4A (Expenses $ 1036945382 including grants of $ 6446365) (Revenue $ 1283967041)
THE PRIMARY EXEMPT PURPOSE OF MIAMI VALLEY HOSPITAL IS TO PROVIDE COMPREHENSIVE INPATIENT, OUTPATIENT, AND EMERGENCY HEALTH CARE SERVICES TO THE RESIDENTS OF MONTGOMERY AND THE SURROUNDING COUNTIES. THE HOSPITAL FURTHERS ITS TAX-EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY IN MANY WAYS. SEE SCHEDULE H FOR MORE INFORMATION.

PART V, SECTION A, LINE 1:
THE STATE OF OHIO DOES NOT LICENSE HOSPITALS, BUT THE OHIO DEPARTMENT OF HEALTH DOES REGISTER HOSPITALS. AS PART OF THIS REGISTRATION PROCESS, HOSPITALS IN THE STATE OF OHIO ARE REQUIRED TO COMPLETE AND SUBMIT THE ANNUAL HOSPITAL REGISTRATION AND PLANNING REPORT (AHR) EACH CALENDAR YEAR.MIAMI VALLEY HOSPITAL'S REGISTRATION NUMBER IS 1247.MIAMI VALLEY HOSPITAL SOUTH'S REGISTRATION NUMBER IS 1489.MIAMI VALLEY HOSPITAL NORTH'S REGISTRATION NUMBER IS 1914.

PART V, SECTION B, LINE 3E:
MIAMI VALLEY HOSPITAL'S SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND WERE IDENTIFIED THROUGH THE CHNA.

PART V, SECTION B, LINE 5:
THE CHNA TEAM COLLECTED 140 MEASURES FROM PUBLICLY AVAILABLE SOURCES, STARTING WITH THE COUNTY HEALTH RANKINGS. CRITERIA FOR INCLUSION INCLUDED AVAILABILITY OF TREND DATA AT THE COUNTY LEVEL AND EASE OF COMPARISON AND UPDATING.THE COLLABORATIVE CHNA FOR 2019 SHARES DATA FOR THE WHOLE REGION AS WELL AS DETAILED COUNTY-LEVEL DATA. SERVICE AREAS OF HOSPITALS VARY, AND THIS APPROACH PROVIDES THE MOST THOROUGH PICTURE OF HEALTH NEEDS LOCALLY AND REGIONALLY. AN ADDED BONUS THIS CYCLE IS THE ACTIVE PARTICIPATION OF THE SOUTHWEST OHIO MEMBERS OF THE ASSOCIATION OF OHIO HEALTH COMMISSIONERS. THE CHNA TEAM REACHED OUT TO THEM IN SPRING 2017 TO TAKE THE FIRST STEPS TOWARDS THE STATE OF OHIO'S REQUIREMENT THAT HEALTH DEPARTMENTS AND HOSPITALS ALIGN THEIR ASSESSMENTS STARTING IN 2020. AS A RESULT, THE CHNA TEAM HAS RESEARCHED MORE SECONDARY DATA MEASURES, INCLUDED HOSPITAL UTILIZATION DATA, OVERSAMPLED VULNERABLE POPULATIONS, AND ENGAGED MORE PARTICIPANTS. A TOTAL OF 1,416 PEOPLE OR ORGANIZATIONS COMPLETED A SURVEY OR ATTENDED A MEETING. A SIGNIFICANT PART OF THE INCREASE WAS DUE TO LOCAL HEALTH DEPARTMENTS HELPING TO PROMOTE AND CONDUCT MEETINGS.THE PRIMARY DATA COLLECTION AND ANALYSIS USED THE NARRATIVE METHOD AND SPECIFICALLY THE TECHNIQUE OF DISCOURSE ANALYSIS. THE FOCUS WAS ON COLLECTING DATA FROM INDIVIDUALS BASED ON THEIR EXPERIENCE. THERE WERE SEVERAL IMPORTANT STEPS TO ENSURE A CONSISTENT PROCESS:1) VERBATIM ENTRY OF COMMENTS - THIS HAPPENS AUTOMATICALLY WITH THE ONLINE SURVEY PROCESS AND SCRIBES WERE TRAINED TO DO THIS AT THE COMMUNITY MEETINGS.2) CREATING CUSTOM TAGS TO SUMMARIZE EACH RESPONSE, E.G., CANCER, DIABETES, HEART DISEASE.3) CREATING THEMES THAT CONNECT SOME OF THE TAGS, E.G., CHRONIC DISEASE.4) PROOFREADING EACH OTHER'S TAGS AND ANALYSIS, WITH REVIEW BY AT LEAST 3 DIFFERENT PEOPLE TO ENSURE OVERALL CONSISTENCY.5) USE OF SURVEYMONKEY'S 'GOLD' LEVEL ENABLED THE CREATION OF CUSTOM TAGS AND INITIAL SORTING. IT ALSO PROVIDED A CONSISTENT WAY TO COMPARE SURVEY RESULTS WITH MEETING RESPONSES. IT WORKED FOR FACE-TO-FACE VERBAL ENCOUNTERS, SUCH AS IN MEETINGS, AS WELL AS WRITTEN RESPONSES. COMMENTS MADE IN PERSON WERE ENTERED INTO SURVEYMONKEY, TAGGED, AND THEMES IDENTIFIED. THE LEAD CONSULTANT CUSTOMIZED THE TAGGING IN SURVEYMONKEY BECAUSE SHE FOUND THAT ITS AUTOMATIC GROUPING OF IDEAS WAS NOT PRECISE ENOUGH AND COULD NOT ACCOUNT FOR CONTEXT OR ADAPT WHEN RESPONSES USED DIFFERENT WORDS FOR SIMILAR CONCEPTS.6) REVIEWING TAGS AT THE COUNTY-LEVEL, URBAN LEVEL, AND REGIONAL LEVEL WAS DONE TO ENSURE THAT THE TAGS AND THEMES MADE SENSE AND WERE APPLICABLE AT ALL LEVELS. FOR EXAMPLE, THE CONSULTANTS CREATED TAGS FOR 'ADDICTION,' 'HEROIN,' 'METH' AS SUBSETS OF THE 'SUBSTANCE ABUSE' THEME, BECAUSE OF THEIR APPARENT FREQUENCY AT THE BEGINNING OF THE TAGGING PROCESS. THEY COUNTED EACH TAG AND SAVED THE COUNT, BUT NONE OF THESE TAGS REACHED HIGH ENOUGH NUMBERS (MORE THAN 5% OF MENTIONS) TO WARRANT ITS OWN CATEGORY IN THE FINAL ANALYSIS. SEE APPENDIX K FOR GUIDELINES USED TO ASSIGN CATEGORIES AND FOR SORTING AND TABULATING RESPONSES.7) SURVEYMONKEY'S FILTER OPTIONS FACILITATED THE PROCESS OF SORTING AND ANALYZING BY COUNTY, BY GROUPS OF COUNTIES, BY TYPE OF SURVEY, AND/OR BY SUB-POPULATION. THIS IS A USEFUL OPTION TO CONSIDER CONTEXT OR CULTURE, SUCH AS URBAN RESPONDENTS OR LATINO RESPONDENTS.THE CHNA TEAM INVOLVED FOUR ENTITIES WORKING CLOSELY TOGETHER: THE HEALTH COLLABORATIVE (LEAD AGENCY); THE GREATER DAYTON AREA HOSPITAL ASSOCIATION; GWEN FINEGAN (LEAD CONSULTANT AND PROJECT MANAGER); AND PUBLIC HEALTH - DAYTON & MONTGOMERY COUNTY (SECONDARY DATA COLLECTION FOR OHIO COUNTIES). THE HEALTH COLLABORATIVE (THC) CONTRACTED WITH MS. FINEGAN TO CONDUCT A COMPREHENSIVE AND COLLABORATIVE ASSESSMENT FOR THE HEALTHCARE SYSTEMS AND HOSPITALS. THE LEAD CONSULTANT ASSEMBLED A TEAM OF FOUR SUB-CONTRACTORS TO ASSIST HER. BOTH THC AND THE GREATER DAYTON AREA HOSPITAL ASSOCIATION (GDAHA) MANAGED THE RELATIONSHIPS AND SIGNED AGREEMENTS WITH THEIR RESPECTIVE MEMBER HOSPITALS. THE LEAD CONSULTANT INITIATED THE CONNECTION WITH THE SOUTHWEST DISTRICT OF THE ASSOCIATION OF OHIO HEALTH COMMISSIONERS (AOHC), AND BOTH SHE AND THC REPRESENTATIVES ATTENDED SIX AOHC MEETINGS.THE LEAD CONSULTANT WORKED CLOSELY WITH ERIK BALSTER, DIRECTOR FOR THE SW DISTRICT OF AOHC AND HEALTH COMMISSIONER OF PREBLE COUNTY TO INCORPORATE AOHC'S REQUESTS AND ENSURE SMOOTH COMMUNICATION. THE LEAD CONSULTANT ALSO WORKED CLOSELY WITH DAWN EBRON, COMMUNITY HEALTH IMPROVEMENT PLANNING AND EPIDEMIOLOGY SUPERVISOR, AND EPIDEMIOLOGISTS KYLE WALLACE, ASHLEY SEYBOLD, AND SUSAN HERZFELD AT PUBLIC HEALTH - DAYTON & MONTGOMERY COUNTY TO COORDINATE MEETINGS AND FOR SECONDARY DATA COLLECTION. INTERACT FOR HEALTH PROVIDED DATA FROM THEIR GREATER CINCINNATI HEALTH STATUS SURVEY AS DID PREVENTIONFIRST! FROM ITS PRIDE SURVEY. LOUISE KENT, PLANNING ADMINISTRATOR FOR THE NORTHERN KENTUCKY HEALTH DEPARTMENT, IDENTIFIED ADDITIONAL DATA SOURCES FOR THE COMMONWEALTH OF KENTUCKY AND THE THREE NORTHERN COUNTIES. THE CINCINNATI HEALTH DEPARTMENT GATHERED DATA FOR THE CITY OF CINCINNATI.

PART V, SECTION B, LINES 6A & 6B:
MIAMI VALLEY HOSPITAL, MIAMI VALLEY HOSPITAL SOUTH, AND MIAMI VALLEY HOSPITAL NORTH PARTNERED WITH MEMBER HOSPITALS OF THE GREATER DAYTON AREA HOSPITAL ASSOCIATION, PUBLIC HEALTH DEPARTMENTS, THE HEALTH COLLABORATIVE IN CINCINNATI, OHIO, ADAMS COUNTY HEALTH DEPARTMENT, BROWN COUNTY HEALTH DEPARTMENT, BUTLER COUNTY HEALTH DEPARTMENT, CHAMPAIGN-URBANA COUNTY DEPARTMENT, CINCINNATI HEALTH DEPARTMENT, CITY OF HAMILTON HEALTH DEPARTMENT, CLARK COUNTY COMBINED HEALTH DISTRICT, CLERMONT COUNTY PUBLIC HEALTH, CLINTON COUNTY HEALTH DEPARTMENT, DARKE COUNTY GENERAL HEALTH DISTRICT, FAYETTE COUNTY PUBLIC HEALTH, GREENE COUNTY PUBLIC HEALTH, HAMILTON COUNTY PUBLIC HEALTH, HIGHLAND COUNTY HEALTH DEPARTMENT, MIAMI COUNTY PUBLIC HEALTH, MIDDLETOWN CITY HEALTH DISTRICT, NORWOOD HEALTH DEPARTMENT, PIQUA CITY HEALTH DEPARTMENT, PREBLE COUNTY PUBLIC HEALTH, PUBLIC HEALTH - DAYTON & MONTGOMERY COUNTY, SIDNEY SHELBY COUNTY HEALTH DEPARTMENT, SPRINGDALE HEALTH DEPARTMENT & WARREN COUNTY COMBINED HEALTH DISTRICT.

