4A (Expenses $ 166769394 including grants of $ 183698) (Revenue $ 194342686)
HOSPITAL SERVICES: INPATIENT, OUTPATIENT, AND 24/7 EMERGENCY DEPARTMENT SERVICES: CVMC HAS 122 LICENSED BEDS TO PROVIDE FOR A FULL SPECTRUM OF INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES. 21,598 INPATIENT DAYS, MORE THAN 250,000 OUTPATIENT PROCEDURES, AND 25,530 EMERGENCY ROOM VISITS WERE RECORDED DURING FISCAL YEAR 2022. OUTPATIENT ANCILLARY SERVICE UNITS MAKE UP THE MAJORITY OF SERVICE VOLUME, INCLUDING 35,016 RADIOLOGY PROCEDURES, 483,831 LAB TESTS, 15,640 CARDIOLOGY TESTS, AND 150,221 UNITS OF PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY. EMERGENCY DEPARTMENT: THE ER IS OPEN 24 HOURS A DAY 365 DAYS A YEAR. THE NUMBER OF PATIENTS SEEN IN THE ER IN FISCAL YEAR 2022 WAS 25,530. THE CANCER TREATMENT CENTER PROVIDED 4,292 ONCOLOGY AND RADIATION TREATMENTS. THE HOSPITAL ALSO HAS BEEN ACTIVE IN ITS OUTREACH TO CENTRAL VERMONT'S UNINSURED AND UNDER INSURED RESIDENTS.

4B (Expenses $ 64956301 including grants of $ 0) (Revenue $ 43931893)
MEDICAL GROUP PRACTICES: AT THE END OF THE FISCAL YEAR WE HAD 28 PRIMARY CARE, INFIRMARY, AND SPECIALTY PRACTICES. THIS INCLUDED 10 PRIMARY AND FAMILY CARE CLINICS, 1 PEDIATRIC CLINIC, AS WELL AS SPECIALTY CLINICS FOR UROLOGY, CARDIOLOGY, PODIATRY, RHEUMATOLOGY, ENT, ENDOCRINOLOGY, ORTHOPAEDICS, PSYCHOLOGY, AND OBSTETRICS/ GYNECOLOGY. THERE WERE A TOTAL OF 543,965 PRACTICE VISITS DURING FISCAL YEAR 2022.

4C (Expenses $ 22602415 including grants of $ 0) (Revenue $ 18694814)
"WOODRIDGE REHAB & NURSING IS A MEDICARE-CERTIFIED 153-LICENSED BED SKILLED NURSING FACILITY LOCATED ON THE CAMPUS OF CENTRAL VERMONT MEDICAL CENTER. APPROXIMATELY TWO-THIRDS OF THE FACILITIES BEDS ARE DEDICATED TO LONG TERM CARE, INCLUDING PALLIATIVE CARE/END OF LIFE CARE AND THE OTHER ONE-THIRD PROVIDE SHORT TERM REHABILITATION THERAPY AND POST-ACUTE CARE FOR A GREAT VARIETY OF MEDICAL CARE CATEGORIES, INCLUDING PAIN MANAGEMENT AND WOUND CARE. THE FACILITY PROVIDES ""PERSON-CENTERED"", ROUND THE CLOCK NURSING CARE AND SOCIAL SERVICES SUPPORT COMPLEMENTING DAILY, ROBUST ACTIVITIES PROGRAMS, FINE DINING AND HAS A FULL COMPLIMENT OF SUPPORT SERVICES INCLUDING HOUSEKEEPING/LAUNDRY, MAINTENANCE AND TRANSPORTATION. MANY OTHER AMENITIES ARE AVAILABLE TO FACILITY RESIDENTS."

PART V, SECTION B, LINE 3E
IN ACCORDANCE WITH REQUIREMENTS SET FORTH IN THE AFFORDABLE CARE ACT AND IN SUPPORT OF ITS COMMUNITY MISSION, CENTRAL VERMONT MEDICAL CENTER (CVMC) IS UNDERTAKING A FY2022/TAX YEAR 2021 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND SUPPORTING A THREE-YEAR IMPLEMENTATION PLAN. THE FY2022 CHNA IS A CONTINUATION OF PAST ASSESSMENTS CONDUCTED SINCE ITS INCEPTION IN 2013. THE FY2022 CHNA SEEKS TO EXPAND UPON PAST ASSESSMENTS TO STRENGTHEN COMMUNITY AND POPULATION HEALTH MANAGEMENT STRATEGIES, WITH A FOCUS ON SOCIAL DETERMINANTS OF HEALTH AND HEALTH EQUITY, WHICH IS CONSISTENT WITH PRIOR ASSESSMENTS. THE FY2022 CHNA FOCUSES ON CVMC'S PRIMARY SERVICE AREA IN WASHINGTON COUNTY. THE FY2022 CHNA IS BEING CONDUCTED IN COLLABORATION WITH THRIVE, CENTRAL VERMONT'S ACCOUNTABLE COMMUNITY FOR HEALTH. CVMC HAS ALSO CONTRACTED WITH COMMUNITY RESEARCH CONSULTING (CRC) WHO ASSISTED IN CONDUCTING THE FY2022 CHNA AND OVERSEES THE FY2022 CHNA RESEARCH AND REPORTING. REPRESENTATIVES FROM CVMC, THRIVE, AND COMMUNITY ACTION NETWORK (CAN) REVIEWED THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FINDINGS IN CONJUNCTION WITH THE VERMONT DEPARTMENT OF HEALTH 2019-23 STATE HEALTH IMPROVEMENT PLAN (SHIP) TO DETERMINE THE MOST PRESSING NEEDS IMPACTING RESIDENTS ACROSS WASHINGTON COUNTY AND THE CVMC SERVICE AREA. THE FOLLOWING CRITERIA WERE APPLIED TO DETERMINE PRIORITIES ON WHICH TO FOCUS COMMUNITY WIDE HEALTH IMPROVEMENT EFFORTS. CHNA FINDINGS PRIORITIZATION CRITERIA: - SCOPE: HOW MANY PEOPLE ARE AFFECTED? - SEVERITY: HOW CRITICAL IS THE ISSUE? - ABILITY TO IMPACT: CAN WE ACHIEVE THE DESIRED OUTCOME? - COMMUNITY READINESS: IS THE COMMUNITY PREPARED TO TAKE ACTION? APPLYING THESE CRITERIA TO THE LIST OF TOP HEALTH NEEDS IDENTIFIED BY THE CHNA RESEARCH, THRIVE AND CAN MEMBERS RANKED AND ORDERED THE COMMUNITY'S HEALTH NEEDS IN THE FOLLOWING ORDER. 1. CHRONIC DISEASE PREVENTION 2. MENTAL HEALTH 3. SUBSTANCE USE DISORDERS 4. SOCIAL DRIVERS OF HEALTH FY2022 CHNA PRELIMINARY FINDINGS: OVERALL, WASHINGTON COUNTY CONTINUES TO BE A HEALTHIER COMMUNITY, SUPPORTED BY NATURAL RESOURCES, BETTER ACCESS TO HEALTHCARE, AND A COLLABORATIVE NETWORK OF HEALTH AND SOCIAL SERVICE PROVIDERS. THE TOP AREAS OF HEALTH NEED ARE CONSISTENT WITH FY2022 CHNA PRIORITY AREAS AND HAVE BEEN GREATLY IMPACTED BY THE COVID-19 PANDEMIC. THE FY2022 CHNA PRIORITIZED THE HEALTH NEEDS AND ALIGNED WITH THE VERMONT DEPARTMENT OF HEALTH SHIP PRIORITIES, PROMOTING COLLABORATION BETWEEN PUBLIC HEALTH, HOSPITAL, AND COMMUNITY BASED ORGANIZATIONS. AS A RESULT OF THE CHNA PROCESS, SIGNIFICANT INVESTMENT HAS OCCURRED WITHIN THE COMMUNITY. ALTHOUGH IT TAKES TIME TO EVALUATE WHETHER OR NOT SPECIFIC ACTIONS ARE MOVING THE NEEDLE ON ISSUES, THE ORGANIZATION FIRMLY BELIEVES THAT THE ACTIONS TAKEN AND FUNDING PROVIDED HAVE HAD A POSITIVE IMPACT ON THE COMMUNITY.

