4A (Expenses $ 272697430 including grants of $ 10750) (Revenue $ 282494434)
OPERATION OF A 331-BED ACUTE CARE HOSPITAL LOCATED IN RIVERDALE, GEORGIA THROUGH PRIME HEALTHCARE FOUNDATION - SOUTHERN REGIONAL, LLC, A DISREGARDED ENTITY FOR FEDERAL TAX PURPOSES.

4B (Expenses $ 146421183 including grants of $ 0) (Revenue $ 152904022)
OPERATION OF A 214-BED ACUTE CARE HOSPITAL LOCATED IN WOONSOCKET, RHODE ISLAND THROUGH PRIME HEALTHCARE FOUNDATION - LANDMARK, LLC, A DISREGARDED ENTITY FOR FEDERAL TAX PURPOSES.

4C (Expenses $ 95828710 including grants of $ 5000) (Revenue $ 100593210)
OPERATION OF A 153-BED ACUTE CARE HOSPITAL LOCATED IN SHERMAN OAKS, CALIFORNIA THROUGH PRIME HEALTHCARE FOUNDATION - SHERMAN OAKS, LLC, A DISREGARDED ENTITY FOR FEDERAL TAX PURPOSES.

4D (Expenses $ 35540 including grants of $ 123477) (Revenue $ 166)
PRIME HEALTHCARE FOUNDATION - REAL ESTATE, LLC

SOUTHERN REGIONAL MEDICAL CENTER
PART V, SECTION B, LINE 5: A COMPREHENSIVE CHNA PROCESS PERFORMED BY SOUTHERN REGIONAL MEDICAL CENTER INCLUDED COLLECTION OF PRIMARY AND SECONDARY DATA. TO PREPARE, A HOSPITAL STEERING COMMITTEE COMPRISED OF SENIOR LEADERSHIP IDENTIFIED CRITERIA TO BE USED AS A GUIDE IN THE DEVELOPMENT AND IMPLEMENTATION OF NEEDS IDENTIFIED IN THE CHNA PROCESS.THE COMMITTEE'S SELECTION OF THE APPROPRIATE GEOGRAPHIC SERVICE AREA WAS BASED ON THE HOSPITAL'S PRIMARY SERVICE AREA (PSA) REPRESENTING ZIP CODES THAT ACCOUNTED FOR 75% OF ANNUAL DISCHARGES FROM THE FACILITY. THE PRIMARY SERVICE AREA INCLUDES SMALL PORTIONS OF LARGE SURROUNDING METROPOLITAN COUNTIES. AFTER TAKING THE BROAD INTERESTS OF THE COMMUNITY SERVED, INCLUDING MEDICALLY UNDERSERVED POPULATIONS, LOWINCOME PERSONS, MINORITY GROUPS, INDIVIDUALS WITH CHRONIC DISEASE NEEDS, AND THE PHYSICAL LOCATION OF THE HOSPITAL IN RELATION TO THOSE IN NEED WERE TAKEN INTO CONSIDERATION, CLAYTON COUNTY WAS SELECTED AS THE COMMUNITY FOR INCLUSION IN THIS REPORT.THE CHNA COMMITTEE OF COMMUNITY LEADERS AND ORGANIZATIONS WAS IDENTIFIED AND CONVENED TO ENGAGED IN DISCUSSIONS TO PROVIDE THEIR INSIGHT ON COMMUNITY NEEDS FROM THEIR PERSPECTIVE. THESE COMMUNITY STAKEHOLDERS ARE INDIVIDUALS WHO REPRESENT KEY INTERESTS, SUCH AS INVESTED IN OR INTERESTED IN THE WORK OF THE HOSPITAL; SPECIAL KNOWLEDGE OF HEALTH ISSUES; IMPORTANCE TO THE SUCCESS OF THE HOSPITAL CHNA PROJECT; AND FORMAL OR INFORMAL LEADERS OF THE COMMUNITY. THESE LEADERS, PARTNERS, AND REPRESENTATIVES WHO PARTICIPATED IN THE CHNA PROCESS WERE ASKED TO: REVIEW AND ASSESS THE NEEDS OF THE COMMUNITY; REVIEW AVAILABLE AND INADEQUATE COMMUNITY RESOURCES; AND PRIORITIZE THE HEALTH NEEDS OF THE COMMUNITY.A KEY COMPONENT IN THE COMMUNITY HEALTH NEEDS ASSESSMENT IS A SURVEY OF COMMUNITY STAKEHOLDERS COMPLETED USING THE FOCUS GROUP METHOD. THESE STAKEHOLDERS INCLUDED A MIX OF INTERNAL AND EXTERNAL REPRESENTATIVES TO SOUTHERN REGIONAL MEDICAL CENTER: PASTORS, PUBLIC HEALTH OFFICIALS, HEALTH CARE PROVIDERS, SOCIAL SERVICE AGENCY REPRESENTATIVES, GOVERNMENT LEADERS, AND BOARD MEMBERS. DUE TO THEIR PROFESSION, TENURE, AND/OR COMMUNITY INVOLVEMENT, COMMUNITY STAKEHOLDERS OFFER DIVERSE PERSPECTIVES AND INFORMATION TO THE COMMUNITY HEALTH NEEDS ASSESSMENT. THEY ARE INDIVIDUALS AT THE FRONT LINE IN THE COMMUNITY THAT CAN BEST IDENTIFY UN-MET SOCIAL AND HEALTH NEEDS OF THE COMMUNITY.

LANDMARK MEDICAL CENTER
"PART V, SECTION B, LINE 5: A KEY INFORMANT SURVEY WAS CONDUCTED WITH COMMUNITY STAKEHOLDERS TO SOLICIT INFORMATION ABOUT COMMUNITY HEALTH NEEDS. A TOTAL OF 45 INDIVIDUALS RESPONDED TO THE SURVEY, INCLUDING HEALTH AND SOCIAL SERVICE PROVIDERS; COMMUNITY AND PUBLIC HEALTH EXPERTS; CIVIC, RELIGIOUS, AND SOCIAL LEADERS; COMMUNITY PLANNERS; POLICY MAKERS AND ELECTED OFFICIALS; AND OTHERS REPRESENTING DIVERSE POPULATIONS INCLUDING MINORITY, LOW-INCOME, AND OTHER UNDERSERVED OR VULNERABLE POPULATIONS.THESE ""KEY INFORMANTS"" WERE ASKED A SERIES OF QUESTIONS ABOUT THEIR PERCEPTIONS OF COMMUNITY HEALTH INCLUDING HEALTH DRIVERS, BARRIERS TO CARE, COMMUNITY INFRASTRUCTURE, AND RECOMMENDATIONS FOR COMMUNITY HEALTH IMPROVEMENT.LANDMARK MEDICAL CENTER ALSO HELD A COMMUNITY PARTNER FORUM ON MARCH 27, 2019 IN PARTNERSHIP WITH THE WOONSOCKET HEALTH EQUITY ZONE. THE OBJECTIVE OF THE FORUM WAS TO SHARE DATA FROM THE CHNA AND GATHER FEEDBACK ON COMMUNITY HEALTH PRIORITIES, GAPS IN SERVICE DELIVERY, AND OPPORTUNITIES FOR COLLABORATION AMONG ORGANIZATIONS. A TOTAL OF 18 PEOPLE ATTENDED THE FORUM AS REPRESENTATIVES OF LANDMARK MEDICAL CENTER, HEALTH AND SOCIAL SERVICE AGENCIES, SENIOR SERVICES, AND CIVIC ORGANIZATIONS.LARGE GROUP DIALOGUE WAS FACILITATED TO DISCUSS CHNA RESEARCH FINDINGS AND PARTICIPANT PERSPECTIVES. THEMES THAT EMERGED DURING THE FORUM WERE ORGANIZED AROUND ROOT CAUSES OR DRIVERS OF HEALTH DISPARITY. HEALTHY PEOPLE 2020 DEFINES A HEALTH DISPARITY AS ""A PARTICULAR TYPE OF HEALTH DIFFERENCE THAT IS CLOSELY LINKED WITH SOCIAL, ECONOMIC, OR ENVIRONMENTAL DISADVANTAGE."""

SHERMAN OAKS HOSPITAL
PART V, SECTION B, LINE 5: A TOTAL OF 8 KEY INFORMANT INTERVIEWS WERE CONDUCTED FOR SHERMAN OAKS HOSPITAL (SOH) SERVICE AREA. EACH INTERVIEW LASTED BETWEEN 30 TO 45 MINUTES. THE KEY INFORMANTS INCLUDED INDIVIDUALS FROM THE LOS ANGELES COUNTY DEPARTMENTS OF HEALTH, MENTAL HEALTH, AND PUBLIC HEALTH, AS WELL AS PUBLIC HEALTH EXPERTS FROM ACADEMIA, LOCAL HOSPITALS, AND CLINICS. UTILIZING A FOCUS GROUP FACILITATION GUIDE, A TWO-HOUR FOCUS GROUPS WERE CONDUCTED WITH 34 COMMUNITY MEMBERS, LEADERS, AND SERVICE PROVIDERS. THE COMMUNITY STAKEHOLDERS THAT PARTICIPATED IN THE CHNA REPRESENTED THE BROAD INTERESTS OF THE COMMUNITY, AND INCLUDED PUBLIC HEALTH EXPERTS AND OTHER INDIVIDUALS KNOWLEDGEABLE ABOUT THE HEALTH NEEDS FOUND IN THE COMMUNITY. A TOTAL OF 203 WRITTEN SURVEYS WERE ADMINISTERED TO PARTICIPANTS BY KEYGROUP AND SOH STAFF. MOST OF THE SURVEYS WERE SOLICITED FROM SHOPPERS IN THE BUSINESS DISTRICTS SURROUNDING SOH, WITH OTHERS COMING FROM ATTENDEES AT SOH'S FARMERS MARKET, AND ADDITIONAL SURVEYS SOLICITED FROM MEETINGS OF CIVIC GROUPS, CHURCHES AND OTHER COMMUNITY ORGANIZATIONS. SECONDARY DATA WAS RETRIEVED THROUGH A REVIEW OF PUBLICLY-COLLECTED DEMOGRAPHIC AND HEALTH STATISTICS. EXCEPT ON RARE OCCASIONS, DATA WAS RETRIEVED VIA ELECTRONIC DATA SEARCHES. DEMOGRAPHIC DATA SUCH AS AGE, ETHNICITY, INCOME, INSURANCE, DISEASE PREVALENCE, AND FIVE-YEAR PROJECTED ESTIMATE INFORMATION WAS EXTRACTED FROM THE CENSUS BUREAU INFORMATION FOUND IN THE AMERICAN COMMUNITY SURVEY SECTION OF THE CENSUS WEBSITE. SOME PORTIONS WERE QUOTED FROM VARIOUS DOCUMENTS THAT ANALYZED CENSUS DATA AND ARE CITED AS USED. ADDITIONAL DATA ON EDUCATION ATTAINMENT, REGION OF BIRTH, GRANDPARENTS CARING FOR THEIR GRANDCHILDREN, AND ENGLISH PROFICIENCY WAS GATHERED FROM THE U.S. BUREAU OF CENSUS (AMERICAN FACTFINDER). IN ADDITION, THE DIGNITY HEALTH (DH) COMMUNITY NEED INDEX (CNI) TOOL WAS REVIEWED TO ASSIST WITH THE IDENTIFICATION OF HIGH NEED AREAS. INFORMATION FOR THIS REPORT CONSISTED OF BOTH SECONDARY AND PRIMARY DATA, AND THEREFORE, THE COLLECTION OF DATA CAME FROM MULTIPLE SOURCES. DATA GATHERED WAS ANALYZED USING METHODS SUCH AS GROUPING AND STATISTICAL ANALYSIS. DATA WAS GROUPED ACCORDING TO HEALTH CONDITIONS, CO-MORBIDITIES, AGE, GENDER, AND ETHNICITY, IN ADDITION TO OTHER SPECIFIC NEEDS FOR THE CHNA REPORT. THE ZIP CODE LEVEL DATA COLLECTED WAS USED TO COMPARE VARIOUS COMMUNITIES IN THE SHERMAN OAKS HOSPITAL SERVICE AREA. THIS COMPARATIVE DATA WAS ANALYZED TO DETERMINE AREAS OF DISPARITY IN THE SOH PSA COMPARED TO THE LARGER AREAS USED FOR COMPARISON. WHERE SIGNIFICANT DEVIATIONS FROM THE LARGE AREA NORMS WERE FOUND, THEY ARE PRESENTED TO SHOW THE IMPORTANT DISPARITIES BETWEEN COMMUNITIES. WHERE THE SOH PSA IS SIMILAR TO THE LARGER AREAS, THE LARGE AREA DATA IS PRESENTED AS REPRESENTATIVE OF THE SOH PSA. IT SHOULD BE NOTED THAT MANY HEALTH CONDITIONS WERE NOT COVERED BY THE VARIOUS SOURCES, SO DIRECT COMPARISON WAS NOT ALWAYS POSSIBLE.

MONTCLAIR HOSPITAL MEDICAL CENTER
PART V, SECTION B, LINE 5: THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) USES SYSTEMATIC, COMPREHENSIVE DATA COLLECTION AND ANALYSIS TO DEFINE PRIORITIES FOR HEALTH IMPROVEMENT, CREATES A COLLABORATIVE COMMUNITY ENVIRONMENT TO ENGAGE STAKEHOLDERS, AND AN OPEN AND TRANSPARENT PROCESS TO LISTEN AND TRULY UNDERSTAND THE HEALTH NEEDS OF SAN BERNARDINO COUNTY, CALIFORNIA. THE SECONDARY ANALYSIS WAS PERFORMED ON ALL OF SAN BERNARDINO COUNTY WITH A FOCUS ON THE SOUTHWESTERN CORNER WHERE MOST OF THE POPULATION AND PATIENT ORIGIN RESIDES. IN MAY 2019, MONTCLAIR HOSPITAL MEDICAL CENTER BEGAN A COMMUNITY HEALTH NEEDS ASSESSMENT FOR SAN BERNARDINO COUNTY, AND SOUGHT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY USING SEVERAL METHODS:- INFORMATION GATHERING, USING SECONDARY PUBLIC HEALTH SOURCES, OCCURRED IN JUNE 2019.- 27 COMMUNITY MEMBERS, NOT FOR PROFIT ORGANIZATIONS REPRESENTING MEDICALLY UNDERSERVED, LOW INCOME, MINORITY POPULATIONS, THE ELDERLY, HEALTH PROVIDERS, AND THE HEALTH DEPARTMENT PARTICIPATED IN TWO FOCUS GROUPS AND ONE INDIVIDUAL INTERVIEW FOR THEIR PERSPECTIVES ON COMMUNITY HEALTH NEEDS AND ISSUES ON JULY 17, 2019.- A COMMUNITY HEALTH SUMMIT WAS CONDUCTED ON JULY 18, 2019 WITH 30 COMMUNITY STAKEHOLDERS. THE AUDIENCE CONSISTED OF HEALTHCARE PROVIDERS, BUSINESS LEADERS, GOVERNMENT REPRESENTATIVES, SCHOOLS, NOT FOR PROFIT ORGANIZATIONS, EMPLOYERS AND OTHER COMMUNITY MEMBERS.

HUNTINGTON BEACH HOSPITAL
"PART V, SECTION B, LINE 5: THE HOSPITAL CONCENTRATED ITS EFFORT IN GATHERING QUALITATIVE PRIMARY DATA THROUGH A SERIES OF CONTACTS WITH KEY STAKEHOLDERS THAT REPRESENT THE COMMUNITY THEY ARE A PART OF, INCLUDING GOVERNMENT REPRESENTATIVES, PUBLIC HEALTH REPRESENTATIVES, HEALTHCARE PROVIDERS, COMMUNITY SERVICE PROVIDERS, AND MINORITY GROUP LEADERS. THREE METHODOLOGIES WERE UTILIZED IN ORDER TO PROVIDE A LARGE SAMPLING OF VIEWS FROM VARIOUS PORTIONS OF THE HUNTINGTON BEACH HOSPITAL (HBH) AND LA PALMA INTERCOMMUNITY HOSPITAL (LA PALMA) SERVICE AREAS. THE TOOLS UTILIZED ARE SUMMARIZED BELOW. COMMUNITY NEEDS SURVEY A SURVEY WAS DISSEMINATED TO THE COMMUNITY IN ENGLISH, SPANISH, KOREAN, MANDARIN CHINESE, AND VIETNAMESE VERSIONS. THE SURVEY REACHED PATIENTS AND COMMUNITY MEMBERS OF ALL AGES AND BACKGROUNDS. PRIMARY SURVEY DISTRIBUTION LOCATIONS INCLUDED CHURCHES, VARIOUS LOCAL INTEREST GROUP MEETINGS, HEALTH FAIRS AND WAITING ROOMS AT HBH AND LA PALMA. RESPONDENTS WERE ALLOWED TO SELECT THE LANGUAGE IN WHICH THEY WISHED TO RESPOND, ALTHOUGH THE QUESTIONS WERE THE SAME IN ALL LANGUAGES. KEY STAKEHOLDERS INTERVIEWS EXTENSIVE INTERVIEWS WITH COMMUNITY LEADERS THAT WOULD BE ABLE TO ADDRESS AND FURTHER DESCRIBE THE NEEDS OF THE COMMUNITY WERE CONDUCTED. COMMUNITY AND GOVERNMENT REPRESENTATIVES WERE INTERVIEWED EITHER IN PERSON OR BY TELEPHONE, INCLUDING REPRESENTATIVES OF THE CITIES OF BUENA PARK, CERRITOS AND HUNTINGTON BEACH. LOCAL HEALTH AGENCY REPRESENTATIVES INCLUDED DIRECTORS OF CALOPTIMA, AND THE ORANGE COUNTY HEALTH CARE AGENCY. REPRESENTATIVES OF VARIOUS ETHNIC AND SOCIAL GROUPS AS WELL AS LOCAL HEALTHCARE PROVIDERS ALSO PARTICIPATED. THE NEEDS EXPRESSED BY THESE LEADERS WERE SUMMARIZED AND PROVIDED AS SUPPLEMENTS TO THE LIST OF ISSUES REVIEWED AND PRIORITIZED BY THE FOCUS GROUP DISCUSSED BELOW. THE PRIMARY ISSUES WITH MULTIPLE MENTIONS WERE MENTAL HEALTH, OBESITY/DIET, AND HOMELESS ISSUES. FOCUS GROUP A COMMUNITY FOCUS GROUP WAS ALSO CONDUCTED. THE GROUP CONSISTED OF LOCAL COMMUNITY MEMBERS, REPRESENTING VARIOUS CITY AGENCIES, LOCAL CLINICS, ETHNIC GROUPS, AND COMMUNITY HEALTH PROVIDERS. THE GROUP WAS ASKED TO PROVIDE OPINIONS AS TO THE MOST IMPORTANT COMMUNITY HEALTH NEEDS IN A ""BRAINSTORMING"" SESSION AT FIRST. THESE IDEAS WERE LISTED IN A SERIES OF FLIP CHART PAGES. IDEAS PROVIDED BY THE KEY INFORMANT INTERVIEWS AND SURVEY RESULTS WERE ADDED TO THE LIST OF POSSIBLE COMMUNITY HEALTH ISSUES. THE IDEAS WERE THEN FILTERED TO A TOTAL OF SIX PRIMARY NEEDS VIA A ""PLACE THE DOTS"" VOTE, USING ADHESIVE DOTS (SIX PER PARTICIPANT) AND ALLOWING EACH MEMBER TO PLACE THE DOTS NEXT TO ISSUES THEY CONSIDERED THE MOST IMPORTANT. SIX ISSUES GENERATED MORE THAN 15 RESPONSES EACH. THESE SIX WERE RANKED IN A SECOND ROUND OF ""PLACE THE DOTS"", USING LABELS WITH VALUES FROM 10 (MOST IMPORTANT) TO 5 (LEAST IMPORTANT), CONSIDERING BOTH THEIR NEED IN THE COMMUNITY AND THE ABILITY OF HBH AND LA PALMA TO ADDRESS THEM. FOCUS GROUP QUESTIONS CONCENTRATED ON DAILY HEALTH BEHAVIORS, PERCEIVED QUALITY OF CARE, ACCESS TO HEALTHCARE, SOCIAL BEHAVIORS AND HEALTH PROBLEMS OF CONCERN."

