKE HEALTH AND/OR LINCOLN COMMUNITY HEALTH CENTER HAD DIABETES. MANY DISEASES ARE LINKED TO NUTRITION, INCLUDING OBESITY, HYPERTENSION, HIGH CHOLESTEROL, DIABETES, AND SOME CANCERS. FOOD INSECURITY, THE STATE OF BEING WITHOUT RELIABLE ACCESS TO A SUFFICIENT QUANTITY OF AFFORDABLE, NUTRITIOUS FOOD, HAS A LARGE IMPACT ON A PERSON'S DIET. IT IS ESTIMATED THAT 17.9% OF DURHAM RESIDENTS (51,710 PEOPLE) ARE FOOD INSECURE.

BULL CITY FIT: IS A COMMUNITY-BASED WELLNESS PROGRAM AND IS PART OF
THE LARGER DUKE CHILDREN'S HEALTHY LIFESTYLES PROGRAM. THE HEALTHY LIFESTYLES PROGRAM SEEKS TO ADDRESS WEIGHT-RELATED HEALTH PROBLEMS FOR CHILDREN BY OFFERING CARING PROVIDERS, FAMILY-CENTERED TREATMENT PROGRAMS, HIGHLY TRAINED EDUCATORS AND RESEARCHERS, AND STRONG COMMUNITY PARTNERSHIPS. BULL CITY FIT HELPS IN THIS EFFORT BY OFFERING FREE EVENING AND WEEKEND ACTIVITY SESSIONS FOR THE LARGER COMMUNITY. THESE SESSIONS COVER VARIOUS THEMES THAT ENCOURAGE AND PROMOTE ACTIVE LIVING, SUCH AS FITNESS GAMES, SPORT LESSONS, EXERCISE ROUTINES, SWIMMING, COOKING, AND GARDENING. EACH ACTIVITY IS FACILITATED WITH THE SUPPORT OF ENERGETIC STAFF AND VOLUNTEERS TO CREATE A POSITIVE AND FUN ENVIRONMENT FOR ALL.BULL CITY FIT EMPOWERS THE WHOLE FAMILY TO INCREASE KNOWLEDGE AND PRACTICE OF PHYSICAL ACTIVITY AND HEALTHY EATING; ADDRESS CURRENT WEIGHT-RELATED ILLNESS AND PREVENT CHRONIC DISEASE THROUGH INCREASED ACTIVITY LEVELS; IMPROVE QUALITY OF LIFE BY PROMOTING HEALTHY BEHAVIORS; INCREASE CONFIDENCE, SUPPORT POSITIVE CHANGE, AND BUILD A LIFELONG COMMITMENT TO A HEALTHY LIFESTYLE.PARTNERS INCLUDE: DURHAM PARKS AND RECREATION; DURHAM CITY GOVERNMENT; DURHAM COUNTY DEPARTMENT OF PUBLIC HEALTH; EAST DURHAM CHILDREN'S INITIATIVE; LINCOLN COMMUNITY HEALTH CENTER; COMMUNITY NUTRITION PARTNERSHIP; VEGGIE VAN; BLUE POINTE YOGA; DURHAM PUBLIC SCHOOLS; PARTNERSHIP FOR A HEALTHY DURHAM; DUKE SERVICE LEARNING; DUKE FAMILY MEDICINE; DUKE CHILDREN'S HOSPITAL AND THE UNC SCHOOL OF SOCIAL WORK.PLANS FOR FY2022: CONTINUE ONLINE OFFERINGS. RETURN TO IN PERSON ACTIVITIES WHEN ALLOWED.PROGRESS IN FY2022: WHILE COVID-19 CONTINUED TO INTERFERE WITH PROGRAMMING, DUH SECURED A $100,000 PLANNING GRANT FOR THE PARTNERSHIP FOR A HEALTH DURHAM'S PHYSICAL ACTIVITY, NUTRITION, AND FOOD ACCESS COMMITTEE TO DEVELOP COMMUNITY-DRIVEN ACTIVITIES TO BUILD ON COMMUNITY ASSETS AND ADDRESS DEFICITS IN OBESITY AND CHRONIC DISEASE PREVENTION OR REDUCTION EFFORTS.

GROUP A - FACILITY 1 - DUKE UNIVERSITY HOSPITAL
"PART V, SECTION B, LINE 16J: AS PART OF DUHS, DUKE UNIVERSITY HOSPITAL PROVIDES A BROCHURE TO ALL ADMISSIONS THAT INCLUDES A BRIEF SUMMARY OF DUHS FINANCIAL ASSISTANCE POLICIES. DUHS ALSO COMMENTS ON THE BACK OF ITS BILLING INVOICES THAT PATIENTS SHOULD CONTACT PATIENT ACCOUNT REPRESENTATIVES TO HELP THEM IF THEY CANNOT PAY THEIR BILL IN FULL. THIS COMMENT REFERENCES GOVERNMENT-SPONSORED PROGRAMS, MONTHLY PAYMENT PROGRAMS, AND OTHER FINANCIAL ASSISTANCE PROGRAMS AVAILABLE FOR PATIENTS WHO MEET CERTAIN FINANCIAL CRITERIA. DUHS ALSO PUBLICIZES ITS FINANCIAL ASSISTANCE POLICY VERBALLY THROUGH ITS FINANCIAL CARE COUNSELORS. PART V, SECTION B, LINE 24: CERTAIN ELECTIVE COSMETIC/AESTHETIC SERVICES, AND OTHER ELECTIVE SERVICES, WERE BILLED AT AN AMOUNT EQUAL TO GROSS CHARGES.DUKE RALEIGH HOSPITAL:PART V, SECTION B, LINE 5: DUKE RALEIGH HOSPITAL (DUKE RALEIGH OR DRAH) COLLABORATED WITH ADVANCE COMMUNITY HEALTH, ALLIANCE HEALTH, UNC REX HEALTHCARE, UNITED WAY OF THE GREATER TRIANGLE, WAKE COUNTY HUMAN SERVICES, WAKE COUNTY MEDICAL SOCIETY COMMUNITY HEALTH FOUNDATION, WAKEMED HEALTH AND HOSPITALS, AND YOUTH THRIVE TO DEVELOP THE 2019 WAKE COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THE PROCESS OF DETERMINING THE PRIORITY HEALTH NEEDS FOR THE 2019 WAKE COUNTY CHNA BEGAN WITH THE COLLECTION AND ANALYSIS OF HUNDREDS OF DATA POINTS. ALL INDIVIDUAL DATA MEASURES FROM BOTH PRIMARY (NEW) AND SECONDARY (EXISTING) SOURCES WERE GATHERED, ANALYZED, AND INTERPRETED. IN ORDER TO COMBINE DATA POINTS INTO MORE EASILY DISCUSSABLE CATEGORIES, ALL INDIVIDUAL DATA MEASURES WERE GROUPED INTO SIX CATEGORIES AND TWENTY-ONE CORRESPONDING FOCUS AREAS BASED ON ""COMMON THEMES"". PRIMARY (NEW) DATA COLLECTION: COMMUNITY MEMBERS PROVIDED INPUT FOR THE ASSESSMENT THROUGH INTERNET-BASED AND TELEPHONE SURVEYS, FOCUS GROUPS, AND AN INTERNET-BASED PRIORITIZATION SURVEY. ADDITIONALLY, KEY LEADERS OF ORGANIZATIONS REPRESENTING BROAD INTERESTS OF THE COMMUNITY PROVIDED INPUT THROUGH AN INTERNET-BASED SURVEY, PARTICIPATION ON THE STEERING COMMITTEE, AND AN INTERNET-BASED PRIORITIZATION SURVEY. THE PROCESS ALSO HAD SIGNIFICANT INPUT AND DIRECTION FROM THE COMMUNITY HEALTH ASSESSMENT TEAM. CONSIDERING ALL OF THESE SOURCES, INPUT FROM NEARLY 5,900 WAKE COUNTY RESIDENTS AND ORGANIZATIONAL LEADERS IS INCLUDED IN THIS COMMUNITY HEALTH NEEDS ASSESSMENT. SECONDARY (EXISTING) DATA: KEY SOURCES FOR EXISTING DATA ON WAKE COUNTY INCLUDED NUMEROUS PUBLIC DATA SOURCES RELATED TO DEMOGRAPHICS, SOCIAL AND ECONOMIC DETERMINANTS OF HEALTH, ENVIRONMENTAL HEALTH, HEALTH STATUS AND DISEASE TRENDS, MENTAL/BEHAVIORAL HEALTH TRENDS, AND MODIFIABLE HEALTH RISKS. FURTHER, SOME LOCAL ORGANIZATIONS PROVIDED INTERNAL DATA THAT WERE ALSO INCORPORATED INTO THE ANALYSIS PROCESS.A PRIORITIZATION MATRIX WAS DEVELOPED TO IDENTIFY THE TOP PRIORITIES FOR THE OVERALL COUNTY AND DETERMINE FINDINGS FOR EACH OF THE SERVICE ZONES. THE PRIORITIZATION MATRIX INCLUDED THE FINDINGS FROM THE ANALYSIS OF THE PRIMARY (NEW) AND SECONDARY (EXISTING) DATA WHICH WERE PRESENTED TO THE STEERING