PART V, SECTION B, LINE 5
THE CHNA INCLUDED AN IN-DEPTH REVIEW OF PRIMARY AND SECONDARY DATA TO COLLECT AND ANALYZE HEALTH TRENDS, SOCIO-ECONOMIC DATA, AND STAKEHOLDER PERSPECTIVES, TO INFORM COMMUNITY HEALTH PLANNING. PRIMARY STUDY METHODS WERE USED TO SOLICIT INPUT FROM HEALTH CARE CONSUMERS AND KEY STAKEHOLDERS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY. SECONDARY STUDY METHODS WERE USED TO IDENTIFY AND ANALYZE STATISTICAL DEMOGRAPHIC AND HEALTH TRENDS. COMMUNITY ENGAGEMENT WAS AN INTEGRAL PART OF THE CHNA WITH WIDE PARTICIPATION BY MORE THAN 1,500 COMMUNITY STAKEHOLDERS WHO PARTICIPATED IN SURVEYS, FOCUS GROUPS, PLANNING MEETINGS, AND OTHER DIALOGUE. SPECIFIC CHNA STUDY METHODS INCLUDED: -AN ANALYSIS OF SECONDARY DATA SOURCES, INCLUDING NATIONAL AND STATE HEALTH STATISTICS, DEMOGRAPHIC AND SOCIAL MEASURES, AND HEALTH CARE UTILIZATION DATA -AN ELECTRONIC KEY STAKEHOLDER SURVEY WITH 171 COMMUNITY REPRESENTATIVES TO SOLICIT INFORMATION ABOUT PERCEIVED HEALTH PRIORITIES, PERSPECTIVES ON EMERGING HEALTH TRENDS, AND RECOMMENDATIONS TO ADVANCE COMMUNITY HEALTH AND WELL-BEING STRATEGIES -A COMMUNITY MEMBER SURVEY COMPLETED BY 1,344 RESIDENTS TO COLLECT COMMUNITY PERSPECTIVES ON HEALTH CONCERNS, BARRIERS TO CARE, AND RECOMMENDATIONS, AND RELATED INSIGHTS -VIRTUAL FOCUS GROUPS WITH INDIVIDUALS REPRESENTING BLACK, INDIGENOUS, AND PEOPLE OF COLOR (BIPOC) AND LGBTQ+ COMMUNITIES -INDIVIDUAL AND SMALL GROUP INTERVIEWS WITH HEALTH AND SOCIAL SERVICE AGENCY REPRESENTATIVES, INCLUDING CVMC, CENTRAL VERMONT HOME HEALTH AND HOSPICE, GREEN MOUNTAIN UNITED WAY, PEOPLE'S HEALTH AND WELLNESS CLINIC, TURNING POINT OF CENTRAL VERMONT, AND WASHINGTON COUNTY SUBSTANCE ABUSE REGIONAL PARTNERSHIP INPUT WAS RECEIVED FROM PERSONS REPRESENTING BROAD INTERESTS OF THE COMMUNITY, INCLUDING LEADERS WITH SPECIAL KNOWLEDGE AND OR EXPERTISE AS WELL AS COMMUNITY RESIDENTS. THE CHNA COMMUNITY STEERING GROUP DISTRIBUTED A COMMUNITY SURVEY THAT WAS COMPLETED BY MORE THAN 1,500 RESIDENTS. IN ADDITION, THE GROUP CIRCULATED A KEY INFORMANT SURVEY THROUGH THRIVE TO COMMUNITY MEMBERS WITH SPECIAL KNOWLEDGE OF COMMUNITY HEALTH STATUS, AND CONDUCTED ADDITIONAL INTERVIEWS WITH 33 KEY INFORMANT STAKEHOLDERS TO OBTAIN A BETTER UNDERSTANDING OF NEEDS AMONG UNDERSERVED POPULATIONS. INPUT WAS COLLECTED, STARTING IN THE BEGINNING OF FALL 2021 AND CONCLUDING DURING THE SUMMER OF 2022.

PART V, SECTION B, LINE 6B
THE FY2022 CHNA WAS CONDUCTED IN COLLABORATION WITH THRIVE, THE REGIONAL ACCOUNTABLE COMMUNITY FOR HEALTH. THIS MULTI-AGENCY COALITION, MADE UP OF HEALTH PROVIDERS, SOCIAL SERVICE AGENCIES, GOVERNMENT, CIVIC, AND RELIGIOUS ENTITIES, AND NUMEROUS OTHER COMMUNITY PARTNERS, IS DEDICATED TO IMPROVING HEALTH FOR THE RESIDENTS OF WASHINGTON AND NORTHERN ORANGE COUNTIES. THRIVE MEMBERS PLAYED AN INTEGRAL ROLE IN OVERSEEING DATA COLLECTION AND REVIEWING FINDINGS TO DETERMINE COMMUNITY HEALTH PRIORITIES BASED ON THE CHNA STUDY. IN ADDITION TO THRIVE MEMBERS, MORE THAN 1,500 COMMUNITY RESIDENTS SHARED THEIR PERSPECTIVES ON COMMUNITY NEEDS THROUGH SURVEYS AND OPEN DIALOGUE. WE VALUE THIS FEEDBACK AND RECOGNIZE THAT ALL COMMUNITY STAKEHOLDERS PLAY AN INTEGRAL PART IN ADVANCING THE HEALTH OF CENTRAL VERMONT. THE CHNA REPORT PROVIDES AN IN-DEPTH VIEW OF THE MANY FACTORS THAT INFLUENCE HEALTH IN OUR COMMUNITY. KNOWING THAT SOCIAL AND ECONOMIC MEASURES OFTEN IMPACT HEALTH MORE THAN HEALTH CARE DELIVERY ALONE, WE SOUGHT TO DEMONSTRATE THE CORRELATION BETWEEN HEALTH DISPARITIES AND SOCIAL DRIVERS OF THE HEALTH ENVIRONMENTAL FACTORS THAT IMPACT OUR HEALTH. IN RESPONSE TO THE FINDINGS FROM THE CHNA REPORT, CENTRAL VERMONT MEDICAL CENTER (CVMC) WORKED WITH OUR COMMUNITY PARTNERS TO OUTLINE A PLAN TO GUIDE OUR COMMUNITY HEALTH AND BENEFIT ACTIVITIES FOR THE 2022-25 PLANNING CYCLE. THROUGHOUT THIS PLANNING CYCLE, CVMC WILL CONTINUE TO EVALUATE OUR ACTIVITIES AND TRACK OUR PROGRESS TOWARD IMPROVING THE ISSUES THAT MOST IMPACT THE HEALTH OF OUR COMMUNITY. IN DOING SO, CVMC WILL CONTINUE TO COLLABORATE WITH OUR PARTNERS, EDUCATE OUR POLICY MAKERS, AND ENGAGE COMMUNITY RESIDENTS TO PROMOTE HEALTH FOR ALL RESIDENTS OF CENTRAL VERMONT.