LA PALMA INTERCOMMUNITY HOSPITAL
"PART V, SECTION B, LINE 5: THE HOSPITAL CONCENTRATED ITS EFFORT IN GATHERING QUALITATIVE PRIMARY DATA THROUGH A SERIES OF CONTACTS WITH KEY STAKEHOLDERS THAT REPRESENT THE COMMUNITY THEY ARE A PART OF, INCLUDING GOVERNMENT REPRESENTATIVES, PUBLIC HEALTH REPRESENTATIVES, HEALTHCARE PROVIDERS, COMMUNITY SERVICE PROVIDERS, AND MINORITY GROUP LEADERS. THREE METHODOLOGIES WERE UTILIZED IN ORDER TO PROVIDE A LARGE SAMPLING OF VIEWS FROM VARIOUS PORTIONS OF THE HUNTINGTON BEACH HOSPITAL (HBH) AND LA PALMA INTERCOMMUNITY HOSPITAL (LA PALMA) SERVICE AREAS. THE TOOLS UTILIZED ARE SUMMARIZED BELOW. COMMUNITY NEEDS SURVEY A SURVEY WAS DISSEMINATED TO THE COMMUNITY IN ENGLISH, SPANISH, KOREAN, MANDARIN CHINESE, AND VIETNAMESE VERSIONS. THE SURVEY REACHED PATIENTS AND COMMUNITY MEMBERS OF ALL AGES AND BACKGROUNDS. PRIMARY SURVEY DISTRIBUTION LOCATIONS INCLUDED CHURCHES, VARIOUS LOCAL INTEREST GROUP MEETINGS, HEALTH FAIRS AND WAITING ROOMS AT HBH AND LA PALMA. RESPONDENTS WERE ALLOWED TO SELECT THE LANGUAGE IN WHICH THEY WISHED TO RESPOND, ALTHOUGH THE QUESTIONS WERE THE SAME IN ALL LANGUAGES. KEY STAKEHOLDERS INTERVIEWS EXTENSIVE INTERVIEWS WITH COMMUNITY LEADERS THAT WOULD BE ABLE TO ADDRESS AND FURTHER DESCRIBE THE NEEDS OF THE COMMUNITY WERE CONDUCTED. COMMUNITY AND GOVERNMENT REPRESENTATIVES WERE INTERVIEWED EITHER IN PERSON OR BY TELEPHONE, INCLUDING REPRESENTATIVES OF THE CITIES OF BUENA PARK, CERRITOS AND HUNTINGTON BEACH. LOCAL HEALTH AGENCY REPRESENTATIVES INCLUDED DIRECTORS OF CALOPTIMA, AND THE ORANGE COUNTY HEALTH CARE AGENCY. REPRESENTATIVES OF VARIOUS ETHNIC AND SOCIAL GROUPS AS WELL AS LOCAL HEALTHCARE PROVIDERS ALSO PARTICIPATED. THE NEEDS EXPRESSED BY THESE LEADERS WERE SUMMARIZED AND PROVIDED AS SUPPLEMENTS TO THE LIST OF ISSUES REVIEWED AND PRIORITIZED BY THE FOCUS GROUP DISCUSSED BELOW. THE PRIMARY ISSUES WITH MULTIPLE MENTIONS WERE MENTAL HEALTH, OBESITY/DIET, AND HOMELESS ISSUES. FOCUS GROUP A COMMUNITY FOCUS GROUP WAS ALSO CONDUCTED. THE GROUP CONSISTED OF LOCAL COMMUNITY MEMBERS, REPRESENTING VARIOUS CITY AGENCIES, LOCAL CLINICS, ETHNIC GROUPS, AND COMMUNITY HEALTH PROVIDERS. THE GROUP WAS ASKED TO PROVIDE OPINIONS AS TO THE MOST IMPORTANT COMMUNITY HEALTH NEEDS IN A ""BRAINSTORMING"" SESSION AT FIRST. THESE IDEAS WERE LISTED IN A SERIES OF FLIP CHART PAGES. IDEAS PROVIDED BY THE KEY INFORMANT INTERVIEWS AND SURVEY RESULTS WERE ADDED TO THE LIST OF POSSIBLE COMMUNITY HEALTH ISSUES. THE IDEAS WERE THEN FILTERED TO A TOTAL OF SIX PRIMARY NEEDS VIA A ""PLACE THE DOTS"" VOTE, USING ADHESIVE DOTS (SIX PER PARTICIPANT) AND ALLOWING EACH MEMBER TO PLACE THE DOTS NEXT TO ISSUES THEY CONSIDERED THE MOST IMPORTANT. SIX ISSUES GENERATED MORE THAN 15 RESPONSES EACH. THESE SIX WERE RANKED IN A SECOND ROUND OF ""PLACE THE DOTS"", USING LABELS WITH VALUES FROM 10 (MOST IMPORTANT) TO 5 (LEAST IMPORTANT), CONSIDERING BOTH THEIR NEED IN THE COMMUNITY AND THE ABILITY OF HBH AND LA PALMA TO ADDRESS THEM. FOCUS GROUP QUESTIONS CONCENTRATED ON DAILY HEALTH BEHAVIORS, PERCEIVED QUALITY OF CARE, ACCESS TO HEALTHCARE, SOCIAL BEHAVIORS AND HEALTH PROBLEMS OF CONCERN."

ENCINO HOSPITAL MEDICAL CENTER
PART V, SECTION B, LINE 5: KEY INFORMANT INTERVIEWS WERE CONDUCTED FOR ENCINO HOSPITAL MEDICAL CENTER SERVICE AREA. EACH INTERVIEW LASTED BETWEEN 15 TO 45 MINUTES. THE KEY INFORMANTS INCLUDED INDIVIDUALS FROM THE LOS ANGELES COUNTY DEPARTMENTS OF HEALTH, MENTAL HEALTH, AND PUBLIC HEALTH, AS WELL AS PUBLIC HEALTH EXPERTS FROM ACADEMIA, LOCAL HOSPITALS, AND CLINICS.UTILIZING A FOCUS GROUP FACILITATION GUIDE, A TWO-HOUR FOCUS GROUP WAS CONDUCTED WITH 34 COMMUNITY MEMBERS, LEADERS, AND SERVICE PROVIDERS. THE COMMUNITY STAKEHOLDERS THAT PARTICIPATED IN THE CHNA REPRESENTED THE BROAD INTERESTS OF THE COMMUNITY, AND INCLUDED PUBLIC HEALTH EXPERTS AND OTHER INDIVIDUALS KNOWLEDGEABLE ABOUT THE HEALTH NEEDS FOUND IN THE COMMUNITY.A TOTAL OF 67 WRITTEN SURVEYS WERE ADMINISTERED TO PARTICIPANTS BY KEYGROUP AND EHMC STAFF. MOST OF THE SURVEYS WERE SOLICITED FROM SHOPPERS IN THE BUSINESS DISTRICTS SURROUNDING EHMC, WITH OTHERS COMING FROM ATTENDEES AT EHMC'S FARMERS MARKET, AND ADDITIONAL SURVEYS SOLICITED FROM MEETINGS OF CIVIC GROUPS, CHURCHES AND OTHER COMMUNITY ORGANIZATIONS.

COSHOCTON REGIONAL MEDICAL CENTER
PART V, SECTION B, LINE 5: COSHOCTON REGIONAL MEDICAL CENTER CONDUCTED TWO FOCUS GROUPS AND FOUR INDIVIDUAL INTERVIEWS WITH PARTICPATION FROM 20 COMMUNITY MEMBERS, NOT-FOR-PROFIT ORGANIZATIONS REPRESENTING MEDICALLY UNDERSERVED, LOW-INCOME, MINORITY POPULATIONS, THE ELDERLY, HEALTH PROVIDERS, AND THE HEALTH DEPARTMENT FOR THEIR PERSPECTIVES ON COMMUNITY HEALTH NEEDS AND ISSUES ON JUNE 26TH, 2019.

SUBURBAN COMMUNITY HOSPITAL
PART V, SECTION B, LINE 5: BOTH PRIMARY AND SECONDARY AND QUANTITATIVE AND QUALITATIVE DATA WERE OBTAINED AND ANALYZED FOR THE NEEDS ASSESSMENT. OBTAINING INFORMATION FROM MULTIPLE SOURCES, KNOWN AS TRIANGULATION, HELPS PROVIDE CONTEXT FOR INFORMATION AND ALLOWS RESEARCHERS TO IDENTIFY RESULTS WHICH ARE CONSISTENT ACROSS MORE THAN ONE DATA SOURCE QUANTITATIVE INFORMATION FROM THE FOLLOWING SOURCES WAS ANALYZED FOR THE HOSPITALS' SERVICE AREA USING THE STATISTICAL PROGRAM FOR SOCIAL SCIENCES (SPSS):-THE 2013, 2015, AND 2020 U.S. CENSUS CLARITAS POP-FACTS ESTIMATES AND PROJECTIONS.-THE MOST RECENT INFORMATION FROM THE PENNSYLVANIA DEPARTMENT OF HEALTH, BUREAU OF HEALTH STATISTICS AND RESEARCH ON FOUR YEAR (2009-2012) AVERAGE RATES FOR NATALITY AND MORTALITY.-PUBLIC HEALTH MANAGEMENT CORPORATION'S(PHMC) 2015 SOUTHEASTERN PENNSYLVANIA HOUSEHOLD HEALTH SURVEY;-2015 COUNTY HEALTH ROADMAPS & RANKINGS FOR MONTGOMERY COUNTY, PA.FREQUENCY DISTRIBUTIONS WERE PRODUCED FOR VARIABLES FOR MULTIPLE YEARS OF VITAL STATISTICS AND U.S. CENSUS DATA SO TRENDS OVER TIME COULD BE IDENTIFIED AND DESCRIBED. IN ADDITION, FOR HOUSEHOLD HEALTH SURVEY MEASURES, TESTS OF SIGNIFICANCE WERE CONDUCTED COMPARING THE HOSPITAL'S SERVICE AREA TO THE HEALTH AND HUMAN SERVICES FOR SOUTHEASTERN PENNSYLVANIA TO OBJECTIVELY IDENTIFY AND PRIORITIZE UNMET NEEDS IN THE CONTEXT OF HOSPITAL'S MISSION STATEMENT AND ROLE IN THE COMMUNITY. IN ADDITION, QUANTITATIVE DATA FOR EACH SERVICE AREA FROM THE HEALTH AND HUMARN SERVICES WAS COMPARED TO HEALTH OBJECTIVES FOR THE UNITED STATES FROM HEALTHY PEOPLE 2020 AND TO DATA COLLECTED FOR PENNSYLVANIA FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION 2014 BEHAVIORAL RISK FACTOR SURVEILLANCE SURVEY.SUBURBAN COMMUNITY HOSPITAL (SCH) COLLABORATED TO IDENTIFY INDIVIDUALS LIVING AND/OR WORKING IN THE COMMUNITIES IN THE HOSPITAL'S SERVICE AREA WHO COULD PROVIDE INPUT ON THE NEEDS ASSESSMENT AS COMMUNITY MEMBERS, LEADERS OR PERSONS WITH KNOWLEDGE OF UNDERSERVED RACIAL MINORITIES, LOW INCOME RESIDENTS, AND/OR THE CHRONICALLY ILL. POTENTIAL PARTICIPANTS FOR THE FOCUS GROUP WERE IDENTIFIED BY THE HOSPITAL'S COMMUNITY OUTREACH STAFF WORKING WITH PHMC, AND INVITED BY PROGRAM STAFF OF ACCION COMUNAL LATINOAMERICANA DE MONTGOMERY COUNTY (ACLAMO) AND THE SUBURBAN FAMILY MEDICAL GROUP TO ATTEND THE MEETING.-THE FOCUS GROUP OF 13 ADULTS WAS CONDUCTED ON MAY 25TH AT THE HOSPITAL'S CANCER CENTER.-ANYONE WHO COULD NOT ATTEND WAS INVITED TO SEND WRITTEN COMMENTS AT ANY TIME.-FOCUS GROUP PARTICIPANTS RECEIVED A $10 GROCERY STORE COUPON AS AN INCENTIVE AND DINNER.-THE FOCUS GROUP DISCUSSION WAS AUDIOTAPED, WITH THE PERMISSION OF THE PARTICIPANTS.-THE HOSPITAL PROVIDED A MEETING VENUE AT THE HOSPITAL'S CANCER CENTER.-THE HOSPITAL LANGUAGE LINE WAS USED TO INTERPRET FROM ENGLISH INTO SPANISH FOR THOSE WHO NEEDED IT.-FOCUS GROUP PARTICIPANTS WERE SERVICE AREA RESIDENTS AFFILIATED WITH: ACCION COMUNAL LATINOAMERICANA DE MONTGOMERY COUNTY STAFF, THE MONTGOMERY COUNTY DEPARTMENT OF HUMAN SERVICES, A CONSTRUCTION WORKER, AN UNEMPLOYED RESIDENT, A RETIRED RESIDENT, AND A DISABLED RESIDENT WHO IS LEGALLY BLIND.-INPUT FROM FOCUS GROUP PARTICIPANTS WAS USED TO FURTHER IDENTIFY AND PRIORITIZE UNMET NEEDS, LOCAL PROBLEMS WITH ACCESS TO CARE, AND POPULATIONS WITH SPECIAL HEALTH CARE NEEDS IN THE CONTEXT OF SCH'S MISSION STATEMENT AND ROLE IN THE COMMUNITY.SUBURBAN COMMUNITY HOSPITAL ALSO IDENTIFIED SEVEN COMMUNITY LEADERS WITH SPECIAL KNOWLEDGE OF MEDICALLY UNDERSERVED POPULATIONS IN THE HOSPITAL'S SERVICE AREA. THESE COMMUNITY LEADERS WERE INTERVIEWED USING A WRITTEN DISCUSSION GUIDE APPROVED BY SCH. INPUT FROM THESE INTERVIEWS WAS INCLUDED IN THE REPORT TO PROVIDE INFORMATION ON UNDERSERVED AREAS.

PAMPA REGIONAL MEDICAL CENTER
PART V, SECTION B, LINE 5: DATA FOR THIS CHNA WAS COLLECTED FROM PRIMARY AND SECONDARY SOURCES TO IDENTIFY KEY FINDINGS AND GAPS THAT MAY EXIST BETWEEN HEALTH NEEDS AND SERVICES PROVIDED WITHIN THE COMMUNITY. THREE METHODS OF COLLECTION FOR PRIMARY DATA WERE USED: 1) SURVEYS 2) FOCUS GROUPS AND 3) PERSONAL INTERVIEWS. SEVERAL SECONDARY DATA SOURCES WERE REVIEWED AND ANALYZED TO IDENTIFY KEY FINDINGS WITH STRATEGIC IMPLICATIONS AND FOR BENCHMARKING OF THE HOSPITAL'S SERVICE AREA.

GLENDORA COMMUNITY HOSPITAL
PART V, SECTION B, LINE 5: THE HOSPITAL CONCENTRATED ITS EFFORT IN GATHERING QUALITATIVE PRIMARY DATA THROUGH A SERIES OF CONTACTS WITH KEY STAKEHOLDERS THAT REPRESENT THE COMMUNITY THEY ARE A PART OF, INCLUDING GOVERNMENT REPRESENTATIVES, MAYOR, PUBLIC HEALTH REPRESENTATIVES, HEALTHCARE PROVIDERS, SERVICE PROVIDERS, REALTORS AND MINORITY GROUP LEADERS. A SURVEY WAS DISSEMINATED TO THE COMMUNITY VIA THE HOSPITALS INVOLVED IN THE HASC REPORT. BOTH ENGLISH AND SPANISH VERSIONS WERE PROVIDED. THE SURVEY REACHED PATIENTS AND COMMUNITY MEMBERS OF ALL AGES AND BACKGROUNDS. EXTENSIVE INTERVIEWS WITH COMMUNITY LEADERS THAT WOULD BE ABLE TO ADDRESS AND FURTHER DESCRIBE THE NEEDS OF THE COMMUNITY WERE CONDUCTED. REPRESENTATIVES OF CITY AND COUNTY AGENCIES INCLUDED THE STAFF OF THE LOS ANGELES COUNTY DEPARTMENT OF HEALTH, AND THE LOS ANGELES COUNTY 4TH DISTRICT SUPERVISOR'S HEALTH LIAISON, AND THE DIRECTOR OF THE LOS ANGELES COUNTY DEPARTMENT OF PUBLIC HEALTH. AVAILABLE SECONDARY DATA WAS USED EXTENSIVELY TO GATHER QUANTITATIVE AND QUALITATIVE INFORMATION ON THE TOTAL SERVICE AREA, HEALTH AND QUALITY OF LIFE INDICATORS, CURRENTLY AVAILABLE SERVICES, EVIDENCE-BASED PREVALENCE OF DISEASES AND CONDITIONS, AND ESTABLISHED ADVERSE HEALTH FACTORS AT THE COMMUNITY AND COUNTY LEVEL. THIS DATA FORMS THE BASIS FOR THE HASC REPORT, AND IS USED HERE AS A BASELINE FOR FURTHER ANALYSIS WHERE PSA DATA WAS AVAILABLE FOR COMPARISON. WHERE PSA-SPECIFIC DATA WAS NOT FOUND, THE HASC REPORT DATA IS PRESENTED. SECONDARY DATA ALSO SERVED AS BENCHMARKING TOOLS TO ADDRESS NEEDS PRIORITY, PROCESSES AND OUTCOMES. INCLUDING HEALTHY PEOPLE 2020 (HEALTHY PEOPLE). HEALTHY PEOPLE PROVIDES SCIENCE-BASED, 10-YEAR NATIONAL OBJECTIVES FOR IMPROVING THE HEALTH OF ALL AMERICANS AND HAS ESTABLISHED NATIONALLY RECOGNIZED BENCHMARKS AND PROGRESS MONITORING. HEALTHY PEOPLE 2020 IS THE RESULT OF A MULTIYEAR PROCESS THAT REFLECTS INPUT FROM A DIVERSE GROUP OF INDIVIDUALS AND ORGANIZATIONS. FURTHER BENCHMARKING INFORMATION WAS ACQUIRED FROM A VARIETY OF RESOURCES, INCLUDING THE U.S. CENSUS BUREAU, UNIFORM DATA SYSTEM MAPPING, COMMUNITY COMMONS, HEALTHY CITY, COUNTY HEALTH RANKINGS & ROADMAPS AND HEALTH INDICATORS WAREHOUSE. THE COUNTY OF LOS ANGELES'S DEPARTMENTS OF PUBLIC AND BEHAVIORAL HEALTH HAVE EMBARKED ON A PROGRAM CALLED THE COMMUNITY VITAL SIGNS INITIATIVE, DESIGNED TO DEVELOP COUNTY-WIDE INFORMATION, ANALYZABLE IN SMALL LOCAL AREAS, WHICH WILL ALLOW HEALTHCARE PROVIDERS OF ALL SORTS TO CREATE PROGRAMS DESIGNED TO IMPROVE THE HEALTH STATUS OF AREA RESIDENTS.

REHABILITATION HOSPITAL OF RHODE ISLAND
"PART V, SECTION B, LINE 5: A KEY INFORMANT SURVEY WAS CONDUCTED WITH COMMUNITY STAKEHOLDERS TO SOLICIT INFORMATION ABOUT COMMUNITY HEALTH NEEDS. A TOTAL OF 45 INDIVIDUALS RESPONDED TO THE SURVEY, INCLUDING HEALTH AND SOCIAL SERVICE PROVIDERS; COMMUNITY AND PUBLIC HEALTH EXPERTS; CIVIC, RELIGIOUS, AND SOCIAL LEADERS; COMMUNITY PLANNERS; POLICY MAKERS AND ELECTED OFFICIALS; AND OTHERS REPRESENTING DIVERSE POPULATIONS INCLUDING MINORITY, LOW-INCOME, AND OTHER UNDERSERVED OR VULNERABLE POPULATIONS.THESE ""KEY INFORMANTS"" WERE ASKED A SERIES OF QUESTIONS ABOUT THEIR PERCEPTIONS OF COMMUNITY HEALTH INCLUDING HEALTH DRIVERS, BARRIERS TO CARE, COMMUNITY INFRASTRUCTURE, AND RECOMMENDATIONS FOR COMMUNITY HEALTH IMPROVEMENT.LANDMARK MEDICAL CENTER ALSO HELD A COMMUNITY PARTNER FORUM ON MARCH 27, 2019 IN PARTNERSHIP WITH THE WOONSOCKET HEALTH EQUITY ZONE. THE OBJECTIVE OF THE FORUM WAS TO SHARE DATA FROM THE CHNA AND GATHER FEEDBACK ON COMMUNITY HEALTH PRIORITIES, GAPS IN SERVICE DELIVERY, AND OPPORTUNITIES FOR COLLABORATION AMONG ORGANIZATIONS. A TOTAL OF 18 PEOPLE ATTENDED THE FORUM AS REPRESENTATIVES OF LANDMARK MEDICAL CENTER, HEALTH AND SOCIAL SERVICE AGENCIES, SENIOR SERVICES, AND CIVIC ORGANIZATIONS.LARGE GROUP DIALOGUE WAS FACILITATED TO DISCUSS CHNA RESEARCH FINDINGS AND PARTICIPANT PERSPECTIVES. THEMES THAT EMERGED DURING THE FORUM WERE ORGANIZED AROUND ROOT CAUSES OR DRIVERS OF HEALTH DISPARITY. HEALTHY PEOPLE 2020 DEFINES A HEALTH DISPARITY AS ""A PARTICULAR TYPE OF HEALTH DIFFERENCE THAT IS CLOSELY LINKED WITH SOCIAL, ECONOMIC, OR ENVIRONMENTAL DISADVANTAGE."""

LANDMARK MEDICAL CENTER
PART V, SECTION B, LINE 6A: THE CHNA WAS CONDUCTED IN CONJUCTION WITH EIGHT OTHER HOSPITAL FACILITIES, INCLUDING LANDMARK MEDICAL CENTER. CARE NEW ENGLAND HEALTH SYSTEM: BUTLER HOSPITAL; KENT HOSPITAL; MEMORIAL HOSPITAL OF RHODE ISLAND; WOMEN & INFANTS HOSPITAL OF RHODE ISLAND CHARTERCARE: OUR LADY OF FATIMA HOSPITAL; ROGER WILLIAMS MEDICAL CENTER, LANDMARK MEDICAL CENTER, SOUTH COUNTY HOSPITAL, WESTERLY HOSPITAL

MONTCLAIR HOSPITAL MEDICAL CENTER
PART V, SECTION B, LINE 6A: PARTICIPANTS IN THE COMMUNITY HEALTH NEEDS ASSESSMENT INCLUDE: LOMA LINDA UNIVERSITY BEHAVIORAL MEDICINE CENTER, LOMA LINDA UNIVERSITY MEDICAL CENTER, LOMA LINDA UNIVERSITY MEDICAL CENTER - MURRIETA, LOMA LINDA UNIVERSITY MEDICAL CENTER CHILDREN'S HOSPITAL, PARKVIEW COMMUNITY HOSPITAL MEDICAL CENTER, REDLANDS COMMUNITY HOSPITAL, RIDGECREST REGIONAL HOSPITAL, SAN ANTONIO REGIONAL HOSPITAL, SAN BERNARDINO MOUNTAINS COMMUNITY HOSPITAL, AND SAN GORGONIO MEMORIAL HOSPITAL.