COMMITTEE IN OCTOBER 2018 AND TO COMMUNITY MEMBERS DURING THE PRIORITIZATION MEETINGS HELD ON JANUARY 31, 2019 AND VIA THE WWW.WAKEGOV.COM/WELLBEING WEBSITE THROUGH MID-FEBRUARY 2019. ADDITIONALLY, STEERING COMMITTEE MEMBERS WERE PROVIDED THE OPPORTUNITY TO COMPLETE AN INTERNET-BASED SURVEY IN WHICH THEY WERE ASKED TO IDENTIFY THEIR TOP THREE AREAS OF NEED BASED ON THE LIST OF TWENTY-ONE FOCUS AREAS. COMMUNITY MEMBERS WERE ASKED TO PROVIDE THE SAME INFORMATION. THESE VARIOUS DATA COMPONENTS WERE THEN ANALYZED AND THE RESULTS WERE WEIGHTED AS FOLLOWS: SECONDARY (EXISTING) DATA - WEIGHTED 50 PERCENT; PRIMARY (NEW) DATA - WEIGHTED 50 PERCENT IN TOTAL, AS FOLLOWS: FOCUS GROUP FINDINGS, TELEPHONE SURVEY RESULTS, AND INTERNET-BASED COMMUNITY SURVEY RESULTS - WEIGHTED 20 PERCENT; COMMUNITY PRIORITIZATION MEETING RESULTS - WEIGHTED 20 PERCENT; AND, STEERING COMMITTEE PRIORITIZATION SURVEY RESULTS - WEIGHTED 10 PERCENT. THIS JOINT CHNA AND RELATED IMPLEMENTATION PLAN WERE ADOPTED BY THE DUHS BOARD OF DIRECTORS IN FISCAL YEAR 2020 AND PUBLISHED ON THE DUKE HEALTH WEBSITE IN OCTOBER 2020, PRIOR TO THE DECEMBER 31, 2020 DEADLINE PROVIDED IN IRS NOTICE 2020-56. DUKE RALEIGH HOSPITAL:PART V, SECTION B, LINE 6A: UNC REX HEALTHCARE, WAKEMED HEALTH AND HOSPITALS.DUKE RALEIGH HOSPITAL:PART V, SECTION B, LINE 6B: UNITED WAY OF THE GREATER TRIANGLE, WAKE COUNTY HUMAN SERVICES, ADVANCE COMMUNITY HEALTH, ALLIANCE HEALTH, YOUTH THRIVE, AND THE WAKE COUNTY MEDICAL SOCIETY COMMUNITY HEALTH FOUNDATION. DUKE RALEIGH HOSPITAL:PART V, SECTION B, LINE 11:THE FOLLOWING FIVE PRIORITY AREAS WERE IDENTIFIED FOR 2020-2022:1. TRANSPORTATION OPTIONS AND TRANSIT2. EMPLOYMENT3. ACCESS TO CARE4. MENTAL HEALTH/SUBSTANCE USE DISORDERS5. HOUSING AND HOMELESSNESS"

1. TRANSPORTATION OPTIONS AND TRANSIT
MANY ASPECTS OF DAILY LIFE REQUIRE THE USE OF TRANSPORTATION SUCH AS EMPLOYMENT, EDUCATION, ACCESS TO NUTRITIONAL FOODS, AND ACCESS TO HEALTHCARE SERVICES AND EACH OF THESE AREAS IMPACTS ONE'S OVERALL HEALTH. THE TRANSPORTATION OPTIONS AND TRANSIT PRIORITY INCLUDES INFORMATION RELATED TO HOW PEOPLE GET AROUND FOR WORK, SCHOOL, AND PLAY AS WELL AS PUBLIC TRANSPORTATION AND OTHER TRANSPORTATION CHOICES. THROUGH THE FOLLOWING ACTIONS, DUKE RALEIGH HOSPITAL WILL WORK COLLABORATELY TO REDUCE BARRIERS TO TRANSPORTATION. * PROVIDE FINANCIAL SUPPORT TO COMMUNITY-BASED ORGANIZATIONS ADDRESSING TRANSPORTATION BARRIERS FOR HEALTHCARE SERVICES. * CONTINUE TO SUPPORT ORGANIZATIONS SUCH AS THE GREATER RALEIGH CHAMBER OF COMMERCE AND MIDTOWN RALEIGH ALLIANCE IN THEIR EFFORTS TO WORK TOWARDS A RELIABLE TRANSPORTATION SYSTEM FOR ALL. * CONTINUE TO IDENTIFY PATIENTS WITH TRANSPORTATION NEEDS AND CONNECT THEM WITH COMMUNITY RESOURCES SUCH AS THE LUNG CANCER INITIATIVE OF NC'S GAS CARD PROGRAM, AMERICAN CANCER SOCIETY'S ROAD TO RECOVERY, THE CARING COMMUNITY FOUNDATION, AND THE NCCARE360 NETWORK.DUKE RALEIGH HOSPITAL SUPPORTED ORGANIZATIONS SUCH AS THE GREATER RALEIGH CHAMBER OF COMMERCE AND MIDTOWN RALEIGH ALLIANCE, WHICH WORK TOWARDS AN ENHANCED TRANSIT AND TRANSPORTATION SYSTEM FOR ALL RESIDENTS. DUKE RALEIGH ALSO PROVIDED $20,000 OF SUPPORT IN FY2022 TO THE LUNG CANCER INITIATIVE OF NC WHICH FUNDS A GAS CARD PROGRAM TO LESSEN THE BURDEN OF LUNG CANCER PATIENTS SEEKING TREATMENT.2. EMPLOYMENT EMPLOYMENT IS ALSO A SOCIAL DETERMINANT OF HEALTH THAT ROSE TO THE TOP OF THE WAKE COUNTY PRIORITIZATION MATRIX. THE EMPLOYMENT PRIORITY INCLUDES INFORMATION RELATED TO HOW MANY PEOPLE HAVE JOBS, WHAT TYPES OF JOBS THEY HAVE, AND WHETHER PEOPLE FEEL THEY CAN GET A GOOD JOB IN WAKE COUNTY. A GOOD-PAYING JOB MAKES IT EASIER FOR WORKERS TO LIVE IN HEALTHIER NEIGHBORHOODS, PROVIDE QUALITY EDUCATION FOR THEIR CHILDREN, SECURE CHILD CARE SERVICES, AND BUY MORE NUTRITIOUS FOOD, ALL OF WHICH AFFECT HEALTH.TO ADDRESS THIS PRIORITY, DUKE RALEIGH HOSPITAL WILL EMPLOY THE FOLLOWING STRATEGY/ACTION ITEMS TO SUPPORT EFFORTS TO INCREASE EMPLOYMENT OPPORTUNITIES:* INCREASE IN MINIMUM WAGE: DUKE UNIVERSITY AND DUKE UNIVERSITY HEALTH SYSTEM INCREASED MINIMUM WAGE TO $15 EFFECTIVE JULY 1, 2019. ON JULY 1, 2022, DUKE UNIVERSITY, INCLUDING DUKE UNIVERSITY HEALTH SYSTEM, INCREASED THE MINIMUM WAGE TO $17 PER HOUR FOR ALL EMPLOYEES WORKING AT LEAST 20 HOURS PER WEEK AND 36 WEEKS PER YEAR.* JOB GROWTH: AS A RESULT OF THE DUKE RALEIGH HOSPITAL SOUTH PAVILION ADDITION THAT OPENED IN 2021, WE WILL GROW BY A FEW HUNDRED NEW JOBS OVER THE NEXT FIVE YEARS. * SUPPORT COMMUNITY: EFFORTS TO PROMOTE ECONOMIC PROSPERITY FOR ALL. THIS INCLUDES CONTINUED COLLABORATION WITH THE GREATER RALEIGH CHAMBER OF COMMERCE AND WAKE COUNTY ECONOMIC DEVELOPMENT BY INVESTING IN THE COMPETITIVE EDGE INITIATIVES AND PARTICIPATING IN THE TRIANGLE DIVERSITY, EQUITY, AND INCLUSIVITY (DEI) ALLIANCE. THIS ALSO INCLUDES COLLABORATING WITH ECONOMIC VITALITY ORGANIZATIONS IN WAKE COUNTY INCLUDING THE CROSBY ADVOCACY GROUP.* PROVIDE OPPORTUNITIES TO PREPARE THE FUTURE HEALTHCARE WORKFORCE. THIS INCLUDES CONTINUED PARTNERSHIP WITH WAKE TECHNICAL COMMUNITY COLLEGE AND WAKE COUNTY PUBLIC SCHOOL SYSTEM (WCPSS). IN FY2022, DUKE RALEIGH CONTINUED TO PARTNER WITH WAKE TECH BY INVESTING IN THEIR EFFORT TO BUILD A CLINICAL PIPELINE IN WAKE COUNTY. DUKE RALEIGH PROVIDED MORE THAN 22,000 CLINICAL ROTATION HOURS IN FY2022. IN ADDITION, DUKE RALEIGH HOSTED ALMOST 30 ENLOE HIGH SCHOOL STUDENTS ONSITE FOR A CAREER FAIR AND TOUR IN OUR EFFORTS TO DEVELOP A HEALTHCARE WORKFORCE PIPELINE AND PARTICIPATED IN ENLOE'S HOSA EVENT TO EDUCATE FUTURE HEALTHCARE WORKERS ON CAREERS IN PUBLIC HEALTH.