PART V, SECTION B, LINES 7A, 7B AND 10A
COMMUNITY HEALTH NEEDS ASSESSMENT https://www.cvmc.org/about-cvmc/community/community-health-needs-assessmen t https://gmcboard.vermont.gov/sites/gmcb/files/documents/CVMC_2022_CHNA_Fin al_Report_-_2022-06-16.pdf IMPLEMENTATION STRATEGY https://www.cvmc.org/about-cvmc/community/community-health-needs-assessmen t HOSPITAL FACILITY WEBSITE: https://www.cvmc.org/sites/default/files/documents/CVMC-Financial-Assistan ce-Policy.pdf

PART V, SECTION B, LINE 11
"CENTRAL VERMONT MEDICAL CENTER'S 2022 CHNA IMPLEMENTATION STRATEGY WAS APPROVED BY THE BOARD OF DIRECTORS FEBRUARY 2022. THIS SPECIFIC IMPLEMENTATION STRATEGY SET OUT THE FOLLOWING OBJECTIVES TO EXPAND ACCESS TO HIGH-QUALITY, COMPREHENSIVE MENTAL HEALTH RESOURCES TO IMPROVE THE HEALTH AND WELL-BEING OF PATIENTS, THEIR FAMILIES, AND COMMUNITY MEMBERS IN WASHINGTON COUNTY: 1. CHRONIC DISEASE PREVENTION: WASHINGTON COUNTY AND VERMONT RESIDENTS ARE GENERALLY HEALTHIER THAN THEIR PEERS NATIONALLY, WITH FEWER HEALTH RISK FACTORS AND LOWER PREVALENCE AND MORTALITY DUE TO CHRONIC DISEASE. HOWEVER, WITH THE COMBINATION OF THE AGING POPULATION OF WASHINGTON COUNTY RESIDENTS, A SLIGHTLY LOWER PERCENTAGE OF ADULTS ACCESSING ROUTINE CARE (72%-72.5%) COMPARED TO THE NATION (75%), AND ADDITIONAL BARRIERS TO ACCESSING CARE, RESIDENTS AREN'T ALWAYS ABLE TO RECEIVE THE PREVENTION CARE THEY NEED. A. PROMOTE UVM HEALTH NETWORK POPULATION HEALTH MANAGEMENT STRATEGY THROUGH IMPROVED CLINICAL COMMUNICATION AND COORDINATION OF CARE. -CONTINUE THE DEVELOPMENT AND IMPLEMENTATION OF OUR PRIMARY CARE DELIVERY MODEL AND THE UVM HEALTH NETWORK POPULATION HEALTH SERVICES ORGANIZATION (PHSO). THE INTENT IS TO CREATE AN EXTENDED CARE TEAM OF RESOURCES INCLUDING CARE COORDINATION, SOCIAL SERVICES, HEALTH COACHING, AND MENTAL HEALTH AND RESOURCE COORDINATION TO POSITIVELY IMPACT CLINICAL HEALTH OUTCOMES FOR OUR PATIENTS, WOODRIDGE RESIDENTS AND OUR COMMUNITY, WHILE MAXIMIZING THE VALUE OF THE SERVICES WE PROVIDE. B. REDUCE DISPARITIES IN CHRONIC DISEASE PREVALENCE AND DEATH RATES. -CVMC PRIMARY CARE AND COMMUNITY PARTNERS WILL IDENTIFY COLLABORATIVE OPPORTUNITIES TO IMPROVE CARE AND SERVICE. C. ADOPT ORGANIZATIONAL AND INSTITUTIONAL PRACTICES THAT ADVANCE EQUITY. -PARTNER WITH CVMC DEI (DIVERSITY, EQUITY, AND INCLUSION) COMMITTEE AND THE PRIDE CENTER OF VERMONT TO IMPROVE CULTURAL COMPETENCE OF PROVIDERS AND ADOPT INCLUSIVE HEALTH CARE ENVIRONMENTS. ASSESS EXISTING PATIENT AND EDUCATION MATERIAL FOR LITERACY LEVELS AND LANGUAGE AVAILABILITY. -ACUTE STROKE READY HOSPITAL (ASRH) CERTIFICATION PROVIDED THROUGH A PARTNERSHIP BETWEEN THE AMERICAN HEART ASSOCIATION/AMERICAN STROKE ASSOCIATION AND THE JOINT COMMISSION RECOGNIZES HOSPITALS THAT MEET STANDARDS TO SUPPORT BETTER OUTCOMES FOR STROKE CARE AS PART OF A STROKE SYSTEM OF CARE. -THROUGH COLLABORATION WITH UVM HEALTH NETWORK AND WITH THE SUPPORT OF TELEMEDICINE SERVICES, CVMC IS PURSUING A CERTIFICATION AS AN ACUTE STROKE READY HOSPITAL FOR FY2024. THIS WILL HELP CVMC STANDARDIZE THE CARE OF PATIENTS WHO ARE SEEN AT THE EMERGENCY DEPARTMENT WITH SIGNS/SYMPTOMS OF A STROKE. THIS WOULD ALSO ASSIST WITH EXPEDITING THEIR TRANSFER, IF NEEDED, TO A HIGHER LEVEL OF CARE. 2. MENTAL HEALTH CARE: ACCESS TO MENTAL HEALTH SERVICES AND TREATMENT WAS IDENTIFIED AS THE #2 HEALTH CHALLENGE IN CHNA SURVEY. IN WASHINGTON COUNTY 21% OF ADULTS ARE DIAGNOSED WITH DEPRESSION AND AN INCREASE OF TEENAGERS WHO REPORTED FEELING CONSISTENTLY SAD OR HOPELESS INCREASED FROM 23.2% TO 30.9% FROM 2013 TO 2019. A. AS PART OF AN INTEGRATED SYSTEM OF CARE IN VERMONT, CVMC WILL ADVANCE BEHAVIORAL HEALTH INTEGRATION WITHIN OUR PRIMARY CARE PRACTICES AND LEVERAGE THE PHSO (POPULATION HEALTH SERVICES ORGANIZATION) MENTAL HEALTH RESOURCE MODEL TO EXTEND RESOURCES IN OUR PRIMARY CARE PRACTICES. B. CVMC, IN COLLABORATION WITH WASHINGTON COUNTY MENTAL HEALTH SERVICES, IS OFFERING ADDITIONAL PRE-NATAL AND POSTPARTUM SUPPORT FOR WOMEN WITH A HISTORY OF, OR AT RISK FOR DEPRESSION OR THE OTHER REMAINING SIGNIFICANT NEEDS IDENTIFIED IN THE CHNA (SUBSTANCE USE DISORDER, AFFORDABLE HOUSING, CHILDHOOD AND FAMILY HEALTH, DISEASE PREVENTION, AND CANCER) HAVE BEEN PRIORITY AREAS IN PREVIOUS CHNA. C. CVMC WILL WORK WITH COMMUNITY PARTNERS TO SUPPORT COMMUNITY MENTAL HEALTH EDUCATION AND MENTAL WELLNESS PROGRAMS (E.G. PHYSICAL ACTIVITY, YOGA, AND MEDITATION). 3. SUBSTANCE USE DISORDERS: WASHINGTON COUNTY RESIDENTS NAMED SUBSTANCE ABUSE INCLUDING ALCOHOL, OPIOID, PRESCRIPTION MEDICATIONS AND MARIJUANA AS THE TOP COMMUNITY HEALTH ISSUE IN THIS SURVEY. WASHINGTON COUNTY ADULTS AND TEENS HAVE HIGH RATES OF BINGE DRINKING AND MARIJUANA USE, AND DEATHS FROM OPIOIDS CONTINUE TO CLIMB. A. IMPROVE ACCESS TO SUBSTANCE USE DISORDER SERVICES AND SUPPORTS ALONG A FULL CONTINUUM OF CARE: -CVMC PROVIDERS, LEADERS AND COMMUNITY PARTNERS WILL COLLABORATE AND SUPPORT STRONGER INTEGRATION OF SUBSTANCE USE INTERVENTIONS: -PEER RECOVERY/SUPPORT SERVICES IN BOTH COMMUNITY AND EMERGENCY DEPARTMENT SETTINGS; -ACCESS TO MEDICATION-ASSISTED TREATMENT (MAT) IN THE EMERGENCY DEPARTMENT AND COORDINATION OF FOLLOW-UP TREATMENT; -EDUCATION AND TRAINING RELATED TO DISTRIBUTION AND USE OF OPIOID OVERDOSE REVERSAL MEDICATIONS; -EDUCATION AND TRAINING RELATED TO OPIOID PRESCRIBING, CHRONIC PAIN MANAGEMENT, AND MAT PROTOCOLS FOR PRESCRIBING PRACTITIONERS. B. PROMOTE A ""COMMUNITY-WIDE SYSTEMS"" FRAMEWORK FOR PREVENTION AND TREATMENT OF SUBSTANCE USE DISORDERS: -CVMC SERVICES AS THE CONVENER FOR THE CENTRAL VERMONT PREVENTION COALITION (CVPC): -SUPPORT CVPC IN BUILDING SAFE HARBOR INITIATIVES TO PREVENT SUBSTANCE USE; -ANALYZE AND UNDERSTAND THE IMPACT OF COVID-19; -SUPPORT ELIMINATION OF STIGMA AND MISUNDERSTANDING OF SUBSTANCE USE; -ADDRESS EQUITABLE AND AFFORDABLE ACCESS TO SERVICES. C. IMPROVE ACCESS TO TREATMENT AND SERVICES FOR ALCOHOL USE DISORDERS: -CVMC IN PARTNERSHIP WITH COMMUNITY AGENCIES AND PEER RECOVER SERVICES, SUPPORT THE REFOCUS ON ALCOHOL DEPENDENCE (ROAD) PROGRAM, AN INNOVATIVE HUB/SPOKE APPROACH TO OUTPATIENT DETOX SERVICES. 4. SOCIAL DETERMINANTS OF HEALTH: ACCESS TO HEALTHY FOODS, HOUSING, TRANSPORTATION AND ECONOMIC STABILITY IMPACT A PERSON'S HEALTH. RESIDENTS OF WASHINGTON COUNTY HAVE LOW RATES OF CONSUMING HEALTHY FOODS, HIGH RATES OF CHRONIC DISEASE BURDEN, DIFFICULTY ACCESSING TRANSPORTATION SERVICES, AND A HIGH HOUSING COST BURDEN, WHICH RESULTS IN HOMELESSNESS OR MARGINAL HOUSING FOR MANY INDIVIDUALS. OTHER AREAS WERE IDENTIFIED WHICH CVMC HAS CHOSEN TO ACKNOWLEDGE, BUT NOT ADDRESS DIRECTLY AS PART OF THE STRATEGIC PLAN BUT CONTINUE TO PARTNER WITH COMMUNITY GROUPS TO ADDRESS: A. COMMUNITY COLLABORATION-CVMC SERVES AS THE CONVENER ORGANIZATION FOR THRIVE, THE WASHINGTON COUNTY ACCOUNTABLE COMMUNITY FOR HEALTH, IN SUPPORTING NEEDS IDENTIFIED IN THIS CHNA. B. FOOD SECURITY-CVMC PARTNERS WITH VERMONT YOUTH CONSERVATION CORPS TO PROVIDE FREE, FRESH PRODUCE AND OTHER STAPLES TO COMMUNITY MEMBERS EVERY MONTH. THROUGH THIS PROGRAM THE HOSPITAL ALSO PROVIDES A SOCIAL GATHERING SPACE TO SUPPORT EDUCATION AND CONVERSATION AROUND HEALTHY FOOD. C. HOMELESSNESS AND AFFORDABLE HOUSING-CVMC PARTICIPATES IN AND SUPPORTS FINDING SOLUTIONS TO END HOMELESSNESS IN CENTRAL VERMONT AND SURROUNDING AREAS AS PART OF THE THRIVE ACCOUNTABLE COMMUNITY FOR HEALTH. D. TRANSPORTATION-CVMC PARTICIPATES IN AND SUPPORTS FINDING SOLUTIONS FOR BARRIERS TO TRANSPORTATION FOR RESIDENTS OF CENTRAL VERMONT AND THE SURROUNDING AREA AS PART OF THE THRIVE ACCOUNTABLE COMMUNITY FOR HEALTH. E. ADOPT ORGANIZATIONAL AND INSTITUTIONAL PRACTICES THAT ADVANCE EQUITY BY PARTNERING CVMC DEI COMMITTEE AND THE PRIDE CENTER OF VERMONT TO IMPROVE CULTURAL COMPETENCE OF PROVIDERS AND ADOPT INCLUSIVE HEALTH CARE ENVIRONMENT. IN ADDITION, CVMC IS ASSESSING EXISTING PATIENT EDUCATION MATERIALS FOR LITERACY LEVELS AND LANGUAGE AVAILABILITY."