REHABILITATION HOSPITAL OF RHODE ISLAND
PART V, SECTION B, LINE 6A: THE CHNA WAS CONDUCTED IN CONJUCTION WITH EIGHT OTHER HOSPITAL FACILITIES, INCLUDING LANDMARK MEDICAL CENTER. CARE NEW ENGLAND HEALTH SYSTEM: BUTLER HOSPITAL; KENT HOSPITAL; MEMORIAL HOSPITAL OF RHODE ISLAND; WOMEN & INFANTS HOSPITAL OF RHODE ISLAND CHARTERCARE: OUR LADY OF FATIMA HOSPITAL; ROGER WILLIAMS MEDICAL CENTER, LANDMARK MEDICAL CENTER, SOUTH COUNTY HOSPITAL, WESTERLY HOSPITAL

LANDMARK MEDICAL CENTER
PART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED IN PARTNERSHIP WITH HOSPITAL ASSOCIATION OF RHODE ISLAND.

REHABILITATION HOSPITAL OF RHODE ISLAND
PART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED IN PARTNERSHIP WITH HOSPITAL ASSOCIATION OF RHODE ISLAND.

SOUTHERN REGIONAL MEDICAL CENTER
PART V, SECTION B, LINE 11: INFORMATION GATHERED FROM THE COMMUNITY STAKEHOLDER DISCUSSIONS, HOSPITAL LEADERSHIP TEAM DISCUSSIONS, AND THE COMPILATION AND REVIEW OF DEMOGRAPHIC AND HEALTH STATUS, AND HOSPITAL UTILIZATION DATA WAS USED TO DETERMINE THE PRIORITY HEALTH NEEDS OF THE POPULATION. A WRITTEN REPORT OF THE OBSERVATIONS, COMMENTS, AND PRIORITIES WAS DEVELOPED. THE COMMITTEE REVIEWED THIS INFORMATION WHICH FOCUSED ON THE IDENTIFIED NEEDS, PRIORITIES, AND COMMUNITY RESOURCES CURRENTLY AVAILABLE. THE COMMITTEE DEBATED THE MERITS OR VALUES OF PRIORITIES, CONSIDERING THE RESOURCES AVAILABLE TO MEET THESE NEEDS. FROM THIS INFORMATION AND DISCUSSION, THE HOSPITAL DEVELOPED THREE PRIORITY NEEDS OF THE COMMUNITY.1. MAINTAIN AND IMPROVE ACCESS TO CARE FOR THE COMMUNITY THAT IS AN UNDERSERVED AREA BY: REDUCING THE SHORTAGE OF HEALTHCARE PROVIDERS WITHIN PRIMARY SERVICE AREA, INCREASING ACCESS TO SERVICES AND HEALTHCARE PROVIDERS, AND DEVELOPING COMMUNITY PARTNERSHIPS TO REDUCE BARRIERS TO APPROPRIATE CARE. 2. INCREASE ACCESS AND PARTICIPATION IN PREVENTIVE SERVICES AND EDUCATION TO TARGETED RESIDENTS IN THIS UNDERSERVED AREA BY: MAINTAINING CHEST PAIN CENTER AND PRIMARY STROKE CENTER ACCREDITATIONS, OFFERING APPROPRIATE EDUCATIONAL PROGRAMMING AND SERVICES, AND ENSURING ACCESS TO TESTING TO PREVENTATIVE SERVICES THROUGH SPECIAL PROGRAMS.3. CONTINUE DRIVE TO INCREASE MENTAL HEALTH SERVICES BY THE COUNTY THROUGH: CLAYTON COUNTY CRISIS STABILIZATION UNIT (CSU) AND COORDINATE ED MENTAL HEALTH CARE. OTHER HEALTH AND SOCIO-ECONOMIC BARRIERS WERE IDENTIFIED BUT NOT ADDRESSED AT THIS TIME. EACH OF THE HEALTH NEEDS ARE IMPORTANT AND IS BEING ADDRESSED BY NUMEROUS PROGRAMS AND INITIATIVES OPERATED BY THE HOSPITAL, OTHER ORGANIZATIONS AND OTHER COMMUNITY PARTNERS OF THE HOSPITAL. HOWEVER, THE HOSPITAL WILL NOT ADDRESS THE NEEDS IDENTIFIED IN THE CHNA DUE TO LIMITED RESOURCES AND THE NEED TO ALLOCATE SIGNIFICANT RESOURCES TO THE PRIORITY HEALTH NEEDS IDENTIFIED ABOVE.OTHER HEALTH AND SOCIO-ECONOMIC BARRIERS NEEDS INCLUDED THE FOLLOWING:- OBESITY AND HEALTHY WEIGHT- DIABETES- WOMEN'S HEALTH SERVICES, INCLUDING BREAST CANCER AND EARLY DETECTION

LANDMARK MEDICAL CENTER
PART V, SECTION B, LINE 11: TO WORK TOWARD HEALTH EQUITY, IT IS IMPERATIVE TO PRIORITIZE RESOURCES AND ACTIVITIES TOWARD THE MOST PRESSING HEALTH AND CROSSCUTTING NEEDS WITHIN COMMUNITIES. IN DETERMINING THE ISSUES ON WHICH TO FOCUS EFFORTS OVER THE NEXT THREE-YEAR CYCLE, LANDMARK MEDICAL CENTER SOLICITED INPUT FROM COMMUNITY PARTNERS AND STAKEHOLDERS TO ALIGN EFFORTS WITH EXISTING INITIATIVES HEADED BY THE RHODE ISLAND DEPARTMENT OF HEALTH, THE HEZS, AND OTHER COMMUNITY PARTNERSHIPS.THE CHNA FINDINGS CONFIRMED THAT MANY RESIDENTS WITHIN THE LANDMARK MEDICAL CENTER SERVICE AREA EXPERIENCE GREATER SOCIOECONOMIC DISPARITIES AND INCREASED HEALTH NEEDS THAN IN OTHER PARTS OF THE STATE. CYCLICAL POVERTY, EXPOSURE TO VIOLENCE, AND POORER HEALTH OUTCOMES LEAD TO SHORTENED LIFE EXPECTANCY FOR MANY RESIDENTS. IN SUPPORT OF CHNA FINDINGS, LANDMARK MEDICAL CENTER WILL FOCUS ON:- BEHAVIORAL HEALTH: REDUCE THE PREVALENCE OF FAMILY TRAUMA- CHRONIC DISEASE: EXPAND ACCESS TO CARE TO REDUCE HEALTH DISPARITIES FOR CHRONIC DISEASE- MATERNAL AND CHILD HEALTH: REDUCE TEEN PREGNANCIES AND IMPROVE BIRTH OUTCOMES FOR MOTHERS AND BABIES

SHERMAN OAKS HOSPITAL
PART V, SECTION B, LINE 11: SHERMAN OAKS HOSPITAL (SOH) FOCUS GROUPS STARTED WITH OVER 37 ISSUES AND KEYGROUP AND THE VCCC GROUPS LISTED 35, BUT IN BOTH CASES, THE GROUPS NARROWED THE RANGE SIGNIFICANTLY, ARRIVING AT A TOP SIX. THE FIRST TWO ARE CLOSELY RELATED. THEY ARE LISTED BELOW WITH THE HOSPITAL PLAN REGARDING EACH ITEM:1. COORDINATION OF CARE - THE HOSPITAL PLANS TO WORK WITH STEPDOWN PROVIDERS, INCLUDING NURSING AND REHABILITATION HOSPITALS, AS WELL AS HOME HEALTH AGENCIES AND SOCIAL SERVICE AGENCIES, TO DEVELOP PROTOCOLS TO SHARE INFORMATION BACK AND FORTH ABOUT CLIENTS TRANSFERRED FROM ONE SITE TO ANOTHER, WITH PROVISIONS TO ASSIST OTHER PROVIDERS IN MAINTAINING HEALTH STATUS OF TRANSFERRED CLIENTS AS THEY CONTINUE THEIR RECOVERY. ADDITIONAL RESEARCH WILL BE DONE TO CREATE METHODOLOGIES FOR IDENTIFYING HIGH-UTILIZATION CLIENTS, AND COORDINATING WITH SOCIAL SERVICE PROVIDERS TO ASSIST IN SUPPORTING THESE CLIENTS IN THEIR HOMES SO THEY DON'T BECOME ADMISSIONS TO THE HOSPITAL.2. TRANSITIONS OF CARE - THE HOSPITALS'S PLAN INCLUDES PROVISIONS TO IMPROVE COMMUNICATIONS BETWEEN THE HOSPITAL AND STEP-DOWN PROVIDERS BOTH BEFORE AND AFTER TRANSITIONS, TO CLARIFY CLIENT NEEDS AND NECESSARY TREATMENT PROTOCOLS UPON TRANSFER, AND FOLLOW-UP COMMUNICATION WITHIN TWO DAYS TO REVIEW CLIENT STATUS AND ADDRESS ANY ISSUES THAT MAY HAVE ARISEN FOLLOWING TRANSFER. AS PAYMENT PROGRAMS DEVELOP TO FACILITATE SUCH SERVICES, THE HOSPITAL WILL WORK WITH PROVIDERS TO MAINTAIN AN EQUITABLE REIMBURSEMENT ENVIRONMENT FOR ALL INVOLVED PARTIES.3. PAYMENT ISSUES - THE HOSPITAL PLANS TO INCLUDE PROVISIONS TO CONTINUE ASSURING THAT CLIENTS WHO CAN GET INSURANCE COVERAGE ARE DIRECTED TO THE APPROPRIATE SOURCES. IN ADDITION, SOH WILL CONTINUE TO REVIEW PLANNED AND NEWLY PASSED LEGISLATION TO ENSURE CONTINUING AFFORDABILITY AMONG CLIENTS.4. MENTAL HEALTH - AS A PRIMARY CARE PROVIDER OF MENTAL HEALTH SERVICES, PARTICULARLY IN GERIATRIC SERVICES, THE HOSPITAL IS DEDICATED TO CONTINUING ITS EXISTING SERVICES. AS MORE FOCUS IS DIRECTED TO MENTAL HEALTH ISSUES ASSOCIATED WITH ACUTE ADMISSIONS TO HOSPITALS, THE HOSPITAL IS EXPANDING ITS COORDINATION PRACTICES WITH COMMUNITY PROVIDERS TO IDENTIFY HIGH-INTENSITY USERS OF HOSPITALS SERVICES WITH ACCOMPANYING MENTAL HEALTH ISSUES THAT CAN BE ADDRESSED IN ALTERNATIVE SETTINGS. WITH BETTER COORDINATION, THESE CLIENTS CAN BE DIRECTED TO MORE APPROPRIATE CARE SITES. SOH WILL ALSO RESEARCH OPTIONS TO COORDINATE COMMUNITY CARE SOLUTIONS WITH THE HOSPITAL'S INPATIENT SERVICES AS CRISES ARISE IN THOSE COMMUNITY LOCATIONS.5. DIABETES - THE HOSPITAL'S PLAN IS PRIMARILY FOCUSED ON EDUCATION, SINCE CARE FOR ACUTE DIABETES ISSUES IS EXPENSIVE AND OFTEN DELIVERED AFTER THE MOST EFFECTIVE TREATMENTS ARE AVAILABLE. SOH WILL CONTINUE TO PARTICIPATE IN HEALTH FAIRS, AND COORDINATE WITH SCHOOLS AND COMMUNITY GROUPS TO EDUCATE AREA RESIDENTS ON THE RISKS THAT LEAD TO DIABETES.6. HEART DISEASE - THE HOSPITAL'S PLAN INCLUDES EDUCATION REGARDING STROKE AND CARDIAC RISKS, ALONG WITH MAINTAINING STATE-OF-THE-ART SERVICES FOR CARDIAC EMERGENCIES SEEN AT THE HOSPITAL.7. LACK OF KNOWLEDGE ABOUT HEALTH SERVICES - THE HOSPITAL PLANS TO FOCUS ON EDUCATIONAL PROGRAMS THAT TARGET AREA RESIDENTS WHO ARE NOT CURRENT CLIENTS OF THE HOSPITAL, DELIVERED AT HEALTH FAIRS, SCHOOLS, RETIREMENT COMMUNITIES AND OTHER LOCATIONS WHERE PEOPLE ARE INTERESTED IN LEARNING ABOUT HEALTH OPTIONS. ADDITIONALLY, THE HOSPITAL STAFF MAINTAINS A DATABASE OF INSURANCE OPTIONS THAT CAN BE USED TO BRING UNINSURED CLIENTSINTO THE INSURED RANKS, AND WORKS WITH ELIGIBLE CLIENTS TO GET THEM COVERED. THIS IS AN ONGOING PROCESS AS INSURANCE PROGRAMS CHANGE OFTEN, AND MANY MORE CHANGES ARE POSSIBLE OVER THE NEXT FEW YEARS. THE PREVIOUS SEVEN ISSUES WERE RAISED BY THE HOSPITAL'S FOCUS GROUPS AND LISTED AS THE PRIMARY ISSUES FOR THE HOSPITAL PSA. ADDITIONAL DATA WAS OBTAINED FROM VCCC'S FOCUS GROUPS CONDUCTED AT OTHER LOCATIONS. THESE INTERVIEWS WERECONDUCTED AT VARIOUS HOSPITALS AND OTHER LOCATIONS THROUGHOUT THE COUNTY OF LOS ANGELES' SERVICE PLANNING AREA 2 (SPA 2). THE SPA 2 FOCUS GROUP'S TOP TEN DATA ALSO IDENTIFIED SOME ADDITIONAL ISSUES THAT AFFECT THE GREATER SAN FERNANDO VALLEY AREA AND RESIDENTS OF THE HOSPITAL'S PSA. THE ISSUES NOT INCLUDED IN HOSPITAL'S TOP SEVEN ARE ADDRESSED BELOW. THE HOSPITAL STAFF WILL WORK WITH HOSPITALS AND AGENCIES THROUGHOUT THE VALLEY TO ADDRESS THESE ISSUES AS WELL AS THOSE SPECIFIC TO THE HOSPITAL.8. OBESITY - THE HOSPITAL'S PLAN INCORPORATES EDUCATION FOR CHILDREN AND ADULTS ABOUT THE HAZARDS OF OBESITY, AND PROMOTION OF HEALTHY EATING AND BEHAVIORAL HABITS.9. CANCER - THE HOSPITAL PLANS TO FOCUS ON TRIAGE FOR CLIENTS ADMITTING WITH CANCER SYMPTOMS, TREATMENT FOR THOSE SYMPTOMS EASILY TREATED, AND REFERRAL TO SPECIALTY HOSPITALS FOR THOSE WITH MORE SERIOUS PROBLEMS, SINCE THE HOSPITAL DOES NOT SPECIALIZE IN CANCER CARE.10. HYPERTENSION - THE HOSPITAL'S PLAN INVOLVES EDUCATION AND INTERVENTION IN CASES WHERE THE CLIENT IS AT THE HOSPITAL, BUT THE BULK OF THE EDUCATION EFFORT WILL BE IN OUTREACH PROGRAMS, COORDINATED WITH THE SENIOR SERVICES PROGRAMS ALREADY IN PLACE AT THE HOSPITAL AND DELIVERED TO SITES IN THE COMMUNITY.11. SUBSTANCE ABUSE DISORDER - THE HOSPITAL'S PLAN INVOLVES EDUCATION AND INTERVENTION IN CASES WHERE THE CLIENT IS AT THE HOSPITAL, BUT THE BULK OF THE EDUCATION EFFORT WILL BE IN OUTREACH PROGRAMS. THE EXISTING SENIOR SERVICES PROGRAMS ARE A USEFUL BASE FOR IDENTIFYING AND TREATING SUBSTANCE ABUSE ISSUES WHICH ARE OFTEN PRESENTED AS EITHER ACUTE TRAUMA, OR AS CONTRIBUTORS TO A MENTAL HEALTH CRISIS THAT ADMITS TO THE GERIATRIC PSYCH PROGRAM. ADDITIONAL EFFORTS ARE UNDERWAY TO IDENTIFY SERVICE PROVIDERS AND CONTINUING TREATMENT LOCATIONS TO ALLOW TRANSFERS OF ABUSE VICTIMS TO LONGER-TERM RECOVERY PROGRAMS THAT CAN FOLLOW UP THE TREATMENT PROVIDED FOR THE ACUTE EPISODE.12. ACCESS TO PRIMARY CARE - AS NOTED IN THE ACCESS TO CARE SECTION OF THIS PLAN, SOH WILL CONTINUE TO ATTEMPT TO FIND INSURANCE COVERAGE FOR ALL WHO PRESENT AT THE HOSPITAL'S ED, AND AS PART OF THAT PROCESS WILL ASSIST IN FINDING A PRIMARY CARE PROVIDER AFFILIATED WITH THE COVERAGE ACHIEVED. IN ADDITION, SOH'S MEDICAL STAFF WILL REACH OUT TO LOCAL CLINICS TO PROVIDE SPECIALTY CARE TO CLINIC PATIENTS AS APPROPRIATE.13. POVERTY - THE HOSPITAL HAS NO CONTROL OVER CLIENTS' INCOMES, AND HAS NO RESOURCES TO AUGMENT INCOMES. HOWEVER, AS NOTED IN THE ACCESS TO CARE SECTION OF THIS PLAN, THE HOSPITAL WILL CONTINUE TO ATTEMPT TO FIND INSURANCE COVERAGE FOR ALL WHO PRESENT AT THE HOSPITAL'S ED, AND AS PART OF THAT PROCESS WILL ASSIST IN FINDING A PRIMARY CARE PROVIDER AFFILIATED WITH THE COVERAGE ACHIEVED. SINCE CLIENTS WITH THE LOWEST INCOMES ARE THE ONES MOST LIKELY TO QUALIFY FOR MEDICAL COVERAGE, THIS PROCESS SHOULD MINIMIZE THE TROUBLE CLIENTS HAVE IN SEEKING CARE. THE ISSUES ABOVE ARE THE CONSENSUS ISSUES FROM MANY SOURCES THAT MERIT THE MOST CONSIDERATION BY HOSPITALS IN THE AREA. EACH HOSPITAL HAS DIFFERING ABILITIES TO ADDRESS EACH ISSUE. AS DISCUSSED ABOVE, SHERMAN OAKS HOSPITAL'S IMPLEMENTATION PLAN WILL FOCUS ON THE ISSUES RELATED TO ACCESS AND MENTAL HEALTH.

MONTCLAIR HOSPITAL MEDICAL CENTER
PART V, SECTION B, LINE 11: TO SUCCESSFULLY MAKE OUR COMMUNITY HEALTHIER, IT IS NECESSARY TO HAVE A COLLABORATIVE VENTURE WHICH BRINGS TOGETHER ALL THE CARE PROVIDERS, CITIZENS, GOVERNMENT, SCHOOLS, CHURCHES, NOT-FOR-PROFIT ORGANIZATIONS AND BUSINESS AND INDUSTRY AROUND AN EFFECTIVE PLAN OF ACTION. BASED ON THE RESULTS OF THE CHNA, MHMC HAS SELECTED FOUR OF THE IDENTIFIED SIGNIFICANT HEALTH NEEDS TO ADDRESS.1. MENTAL HEALTH2. OBESITY/DIABETES3. EDUCATION4. ACCESS TO CAREMHMC PLANS TO MEET THE MENTAL HEALTH SIGNIFICANT HEALTH NEED BY:1. IMPROVE MENTAL HEALTH EVALUATIONS FROM THE EMERGENCY DEPARTMENT (ED).A. THE HOSPITAL IMPLEMENTED A NEW SERVICE LINE, TELE-PSYCH, TO EVALUATE PATIENTS FROM THE EMERGENCY DEPARTMENT (ED) AND THOSE WAITING TO BE PLACED IN A BEHAVIORAL HEALTH FACILITY TO BE MANAGED IN-HOUSE BY A PSYCHIATRIST. CASE MANAGEMENT WORKS ON THE PROPER PLACEMENT AND ENSURES THAT ONCE THEY ARE MEDICALLY CLEARED, THEY HAVE RESOURCES PROVIDED TO THEM AS A PSYCHOLOGY FOLLOW UP.2. INCREASE AWARENESS AND DECREASE STIGMA OF MENTAL HEALTHA. THE HOSPITAL WILL PARTICIPATE IN FUTURE MENTAL HEALTH SUMMITS FOR SAN BERNARDINO COUNTY.B. MHMC WILL DISTRIBUTE FLYERS ON SUICIDE PREVENTION AT HEALTH FAIRS TO HELP PROMOTE THE 211 SAN BERNARDINO HELP LINE.3. IMPROVE ACCESS TO MENTAL HEALTH SERVICESA. CREATE A NEW SERVICE LINE FOR PATIENTS IN NEED OF BEHAVIORAL HEALTH SERVICES IN PARTNERSHIP WITH SISTER FACILITY GLENDORA OAKS BEHAVIORAL HEALTH (PREVIOUSLY GLENDORA COMMUNITY HOSPITAL) TO PLACE SENIORS 55+ AND WITH CHINO VALLEY MEDICAL CENTER AS THEY WORK TO PARTNER WITH INLAND EMPIRE HEALTH PLAN (IEHP) CREATING BEHAVIORAL HEALTH SERVICES.MHMC PLANS TO MEET THE SIGNIFICANT DIABETES HEALTH NEED BY:1. IMPROVE NUTRITION AND INCREASE EXERCISE FOR STAFF AND COMMUNITY MEMBERS.A. PROVIDE A LECTURE ON NUTRITION WITH A REGISTERED DIETICIAN TARGETING CURRENT EMPLOYEES AND COMMUNITY MEMBERS.B. HOST EXERCISE CLASSES SUCH AS YOGA ON THE FRONT LAWN FOR BOTH STAFF AND PATIENTS.C. ENCOURAGE STAFF TO PARTICIPATE IN COMMUNITY AND CORPORATE HEALTH CHALLENGES.D. PROVIDE PEDOMETERS FOR EMPLOYEES AND PROMOTE A CONTEST INCREASING ENGAGEMENT WITH EXERCISE.E. SPONSOR A DIABETES CLASS OFFERED TO THE COMMUNITY BY COLLABORATING WITH THE NEARBY FEDERALLY QUALIFIED HEALTH CENTER (FQHC).2. INCREASE DIAGNOSIS OF DIABETES TO PROVIDE EARLIER INTERVENTIONS.A. PROVIDE COMPLIMENTARY DIABETES SCREENINGS TO THE COMMUNITY AT HEALTH FAIRS.MHMC PLANS TO MEET THE EDUCATION SIGNIFICANT HEALTH NEED BY:1. INCREASE INTEREST IN WORKING IN HOSPITALS.A. PARTICIPATE WITH THE PROMISE SCHOLARS PROGRAM AT THE LOCAL SCHOOLS TO EDUCATE STUDENTS ABOUT WORKING IN A HOSPITAL.