3. ACCESS TO CARE
"ACCESS TO CARE WAS INDENTIFIED AS A TOP PRIORITY IN THE 2013 AND 2016 WAKE COUNTY CHNAS AND REMAINS A TOP PRIORITY IN THE 2019 WAKE COUNTY CHNA. THIS PRIORITY INCLUDES HOW AND WHY PEOPLE USE OR DO NOT USE HEALTHCARE, HOW MANY PEOPLE HAVE HEALTH INSURANCE, HOW MUCH HEALTHCARE THERE IS IN THE COMMUNITY, AND HOW MUCH INFORMATION THERE IS ABOUT HEALTHCARE.THE ABILITY TO ACCESS HEALTH SERVICES IS A CRITICAL PUBLIC HEALTH ISSUE, AS PRIMARY AND PREVENTATIVE SERVICES CAN HELP TO PREVENT OR MANAGE CHRONIC ILLNESSES AND THEREFORE IMPROVE THE HEALTH OF THE COMMUNITY. DUKE RALEIGH HOSPITAL IS ACTIVELY ENGAGED IN IMPROVING ACCESS TO HEALTH SERVICES FOR ALL THROUGH STRATEGIC INITIATIVES AND COMMUNITY PARTNERSHIPS. TO ADDRESS THIS PRIORITY DUKE RALEIGH HOSPITAL WILL EMPLOY THE FOLLOWING MAJOR ACTIONS/ACTIVITES: * CONTINUED TO PROVIDE FINANCIAL ASSISTANCE VIA DUKE UNIVERSITY HEALTH SYSTEM'S FINANCIAL ASSISTANCE POLICIES. IN FISCAL YEAR 2022, DUKE RALEIGH HOSPITAL PROVIDED APPROXIMATELY $21.9 MILLION IN CHARITY CARE AT ESTIMATED COST.* SUPPORTED COMMUNITY PARTNERS WORKING TO PROVIDE CARE TO UNINSURED POPULATIONS. THIS INCLUDES ORGANIZATIONS SUCH AS ALLIANCE MEDICAL MINISTRY, URBAN MINISTRIES OF WAKE COUNTY, AND PROJECT ACCESS OF WAKE COUNTY. IN FY22, DUKE RALEIGH PROVIDED $30,000 IN FUNDING TO ALLIANCE MEDICAL MINISTRY TO SUPPORT THEIR EFFORTS TO PROVIDE COMPREHENSIVE, COMPASSIONATE AND AFFORDABLE HEALTHCARE TO WORKING, UNINSURED ADULTS IN WAKE COUNTY. BETWEEN FY17-22, DUKE RALEIGH DONATED AND PACKED OVER 4,500 POUNDS OF RICE AND BEANS FOR URBAN MINISTRIES OF WAKE COUNTY'S CLIENT CHOICE PANTRY, WHICH ENGAGED 50+ EMPLOYEES.* CONTINUED TO PROVIDE IN-KIND LAB SERVICES TO URBAN MINISTRIES OF WAKE COUNTY'S OPEN DOOR CLINIC. IN FY2022, DUKE RALEIGH HOSPITAL PROVIDED LAB TESTS IN-KIND FOR URBAN MINISTRIES OF WAKE COUNTY OPEN DOOR CLINIC WORTH MORE THAN $2 MILLION. * CONTINUED TO PROVIDE MONTHLY DIABETES EDUCATION CLASSES AT ALLIANCE MEDICAL MINISTRY IN-KIND.* CONTINUED TO PROVIDE DONATED CARE TO PROJECT ACCESS OF WAKE COUNTY, A PRIVATE, NON-PROFIT PROGRAM THAT CONNECTS ELIGIBLE UNINSURED CLIENTS TO HIGH QUALITY MEDICAL SERVICES. IN FY2022, DUKE RALEIGH HOSPITAL PROVIDED APPROXIMATELY $4.1 MILLION OF DONATED CARE TO PROJECT ACCESS OF WAKE COUNTY CLIENTS.* EXPAND CAPACITY TO CONDUCT SOCIAL SCREENINGS AND SUPPORT LINKAGES TO COMMUNITY RESOURCES. THIS INCLUDES PILOTING NCCARE360 AS WELL AS WORKING WITH THE DUKE BENEFITS ENROLLMENT CENTER. DUKE RALEIGH IS CURRENTLY DEVELOPING PLANS TO PILOT USE OF NCCARE 360 TO INTEGRATE ASSESSMENT FOR AND ADDRESSING FOOD INSECURITY AMONG PATIENTS ENTERING VIA DUKE RALEIGH'S EMERGENCY DEPARTMENT. PRELIMINARY WORK IS BEGINNING IN FY2023.* CONTINUED TO PROVIDE THE HEALTH LITERACY COURSE AS PART OF THE NURSE RESIDENCY CURRICULUM THROUGH OUR CLINICAL EDUCATION DEPARTMENT. IN FY2022, ONE HEALTH LITERACY CLASS WAS TAUGHT AS PART OF THE CURRICULUM WITH A TOTAL OF 91 GRADUATE NURSES EDUCATED.* EXPANDED COMMUNITY OUTREACH AND EDUCATION EFFORTS AROUND STROKE, CARDIOVASCULAR DISEASE, DIABETES, CANCER, ORTHOPEDICS, SPORTS MEDICINE AND MORE THROUGH PARTNERING WITH LOCAL ORGANIZATIONS, AGENCIES, AND BUSINESSES. EACH YEAR, DUKE RALEIGH SPONSORS THE MIDTOWN FARMERS MARKET, WHICH PROMOTES A HEALTHY LIFESTYLE AS WELL AS PROVIDES A VENUE FOR DUKE RALEIGH TO SHARE HEALTHY EDUCATION FROM APRIL THROUGH NOVEMBER HOSTING 4 DAYS FOCUSED ON MENTAL HEALTH, WELLBEING, AND CANCER CARE. DUKE RALEIGH DEVELOPED PROGRAMMING AND PROVIDED FINANCIAL SUPPORT TO INCREASE CHILDREN'S ACCESS TO NUTRITIOUS FOOD. IN FY22, DUKE RALEIGH PROVIDED $5,000 IN FINANCIAL SUPPORT TO THE INTER-FAITH FOOD SHUTTLE AND $2,500 TO MEALS ON WHEELS OF WAKE COUNTY TO SUPPORT A VARIETY OF NEEDS.4. MENTAL HEALTH/SUBSTANCE USE DISORDERSMENTAL HEALTH/SUBSTANCE USE DISORDERS WAS AN IDENTIFIED PRIORITY IN BOTH THE 2013 AND 2016 WAKE COUNTY CHNAS. WAKE COUNTY HAS EXPERIENCED AN INCREASE IN THE PREVALENCE AND SEVERITY OF MENTAL HEALTH AND SUBSTANCE USE PROBLEMS. THIS PRIORITY INCLUDES MENTAL HEALTH DISEASE (LIKE DEPRESSION, ALZHEIMER'S AND SCHIZOPHRENIA), POOR MENTAL HEALTH DAYS, AND HURTING ONESELF AS WELL AS ALCOHOL, OPIOID, AND ILLEGAL DRUG USE AND DATA RELATED TO OVERDOSES. DUE TO THE SCOPE AND COMPLEXITY OF MENTAL HEALTH AND SUBSTANCE USE, A COLLECTIVE AND COLLABORATIVE APPROACH IS NEEDED. DUKE RALEIGH HOSPITAL WILL CONTINUE TO WORK COLLABORATIVELY AND SUPPORT OPPORTUNITIES TO IMPROVE ACCESS TO MENTAL HEALTH SERVICES AND REDUCE SUBSTANCE USE BY ENGAGING IN THE FOLLOWING MAJOR ACTIONS/ACTIVITIES: * DEVELOPED FURTHER BEHAVIORAL HEALTH SERVICE LINE CAPABILITIES AT DUKE RALEIGH HOSPITAL WITH DEDICATED SERVICE LINE LEADERSHIP, ROUNDING NURSES, SOCIAL WORKERS, AND LEVERAGE THE USE OF NCCARE360 RESOURCES. DUKE RALEIGH HAS HIRED A NEUROSCIENCES & BEHAVIORAL HEALTH SERVICES LINE DIRECTOR, AS WELL AS A PROGRAM MANAGER FOR ""CARING FOR EACH OTHER"" TO HELP ADDRESS THE GROWING MENTAL HEALTH AND BEHAVIORAL SUPPORT NEEDED BY OUR COMMUNITY, BOTH INTERNAL AND EXTERNAL TO DUKE.* CONTINUED TO SERVE ON THE FOLLOWING COMMUNITY COALITIONS/WORKGROUPS: NORTH CAROLINA ASSOCIATION (NCHA) BEHAVIORAL HEALTH WORKGROUP, WAKE COUNTY DRUG OVERDOSE PREVENTION COALITION, AND WAKEBROOK COMMUNITY PARTNERSHIP.* CONTINUED TO SUPPORT EFFORTS TO INCREASE COMMUNITY-BASED RESOURCES THROUGH GRANTS AND SPONSORSHIPS. IN FY2022, DRAH PROVIDED FINANCIAL SUPPORT TO TRIANGLE FAMILY SERVICES TO SUPPORT THEIR EFFORTS TO EXPAND ACCESS TO SUSTAINABLE MENTAL HEALTH SERVICES IN OUR COMMUNITY. DRAH ALSO PROVIDED SUPPORT FOR THE ADVERSE CHILDHOOD EXPERIENCES (ACES) RESILIENCE IN WAKE COUNTY INITIATIVE. THIS INITIATIVE IS A MULTI-SECTOR, COMMUNITY-DRIVEN MOVEMENT TO ADDRESS AND PREVENT ACES AND BUILD RESILIENCE IN WAKE COUNTY. 5. HOUSING AND HOMELESSNESSHOUSING AND HOMELESSNESS ARE ALSO SOCIAL DETERMINANTS OF HEALTH THAT ROSE TO THE TOP OF THE WAKE COUNTY PRIORITIZATION MATRIX TO BECOME A PRIORITY AREA FOR THE COUNTY TO FOCUS ON OVER THE COMING YEARS. THE HOUSING AND HOMELESSNESS PRIORITY INCLUDES COST OF HOUSING, HOUSING CHOICES, AND HOW MANY PEOPLE ARE HOMELESS. HEALTHY HOMES PROMOTE GOOD PHYSICAL AND MENTAL HEALTH, AFFECTING THE OVERALL ABILITY OF FAMILIES TO MAKE HEALTHY CHOICES. DUKE RALEIGH HOSPITAL WILL SUPPORT EFFORTS TO INCREASE ACCESS TO SAFE AND HEALTHY HOUSING THROUGH THE FOLLOWING ACTIONS:* EXPAND CAPABILITIES TO IDENTIFY PATIENTS WITH HOUSING/SHELTER NEEDS AND CONNECT THEM WITH COMMUNITY RESOURCES.* SUPPORT EFFORTS TO INCREASE COMMUNITY-BASED ORGANIZATIONS' CAPACITY TO PROVIDE SAFE, QUALITY, AFFORDABLE HOUSING AND SHELTER. IN FY2017-FY2022, DUKE RALEIGH HOSPITAL PROVIDED SUPPORT FOR HABITAT FOR HUMANITY OF WAKE COUNTY THROUGH FINANCIAL CONTRIBUTIONS AND EMPLOYEE VOLUNTEERISM. * CONTINUED SUPPORT FOR TRIANGLE FAMILY SERVICES, WHICH PROVIDES EMERGENCY HOUSING ASSISTANCE, RENTAL ASSISTANCE, AND STREET OUTREACH.* CONTINUED SUPPORT FOR RALEIGH WAKE PARTNERSHIP TO END AND PREVENT HOMELESS (THE PARTNERSHIP) EFFORTS. * CONTINUED SUPPORT FOR URBAN MINISTRIES OF WAKE COUNTY, WHICH RUNS THE HELEN WRIGHT CENTER FOR WOMEN, A PROGRAM FOR SINGLE, HOMELESS WOMEN.DUKE RALEIGH HOSPITAL:PART V, SECTION B, LINE 16J: AS PART OF DUHS, DUKE RALEIGH HOSPITAL PROVIDES A BROCHURE TO ALL ADMISSIONS THAT INCLUDES A BRIEF SUMMARY OF DUHS FINANCIAL ASSISTANCE POLICIES. DUHS ALSO COMMENTS ON THE BACK OF ITS BILLING INVOICES THAT PATIENTS SHOULD CONTACT PATIENT ACCOUNT REPRESENTATIVES TO HELP THEM IF THEY CANNOT PAY THEIR BILL IN FULL. THIS COMMENT REFERENCES GOVERNMENT-SPONSORED PROGRAMS, MONTHLY PAYMENT PROGRAMS, AND OTHER FINANCIAL ASSISTANCE PROGRAMS AVAILABLE FOR PATIENTS WHO MEET CERTAIN FINANCIAL CRITERIA. DUHS ALSO PUBLICIZED ITS FINANCIAL ASSISTANCE POLICY VERBALLY THROUGH ITS FINANCIAL CARE COUNSELORS.DUKE RALEIGH HOSPITAL:PART V, SECTION B, LINE 24: CERTAIN ELECTIVE COSMETIC/AESTHETIC SERVICES, AND OTHER ELECTIVE SERVICES, WERE BILLED AT AN AMOUNT EQUAL TO GROSS CHARGES."