PART V, SECTION B, LINES 7A & 10A:
THE DIRECT WEBSITE ADDRESS WHERE THE 2019 CHNA AND THE 2020 COMMUNITY HEALTH IMPLEMENTATION PLAN CAN BE ACCESSED IS:HTTPS://WWW.PREMIERHEALTH.COM/ABOUT-PREMIER/COMMUNITY-INVOLVEMENT/COMMUNITY-HEALTH-IMPROVEMENT

PART V, SECTION B, LINE 11:
MIAMI VALLEY HOSPITAL (MVH), MIAMI VALLEY HOSPITAL SOUTH (MVHS), AND MIAMI VALLEY HOSPITAL NORTH (MVHN) ADOPTED AN IMPLEMENTATION STRATEGY TO ADDRESS THE FOLLOWING PRIORITIZED NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA):*ACCESS TO CARE AND/OR SERVICES*CHRONIC DISEASE*HEALTHY BEHAVIORS*SUBSTANCE ABUSE AND MENTAL HEALTHMVH AND MVHNACCESS TO CARE/SERVICESCOMMUNITY PARAMEDICINE PROGRAMMETRICS: NUMBER OF HOME ASSESSMENTS. NUMBER OR PERCENT OF PATIENTS CONNECTED TO COMMUNITY RESOURCES. REDUCTION IN NUMBER OF EMERGENCY DEPARTMENT VISITS. DECREASED CALLS TO LOCAL 911 SERVICES.HEALTH ISSUE: PATIENTS WITHOUT ACCESS TO REGULAR MEDICAL CARE OFTEN HAVE UNNECESSARY VISITS TO EMERGENCY DEPARTMENTS AND UNPLANNED HOSPITAL READMISSIONS.INTERVENTION'S GOAL: THE GOAL IS TO MEET THE NEEDS OF VULNERABLE RESIDENTS, WHO ARE NOT ELIGIBLE FOR HOME HEALTH CARE, BY PROVIDING CARE FROM COMMUNITY PARAMEDICS AND CONNECTING THEM TO AVAILABLE RESOURCES.DESCRIPTION: THE PROGRAM HAS BEEN DESIGNED TO PROVIDE THE RESIDENT WITH PERSONALIZED HEALTH AND WELLNESS SUPPORT IN THE COMFORT OF THEIR OWN HOME. THE PROGRAM WILL HELP THEM MANAGE THEIR NEEDS INCLUDING MEDICATIONS, AS WELL AS CONNECTING THE PATIENTS WITH PRIMARY CARE PHYSICIANS, PRENATAL CARE, SENIOR CARE SERVICES, AND MORE. THE TEAM, WHICH COMPRISES A PARAMEDIC AND EMERGENCY MEDICAL TECHNICIAN FROM DAYTON FIRE ALONG WITH A SOCIAL WORKER FROM THE CITY OF DAYTON, WILL VISIT THE HOME AND IDENTIFY BASIC NEEDS SUCH AS FOOD AND SAFETY. THE CREW WILL THEN DEVELOP A CARE PLAN THAT FACTORS IN THE PATIENT'S UNIQUE HOME ENVIRONMENT, SUPPORT, AND HEALTH CARE NEEDS. THE TEAM CAN ALSO WORK TO CONNECT THE PATIENT WITH COMMUNITY RESOURCES, SUCH AS HOUSING, UTILITIES, INSURANCE, PRESCRIPTION DELIVERY, TRANSPORTATION, OR ANY OTHER NEEDS THAT THE PATIENT/CARE TEAM IDENTIFY AS HAVING A POSITIVE EFFECT ON THE RESIDENT'S HEALTH AND WELLNESS. RESIDENTS ARE IDENTIFIED FOR THE PROGRAM THROUGH HOSPITALS, 911 EMS AGENCIES, PHYSICIANS, FAMILY MEMBERS, ETCBACKGROUND: ANALYSIS OF FREQUENT EMERGENCY VISITS WAS PERFORMED, AND 20 PATIENTS WHO LIVED IN ZIP CODE 45406 ACCOUNTED FOR MORE THAN 600 VISITS. THEY HAD CHRONIC CONDITIONS SUCH AS PULMONARY DISEASE, DIABETES, HYPERTENSION, AND KIDNEY DISEASE AS WELL AS PSYCHOSOCIAL, FINANCIAL, AND/OR SAFETY NEEDS. THE RESIDENTS WERE NOT CONNECTED TO PRIMARY CARE PHYSICIANS AND RESORTED TO CRISIS MANAGEMENT OF THEIR HEALTH CARE ISSUES. IN 2016, THE STATE OF OHIO PASSED A LAW ALLOWING TRAINED PARAMEDICS TO FUNCTION IN NON-EMERGENCY AND HOME SITUATIONS, THUS PROVIDING AN ALTERNATIVE TO AN AMBULANCE RUN TO A HOSPITAL'S EMERGENCY DEPARTMENT. PREMIER HEALTH IS THE LEAD ORGANIZATION WITH STAFFING BY THE DAYTON FIRE DEPARTMENT.PARTNERS: DAYTON FIRE DEPARTMENT AND THE CITY OF DAYTONMVH, MVHS, MVHNACCESS TO CARE/SERVICESER VIRTUAL CAREMETRICS: NUMBER OF NEW SITES, NUMBER OF RESIDENTS SERVED, REASON FOR CONSULTATIONS, EMERGENCY DEPARTMENT TRANSFERS/HOSPITALIZATION RATES, AND PATIENT AND CLINICIAN SATISFACTION.HEALTH ISSUE: AS NURSING FACILITIES ARE CALLED UPON TO CARE FOR HIGHER-ACUITY PATIENTS AND DRIVE BETTER OUTCOMES AT A FRACTION OF THE COST OF A HOSPITALIZATION, SYSTEMS ARE REQUIRED THAT DELIVER QUALITY PHYSICIANS TO THE BEDSIDE AT TIMES OF CHANGE OF CONDITION.INTERVENTION'S GOAL: THE GOAL OF THE PROGRAM IS TO FACILITATE EARLY TREATMENT OF CONDITIONS, REDUCE EMERGENCY ROOM TRANSFERS AND HOSPITALIZATIONS, AND REDUCE CARE COSTS FOR RESIDENTS. THE LONG-TERM PLAN IS TO EXPAND ER VIRTUAL CARE TO NURSING FACILITIES ACROSS OUR MARKET AND EXPAND SERVICE OFFERINGS TO INCLUDE SPECIALTIES SUCH AS NEUROLOGY, WOUND CARE, AND BEHAVIORAL HEALTH.DESCRIPTION: VIDEO CONSULTATION WITH A DOCTOR CAN EXPEDITE EVALUATION OR TREATMENT FOR PATIENTS AT NURSING FACILITIES OR AT HOME. ER VIRTUAL CARE USES REAL-TIME VIDEO AND AUDIO FOR AN EMERGENCY MEDICINE PHYSICIAN TO TREAT A PATIENT REMOTELY. BY REMOVING GEOGRAPHICAL BOUNDARIES, THE HOSPITAL CAN LEVERAGE AVAILABLE PROVIDERS FROM A DISTANCE TO PROVIDE SUPPORT AND TREAT PATIENTS. THIS TELEMEDICINE SOLUTION CAN HELP ADDRESS UNNECESSARY TRANSFER OF NURSING HOME AND ASSISTED LIVING RESIDENTS TO HOSPITALS BY ALLOWING ACCESS TO EMERGENCY MEDICINE SPECIALISTS FOR AFTER HOUR AND WEEKEND COVERAGE.BACKGROUND: THE CLOSURE OF GOOD SAMARITAN HOSPITAL LED TO AN INCREASED DEMAND IN SERVICES AT MVH-NORTH. CLINICAL AND OPERATIONAL LEADERSHIP IDENTIFIED AN OPPORTUNITY TO LEVERAGE TELEMEDICINE AND HELP TREAT PATIENTS THAT PRESENT WITH LOW ACUITY SYMPTOMS TO EXPEDITE TREATMENT A REDUCE WAIT TIMES. INITIAL RESULTS ON UTILIZATION AND PATIENT SATISFACTION WERE POSITIVE AND EXPANDED PREMIER HEALTH'S SCOPE FOR INCLUSION OF COMMUNITY PARTNER FACILITIES. NURSING FACILITIES ARE CHALLENGED WITH CARING FOR HIGHER ACUITY PATIENTS. THE SERVICE PROMOTES PREMIER HEALTH'S MISSION IN PROVIDING HIGHEST QUALITY OF CARE AT THE RIGHT TIME AND RIGHT PLACE.PARTNERS: MIAMI VALLEY EMERGENCY SPECIALISTS, SPRINGMEADE HEALTH CENTER, AND KOESTER PAVILIONMVH AND MVHNCOMMUNITY HEALTH MOBILE CLINICMETRICS: NUMBER OF PEOPLE SERVED. NUMBER OF PEOPLE CONNECTED TO RESOURCES. PERCENT OF PEOPLE IDENTIFIED AS 'AT RISK AND RECEIVING FOLLOW-UP.HEALTH ISSUE: BOTH URBAN AND RURAL RESIDENTS CAN EXPERIENCE OBSTACLES TO RECEIVING MEDICAL CARE. A MOBILE CLINIC CAN TRAVEL TO LOCATIONS CONVENIENT FOR RESIDENTS IN UNDERSERVED AREAS.INTERVENTION'S GOAL: THE GOAL IS TO BRING HEALTHCARE PROVIDERS AND SERVICES ON A ROUTINE BASIS TO UNDERSERVED COMMUNITIES THROUGH THE PREMIER COMMUNITY HEALTH MOBILE CLINIC PROGRAM. THE GOAL IS TO MAKE QUALITY HEALTHCARE ACCESSIBLE TO SUCH LOCATIONS AS PREBLE COUNTY AND WEST DAYTON BY UTILIZING SITES AT NONPROFIT ORGANIZATIONS, PARTICIPATING CVS PHARMACIES, AND LOCAL SCHOOLS.DESCRIPTION: THE PROGRAM UTILIZES MEDICAL PROVIDERS WHO OFFER PATIENTS ASSESSMENTS, COUNSELING, FOLLOW-UP CARE, AND REFERRALS THROUGH THE PREMIER HEALTH ONLINE SCHEDULING PORTAL. THE PATIENTS ARE PROVIDED BLOOD PRESSURE, CHOLESTEROL, BLOOD GLUCOSE, A1C SCREENINGS, (ALL WITH IMMEDIATE RESULTS) AS WELL AS FLU SHOTS ADMINISTERED BY PREMIER COMMUNITY HEALTH NURSES. THE CARE WILL BE DOCUMENTED IN EPIC ALLOWING TRACKING OF PROGRESS AND PROVIDING ACCESS OF THEIR MOBILE CLINIC'S VISITS TO OTHER PROVIDERS AS NEEDED. ALONG WITH THE HEALTH SCREENINGS RESULTS AND COUNSELING PROVIDED BY THE HEALTHCARE PROVIDER, THE PROGRAM ALSO PROVIDES EDUCATION THROUGH THE WELLNESS DEPARTMENT OF TAKE-HOME LITERATURE ABOUT CHRONIC DISEASE AND HEALTHY LIFESTYLE ALTERNATIVES. WITH THIS PARTNERSHIP THE PROGRAM WILL PROVIDE APPROXIMATELY 700 HOURS OF SERVICE, BETWEEN NOVEMBER 2019 AND DECEMBER 2020 AND PROJECTED 700 HOURS OF SERVICE BETWEEN 2021 AND 2022, TO THE UNDERSERVED COMMUNITY.BACKGROUND: THE PREMIER COMMUNITY HEALTH MOBILE CLINIC PROGRAM HAS PARTNERED WITH WRIGHT STATE PHYSICIAN RESIDENTS, PREMIER HEALTH URGENT CARE CENTERS, AND A PRIMARY CARE PHYSICIAN FROM ONEFIFTEEN TO PROVIDE ACCESSIBLE HEALTHCARE ASSESSMENTS, CONSULTATIONS AND REFERRALS TO PATIENTS IN THE TARGETED AREAS. A NEW PARTNERSHIP WITH CVS ENABLES THE MOBILE CLINIC TO PROVIDE SERVICES IN LOCATIONS WHERE THERE IS NOT A MINUTECLINIC AVAILABLE. THERE WILL BE UP TO 10 CVS SITES IN DAYTON AND NEAR ATRIUM MEDICAL CENTER, WHERE THE MOBILE CLINIC CAN PARK AND SEE PATIENTS. SCHOOLS WILL ALSO OFFER A COMMUNITY LOCATION FOR THE PUBLIC AND SCHOOL STAFF.PARTNERS: CVS PHARMACY LOCATIONS IN GERMANTOWN, TROTWOOD, NEW LEBANON, EATON, AND MORE; DAYTON SALVATION ARMY-KROC CENTER; GRATIS FIRE DEPARTMENT; MADISON LOCAL SCHOOLS; PREBLE COUNTY CHAMBER OF COMMERCE; PREBLE COUNTY HEALTH DEPARTMENT; PREBLE SHAWNEE SCHOOLS; PREMIER HEALTH URGENT CARE CENTERS; SAMARITAN BEHAVIORAL HEALTH INC.; VALLEY VIEW LOCAL SCHOOLS; SOMERVILLE COMMUNITY CHURCH; WRIGHT STATE PHYSICIANS; HELP ME GROW; TRI-COUNTY NORTH; BROOKVILLE SCHOOLS; MAXON FOUNDATION; AND ATRIUM MEDICAL CENTER FOUNDATION.