HUNTINGTON BEACH HOSPITAL
PART V, SECTION B, LINE 11: 1. HOSPITAL OUTREACH HBH HAS BEEN SUCCESSFUL IN GETTING CLIENTS TO COME TO THE HOSPITAL, BUT SEVERAL PARTICIPANTS NOTED THAT IT HAS BEEN VIEWED BY SOME PARTS OF THE COMMUNITY AS REMOTE. HBH IS CLOSE TO SEVERAL LOW-INCOME AREAS IN HUNTINGTON BEACH, BUT REPRESENTATIVES OF THOSE COMMUNITIES NOTED THAT THEIR RESIDENTS TEN TO BYPASS HBH IN FAVOR OF OTHER HOSPITALS FURTHER AWAY.A. THE HOSPITAL'S CURRENT MANAGEMENT IS IN THE PROCESS OF OUTREACH TO THE AREA COMMUNITIES THAT HAVE HISTORICALLY BYPASSED THE HOSPITAL TO SERVE THEM BETTER.B. A LIST OF COMMUNITY ORGANIZATIONS IS BEING DEVELOPED TO PROVIDE TARGETED PROPOSALS WHICH WILL REQUEST SPECIFIC ISSUES UNIQUE TO EACH ORGANIZATION, AND WHICH CAN BE ADDRESSED BY HBH.2. MENTAL HEALTH - WHILE MENTAL HEALTH CARE IS A MANDATORY COVERED SERVICE UNDER ACA REGULATIONS, PAYORS HAVE ONLY RECENTLY BEGUN PROVIDING ADEQUATE COMPENSATION FOR INPATIENT SERVICES. HBH HAS BEEN IN THE FOREFRONT OF DEVELOPING SERVICES FOR BEHAVIORAL HEALTH CLIENTS, AND CURRENTLY OPERATES ONE OF THE FEW SECURED BEHAVIORAL HEALTH FACILITIES LICENSED TO PROVIDE CARE FOR THOSE ADMITTED UNDER INVOLUNTARY CRITERIA (OFTEN DESIGNATED AS 5150 CLIENTS AFTER THE STATE'S DEFINING LEGISLATION). THIS LEADERSHIP IS EXPECTED TO CONTINUE.A. HBH WILL CONTINUE TO PROVIDE A COMPREHENSIVE ARRAY OF INPATIENT SERVICES FOR BEHAVIOR AND MENTAL HEALTH CLIENTS, WHILE WORKING WITH PUBLIC HEALTH AND SOCIAL SERVICES AGENCIES TO DEVELOP PLANS TO ADDRESS THESE ISSUES BEFORE THEY BECOME ACUTE. IMPLEMENTATION PLAN TO MEET COMMUNITY HEALTH NEEDS 2019-2021B. HBH WILL SEEK COOPERATION WITH PUBLIC HEALTH AGENCIES, FIRST RESPONDERS AND SOCIAL SERVICES PROVIDERS TO IDENTIFY HIGH UTILIZERS OF MENTAL HEALTH SERVICES AND DEVELOP METHODS TO SERVE THESE PEOPLE IN THEIR HOMES.3. OPIOIDS - PRESCRIPTION OPIOID ABUSE HAS EMERGED AS A SIGNIFICANT PROBLEM NATIONWIDE, AND FOCUS GROUP MEMBERS NOTED THAT IT IS GROWING AS AN ISSUE IN THE AREA. A COMPOUNDING PROBLEM IS THE PROLIFERATION OF RELATED OPIOID COMPOUNDS BOTH NATURAL AND MAN-MADE. WHILE HBH DOES NOT PRESCRIBE, ITS MEDICAL STAFF IS INVOLVED WITH THE SUPERVISION AND MANAGEMENT OF CLIENTS USE OF PRESCRIPTION OPIOIDS.A. THE HOSPITAL IS ACTIVELY WORKING WITH ITS MEDICAL STAFF TO DEVELOP PROTOCOLS TO PROTECT PATIENTS FROM OVERUSE, AND IS REACHING OUT TO COMMUNITY ORGANIZATIONS TO ASSIST THEM IN WORKING WITH COMMUNITY MEMBERS' SUBSTANCE ABUSE PROBLEMS.B. IN EDUCATION PROGRAMS AT COMMUNITY SITES, EMPHASIS WILL BE PLACED ON AVOIDING THE RISKS OF OPIOID ABUSE, AS WELL AS IN DISCUSSING OTHER SUBSTANCE ABUSE ISSUES.4. CAREGIVER EDUCATION - MANY HOSPITAL CLIENTS COMPLETE THEIR COURSE OF RECOVERY IN VENUES OTHER THAN THE HOSPITAL, WHETHER IN NURSING FACILITIES OR, INCREASINGLY, AT HOME. THE CAREGIVERS FOR THESE PATIENTS MAY HAVE LIMITED OR NO FORMAL CAREGIVING TRAINING. SINCE THE OUTCOMES FOR THESE PATIENTS ARE DEPENDENT ON THE ABILITY OF THE CAREGIVERS TO DEAL WITH THE PROBLEMS THAT ARISE, TRAINING IS A CRUCIAL ELEMENT OF THE RECOVERY PROCESS. ALTHOUGH HOME HEALTH AGENCIES CAN PROVIDE IN-HOME SERVICES, THE MOST INTIMATE CARE IS OFTEN PROVIDED BY FAMILY MEMBERS OR OTHER LAY PEOPLE. THE COURSE OF RECOVERY IS THUS DEPENDENT ON PEOPLE WITH NO FORMAL TRAINING, WHO CAN BE TAUGHT THE BASICS OF CARE NEEDED TO ASSURE FULL RECOVERY.A. HBH IS WORKING WITH ITS REFERRAL SOURCES TO ASSURE THAT THE CARE PROVIDED IN STEP-DOWN ENVIRONMENTS IS ADEQUATE TO ALLOW PATIENTS TO CONTINUE THEIR RECOVERY TO THE FULLEST EXTENT POSSIBLE.B. HBH WILL EXPLORE NEW PROTOCOLS FOR EDUCATING LAY CAREGIVERS IN MANAGING RECOVERY PROCESSES FOR PATIENTS IN THEIR CARE, WITH EMPHASIS ON EMPOWERING CAREGIVERS TO IDENTIFY RISKS AND CONDITIONS THAT COULD NEGATIVELY IMPACT THE COURSE OF CARE.5. GRANTS - THE PROCESS OF RESEARCH AND DEVELOPMENT FOR NEW METHODOLOGIES IN TREATMENT OFTEN INVOLVES PHILANTHROPIC ORGANIZATIONS. HBH HAS NOT HISTORICALLY SOUGHT GRANTS, BUT HAS CONTACTS WITHIN ITS OWNERSHIP FOUNDATION AS WELL AS WITH OUTSIDE FUNDERS TO PROVIDE SEED MONEY FOR CAREGIVING INNOVATIONS.A. HBH WILL SOLICIT IDEAS FOR INNOVATIONS IN CARE FROM ITS STAFF, AS WELL AS FROM LOCAL SERVICE AGENCIES, AND CHAMPION IDEAS PRESENTED THAT MERIT RESEARCH.B. HBH WILL REACH OUT TO VARIOUS COMMUNITY GROUPS TO WORK WITH THEM ON NEW PROGRAMS, THEY MAY HAVE REQUESTS FOR FUNDING THAT THE HOSPITAL CAN FACILITATE.6. DENTAL - AS MORE PEOPLE GAIN HEALTH INSURANCE, ONE HEALTH CATEGORY NOT NORMALLY COVERED IS DENTAL CARE. IMPLEMENTATION PLAN TO MEET COMMUNITY HEALTH NEEDS 2019-2021A. SINCE MANY CLINICAL PROVIDERS OF DENTAL CARE NOW HAVE CONTRACTS WITH MEDICAL OR OTHER PAYORS TO PROVIDE SERVICES, HBH WILL DEVELOP A LIST OF REFERRAL RESOURCES TO PROVIDE TO HOSPITAL CLIENTS WHO HAVE DENTAL ISSUES IN ADDITION TO THE PROBLEMS THAT CAUSED THEM TO SEE HOSPITAL CARE.B. WHERE POSSIBLE, HBH WILL ASSIST PATIENTS IN OBTAINING HEALTHCARE COVERAGE THAT WILL INCLUDE DENTAL SERVICES, AND GUIDE THEM THROUGH THE APPLICATION PROCESSES NEEDED TO QUALIFY THEM.7. DEMENTIA / ALZHEIMER'S DISEASE THIS ISSUE OFTEN PRESENTS ITSELF AT HBH HAS AN EMERGENCY ADMISSION FOR INJURY SUSTAINED AS A RESULT OF FAULTY MEMORY OR OTHER MENTAL PROCESS.A. HBH'S PRIMARY RESPONSIBILITY FOR CLIENTS WITH DEMENTIA SYMPTOMS IS TO PROPERLY DIAGNOSE AND CONFIRM THAT THE PROBLEM IS LONG-TERM AS OPPOSED TO ACUTE IN NATURE.B. IN ITS ROLE AS A CLEARINGHOUSE FOR BEHAVIORAL AND SUBSTANCE ABUSE ISSUES, HBH STAFF IS ACCUSTOMED TO DISCERNING SUBTLE CLUES FOR LONGER-TERM MENTAL ISSUES.C. HBH IS WELL-POSITIONED TO ACT AS A REFERRAL SOURCE TO ORGANIZATIONS SPECIALIZING IN CARING FOR THESE CLIENTS.D. HBH WILL CONTINUE TO WORK WITH LOCAL AGENCIES AND PROVIDERS TO MAKE SURE THAT CLIENTS ARE REFERRED TO APPROPRIATE PROVIDERS FOR LONG-TERM CARE. THESE SEVEN ISSUES ARE THE ONES DETERMINED BY THE FOCUS GROUP PROCESS TO BE THE MOST IMPORTANT TO THE COMMUNITY. IT SHOULD BE NOTED THAT SEVERAL OF THEM ARE ONLY MARGINALLY ADDRESSABLE BY ANY HOSPITAL, ALTHOUGH HBH WILL CONTINUE TO MEET THE IMMEDIATE NEEDS OF PATIENTS WHO PRESENT AT THE HOSPITAL WITH THESE NEEDS, AND FIND APPROPRIATE REFERRAL SOURCES TO DIRECTLY ADDRESS THEIR CORE ISSUES.

LA PALMA INTERCOMMUNITY HOSPITAL
PART V, SECTION B, LINE 11: THE PROGRAMS OUTLINED ABOVE ARE ALL PLANNED TO CONTINUE, AND ADDITIONAL PROGRAMS ARE PLANNED TO ADDRESS THE ISSUES RAISED IN FOCUS GROUP AND ORANGE COUNTY HEALTH IMPROVEMENT PLAN 2017-2019. THE ISSUES CONSIDERED MOST PRESSING IN THE 2018 COMMUNITY HEALTH NEEDS ASSESSMENT ARE ADDRESSED IN THE FOLLOWING SECTION.1. MENTAL HEALTH THIS ISSUE WAS THE MOST CITED, AND LPIH IS ACTIVELY EXPANDING ITS SERVICES TO MEET THE GROWING DEMAND. IN ADDITION TO EXISTING SERVICES, SEVERAL EXPANSIONS OF INPATIENT SERVICES ARE IN PROCESS AND EXPECTED TO BECOME ACTIVE WITHIN THE NEXT THREE YEARS. THESE INCLUDE: EXPANSION OF THE DESIGNATED INPATIENT MATURE ADULT PSYCHIATRIC UNIT PROVIDING 16 BEDS, WITH AN ADDITIONAL 6 BEDS. THIS IS EXPECTED TO OPEN BY 2019. - CONTINUING THE APPROVAL PROCESS TO ALLOW OPERATION AS A LOCKED UNIT FOR PATIENTS ADMITTED UNDER THE STATE'S 5150 DESIGNATION. THIS WILL ALLOW THE HOSPITAL TO OFFER A COMPREHENSIVE RANGE OF INPATIENT SERVICES FOR A BROADER BASE OF INDIVIDUALS IN NEED OF MENTAL HEALTH SERVICES.- THESE EXPANSIONS WILL ALLOW THE HOSPITAL TO INCREASE ITS RANGE OF SERVICES TO BEHAVIORAL CLIENTS, AND TO SERVE A LARGER ROLE IN CARING FOR THE MENTAL HEALTH OF THE COMMUNITY2. TRAINING FOR MENTAL HEALTH SERVICES - THIS ISSUE IS DIRECTLY RELATED TO ISSUE #1, BUT HIGHLIGHTS THE NEED FOR EDUCATION OF FIRST RESPONDERS AND CLINICIANS AS TO THE VARYING NEEDS OF SUBGROUPS IN THE MENTAL HEALTH SPECTRUM, INCLUDING DRUG AND ALCOHOL ABUSE, MISUSE OF PRESCRIPTION PHARMACEUTICALS, MEDICATION COMPLIANCE, INTERACTIONS WITH HOMELESS PERSONS WHO MAY OR MAY NOT BE HAVING MENTAL HEALTH CRISES, AND OTHER ISSUES. LPIH'S STAFF CAN PROVIDE EXPERT GUIDANCE TO FIRST RESPONDERS IN DEALING WITH THESE VARIOUS ISSUES, IN ADDITION TO SERVING AS AN INSTITUTIONAL RESOURCE FOR THOSE WHO REQUIRE INPATIENT SERVICES. LPIH'S STAFF IS IN AN IDEAL POSITION TO PROVIDE EDUCATION AND TRAINING SERVICES TO MEMBERS OF THE PUBLIC HEALTH AND SOCIAL SERVICES AGENCIES THAT HAVE DIRECT CONTACT WITH CLIENTS EXPERIENCING MENTAL HEALTH ISSUES, AND WILL EXPLORE OPTIONS FOR DEVELOPING PROGRAMS TO MEET THEIR NEEDS.EXAMPLES OF PROGRAMS INCLUDE:- TRAINING OF FIRST RESPONDERS TO DE-ESCALATE CRISIS SITUATIONS, AND REDIRECT PERSONS EXPERIENCING THE CRISES TO APPROPRIATE CARE SITUATIONS.- WORKING WITH SOCIAL SERVICE AGENCIES TO ASSESS HOME SITUATIONS THAT CAN PROVOKE MENTAL HEALTH CRISES, AND BRING APPROPRIATE RESOURCES TO ADDRESS THE SITUATION. LA PALMA INTERCOMMUNITY HOSPITAL IMPLEMENTATION PLAN FOR MEETING IDENTIFIED COMMUNITY NEEDS 2019-2021 - WORKING WITH LOCAL PHYSICIANS TO RECOGNIZE POTENTIAL PRESCRIPTION PHARMACEUTICAL MISUSE AND DEVELOP ALTERNATIVE TREATMENTS TO LIMIT USE OF PSYCHOACTIVE DRUGS.3. HOUSING FOR HOMELESS - WHILE HOSPITALS ARE NOT HOUSING PROVIDERS, THEY CAN PROVIDE SHORT-TERM SHELTER WHEN MEDICAL CRISES OCCUR TO HOMELESS INDIVIDUALS. LPIH HAS CAPACITY TO SERVE CLIENTS WHOSE IMMEDIATE NEEDS INVOLVE HOUSING WITH MEDICAL SERVICES, AND WILL CONTINUE TO WORK WITH LONGER-TERM HOUSING PROVIDERS TO EASE THE TRANSITION TO MORE STABLE ENVIRONMENTS. RECENT PROPOSALS BY REPRESENTATIVES OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES AND STATE MEDICAL PROGRAMS WOULD PROVIDE FUNDS TO ALLOW PROVIDERS TO MAKE ARRANGEMENTS FOR HOUSING. LPIH WILL MONITOR THE PROGRESS OF THESE PROPOSALS, AND IF REIMBURSEMENT PROGRAMS CHANGE TO ENCOMPASS HOUSING SOLUTIONS, LPIH WILL DEVELOP APPROPRIATE PROGRAMS TO ADMINISTER THE PROCESS.4. COORDINATING TRANSITIONS BETWEEN CARE LEVELS AS SOCIAL DETERMINANTS OF HEALTH BECOME MORE RECOGNIZED AS IMPORTANT FACTORS IN MAINTAINING RESIDENTS IN THEIR HOMES, HOSPITALS AND OTHER INSTITUTIONAL PROVIDERS MUST DEVELOP PROTOCOLS TO FACILITATE MOVEMENT TO AND FROM HOSPITALS, INCLUDING COORDINATION OF SERVICES AND TRANSFER OF PATIENT INFORMATION BETWEEN PROVIDERS. IT IS ALSO IMPORTANT TO BE AN ADVOCATE FOR HIGHLIGHTING HIGH USERS OF HOSPITAL SERVICES, AND WORKING WITH SOCIAL SERVICE AGENCIES AND FIRST RESPONDERS TO COORDINATE SERVICES TO PREVENT CRISES THAT CAUSE THESE PEOPLE TO ACCESS HEALTH PROVIDERS UNNECESSARILY. LPIH CAN WORK WITH LOCAL AGENCIES TO DEVELOP THE PROTOCOLS THAT AID RESIDENTS TO RECOGNIZE PROBLEMS AND SOLVE THEM WITHOUT RESORTING TO EMERGENCY SERVICES.5. VETERANS' ISSUES AS MORE VETERANS RETURN FROM ACTIVE SERVICE, AND OLDER VETERANS AGE, THE NEED FOR SERVICES AMONG MILITARY RETIREES IS INCREASING. THE LOGICAL FIRST RESPONDER TO THESE NEEDS IN THE VETERANS' ADMINISTRATION HEALTHCARE SYSTEM, BUT MANY VETERANS EXPERIENCE PROBLEMS THAT BRING THEM TO OTHER HOSPITALS OR SERVICE PROVIDERS. LPIH WILL DEVELOP PROTOCOLS TO ASSESS VETERANS WHO PRESENT AT THE HOSPITAL, AND COORDINATE WITH VA AND VETERANS ORGANIZATIONS IN MAINTAINING CARE FOR THESE PATIENTS FOLLOWING THEIR ACUTE EPISODES. LA PALMA INTERCOMMUNITY HOSPITAL IMPLEMENTATION PLAN FOR MEETING IDENTIFIED COMMUNITY NEEDS 2019-20216. LOW INCOME CARE PLACEMENT - THIS ISSUE REVOLVED AROUND WORRIES THAT LOW-INCOME CLIENTS WOULD STILL HAVE PROBLEMS ACCESSING HOSPITAL SERVICES DUE TO DEDUCTIBLES AND COPAYS. THE PROBLEM HAS MORPHED SOMEWHAT FROM LACK OF INSURANCE AS EXPRESSED IN THE LAST COMMUNITY HEALTH NEEDS ASSESSMENT IN 2015, TO PROBLEMS PAYING DEDUCTIBLES, WHICH UNDER MANY COVERED CALIFORNIA PLANS MAY REACH MULTIPLE THOUSANDS. HOSPITALS ARE ADDRESSING THIS BY ASSISTING CLIENTS IN GETTING QUALIFIED FOR COVERAGE THEY MAY NOT REALIZE EXISTS. AS WAS NOTED EARLIER, THE SECRETARY OF HEALTH AND HUMAN SERVICES HAS SUGGESTED THAT MEDICARE/MEDICAID PROVIDERS MAY BE ALLOWED IN THE FUTURE TO PROVIDE FINANCIAL HOUSING ASSISTANCE TO ENSURE SAFE LIVING CONDITIONS FOR LOW-INCOME CLIENTS UPON DISCHARGE FROM HOSPITAL CARE. LPIH WILL MONITOR THIS DEVELOPMENT, AND PARTICIPATE IN PROGRAMS DEVELOPED, TO THE EXTENT ALLOWED IN DEVELOPING/MANAGING/FINANCING PLACEMENT ALTERNATIVES. IT IS IMPORTANT TO NOTE THAT MOST OF THE ISSUES RAISED ABOVE ARE NOT MEDICAL DIAGNOSES, BUT INSTEAD ARE LIFESTYLE AND ECONOMIC CONDITIONS WHICH GENERATED NEED FOR MEDICAL CARE. IN ORDER TO BRING ATTENTION TO MEDICAL ISSUES IN THE AREA, LPIH REVIEWED THE ORANGE COUNTY HEALTH IMPROVEMENT PLAN 2017-2019 (OCHIP). THIS DOCUMENT OUTLINES FOUR PRIORITY AREAS, OF WHICH ALL ARE WITHIN THE PURVIEW OF SERVICES OFFERED BY LPIH. THESE PRIORITY AREAS ARE SUMMARIZED HERE. AS PART OF ITS MISSION TO PROVIDE COMPREHENSIVE, QUALITY HEALTHCARE IN A CONVENIENT, COMPASSIONATE AND COST-EFFECTIVE MANNER. LPIH WILL PARTICIPATE IN MEETING THE PRIORITIES SET OUT IN THAT PLAN.