GROUP A - FACILITY 3 - DUKE REGIONAL HOSPITAL:
"PART V, SECTION B, LINE 5: AS PART OF DUKE HEALTH, DUKE REGIONAL HOSPITAL (""DRH"") PARTNERED WITH DURHAM COUNTY DEPARTMENT OF PUBLIC HEALTH AND THE PARTNERSHIP FOR A HEALTHY DURHAM TO CONDUCT THE 2020 DURHAM COMMUNITY HEALTH ASSESSMENT. THE 2020 SURVEY WAS CONDUCTED BETWEEN MAY AND SEPTEMBER 2019, AND CARRIED OUT BY 243 COMMUNITY VOLUNTEERS, PARTNERSHIP MEMBERS, AND STAFF FROM DURHAM COUNTY DEPARTMENT OF PUBLIC HEALTH AND DUKE HEALTH. THE COUNTY WIDE SURVEY SAMPLE SIZE WAS DOUBLED IN 2019 TO ANALYZE DATA BY RACE AND ETHNICITY. THE ASSESSMENT INCLUDED 612 RESIDENT SURVEYS IN COUNTY WIDE AND HISPANIC OR LATINO NEIGHBORHOOD SAMPLES. COMMUNITY LISTENING SESSIONS WERE CONDUCTED VIA ZOOM DUE TO COVID-19 RESTRICTIONS. THE COMMUNITY HEALTH ASSESSMENT TEAM COMPRISED OF REPRESENTATIVES FROM LOCAL GOVERNMENTS, HEALTH CARE SYSTEMS, COLLEGES & UNIVERSITIES, COMMUNITY-BASED ORGANIZATIONS AND NON-PROFITS IN SECTORS OF PHYSICAL AND MENTAL HEALTH, TRANSPORTATION, EDUCATION, HOUSING, RESEARCH, FOOD ACCESS, PLANNING ENVIRONMENT AND MORE - WORKED TO DIRECT THE ACTIVITIES OF THE ASSESSMENT AND PROVIDE WRITTEN CONTENT AND EXPERTISE ON ISSUES OF INTEREST. THIS JOINT CHNA AND RELATED IMPLEMENTATION PLAN WAS ADOPTED BY THE DUHS BOARD OF DIRECTORS AND PUBLISHED ON THE DUKE HEALTH WEBSITE IN FISCAL YEAR 2022 (TAX YEAR 2021).GROUP A - FACILITY 3 - DUKE REGIONAL HOSPITAL:PART V, SECTION B, LINE 6A: DUKE UNIVERSITY HOSPITALGROUP A - FACILITY 3 - DUKE REGIONAL HOSPITAL:PART V, SECTION B, LINE 6B: THE PARTNERSHIP FOR A HEALTHY DURHAM AND THE DURHAM COUNTY HEALTH DEPARTMENTGROUP A - FACILITY 3 - DUKE REGIONAL HOSPITAL:PART V, SECTION B, LINE 11: THE ASSESSMENT IDENTIFIED FIVE HEALTH PRIORITIES FOR 2021-2023:1. AFFORDABLE HOUSING2. ACCESS TO HEALTHCARE AND HEALTH INSURANCE3. POVERTY4. MENTAL HEALTH5. OBESITY, DIABETES AND FOOD ACCESSDUKE REGIONAL HOSPITAL CONSIDERS THE DRH COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION PLAN DOCUMENT TO BE A ""WORKING PLAN"" THAT WILL CONTINUE TO EVOLVE OVER THIS THREE-YEAR PERIOD IN ORDER TO ENSURE THE EFFICACY OF STRATEGIES INTENDED TO MEET EXPRESSED COMMUNITY HEALTH NEEDS. THIS IMPLEMENTATION PLAN DOES NOT CONTAIN DESCRIPTIONS OF THE COMMUNITY HEALTH IMPROVEMENT WORK CARRIED OUT BY OTHER COMPONENTS OF DUKE HEALTH OR DUKE UNIVERSITY. THIS IMPLEMENTATION PLAN REPRESENTS ONLY DUKE REGIONAL HOSPITAL'S CONTINUALLY EVOLVING VARIETY OF PROGRAMS AND ACTIVITIES IN THE FIVE PRIORITY AREAS TO IMPROVE HEALTH WITHIN THE DURHAM COMMUNITY.1 AND 3. AFFORDABLE HOUSING AND POVERTYMINIMUM WAGE: EFFECTIVE 7/1/2019, DU AND DUHS INCREASED THE MINIMUM WAGE TO $15 PER HOUR FOR ALL EMPLOYEES. ON JULY 1, 2022, DUKE UNIVERSITY, INCLUDING DUKE UNIVERSITY HEALTH SYSTEM, INCREASED THE MINIMUM WAGE TO $17 PER HOUR FOR ALL EMPLOYEES WORKING AT LEAST 20 HOURS PER WEEK AND 36 WEEKS PER YEAR.FILL THAT BUS AND SALVATION ARMY ANGEL TREE: EMPLOYEES HAVE DONATED BINS OF SCHOOL SUPPLIES TO CRAYONS2CALCULATORS AND FILL THAT BUS! CAMPAIGN EACH YEAR SINCE 2015 TO SUPPORT DURHAM PUBLIC SCHOOLS. TEACHERS FROM THE SCHOOLS WITH THE HIGHEST POVERTY LEVELS WERE INVITED TO PICK OUT SUPPLIES NEEDED IN THEIR CLASSROOMS.EACH DECEMBER, EMPLOYEES ""ADOPT"" 100 CHILDREN FROM DUKE REGIONAL'S SALVATION ARMY ANGEL TREE. CHILDREN IN DURHAM HAVE RECEIVED CLOTHING, BOOKS AND TOYS THANKS TO THE GENEROUS DONATIONS. EXTRA GIFTS ARE ALSO DONATED TO THE SALVATION ARMY FOR OTHER NEEDY FAMILIES IN THE AREA.2022 GOAL: DUKE REGIONAL HOSPITAL WILL CONTINUE A SIMILAR LEVEL OF SUPPORT TO BENEFIT UNDERSERVED CHILDREN OR FAMILIES IN OUR COMMUNITY.2022 PROGRESS: DUKE REGIONAL HOSPITAL SUPPORTED CRAYONS2CALCULATOR FILL THE BUS! CAMPAIGN, THE SALVATION ARMY TREE GIFT DRIVE AND A FOOD DRIVE FOR THE NORTH CAROLINA FOOD BANK OF CENTRAL AND EASTERN NC.EDUCATION: DUKE REGIONAL HOSPITAL HAS IDENTIFIED EDUCATION AS A PRIORITY OF ITS COMMUNITY STRATEGY TO HELP PREVENT POVERTY. DUKE REGIONAL HOSPITAL IS COMMITTED TO HELP TRAIN THE HEALTHCARE WORKERS OF THE FUTURE. IN FY21, DRH INVESTED $5.0 MILLION IN TEACHING AND TRAINING HEALTHCARE PROFESSIONALS. DURING FISCAL YEARS 2017 THROUGH 2020, DRH PROVIDED OPPORTUNITIES FOR 70 PRE-HEALTH UNDERGRADUATE STUDENTS FROM LOCAL COLLEGES AND UNIVERSITIES TO SHADOW AND VOLUNTEER ALONGSIDE CLINICAL AND CUSTOMER SERVICE STAFF AS AMBASSADORS IN THE EMERGENCY DEPARTMENT. DRH ALSO PROVIDED AN EIGHT-WEEK JUNIOR VOLUNTEER PROGRAM FOR AREA HIGH SCHOOL STUDENTS TO GAIN CLERICAL AND CUSTOMER SERVICE WORK EXPERIENCES IN A HEALTH CARE SETTING. DUE TO COVID-19, IN-PERSON SHADOWING AND VOLUNTEER OPPORTUNITIES WERE HALTED IN MARCH 2020, BUT DRH CONTINUED TO FIND CREATIVE WAYS TO ENGAGE STUDENTS VIRTUALLY AND WELCOMED CLINICAL STUDENTS BACK TO CAMPUS USING A SLOW AND MEASURED RE-ENTRY OF STUDENTS STARTING IN THE SUMMER OF 2020. SINCE THAT TIME, MORE CLINICAL STUDENTS HAVE RETURNED AND CONTINUE TO FOLLOW ALL DUHS RESTRICTIONS AS NEEDED.FY2022 GOAL: DRH WILL CONTINUE THE SAME LEVEL OF SUPPORT.FY2022 PROGRESS: DRH INVESTED $6.6 MILLION IN TEACHING AND TRAINING HEALTHCARE PROFESSIONALS. CITY OF MEDICINE ACADEMY: DUKE REGIONAL HOSPITAL HAS BEEN A PARTNER WITH CITY OF MEDICINE ACADEMY (CMA) AND DURHAM PUBLIC SCHOOLS SINCE THE PROGRAM'S INCEPTION AT SOUTHERN HIGH SCHOOL IN THE 1990S. IN AUGUST 2011, CMA MOVED TO A NEW FACILITY LOCATED ON THE DUKE REGIONAL CAMPUS. AS PART OF OUR PARTNERSHIP, DUKE REGIONAL HOSPITAL HOSTS STUDENTS FOR CLINICAL ROTATIONS AND INTERNSHIPS, PROVIDES CPR TRAINING AND HOSTS THE ANNUAL SENIOR AWARDS NIGHT IN THE HOSPITAL AUDITORIUM.2022 GOAL: DUKE REGIONAL HOSPITAL WILL CONTINUE ITS PARTNERSHIP WITH CMA.2022 PROGRESS: DUKE REGIONAL CONTINUED TO PARTNER WITH CMA.PROJECT SEARCH: DUKE REGIONAL HOSPITAL WAS THE FIRST HOST HOSPITAL IN THE STATE FOR PROJECT SEARCH, A PARTNERSHIP WITH DURHAM PUBLIC SCHOOLS, OE ENTERPRISES, NORTH CAROLINA VOCATIONAL REHABILITATION AND ALLIANCE BEHAVIORAL HEALTH THAT PROVIDES CAREER DEVELOPMENT EXPERIENCES TO SENIOR HIGH SCHOOL STUDENTS WITH DEVELOPMENTAL AND INTELLECTUAL DISABILITIES. 2022 GOAL: CONTINUE TO SERVE AS A HOST SITE FOR PROJECT SEARCH.2022 PROGRESS: DUKE REGIONAL HOSPITAL CONTINUED TO SERVE AS A HOST SITE FOR PROJECT SEARCH ADDING 10 NEW GRADUATES IN 2022 FOR A TOTAL OF GRADUATES TO 87 TO DATE. APPROXIMATELY HALF ARE EMPLOYEED IN THE COMMUNITY, WITH FOUR GRADUATES WORKING AT DUKE REGIONAL HOSPITAL."