PART V, SECTION B, LINE 15E
"FROM REGISTRATION, PATIENTS ARE ROUTINELY REFERRED TO THE CVMC FINANCIAL ADVOCACY DEPARTMENT OR COMMUNITY HEALTH IMPROVEMENT DEPARTMENT. BOTH AREAS PROVIDE KNOWLEDGE AND ASSISTANCE IN THE APPLICATION PROCESS FOR CHARITY AND OTHER APPLICABLE FUNDING SOURCES. ADVOCATES ACTIVELY EDUCATE ALL INPATIENT, OBSERVATION AND OUTPATIENT INVASIVE SERVICE PATIENTS OF OUR PROGRAM, PRIOR TO OR CONCURRENT WITH THE PATIENTS' STAY, SUBSEQUENTLY AIDING IN THE APPLICATION PROCESS FOR STATE AID AND CENTRAL VERMONT MEDICAL CENTER'S FINANCIAL PROGRAM. WHILE THE FINANCIAL ASSISTANCE POLICY DOES NOT PROVIDE A LIST OF ""EXTERNAL"" CONTACT INFORMATION FOR NON-CENTRAL VERMONT MEDICAL CENTER PARTIES OR AGENCIES WHO MAY ASSIST PATIENTS IN THE APPLICATION PROCESS, APPLICATION COMPLETION AID IS WELL PUBLISHED WITH MULTIPLE INTERNAL, ORGANIZATIONAL AND CENTRAL VERMONT MEDICAL CENTER COMMUNITY HEALTH ASSISTANCE TEAM MEMBERS AVAILABLE TO ASSIST OUR PATIENTS. IT IS ALSO IMPORTANT TO NOTE, PATIENTS ARE REVIEWED IN ADVANCE OF SERVICE FOR POTENTIAL HARDSHIP; THE UNINSURED AND UNDERINSURED PATIENTS WHO ARE IDENTIFIED ARE ACTIVELY COUNSELED WITH HELP FOR GOVERNMENT AND EXCHANGE PROGRAMS AS WELL AS ASSISTANCE IN THE CENTRAL VERMONT MEDICAL CENTER FINANCIAL ASSISTANCE PROGRAM."