PART V, SECTION B, LINE 11: (CONTINUED)
MVHNSENIOR EMERGENCY CENTERMETRICS: CHANGE IN PATIENT VOLUME; READMISSION RATES; SUSPECTED ABUSE/NEGLECT; RETURN ED VISITS WITHIN 72 HOURS OF DISCHARGE; AND TRANSFERS TO HIGHER LEVELS OF CARE. ADDITION OF 4TH SENIOR-FRIENDLY ROOM. NUMBER OF REFERRALS AND COMPLIANCE WITH COMPLETION OF REFERRALS.HEALTH ISSUE: SENIOR VISITS TO THE EMERGENCY DEPARTMENT HAVE INCREASED BY 45.7% SINCE 2018.INTERVENTION'S GOAL: THE GOAL IS TO PROVIDE AGE-APPROPRIATE SCREENING AND INTERVENTION IN THE EMERGENCY DEPARTMENT.DESCRIPTION: MIAMI VALLEY HOSPITAL NORTH CREATED 3 SENIOR-FRIENDLY ACCESSIBLE ROOMS WITH CALM COLORS, SPECIALIZED LIGHTING, EASY-TO-READ CLOCKS, AND MOBILITY AIDS. ALL PATIENTS AGE 65+ WITH AN ACUITY LEVEL OF 2.5 RECEIVE AN ASSESSMENT THAT INCLUDES ELDER ABUSE SCREENING, MENTAL HEALTH SCREENING, AND CAREGIVER STRAIN SCREENING. A POOR OR VERY POOR ASSESSMENT TRIGGERS AN RN TO MAKE A REFERRAL. THEY CAN REQUEST A CASE MANAGER AND/OR SOCIAL WORKER TO SEE THE PATIENT. FOUR RNS HAVE BEEN TRAINED AS SENIOR CHAMPIONS. A FIDELITY HEALTH CARE RN FOLLOWS UP BY PHONE WITHIN 24 HOURS TO VERIFY FOLLOW-UP APPOINTMENTS, REVIEW DISCHARGE INSTRUCTIONS, AND ASSESS THE NEED FOR ANY FURTHER REFERRALS.BACKGROUND: SENIOR VISITS ACCOUNT FOR MORE THAN 30% OF EMERGENCY DEPARTMENT VISITS. ABOUT 20% OF THE PATIENTS IN THE MIAMI VALLEY HOSPITAL NORTH EMERGENCY DEPARTMENT ARE AGES 65 AND OLDER.MVH, MVHS, MVHNACCESS TO CARE/SERVICES AND CHRONIC DISEASECOMMUNITY HEALTH VOUCHER PROGRAMMETRICS: FOR THE 3-YEAR PERIOD, A PROJECTED 183 WOMEN WILL BE SERVED BYTHE COMMUNITY HEALTH VOUCHER PROGRAM AMONG MIAMI VALLEY HOSPITAL, MIAMI VALLEY HOSPITAL NORTH, AND MIAMI VALLEY HOSPITAL SOUTH. EXPANDED ELIGIBILITY FOR BCCP IMPACTED THE NUMBER OF WOMEN WHO NEEDED TO UTILIZE GOOD SAMARITAN HOSPITAL FOUNDATION FUNDING. HOWEVER, THE SAME WOMEN WHO ENROLLED IN BCCP WILL LIKELY NEED THIS COVERAGE NEXT YEAR, SINCE THE BCCP ONLY COVERS BI-YEARLY SCREENINGS. THE MIAMI VALLEY HOSPITAL FOUNDATION ALSO FUNDS THIS PROGRAM. IN 2020, THE PROGRAM COORDINATOR AND COMMUNITY ENGAGEMENT SPECIALIST BEGAN NEGOTIATING ADDITIONAL SERVICES THAT CAN BE COVERED BY THIS FUNDING. THEY ARE IN THE PROCESS OF DETERMINING HOW TO REFER AND COVER CLIENTS FOR SERVICES AT THE HIGH-RISK BREAST CENTERS (MIAMI VALLEY HOSPITAL SOUTH AND MIAMI VALLEY HOSPITAL NORTH). THERE HAS ALSO BEEN DISCUSSION ABOUT THE FEASIBILITY OF USING THESE FUNDS TO OFFSET THE COSTS OF PROSTHETICS AND OTHER NEEDED ITEMS FOR WOMEN WHO HAVE MASTECTOMIES. THESE PROJECTS ARE NEW AND ONGOING, BUT IT IS ANTICIPATED THAT THEY WILL LEAD TO A HIGHER UTILIZATION OF THIS FUNDING.HEALTH ISSUE: THIS PROGRAM SUPPLEMENTS THE STATE OF OHIO'S FUNDING TO ENCOURAGE WOMEN TO BE SCREENED FOR BREAST CANCER AND CERVICAL CANCER. IT PROVIDES FINANCIAL ASSISTANCE TO WOMEN WHO ARE NOT ELIGIBLE FOR THE STATE PROGRAM, AND IT ALSO COVERS DIAGNOSTIC TESTING AND BIOPSIES.INTERVENTION'S GOAL: THE MISSION OF THE VOUCHER PROGRAM IS TO PROVIDE FINANCIAL ASSISTANCE TO DETECT BREAST AND CERVICAL CANCERS AT THE EARLIEST STAGE TO UNINSURED AND UNDER-INSURED COMMUNITY RESIDENTS.DESCRIPTION: THE FOLLOWING SERVICES ARE COVERED BY THIS PROGRAM:SCREENING MAMMOGRAMS; DIAGNOSTIC MAMMOGRAMS; BREAST ULTRASOUNDS; BREAST BIOPSY; SURGICAL CONSULT (BREAST); PAP TESTS; CLINICAL BREAST EXAMS; COLPOSCOPIES; AND EDUCATIONAL MATERIALS.BACKGROUND: THIS PROGRAM IS FUNDED THROUGH THE GOOD SAMARITAN HOSPITAL FOUNDATION, THE MIAMI VALLEY HOSPITAL FOUNDATION, AND OTHER COMMUNITY DONATIONS. CLIENTS MUST BE UNINSURED OR UNDERINSURED (COPAYMENT, DEDUCTIBLE, COINSURANCE) WITH INCOME AT OR BELOW 400% OF FEDERAL POVERTY LEVEL.PARTNERS: ATRIUM MEDICAL CENTER, GOOD SAMARITAN HOSPITAL FOUNDATION, UPPER VALLEY MEDICAL CENTER FOUNDATIONS, MIAMI VALLEY HOSPITAL FOUNDATION (HELP HER FIGHT), KROGER, BREAST CANCER FOUNDATION, AND KUHNS BROTHERS.MVH AND MVHSINFANT MORTALITYHEALTHCARE COPE (COST OF POVERTY EXPERIENCE) TRAININGMETRICS: PRE-, POST- AND FOLLOW-ON-SURVEYS ARE ADMINISTERED TO PARTICIPANTS AND VOLUNTEERS TO EVALUATE THEIR PERCEPTIONS OF POVERTY. THE PRE- AND POST-SURVEYS OCCUR AS PEOPLE ENTER THE EVENT AND THEN FOLLOWING THE DEBRIEF. THE FOLLOW-ON SURVEY IS SENT LATER.HEALTH ISSUE: INFANT MORTALITY FOR BLACK INFANTS IN MONTGOMERY COUNTY IS DISPROPORTIONATELY HIGHER THAN FOR WHITE INFANTS. THIS IS THE FIFTH WORSE RATE IN OHIO. PREMATURITY ACCOUNTS FOR 50% OF THE DEATHS OF BLACK INFANTS. MATERNAL STRESS IS A SIGNIFICANT FACTOR IN PREMATURE LABOR, AND BLACK MOTHERS FACE MULTIPLE STRESSORS FROM DAILY ENCOUNTERS WITH RACISM. THE LACK OF PROGRESS IN THE REGION TO COMBAT INFANT MORTALITY LEADS TO THIS DEEPER LEVEL OF TRAINING FOR MATERNITY NURSING STAFF AND HOSPITAL LEADERS.INTERVENTION'S GOAL: THE GOAL IS TO IMPROVE INTERACTIONS WITH LOW-INCOME AND MINORITY FAMILIES TO ENSURE CULTURALLY APPROPRIATE AND TRAUMA-INFORMED CARE IS CONSISTENTLY DELIVERED.DESCRIPTION: PARTICIPATION DEEPENS THE UNDERSTANDING OF THE REALITIES OF POVERTY AND IMPLICIT BIAS; IMPROVES PROFESSIONAL APPROACH AND CONNECTIONS; DEVELOPS PRACTICES TO HELP BRIDGE THE HEALTH EQUITY GAP; AND BUILDS PARTNERSHIPS WITH THE COMMUNITY TO IMPROVE HEALTH OUTCOMES. TEN COPE TRAINING SESSIONS WILL INVOLVE 428 PARTICIPANTS, OF WHOM 85% WILL BE NURSES. THE PROGRAM STARTED IN JANUARY 2020 AND CONCLUDES IN APRIL 2020. PREMIER HEALTH CURRENTLY HAS TWO TRAINED COPE FACILITATORS AND THE NECESSARY EQUIPMENT. PART OF THE PROGRAM WILL BE TO TRAIN TWO MORE COPE FACILITATORS.BACKGROUND: COPE IS A TOOL THAT HELPS HOSPITALS BUILD A CULTURE AND INFRASTRUCTURE TO DELIVER CARE THAT IS EQUITABLE FOR ALL PATIENT POPULATIONS. A HEALTHCARE VERSION IS TARGETED FOR HEALTH PROFESSIONALS.PARTNER: THINK TANK AND SAMARITAN BEHAVIORAL HEALTH INC.MVHINFANT MORTALITY CONFERENCEMETRICS: NUMBER OF ATTENDEES (300 IN 2019); DEMOGRAPHIC AND OCCUPATIONAL DIVERSITY OF ATTENDEES; AND CONFERENCE EVALUATION RESULTS.HEALTH ISSUE: INFANT MORTALITY FOR BLACK INFANTS IN MONTGOMERY COUNTY IS DISPROPORTIONATELY HIGHER THAN FOR WHITE INFANTS. THIS IS THE FIFTH WORSE RATE IN OHIO.INTERVENTION'S GOAL: THE GOAL IS TO BRING TOGETHER A DIVERSE GROUP OF PROFESSIONALS AND LAY PEOPLE WHO SHARE A FOCUS ON IMPROVING BIRTH OUTCOMES AND WHO WANT TO LEARN AND DO MORE TOGETHER.DESCRIPTION: THERE ARE MULTIPLE SESSIONS DESIGNED TO INFORM, INSPIRE, AND CONNECT PEOPLE TO RESOURCES IN THE COMMUNITY. SPEAKERS INCLUDE PROFESSIONALS IN THE FIELD AS WELL AS PEOPLE WHO SHARE THEIR PERSONAL EXPERIENCE.BACKGROUND: PREMIER HEALTH HELPS HOST THE ANNUAL INFANT MORTALITY CONFERENCE, WHICH IS A PROJECT OF THE EVERYONE REACH ONE DAYTON & MONTGOMERY COUNTY INFANT MORTALITY TASK FORCE. THE CONFERENCE IN 2020 WILL BE ITS FOURTH YEAR.PARTNERS: PUBLIC HEALTH-DAYTON & MONTGOMERY COUNTY, MONTGOMERY COUNTY, OHIO COMMISSION ON MINORITY HEALTH, MARCH OF DIMES, KETTERING HEALTH NETWORK, AND FIVE RIVERS HEALTH CENTERS, AMONG OTHERS.