2. ACCESS TO HEALTHCARE AND HEALTH INSURANCE
"LINCOLN COMMUNITY HEALTH CENTER (LCHC): IS A FEDERALLY QUALIFIED COMMUNITY HEALTH CENTER THAT PROVIDES PRIMARY CARE SERVICES FOR ABOUT 40,000 PATIENTS EACH YEAR. APPROXIMATELY 50 PERCENT OF LCHC PATIENTS ARE UNINSURED AND 52% ARE LIVING AT OR BELOW 100% OF THE FEDERAL POVERTY LEVEL. IN ADDITION TO GENEROUS FINANCIAL SUPPORT, DUKE REGIONAL HOSPITAL PROVIDES ENGINEERING, ENVIRONMENTAL, LABORATORY, PHARMACY AND RADIOLOGY SERVICES. THE TOTAL DUKE REGIONAL HOSPITAL CONTRIBUTION TO LCHC IN FY 2022, INCLUDING MONETARY AND IN-KIND SERVICES, WAS $8.2 MILLION.DURHAM COUNTY EMERGENCY MEDICAL SERVICES (EMS): SERVES AS THE PRIMARY PROVIDER OF EMERGENCY AMBULANCE SERVICES AND ALTERNATIVE MEDICAL TRANSPORTATION IN DURHAM COUNTY. IN FY 2022, DUKE REGIONAL HOSPITAL CONTRIBUTED $2.6 MILLION TO THE COUNTY TO SUPPORT DURHAM EMS.PROJECT ACCESS OF DURHAM COUNTY (PADC): COORDINATES SPECIALTY CARE AT NO CHARGE TO UNINSURED AND UNDERINSURED DURHAM RESIDENTS LIVING AT OR BELOW 200 PERCENT OF THE FEDERAL POVERTY LEVEL. THESE RESIDENTS HAVE ACCESS TO PRIMARY HEALTH CARE THROUGH LINCOLN COMMUNITY HEALTH CENTER. 2022 GOAL: CONTINUE A SIMILAR LEVEL OF SUPPORT.2022 PROGRESS: DUKE REGIONAL HOSPITAL CONTINUED TO PROVIDE EPISODES OF CARE IN FY2022 AND PROVIDED FINANCIAL SUPPORT ($15,000) IN LIEU OF PROVIDING SPACE AFTER PADC RELOCATED TO A NON-HOSPITAL BUILDING IN FY2021.FINANCIAL ASSISTANCE: EACH YEAR DUKE REGIONAL HOSPITAL PROVIDES NO-COST OR DISCOUNTED URGENT OR EMERGENT HEALTH CARE SERVICES TO PATIENTS WHO WERE UNABLE TO PAY. IN FY 2022 DUKE REGIONAL PROVIDED $30.2 MILLION (AT ESTIMATED COST) IN FINANCIAL ASSISTANCE.4. MENTAL HEALTHIN 2021, DUKE REGIONAL OPENED THE NEW BEHAVIORAL HEALTH CENTER NORTH DURHAM AND EXPANDED EMERGENCY DEPARTMENT TO PROVIDE MORE COMPREHENSIVE CARE FOR OUR BEHAVIORAL HEALTH PATIENTS. THIS $102.4 MILLION PROJECT EXPANDED THE HOSPITAL'S EMERGENCY ROOM AND CONSOLIDATED INPATIENT, OUTPATIENT, AND EMERGENCY BEHAVIORAL HEALTH SERVICES ON DUKE REGIONAL'S CAMPUS, WITH THE GOAL OF PROVIDING BETTER COORDINATION OF CARE FOR BEHAVIORAL HEALTH PATIENTS IN DURHAM AND REGIONALLY. THE CENTER INCORPORATES MEETING SPACE SPECIALLY DESIGNED TO BE USED BY COMMUNITY-BASED ORGANIZATIONS PROVIDING SERVICES FOR BEHAVIORAL HEALTH PATIENTS AND THEIR FAMILIES.5. OBESITY, DIABETES, AND FOOD ACCESSBEYOND ITS CLINICAL SERVICE LINES IN THE HOSPITAL, DRH COLLABORATES WITH NUMEROUS DURHAM NON-PROFITS AND OTHER ENTITIES WITHIN THE DUKE UNIVERSITY HEALTH SYSTEM THAT ARE SPECIFICALLY FOCUSED ON COMMUNITY-BASED MECHANISMS FOR THE PREVENTION AND TREATMENT OF OBESITY AND DIABETES AND ON ISSUES OF FOOD ACCESS.IN ADDITION TO THE ABOVE ACTIVITIES SPECIFICALLY RELATED TO THE CHNA IDENTIFIED HEALTH PRIORITIES, DUKE REGIONAL HOSPITAL SUPPORTS HEALTH NEEDS OF ITS COMMUNITY IN THE FOLLOWING WAYS:THE LOOK GOOD FEEL BETTER PROGRAM IS A NON-MEDICAL, BRAND-NEUTRAL PROGRAM THAT PROVIDES SUPPORT FOR FEMALE CANCER TREATMENT PATIENTS WHO HAVE EXPERIENCED HAIR LOSS OR OTHER PHYSICAL APPEARANCE CHANGES DUE TO CHEMOTHERAPY OR RADIATION TREATMENTS. FOR MORE THAN A DECADE, DRH HAS SUPPORTED THIS PROGRAM AS A HOST SITE. DUE TO COVID-19, DUKE REGIONAL SPONSORED THE MONTHLY WORKSHOPS IN A VIRTUAL FORMAT DURING FY2022. STROKE SUPPORT: DUKE REGIONAL OFFERS A MONTHLY STROKE SUPPORT GROUP THAT PROVIDES EDUCATION, SUPPORT AND RESOURCES FOR INDIVIDUALS WHO HAVE BEEN AFFECTED BY STROKE. THE SUPPORT GROUP STARTED IN 2006 AND TYPICALLY HOSTS 20-25 PARTICIPANTS A MONTH. DUKE REGIONAL CONTINUED THE MONTHLY STROKE SUPPORT PROGRAM IN A VIRTUAL FORMAT DURING FY2022.COVID-19: WITH STRONG COMMUNITY PARTNERSHIPS, DUKE REGIONAL COORDINATED THE HEALTH SYSTEM EFFORTS TO PROVIDE COVID-19 VACCINATIONS EQUITABLY IN DURHAM BY MANAGING THE DAILY OPERATIONS FOR THE CLINICS FOCUSED ON SERVING OUR MOST VULNERABLE COMMUNITY MEMBERS. THE HOSPITAL OPENED AN ON-SITE CLINIC TO VACCINATE COMMUNITY PROVIDERS AND, ONCE ELIGIBLE, EDUCATORS. DRH PARTNERED WITH DURHAM PUBLIC SCHOOLS AND DURHAM COUNTY HEALTH DEPARTMENT TO OPEN A VACCINATION SITE AT SOUTHERN SCHOOL OF ENERGY AND SUSTAINABILITY, LOCATED IN ONE OF THE ZIP CODES MOST DISPROPORTIONATELY IMPACTED BY COVID-19. WHEN STUDENTS RETURNED TO CAMPUS IN APRIL 2021, THE HOSPITAL PARTNERED WITH THE CITY OF DURHAM TO MOVE THE CLINIC TO THE OLD WHEELS SKATE PARK. THE HOSPITAL PARTNERED WITH NUMEROUS COMMUNITY ORGANIZATIONS TO BRING ""MOBILE"" VACCINATION CLINICS WHERE THEY WERE MOST NEEDED, CONDUCTING MORE THAN 30 EVENTS FROM FEBRUARY 2021 THROUGH JUNE 2022. IN TOTAL, THE HOSPITAL DISTRIBUTED MORE THAN 50,000 DOSES OF COVID-19 VACCINE WITH THESE EFFORTS.FUNDRAISING AND OUTREACH: DUKE REGIONAL CONDUCTS A NUMBER OF FUNDRAISING AND OUTREACH ACTIVITIES IN THE DURHAM COMMUNITY AND BEYOND. DUKE REGIONAL EMPLOYEES RAISE FUNDS EACH YEAR FOR CHARITABLE ORGANIZATIONS, INCLUDING DUKE COMMUNITY GIVING (INCLUDING UNITED WAY OF THE GREATER TRIANGLE), AMERICAN HEART ASSOCIATION HEART WALK, AND MARCH OF DIMES. IN FY2022, DUKE REGIONAL RAISED $37,099 FOR LOCAL CHARITIES. THE HOSPITAL CONTINUES TO PARTNER WITH LOCAL NONPROFITS ON ENDEAVORS THAT EDUCATE OUR COMMUNITY ABOUT HEALTH INITIATIVES AND DISPARATIES AND PROVIDES OFFICE SPACE FOR THE DURHAM COMMUNITY HEALTH COALITION. IN FY2022, DRH PARTNERED WTH THE AMERICAN RED CROSS TO HOST 5 BLOOD DRIVES - AN INCREASE FROM THE PREVIOUS YEAR TO SUPPORT A CRITICAL BLOOD SHORTAGE. THESE DRIVES RESULTED IN COLLECTING 115 UNITS OF BLOOD."