PART V, SECTION B, LINES 16A, 16B & 16C:
FINANCIAL ASSISTANCE POLICY (FAP) RESOURCES THE FAP, THE FAP APPLICATION FORM, AND A PLAIN LANGUAGE SUMMARY (FINANCIAL ASSISTANCE POLICY - SUMMARY) OF THE FAP WAS WIDELY AVAILABLE AT THE CENTRAL VERMONT MEDICAL CENTER FINANCIAL ASSISTANCE WEBPAGE LOCATED AT: https://www.cvmc.org/patients-visitors/patient-financial-services/patient- financial-service-documents

PART V, SECTION B, LINE 16J
"WHILE THE FINANCIAL ASSISTANCE POLICY DOES NOT PROVIDE A LIST OF ""EXTERNAL"" CONTACT INFORMATION FOR NON-CENTRAL VERMONT MEDICAL CENTER PARTIES OR AGENCIES WHO MAY ASSIST PATIENTS IN THE APPLICATION PROCESS, APPLICATION COMPLETION AID IS WELL PUBLISHED WITH MULTIPLE INTERNAL, ORGANIZATIONAL AND CENTRAL VERMONT MEDICAL CENTER COMMUNITY HEALTH ASSISTANCE TEAM MEMBERS AVAILABLE TO ASSIST OUR PATIENTS. IT IS ALSO IMPORTANT TO NOTE, PATIENTS ARE REVIEWED IN ADVANCE OF SERVICE FOR POTENTIAL HARDSHIP; THE UNINSURED AND UNDERINSURED PATIENTS WHO ARE IDENTIFIED ARE ACTIVELY COUNSELED WITH HELP FOR GOVERNMENT AND EXCHANGE PROGRAMS AS WELL AS ASSISTANCE IN THE CENTRAL VERMONT MEDICAL CENTER FINANCIAL ASSISTANCE PROGRAM."

PART V, SECTION B, LINE 18F
CVMC DID NOT INITIATE ANY OF THE ACTIONS DESCRIBED IN SCHEDULE H, PART V, SECTION B, LINE 18. HOWEVER, IF THE HOSPITAL HAD UNDERTAKEN ANY OF THE LISTED ACTIONS, IT WOULD HAVE FIRST NOTIFIED PATIENTS OF ITS FINANCIAL ASSISTANCE POLICY ON ADMISSION, PRIOR TO DISCHARGE, AND IN COMMUNICATIONS WITH THE PATIENTS REGARDING THEIR BILLS. ADDITIONALLY, CVMC WOULD HAVE DOCUMENTED ITS DETERMINATION OF WHETHER PATIENTS WERE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL FACILITY'S FINANCIAL ASSISTANCE POLICY.

SCHEDULE H, PART VI, LINE 1
THE ORGANIZATION'S REQUIRED SCHEDULE H SPECIFIC LINE ITEM DESCRIPTIONS ARE AS FOLLOWS:

PART I, LINES 3A-C:
"TO QUALIFY FOR FINANCIAL ASSISTANCE, AN ELIGIBLE PATIENT MUST PASS BOTH AN INCOME AND ASSETS TEST. INCOME IS SET AT A MAXIMUM OF 400% OF FEDERAL POVERTY LEVEL GUIDELINES (""FPLG"") AND THE ASSETS TEST IS SET AT $50,000 LIQUID ASSETS, AS FURTHER DEFINED AND DESCRIBED IN THE POLICY. ASSISTANCE IS GRANTED BASED UPON THE PATIENT'S INCOME FPLG."

PART I, LINE 7:
CENTRAL VERMONT MEDICAL CENTER UTILIZED THE AXIOM COST ACCOUNTING SYSTEM TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE ON LINE 7. THE COST ACCOUNTING SYSTEM ADDRESSES ALL PATIENT SEGMENTS, INCLUDING, BUT NOT LIMITED TO, INPATIENT, OUTPATIENT, EMERGENCY ROOM, PRIVATE INSURANCE, MEDICAID, MEDICARE, UNINSURED AND SELF PAY. THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2 WAS ALSO UTILIZED FOR SOME OF THE FIGURES REPORTED IN THE TABLE ON LINE 7. THE CENTRAL VERMONT MEDICAL CENTER'S ANNUAL MEDICAID PROVIDER TAX IS ASSESSED ON VERMONT ACUTE CARE HOSPITALS BY THE STATE OF VERMONT. THE TAX ASSESSMENT IS CALCULATED AS 6% OF A HOSPITAL'S BASE YEAR NET PATIENT CARE REVENUE.

PART I, LINE 7, COLUMN (F):
THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE AMOUNT REPORTED ON LINE 7(F) IS $0. PATIENT-RELATED BAD DEBT IN THE AMOUNT OF $7,540,979 IS NETTED FROM PATIENT REVENUE IN PART VIII, LINE 2.

PART III, LINE 2:
CENTRAL VERMONT MEDICAL CENTER'S FINANCIAL STATEMENTS INCLUDE A FOOTNOTE DESCRIBING BAD DEBT EXPENSE. RECEIVABLES ARE REPORTED NET OF AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE PROVISION FOR PATIENT RELATED BAD DEBT IS REPORTED AS A DEDUCTION FROM GROSS REVENUE. THIS EXPENSE IS DETERMINED AS A PERCENTAGE OF GROSS PATIENT SERVICE REVENUE BASED ON ACTUAL WRITE-OFF HISTORY, REVIEWED ON A QUARTERLY BASIS AND ADJUSTED ON A SEMI-ANNUAL BASIS.

PART III, LINE 3:
DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE NETTED AGAINST THE TOTAL GROSS CHARGES WHEN DETERMINING BAD DEBT EXPENSE. THE $150,820 REFLECTS THE ADJUSTED BAD DEBT EXPENSE FOR ALL PATIENTS WHO SUBMITTED AN INITIAL APPLICATION, BUT UPON FOLLOW-UP, DID NOT RESPOND TO REQUESTS FOR ADDITIONAL INFORMATION OR SUPPORTING DOCUMENTATION.

PART III, LINE 4:
PLEASE REFERENCE FOOTNOTE NUMBER 4 ON PAGES 22-27 IN THE FISCAL YEAR 2022 AUDITED CONSOLIDATED FINANCIAL STATEMENTS.

PART III, LINE 8:
THE AMOUNT REPORTED IN PART III, LINE 6, MEDICARE ALLOWABLE COSTS OF CARE, IS DERIVED FROM CENTRAL VERMONT MEDICAL CENTER'S FYE 9/30/22 MEDICARE COST REPORT, WORKSHEET D-1, COMPUTATION OF INPATIENT OPERATING COSTS, WORKSHEET E PART B, CALCULATION OF OUTPATIENT SETTLEMENT, AND WORKSHEET I-4, COMPUTATION OF AVERAGE COST PER TREATMENT FOR OUTPATIENT RENAL DIALYSIS. WHILE CVMC HAS HISTORICALLY FOLLOWED THE CATHOLIC HOSPITAL ASSOCIATION'S GUIDANCE AND HAS NOT CONSIDERED ANY MEDICARE SHORTFALL (REPORTED IN PART III, LINE 7) AS A COMMUNITY BENEFIT, IT IS LIKELY THAT SOME PORTION OF MEDICARE PATIENTS WOULD HAVE QUALIFIED FOR CHARITY CARE UNDER OUR POLICIES IN THE ABSENCE OF MEDICARE COVERAGE, SUCH THAT SHORTFALLS ASSOCIATED WITH THOSE PATIENTS WOULD OTHERWISE HAVE BEEN INCLUDED IN OUR COMMUNITY BENEFITS.