PART V, SECTION B, LINE 11: (CONTINUED)
"MVHHELP ME GROW BRIGHTER FUTURESMETRICS: CASELOAD OF 1,770 FAMILIES. 100% RECEIVING HOME VISIT SERVICES RECEIVE EDUCATION AND ASSESSMENT OF A SAFE SLEEP ENVIRONMENT. 100% OF ALL MOMS, PRENATAL TO AGE 1 OF THE CHILD, ARE SCREENED FOR DEPRESSION. 100% OF HEALTHY INFANTS SURVIVE TO FIRST BIRTHDAY. MORE THAN 80% OF MOMS, ENROLLED PRENATALLY, INITIATE BREASTFEEDING. 54% ARE STILL BREASTFEEDING AT 6 MONTHS. EXPANSION TO SERVE AT LEAST ONE MORE GEOGRAPHIC AREA.HEALTH ISSUE: IN 2017 THE AFRICAN AMERICAN INFANT MORTALITY RATE WAS 16.9 IN MONTGOMERY COUNTY.INTERVENTION'S GOALS: THE GOALS ARE TO REDUCE INFANT MORTALITY THROUGH HOME VISITS FROM BIRTH TO AGE 3 AND TO REACH A CASELOAD OF 1,770 FAMILIES FOR 2020-2022.DESCRIPTION: HOME VISITS INCLUDE EDUCATION ABOUT SAFE SLEEP, SMOKING CESSATION, REDUCING CHILD MALTREATMENT AND INJURY, AND ENCOURAGING MOTHERS TO BREASTFEED. MAKING CONNECTIONS TO RECRUIT PREGNANT FIRST-TIME MOMS EARLY IN PREGNANCY IS CRITICAL. ONE OF THE FORT HAMILTON STAFF HAS TRANSITIONED TO SERVE MONTGOMERY AND PREBLE COUNTIES. A TOTAL OF TWO STAFF ARE AVAILABLE TO SERVE PREBLE COUNTY, EXPECTING A GROWTH OF 25 CLIENTS. MIAMI COUNTY HAS EXPRESSED AN INTEREST IN ADDING THE NURSE FAMILY PARTNERSHIP TO THEIR SERVICES. HELP ME GROW BRIGHTER FUTURES WOULD LIKE TO PARTNER BY UTILIZING EXISTING STAFF TO SUPPORT MIAMI COUNTY.BACKGROUND: IN 2018 AND 2019, HELP ME GROW BRIGHTER FUTURES RECEIVED INCREASED FUNDING THROUGH MEDICAID TO EXPAND HOME VISITING FOR REDUCING INFANT MORTALITY. ENROLLMENT IN HOME VISITING INCREASED BY NEARLY 200%. IN 2017 THE AFRICAN AMERICAN INFANT MORTALITY RATE WAS 16.9 IN MONTGOMERY COUNTY AND IN 2018 IT DECREASED TO A RATE OF 10.5. 1,660 MONTGOMERY COUNTY YOUNG CHILDREN OR PREGNANT MOMS ARE CURRENTLY BEING SERVED WITH HOME VISITS AND SERVICES BY THE HELP ME GROW BRIGHTER FUTURES PROGRAM. THERE WERE 22,713 HOME VISITS COMPLETED WITH FAMILIES IN 2019. THE NURSE FAMILY PARTNERSHIP EXPANDED INTO BUTLER COUNTY, ADDING STAFF AT ATRIUM MEDICAL CENTER AND FORT HAMILTON HOSPITAL, TO SERVE 100 FIRST TIME PREGNANT WOMEN. THE NURSE FAMILY PARTNERSHIP IS EXPLORING PROVIDING SERVICES IN MORE COUNTIES.PARTNERS: GREATER DAYTON AREA HOSPITAL ASSOCIATION, KETTERING HEALTH NETWORK, LIFE STAGES CENTERING, FIVE RIVERS HEALTH CENTER, SOUTHVIEW OMEN'S CENTER, GRANDVIEW WOMEN'S CENTER, PUBLIC HEALTH, PHYSICIAN OFFICES, AND A VARIETY OF COMMUNITY PROGRAMS SUCH AS THE WESLEY CENTER, ELIZABETH NEW LIFE, MIAMI VALLEY CHILD DEVELOPMENT CENTER, PROMISE TO HOPE, LIFE RESOURCE CENTER, AND FAMILY SERVICE AGENCY.MVHINFANT MORTALITY AND SUBSTANCE ABUSEPROMISE TO HOPEMETRICS: THE 2020 BUDGET COVERS AN AVERAGE OF 9 MONTHS OF SERVICE FOR 195 CLIENTS.HEALTH ISSUE: TO ENSURE HEALTHY OUTCOMES, PREGNANT WOMEN WITH SUBSTANCE USE DISORDER OR OPIATE USE DISORDER REQUIRE A MULTIDISCIPLINARY APPROACH WITH CONNECTION TO COMMUNITY RESOURCES.INTERVENTION'S GOALS: THE GOALS ARE: 1) DECREASE THE NUMBER OF UNINTENTIONAL DEATHS DUE TO SUBSTANCE OVERDOSE IN MONTGOMERY COUNTY, THEREBY DECREASING THE MATERNAL AND INFANT MORTALITY RATES. 2) INCREASE THE PERCENTAGE OF MOTHERS WHO CAN SUCCESSFULLY PARENT THEIR INFANTS FOLLOWING DELIVERY, AS OPPOSED TO PLACEMENT BY CHILDREN SERVICES. 3)DECREASE THE AVERAGE HOSPITAL LENGTH OF STAY FOR INFANTS WHO ARE DIAGNOSED WITH NEONATAL ABSTINENCE SYNDROME (NAS) AND/OR PRENATAL SUBSTANCE EXPOSURE. 4) CONTINUE TO INCREASE THE BREASTFEEDING RATE FOR MOTHERS ACTIVE IN RECOVERY AT DELIVERY.DESCRIPTION: A TEAM OF PHYSICIANS, A REGISTERED NURSE, AND A LICENSED INDEPENDENT SOCIAL WORKER WORK COLLABORATIVELY TO MEET THE UNIQUE NEEDS OF PREGNANT WOMEN WITH OPIATE USE DISORDER AND/OR SUBSTANCE USE DISORDER AND THEIR INFANTS. MIAMI VALLEY HOSPITAL OFFERS THE FACILITIES, THE HIGHLY SPECIALIZED EQUIPMENT, AND THE EXPERIENCED PHYSICIANS, NURSES, AND RELATED STAFF TO PROVIDE CARE FOR THE BOTH THE MOTHER AND INFANT. TO ENSURE THE HEALTHIEST OUTCOMES POSSIBLE FOR BOTH MOTHER AND CHILD, PERSONALIZED MEDICAL CARE AND WRAPAROUND SOCIAL SUPPORT ARE PROVIDED. PROMISE TO HOPE INITIATES MEDICATION ASSISTED TREATMENT (MAT) - (THE USE OF FDA- APPROVED MEDICATIONS, IN COMBINATION WITH INDIVIDUAL AND GROUP THERAPIES, TO TREAT OPIATE USE DISORDER AND/OR SUBSTANCE USE DISORDER) AND CONNECTS THE MOTHER WITH A RECOVERY AGENCY OF HER CHOICE IN THE COMMUNITY FOR ONGOING TREATMENT.BACKGROUND: PROMISE TO HOPE HAS SERVED 500 PREGNANT WOMEN WITH OPIATE USE DISORDER SINCE ITS INCEPTION IN MAY 2015. IT PROVIDES TREATMENT DURING PREGNANCY AND FOR UP TO A YEAR AFTER THE BIRTH. IN 2020, PROMISETO HOPE EXPANDED TO INCLUDE PREGNANT WOMEN WITH ANY TYPE OF SUBSTANCE USE DISORDER RATHER THAN JUST TARGETING OPIATES. THE PROMISE TO HOPE PROGRAM HAS JOINED THE OHIO PERINATAL QUALITY COLLABORATIVE AND IS WORKING WITH HOSPITALS IN CINCINNATI, DAYTON, TOLEDO, ATHENS, CLEVELAND AND COLUMBUS TO IMPROVE OUTCOMES FOR MOMS AND INFANTS.PARTNERS: ADAMHS BOARD OF MONTGOMERY COUNTY; JOSHUA RECOVERY MINISTRIES; FIVE RIVERS HEALTH CENTERS; NOVA BEHAVIORAL HEALTH; SAMARITAN BEHAVIORAL HEALTH; RECOVERY WORKS HEALING CENTER; AND TCN BEHAVIORAL HEALTH.MVHBRIGID'S PATHMETRICS: FOR 2018 AND 2019, BRIGID'S PATH REPORTS THE FOLLOWING OUTCOMES:* 70 BABIES RECEIVED CARE.* 86% OF FAMILIES STAYED ENGAGED WITH THE BRIGID'S PATH FAMILY ADVOCATE SINCE OPENING.* 86% OF BABIES WERE DISCHARGED TO PARENTS OR FAMILY; ONLY 10 BABIES WERE PLACED IN THE CUSTODY OF CHILDREN'S SERVICES.* THE AVERAGE LENGTH OF STAY WAS 56 DAYS.HEALTH ISSUE: SUBSTANCE ABUSE IS A CONTINUING PROBLEM IN THE MIAMI VALLEY. TO ENSURE HEALTHY OUTCOMES FOR THEIR INFANTS, PREGNANT WOMEN AND MOTHERS WITH ADDICTION REQUIRE ADDITIONAL RESOURCES.INTERVENTION'S GOAL: THE GOAL IS TO CREATE A CONTINUUM OF CARE FOR BABIES AND FAMILIES IMPACTED BY SUBSTANCE USE DISORDER.DESCRIPTION: BRIGID'S PATH PROVIDES CARE AND SERVICES FOR BABIES, MOTHERS, AND FAMILY MEMBERS COPING WITH BIRTH AND ADDICTION. ITS PRIMARY WORK IS TO CARE FOR INFANTS BORN EXPOSED TO AN ADDICTIVE SUBSTANCE LIKE PRESCRIPTION MEDICATION, OPIOIDS OR OTHER DRUGS. THEIR SKILLED MEDICAL STAFF AND VOLUNTEERS ARE AVAILABLE 24 HOURS A DAY, 7 DAYS A WEEK. THEY ENCOURAGE MOTHERS TO ROOM WITH, CARE FOR, AND BOND WITH THEIR BABIES AS MUCH AS POSSIBLE. SERVICES FOR BABIES INCLUDE THERAPEUTIC TECHNIQUES - BOTH MEDICINAL AND NONPHARMACOLOGICAL. THE NURSING TEAM WORKS CLOSELY WITH MOTHERS AND FAMILY MEMBERS TO SUPPORT THEIR CARING FOR THEIR BABIES. FAMILY ADVOCACY SERVICES HELP THEM COORDINATE CARE WITH OTHER PROVIDERS AND TO NAVIGATE CHILDREN'S SERVICES AND THE COURT SYSTEM, AS NECESSARY.BACKGROUND: BRIGID'S PATH STARTED CARING FOR BABIES IN DECEMBER 2017. BRIGID'S PATH IS THE FIRST FACILITY IN OHIO AND THE SECOND IN THE NATION TO OFFER AN IN-PATIENT, HOME-LIKE APPROACH TO SERVING BABIES BORN EXPOSED TO ADDICTIVE SUBSTANCES.PARTNERS: BRIGID'S PATH ALSO WORKS WITH COMMUNITY PARTNERS TO PROVIDE RESOURCES FOR MOTHERS TO ACHIEVE THE STABILITY THAT WILL HELP THEM CARE FOR THEIR CHILDREN FOR BOTH THE NEAR- AND LONG-TERM.MVH AND MVHNCHRONIC DISEASE AND HEALTHY BEHAVIORSBARBERSHOP PROGRAMMETRICS: EXPANSION TO TWO ADDITIONAL SITES: MIDDLETOWN AND MIAMI COUNTYHEALTH ISSUE: THERE ARE HEALTH DISPARITIES, ESPECIALLY FOR CHRONIC DISEASES, FOR THE AFRICAN-AMERICAN COMMUNITY. ACCORDING TO THE CDC, ""NEW"" ANALYSIS SHOWS THAT YOUNGER AFRICAN AMERICANS ARE LIVING WITH OR DYING OF MANY CONDITIONS TYPICALLY FOUND IN WHITE AMERICANS AT OLDER AGES. CHRONIC DISEASES AND SOME OF THEIR RISK FACTORS MAY BE SILENT OR NOT DIAGNOSED DURING THESE EARLY YEARS. HEALTH DIFFERENCES ARE OFTEN DUE TO ECONOMIC AND SOCIAL CONDITIONS THAT ARE MORE COMMON AMONG AFRICAN AMERICANS THAN WHITES. FOR EXAMPLE, AFRICAN AMERICAN ADULTS ARE MORE LIKELY TO REPORT THEY CANNOT SEE A DOCTOR BECAUSE OF COST.INTERVENTION'S GOAL: THE GOAL IS TO INCREASE AWARENESS OF CHRONIC HEALTH CONDITIONS AND TO PROMOTE HEALTHY LIFESTYLE CHOICES WITHIN THE AFRICAN-AMERICAN COMMUNITY.DESCRIPTION: PARTNERING WITH THE LOCAL HEALTH DEPARTMENT, PUBLIC HEALTH-DAYTON & MONTGOMERY COUNTY, WILL HELP TO FURTHER EXPAND SERVICES FOR THE COMMUNITY. BARBERS (AND SALON OWNERS) HAVE A CLOSE BOND WITH THEIR CLIENTS. THEY CAN SERVE AS MODELS OF GOOD HEALTH AND/OR HELP CONNECT THEIR CLIENTS TO HEALTH SERVICES. THE PROGRAM PROVIDES FREE, VOLUNTARY, AND CONVENIENT HEALTH SCREENINGS ON SATURDAYS AT THE SHOPS. HEALTH FAIRS, EVENTS, AND FUN CHALLENGES ALSO OCCUR.BACKGROUND: PREMIER HEALTH DEVELOPED THE BARBERSHOP HEALTH PROGRAM, WHICH NOW HAS 5 LOCATIONS. ATRIUM MEDICAL CENTER IS INTERESTED IN EXPANDING TO INCLUDE ONE OR MORE LOCATIONS IN THE HAMILTON AND MIDDLETOWN AREAS, ALONG WITH EXPANSION TO MIAMI COUNTY FOR THE UPPER VALLEY MEDICAL CENTER. THE ORIGINAL 3 BARBERSHOPS RESULTED IN 249 SCREENINGS.PARTNERS: DEEEZ CUTTZ, SERENITY SALON, MAN UP"