ENCINO HOSPITAL MEDICAL CENTER
PART V, SECTION B, LINE 11: KEYGROUP CONDUCTED FOCUS GROUP SURVEYS AND INDIVIDUAL PHONE INTERVIEWS WITH REPRESENTATIVES OF AREA HEALTH AGENCIES, SOCIAL SERVICE PROVIDERS, AND LOCAL GOVERNMENT ORGANIZATIONS (COLLECTIVELY, KEY INFORMANTS). OVER 35 HEALTH NEEDS WERE SUGGESTED BY THE KEY INFORMANTS, AND WERE WINNOWED DOWN TO THOSE CONSIDERED MOST IMPORTANT BY THE FOCUS GROUP PARTICIPANTS.1. HOSPITAL SERVICES MARKETING AND OUTREACH THE HOSPITAL'S PLAN INCLUDES A REVAMP OF THE HOSPITAL'S WEBSITE TO MAKE IT MORE SELF-EXPLANATORY AND CUSTOMER FRIENDLY. A PROVIDER SEARCH FUNCTION WILL ALLOW USERS TO FIND SERVICES NEARBY BUT NOT OFFERED AT EHMC. FACEBOOK AND TWITTER PRESENCES ARE IN DEVELOPMENT, ALONG WITH A NEXTDOC FUNCTION. INCREASED PRESENCE AT NEARBY SERVICE GROUPS (ROTARY, CHAMBER OF COMMERCE, ETC.), AND GREATER PARTICIPATION IN LOCAL HEALTH FAIRS AND VALLEY ECONOMIC ALLIANCE PROGRAMS WILL INCREASE VISIBILITY. ADDITIONAL OUTREACH TO LOCAL COMMUNITY SOCIAL SERVICE AND HEALTH AWARENESS ORGANIZATIONS TO COORDINATE SERVICES WITH THE NEEDS EXPERIENCED BY THOSE ORGANIZATIONS WILL ALLOW THEM TO UTILIZE. IN THE COVID-19 ENVIRONMENT, THIS PROCESS IS LIMITED IN SCOPE DUE TO SOCIAL DISTANCE REQUIREMENTS, BUT AS THOSE RESTRICTIONS ARE EASED, INTERACTION WITH OTHER ORGANIZATIONS WILL BE FACILITATED AND EXPANDED.2. MENTAL HEALTH THE HOSPITAL'S PLAN BUILDS ON ITS EXISTING EXPERTISE IN PROVIDING SERVICES TO ELDERLY RESIDENTS WITH MENTAL HEALTH ISSUES, AND EXPANDS INTO ADDITIONAL AREAS RELATED TO MENTAL HEALTH CARE. AS ONE OF THE FEW HOSPITALS WITH BOTH A SECURE SERVICE AND LOWER-INTENSITY BEDS, EHMC IS WELL POSITIONED TO COPE WITH THE EXPECTED INCREASE IN SENIORS WITH DEPRESSION AND/OR OTHER MENTAL HEALTH ISSUES AS THE GENERAL POPULATION AGES. THE COVID-19 PANDEMIC MAY SPEED THE INCREASE IN DEMAND FOR THESE SERVICES, AND THE HOSPITAL WILL MAINTAIN VIGILANCE TO ALLOW IT TO ADDRESS THE NEEDS AS THEY PRESENT THEMSELVES. 3. COMMUNITY SERVICES AWARENESS THE HOSPITAL'S PLAN INCLUDES COMMUNICATION WITH COMMUNITY SERVICES ORGANIZATIONS, AND UPDATES TO THE EXISTING CITY 211 RESOURCE AND OTHER REFERRAL AGENCIES TO MEET SPECIFIC NEEDS OF PATIENTS AND COMMUNITY MEMBERS WITH WHICH THE HOSPITAL COMES INTO CONTACT. AS NEW ORGANIZATIONS ARISE TO ADDRESS NEWLY DEFINED SOCIAL DETERMINANTS OF HEALTH (SDOH), THESE ORGANIZATIONS WILL BE INTEGRATED INTO THE INTAKE AND DISCHARGE PLANNING PROCESS AT THE EHMC TO ASSURE THAT NON-MEDICAL, BUT INFLUENTIAL, LIFESTYLE ISSUES DON'T RESULT IN RE-ADMISSION TO THE HOSPITAL, AND TO EASE THE PATH BACK TO MAXIMUM HEALTH STATUS FOR EACH RESIDENT. 4. HOMELESSNESS ISSUES THE HOSPITAL'S PLAN WILL FOCUS ON CITY AND COUNTY INNOVATIONS TO ASSIST CURRENTLY HOMELESS RESIDENTS OF THE PSA TO FIND HOUSING AND SUPPORTIVE SERVICES TO FACILITATE THEIR RE-ENTRY INTO MAINSTREAM HOUSING, EMPLOYMENT, AND MENTAL HEALTH STATUS. THESE PROGRAMS ARE STILL IN DEVELOPMENT, AND THE ULTIMATE AVAILABILITY OF HOUSING OPTIONS BEYOND THE KNOWN COVID-19 INTERIM SOLUTIONS AS OF THIS REPORT DATE WILL INFLUENCE EHMC'S ABILITY TO PARTICIPATE IN REFERRAL AND TREATMENT PROGRAMS. UNTIL MORE CONCRETE PROGRAMS ARE DEFINED, AND PARTICIPATION REGULATIONS CLARIFIED, EHMC WILL CONTINUE TO MONITOR PLANS AND REFER HOMELESS PATIENTS TREATED AT THE HOSPITAL TO EXISTING SERVICE PROVIDERS AS APPROPRIATE. 5. CHRONIC CARE MANAGEMENT THE HOSPITAL'S PLAN INCLUDES IMPROVED COMMUNICATION WITH COMMUNITY SERVICES ORGANIZATIONS DEALING WITH THE SDOH ISSUES IDENTIFIED AS MEDICAL PRECURSORS. IN ADDITION, AS SERVICES BECOME AVAILABLE TO ASSIST FORMER PATIENTS TO TRANSITION BACK TO THEIR HOME, AND ASSESS THOSE ENVIRONMENTS FOR POTENTIAL HAZARDS AND LIFESTYLE ISSUES, THE HOSPITAL WILL WORK WITH THESE ORGANIZATIONS AND THE PAYORS THAT COVER PATIENTS' HOSPITALIZATION COSTS TO COORDINATE SERVICES THAT WILL MINIMIZE THE POTENTIAL FOR REHOSPITALIZATION, AND CONTRIBUTE TO HIGHER LEVELS OF RESIDENT HEALTH. 6. OBESITY THE HOSPITAL'S PLAN INCLUDES CONTINUATION OF ITS EXISTING PROGRAMS FOR ACUTE INCIDENCES OF DISEASES ASSOCIATED WITH OBESITY, AS WELL AS MAINTENANCE OF OUTPATIENT PROGRAMS ADDRESSING DIABETES AND CARDIAC DISEASE. A NEW PROGRAM COORDINATED WITH EPIC CARDIOLOGY WILL ALLOW GREATER RANGE OF SERVICES, AND IN COORDINATION WITH SHERMAN OAKS HOSPITAL, PROVIDE ADDITIONAL CARDIAC CATHETERIZATION SERVICES IN A NEW CATH LAB SETTING. 7. CANCER - THE HOSPITAL'S PLAN IS RELATIVELY MINIMAL WITH RELATION TO CANCER, SINCE IT DOES NOT SPECIALIZE IN CANCER TREATMENT. ASIDE FROM HANDLING EMERGENCY DEPARTMENT ADMISSIONS FOR ACUTE PROBLEMS, EHMC'S INVOLVEMENT IN CANCER ISSUES WILL BE LIMITED TO REFERRALS TO SPECIALIZED PROVIDERS AS APPROPRIATE. 8. HYPERTENSION THE HOSPITAL'S PLAN INVOLVES CONTINUATION OF EXISTING CARDIAC SERVICES, AND FUTURE PLANS INCLUDE EXPANSION OF INPATIENT SERVICES IN COORDINATION WITH SHERMAN OAKS HOSPITAL IN OPERATING A NEW CARDIAC CATHETERIZATION LAB, WHICH WILL ALLOW FOR MORE PRECISE DIAGNOSIS OF VASCULAR PROBLEMS AND ALLOW FOR INTERVENTIONAL CARDIOLOGY PROCEDURES IMMEDIATELY UPON DIAGNOSIS. THIS EXPANSION WILL BE PUBLICIZED THROUGHOUT THE COMMUNITY TO MAKE THE PUBLIC AWARE OF THE NEW OPTIONS. 9. SUBSTANCE ABUSE DISORDER THE HOSPITAL'S PLAN CENTERS ON ITS EXISTING SENIOR BEHAVIORAL HEALTH PROGRAM, INCLUDING BOTH INPATIENT AND OUTPATIENT SERVICES FOR THOSE WITH BOTH MENTAL HEALTH ISSUES AND SUBSTANCE ABUSE PROBLEMS. THE COMPREHENSIVENESS OF THE PROGRAM, INCLUDING A SENIOR EMERGENCY ROOM, 13-BED SECURED WING FOR INVOLUNTARY ADMISSIONS, AND MULTIPLE TREATMENT MODALITIES ORIENTED TOWARD SENIORS, WILL FACILITATE GROWTH IN THIS AREA AS MORE PSA RESIDENTS MOVE INTO THE APPROPRIATE AGE GROUP. THE PROGRAM'S EXISTING CONNECTIONS TO SOCIAL SERVICE AGENCIES AND STEP-DOWN PROGRAMS WILL ALLOW THE HOSPITAL TO CONTINUE TO MOVE CLIENTS TO APPROPRIATE TREATMENT SETTINGS AS APPROPRIATE. 10. ACCESS TO PRIMARY CARE THE HOSPITAL'S PLAN INCORPORATES EXISTING REFERRAL PROGRAMS TO ASSURE ADMISSIONS FROM THE EMERGENCY DEPARTMENT TO ACCESS PAYMENT PROGRAMS THAT WILL COVER NEEDED CARE, AND WORK WITH PAYORS TO ASSURE THAT FIRST-TIME ADMISSIONS ARE FOLLOWED UPON DISCHARGE TO ASSURE THAT NEEDED FOLLOW UP SERVICES ARE PROVIDED TO KEEP THEM IN THE MANAGED CARE PLAN'S CONTINUUM OF CARE. TO THE EXTENT THAT COVID-19 SYMPTOMS ARE FOUND ON TRIAGE, APPROPRIATE ISOLATION AND CARE PROTOCOLS WILL BE FOLLOWED.11. POVERTY THE HOSPITAL'S PLAN INCLUDES CONTINUATION OF ITS EXISTING PROGRAMS TO CARE FOR PATIENTS WHO PRESENT IN THE EMERGENCY DEPARTMENT AND TO FIND THEM INSURANCE COVERAGE AS AVAILABLE. EHMC WILL ASSIST PATIENTS COMPLETING TREATMENT WITH POVERTY ISSUES SUCH AS HOMELESSNESS, FOOD INSECURITY, MEDICATION INTERACTIONS, OR INADEQUATE HOUSING, TO ACCESS PROVIDERS WHO WILL HELP THEM DEAL WITH THE ISSUES INVOLVED. THE ISSUES ABOVE ARE THE CONSENSUS ISSUES FROM MANY SOURCES THAT MERIT THE MOST CONSIDERATION BY HOSPITALS IN THE AREA. EACH HOSPITAL HAS DIFFERING ABILITIES TO ADDRESS EACH ISSUE. AS DISCUSSED ABOVE, ENCINO HOSPITAL'S IMPLEMENTATION PLAN WILL FOCUS ON THE ISSUES RELATED TO ACCESS AND MENTAL HEALTH.

COSHOCTON REGIONAL MEDICAL CENTER
PART V, SECTION B, LINE 11: BASED ON THE RESULTS OF THE CHNA FROM INTERVIEWS, FOCUS GROUPS AND PRIORITIZATION FROM COSHOCTON COUNTY HEALTH DEPARTMENT AND THE CITY OF COSHOCTON HEALTH DEPARTMENT, COSHOCTON REGIONAL MEDICAL CENTER HAS SELECTED THREE OF THE IDENTIFIED SIGNIFICANT HEALTH NEEDS TO ADDRESS.1. SUBSTANCE USE/ MENTAL HEALTH2. HEALTHY EATING/ ACTIVE LIVING3. TOBACCO USECRMC DOES NOT INTEND TO ADDRESS THE FOLLOWING SIGNIFICANT HEALTH NEEDS:1. TRANSPORTATION2. HOMELESSNESSDUE TO RESOURCE LIMITATIONS, WE ARE NOT ADDRESSING TRANSPORTATION AND HOMELESSNESS AS THIS WILL REQUIRE LOCAL CITY AND COUNTY RESOURCES TO IMPLEMENT INFRASTRUCTURES TO FUND THE RESOLUTION OF THESE ISSUES.

SUBURBAN COMMUNITY HOSPITAL
PART V, SECTION B, LINE 11: BASED UPON THE INFORMATION COLLECTED AND ANALYZED FOR THIS NEEDS ASSESSMENT, THERE ARE A NUMBER OF AREAS IN WHICH THE HEALTH STATUS OF THE ADULTS AND CHILDREN IN THE HOSPITAL'S SERVICE AREA COULD BE IMPROVED. HOWEVER, THERE ARE ALREADY MANY PROGRAMS THAT SERVE THE AREA ALREADY ADDRESSING MANY OF THESE HEALTH ISSUES. IN ADDITION, SOME ISSUES ARE BETTER ADDRESSED BY AGENCIES, ORGANIZATIONS AND PROVIDERS WHOSE MISSION IT IS TO PROVIDE PREVENTION AND INTERVENTION PROGRAMS FOR THESE PUBLIC HEALTH PROBLEMS. THE FOLLOWING ISSUES WERE IDENTIFIED AS TOP CONCERNS FOR THE SERVICE AREA:MATERNAL AND CHILD HEALTHPROGRAMS ADDRESSING MATERNAL AND CHILD HEALTH, INCLUDING PRENATAL CARE, PREMATURE BIRTHS, INFANT MORTALITY, AND HIGH LEAD LEVELS IN CHILDREN, ARE ALREADY AMONG THE SERVICES PROVIDED BY THE MONTGOMERY COUNTY HEALTH DEPARTMENT. THE HEALTH DEPARTMENT PROVIDES A WEALTH OF SERVICES TO LOW INCOME FAMILIES TO ENSURE A HEALTHY PREGNANCY, BIRTH, AND CHILDHOOD. IN ADDITION, THE HEALTH DEPARTMENT IS LINKED TO MANY COMMUNITY AGENCIES THAT PROVIDE NEEDED HEALTH AND SOCIAL SERVICES NOT OFFERED BY THE HEALTH DEPARTMENT OR ITS CLINICS. SINCE SCH DOES NOT HAVE MATERNITY, GYNECOLOGY, OR PEDIATRIC SERVICES, IT PROBABLY IS NOT EFFICIENT FOR THEM TO ADDRESS THESE TOPICS.MORTALITYHIGH MORTALITY RATES FOR ALL CANCERS, FEMALE BREAST AND COLORECTAL CANCER, CORONARY HEART DISEASE AND STROKE CAN BE ADDRESSED THROUGH PUBLIC HEALTH EDUCATION AND SCREENINGS IN THE COMMUNITY AS WELL AS IN HOSPITAL SETTINGS. PREVENTIVE EDUCATION SHOULD FOCUS ON SMOKING CESSATION, NUTRITION, AND THE IMPORTANCE OF EARLY IDENTIFICATION AND TREATMENT OF BREAST AND COLORECTAL CANCERS, HIGH BLOOD PRESSURE, AND OBESITY THROUGH SCREENINGS. THE IMPORTANCE OF SCREENINGS AND OTHER HEALTH TOPICS ARE ADDRESSED IN AN EXTENSIVE LIST OF HEALTH EDUCATION CLASSES FOR ADULTS AND CHILDREN PROVIDED BY THE MONTGOMERY COUNTY HEALTH DEPARTMENT AT ORGANIZATIONS, SCHOOLS, WORKSITES AND THE COMMUNITY FREE OF CHARGE.PREVENTIVE SCREENINGSMOST INSURED INDIVIDUALS RECEIVE HEALTH SCREENINGS THROUGH THEIR PRIMARY CARE PHYSICIAN AIMED AT PREVENTING OR TREATING SERIOUS CHRONIC CONDITIONS AT AN EARLY STAGE. IN MONTGOMERY COUNTY, THOSE WHO ARE UNINSURED OR CANNOT AFFORD A PRIVATE PHYSICIAN CAN RECEIVE PRIMARY HEALTH CARE, INCLUDING SCREENINGS, AT THREE PUBLIC HEALTH CLINICS LOCATED IN POTTSTOWN, NORRISTOWN, AND WILLOW GROVE. HOWEVER, MANY UNDOCUMENTED INDIVIDUALS ARE AFRAID TO VISIT A HEALTH CLINIC OR PRIVATE PHYSICIAN. FATHER AUGUSTUS PULEO OF ST. PATRICK'S CHURCH CONDUCTS A WEEKLY HEALTH SCREENING CLINIC AFTER MASS ON SUNDAY FOR ANYONE WHO WISHES TO COME. THE CLINIC IS STAFFED BY A MEDICAL RESIDENT FROM SCH AND PROVIDES SIMPLE SCREENINGS AND REFERRALS AS NEEDED. MANY OF THE CLINIC PATIENTS ARE UNDOCUMENTED, AND THIS PROVIDES AN EXCELLENT RESOURCE FOR THEM. THE HOSPITAL ALSO SEES PATIENTS REFERRED FROM FATHER PULEO'S CLINIC AT THE SCH FAMILY MEDICINE CLINIC FOR FOLLOW-UP AND ALSO PROCESSES THEIR LABORATORY TESTING FOR FREE. HEALTH SCREENINGS ARE ALSO A MAJOR COMPONENT OF COUNTLESS HEALTH FAIRS THAT SCH SPONSORS THROUGHOUT THE YEAR.POOR NUTRITION AND OBESITYOBESITY AND POOR NUTRITIONAL HABITS AMONG ADULTS AND CHILDREN THAT CONTRIBUTE TO THIS CONDITION WAS NAMED ONE OF THE TOP HEALTH CARE CONCERNS IN THE SERVICE AREA BY KEY INFORMANTS AND FOCUS GROUP PARTICIPANTS. THE MONTGOMERY COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES SEES POOR NUTRITION AND FOOD INSECURITY BECAUSE OF THE HIGH COST OF HOUSING. THEY ARE TRYING TO COORDINATE DISTRIBUTION OF FOOD FROM THE MANY FOOD PANTRIES AND FARMER'S MARKETS THROUGHOUT THE COUNTY. OBESITY IS AN IMPORTANT FACTOR IN MANY CHRONIC HEALTH CONDITIONS, AND IS BEING ADDRESSED BY THE HOSPITAL IN TWO KEY AREAS, STROKE AND HEART PREVENTION AND CARE. THE HOSPITAL IS RATED AS A TOP PERFORMER ON KEY QUALITY MEASURES BY THE JOINT COMMISSION AND HAS CERTIFICATION AS A PRIMARY STROKE CENTER, BEING NAMED BEST HOSPITAL IN MONTGOMERY COUNTY AND NUMEROUS ACHIEVEMENTS FOR HEART AND STROKE CARE. THE HOSPITAL ALREADY PROVIDES MEDICAL CARE, EDUCATIONAL PROGRAMS, AND COMMUNITY OUTREACH SERVICES DIRECTED TO PREVENTING AND TREATING THESE CONDITIONS.BEHAVIORAL HEALTHSERIOUS MENTAL ILLNESS IN ADULTS AND CHILDREN WAS IDENTIFIED AS A TOP ISSUE OF CONCERN BASED ON REVIEW OF THE QUANTITATIVE AND QUALITATIVE DATA FOR THIS REPORT. SPECIFIC MENTAL HEALTH ISSUES INCLUDE SUICIDE AND SUICIDALITY, AND DEPRESSION. PARTICIPANTS IDENTIFIED THE NEED FOR MORE PSYCHIATRISTS, ESPECIALLY THOSE WHO WILL ACCEPT REFERRALS FROM EMERGENCY ROOM PATIENTS AND FOR THOSE WHO TREAT CHILDREN AND ADOLESCENTS AND ACCEPT INSURANCE. A SEPARATE PROGRAM FOR EMERGENCY ROOM MENTAL HEALTH SERVICES WAS ALSO IDENTIFIED AS AN IMPORTANT GOAL FOR HOSPITAL EMERGENCY ROOMS OVERWHELMED BY THE SERIOUSLY MENTALLY ILL. REFERRALS FROM THE EMERGENCY ROOM THAT ARE MORE LIKELY TO RESULT IN AFTERCARE ARE ALSO NEEDED. SINCE SCH IS ONE OF TWO ACUTE CARE HOSPITALS WITH EMERGENCY ROOMS THAT ARE ADJACENT TO NORRISTOWN BOROUGH, THEY MAY WANT TO CONSIDER WORKING WITH THE EMERGENCY SERVICES PROGRAM AND EINSTEIN MEDICAL CENTER MONTGOMERY ON THIS ISSUE. SCH IS SEEN AS NEUTRAL SO THEY HAVE A LOT OF INFLUENCE IN THE COMMUNITY.OPIOID ADDICTION IS EPIDEMIC IN MONTGOMERY COUNTY, ESPECIALLY IN POTTSTOWN AND IN THE SCHOOLS, AS IT IS IN THE REST OF THE NATION. NORRISTOWN ALSO HAS A SIGNIFICANT NUMBER OF OPIOID ADDICTION DEATHS AND EMERGENCIES. THIS SERIOUS PROBLEM WAS MENTIONED BY ALL PARTICIPANTS IN KEY INFORMANT INTERVIEWS AND THE FOCUS GROUP. OPIOID ADDICTION IS BEING ADDRESSED AT THE STATE AND COUNTY LEVELS BY GOVERNMENT AND COALITIONS OF AGENCIES AND ORGANIZATIONS WITH PRESCRIPTION MONITORING PROGRAMS, NARCAN DISTRIBUTION, MORE INPATIENT AND OUTPATIENT SLOTS FOR TREATMENT FUNDED THROUGH THE AFFORDABLE CARE ACT, AND PROVIDER EDUCATION. SCH MAY WANT TO PARTICIPATE IN THESE DISCUSSIONS, IF THEY ARE NOT ALREADY DOING SO, SINCE OPIATE ADDICTION AND OTHER SUBSTANCE ABUSE RESULTS IN MANY AVOIDABLE EMERGENCY ROOM VISITS.