GROUP A - FACILITY 3 - DUKE REGIONAL HOSPITAL
PART V, SECTION B, LINE 16J: AS PART OF DUHS, DUKE REGIONAL HOSPITAL PROVIDES A BROCHURE TO ALL ADMISSIONS THAT INCLUDES A BRIEF SUMMARY OF DUHS FINANCIAL ASSISTANCE POLICIES. DUHS ALSO COMMENTS ON THE BACK OF ITS BILLING INVOICES THAT PATIENTS SHOULD CONTACT PATIENT ACCOUNT REPRESENTATIVES TO HELP THEM IF THEY CANNOT PAY THEIR BILL IN FULL. THIS COMMENT REFERENCES GOVERNMENT-SPONSORED PROGRAMS, MONTHLY PAYMENT PROGRAMS, AND OTHER FINANCIAL ASSISTANCE PROGRAMS AVAILABLE FOR PATIENTS WHO MEET CERTAIN FINANCIAL CRITERIA. DUHS ALSO PUBLICIZED ITS FINANCIAL ASSISTANCE POLICY VERBALLY THROUGH ITS FINANCIAL CARE COUNSELORS.GROUP A - FACILITY 3 - DUKE REGIONAL HOSPITALPART V, SECTION B, LINE 24: CERTAIN ELECTIVE COSMETIC/AESTHETIC SERVICES, AND OTHER ELECTIVE SERVICES, WERE BILLED AT AN AMOUNT EQUAL TO GROSS CHARGES.

PART I, LINE 3C:
"NOT APPLICABLEPART I, LINE 6A:NOT APPLICABLEPART I, LINE 7, COLUMN F:TOTAL GROSS COMMUNITY BENEFIT EXPENSE AS A PERCENT OF TOTAL EXPENSES IS 10.3%.PART I, LINE 7:CHARITY CARE AT COST IS DETERMINED USING THE COST-TO-CHARGE CALCULATION FROM WORKSHEET 2, IN ORDER TO CALCULATE THE AMOUNTS REPORTED ON THE TABLE. UNREIMBURSED MEDICAID IS DETERMINED USING A COST ACCOUNTING SYSTEM THAT ADDRESSES ALL PATIENT SEGMENTS.CHARITY CARE, UNREIMBURSED MEDICAID, AND COMMUNITY HEALTH IMPROVEMENT SERVICES INCLUDE FINANCIAL ASSISTANCE AND OTHER COMMUNITY BENEFIT COSTS PROVIDED BY DUHS' SUPPORT CORPORATIONS, DUKE UNIVERSITY AFFILIATED PHYSICIANS AND DUKE INTEGRATED NETWORK, THAT FILE SEPARATE 990S BUT ARE NOT REQUIRED TO COMPLETE A SCHEDULE H SINCE NOT A HOSPITAL. TOTAL NET COMMUNITY BENEFIT EXPENSES FOR THESE ENTITIES TOTALED $21.1 MILLION IN FY2022.PART II, COMMUNITY BUILDING ACTIVITIES:THESE ACTIVITIES ARE INCLUDED IN DUKE UNIVERSITY HEALTH SYSTEM, INC.'S (DUHS) OPERATING EXPENSES AND ARE NOT TRACKED SEPARATELY FOR COMMUNITY BENEFIT REPORTING PURPOSES.PART III, LINE 1 AND LINE 2:DUHS PROVIDED UNCOMPENSATED CARE AT ESTIMATED COSTS IN THE FORM OF IMPLICIT PRICE CONCESSIONS (CONSIDERED BAD DEBT EXPENSE PRIOR TO ADOPTION OF ACCOUNTING STANDARDS UPDATE 2014-16, ""REVENUE FROM CONTRACTS WITH CUSTOMERS"" IN FY2019) ASSOCIATED WITH UNCOLLECTIBLE PATIENT ACCOUNTS AT AN ESTIMATED COST OF $32,754,000 IN FISCAL YEAR 2022. DUHS USED THE COST-TO-CHARGE RATIO FROM WORKSHEET 2 TO ESTIMATE COST.PART III, LINE 3:DUHS PRESUMPTIVELY SCREENS ALL UNINSURED PATIENTS AND ALL PATIENTS ENTERING THROUGH THE EMERGENCY DEPARTMENT, REGARDLESS OF INSURANCE STATUS, FOR FINANCIAL ASSISTANCE. WHILE THESE PRESUMPTIVE PROCESSES IDENTIFY A SUBSET OF PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE WITHOUT NEEDING DIRECT INPUT FROM THE PATIENT, THOSE WHO DO NOT FALL UNDER THE PRESUMPTIVE SCREENING CRITERIA WILL NEED TO PROVIDE INFORMATION TO QUALIFY FOR FINANCIAL ASSISTANCE UNDER DUHS' FINANCIAL ASSISTANCE POLICY. A PORTION OF IMPLICIT PRICE CONCESSIONS (FORMERLY CONSIDERED BAD DEBT EXPENSE) SHOULD BE INCLUDED AS A COMMUNITY BENEFIT, BUT THE PORTION THAT IS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER OUR FINANCIAL ASSISTANCE POLICY IS INDETERMINABLE BECAUSE OF THOSE PATIENTS WHO FAIL TO APPLY FOR OR PROVIDE INFORMATION NEEDED TO DETERMINE THEIR ELIGIBILITY UNDER THE DUHS FAP. DUHS, INC. FOLLOWS ITS MISSION TO THE COMMUNITY AND PROVIDES EMERGENT SERVICES TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. PATIENTS WHO MAY QUALIFY FOR FINANCIAL ASSISTANCE ARE REPORTED AS AN IMPLICIT PRICE CONCESSION INSTEAD BECAUSE OF THOSE PATIENTS' INABILITY OR UNWILLINGNESS TO PROVIDE THE NECESSARY DOCUMENTATION REQUIRED TO DETERMINE FINANCIAL ASSISTANCE CLASSIFICATION.PART III, LINE 4:PAGES 19-21 IN THE FY2022 AUDITED FINANCIAL STATEMENT FOOTNOTES DESCRIBE IMPLICIT PRICE CONCESSIONS RELATED TO UNINSURED PATIENTS.PART III, LINE 7:TOTAL UNREIMBURSED COSTS ATTRIBUTABLE TO PROVIDING SERVICES UNDER MEDICARE AS REPORTED IN THE JUNE 30, 2022 DUHS CONSOLIDATED FINANCIAL STATEMENTS ARE $501,257,000 AS COMPARED TO $152,411,247 AS REPORTED IN SECTION B, LINE 7 OF SCHEDULE H. THE DUHS TOTAL MEDICARE SHORTFALL OF $501,257,000 IS DERIVED FROM THE COST ACCOUNTING SYSTEM WHICH INCLUDES ALL PAYMENTS AND COSTS ASSOCIATED WITH MEDICARE PATIENTS, WHEREAS THE AMOUNT REPORTED IN SECTION B OF SCHEDULE H IS DERIVED BASED ON IRS INSTRUCTIONS. IRS INSTRUCTIONS SPECIFY THAT ONLY A PORTION OF COSTS ASSOCIATED WITH MEDICARE BENEFICIARIES BE REPORTED ON SCHEDULE H. SIGNIFICANT MEDICARE COSTS EXCLUDED FROM SCHEDULE H DATA INCLUDE THOSE ASSOCIATED WITH MEDICARE PATIENTS COVERED UNDER MANAGED CARE PLANS AND COSTS REIMBURSED THROUGH MEANS NOT REPORTED ON THE COST REPORT.PART III, LINE 8:MEDICARE RATES AND THE NUMBER OF MEDICARE PATIENTS DUHS TREATS ARE NOT NEGOTIATED. MEDICARE DOES NOT FULLY COMPENSATE DUHS FOR THE COST OF PROVIDING CARE TO MEDICARE BENEFICIARIES. DUHS CONTINUES TO SERVE THE MEDICARE POPULATION AS MEDICARE REIMBURSEMENT RATES DECLINE RELATIVE TO THE COST OF CARE. THEREFORE, ANY LOSS RELATED TO PROVIDING CARE FOR MEDICARE PATIENTS SHOULD BE CLASSIFIED AS A COMMUNITY BENEFIT. DUHS FOLLOWED THE MEDICARE COST REPORT RULES AND GUIDELINES IN DETERMINING THE COSTS REPORTED ON LINE 6. THESE RULES USE A VARIETY OF DIFFERENT METHODOLOGIES BASED ON THE TYPE OF SERVICE.PART III, LINE 9B:COLLECTION EFFORTS ARE IMMEDIATELY STOPPED FOR PATIENTS WHO SUBMIT A FINANCIAL ASSISTANCE APPLICATION. PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE ARE NOT PURSUED USING ANY DEBT COLLECTION PRACTICES."