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MVHSONCOLOGY EXERCISE PROGRAMMETRICS: PRE- AND POST- PHYSICAL FITNESS PARAMETERS (AEROBIC CAPACITY, MUSCULAR STRENGTH, MUSCULAR ENDURANCE, BODY COMPOSITION) AS WELL AS PSYCHOSOCIAL PARAMETERS ARE TRACKED. THE PSYCHOSOCIAL COMPONENT EVALUATES DEPRESSION, ANXIETY, QUALITY OF LIFE, AND CANCER-RELATED FATIGUE. AS PART OF THE EXERCISE PRESCRIPTION, THE PATIENT'S MET LEVEL IS MONITORED. MET LEVELS (METABOLIC EQUIVALENTS) CORRESPOND TO ACTIVITIES OF DAILY LIVING.HEALTH ISSUE: EXERCISE ASSISTS IN CANCER RECOVERY.INTERVENTION'S GOAL: THE GOAL IS TO RETURN THE CANCER SURVIVOR TO THEIR PRE-CANCER DIAGNOSIS FUNCTIONAL STATUS, OR BETTER. THE TARGET IS FOR A PATIENT TO REACH 2 MET LEVELS FROM INCEPTION OF PROGRAM TO GRADUATION.DESCRIPTION: THE ONCOLOGY EXERCISE REHAB PROGRAM WAS DESIGNED SPECIFICALLY FOR THOSE DIAGNOSED WITH CANCER. IN A GROUP SETTING, CERTIFIED INSTRUCTORS TAILOR THE CLASSES TO THE PATIENT'S INDIVIDUAL NEEDS AND ABILITIES. PRE- AND POST-ASSESSMENTS MEASURE STRENGTH, ENDURANCE, CARDIORESPIRATORY FITNESS, FLEXIBILITY, AND BODY COMPOSITION. IT IS A 12-WEEK, TWICE-A-WEEK, PROGRAM.BACKGROUND: THE PROGRAM IS OFFERED AT NO CHARGE DUE TO THE GENEROSITY OF THE LOCAL COMMUNITY. DATA FROM THE FIRST COHORT REFLECTED POSITIVE SIGNIFICANT DIFFERENCES FOR EVERY PATIENT IN MOST PARAMETERS, BOTH PHYSICAL AND PSYCHOSOCIAL, BASED ON THE PRE- AND POST-ASSESSMENTS. MANY PATIENTS PRESENTED WITH A MET OF 2-3 AND GRADUATED WITH A MET OF 4-6+.PARTNERS: MAPLE TREE CANCER ALLIANCE, ST. LEONARD, UPPER VALLEY MEDICAL CENTER, MIAMI VALLEY HOSPITAL NORTH, ATRIUM MEDICAL CENTER, DAYTON PHYSICIANS, AND MIAMI VALLEY HOSPITAL FOUNDATIONMVHFOOD SECURITY: MOBILE GROCERY AND GEM CITY MARKETMETRICS: HOMEFULL WILL USE A ROBUST POINT-OF-SALE SYSTEM THAT TRACKS WHAT PEOPLE ARE BUYING, HOW MUCH SPENDING IS ON 'HEALTHY' FOODS, CUSTOMER LOCATION/ZIP CODE, AND HAS THE CAPACITY TO ASK SURVEY QUESTIONS AT CHECKOUT. HEALTH ISSUE: FOOD DESERTS AND FOOD INSECURITY IN DAYTON. LACK OF ACCESS TO A FULL-SERVICE GROCERY STORE IS IMPACTING DAYTONIANS' HEALTH. NATIONAL STUDIES HAVE SHOWN RESIDENTS WHO LIVE NEAR SUPERMARKETS HAVE LOWER RATES OF DIET-RELATED DISEASES THAN THOSE WITH LIMITED ACCESS. DAYTON HAS HIGHER THAN AVERAGE RATES OF DIABETES AND OTHER CHRONIC ILLNESS, AND OVER A THIRD OF ADULTS IN OUR NEIGHBORHOODS REPORT EATING FEWER THAN ONE VEGETABLE PER DAY. ACCORDING TO A 2015 STUDY BY FRAC, DAYTON IS IN THE BOTTOM QUARTILE OF CITIES IN THE NATION FOR FOOD HARDSHIP FOR FAMILIES WITH CHILDREN. A RECENT GALLUP POLL SHOWS 29.4% OF HOUSEHOLDS IN THE REGION REPORT TROUBLE OBTAINING HEALTHY FOOD. THE REGION HAS FEWER GROCERY AND WIC AND SNAP STORES PER CAPITA THAN THE OHIO AVERAGE.INTERVENTION'S GOAL: THE GOAL IS TO PROVIDE ACCESS TO GROCERIES IN FOOD DESERTS.DESCRIPTION: THE VEHICLE WOULD OFFER SHELVES OF FOOD AND CARTS, SIMILAR TO A BRICK-AND-MORTAR STORE. IT WOULD ROTATE TO DIFFERENT LOCATIONS IN DAYTON NOT SERVED BY A STORE.BACKGROUND: THE GEM CITY MARKET PROJECT IS A COMMUNITY-LED INITIATIVE TO CREATE A GROCERY STORE ON SALEM AVENUE. IT HAS SECURED CONSTRUCTION FINANCING AND SITE CONTROL, BUT UNTIL THE STORE IS BUILT AND OPEN, THE MOBILE GROCERY WILL BE ABLE TO OFFER GROCERIES TO NEIGHBORHOODS IN NEED.PARTNERS: HOMEFULL, DAYTON CHILDREN'S, KETTERING HEALTH NETWORKMVH, MVHS, MVHNTHE DAILY MILEMETRICS: EXPANSION TO AT LEAST TWO MORE SCHOOL DISTRICTS IN THE REGIONHEALTH ISSUE: HEALTHY BEHAVIORSINTERVENTION'S GOALS: THE GOAL IS TO PRESENT PHYSICAL ACTIVITY AS AN IMPORTANT OPPORTUNITY THAT SHAPES HEALTH, DEVELOPMENT AND FUTURE PHYSICAL ACTIVITY BEHAVIOR IN CHILDREN. CHILDREN WILL EXPERIENCE HIGHER LEVELS OF FITNESS, LOWER BODY FAT, AND STRONGER BONES AND MUSCLES WITH AN INCREASE IN PHYSICAL ACTIVITY LEVELS.DESCRIPTION: REGULAR PHYSICAL ACTIVITY ALSO BENEFITS THE MENTAL AND SOCIAL HEALTH OF CHILDREN. THE DAILY MILE IS A WELLNESS INTERVENTION DEVELOPED IN SCOTLAND, DESIGNED TO INCREASE PHYSICAL ACTIVITY LEVELS DURING THE SCHOOL DAY BY ENCOURAGING CHILDREN TO PARTICIPATE IN A JOG OR RUN, AT THEIR OWN PACE - WITH WALKING KEPT TO A MINIMUM. THE DAILY MILE OBJECTIVES COINCIDE WITH HEALTHY PEOPLE 2020 OBJECTIVES - TO TARGET YOUNGER CHILDREN THROUGH PHYSICAL ACTIVITY IN CHILDCARE SETTINGS.BACKGROUND: THE DAILY MILE CURRENTLY INFLUENCES PHYSICAL ACTIVITY BEHAVIOR AT FOUR SCHOOLS, POSITIVELY AFFECTING 340 STUDENTS DURING THE 2019-2020 SCHOOL YEAR. THE DAILY MILE WAS DEVELOPED IN 2012 AND PRIMARILY FEATURED IN SCOTLAND AND ENGLAND SCHOOLS; HOWEVER, ITS POSITIVE IMPACT ON THE CHILDREN RESULTED IN PARTICIPATION FROM OVER 10,943 SCHOOLS AND NURSERIES WORLDWIDE AND 2,309,784 STUDENTS. PREMIER HEALTH AND THE INVOLVED PARTNERS INTRODUCED THE FIRST DAILY MILE PILOT PROGRAM IN 2018. THE PILOT PROGRAM RESULTED IN A 52.7% PARTICIPATION RATE IN WHICH 80% (OF THE STUDENTS PARTICIPATING) DEMONSTRATED GROWTH IN THEIR LEVEL OF ENDURANCE. THE SUCCESS OF THE DAILY MILE CAN BE CREDITED TO THE PARTNERSHIP BETWEEN THE ORGANIZATIONS AND THE SCHOOL'S EDUCATORS. PREMIER AND THE COMMUNITY AGENCIES INVOLVED WITH THE PROJECT CONTINUE TO WORK TO EXPAND THE PROGRAM WITHIN LOCAL SCHOOL DISTRICTS.PARTNERS: DAYTON CHILDREN'S HOSPITAL; PUBLIC HEALTH DAYTON & MONTGOMERY COUNTY; FIVE RIVERS METROPARKS; CENTERVILLE CITY SCHOOL DISTRICT; MIAMISBURG CITY SCHOOL DISTRICT; AND CENTERVILLE-WASHINGTON PARK DISTRICTMVH, MVHNSUBSTANCE ABUSE AND MENTAL HEALTHONEFIFTEENMETRICS: EXPECTED OUTCOMES INCLUDE THE FOLLOWING:OPENING A 58-BED HOUSING UNIT BY THE END OF SUMMER 2020* 85% OF PATIENTS WILL HAVE A COMMUNITY-BASED VISIT WITHIN 30 DAYS OF EVALUATION.* 80% WILL HAVE BARRIERS TO CARE ADDRESSED.* 75% INITIATE TREATMENT WITHIN 30 DAYS OF EVALUATION.* 70% HAVE NALOXONE TRAINING AND ACCESS TO KIT.* 65% OF APPOINTMENTS KEPT.HEALTH ISSUE: THERE EXISTS A GAP FOR SUBSTANCE DETOX SERVICES AND CRISIS STABILIZATION.INTERVENTION'S GOALS: THE GOAL IS TO REMOVE BARRIERS TO TREATMENT REGARDLESS OF PAYOR SOURCE; PROVIDE ON-DEMAND SERVICES 24/7; AND REFER TO ONGOING TREATMENT BASED UPON ASSESSMENT PROCESS FOLLOWING THE ASAM (AMERICAN SOCIETY OF ADDICTION MEDICINE) CRITERIA.DESCRIPTION: ACCESS CAN BE VIA A REFERRAL FROM THE AREA HOSPITALS AND EMERGENCY ROOMS, EMTS, WALK-INS AND VIA POLICE ESCORT. CRISISCARE ALSO WILL AID IN REFERRING TO THIS SERVICE AND GUIDE ANY CALLERS OR WALK-INS TO THE CRISIS STABILIZATION UNIT AS APPROPRIATE. IN ADDITION, PLANNING AND IMPLEMENTING AN INPATIENT SETTING THAT DEDICATES A PORTION OF BEDS TO MEDICALLY COMPLICATED CLIENTS IN NEED OF DETOX TREATMENT FROM ALCOHOL, BENZODIAZEPINES AND OPIATES. THE ULTIMATE END GOAL IS TO PROVIDE A TECH ENABLED ECOSYSTEM TO THE SURROUNDING AREA THAT ALSO INCLUDES A 58-BED HOUSING UNIT CURRENTLY UNDER CONSTRUCTION AND SLATED FOR SERVICES BY THE END OF SUMMER 2020. IN THE CRISIS STABILIZATION UNIT, THE PATIENT RECEIVES A DIAGNOSIS AND IS THEN REFERRED TO OUTPATIENT TREATMENT AT SBHI THAT INCLUDES INDIVIDUAL AND GROUP THERAPY AND MEDICATED ASSISTED TREATMENT. THE PHYSICIANS PRESCRIBE VIVITROL AND SUBOXONE. ALL SUBSTANCE USE DISORDERS ARE TREATED. APPROPRIATE LEVELS OF CARE ARE BASED ON THE ASAM CRITERIA: TREATMENT CRITERIA FOR ADDICTIVE, SUBSTANCE-RELATED, AND CO-OCCURRING CONDITIONS. THE CRITERIA PROVIDE RESEARCH-VALIDATED STANDARDS FOR OUTCOME-ORIENTED CARE IN ADDICTION TREATMENT.BACKGROUND: ONEFIFTEEN IS A NON-PROFIT DEDICATED TO THE FULL AND SUSTAINED RECOVERY OF PEOPLE LIVING WITH OPIOID ADDICTION IN MONTGOMERY COUNTY. IT IS NAMED FOR THE 115 PEOPLE WHO DIED OF OPIOID OVERDOSES EACH DAY IN THE U.S. IN 2017. ONEFIFTEEN LAUNCHED IN 2019 WITH PREMIER HEALTH PARTNERS AND KETTERING HEALTH NETWORK IN PARTNERSHIP WITH VERILY, A SISTER COMPANY TO GOOGLE. ONEFIFTEEN HAS OPENED TWO OF THE SIX PLANNED FACILITIES ON A CAMPUS FOR OPIOID ADDICTION TREATMENT AND RECOVERY. THE FIRST TWO FACILITIES PROVIDE 33,000 SQUARE FEET OF SPACES FOR OUTPATIENT AND INPATIENT RESIDENTIAL CARE PLUS COMMUNITY-BASED WRAPAROUND SERVICES. PREMIER HEALTH PARTNERS' EXECUTIVE VICE PRESIDENT AND CHIEF OPERATING OFFICER SERVES ON ONEFIFTEEN'S BOARD. SBHI HAS BEEN PROVIDING SERVICES TO THE COMMUNITY FOR 51 YEARS FOR BOTH MENTAL HEALTH AND SUBSTANCE TREATMENT SERVICES AND HAS A LONG HISTORY OF PARTNERSHIP THROUGHOUT A THREE-COUNTY AREA. SBHI ALSO PROVIDES DAWN (DEATH AVOIDED WITH NALOXONE) KITS TO THE COMMUNITY AND PROVIDES TRAINING TO AREA BUSINESSES AND FAMILY MEMBERS OF THOSE ADDICTED AND HAS BEEN ADVOCATING TO HELP THOSE WHO OVERDOSE AND PROVIDE A TOOL TO FRIENDS AND FAMILY TO AID IN THESE SITUATIONS.PARTNERS: ADAMHS, GDAHA, KETTERING, SAMARITAN BEHAVIORAL HEALTH, INC.