PAMPA REGIONAL MEDICAL CENTER
PART V, SECTION B, LINE 11: FINANCIAL RESOURCES AND FUNDING:FINANCIAL RESOURCES AND FUNDING FOR HEALTHCARE SERVICES ARE LIMITED, THUS PREVENTING PROVIDERS FROM MEETING IDENTIFIED UNMET HEALTH NEEDS IN THE COMMUNITY.THERE IS GROWING CONCERN ABOUT THE INCREASINGLY LIMITED FUNDING AND FINANCIAL RESOURCES AVAILABLE FOR HEALTHCARE SERVICES FROM BOTH PUBLIC AND PRIVATE SOURCES.PROFESSIONAL SHORTAGES:SHORTAGE OF CRITICAL HEALTHCARE WORKFORCE DECREASES NEEDED ACCESS TO HEALTHCARE SERVICES. THERE IS A SHORTAGE OF CRITICAL HEALTHCARE MANPOWER IN A NUMBER OF AREAS INCLUDING PHYSICIANS IN SPECIALTIES SUCH AS FAMILY PRACTICE, PEDIATRICS, OPHTHALMOLOGY, EMERGENCY ROOM, ANESTHESIOLOGY, RADIOLOGY AND PATHOLOGY IN THE COMMUNITY. THERE IS ALSO A SIGNIFICANT NEED FOR MENTAL HEALTH AND SUBSTANCE ABUSE PROVIDERS INCLUDING PSYCHIATRISTS, THERAPISTS, AND COUNSELORS IN THE COMMUNITY.LIMITED ACCESS TO HEALTHCARE SERVICES:ACCESS TO HEALTHCARE SERVICES IS LIMITED, PARTICULARLY FOR VARIOUS AT-RISK POPULATIONS. TRANSPORTATION SERVICES ARE LIMITED, PARTICULARLY IN MORE OF THE OUTLYING, RURAL AREAS, WHICH IN TURN LIMITS ACCESS TO NEEDED HEALTHCARE SERVICES FOR AT-RISK POPULATIONS.ACCESS TO MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES FOR AT-RISK POPULATIONS WAS NOTED AS A PARTICULAR PROBLEM.LIMITED ACCESS TO MENTAL HEALTHCARE AND ADDICTION SERVICES:ACCESS TO MENTAL HEALTH SERVICES IS LIMITED, PARTICULARLY FOR VARIOUS AT-RISK POPULATIONS; THEREFORE, THE OFFERING OF NEW OR EXPANDED MENTAL HEALTH SERVICES IS NEEDED TO MEET THESE NEEDS.AVAILABILITY AND ACCESS TO MENTAL HEALTH, ALCOHOL AND SUBSTANCE ABUSE PROVIDERS AND SERVICES ARE SEVERELY LIMITED. IMPROVEMENT IS NEEDED WITH INTERFACING, COORDINATING AND COMMUNICATION AMONG HEALTHCARE AND SOCIAL SERVICE PROVIDERS, PARTICULARLY THOSE IMPACTING LOW INCOME AND OTHER AT-RISK POPULATIONS.ALTHOUGH SERVICES ARE BEING PROVIDED FOR AT-RISK POPULATIONS, THESE SERVICES ARE LIMITED. THIS IS ESPECIALLY TRUE AS IT RELATES TO SERVICES FOR THE SERIOUSLY MENTALLY ILL, DETOX, ADULT ALCOHOL AND DRUG ABUSE, CO-OCCURRING DISORDERS, CHILD AND ADOLESCENT PSYCHIATRIC, AND CHILD AND ADOLESCENT ALCOHOL AND DRUG ABUSE POPULATIONS.DETERMINING THE ENTRY-POINT INTO THE MENTAL HEALTHCARE SYSTEM CAN BE CONFUSING FOR POTENTIAL PATIENTS, PARTICULARLY FOR LOW INCOME/AT-RISK POPULATIONS. THE HOSPITAL EMERGENCY DEPARTMENT IS VIEWED AS A LESS-THAN-IDEAL ENTRY POINT.AS A POINT-OF-ENTRY DURING MENTAL HEALTH CRISES, THE HOSPITAL EMERGENCY ROOM HAS A LIMITED AMOUNT OF SPECIALIZED RESOURCES.COMMUNITY PERCEPTION OF ACCESSIBILITY OF HEALTH EDUCATION, PROMOTION, AND PREVENTIVE SERVICES:THERE IS A PERCEPTION THE COMMUNITY SUFFERS FROM A SHORTAGE OF EDUCATION, PROMOTION, AND PREVENTIVE SERVICES.THERE IS A NEED FOR A RESOURCE BOARD OR SHARED SERVICES SYSTEM LISTING TO PROVIDE INFORMATION ABOUT HOW MUCH SERVICES COST AND WHAT IS AVAILABLE FOR NO COST TO LOW-INCOME AND AT-RISK POPULATIONS.THERE IS A NEED FOR ADDITIONAL AND MORE EFFECTIVE HEALTH EDUCATION, HEALTH PROMOTION AND PREVENTION SERVICES SPECIFICALLY TARGETED AT LOW-INCOME AND AT-RISK POPULATIONS IN SOME REGIONS OF THE SERVICE AREA.TOPICS FOR EDUCATION, PROMOTION, AND PREVENTIVE SERVICES NEEDED INCLUDED: DIABETES, SMOKING, NUTRITION, MENTAL HEALTH AND WOMEN'S HEALTH.THERE IS A NEED FOR EDUCATION ON HEALTH RISKS OF SMOKING IN GRAY COUNTY AND THROUGHOUT THE SERVICE AREA INCLUDING TARGETED EDUCATION OF SCHOOL AGE CHILDREN AND YOUTH.THERE IS A NEED FOR INCREASED PROGRAMS FOR SMOKING CESSATION PROGRAMING AND CAMPAIGNING IN GRAY COUNTY AND THROUGHOUT THE SERVICE AREA.

GLENDORA COMMUNITY HOSPITAL
PART V, SECTION B, LINE 11: RESOURCES CURRENTLY EXIST IN THE COMMUNITY TO ADDRESS MOST OF THE PRIORITY NEEDS, ALTHOUGH IN EACH CASE, MORE RESOURCES WOULD BE USEFUL IN COMBATING THE PROBLEMS. OVER 40 HEALTH NEEDS WERE SUGGESTED BY THE KEY INFORMANTS. FIVE OF THESE NEEDS WERE SPECIFIC DISEASES OR CONDITIONS THAT ARE INDICATORS OF POOR HEALTH. THEY ARE LISTED BELOW, WITH A SHORT SUMMARY OF THEIR IMPACT ON COMMUNITY HEALTH.1. DIABETES - THERE ARE TWO PRIMARY TYPES: JUVENILE ONSET (TYPE 1) DIABETES, TYPICALLY DIAGNOSED IN CHILDREN, IS A CONDITION DUE TO THE BODY'S INABILITY TO MAKE ENOUGH INSULIN TO MANAGE DIGESTION. IT IS BEST CONTROLLED WITH DIET AND WEIGHT MANAGEMENT, ALTHOUGH MEDICATION EXISTS TO CONTROL INSULIN LEVELS. ADULT ONSET (TYPE 2) DIABETES IS MOST OFTEN A LIFESTYLE DISEASE, BROUGHT ON BY EXCESS WEIGHT, LACK OF EXERCISE AND/OR DIET. IT IS ALSO CONTROLLABLE WITH APPROPRIATE CHANGES TO DIET, EXERCISE REGIMENS AND OTHER LIFESTYLE CHOICES.2. OBESITY - AS A CONTRIBUTOR TO DIABETES, HIGH BLOOD PRESSURE, CARDIAC PROBLEMS AND ORTHOPEDIC ISSUES, THIS WAS MENTIONED BY SEVERAL RESPONDENTS. LOS ANGELES COUNTY DEPARTMENT OF HEALTH PROVIDES DATA ON HEALTH STATUS FOR EIGHT SPECIFIC PLAN AREAS (SPAS) GLENDORA IS IN SPA 3 - SAN GABRIEL VALLEY. SPA 3 RATES FOR OBESITY IN 2013 WERE LOWER THAN BOTH THE COUNTY AVERAGE FOR CHILDREN, AND WITHIN LOS ANGELES STATISTICAL NORMS FOR ADULTS. NONETHELESS, THE FACT THAT ALL AGE CATEGORIES REPORTED BETWEEN 20% AND 35% RATES OF OVERWEIGHT AND OBESITY INDICATES A SIGNIFICANT OPPORTUNITY FOR IMPROVEMENT.3. MENTAL HEALTH - SEVERAL RESPONDENTS MENTIONED A LIMITED SUPPLY OF MENTAL HEALTH SERVICES, AS WELL AS A HISTORICAL LACK OF PAYMENT PROGRAMS FOR MENTAL HEALTH SERVICES. THE SOURCES OF CARE FOR MENTAL HEALTH ISSUES ARE TYPICALLY OUTPATIENT SETTINGS, BUT PHYSICAL PROBLEMS EITHER CAUSED BY, OR COMPLICATIONS OF, MENTAL PROBLEMS ARE A MAJOR FACTOR IN BRINGING CLIENTS TO HOSPITAL EMERGENCY DEPARTMENTS. VARIOUS LAWS HAVE BEEN PASSED IN THE PAST 25 YEARS TO IMPROVE MENTAL HEALTH CARE, AND PROVISIONS OF THE AFFORDABLE CARE ACT MANDATE MENTAL HEALTH PARITY IN PAYMENT AND TREATMENT, BUT THE REGULATIONS TO DEFINE THAT PARITY ARE NOT YET CLEAR. IT IS EXPECTED THAT MENTAL HEALTH SERVICES WILL IMPROVE AS PAYORS DEVELOP SYSTEMS TO REIMBURSE PROVIDERS FOR THE SERVICES THEY OFFER, BUT TREATMENT FOR CHRONIC MENTAL HEALTH ISSUES IS BEYOND THE SCOPE OF MOST HOSPITALS. THE PRIMARY ISSUE FOR ACUTE CARE PROVIDERS IS DEVELOPING PROTOCOLS FOR ADDRESSING MENTAL HEALTH ISSUES THAT PRESENT ALONG WITH THE ACUTE MEDICAL PROBLEMS THAT BRING PATIENTS TO THE ED.4. ACCESS TO HEALTHCARE - PASSAGE OF THE AFFORDABLE CARE ACT HAS HAD A POSITIVE EFFECT ON THE NUMBER OF AREA RESIDENTS WHO LACK HEALTH INSURANCE, BUT PROVIDERS OF CARE TO LOW-INCOME CLIENTS STILL REPORT DIFFICULTY MAKING REFERRALS TO SPECIALISTS. IN MANY AREAS, WAIT TIMES FOR APPOINTMENTS FOR MEDICAL RECIPIENTS ARE STILL LONGER THAN OPTIMUM.5. SUBSTANCE ABUSE - THIS OMNIBUS CATEGORY INCLUDES ALCOHOLISM, ADDICTION TO NUMEROUS ILLEGAL SUBSTANCES, AND INAPPROPRIATE USE OF PRESCRIPTION MEDICATIONS. MOST OF THE ISSUES ARE CHRONIC IN NATURE, ALTHOUGH THE PRESENTING SYMPTOMS IN HOSPITAL EDS ARE USUALLY ACUTE MEDICAL CRISES, SUCH AS ACCIDENTS, TRAUMA, OVERDOSE, OR INJURIES RESULTING FROM UNWISE ACTIONS WHILE INTOXICATED. MUCH OF THE WORK ON SUBSTANCE ABUSE IS FUNDED BY MENTAL HEALTH PAYORS, SINCE THE ADDICTION ISSUES UNDERLYING THE PROBLEMS ARE CONSIDERED MENTAL-HEALTH RELATED.

REHABILITATION HOSPITAL OF RHODE ISLAND
PART V, SECTION B, LINE 11: TO WORK TOWARD HEALTH EQUITY, IT IS IMPERATIVE TO PRIORITIZE RESOURCES AND ACTIVITIES TOWARD THE MOST PRESSING HEALTH AND CROSSCUTTING NEEDS WITHIN COMMUNITIES. IN DETERMINING THE ISSUES ON WHICH TO FOCUS EFFORTS OVER THE NEXT THREE-YEAR CYCLE, LANDMARK MEDICAL CENTER SOLICITED INPUT FROM COMMUNITY PARTNERS AND STAKEHOLDERS TO ALIGN EFFORTS WITH EXISTING INITIATIVES HEADED BY THE RHODE ISLAND DEPARTMENT OF HEALTH, THE HEZS, AND OTHER COMMUNITY PARTNERSHIPS.THE CHNA FINDINGS CONFIRMED THAT MANY RESIDENTS WITHIN THE LANDMARK MEDICAL CENTER SERVICE AREA EXPERIENCE GREATER SOCIOECONOMIC DISPARITIES AND INCREASED HEALTH NEEDS THAN IN OTHER PARTS OF THE STATE. CYCLICAL POVERTY, EXPOSURE TO VIOLENCE, AND POORER HEALTH OUTCOMES LEAD TO SHORTENED LIFE EXPECTANCY FOR MANY RESIDENTS. IN SUPPORT OF CHNA FINDINGS, LANDMARK MEDICAL CENTER WILL FOCUS ON:- BEHAVIORAL HEALTH: REDUCE THE PREVALENCE OF FAMILY TRAUMA- CHRONIC DISEASE: EXPAND ACCESS TO CARE TO REDUCE HEALTH DISPARITIES FOR CHRONIC DISEASE- MATERNAL AND CHILD HEALTH: REDUCE TEEN PREGNANCIES AND IMPROVE BIRTH OUTCOMES FOR MOTHERS AND BABIES

HUNTINGTON BEACH HOSPITAL
PART V, SECTION B, LINE 13B: APPROVED IN SOME INSTANCES OF HOMELESSNESS/DECEASED WITH NO KNOWN NEXT OF KIN

LA PALMA INTERCOMMUNITY HOSPITAL
PART V, SECTION B, LINE 13B: APPROVED IN SOME INSTANCES OF HOMELESSNESS/DECEASED WITH NO KNOWN NEXT OF KIN.

SCHEDULE H, PART V, LINE 7A - LANDMARK MEDICAL CENTER
HTTPS://WWW.LANDMARKMEDICAL.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/

SCHEDULE H, PART V, LINE 7A - SHERMAN OAKS
WWW.SHERMANOAKSHOSPITAL.ORG/ABOUT-US/COMMUNITY-BENEFITS.ASPX

SCHEDULE H, PART V, LINE 7A - COSHOCTON
HTTPS://WWW.COSHOCTONHOSPITAL.ORG/ABOUT-US/COMMUNITY-SERVICE/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/

SCHEDULE H, PART V, LINE 10A - COSHOCTON
HTTPS://WWW.COSHOCTONHOSPITAL.ORG/ABOUT-US/COMMUNITY-SERVICE/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/

SCHEDULE H, PART V, LINE 7A - SUBURBAN
HTTPS://WWW.SUBURBANHOSP.ORG/DOCUMENTS/CHNA-REPORT-FINAL_SEP-2017.PDF

SCHEDULE H, PART V, LINE 10A - SUBURBAN
WWW.SUBURBANHOSP.ORG/DOCUMENTS/SUB-COMM-HOSPITAL-CHNA-VERSION2-(1).PDF

SCHEDULE H, PART V, LINE 7A - PAMPA
HTTPS://WWW.PRMCTX.COM/ABOUT-US/QUALITY-PATIENT-SAFETY-CLINICAL-EXCELLENCE/

SCHEDULE H, PART V, LINE 7A - HUNTINGTON BEACH
HTTPS://WWW.HBHOSPITAL.ORG/DOCUMENTS/COMMUNITY-BENEFIT-HBH-2019.PDF

PART II, COMMUNITY BUILDING ACTIVITIES:
LA PALMA INTERCOMMUNITY HOSPITAL:COMMUNITY HEALTH IMPROVEMENT ADVOCACY: TOGETHER WITH COMMUNITY ORGANIZATIONS, PRIME HEALTHCARE LA PALMA, PROVIDED HEALTH SCREEINGS, NURTRITIONAL COUNSELING, VARIOUS WORKSHOPS, AND TRANSPORTATION TO THE COMMUNITY AND SENIORS. PAMPA REGIONAL MEDICAL CENTER:COMMUNITY SUPPORT & COMMUNITY HEALTH IMPROVEMENT ADVOCACY: PAMPA REGIONAL MEDICAL CENTER TOOK PART IN A HEALTH FAIR AND WAS EVENT SPONSER FOR MANY DIFFERENT ORGANIZATIONS IN THE COMMUNITY, SUPPORTING EFFORTS RANGING FROM SENIOR AND PREGNANCY RESOURCES TO FINE ART ENRICHMENT AND FOOD FOR CHILDREN.

PART III, LINE 2:
THE AMOUNT REPORTED ON LINE 2 IS BASED ON BAD DEBTS PER THE AUDITED FINANCIAL STATEMENTS.

PART III, LINE 3:
LANDMARK & RHODE ISLAND:THE ESTIMATED AMOUNT OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY IS THE ACTUAL BAD DEBT AS EACH HAVE A SEPARATE ACCOUNT.ENCINO & SHERMAN OAKS:THE COST TO CHARGE RATIO WAS USED TO DETERMINE THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS UNDER THE FINANCIAL ASSISTANCE POLICY.MONTCLAIR:PATIENTS WHO QUALIFY, AND ARE GIVEN FINANCIAL ASSISTANCE, ARE GROUPED AND CLASSIFIED WITHIN THE PATIENT ACCOUNTING SYSTEMS. THESE ACTUAL AMOUNTS, FROM THE ACTUAL PATIENTS, WERE USED TO DETERMINE THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO THE FINANCIAL ASSISTANCE POLICY.SUBURBAN, SOUTHERN REGIONAL & COSHOCTON:THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE IS DEEMED TO BE $0 SINCE THE ACTIVITY ASSOCIATED WITH THE PATIENTS THAT ARE ELIGIBLE FOR FINANCIAL ASSISTANCE IS CAPTURED AS EITHER CHARITY OR POLICY ADJUSTMENT, WHICH ARE DISTINCT FROM BAD DEBT EXPENSE.PAMPA:CHARITY CARE POLICY IS GENEROUS ENOUGH TO ENCOMPASS THE MAJORITY OF OUR ININSURED AND UNDERINSURED RESIDENTS. HAD PATIENTS WITH BAD DEBT HAVE APPLIED, THEY WOULD MOST GENERALLY QUALIFY FOR ASSISTANCE.HUNTINGTON BEACH & LA PALMA:THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE IS DEEMED TO BE $0 SINCE THE ACTIVITY ASSOCIATED WITH THE PATIENTS THAT ARE ELIGIBLE FOR FINANCIAL ASSISTANCE IS CAPTURED AS EITHER CHARITY OR POLICY ADJUSTMENT, WHICH ARE DISTINCT FROM BAD DEBT.EAST VALLEY GLENDORA:ALL GROSS CHARGES ARE DEEMED CHARITABLE ON ACCOUNTS WHERE A CHARITY APPLICATION HAS BEEN SUBMITTED AND APPROVED.

PART III, LINE 4:
THE BAD DEBT EXPENSE FOOTNOTE IS INCLUDED ON PAGE 8 OF THE AUDITED FINANCIAL STATEMENTS.

PART III, LINE 8:
THE FOLLOWING HOSPITALS USED THE COST TO CHARGE RATIO TO REPORT THE MEDICARE ALLOWABLE COSTS ON LINE 6:PRIME HEALTHCARE SERVICES - SHERMAN OAKS, LLCPRIME HEALTHCARE SERVICES - MONTCLAIR, LLCPRIME HEALTHCARE SERVICES - ENCINO HOSPITAL, LLCPRIME HEALTHCARE FOUNDATION - SOUTHERN REGIONAL, LLCEAST VALLEY GLENDORA HOSPITAL, LLCPRIME HEALTHCARE SERVICES - LANDMARK MEDICAL CENTERPRIME HEALTHCARE SERVICES - REHABILITATION HOSPITAL OF RHODE ISLANDPRIME HEALTHCARE FOUNDATION - COSHOCTON, LLCTHE FOLLOWING HOSPITALS USED OTHER COSTING METHODOLOGIES TO REPORT THE MEDICARE ALLOWABLE COSTS ON LINE 6:PRIME HEALTHCARE HUNTINGTON BEACH LLCPRIME HEALTHCARE SERVICES - PAMPA, LLCPRIME HEALTHCARE SERVICES - SUBURBAN HOSPITAL, LLCPRIME HEALTHCARE LA PALMA, LLCPAMPATHE COSTING METHODOLOGY WAS BASED ON A CONTRACTUAL MODEL WHERE ALLOWABLE COSTS ARE CALCULATED USING COSTS ACCOUNTING METHODS.HUNTINGTON BEACH & LA PALMATHE COSTING METHODOLOGY WAS BASED ON THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) COST REPORT COMPONENTS.LA PALMATHE COSTING METHODOLOGY WAS BASED ON THE COST REPORT.SUBURBANTHE COSTING METHODOLOGY WAS BASED ON THE PERCENTAGE OF TOTAL MEDICARE GROSS REVENUES OF TOTAL GROSS REVENUES.