PART III, LINE 9B:
THE COLLECTION PROCESS IN PLACE AT CENTRAL VERMONT MEDICAL CENTER (CVMC) INCLUDES GENERATION OF MONTHLY STATEMENTS, FOLLOWED BY A PRE-COLLECTION LETTER OVER THE COURSE OF 120 DAYS. IN THE CASE OF UNDELIVERABLE MAIL, EFFORTS WILL BE MADE TO REACH THE PATIENT BY TELEPHONE. IF A NEW BILLING ADDRESS IS OBTAINED, THE 120 DAY WINDOW WILL BEGIN AGAIN. IF NO CONTACT CAN BE MADE AND PAYMENT IS NOT RECEIVED WITHIN THE REVISED 120 DAY WINDOW, THE ACCOUNT WILL BE REFERRED TO A COLLECTION AGENCY. IF CONTACT IS MADE, THE PATIENT WILL BE OFFERED A BUDGET PLAN. ALL STATEMENTS, LETTERS AND CONTACT WILL INCLUDE THE FACT THAT FINANCIAL ASSISTANCE IS AVAILABLE. REASONABLE EFFORTS WILL BE MADE TO DETERMINE IF A PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE PRIOR TO BALANCE TRANSFER TO COLLECTIONS. REASONABLE EFFORTS MAY INCLUDE THE USE OF PRESUMPTIVE SCORING, THE NOTIFICATION AND PROCESSING OF APPLICATIONS AND NOTIFICATION BEFORE, DURING AND AFTER CARE. CVMC WILL PROCESS APPLICATIONS SUBMITTED BY INDIVIDUALS DURING THE APPLICATION PERIOD WHICH BEGINS ON THE DATE A BILLING STATEMENT FOR THE PATIENT BALANCE OF CARE IS PRESENTED AND ENDS 240 DAYS LATER. IF AT THE END OF THE 120 NOTIFICATION PERIOD AND ACCOUNT HAS BEEN REFERRED TO A COLLECTION AGENCY AND AN APPLICATION IS RECEIVED AND GRANTED WITHIN THE 240 DAY APPLICATION PERIOD, ACCOUNTS SHALL BE RECALLED FROM THE AGENCY AND PROCESSED UNDER THE FINANCIAL ASSISTANCE PROGRAM.

NEEDS ASSESSMENT
PART VI, LINE 2 THE COMPREHENSIVE 2022 CHNA INCLUDED AN IN-DEPTH REVIEW OF PRIMARY AND SECONDARY DATA, HEALTH TRENDS, SOCIO-ECONOMIC STATISTICS, STAKEHOLDER PERCEPTIONS AND OTHER INFORMATION. CVMC AND THRIVE ANALYZED THE DATA TO ALIGN WITH THE VERMONT DEPARTMENT OF HEALTH STATE HEALTH IMPROVEMENT PLAN (SHIP) TO INFORM COMMUNITY HEALTH PLANNING. PRIMARY STUDY METHODS WERE USED TO SOLICIT INPUT FROM HEALTH CARE CONSUMERS AND KEY COMMUNITY STAKEHOLDERS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY. SECONDARY STUDY METHODS WERE USED TO IDENTIFY AND ANALYZE STATISTICAL DEMOGRAPHIC AND HEALTH TRENDS. COMMUNITY ENGAGEMENT WAS AN INTEGRAL PART OF THE 2022 CHNA WITH WIDE PARTICIPATION FROM NEARLY 1,500 COMMUNITY STAKEHOLDERS WHO PARTICIPATED IN SURVEYS, FOCUS GROUPS, PLANNING MEETINGS, AND OTHER DIALOGUE. IN ADDITION TO THE TRIENNIAL CHNA, CVMC REGULARY MONITORS THE HEALTH NEEDS OF THE CENTRAL VERMONT COMMUNITY, THROUGH THRIVE, THE REGIONAL ACCOUNTABLE COMMUNITY FOR HEALTH (ACH). THRIVE MEMBERS HOLD REGULAR MEETINGS TO SUPPORT THE INTEGRATION OF HIGH-QUALITY MEDICAL CARE, MENTAL HEALTH AND SUBSTANCE USE TREATMENT SERVICES, AND SOCIAL SERVICES, BOTH GOVERNMENTAL AND NON-GOVERNMENTAL, FOR THOSE IN NEED OF CARE. THRIVE ALSO STRIVES TO SUPPORT COMMUNITY WIDE PREVENTION EFFORTS ACROSS ITS DEFINED DEOGRAPHIC AREA TO REDUCE DISPARITIES IN THE DISTRIBUTION OF HEALTH AND WELLNESS. THE FOLLOWING ORGANIZATIONS AND AGENCIES ARE COLLECTIVELY REFERRED TO AS THE LEADERSHIP PARTNERS TEAM OF THRIVE: -BLUECROSS/BLUESHIELD OF VERMONT -CAPSTONE COMMUNITY ACTION -CENTRAL VERMONT COUNCIL ON AGING -CENTRAL VERMONT HOME HEALTH & HOSPICE -CENTRAL VERMONT MEDICAL CENTER -CENTRAL VERMONT REGIONAL PLANNING COMMISSION -DOWNSTREET HOUSING & COMMUNITY DEVELOPMENT -FAMILY CENTER OF WASHINGTON COUNTY -GOOD SAMARITAN HAVEN -GREEN MOUNTAIN UNITED WAY -ONECARE VERMONT -PEOPLE'S HEALTH & WELLNESS CLINIC -VERMONT AGENCY OF HUMAN SERVICES -VERMONT DEPARTMENT OF HEALTH -VERMONT FOODBANK -WASHINGTON COUNTY MENTAL HEALTH SERVICES THE COMMUNITY HEALTH NEEDS ASSESSMENT IS AVAILABLE AT THE FOLLOWING WEB ADDRESS: https://www.cvmc.org/about-cvmc/community/community-health-needs-assessmen t

STATE FILING OF COMMUNITY BENEFIT REPORT
PART VI, LINE 7 THE CENTRAL VERMONT MEDICAL FILES A COMMUNITY BENEFIT REPORT WITH THE STATE OF VERMONT.

PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE
PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: CENTRAL VERMONT MEDICAL CENTER UTILIZES A VARIETY OF METHODS TO INFORM, EDUCATE AND ASSIST PATIENTS IN IDENTIFYING PAYMENT SOURCES, INCLUDING STATE / FEDERAL PROGRAMS AS WELL AS OUR PATIENT ASSISTANCE PROGRAM. INFORM & EDUCATE: PATIENT EDUCATION IS PROVIDED ACROSS THE CONTINUUM OF CARE. PATIENT BENEFIT ADVISORS, FINANCIAL ADVOCATES, REGISTRARS, CASE MANAGERS, SOCIAL WORKERS AND CUSTOMER SERVICE REPRESENTATIVES ACTIVELY INFORM AND EDUCATE PATIENTS ON THE PROGRAM, GUIDELINES, REQUIREMENTS FROM: - PRE-ARRIVAL SCREENING/REGISTRATION TO POINT OF SALE EDUCATION AT REGISTRATION - AT THE BEDSIDE OF AN INPATIENT OR OBSERVATION PATIENT- AFTER DISCHARGE WITH CONTINUED FOLLOW-UP BY FINANCIAL ADVOCATES AND - DURING THE SELF-PAY BILLING FOLLOW-UP PROCESS. PATIENTS ARE INFORMED OF THE PROGRAM, APPLICATIONS AND ASSISTANCE WITH COMPLETION ARE PROVIDED WITH FINANCIAL ADVOCATES ALSO PROVIDING EDUCATION AND ASSISTANCE FOR MEDICAID AND HEALTH INFORMATION EXCHANGE PROGRAMS, ALONG WITH ASSISTANCE IN APPLYING FOR THE UVM MEDICAL CENTER FINANCIAL ASSISTANCE PROGRAM. PATIENTS ARE ROUTINELY REFERRED TO ADVOCATES AND ADVISORS IN ADVANCE OF SERVICE WITH ADVOCATES ACTIVELY ASSISTING PATIENTS WHOM ARE ADMITTED TO THE ORGANIZATION URGENTLY OR EMERGENTLY. POLICIES, SUMMARIES AND APPLICATIONS ARE AVAILABLE AT ALL REGISTRATION LOCATIONS, THEY ARE REFERENCED IN ALL INTERVIEW PROCESSES AND FURTHER AVAILABLE IN THE WAITING AREAS. OUR ORGANIZATIONAL WEBSITES PROVIDE EDUCATION, APPLICATIONS, POLICIES, SUMMARIES, AND FAQ DOCUMENTS ALONG WITH CONTACT INFORMATION AS A PASSIVE MEANS OF COMMUNICATION IN ADDITION TO THE ACTIVE EDUCATION REFERENCED PREVIOUSLY. OUR BILLING STATEMENTS REFLECT FINANCIAL ASSISTANCE HELP AND OUR COMMUNITY BENEFIT TEAM EDUCATE WITHIN THE COMMUNITY ON OUR PROGRAMS. APPLICATIONS AND INFORMATION ARE ADDITIONALLY AVAILABLE IN THE LOCAL COMMUNITY HEALTH CENTERS. ASSIST: - ALL INPATIENT AND OUTPATIENT PROCEDURES ARE FINANCIALLY SCREENED TO IDENTIFY THE UNDERINSURED OR UNINSURED PATIENT POPULATION. PRIOR TO SERVICE, CONCURRENT WITH SERVICE AND POST SERVICE, OUR PATIENT FINANCIAL COUNSELORS WILL CALL AND/OR MEET WITH PATIENTS AND FAMILIES TO EDUCATE THEM ON THE AVAILABLE PROGRAMS AND WHERE APPLICABLE, ASSIST IN THE APPLICATION PROCESS. THIS INCLUDES STATE AND FEDERAL AID APPLICATIONS AND THE CENTRAL VERMONT MEDICAL CENTER CHARITY APPLICATION PROCESS. - OUR FINANCIAL COUNSELORS /ADVOCATES HAVE BEEN CERTIFIED AS ASSISTERS IN THE PROCESS FOR HEALTH EXCHANGE INSURANCE, MEDICAID AND THE FINANCIAL ASSISTANCE PROGRAMS. COUNSELORS WILL ADDITIONALLY MEET WITH PATIENTS AT THE BEDSIDE TO HELP COMPLETE THE APPLICATIONS, PROVIDE DETAILS ON SUPPORTING DOCUMENTATION NEEDS AND FACILITATE AND EXPEDITE THE REVIEW PROCESS UNTIL A NOTICE OF DECISION HAS BEEN RECEIVED. PROCESS UNTIL A NOTICE OF DECISION HAS BEEN RECEIVED.

PROMOTION OF COMMUNITY HEALTH
PART VI, LINE 5 AS A PARTNER IN THE UNIVERSITY OF VERMONT HEALTH NETWORK, CENTRAL VERMONT MEDICAL CENTER IS PART OF A REGION-WIDE EFFORT TO TRANSFORM HEALTH CARE THAT IS TRANSLATING TO BETTER CARE HERE IN OUR LOCAL CENTRAL VERMONT COMMUNITIES. IN ADDITION TO OUR NETWORK PARTNERSHIP, WE BELIEVE THAT MAINTAINING THE HIGHEST QUALITY CARE FOR OUR PATIENTS ALSO DEPENDS ON OUR SUPPORT AND COLLABORATION WITH THE MANY LOCAL ORGANIZATIONS THROUGHOUT CENTRAL VERMONT THAT ARE ALSO PROVIDING VITAL SERVICES TO OUR COMMUNITY. SOME OF OUR COMMUNITY PARTNERS INCLUDE: A. CENTRAL VERMONT HOME HEALTH AND HOSPICE B. GREEN MOUNTAIN TRANSIT AUTHORITY (GMTA) C. GREEN MOUNTAIN UNITY WAY D. PEOPLE'S HEALTH AND WELLNESS CLINIC (PHWC) E. PHARMACIES F. VERMONT STATE DEPARTMENT OF HEALTH G. WASHINGTON COUNTY MENTAL HEALTH THE MAJORITY OF CVMC'S GOVERNING BODY (BOARD OF TRUSTEES) IS COMPRISED OF INDIVIDUALS WHO RESIDE IN CVMC'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES, FAMILY MEMBERS, NOR CONTRACTORS OF THE ORGANIZATION. CVMC EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY. CENTRAL VERMONT MEDICAL CENTER (CVMC) IS ALSO THE ADMINISTRATIVE ENTITY FOR THE VERMONT BLUEPRINT FOR HEALTH, PATIENT CENTERED MEDICAL HOMES FOR THE BARRE HEALTH SERVICE AREA (HSA). THE GOAL OF THE VERMONT BLUEPRINT FOR HEALTH, PASSED BY THE VERMONT LEGISLATURE IN 2010, IS TO SUPPORT VERMONT'S EFFORTS TO DEVELOP A COMPREHENSIVE, PROACTIVE SYSTEM OF CARE THAT IMPROVES THE QUALITY OF LIFE FOR PEOPLE WITH, OR AT RISK FOR CHRONIC CONDITIONS. AT THE END OF 2020, OVER 50 PRIMARY CARE PROVIDERS WERE ALL PART OF A RECOGNIZED NATIONAL COMMITTEE FOR QUALITY ASSURANCE, PATIENT CENTERED MEDICAL HOME IN THE BARRE HSA CARING FOR OVER 30,000 PATIENTS. THE CVMC COMMUNITY HEALTH TEAM (CHT) IS A PATIENT-CENTERED MULTIDISCIPLINARY TEAM THAT STRIVES TO IMPROVE THE PRIMARY HEALTH AND WELLNESS FOR ALL PATIENTS IN CENTRAL VERMONT. CHT IS COMMITTED TO REMOVING HEALTH BARRIERS BY OFFERING SERVICE FREE OF CHARGE, WHICH CONSISTS OF A NURSE, OR DIETITIAN, OR WELLNESS COACH, OR CLINICAL SOCIAL WORKERS IN THE COMFORT OF YOUR PRIMARY CARE OFFICE. CHT SERVICES CAN HELP YOU OR THOSE YOU LOVE IMPROVE THEIR CHANCES FOR REACHING GOALS WHILE PROVIDING ONE-ON-ONE SUPPORT. THE CHT TEAM WORKS WITHIN THE CVMC PRIMARY CARE PRACTICES AROUND CENTRAL VERMONT, AS WELL AS WOMEN'S HEALTH. CVMC APPLIES SURPLUS FUNDS TO REVITALIZE FACILITIES, PURCHASE EQUIPMENT, STAFF EDUCATION AND TO ENHANCE PROGRAMS TO PROVIDE BETTER PATIENT AND FAMILY CENTERED CARE (PFCC).