PART V, SECTION B, LINE 11: (CONTINUED)
MVH, MVHS, MVHNPRESTO (PROMOTING ENGAGEMENT FOR SAFE TRAINING OF OPIOIDS)METRICS: ATTRACT AT LEAST 38 PRIMARY CARE PROVIDERS TO PARTICIPATE IN THE RESEARCH STUDY. THEIR PARTICIPATION WILL HELP THE RESEARCHERS TEST AND DEVELOP AN EFFICIENT AND EFFECTIVE PROTOCOL TO GUIDE OTHER PROVIDERS.HEALTH ISSUE: OHIO IS ONE OF THE STATES HARDEST HIT BY THE NATION'S OPIOID CRISIS. OHIO'S RATE OF UNINTENTIONAL OPIOID OVERDOSE RATE WAS NEARLY THREE TIMES THE U.S. AVERAGE IN 2017. ACCORDING TO THE OHIO DEPARTMENT OF HEALTH, 80% OF OHIOANS WHO DIED FROM AN OVERDOSE IN 2016 HAD A HISTORY OF OPIOID PRESCRIPTIONS.INTERVENTION'S GOAL: PREMIER HEALTH WILL RECRUIT SYSTEM-WIDE TO ATTRACT AT LEAST 38 OF THE 150 PRIMARY CARE PROVIDERS THAT WRIGHT STATE UNIVERSITY WILL TRAIN IN HOW TO ENGAGE PATIENTS TO TAPER DOWN THEIR OPIOID PRESCRIPTION USE.DESCRIPTION: THE PRESTO PROTOCOL IS MODELED ON THE SBIRT APPROACH OF SCREENING, BRIEF INTERVENTION, AND REFERRAL TO TREATMENT. IT INCORPORATES CDC OPIOID PRESCRIBING GUIDELINES, USE OF OHIO'S PRESCRIPTION DRUG MONITORING PROGRAM, AND MOTIVATIONAL INTERVIEWING. PARTICIPATING PROVIDERS WILL AGREE TO PARTICIPATE IN THE OHIO AUTOMATED RX REPORTING SYSTEM (OARRS) AND HAVE DE-IDENTIFIED PRESCRIBING DATA SHARED WITH INVESTIGATORS. THEY WILL PARTICIPATE IN A 3-HOUR IN-PERSON TRAINING EVENT AS WELL AS A 1-HOUR FOLLOW-UP TRAINING ABOUT 4-6 WEEKS LATER. THEY WILL BE ENCOURAGED TO USE THE PRESTO PROTOCOL AND MOTIVATIONAL INTERVIEWING WITH APPROPRIATE PATIENTS. EACH PROVIDER WILL RECEIVE $1,000 FOR COMPLETION OF THE TWO TRAINING EVENTS TO ASSIST WITH THE COST OF ATTENDING. THEY WILL ALSO RECEIVE 3 HOURS OF CONTINUING EDUCATION CREDITS. FULL IMPLEMENTATION IS EXPECTED IN LATE 2020 OR EARLY 2021.BACKGROUND: THE OHIO DEPARTMENT OF HIGHER EDUCATION AWARDED FUNDING TO RESEARCH SUBSTANCE USE DISORDERS. WRIGHT STATE UNIVERSITY RECEIVED AN AWARD TO TRAIN PRIMARY CARE PROVIDERS IN A PRESCRIPTION-TAPERING PROTOCOL KNOWN AS PRESTO.PARTNERS: MERCY HEALTH, WRIGHT STATE UNIVERSITYMVHSOCIAL DETERMINANTS OF HEALTHONMAIN PROJECTMETRICS: CONSTRUCTION ON PHASE I INFRASTRUCTURE COULD BEGIN BEFORE THE END OF 2020 AND CONSTRUCTION ON THE FIRST BUILDING COULD BEGIN IN THE FIRST HALF OF 2021.HEALTH ISSUE: SOCIAL DETERMINANTS OF HEALTH INCLUDE EDUCATION, EMPLOYMENT, ENVIRONMENT, AND GEOGRAPHIC LOCATION. COMMUNITY-BASED DEVELOPMENT THAT IS THOUGHTFUL AND SUSTAINABLE CAN IMPROVE HEALTH CONDITIONS FOR NEIGHBORHOODS.INTERVENTION'S GOAL: THE GOAL IS TO CREATE A PLACE THAT WILL LINK INDUSTRY, SCIENCE AND TECHNOLOGY WITH UNIVERSITY OF DAYTON STUDENTS AND FACULTY IN AN INNOVATIVE SETTING CLOSE TO CAMPUS. ONMAIN WOULD CONNECT TO THE CAMPUS AND DOWNTOWN AND SURROUNDING NEIGHBORHOODS.DESCRIPTION: ONMAIN HAS CREATED A MASTER PLAN FOR DEVELOPMENT OF THE SITE NEAR THE UNIVERSITY OF DAYTON. IT HAS THE CAPACITY TO PRODUCE A MILLION SQUARE FEET FOR EMPLOYMENT, 3,500 JOBS, 1,500 MIXED-USE AND MIXED-INCOME HOUSING UNITS, AND A RANGE OF PUBLIC SPACES. FEATURES INCLUDE A WALKABLE COMMUNITY, URBAN AGRICULTURE, AND DESIGN STANDARDS FOR BUILDINGS THAT INTEGRATE ENVIRONMENTAL SUSTAINABILITY AND WELLNESS.BACKGROUND: IN OCTOBER 2018, THE FORMER MONTGOMERY COUNTY FAIRGROUNDS RECEIVED A NEW NAME AND A NEW DIRECTION AS A PLACE THAT FOSTERS IMAGINATION, INNOVATION AND INCLUSIVITY. PREMIER HEALTH AND THE UNIVERSITY OF DAYTON ANNOUNCED A NEW NAME FOR THE 38 ACRES AT THE NORTHWEST CORNER OF MAIN AND STEWART STREETS - ONMAIN: DAYTON'S IMAGINATION DISTRICT - EMBODYING A VISION FOR THE SITE AS A PLACE WHERE DAYTON'S HISTORY OF INNOVATION TAKES OFF INTO THE FUTURE. FULL REALIZATION OF THE VISION'S POTENTIAL IS EXPECTED TO TAKE 15-20 YEARS.PARTNERS: CITY OF DAYTON AND THE UNIVERSITY OF DAYTONMVHNPHOENIX NEXTMETRICS: ATTRACTION OF PRIVATE DEVELOPMENT; LEVERAGING ADDITIONAL FUNDING (GRANTS AND PRIVATE DOLLARS); MAINTAINING COMMUNITY INVOLVEMENT; MAINTAINING THE LEADERSHIP STRUCTURE; AND MAKING AN IMPACT ON THE COMMUNITY.HEALTH ISSUE: SOCIAL DETERMINANTS OF HEALTH INCLUDE EDUCATION, EMPLOYMENT, ENVIRONMENT, AND GEOGRAPHIC LOCATION. COMMUNITY-BASED DEVELOPMENT THAT IS THOUGHTFUL AND SUSTAINABLE CAN IMPROVE HEALTH CONDITIONS FOR NEIGHBORHOODS.INTERVENTION'S GOALS: THE PROJECT'S GOALS ARE TO DRIVE ECONOMIC VITALITY; CREATE JOBS; ENHANCE THE AREA'S IMAGE; LEVERAGE INVESTMENT; PROMOTE HEALTHY LIVING; AND ADVANCE NEXT GENERATION LEARNING.DESCRIPTION: THE CITY OF DAYTON HAS COMMITTED $15 MILLION OVER 10 YEARS, INFRASTRUCTURE UPGRADES FOR SALEM AVENUE, AND HOUSING/BUSINESS DEVELOPMENT. THE STATE OF OHIO HAS COMMITTED $12 MILLION TO THE SALEM AVENUE INFRASTRUCTURE UPGRADES.BACKGROUND: IN THE AFTERMATH OF THE CLOSING OF THE GOOD SAMARITAN HOSPITAL IN 2018, THE CITY OF DAYTON, THE STATE OF OHIO, AND PREMIER HEALTH DEVELOPED A PLAN TO IMPROVE A 13-ACRE SITE IN THE WEST DAYTON NEIGHBORHOOD AND CREATE A FOUNDATION FOR REUSE OF THE SITE AND SUSTAINABLE DEVELOPMENT TO BENEFIT THE COMMUNITY AND ITS RESIDENTS.PARTNERS: CITY OF DAYTON AND THE STATE OF OHIO