NEEDS ASSESSMENT:
PART VI, LINE 2:DUHS USES SEVERAL MECHANISMS TO ASSESS AND ADDRESS THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES. DUHS IS A LEAD PARTNER ON THE DEVELOPMENT OF COMMUNITY HEALTH NEEDS ASSESSMENTS IN DURHAM COUNTY AND WAKE COUNTY. DUHS ACTIVELY VOLUNTEERS TO COLLECT DATA AND PARTICIPATE ON COMMITTEES IDENTIFYING THE PRIORITIES AND DEVELOPING STRATEGIES TO ADDRESS THE IDENTIFIED PRIORITIES. IN 2019, DUHS BEGAN A PILOT OF SCREENING ITS PATIENTS FOR UNMET SOCIAL NEEDS INCLUDING FOOD INSECURITY, HOUSING INSECURITY, TRANSPORTATION, AND MENTAL HEALTH. THE SCREENING IS MANAGED THROUGH EPIC AND WHEN PATIENTS SCREEN POSITIVE FOR A SOCIAL NEED, DUHS MAKES AN IMMEDIATE REFERRAL, THROUGH A STATEWIDE SYSTEM CALLED NCCARE360, TO COMMUNITY-BASED RESOURCES THAT PROVIDE SUPPORT SERVICES IN THE IDENTIFIED AREA(S). OVER 50 SITES ARE PARTICIPATING IN THE SCREENING OF SOCIAL NEEDS. DUKE UNIVERSITY'S BOARD OF TRUSTEES APPROVED THE STRATEGIC COMMUNITY IMPACT PLAN (SCIP) IN 2019 WHICH OUTLINES FIVE COMMUNITY FOCUS AREAS AND PRIORITIES BASED ON COMMUNITY LISTENING SESSIONS: (1) HOUSING (PRIORITY: AFFORDABLE HOUSING AND INFRASTRUCTURE; (2) EDUCATION (PRIORITY: EARLY CHILDHOOD DEVELOPMENT); (3) EMPLOYMENT (PRIORITY: COLLEGE AND CAREER READINESS); (4) HEALTH (PRIORITY: FOOD SECURITY); AND (5) COMMUNITY (PRIORITY: NONPROFIT CAPACITY). THESE FOCUS AREAS ALIGN WITH THE CHNA PRIORITIES AND PATIENT SCREENING DATA. DUHS HAS EMBRACED THE SCIP AS AN INTEGRAL PART OF ITS STRATEGIC GOAL TO ADVANCE HEALTH EQUITY. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:PART VI, LINE 3:DUHS EMPLOYS NUMEROUS MEANS TO EDUCATE PATIENTS ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS OR UNDER THE DUHS FINANCIAL ASSISTANCE POLICY. DETAILED INFORMATION IS POSTED ON WWW.DUKEHEALTH.ORG (DUHS' WEBSITE) ALONG WITH HARDCOPY BROCHURES THAT ARE AVAILABLE IN ENGLISH OR SPANISH AT ALL OF OUR PATIENT REGISTRATION LOCATIONS. ALL INPATIENTS AND EMERGENCY DEPARTMENT PATIENTS ARE ALSO PROVIDED WITH A HARDCOPY, ONE-PAGE SUMMARY OF THE WAYS DUHS CAN ASSIST PATIENTS FINANCIALLY. FOR OUTPATIENTS, THIS SAME ONE-PAGE SUMMARY IS PROVIDED ON THEIR FIRST VISIT TO THE INSTITUTION. IN ADDITION, DUHS EMPLOYS FINANCIAL CARE COUNSELORS WHO MEET INDIVIDUALLY WITH PATIENTS WHO HAVE QUESTIONS REGARDING PAYMENT FOR THEIR CARE. DUHS ALSO EMPLOYS MEDICAID ASSISTANCE COUNSELORS WHO SPECIALIZE IN ASSISTING PATIENTS TO APPLY FOR MEDICAID, DISABILITY, AND OTHER FEDERAL, STATE, AND LOCAL PROGRAMS. DUHS ASSISTS BETWEEN 12,000-15,000 PATIENTS IN APPLYING AND BECOMING ELIGIBLE FOR THESE PROGRAMS ANNUALLY. FINALLY, PATIENTS MAY ALWAYS CONTACT DUHS' TOLL FREE CUSTOMER SERVICE NUMBER TO REQUEST INFORMATION ABOUT THEIR BILL OR OBTAIN A FINANCIAL ASSISTANCE APPLICATION.COMMUNITY INFORMATION:PART VI, LINE 4:DUHS SERVES A BROAD, CULTURALLY, RACIALLY AND SOCIALLY DIVERSE GEOGRAPHIC AND DEMOGRAPHIC REGION. DUHS' HOME CITY OF DURHAM IS THE CORE, BUT DUHS' REACH EXTENDS INTO THE SURROUNDING RESEARCH TRIANGLE AREA OF NORTH CAROLINA AND THE STATE'S LARGER NORTHERN PIEDMONT REGION, AS WELL AS STATEWIDE, NATIONALLY AND GLOBALLY. DUHS' PRIMARY SERVICE AREA (PSA) IS A 7-COUNTY REGION IN NC THAT INCLUDES ALAMANCE, DURHAM, GRANVILLE, ORANGE, PERSON, VANCE AND WAKE COUNTIES. THIS 7-COUNTY REGION REPRESENTS APPROXIMATELY 18% OF NC'S POPULATION BASED ON FEDERAL FISCAL YEAR (FFY) 2020 DATA. THE WEIGHTED AVERAGE MEDIAN HOUSEHOLD INCOME IN ITS PSA IS $71,807. APPROXIMATELY 67% OF INPATIENT DISCHARGES FROM DUHS FACILITIES IN FFY 2021 WERE PATIENTS FROM ITS PSA. THE POPULATION IN DUHS' PSA IS EXPECTED TO GROW AT A HIGHER RATE OVER THE NEXT 5 YEARS FROM 2020 TO 2025 COMPARED TO NC'S OVERALL EXPECTED POPULATION GROWTH RATE. THE PSA 5-YEAR CAGR IS EXPECTED TO BE 1.8% COMPARED TO THE OVERALL ESTIMATED NC RATE OF 1.1%. DUHS' SECONDARY SERVICE AREA COVERS 15 COUNTIES IN NORTH CAROLINA AND SOUTHERN VIRGINIA WITH A POPULATION OF APPROXIMATELY 2 MILLION. PROMOTION OF COMMUNITY HEALTH:PART VI, LINE 5:DUHS PROMOTES THE HEALTH OF THE COMMUNITIES IT SERVES THROUGH A NUMBER OF COMMUNITY BUILDING ACTIVITIES. CENTRAL TO MANY OF THE EFFORTS IS DUHS' OFFICE OF COMMUNITY HEALTH (FORMERLY KNOWN AS THE OFFICE OF COMMUNITY RELATIONS). THE OFFICE PREVIOUSLY REPORTED TO THE DUKE HEALTH CHANCELLOR/ DUHS' CEO ONLY. OCH NOW REPORTS DUALLY TO (1) THE CHANCELLOR/CEO OF THE HEALTH SYSTEM AND (2) DUKE'S VICE PRESIDENT OF COMMUNITY AFFAIRS TO FACILITATE LEVERAGING ASSETS ACROSS THE ENTIRE DUKE ENTERPRISE TO ASSESS AND ADDRESS COMMUNITY NEEDS. OCH ALSO FACILITATES THE DEVELOPMENT OF COORDINATED, SYSTEM-LEVEL INITIATIVES TO ADDRESS IDENTIFIED COMMUNITY NEEDS IN PARTNERSHIP WITH COMMUNITY-BASED ORGANIZATIONS. OCH ORGANIZES ANNUAL HEALTH SUMMITS TO BRING COMMUNITY MEMBERS, ELECTED OFFICIALS, PROVIDERS, AND OTHERS TOGETHER TO GENERATE AND SHARE INFORMATION, COLLECT ADDITIONAL DATA, AND DEVELOP STRATEGIES COLLABORATIVELY IN SOCIAL DRIVERS AREAS. DUHS' OFFICE OF COMMUNITY HEALTH, WHOSE ASSOCIATE VICE PRESIDENT SERVES AS A FULL-TIME LIAISON IN DURHAM AND IN DUHS' PRIMARY SERVICE AREAS. THE OFFICE SPONSORS AND FACILITATES COMMUNITY EVENTS SUCH AS THE ANNUAL COMMUNITY HEALTH SUMMIT AND SIMILAR REGIONAL AND STATE HEALTH SUMMITS THAT RAISE AWARENESS OF COMMUNITY HEALTH NEEDS, PROMOTE PREVENTION AND WELLNESS, AND CHART A COURSE FOR SOLVING HEALTH-RELATED SOCIAL NEED (HRSN) ISSUES AND DISPARITIES. IN ADDITION, THE OFFICE PROVIDES A POINT OF DIRECT CONTACT FOR COMMUNITY MEMBERS WHO HAVE QUESTIONS OR CONCERNS ABOUT COMMUNITY ISSUES OR ABOUT ACCESS TO HEALTH CARE SERVICES. THE OFFICE ALSO PROVIDES DIRECT FINANCIAL SUPPORT TO A VARIETY OF COMMUNITY GROUPS THROUGH THE BUILDING HEALTHY COMMUNITIES GRANTS PROGRAM. THE ASSOCIATE VICE-PRESIDENT AND STAFF SERVE ON A NUMBER OF COMMUNITY BOARDS AND HEALTH-RELATED COMMITTEES. STAFF FROM THE OFFICE OF COMMUNITY HEALTH AND DUHS REPRESENTATIVES IMMERSED IN COMMUNITY ENGAGEMENT ACTIVITIES CREATED FORMAL PRINCIPLES OF COMMUNITY ENGAGEMENT THAT COMMIT DUHS AND ITS COMMUNITY PARTNERS TO DEVELOPING PROPOSED PROJECTS AND INITIATIVES BASED ON TRUST, RESPECT, DIVERSITY, SAFETY AND COMMUNITY-IDENTIFIED NEEDS. THESE PRINCIPLES HAVE BEEN INCORPORATED INTO COMMUNITY-BASED HEALTHCARE PROJECTS INCLUDING COMMUNITY CLINICS, FOCUS GROUPS, CHNA IMPLEMENTATION PLANS, AND DUHS' ANNUAL HEALTH SUMMIT.