PART III, LINE 9B:
PRIME HEALTHCARE NONPROFIT FACILITIES MAY USE THE SERVICES OF AN EXTERNAL COLLECTION AGENCY FOR THE COLLECTION OF PATIENT DEBT. NO DEBT SHALL BE ADVANCED FOR COLLECTION UNTIL THE DIRECTOR OF THE HOSPITAL PFS OR HIS/HER DESIGNEE HAS REVIEWED THE ACCOUNT AND APPROVED THE ADVANCEMENT OF THE DEBT TO COLLECTION. PRIME HEALTHCARE NONPROFIT FACILITIES SHALL OBTAIN AN AGREEMENT FROM EACH COLLECTION AGENCY THAT IT UTILIZES TO COLLECT PATIENT DEBT THAT THE AGENCY WILL COMPLY WITH THE REQUIREMENTS OF THE FINANCIAL ASSISTANCE POLICY AND APPLICABLE STATE LAW.IF A PATIENT DOES NOT APPLY FOR FINANCIAL ASSISTANCE OR IS DENIED FINANCIAL ASSISTANCE AND FAILS TO PAY THEIR BILL, THE PATIENT MAY BE SUBJECT TO VARIOUS COLLECTION ACTIONS, INCLUDING EXTRAORDINARY COLLECTION ACTIONS, SUBJECT TO APPLICABLE STATE LAW. NOTWITHSTANDING THE FOREGOING, NEITHER THE HOSPITAL NOR ANY COLLECTION AGENCY WITH WHICH IT CONTRACTS SHALL ENGAGE IN ANY EXTRAORDINARY COLLECTION ACTIONS (I) AT ANY TIME PRIOR TO ONE HUNDRED FIFTY (150) DAYS FOLLOWING THE FIRST POST-DISCHARGE STATEMENT SENT TO A PATIENT OR (II) WITHOUT FIRST MAKING REASONABLE EFFORTS TO DETERMINE WHETHER A PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THIS POLICY. IN ADDITION, AND EVEN IF THE ABOVE TWO CONDITIONS ARE SATISFIED, HOSPITAL OR ITS CONTRACTED COLLECTION AGENCIES MUST SEND A NOTICE TO THE PATIENT AT LEAST THIRTY (30) DAYS BEFORE COMMENCING ANY EXTRAORDINARY COLLECTION ACTIONS, WHICH SPECIFIES THE FOLLOWING: (I) COLLECTION ACTIVITIES THE HOSPITAL OR CONTRACTED COLLECTION AGENCY MAY TAKE, (II) THE DATE AFTER WHICH SUCH ACTIONS MAY BE TAKEN (WHICH DATE SHALL BE NO EARLIER THAN THIRTY (30) DAYS OF THE NOTICE DATE, (III) THAT FINANCIAL ASSISTANCE IS AVAILABLE FOR ELIGIBLE PATIENTS. A COPY OF THE PLAIN LANGUAGE SUMMARY WILL BE INCLUDED WITH SUCH NOTICE. REASONABLE EFFORTS MUST BE MADE (AND DOCUMENTED) TO ORALLY NOTIFY PATIENTS OF THIS POLICY. IF THE PATIENT APPLIES FOR FINANCIAL ASSISTANCE, ANY EXTRAORDINARY COLLECTION ACTIONS THAT MAY BE IN PROCESS WILL BE SUSPENDED IMMEDIATELY PENDING THE DECISION ON THE PATIENT'S APPLICATION.IN ADDITION, IF A PATIENT IS ATTEMPTING TO QUALIFY FOR ELIGIBILITY UNDER THIS FINANCIAL ASSISTANCE AND IS ATTEMPTING IN GOOD FAITH TO SETTLE AN OUTSTANDING BILL WITH THE HOSPITAL BY NEGOTIATING A REASONABLE PAYMENT PLAN OR MAKING REGULAR PARTIAL PAYMENTS OF A REASONABLE AMOUNT, THE HOSPITAL SHALL NOT SEND THE UNPAID BILL TO ANY COLLECTION AGENCY.THE HOSPITAL SHALL NOT, IN DEALING WITH PATIENTS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY, USE WAGE GARNISHMENTS OR LIENS ON PRIMARY RESIDENCES AS A MEANS OF COLLECTING UNPAID HOSPITAL BILLS.

PART VI, LINE 5:
ALL OF THE HOSPITALS CONDUCT OUTREACH PROGRAMS AS FURTHER DISCUSSED IN ITS CHNA REPORTS.

PART VI, LINE 7, REPORTS FILED WITH STATES
CA

SCHEDULE H, PART VI, LINE 4 - ENCINO COMMUNITY INFORMATION
ENCINO HOSPITAL MEDICAL CENTER PRIMARY SERVICE AREA COVERS 11 ZIP CODES IN THE SAN FERNANDO VALLEY AREA OF NORTHERN LOS ANGELES COUNTY, AND IS HOME TO MORE THAN 278,000 RESIDENTS. DATA GATHERED FROM THE 2010-2017 U.S. CENSUS AMERICAN COMMUNITY SURVEY ESTIMATES SHOW THAT MALE AND FEMALE POPULATIONS ARE SPLIT ALMOST EQUALLY.THE EHMC PSA SHOWS THE GREATEST CONCENTRATION OF RESIDENTS IN THE WORKING AGES (25-64) COMPARED TO SPA 2 OR LOS ANGELES COUNTY, AND CORRESPONDINGLY LOWER PROPORTIONS OF RESIDENTS IN OTHER GROUPS.OUT OF THE TOTAL ENCINO HOSPITAL MEDICAL CENTER PSA POPULATION (278,668), 11% ARE ADULTS 65 YEAR OR OLDER. ABOUT 3% (8,859) ARE OLDER ADULTS AGES 80 PLUS.

PART VI, LINE 2:
SOUTHERN REGIONAL NEEDS ASSESSMENTHEALTH NEEDS ARE GENERALLY ASSESSED THROUGH A STRATEGIC PLANNING PROCESS THAT LOOKS AT THE PRIMARY AND SECONDARY SERVICE AREAS FOR TRENDS IN AGE, INCOME, AND USE RATES FOR VARIOUS SERVICES AND ILLNESSES. COMMUNITY NEEDS ARE ALSO BASED ON A NEEDS ASSESSMENT RELATED TO VARIOUS PHYSICIAN SPECIALTIES, FOR EXAMPLE, THE SERVICE AREA HAS NEEDS FOR PRIMARY CARE PHYSICIANS. THE ORGANIZATION WORKS WITH LOCAL PHYSICIAN PRACTICES TO SHAPE THIS INFORMATION AND ENCOURAGE VARIOUS PHYSICIAN RECRUITMENT ACTIVITIES. HEALTH NEEDS ARE ALSO INDIRECTLY ASSESSED BY ANALYZING TRENDS FROM SERVICES OFFERED AT THE HOSPITAL AND THE HEALTH STATUS OF THOSE PATIENTS.LANDMARK & RHODE ISLAND NEEDS ASSESSMENTLANDMARK MEDICAL CENTER AND REHABILITATION HOSPITAL OF RHODE ISLAND PARTICIPATE IN THE HEALTH EQUITY ZONE STEERING COMMITTEE, A DOH FUNDED COMMUNITY HEALTH EFFORT COMPRISED OF STAKEHOLDERS AND CONSUMERS FROM NORTHERN RHODE ISLAND. THIS MONTHLY INITIATIVE IS HOSTED AT LANDMARK AND PROVIDES A FORUM FOR DISCUSSION ON COMMUNITY NEED AND OPPORTUNITIES FOR COLLABORATION.ENCINO & SHERMAN OAKS NEEDS ASSESSMENTTHE HEALTHCARE NEEDS OF THE COMMUNITIES SERVED BY ENCINO HOSPITAL AND SHERMAN OAKS HOSPITAL ARE ASSESSED IN A VARIETY OF WAYS INCLUDING FOCUS GROUPS, SURVEYS AND DATA ANALYSIS. TO BETTER UNDERSTAND THE HEALTH NEEDS IN THE HOSPITAL SERVICE AREA, NUMEROUS STATE AND COUNTY SOURCES WERE REVIEWED.MONTCLAIR NEEDS ASSESSMENTTHE HEALTHCARE NEEDS OF THE COMMUNITIES SERVED BY MONTCLAIR HOSPITAL MEDICAL CENTER ARE ASSESSED IN A VARIETY OF WAYS INCLUDING DIRECT INPUT FROM THE COMMUNITY DURING COMMUNITY EVENTS, COMMUNITY PHYSICIANS DURING OUTREACH OPPORTUNITIES, LOCAL POLICE AND FIRE DEPARTMENT AND CITY COUNCIL REPRESENTATION ON OUR BOARD OF DIRECTORS AND TELEPHONE SURVEYS OF PATIENTS AND FAMILIES.SUBURBAN NEEDS ASSESSMENTTHE HEALTHCARE NEEDS OF THE COMMUNITIES SERVED BY SUBURBAN COMMUNITY HOSPITAL WERE ASSESSED BY CONDUCTING SURVEYS, FOCUS GROUP AND INTERVIEWS WITH COMMUNITY LEADERS WITH SPECIAL KNOWLEDGE OF MEDICALLY UNDERSERVED POPULATIONS IN THE HOSPITAL SERVICE AREA.PAMPA NEEDS ASSESSMENTTHE HEALTH CARE NEEDS TO THE COMMUNITIES SERVED BY PRIME HEALTHCARE SERVICES - PAMPA LLC ARE ASSESSED IN A VARIETY OF WAYS INCLUDING QUESTIONNAIRES THAT ARE MAILED OUT TO THE ENTIRE COMMUNITY AND HANDED OUT AT THE FACILITY.GLENDORA NEEDS ASSESSMENTTHIS COMMUNITY HEALTH NEEDS ASSESSMENT WAS DIRECTED BY GLENDORA COMMUNITY HOSPITAL TO ADDRESS NEEDS FOR RESIDENTS IN THE NEARBY AREA, ACCOUNTING FOR NEARLY 80% OF ALL DISCHARGES FROM THE HOSPITAL IN 2018. ADDITIONAL DATA WAS EXTRACTED FROM VARIOUS COMMUNITY AND GOVERNMENT SOURCES WHICH INCLUDE AREAS OUTSIDE OF GCH'S PRIMARY SERVICE AREA, BUT CONTRIBUTE A SMALL PORTION OF THE HOSPITAL'S UTILIZATION.THE CHNA PROCESS INCORPORATES THREE MAJOR AREAS OF STUDY AND ANALYSIS. THESE INCLUDE:- QUANTITATIVE DATA REVIEW AND ANALYSIS, IN WHICH DATA PROVIDED BY NUMEROUS SOURCES ARE REVIEWED, ANALYZED, AND SUMMARIZED.THE SALIENT CONCLUSIONS DRAWN ARE REPORTED. THESE PROCESSES CONCENTRATE ON USE RATES, DISEASE INCIDENCE, POPULATION RATIOS, AND OTHER NUMERICALLY ORGANIZED DATA. IT SHOULD BE NOTED THAT THE VARIETY OF SOURCES USED INCLUDE MANY DEFINITIONS AND TIME PERIODS. OFTEN DATA PRESENTED MAY NOT RELATE TO THE SAME TIME PERIOD OR POPULATION AS OTHER PRESENTATIONS. SOURCES INCLUDED THE LOS ANGELES COUNTY DEPARTMENT OF HEALTH'S (LADPH) KEY INDICATORS OR HEALTH (KIH), LADPH'S EPIDEMIOLOGY REPORTS, US CENSUS BUREAU DATA, AND OTHER SOURCES FOR AREA-SPECIFIC DATA.- QUALITATIVE DATA IN THE FORM OF WRITTEN SURVEYS. THESE ARE DISTRIBUTED BY PARTICIPATING HOSPITALS, AND THE RESPONSES CONSOLIDATED INTO ONE REPORT, SO SERVICE-AREA-SPECIFIC ANALYSIS WAS NOT POSSIBLE. THE RESULTS ARE LARGELY INTERPRETED TO CROSS-CHECK THE RESPONSES FROM THE KEY INFORMANTS INVOLVED VIA FOCUS GROUPS AND PHONE INTERVIEWS. THE HIGHLY-DETAILED SURVEYS ALSO PRODUCED INFORMATION ABOUT HEALTH STATUS OF THE RESPONDENTS, AS WELL AS THEIR VIEWS ON HEALTH NEEDS IN THE OVERALL AREA.- REPRESENTATIVES OF AREA HEALTH AGENCIES, SOCIAL SERVICE PROVIDERS, AND LOCAL GOVERNMENT ORGANIZATIONS (COLLECTIVELY, KEY INFORMANTS) WERE INVITED TO SEVERAL FOCUS GROUP SESSIONS TO OFFER THEIR OPINIONS AS TO COMMUNITY HEALTH NEEDS. THOSE KEY INFORMANTS WHO COULD NOT MAKE ANY OF THE SESSIONS WERE INTERVIEWED BY PHONE AND THEIR RESPONSES INCORPORATED INTO THE RESPONSES GENERATED BY THE FOCUS GROUPS.EACH METHODOLOGY GENERATES USEFUL DATA IN DIFFERENT WAYS, AND THE CONCLUSIONS DRAWN ADDRESS EACH METHODOLOGY AS APPROPRIATE. IT SHOULD BE NOTED THAT THERE ARE THREE DIFFERENT SERVICE AREAS ADDRESSED IN THIS ANALYSISLA PALMA NEEDS ASSESSMENTIN ACCORDANCE WITH REQUIREMENTS UNDER THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (ACA) ENACTED ON MARCH 23, 2010, LA PALMA INTERCOMMUNITY HOSPITAL (LPIH) HAS PREPARED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), WHICH NONPROFIT HOSPITAL ORGANIZATIONS MUST PREPARE EVERY THREE YEARS TO SATISFY REQUIREMENTS UNDER SECTION 501(C) 3 OF THE INTERNAL REVENUE CODE. AS PART OF THE CHNA, EACH HOSPITAL IS REQUIRED TO COLLECT INPUT FROM DESIGNATED INDIVIDUALS IN THE COMMUNITY, INCLUDING PUBLIC HEALTH EXPERTS, AS WELL AS MEMBERS, REPRESENTATIVES OR LEADERS OF LOW-INCOME, MINORITY, AND MEDICALLY UNDERSERVED POPULATIONS AND INDIVIDUALS WITH CHRONIC CONDITIONS.A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS DIRECTED BY LA PALMA INTERCOMMUNITY HOSPITAL (LPIH) FOR AROUND 1.2 MILLION RESIDENTS OF THE HOSPITAL SERVICE AREA LOCATED IN A TOTAL OF 7 ZIP CODES (INCORPORATED AND UNINCORPORATED CITIES/COMMUNITIES), MOSTLY IN NORTHWEST ORANGE AND SOUTHEASTERN LOS ANGELES COUNTIES. THIS AREA IS MOSTLY BUILT OUT, WITH MINIMAL UNDEVELOPED PORTIONS. LPIH PROVIDES SERVICES TO THIS GEOGRAPHICALLY, ECONOMICALLY, AND ETHNICALLY DIVERSE REGION.LA PALMA INTERCOMMUNITY HOSPITAL CONTRACTED WITH KEYGROUP (KEYGROUP) TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT THAT COMPLIED WITH CALIFORNIA'S SENATE BILL 697 (SB 697) AND ALSO MEETS REQUIREMENTS UNDER THE PATIENT PROTECTION AND AFFORDABLE CARE ACT. THE PROCESS AND THE OUTCOME OF THE CHNA ARE DESCRIBED IN THIS REPORT. TO BETTER UNDERSTAND THE HEALTH NEEDS IN THE HOSPITAL SERVICE AREA, KEYGROUP REVIEWED NUMEROUS STATE AND COUNTY SOURCES. A LOCAL LITERATURE REVIEW WAS CONDUCTED, AND COMMUNITY ASSETS AND RESOURCES WERE DOCUMENTED.KEYGROUP'S RESEARCH ELICITED 24 HEALTH NEEDS AS STATED BY FOCUS GROUPS, KEY INFORMANT INTERVIEWS AND SURVEYS. IN ORDER TO CUT DOWN THE LIST OF HEALTH NEEDS, A MULTI-VOTING APPROACH WAS EXECUTED WITH 34 PARTICIPANTS IN THE PRIORITIZATION MEETING. THE PARTICIPANTS WERE INSTRUCTED TO IDENTIFY AND MARK THE MOST IMPORTANT HEALTH NEEDS. THIS PROCESS STREAMLINED THE LIST TO 15 TOP HEALTH NEEDS. IN THE SECOND ROUND OF THE MULTI-VOTING PROCESS, THE PARTICIPANTS WERE ASKED TO RANK THESE HEALTH NEEDS FROM 10 (BEING MOST IMPORTANT) TO 6 (BEING LEAST IMPORTANT). USING THESE RANKINGS, EACH HEALTH NEED WAS ASSIGNED A POINT VALUE. AFTER THE RANKING PROCESS, ONLY SIX NEEDS SCORED OVER 35 POINTS, SO THE TOP SIX WERE SELECTED AS PRIMARY AREAS OF CONCENTRATION. THESE WERE SUBMITTED TO THE STEERING COMMITTEE FOR FINAL PRIORITIZATION IN TERMS OF LPIH'S RESPONSE.COSHOCTON NEEDS ASSESSMENTTHE HEALTHCARE NEEDS OF THE COMMUNITIES SERVED BY COSHOCTON REGIONAL MEDICAL CENTER (CRMC) WERE ASSESSED BY CONDUCTING SURVEYS WITH MEMBERS OF THE COMMUNITY WHO HAVE A UNIQUE AND SPECIALIZED UNDERSTANDING OF THE NEEDS OF THE POPULATION. CRMC TARGETED THOSE WITH EXPERIENCE IN PUBLIC HEALTH, THE UNINSURED POPULATION, LOW-INCOME POPULATIONS, MINORITY POPULATIONS AND THOSE WHO ARE STRUGGLING WITH CHRONIC DISEASES. CRMC ALSO COLLABORATES WITH LOCAL HEALTH AND SOCIAL SERVICES GROUPS WHOSE REPRESENTATIVES PROVIDE CRITICAL INSIGHT INTO THE FACTORS THAT AFFECT THE HEALTH OF THE VARIOUS POPULATION SEGMENTS.

PART VI, LINE 3:
"IN ORDER TO ENSURE THAT PATIENTS ARE AWARE OF THE EXISTENCE OF THE FINANCIAL ASSISTANCE POLICY, THE HOSPITAL SHALL WIDELY DISSEMINATE THE EXISTENCE AND TERMS OF THIS POLICY THROUGHOUT ITS SERVICE AREA. IN ADDITION TO OTHER APPROPRIATE EFFORTS TO INFORM THE COMMUNITY ABOUT THE POLICY IN A WAY TARGETED TO REACH COMMUNITY MEMBERS MOST LIKELY TO NEED FINANCIAL ASSISTANCE, THE FOLLOWING ACTIONS SHALL BE TAKEN:A. WRITTEN NOTICE TO ALL PATIENTSEACH PATIENT WHO IS SEEN AT A PRIME HEALTHCARE FOUNDATION FACILITY, WHETHER ADMITTED OR NOT, SHALL RECEIVE THE PLAIN LANGUAGE SUMMARY. THE NOTICE SHALL BE PROVIDED IN NON-ENGLISH LANGUAGES SPOKEN BY A SUBSTANTIAL NUMBER OF THE PATIENTS SERVED BY THE HOSPITAL.B. POSTING OF NOTICESTHE NOTICE OF HOSPITAL FINANCIAL AID"" SHALL BE CLEARLY AND CONSPICUOUSLY POSTED IN LOCATIONS THAT ARE VISIBLE TO THE PATIENTS IN THE FOLLOWING AREAS: (1) EMERGENCY DEPARTMENT; (2) BILLING OFFICE; (3) ADMISSIONS OFFICE; (4) OTHER OUTPATIENT SETTINGS; AND (5) THE HOSPITAL'S WEBSITE. THE NOTICES SHALL BE PROVIDED IN NON-ENGLISH LANGUAGES SPOKEN BY A SUBSTANTIAL NUMBER OF THE PATIENTS SERVED BY THE HOSPITAL.C. NOTICES TO ACCOMPANY BILLING STATEMENTS EVERY POST-DISCHARGE STATEMENT SHALL INCLUDE A COPY OF THE NOTICE REGARDING THE CHARITY CARE & DISCOUNTED PAYMENT PROGRAM PROVIDED BY PRIME HEALTHCARE FOUNDATION. EACH BILL THAT IS SENT TO A PATIENT WHO HAS NOT PROVIDED PROOF OF COVERAGE BY A THIRD PARTY AT THE TIME CARE IS PROVIDED OR UPON DISCHARGE MUST INCLUDE A STATEMENT OF CHARGES FOR SERVICES RENDERED BY THE HOSPITAL.D. AVAILABILITY OF FINANCIAL ASSISTANCE DOCUMENTSTHE HOSPITAL SHALL POST A COPY OF ITS FINANCIAL ASSISTANCE POLICY, THE PLAIN LANGUAGE SUMMARY, AND THE FINANCIAL ASSISTANCE APPLICATION ON ITS WEBSITE AND MAKE ALL SUCH DOCUMENTS AVAILABLE FOR FREE DOWNLOAD. SUCH DOCUMENTS SHALL BE AVAILABLE IN THE EMERGENCY ROOM AND ADMISSIONS OFFICE AND BY MAIL UPON REQUEST. THE DOCUMENTS SHALL BE PROVIDED IN NON-ENGLISH LANGUAGES SPOKEN BY A SUBSTANTIAL NUMBER OF THE PATIENTS SERVED BY THE HOSPITAL.E. ACCESSIBILITY TO LIMITED ENGLISH PROFICIENT INDIVIDUALSTHE HOSPITAL SHALL MAKE TRANSLATIONS OF THIS POLICY, THE PLAIN LANGUAGE SUMMARY, AND THE FINANCIAL ASSISTANCE APPLICATION AVAILABLE IN ANY LANGUAGE THAT IS THE PRIMARY LANGUAGE OF THE LESSER OF ONE THOUSAND (1,000)INDIVIDUALS OR FIVE PERCENT (5%) OF THE POPULATION OF THE COMMUNITIES SERVED BY THE HOSPITAL."