PART V, SECTION B, LINES 16 A, B, AND C:
THE DIRECT WEBSITE ADDRESS WHERE A COPY OF THE FINANCIAL ASSISTANCE POLICY (FAP), FAP APPLICATION AND PLAIN LANGUAGE SUMMARY OF THE FAP CAN BE ACCESSED IS:HTTPS://WWW.PREMIERHEALTH.COM/PATIENT-AND-VISITOR-GUIDE/PATIENT-GUIDE/COSTS-AND-INSURANCE/BILLING/FINANCIAL-ASSISTANCE

PART V, SECTION B, LINE 16J:
THE HOSPITAL WIDELY DISTRIBUTES INFORMATION ABOUT ITS FINANCIAL ASSISTANCE POLICY WITHIN THE AREA THAT IT SERVES. THIS INFORMATION INCLUDES THE METHOD OF APPLYING FOR AND ACCESSING FINANCIAL ASSISTANCE. NOTICES ARE PUBLICIZED IN PATIENTS' BILLS AND ARE POSTED IN THE EMERGENCY ROOM, ADMITTING AND REGISTRATION AREAS, AS WELL AS OTHER PUBLIC AREAS. THE FINANCIAL ASSISTANCE POLICY IS PUBLISHED ON THE HOSPITAL'S WEBSITE. FINANCIAL COUNSELORS, PATIENT ADVOCATES, AND CUSTOMER SERVICE REPRESENTATIVES DISCUSS THE FINANCIAL ASSISTANCE POLICY WITH ALL UNINSURED PATIENTS, AND ANY PATIENT WHO EXPRESSES FINANCIAL HARDSHIP WITH PAYING THEIR BILL. APPLICATIONS FOR FINANCIAL ASSISTANCE POLICY ARE AVAILABLE IN BOTH ENGLISH AND SPANISH.

PART I, LINE 7:
A COST TO CHARGE RATIO WAS USED TO CALCULATE THIS FINANCIAL ASSISTANCE AT COST. THIS CALCULATION TAKES TOTAL OPERATING EXPENSES LESS OTHER OPERATING REVENUES DIVIDED BY TOTAL GROSS REVENUES. UNREIMBURSED MEDICAID AND OTHER MEANS-TESTED GOVERNMENTAL PROGRAMS WERE CALCULATED USING A COST ACCOUNTING SYSTEM. THIS SYSTEM ADDRESSES ALL PATIENT SEGMENTS AND INCLUDES FULLY LOADED COSTS. FOR THE REMAINING ITEMS, THE ORGANIZATION USED SPECIFIC NUMBERS FOR EXPENSE PAID DIRECTLY FOR THESE SERVICES.

PART I, LINE 6A:
THE COMMUNITY BENEFIT REPORT FOR MIAMI VALLEY HOSPITAL IS PART OF THE PREMIER HEALTH REPORT (EIN# 31-1446699).

PART I, LINE 7G:
MIAMI VALLEY HOSPITAL (MVH) PROVIDES SUBSIDIZED EMERGENCY SERVICES BY OPERATING A 24-HOUR EMERGENCY ROOM 365 DAYS PER YEAR. THIS EMERGENCY ROOM IS OPEN TO ALL INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL INCURS EXPENSES RELATED TO CALL TIME AND PHYSICIAN SUBSIDIES DUE TO THE LARGE NUMBER OF INDIGENT PATIENTS COMING THROUGH THE EMERGENCY ROOM. FOR 2021, THE AMOUNT PAID FOR CALL AND SUBSIDIES WAS $23,823,000.

PART II:
MIAMI VALLEY HOSPITAL (MVH) IS COMMITTED TO IMPROVING THE HEALTH OF THE COMMUNITIES IT SERVES THROUGH A VARIETY OF PREVENTION, HEALTH IMPROVEMENT AND ENGAGEMENT PROGRAMS. AS PART OF ITS OVERALL COMMITMENT TO THE COMMUNITY, MVH FOCUSES ON FOUR AREAS OF SERVICE:--INVESTING IN THE COMMUNITY--PREVENTION AND WELLNESS--COMMITMENT TO THE UNDER-SERVED--COMMUNITY ENGAGEMENTTHE PROGRAM SUPPORTED BY MVH DURING 2021 WAS:1) NEIGHBORHOOD REVITALIZATION AND DEVELOPMENT THROUGH A CONTRIBUTION OF $4,000 TO THE PHOENIX PROJECT. THE GOALS OF THIS PROJECT ARE TO REDUCE AND DETER CRIME, REVITALIZE THE APPEARANCE OF THE NEIGHBORHOOD AND ACTIVATE LINKAGES FOR PHYSICAL, MENTAL AND SOCIAL HEALTH SERVICES. THIS PROGRAM ALSO PURCHASES PROPERTIES IN THE SURROUNDING AREA, REHABILITATES THEM AND SELLS THEM TO THOSE IN NEED.

PART III, LINE 4:
THE ORGANIZATION DOES NOT HAVE A FOOTNOTE IN THE AUDITED FINANCIAL STATEMENTS WHICH DISCUSSES THIS CALCULATION.

PART III, LINE 8:
THE ORGANIZATION'S SHORTFALL SHOULD BE CONSIDERED CHARITY CARE BECAUSE IT IS PROVIDING HIGH-QUALITY CARE, IN EXCESS OF THE COST, TO OUR COMMUNITY RESIDENTS THAT NEED CARE. THE MEDICARE POPULATION AT THE ORGANIZATION IS IN EXCESS OF 45% OF NET PATIENT REVENUE. THE ORGANIZATION USED A COST ACCOUNTING SYSTEM TO CALCULATE THE MEDICARE ALLOWABLE COSTS.

PART III, LINE 9B:
THE ORGANIZATION MAKES REASONABLE EFFORTS TO DETERMINE WHETHER OR NOT AN INDIVIDUAL IS ELIGIBLE FOR ASSISTANCE UNDER THE STATE OR HOSPITAL FINANCIAL ASSISTANCE POLICY BEFORE ENGAGING IN EXTRAORDINARY COLLECTIVE ACTIONS AGAINST THAT INDIVIDUAL. PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE ARE OFFERED REASONABLE PAYMENT PLAN ARRANGEMENTS FOR ANY REMAINING BALANCES. ANY THIRD-PARTY COLLECTING SELF-PAY RECEIVABLES ON OUR BEHALF IS REQUIRED TO MAKE REASONABLE EFFORTS TO DETERMINE IF THE INDIVIDUAL MEETS THE QUALIFICATIONS OF THE STATE OR OF OUR HOSPITAL FINANCIAL ASSISTANCE PROGRAMS.REASONABLE EFFORTS INCLUDE:A. VALIDATING THAT THE PATIENT OWES THE UNPAID BILLS AND THAT ALL SOURCES OF THIRD-PARTY PAYMENT HAVE BEEN IDENTIFIED AND BILLED BY THE HOSPITAL.B. DOCUMENTED THAT THE ORGANIZATION HAS OR HAS ATTEMPTED TO OFFER THE PATIENT THE OPPORTUNITY TO APPLY FOR CHARITY CARE UNDER ITS FINANCIAL ASSISTANCE POLICY.C. DOCUMENTED THAT THE PATIENT DOES NOT QUALIFY FOR FINANCIAL ASSISTANCE.D. DOCUMENT THAT THE PATIENT HAS BEEN OFFERED AND ACCEPTED TERMS FOR A PAYMENT PLAN BUT HAS NOT HONORED THE TERMS OF THAT PLAN.THE FINANCIAL COUNSELORS MEET WITH INPATIENT, OUTPATIENT, SELF-PAY, AND OTHER PATIENTS UPON REQUEST WHO MAY NEED FINANCIAL ASSISTANCE. IN ADDITION TO ASSISTING PATIENTS WHO WANT TO APPLY FOR ASSISTANCE THROUGH THE MEDICAID PROGRAM, THE FINANCIAL COUNSELOR WILL PROVIDE THE PATIENT WITH A FINANCIAL ASSISTANCE APPLICATION.

PART III, LINES 2 & 3:
BAD DEBT EXPENSE IS INCURRED WHEN AN ACCOUNT IS TAKEN OUT OF ACCOUNTS RECEIVABLE AND TURNED OVER TO A COLLECTION AGENCY. THIS ACTION MAY OCCUR IF A PATIENT REFUSES PAYMENT ARRANGEMENTS, REFUSES TO APPLY FOR FINANCIAL ASSISTANCE, AND THERE IS NOT AN INSURANCE BALANCE BEING CONTENDED. AN ACCOUNT IS WRITTEN OFF TO BAD DEBT AFTER 130 DAYS IF AN ATTEMPT TO COLLECT FROM THE PATIENT IS MADE WITHIN OUR COLLECTION POLICY. THE COLLECTION AGENCY ATTEMPTS TO COLLECT THE ACCOUNT IN ACCORDANCE WITH ESTABLISHED GUIDELINES. COLLECTION ATTEMPTS ARE CEASED AND THE ACCOUNT RETURNED TO THE ORGANIZATION IF THE PATIENT APPLIES FOR FINANCIAL ASSISTANCE. ANY AMOUNTS COLLECTED FROM THESE ACCOUNTS ARE CREDITED BACK AGAINST BAD DEBT EXPENSE. THE ORGANIZATION RECOGNIZES THERE ARE ACCOUNTS WRITTEN OFF TO BAD DEBT THAT MAY HAVE QUALIFIED FOR CHARITY CARE IF THE PATIENT HAD PROVIDED THE NECESSARY FINANCIAL INFORMATION. TO RESOLVE THIS, THE ORGANIZATION HAS ENGAGED A THIRD-PARTY VENDOR TO ANALYZE DATA BASED ON CREDIT SCORES TO REALLOCATE SOME OF THIS EXPENSE TO CHARITY CARE. A REPRESENTATIVE SAMPLE OF THESE ACCOUNTS IS THEN SENT TO OUR THIRD-PARTY VENDOR WHO GATHERS EXTERNAL CREDIT DATA THAT PRESENTS THE ACCOUNT AS LESS THAN 100% FEDERAL POVERTY LEVEL OR NOT ENOUGH INFORMATION (TYPICALLY INDICATIVE OF INDIGENT). THESE ACCOUNTS ARE RECLASSED FROM BAD DEBT EXPENSE TO CHARITY EXPENSE ON OUR INCOME STATEMENT. ANY CREDIT SCORE THAT PRESENTS THE ACCOUNTS AS GREATER THAN 100% FEDERAL POVERTY LEVEL REMAINS IN BAD DEBT EXPENSE. DUE TO THIS PROCESS, THE ORGANIZATION HAS USED BEST EFFORTS TO NOT REPORT BAD DEBT EXPENSE FOR PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY.

PART VI, LINE 2:
THE ORGANIZATION WORKS WITH THE COMMUNITY ON PROGRAMS THAT ADDRESS THE UNDERLYING CAUSES OF PERSISTENT HEALTH PROBLEMS AS PART OF A COMPREHENSIVE STRATEGY TO IMPROVE THE HEALTH STATUS AND QUALITY OF LIFE FOR IDENTIFIED MEMBERS OF THE COMMUNITY WHO ARE ECONOMICALLY DISADVANTAGED, DISENFRANCHISED, AND/OR WHO HAVE DISPROPORTIONATE UNMET HEALTH NEEDS. THE ORGANIZATION STRIVES TO WORK WITH PREMIER HEALTH, THE HOSPITAL BOARD OF TRUSTEES, EXECUTIVE MANAGEMENT, MANAGERS, STAFF MEMBERS, COMMUNITY GROUPS, AND INDIVIDUALS TO PROVIDE A COLLABORATIVE APPROACH TO THE GOVERNANCE AND MANAGEMENT OF COMMUNITY BENEFIT ACTIVITIES.