COMMUNITY INFORMATION
PART VI, LINE 4 COMMUNITY INFORMATION: CENTRAL VERMONT MEDICAL CENTER PRIMARILY SERVES RESIDENTS OF WASHINGTON COUNTY AND NEIGHBORING COMMUNITIES IN CALEDONIA, CHITTENDEN, LAMOILLE, AND ORANGE COUNTIES. DEMOGRAPHICS: -SINCE 2010, VERMONT SAW A SMALLER INCREASE IN POPULATION (+2.8%) THAN US OVERALL (+7.4%). THE WASHINGTON COUNTY POPULATION WAS GENERALLY STAGNANT, INCREASINGLY 0.5% OR 273 PEOPLE FROM 2010, ENDING WITH A POPULATION OF 59,807. -FROM 2010 TO 2020, THE WHITE POPULATION DECLINES -5.3%. THE LARGEST POPULATION INCREASES WERE SEEN AMONG MULTIRACIAL (+2,642 PEOPLE) AND OTHER RACE (+316 PEOPLE) INDIVIDUALS. DESPITE INCREASING DIVERSITY, THE WHITE POPLUATION IN WASHINGTON COUNTY IS APPROXIMATELY 90% OF RESIDENTS. -APPROXIMATELY 19% OF WASHINGTON COUNTY AND VERMONT RESIDENTS ARE AGED 65 OR OLDER COMPARED TO 15.6% NATIONWIDE. THE YOUTH POPULATION UNDER AGE 18 IS PROPORTIONATELY SMALLER IN WASHINGTON COUTY AND VERMONT THAN THE NATION, ESTIMATED AT 19% VERSUS 22.6%. -APPROXIMATELY 11% OF VERMONT AND WASHINGTON COUNTY RESIDENTS LIVE IN POVERTY COMPARED TO 13.4% NATIONALLY. -WITHIN WASHINGTON COUNTY, CHILDHOOD POVERTY IS HIGHER IN THE CABOT ZIP CODE 05647 (33.5%), WATERBURY CENTER ZIP CODE 05677 (27.0%), AND BARRE ZIP CODE 05641 (24.8%). -SINCE THE 2019 CHNA THE WASHINGTON COUNTY, POVERTY DECLINES FOR WHITE, BLACK/AFRICAN AMERICAN, AND LATINX RESIDENTS BUT INCREASED FOR ASIAN AND MULTIRACIAL RESIDENTS. NOTABLE, THE PROPORTION OF ASIAN RESIDENTS LIVING IN POVERTY INCREASED FROM 13.6% TO 22.4%. -IN WASHINGTON COUNTY, THE PERCENTAGE OF BLACK/AFRICAN AMERICAN RESIDENTS LIVING IN PVOVERTY (13.5%) DECLINED AND IS ONLY SLIGHTLY HIGHER THAN THE PERCENTAGE FOR WHITE RESIDENTS (10.1%), BUT THE MEDIAN HOUSEHOLD INCOME FOR BLACK/AFRICAN AMERICANS ($27,273) IS LESS THAN HALF THE MEDIAN INCOME FOR WHITES ($63,454). -APPROXIMATELY 29% OF HOMEOWNERS IN WASHINGTON COUNTY ARE CONSIDERED HOUSING COST BURDENED, A DECREASE FROM THE 2019 CHNA FINDING (31.2%) AND A SIMILAR PROPORTION AS THE STATE AND NATION OVERALL. -THE PERCENTAGE OF RENTERS COST BURDENED BY THEIR MONTHLY RENT EXPENSE DECLINED FROM THE 2019 CHNA, FROM 47.3% TO 42.9%, BUT STILL REPRESENTS MORE THAN 1 IN 4 RENTAL HOUSEHOLDS. -AS OF 2019, 12% OF VERMONT ADULTS HAD A CURRENT ASTHMA DIAGNOSIS COMPARED TO 8.9% NATIONALLY. WITHIN WASHINGTON COUNTY, AN ESTIMATED 10.7% OF ADULTS HAD AN ASTHMA DIAGNOSIS. ACCESS TO HEALTH CARE: -WASHINGTON COUNTY CONTINUES TO HAVE A LOWER PERCENTAGE OF UNINSURED RESIDENTS THAN THE STATE AND NATION AND MEETS THE HP2030 GOAL OF 92.1% INSURED RESIDENTS. -CONSISTENT WITH PRIOR YEARS OF DATA, 25.5% OF RESIDENTS HAVE MEDICAID INSURANCE (ALONE OR IN COMBINATION WITH OTHER INSURANCE). THE PERCENTAGE OF MEDICARE INSURED RESIDENTS INCREASED SLIGHTLY FROM THE 2019 CHNA FROM 19.7% TO 20.9%, A FINDING CONSISTENT WITH THE COUNTY'S AGING DEMOGRAPHIC. -WASHINGON COUNTY HAS LOW UNINSURED PERCENTAGES ACROSS ALL REPORTED RACIAL AND ETHNIC GROUPS, EXCLUDING ASIANS. THE PERCENTAGE OF UNINSURED WASHINGTON COUNTY ASIAN RESIDENTS (13.2%) MORE THAN TRIPLED FROM FIVE YEARS AGO (3.8%) AND IS MORE THAN DOUBLE THE STATEWIDE PERCENTAGE (4.8%). -WASHINGTON COUNTY HAS MORE PRIMARY CARE PROVIDERS THAN THE STATE, AND THE RATE OF PROVIDERS INCREASED FROM THE 2019 CHNA, FROM 102.4 TO 106.6 PER 100,000. DESPITE HAVING BETTER AVAILABILITY OF PRIMARY CARE PROVIDERS, BOTH WASHINGTON COUNTY AND VERMONT OVERALL HAVE SLIGHTLY LOWER PERCENTAGES OF ADULTS ACCESSING ROUTINE CARE (72%-72.5%) COMPARED TO THE NATION (75%)

AFFILIATED HEALTH CARE SYSTEM
PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM: AS OF OCTOBER 1, 2011, CENTRAL VERMONT MEDICAL CENTER, INC. (CVMC) AND THE UNIVERSITY OF VERMONT MEDICAL CENTER (UVMMC) BECAME MEMBERS OF THE UNIVERSITY OF VERMONT HEALTH NETWORK (UVMHN), AN INTEGRATED SYSTEM OF CARE SERVING THE COMMUNITIES OF VERMONT AND NORTHERN NEW YORK. THE UNIVERSITY OF VERMONT HEALTH NETWORK IS CARRYING OUT CENTRALIZED ACTIVITIES FOR THE BENEFIT OF PATIENTS OF PARTNER ORGANIZATIONS, INCLUDING IMPROVING ACCESS TO LOCAL CARE, COST SAVINGS THROUGH GREATER JOINT PURCHASING POWER, ENHANCING INFORMATION TECHNOLOGY, INCREASING ACADEMIC OPPORTUNITIES FOR PHYSICIANS, ENGAGING IN REGIONAL STRATEGIC PLANNING, AND PARTICIPATING IN JOINT QUALITY AND CLINICAL INITIATIVES. SINCE THE HEALTH NETWORK'S INCEPTION, CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MEDICAL CENTER, ELIZABETH COMMUNITY HOSPITAL, ALICE HYDE MEDICAL CENTER, PORTER MEDICAL CENTER, AND UVM HEALTH NETWORK HOME HEALTH & HOSPICE HAVE ALSO JOINED.