IN ADDITION TO COMMUNITY BUILDING ACTIVITIES,
DUHS PROMOTES THE HEALTH OF ITS COMMUNITIES IN A NUMBER OF IMPORTANT WAYS. ONE OF DUHS' THREE CONSTITUENT HOSPITALS, DUKE REGIONAL, HAS AN OPEN MEDICAL STAFF AND A HOSPITAL CORPORATION BOARD, WHICH IS A COUNTY APPOINTED BOARD RESPONSIBLE FOR HOSPITAL OVERSIGHT. IN ADDITION, APPROXIMATELY 50 LOCAL LEADERS IN THE DURHAM FAITH COMMUNITY ARE WORKING WITH DUKE HEALTH TO LOOK AT HOW TO ADDRESS THE NEEDS OF THEIR CONGREGATIONS AND COMMUNITIES BY COMBINING THE TRADITIONS OF THE FAITH COMMUNITY WITH THE KNOWLEDGE OF MODERN MEDICINE. DUHS' CEO ALSO HAS A CHANCELLOR'S COMMUNITY HEALTH ADVISORY BOARD TO PROVIDE FEEDBACK ON A VARIETY OF ISSUES, INCLUDING USE OF DUHS RESOURCES, HEALTH SERVICE DELIVERY SYSTEMS AND LONG-RANGE GOALS TO REDUCE HEALTH RISKS AND DISPARITIES IN DURHAM COUNTY. THE BOARD INCLUDES STATE AND LOCAL ELECTED OFFICIALS, NEIGHBORHOOD COUNCILS AND OTHER GRASSROOTS ORGANIZATIONS, POLITICAL GROUPS, DURHAM PUBLIC SCHOOLS, AMONG OTHERS. DUHS MAINTAINS A BUILDING HEALTHY COMMUNITIES GRANTS COMMITTEE TO REVIEW COMMUNITY REQUESTS FOR PHILANTHROPIC ASSISTANCE THAT PROMOTE HEALTH AND WELLNESS. DUHS FORMED A COMMUNITY HEALTH EXECUTIVE COUNCIL COMPRISED OF LEADERS ACROSS DUKE HEALTH TO OVERSEE STRATEGIES DESIGNED TO ADVANCE HEALTH EQUITY AND ADDRESS HEALTH-RELATED SOCIAL NEEDS. ADDITIONALLY, SEVERAL COMMITTEES/COUNCILS HAVE BEEN FORMED AROUND SPECIFIC HEALTH-RELATED SOCIAL NEEDS TO DISCUSS COMMUNITY STATUS, CAPACITY NEEDS OF COMMUNITY-BASED ORGANIZATIONS, AND TO INFORM SYSTEM-LEVEL EFFORTS.DUKE HEALTH PROVIDES VARIOUS OPPORTUNITIES FOR STUDENTS TO INTERACT WITH DIFFERENT HEALTH CARE PROFESSIONALS ACROSS THE SYSTEM. THE OFFICE OF COMMUNITY HEALTH, DRH, AND OTHER KEY COMMUNITY PARTICIPANTS ARE ACTIVE IN A WORKFORCE DEVELOPMENT PROJECT CALLED PROJECT SEARCH. THIS PROGRAM, MODELED AFTER THE PROGRAM AT CINCINNATI CHILDREN'S HOSPITAL, PROVIDES YOUTH WITH DISABILITIES EMPLOYMENT TRAINING AND CAREER OPPORTUNITIES IN DURHAM-ORANGE MEDICAL SOCIETY AND THE DURHAM ACADEMY OF MEDICINE, DENTISTRY AND PHARMACY (AN ASSOCIATION FOR AFRICAN-AMERICAN MEDICAL PROFESSIONALS) TO PROMOTE THE SUCCESS OF THE CITY OF MEDICINE ACADEMY (CMA). THE CMA IS A PUBLIC MAGNET HIGH SCHOOL DESIGNED FOR STUDENTS INTERESTED IN HEALTH CARE CAREERS. FACULTY ARE INVOLVED WITH MENTORING STUDENTS AND CLASSROOM LECTURES. DUHS IS A KEY PARTICIPANT IN THE ANNUAL BULL CITY FRESH START EVENT. STAFF FROM THE DUKE SCHOOL OF NURSING, DUKE EYE CENTER, AND STAFF AFFILIATED WITH LINCOLN COMMUNITY HEALTH CENTER HEALTHCARE FOR THE HOMELESS CLINIC VOLUNTEER TIME AND RESOURCES AT THIS IMPORTANT EVENT. STUDENTS FROM THE DUKE SCHOOLS OF MEDICINE AND NURSING ENGAGE COMMUNITIES IN DURHAM AND BEYOND IN ACTIVITIES THAT INCLUDE FREE BLOOD PRESSURE SCREENINGS FOR THE HOMELESS, AND IDENTIFYING THE HEALTH CARE NEEDS OF A LOW WEALTH COMMUNITY SCHOOL AND DEVELOPING A CURRICULUM FOR STUDENTS AND PARENTS THAT ADDRESSES THOSE NEEDS. STUDENTS HAVE ALSO FORMED FOOD SECURITY INITIATIVES INCLUDING ROOT CAUSES' FRESH PRODUCE PROGRAM THAT DISTRIBUTES FOOD TO COMMUNITY RESIDENTS BASED ON PROVIDER PRESCRIPTIONS. OCH IS ALSO AN ADVISOR TO A STUDENT-LED GROUP CALLED THE FOOD RECOVERY NETWORK THAT PACKAGES UNUSED, PREPARED MEALS FROM DINING SERVICES ACROSS THE UNIVERSITY AND DELIVERS THEM TO COMMUNITY-BASED ORGANIZATIONS FOR DISTRIBUTION TO COMMUNITY MEMBERS IN NEED.AFFILIATED HEALTH CARE SYSTEM ROLES:PART VI, LINE 6:DUHS PROVIDES VIRTUALLY ALL LEVELS OF CARE BEGINNING WITH DUKE UNIVERSITY AFFILIATED PHYSICIANS (DBA DUKE PRIMARY CARE) (DPC). DPC IS A BROAD NETWORK OF COMMUNITY-BASED SERVICES THAT INCLUDE FAMILY MEDICINE, PEDIATRICS, INTERNAL MEDICINE, AND URGENT CARE. THE HOSPITALS PROVIDE ROUTINE INPATIENT AND OUTPATIENT CARE. IN DURHAM COUNTY, DUH AND DRH WORK TOGETHER TO MAXIMIZE FACILITY UTILIZATION PROVIDING ROUTINE AND ADVANCED LEVELS OF CARE. DUH ALSO OPERATES A TRAUMA CENTER WITH AIR AMBULANCE SERVICE. DRAH SERVES THE WAKE COUNTY AREA AS A COMMUNITY HOSPITAL. THE DRAH CAMPUS HAS SEVERAL MEDICAL OFFICE BUILDINGS ENHANCING CONVENIENCE FOR THE PATIENT IN NON-EMERGENT CASES AND PROVIDES STREAMLINED ACCESS TO HIGH-DEMAND PROCEDURES SUCH AS CARDIAC CATHETERIZATION AND RADIOLOGY PROCEDURES. DUHS CONTINUES TO EXPAND ITS AMBULATORY FOOTPRINT TO PROVIDE CARE CLOSE TO PATIENTS' HOMES, EXTEND ACCESS TO NEW COMMUNITIES AND MEET GROWING POPULATION NEEDS EFFICIENTLY AND EFFECTIVELY. DUHS' POPULATION HEALTH MANAGEMENT OFFICE WITHIN DUKE INTEGRATED NETWORK, INC. IS THE CENTRAL ENTITY AT DUKE GUIDING CARE TRANSFORMATION FOR VALUE BASED CARE, INCLUDING CARE MANAGEMENT PROGRAMS AND DEPLOYMENT OF RELATED DATA AND ANALYTICS PROGRAMS, AS WELL AS FOSTERING RELATIONSHIPS WITH PAYERS, COMMUNITY RESOURCES, AND PHYSICIANS WITHIN THE SERVICE AREA. DUHS ALSO OPERATES HOME HEALTH AND HOME INFUSION SERVICES TO TREAT AND CARE FOR PATIENTS IN THE COMFORT OF THEIR HOME. THIS IS OBVIOUSLY PRACTICAL FOR PATIENTS NOT REQUIRING AN INPATIENT STAY BUT IN NEED OF ONGOING CARE AT A SUB-ACUTE LEVEL. FINALLY, HOSPICE PROVIDES PALLIATIVE CARE FOR PATIENTS NOT RESPONDING TO CURATIVE CARE. PAIN MANAGEMENT, SYMPTOM MANAGEMENT, AND PSYCHOLOGICAL AND SPIRITUAL SUPPORT PROVIDE A ROUNDED APPROACH TO COMPASSIONATELY ASSIST TERMINAL PATIENTS AND THEIR FAMILIES WITH THE PROCESS OF DYING. ALL OF THE OPERATING UNITS OF DUHS WORK TOGETHER TO PROVIDE THE RIGHT LEVEL OF CARE FOR THE PATIENT IN THE MOST BENEFICIAL MANNER. IN ADDITION TO THE REACTIVE ACTIVITIES OF DIAGNOSTIC CARE, DUHS ALSO SUPPORTS AND PROMOTES HEALTH AND WELL-BEING AT DUKE HEALTH & FITNESS CENTER, AND DUKE INTEGRATIVE MEDICINE. THESE SERVICES INCLUDE A MEDICALLY-BASED WEIGHT LOSS PROGRAM, MEDICALLY-BASED FITNESS, WELLNESS AND REHABILITATION PROGRAMS.LIST OF ALL STATES WHICH ORGANIZATION FILES A COMMUNITY BENEFIT REPORT:PART VI, LINE 7:NORTH CAROLINA