PART VI, LINE 4:
THE ORGANIZATION IS LOCATED IN DAYTON, OHIO. OUR TARGET POPULATION INCLUDES CITIZENS OF DAYTON, AS WELL AS SURROUNDING COMMUNITIES. MIAMI VALLEY HOSPITAL'S TOTAL PRIMARY AND SECONDARY SERVICE AREA POPULATION IS APPROXIMATELY 535,000 PEOPLE. INCLUDING THE ADJACENT COUNTIES, WHICH ARE ALSO SERVED (GREENE, MIAMI, PREBLE), MIAMI VALLEY HOSPITAL'S TOTAL PRIMARY AND SECONDARY SERVICE AREA POPULATION APPROACHES 842,000 RESIDENTS. THE MEDIAN HOUSEHOLD INCOME OF MONTGOMERY COUNTY IS SLIGHTLY ABOVE $53,100 PER YEAR, WITH APPROXIMATELY 14.7% OF ITS CITIZENS LIVING BELOW THE FEDERAL POVERTY LEVEL. FOR 2021, MEDICARE PATIENTS REPRESENTED 45.8% OF GROSS PATIENT REVENUE AND MEDICAID REPRESENTED 23.3% OF GROSS PATIENT REVENUE.

PART VI, LINE 7:
OHIO

PART III, SECTION B, LINES 5, 6, AND 7:
THE AMOUNTS REPORTED ON LINES 5, 6, AND 7 DO NOT INCLUDE CERTAIN MEDICARE PROGRAM REVENUES AND COSTS, AND THUS DO NOT REFLECT ALL OF THE ORGANIZATION'S REVENUES AND COSTS ASSOCIATED WITH ITS PARTICIPATION IN MEDICARE PROGRAMS. IN ADDITION TO THE AMOUNTS REPORTED ON LINE 5, 6, AND 7, THE ORGANIZATION RECEIVED REVENUE OF $253,672,000 AND INCURRED COST OF $374,801,000, FOR AN ADDITIONAL NET SHORTFALL OF $121,129,000 ASSOCIATED WITH THESE PROGRAMS. BELOW IS A RECONCILIATION OF THE AMOUNTS ASSOCIATED WITH MEDICARE PROGRAMS.ALLOWABLE MEDICARE REVENUE PER MEDICARE COST REPORT(PART III, SECTION B) $200,249,000MEDICARE REVENUE NOT REPORTED IN PART III, SECTION B $253,672,000TOTAL MEDICARE ASSOCIATED REVENUE $453,921,000ALLOWABLE MEDICARE COST PER MEDICARE COST REPORT (PART III, SECTION B) $206,412,000MEDICARE COST NOT REPORTED IN PART III, SECTION B $374,801,000TOTAL MEDICARE ASSOCIATED COST $581,213,000MEDICARE SHORTFALL PER PART III, SECTION B $6,163,000ADDITIONAL SHORTFALL NOT INCLUDED IN PART III, SECTION B $121,129,000TOTAL MEDICARE SHORTFALL $127,292,000

PART VI, LINE 3:
THERE ARE SEVERAL WAYS IN WHICH OUR ORGANIZATION INFORMS AND EDUCATES PATIENTS WHO MAY BE BILLED FOR SERVICES ABOUT ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS, OR UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. FIRST, NOTIFICATION OF SUCH AVAILABLE ASSISTANCE IS CLEARLY POSTED IN REGISTRATION AREAS, AS WELL AS MATERNITY AND EMERGENCY DEPARTMENTS. NEXT, PATIENT ADVOCATES, PATIENT ACCESS STAFF MEMBERS, AND FINANCIAL COUNSELORS IN THE INPATIENT AND EMERGENCY DEPARTMENTS MEET WITH UNINSURED AND UNDERINSURED PATIENTS, AND THOSE WITH ONLY MEDICARE COVERAGE TO DISCUSS ELIGIBILITY FOR ASSISTANCE. FINANCIAL COUNSELORS ALSO DISCUSS OPTIONS TO RESOLVE UNPAID ACCOUNT BALANCES WITH UNINSURED AND UNDERINSURED PATIENTS. THE FINANCIAL ASSISTANCE POLICY IS POSTED ON THE HOSPITAL'S WEBSITE, ALONG WITH INFORMATION ON HOW TO OBTAIN AN APPLICATION. WHEN A PATIENT RECEIVES A BILL, THE REVERSE SIDE OF THE BILL CONTAINS INFORMATION ABOUT THE STATE OF OHIO FREE CARE PROGRAM (CARE ASSURANCE) AND A FINANCIAL ASSISTANCE APPLICATION. THE BILLING STATEMENTS OFFER THE FINANCIAL ASSISTANCE OPTIONS AVAILABLE, AND THE CONTACT INFORMATION FOR ASSISTANCE.

PART VI, LINE 5:
MIAMI VALLEY HOSPITAL'S MOST VISIBLE CONTRIBUTION TO THE COMMUNITY IS IN THE FORM OF PROVIDING HIGH-QUALITY INPATIENT AND OUTPATIENT CARE TO OUR PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. MIAMI VALLEY HOSPITAL IS THE REGION'S ONLY LEVEL I TRAUMA CENTER AND OPERATES A CRITICAL CARE TRANSPORT SERVICE. THIS TRANSPORT SERVICE INCLUDES 24-HOUR AIR AMBULANCE SERVICE OPERATING FOUR HELICOPTERS. MIAMI VALLEY HOSPITAL ALSO OFFERS ONE OF THE REGION'S FOUR LEVEL III NEONATAL INTENSIVE CARE UNIT. A FREE-STANDING EMERGENCY DEPARTMENT IS OPERATED IN GREENE COUNTY TO PROVIDE LOCAL TRAUMA CARE TO RESIDENTS IN THIS RURAL AREA. FURTHER ACCESS TO COMPREHENSIVE PRIMARY AND PREVENTATIVE CARE TO RESIDENTS IN MEDICALLY UNDERSERVED AREAS, REGARDLESS OF THEIR ABILITY TO PAY, IS SUPPORTED THROUGH FINANCIAL CONTRIBUTIONS TO THE LOCAL FEDERALLY QUALIFIED HEALTH CENTER. MIAMI VALLEY HOSPITAL ALSO OPERATES THE REGIONAL ADULT BURN CENTER WHICH IS ONE OF THE MOST WIDELY RECOGNIZED FACILITIES IN WEST CENTRAL OHIO FOR THE TREATMENT OF ADULT BURN PATIENTS. IN ADDITION, MVH'S REHABILITATION INSTITUTE OF OHIO (RIO) IS ONE OF THE NATION'S LARGEST PHYSICAL MEDICINE DEPARTMENTS BASED IN A COMMUNITY HOSPITAL. RIO'S PURPOSE IS TO ENHANCE THE LEVEL OF INDEPENDENCE OF PATIENTS WITH PHYSICAL AND COGNITIVE DISABILITIES TOMOVE TO THE NEXT LEVEL BASED ON THEIR FUNCTIONAL CAPABILITIES. OUR MISSION INCLUDES CONTINUALLY STRIVING TO ENRICH THE COMMUNITY BY TRAINING AND EDUCATING FUTURE HEALTHCARE WORKERS, OFFERING HEALTH AWARENESS AND EDUCATION TO THE COMMUNITY, SUCH AS PROMOTION OF BREAST CANCER SCREENINGS, WOMEN AND INFANT HEALTH, DIABETIC WELLNESS AND DRIVER SAFETY AWARENESS FOR HIGH-SCHOOL STUDENTS. THE HOSPITAL ALSO PROVIDES RELEVANT EDUCATION FOR EMS AND PRE-HOSPITAL CARE PROVIDERS THROUGHOUT THE REGION. THE TRAINING INCLUDES LOCAL CASE REVIEWS, LECTURES, HANDS-ON SIMULATION AND PANEL DISCUSSIONS PERTAINING TO THE EDUCATION ON USE OF TOOLS, PRIORITIES OF PATIENT CARE AND OTHER CRITICAL INFORMATION. MIAMI VALLEY HOSPITAL PARTNERS WITH MANY OF THE LOCAL SCHOOLS TO PROVIDE CERTIFIED AND LICENSED ATHLETIC TRAINERS AT THEIR CAMPUSES TO AID IN INJURY PREVENTION, RECOGNITION AND TREATMENT OF SPORTS-RELATED INJURIES. THE HOSPITAL ALSO SUPPORTS THE COMMUNITY THROUGH SPONSORSHIPS AND PARTICIPATION IN LOCAL FUNDRAISING EVENTS THAT PROMOTE HEALTHY LIFESTYLE CHOICES, PREVENTATIVE CARE, CHRONIC DISEASE MANAGEMENT AND GENERAL HEALTH EDUCATION. WITHIN THE HOSPITAL, INTERPRETERS ARE OFFERED TO PATIENTS AT NO COST AS A RESULT OF INCREASED VOLUMES OF NON-ENGLISH-SPEAKING PATIENTS. MIAMI VALLEY HOSPITAL PROVIDES SPIRITUAL CARE SUPPORT SERVICES TO PATIENTS AND FAMILY MEMBERS UTILIZING 8 TRAINED PROFESSIONALS CHAPLAINS, 24 HOURS A DAY, 7 DAYS A WEEK.THE HOSPITAL HAS AN OPEN MEDICAL STAFF, PARTICIPATES IN MEDICAID AND MEDICARE, AND HAS AN ACTIVE CHARITY CARE PROGRAM. MIAMI VALLEY HOSPITAL'S MISSION REFLECTS A COMMITMENT TO PROVIDE HIGH-QUALITY COST-EFFECTIVE HEALTH SERVICES TO THE DIVERSE COMMUNITIES THAT IT SERVES. AT THE CORE OF THE COMMITMENT IS THE BELIEF THAT IN ORDER TO MEET OUR PATIENTS' EXPECTATIONS AND TO IMPROVE TREATMENT OUTCOMES, IT IS NECESSARY FOR US TO UNDERSTAND THE PATIENT'S FRAME OF REFERENCE. A DIVERSE WORKFORCE ALLOWS US TO DRAW UPON THE RICHNESS OF OUR HUMAN RESOURCES, CREATE A POSITIVE WORK ENVIRONMENT, AND MEET THE EXPECTATIONS OF THOSE WE SERVE. MIAMI VALLEY HOSPITAL'S COMMITMENT TO DIVERSITY IS ACCOMPLISHED BY:* TAKING A LEADERSHIP ROLE IN CREATING AND SUSTAINING AN ORGANIZATIONAL ENVIRONMENT THAT ACTIVELY SUPPORTS DIVERSITY,* POSITIONING DIVERSITY AS A LONG-TERM COMPREHENSIVE ORGANIZATIONAL STRATEGY,* ESTABLISHING AND SUPPORTING RELATIONSHIPS WITH MINORITY AND DIVERSITY FOCUSED ORGANIZATIONS AND* PROVIDING EMPLOYMENT AND EDUCATION OPPORTUNITIES FOR INDIVIDUALS WITH SIGNIFICANT DISABILITIES.

PART VI, LINE 6:
PREMIER HEALTH (PREMIER) IS THE SOLE MEMBER OF MIAMI VALLEY HOSPITAL, TWO OTHER HOSPITALS (FIVE LOCATIONS IN TOTAL), AND SEVERAL OTHER HEALTH CARE SERVICE SUBSIDIARIES. PREMIER HAS THE AUTHORITY TO OPERATE EACH HOSPITAL WITH RESPECT TO MATTERS SUCH AS BUDGETING, STRATEGIC PLANNING, MANAGED CARE CONTRACTING, EMPLOYEE COMPENSATION, TRANSFER/SALE OF MATERIAL ASSETS, ETC. AS AN INTEGRATED HEALTHCARE SYSTEM, PREMIER PROVIDES A CONTINUUM OF CARE FOR THE RESIDENTS OF SOUTHWEST OHIO. AS A SYSTEM, PREMIER IS A COMMUNITY LEADER IN SUPPORTING VARIOUS COMMUNITY BENEFIT PROGRAMS THAT ALIGN WITH ITS CURRENT CHNA. RESOURCES ARE LEVERAGED IN EACH ENTITY WITHIN THE PREMIER SYSTEM TO SUPPORT THESE PROGRAMS IDENTIFIED AT THE PREMIER SYSTEM LEVEL. THE POLICIES FOR BAD DEBT AND CHARITY COLLECTIONS ARE ESTABLISHED BY PREMIER.