SCHEDULE H, PART VI, LINE 2 - HUNTINGTON BEACH NEEDS ASSESSMENT
COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS DIRECTED BY HUNTINGTON BEACH HOSPITAL (HBH) FOR AROUND 478,000 RESIDENTS OF THE HOSPITAL SERVICE AREA LOCATED IN A TOTAL OF 9 ZIP CODES (INCORPORATED AND UNINCORPORATED CITIES/COMMUNITIES), MOSTLY IN SOUTHWEST ORANGE COUNTY. THIS AREA IS MOSTLY BUILT OUT, WITH MINIMAL UNDEVELOPED PORTIONS. HBH PROVIDES SERVICES TO THIS GEOGRAPHICALLY, ECONOMICALLY, AND ETHNICALLY DIVERSE REGION.HUNTINGTON BEACH HOSPITAL CONTRACTED WITH KEYGROUP (KEYGROUP) TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT THAT COMPLIED WITH CALIFORNIA'S SENATE BILL 697 (SB 697) AND ALSO MEETS NEW REQUIREMENTS UNDER THE PATIENT PROTECTION AND AFFORDABLE CARE ACT. THE PROCESS AND THE OUTCOME OF THE CHNA ARE DESCRIBED IN THIS REPORT. TO BETTER UNDERSTAND THE HEALTH NEEDS IN THE HOSPITAL SERVICE AREA, KEYGROUP REVIEWED NUMEROUS STATE AND COUNTY SOURCES. A LOCAL LITERATURE REVIEW WAS CONDUCTED, AND COMMUNITY ASSETS AND RESOURCES WERE DOCUMENTED. HEALTH PROVIDERS IN ORANGE COUNTY HAVE BEEN DEVELOPING PROGRAMS TO ADDRESS HEALTH NEEDS COUNTYWIDE, AND A SUMMARY OF THIS PROCESS IS CONTAINED IN THE ORANGE COUNTY HEALTH IMPROVEMENT PLAN 20142016 (OCHIP), ALONG WITH VARIOUS REPORTS THAT PROVIDED INPUT TO THAT DOCUMENT. HBH PLANS TO PARTICIPATE IN THE SOLUTIONS PROPOSED, AND TO PROVIDE HOSPITAL SPECIFIC SERVICES MEETING SOME OF THE NEEDS OUTLINED.KEYGROUP'S RESEARCH ELICITED 34 HEALTH NEEDS AS STATED BY FOCUS GROUPS, KEY INFORMANT INTERVIEWS AND SURVEYS. IN ORDER TO CUT DOWN THE LIST OF 34 HEALTH NEEDS, A MULTIVOTING APPROACH WAS EXECUTED BY A FOCUS GROUP WITH 10 PARTICIPANTS IN THE PRIORITIZATION MEETING.THE PARTICIPANTS WERE INSTRUCTED TO IDENTIFY AND MARK THE MOST IMPORTANT HEALTH NEEDS. THIS PROCESS STREAMLINED THE LIST TO 7 TOP HEALTH NEEDS.

SCHEDULE H, PART VI, LINE 4 - PAMPA COMMUNITY INFORMATION
PAMPA IS CONSIDERED A RURAL SERVICE AREA SERVICING ALL SURROUNDING COUNTIES FOR 60+ MILES. PAMPA IS THE SECOND LARGEST CITY IN THE TEXAS PANHANDLE WITH PAMPA ALONE HAVING A POPULATION OF OVER 18,000 PEOPLE AND A MEDIAN AGE OF 36. PAMPA AND ITS SURROUNDING AREAS HAVE A WIDE ARRAY OF CULTURAL DIVERSITY WITH MANY HOMES HAVING 4+ HOUSEHOLD MEMBERS. A MAJORITY OF COMMUNITY MEMBERS ARE MIDDLE TO LOW INCOME AND EVEN BELOW POVERTY LEVEL.THE CHNA WAS CONDUCTED BY THE HOSPITAL DURING 2018 ON BEHALF OF THE APPROXIMATELY 83,706 (2017 US CENSUS) RESIDENTS OF ARMSTRONG, CARSON, COLLINGSWORTH, DONLEY, GRAY, HEMPHILL, HUTCHINSON, LIPSCOMB, OCHILTREE, ROBERTS AND WHEELER COUNTIES LOCATED IN THE PANHANDLE AREA OF TEXAS.THE HOSPITAL'S SERVICE AREA INCLUDES A RURAL AREA WHICH COVERS ROUGHLY 10,083 SQUARE MILES, WITH THE LOCAL ECONOMY AND SURROUNDING AREAS FOCUSED ON HEALTHCARE, AGRICULTURE, OIL AND GAS, TOURISM, AND RETAIL ACTIVITIES. GRAY COUNTY AND ITS POPULATION OF 22,962 REPRESENTS APPROXIMATELY 27% OF THE TOTAL SERVICE AREA POPULATION. MEDIAN AGE IN THE SERVICE AREA IS 38.3 YEARS. THE MEDIAN AGE FOR THE STATE OF TEXAS IS 34.3 YEARS. PERSONS FROM AGE 18 TO 64 REPRESENT THE LARGEST POPULATION RANGE (57.94%) FOR THE SERVICE AREA. THE YOUNGEST AGE RANGE IS 0 TO 4 YEARS, AND THIS RANGE COMPRISED 7.08% OF THE SERVICE AREA.

PART VI, LINE 4:
"SOUTHERN REGIONAL MEDICAL CENTER:THE COMMUNITY SERVED BY SOUTHERN REGIONAL MEDICAL CENTER (SRMC), OR THE SRMC PRIMARY SERVICE AREA (PSA), IS DEFINED AS THE AREA FROM WHICH 75% OF SRMC'S INPATIENT ADMISSIONS ORIGINATE. THIS DEFINITION IS CONSISTENT WITH STARK PHYSICIAN RECRUITMENT REGULATIONS. AT THE ZIP CODE LEVEL, SRMC'S PSA ENCOMPASSES TWELVE (12) ZIP CODES IN CLAYTON, SOUTH FULTON, SOUTH DEKALB, AND HENRY COUNTIES. AT THE COUNTY LEVEL, SRMC'S PRIMARY SERVICE AREA INCLUDES CLAYTON, FULTON, HENRY, AND DEKALB COUNTIES. DEMOGRAPHIC INFORMATION FOR THE SRMC PSA IS PROVIDED AT THE ZIP CODE LEVEL. WHILE THE GREATEST PERCENTAGE OF THE SRMC SERVICE AREA POPULATION COME FROM CLAYTON COUNTY, THE SRMC SERVICE AREA ALSO ENCOMPASSES 5 ZIP CODES FROM FULTON COUNTY (30349), HENRY COUNTY (30228, 30281, 30253), AND DEKALB COUNTY (30294).IN THE PAST DECADE, THE SRMC PSA COUNTIES AND PSA ZIP CODES ALSO EXPERIENCED SIGNIFICANT POPULATION GROWTH. BETWEEN 2013 AND 2016, THE POPULATION OF THE SRMC PSA COUNTIES POPULATION GREW BY 13,572 PEOPLE TOTAL WITH AN AVERAGE ANNUAL GROWTH RATE OF 2.7%.THE POPULATION IN CLAYTON COUNTY AND SURROUNDING ZIP CODES FOR THE SRMC SERVICE AREA IS LESS EDUCATED, MORE DIVERSE, WITH LOWER INCOME EARNINGS THAN THE AVERAGE U.S. POPULATION. THE SERVICE AREA POPULATION RANKS MOST DIVERSE IN THE STATE OF GEORGIA WITH GREATER NON-ENGLISH SPEAKING POPULATIONS.LANDMARK MEDICAL CENTER:LANDMARK MEDICAL CENTER SERVES THE FOLLOWING ZIP CODES, PRIMARILY IN PROVIDENCE COUNTY, RHODE ISLAND: 02895 WOONSOCKET, 02896 NORTH SMITHFIELD, 02917 SMITHFIELD, 02876 BURRILLVILLE, 02830 HARRISVILLE, 02859 PASCOAG, 02019 BELLINGHAM, MA, 02703 ATTLEBORO, MA, 02760 NORTH ATTLEBORO, MA, 01516 DOUGLAS, MA, 02038 FRANKLIN, MA, 01756 MENDON, MA, 02828 GREENVILLE, 02865 LINCOLN, 02838 MANVILLE, 02864 CUMBERLAND, 02829 GLOCESTER, 02814 CHEPACHET, 01504 BLACKSTONE, MA, 01529 MILLVILLE, MA, 02671 NORTH ATTLEBORO, MA, 02762 PLAINVILLE, MA, 02035 FOXBORO, MA, 02048 MANSFIELD, MA, 01569 UXBRIDGE, MA, AND 02093 WRENTHAM, MA.THE POPULATION ACROSS LANDMARK MEDICAL CENTER'S SERVICE AREA IS PRIMARILY WHITE WITH LESS THAN 10% OF RESIDENTS IDENTIFYING WITH ANOTHER RACE OR ETHNICITY. THE MEDIAN AGE OF RESIDENTS IS HIGHER THAN THE STATE, AS IS THE MEDIAN HOUSEHOLD INCOME. IN AGGREGATE, BLACK/AFRICAN AMERICAN AND HISPANIC/LATINO RESIDENTS HAVE A LOWER MEDIAN INCOME THAN ASIAN OR WHITE RESIDENTS.REHABILITATION HOSPITAL OF RHODE ISLAND:APPROXIMATELY 325 PATIENTS PER YEAR RELY ON INPATIENT CARE AT REHABILITATION HOSPITAL OF RHODE ISLAND (RHRI). REFERRAL PATTERNS INCLUDE STATEWIDE AND OTHER NEW ENGLAND STATES SUCH AS MASSACHUSETTS AND MAINE. HOWEVER, THE PREDOMINANCE OF ADMISSIONS COME FROM THE NORTHERN RHODE ISLAND COMMUNITY. OUTPATIENT THERAPY SERVES APPROXIMATELY 3,338 PATIENTS PER YEAR AND DRAWS MOSTLY FROM NORTHERN RHODE ISLAND AND NEARBY MASSACHUSETTS.SUBURBAN COMMUNITY HOSPITAL:SUBURBAN COMMUNITY HOSPITAL HAS BEEN PART OF THE CENTRAL MONTGOMERY COUNTY COMMUNITY SINCE 1944. THE HOSPITAL'S SERVICE AREA IS DEFINED AS THE ZIP CODES WHERE 80% OF THE HOSPITAL'S PATIENTS ORIGINATE IN THE AREA SURROUNDING EAST NORRITON, PA THAT INCLUDE: (19401) NORRISTOWN, (19403) NORRISTOWN, AUDUBON, EAST AND WEST NORRITON, JEFFERSONVILLE, TROOPER, (19422) BLUE BELL, (19428) CONSHOHOCKEN, (19462) PLYMOUTH MEETING, (19405) BRIDGEPORT, (19406) KING OF PRUSSIA AND (19426) COLLEGEVILLE.THE 2015 POPULATION OF THE SUBURBAN COMMUNITY HOSPITAL SERVICE AREA IS 205,910. IT WAS 203,946 IN 2013 AND IS PREDICTED TO INCREASE TO 210,909 IN 2020.THE LARGEST PROPORTION OF THE POPULATION IN THE SUBURBAN COMMUNITY HOSPITAL SERVICE AREA IS THE 18-44 YEAR OLDS, WHO MAKE UP MORE THAN ONE-THIRD (36%) OF THE POPULATION (74,711). THE PROPORTION OF THIS AGE GROUP, AS WELL AS CHILDREN AGED 0-17 (22%; REPRESENTING 44,431 CHILDREN) IS PREDICTED TO REMAIN STEADY INTO 2020.THE MAJORITY OF SUBURBAN COMMUNITY HOSPITAL SERVICE AREA RESIDENTS ARE WHITE (70%), 11% ARE BLACK, 9% ARE LATINO, AND 8% ARE ASIAN. THIS PATTERN IS SLIGHTLY MORE RACIALLY AND ETHNICALLY DIVERSE THAN THE POPULATION OF MONTGOMERY COUNTY AS A WHOLE, WHERE 77% OF RESIDENTS ARE WHITE, 9% ARE BLACK, 5% ARE LATINO, AND 7% ARE ASIAN.GLENDORA COMMUNITY HOSPITAL:THE CHNA PROCESS INVOLVES ANALYSIS OF SEVERAL AREAS THAT ARE GERMANE TO THE PROVISION OF SERVICES TO THE GCH ""COMMUNITY"". THE MOST DIRECTLY APPLICABLE IS THE AREA IMMEDIATELY SURROUNDING THE HOSPITAL: THE CITIES OF AZUSA (ZIP CODE 91702), GLENDORA (91740), BALDWIN PARK (91706), DUARTE (91010), AND ONE POMONA ZIP CODE (91768) ACCOUNT FOR 45% OF ALL DISCHARGES IN 2017. THESE ZIP CODES CONSTITUTE THE PRIMARY SERVICE AREA (PSA). WHILE THE ZIP CODES LISTED IN THE PSA ACCOUNT FOR ALMOST HALF OF ALL DISCHARGES, A SECOND GLENDORA ZIP CODE (91741) AND SURROUNDING CITIES INCLUDING COVINA (91722), EL MONTE (91732), POMONA (91766), SAN DIMAS (91773) AND WEST COVINA (91790) ACCOUNT FOR ANOTHER 34%. THESE ARE CLASSIFIED AS THE SECONDARY SERVICE AREA (SSA). THE TWO SERVICE AREAS TOGETHER ACCOUNT FOR 79% OF ALL DISCHARGES FROM GCH, AND TOGETHER THEY ARE NAMED THE TOTAL SERVICE AREA (TSA). NO ZIP CODES OUTSIDE OF THESE AREAS CONTRIBUTED MORE THAN 1% OF TOTAL DISCHARGES.LA PALMA INTERCOMMUNITY HOSPITAL:LA PALMA INTERCOMMUNITY HOSPITAL TOTAL SERVICE AREA (TSA) COVERED A POPULATION OF APPROXIMATELY 891,000 IN 2015, ACCORDING TO US CENSUS ESTIMATES. OF THAT TOTAL ROUGHLY 40% COMES FROM THE NEARBY AREA DEFINED AS THE PRIMARY SERVICE AREA (PSA), WITH THE REMAINDER FROM SCATTERED ZIP CODES DEFINED AS THE SECONDARY SERVICE AREA (SSA).DATA IS PROVIDED FOR EACH ZIP CODE IN THE PSA AND SSA AS OF 2015. IT IS CONSOLIDATED FOR THE TSA, AND COMPARISON FIGURES ARE PROVIDED FOR ORANGE COUNTY, THE STATE OF CALIFORNIA, AND THE UNITED STATES.HUNTINGTON BEACH HOSPITAL:HUNTINGTON BEACH HOSPITAL TOTAL SERVICE AREA (TSA) COVERS A POPULATION OF APPROXIMATELY 475,000 IN 2018 (USA CENSUS ESTIMATE). OF THIS TOTAL ROUGHLY 42% ARE IN THE PSA AND THE REMAINDER ARE IN THE SSA.DATA IS PROVIDED FOR EACH ZIP CODE IN THE PSA AND SSA. IT IS CONSOLIDATED FOR THE TSA, AND COMPARISON FIGURES ARE PROVIDED FOR ORANGE COUNTY, THE STATE OF CALIFORNIA, AND THE UNITED STATES. SHERMAN OAKS:SHERMAN OAKS HOSPITAL (SOH) SERVICE AREA COVERS 11 ZIP CODES IN THE SAN FERNANDO VALLEY AREA OF NORTHERN LOS ANGELES COUNTY, AND IS HOME TO MORE THAN 278,000 RESIDENTS. DATA GATHERED FROM THE 2010-2017 U.S. CENSUS AMERICAN COMMUNITY SURVEY ESTIMATES SHOW THAT MALE AND FEMALE POPULATIONS ARE SPLIT ALMOST EQUALLY. THE HOSPITAL'S SERVICE AREA SPANS CITIES, COMMUNITIES, AND UNINCORPORATED AREAS IN THE SAN FERNANDO VALLEY AND LOS ANGELES COUNTY. THE SAN FERNANDO VALLEY IS IN THE SERVICE PLANNING AREA 2 (SPA 2) OF LOS ANGELES COUNTY. WHILE DEFINITIONS CAN VARY REGARDING SERVICE AREAS, OVER HALF OF ALL DISCHARGES FROM SOH ORIGINATED FROM ONLY 11 ZIP CODES. CONCENTRATED ALONG THE SOUTHERN EDGE OF THE SAN FERNANDO VALLEY, THEY INCLUDE: ENCINO (91436) NORTH HOLLYWOOD (91605, 91606), PANORAMA CITY (91402), SHERMAN OAKS (91403, 91423), STUDIO CITY (91604), VALLEY VILLAGE (91607), AND VAN NUYS (91401, 91403, 91405, 91406, 91411). THE SOH PRIMARY SERVICE AREA SHOWS THE GREATEST CONCENTRATION OF RESIDENTS IN THE WORKING AGES (25-64) AND LOWER PROPORTIONS OF RESIDENTS IN OTHER GROUPS. LOW INCOME LEVELS CREATE OBSTACLES TO GAINING ACCESS TO MEDICAL SERVICES, PURCHASING HEALTHY FOODS, AND OTHER NECESSITIES. JUST OVER 6% OF SHERMAN OAKS HOSPITAL SERVICE AREA SERVICE AREA EARNS LESS THAN $10,000. THE ETHNIC COMPOSITION OF THE SHERMAN OAKS HOSPITAL PRIMARY SERVICE AREA IS LARGELY WHITE (49%) FOLLOWED BY HISPANIC/LATINO (37%), AFRICAN-AMERICAN (4%) AND TWO OR MORE RACES (3%). ALL OTHER GROUPS REPRESENT LESS THAN ONE PERCENT OF ALL RESIDENTS. EDUCATION PLAYS A VERY SIGNIFICANT ROLE IN ALL ASPECTS OF LIFE, INCLUDING MAINTAINING A HEALTHY LIFESTYLE. IN THE SHERMAN OAKS HOSPITAL PRIMARY SERVICE AREA, THE HIGHEST PERCENTAGE OF ADULTS 25 YEARS OR OLDER ARE THOSE WITH A BACHELOR'S DEGREE."

SCHEDULE H, PART VI, LINE 4 - MONTCLAIR COMMUNITY INFORMATION
SAN BERNARDINO COUNTY WAS THE PRIMARY FOCUS OF THE CHNA DUE TO THE SERVICE AREA OF MONTCLAIR HOSPITAL MEDICAL CENTER. USED AS THE STUDY AREA, SAN BERNARDINO COUNTY PROVIDED 70% OF INPATIENT DISCHARGES. THE COMMUNITY INCLUDES MEDICALLY UNDERSERVED, LOW INCOME AND MINORITY POPULATIONS WHO LIVE IN THE GEOGRAPHIC AREAS FROM WHICH MONTCLAIR HOSPITAL MEDICAL CENTER DRAWS THEIR PATIENTS. ALL PATIENTS WERE USED TO DETERMINE THE SERVICE AREA WITHOUT REGARD TO INSURANCE COVERAGE OR ELIGIBILITY FOR FINANCIAL ASSISTANCE UNDER MONTCLAIR HOSPITAL MEDICAL CENTER'S FINANCIAL ASSISTANCE POLICY.THE IMPLEMENTATION PLAN WILL FOCUS ON THE SOUTHWEST CORNER OF SAN BERNARDINO COUNTY WHERE THE MAJORITY OF PATIENTS AND POPULATION IS LOCATED. THE COUNTY OF SAN BERNARDINO IS THE LARGEST COUNTY IN THE U.S. BY AREA. IT IS CLOSE TO THE SIZE OF WEST VIRGINIA AND LARGER THAN EACH OF THE NINE SMALLEST STATES. IT COVERS 20,105 SQUARE MILES. IT IS THE FIFTH MOST POPULOUS COUNTY IN CA AND THE 14TH MOST POPULOUS IN THE U.S. HOWEVER VAST PARTS OF THE COUNTY CONTAIN THINLY POPULATED MOUNTAINS AND DESERTS. ALTHOUGH THE ENTIRE COUNTY'S HEALTH WILL BE ASSESSED, IMPROVEMENT EFFORTS WILL BE FOCUSED ON THE SOUTHWEST PORTION OF THE COUNTY.

SCHEDULE H, PART VI, LINE 4 - COSHOCTON COMMUNITY INFORMATION
THE PRIMARY SERVICE AREA OF COSHOCTON REGIONAL HEALTH CENTER IS DEFINED AS THE COUNTY OF COSHOCTON, ENCOMPASSING A POPULATION OF 36,569 PEOPLE IN THE EASTERN CENTRAL SECTION OF OHIO; 91.86% OF THE HOSPITAL'S DISCHARGED PATIENTS ARE RESIDENTS OF COSHOCTON COUNTY. COSHOCTON COUNTY IS A RURAL COMMUNITY WHOSE POPULATION OF 36,569 (U.S. CENSUS BUREAU, 2015 ESTIMATE) IS DISTRIBUTED WITHIN A LAND MASS OF 564.1 SQUARE MILES.MEDIAN INCOME IS THE ACCEPTED MEASUREMENT OF HOUSEHOLD WEALTH USED TO MAKE COMPARISONS BETWEEN GEOGRAPHIC REGIONS. THE MEDIAN IS DETERMINED BY PLACING ALL EARNINGS IN VALUE ORDER AND FINDING THE EXACT MIDDLE NUMBER. THIS DIVIDES THE HOUSEHOLDS INTO TWO DISTINCT SECTIONS, WITH EXACTLY HALF FALLING BELOW THE MEDIAN AND EXACTLY HALF FALLING ABOVE. THIS IS CONSIDERED A MORE ACCURATE MEASUREMENT THAN AN AVERAGE, SINCE THE MEDIAN IS NOT STATISTICALLY AFFECTED BY DRAMATICALLY HIGH OR LOW INCOME LEVELS. COSHOCTON COUNTY CONTINUES TO LAG BEHIND BOTH OHIO AND THE UNITED STATES IN TERMS OF ITS MEDIAN INCOME LEVEL. ACCORDING TO THE MOST RECENT AVAILABLE DATA, COSHOCTON COUNTY FELL SHORT OF OHIO'S MEDIAN INCOME OF $49,349 AND THE NATIONAL MEDIAN INCOME OF $53,657 WITH A MEDIAN INCOME OF $41,547 IN 2014.