Northern Neck Community Needs Assessment

1. Northern Neck Community Needs Assessment Presentation to the Riverside Tappahannock Board of Directors

2. Four New IRS Requirements for Charitable 501(c)(3) Hospitals With The Affordable Care Act (ACA) • Section 501 (r) of the ACA requires each 501(c)(3) hospital organization on a facility-by-facility basis to • Establish written financial assistance and emergency medical policies • Limit amounts charged for emergency or other medically necessary care to individuals eligible for assistance under the hospital’s financial assistance policy. • Make reasonable efforts to determine whether an individual is eligible for assistance under the hospital’s financial assistance policy before engaging in extraordinary collection actions against an individual and • Conduct a Community Health Needs Assessment (CHNA) at least once every three years. • This CHNA requirement is effective for tax years beginning after March 23, 2012. • Must adopt a written implementation strategy to address identified community needs • Include input from persons who represent the broad interest of the community • Include input from persons having public health knowledge or expertise • Make assessment widely available to the public • Failure to comply is $50,000 fine per tax year

3. CHNA Benefits • Identify key opportunities for clinical offerings. • Identify opportunities for community health outreach. • Solidify population health understanding during transition to ACO markets. • On the Northern Neck – provides opportunity to connect with community leaders to help emphasize the importance of a local, community hospital dedicated to community needs.

4. Who and How… • Riverside commissioned Community Health Solutions to conduct a community health needs assessment of the Riverside Tappahannock Hospital service area. • The RTH service area spans 35 ZIP codes across Essex, King & Queen, King Williams, Lancaster, Northumberland, Richmond and Westmoreland Counties. • Methodology: Two Pronged Approach • Community Insight Profile • Qualitative analysis from survey of community stakeholders • Community Indicator Profile • Quantitative analysis from community health status indicators

5. Community Insight Profile • Survey sent to 88 community stakeholders • Response rate of 49% (43) • Survey participants were asked to provide viewpoints on: • Important health concerns in the community; • Significant service gaps in the community; and • Ideas for addressing health concerns and service gaps

6. Organizational Affiliations of Survey Respondents • Bay Rivers Telehealth Alliance • Colonial Beach Public Schools • Essex County Emergency Services • Essex County Board of Supervisors • Essex County Chamber of Commerce • Essex County Department of Social Services • Essex County Public Schools • Essex County Sherriff’s Office • First Baptist Church • King & Queen County Board of Supervisors • King & Queen County Social Services • King William County Emergency Services • King William County Public Schools • King William Pharmacy • King William Social Services • Lancaster County Department of Social Services • Middle Peninsula Northern Neck Community Services Board • Northumberland County Board of Supervisors • Northumberland County Chamber of Commerce • Northumberland County Department of Social Services • Northumberland County Sherriff’s Office • Northumberland Elementary School • Richmond County Department of Social Services • Richmond County Sherriff’s Office • Richmond County YMCA • Riverside Health System – Physician (7) • Riverside Tappahannock Hospice • Riverside Tappahannock Home Health Agency • Tappahannock Regional Free Clinic • The Orchard • Three Rivers Health District • Town of Tappahannock (2) • Town of Warsaw • Virginia Cooperative Extension • Westmoreland Medical Center • Unknown Organization

7. Important Community Health Concerns Identified by Survey Respondents Top Health Concerns Identified: Adult Obesity Heart Disease & Stroke Cancer Diabetes Mental Health Concerns Substance Abuse – Illegal Drugs

8. Important Community Service Gaps Identified by Survey Respondents Top Service Gaps Identified: Aging Services Behavioral Health Services (including mental health, substance use and intellectual disability) Transportation Health Care Coverage Long Term Care Services

9. Community Indicator Profile The needs assessment reviewed 9 specific profiles: • Health Demographic Trend Profile • Health Demographic Snapshot • Mortality Profile • Maternal and Infant Health Profile • Preventable Hospitalization Profile • Behavioral Health Hospital Discharge Profile • Adult Health Risk Factor Profile • Child Health Risk Factor Profile • Uninsured Profile • Medically Underserved Profile

10. Highlights of Indicator Review • Compared to the rest of Virginia, the Northern Neck region • Is more sparsely populated • Has proportionately more seniors age 65+ • Has proportionately more African American residents • Has lower income levels • Has proportionately more adults without a high school education • The leading causes of death in 2010 were • Malignant Neoplasm (Cancer) • Heart disease • Cerebrovascular disease (Stroke) • The age-group death rates per 100,000 population were higher in the Northern Neck region than the statewide rates for adults age 45-64 and lower for seniors age 65+

11. Highlights of Indicator Review (cont.) • Compared to the rest of Virginia, the Northern Neck region in 2010 • Had comparable rates of low weight births • Had comparable rates of births without early prenatal care • Had higher rates of non-marital births • Had higher five-year infant mortality rates in some areas (Essex, King William, Lancaster, Richmond and Westmoreland Counties) • Had higher teen pregnancy rates • A review of the Agency for Healthcare Research and Quality’s Preventions Quality Indicators (PQI’s) showed the PQI discharge rates per 100,000 population were higher than the statewide rates for adults age 18 – 64, and lower for seniors age 65+. The leading diagnoses for these discharges were: • Congestive Heart Failure (CHF) • Bacterial Pneumonia • Chronic Obstructive Pulmonary Disorder (COPD)

12. Highlights of Indicator Review (cont.) • The Behavioral Health inpatient discharge rates per 100,000 for the Northern Neck study region in 2011 was higher that the statewide rates for children age 0-17 and lower than statewide rates for adults age 18+. The leading diagnoses for these discharges were: • Affective Psychoses • General symptoms • Schizophrenic disorders • The Health Risk Factor Profile revealed both health risks and chronic conditions prevalent in the area. • A substantial number of adults in the area may have health risks related to: • Nutrition • Physical activity • Weight • Tobacco • Alcohol

13. Highlights of Indicator Review (cont.) • The Child Health Risk Factor Profile estimates that large numbers of children in the study area are not meeting the recommendations for healthy eating, physical activity and healthy weight. • The Uninsured Profile estimates 9,059 (16%) non-elderly residents were uninsured at any given point in time. • The large majority of uninsured residents were estimated to have income at or below 200% of the federal poverty level. • All of the areas in the Riverside Tappahannock Hospital market area have full designation as Medically Underserved Areas (MUAs)

14. Action Plan and Timeline • January 22 – Present findings to Riverside Shore Memorial Board of Directors • January 22 – email thank you note and executive summary to all survey invitees • January 23 – Invite the major stakeholders to serve as the Action Plan Work Group (APWG)* • By February 15, host first meeting of APWG • By March 8, host second meeting of APWG • By March 20, finalize action plan • March 26 – Report Action Plan to Board for approval * Defined in an upcoming slide

15. Action Plan Work Group • Eastern Shore Rural Health System • Community Services Board • Hospice • Health Department • County Administrators • County School Superintendents • Eastern Shore Chamber • YMCA • ES Agency on Aging • ES Community College • Community Health Research, Eastern Virginia Medical School • ES Against Domestic Violence

16. Action Plan Recommendations • There are three “buckets” of recommendations: • Those action items that are the full responsibility of RHS • Those action items that are solved through collaborative relationships with community and not necessarily lead by RHS • Those action items that are resolved in community without the involvement of RHS

17. Questions?