Community Health Needs Assessment

1. Community Health Needs Assessment Western Maryland Health System In collaboration with Allegany County Health Department 2011

2. Background • The Patient Protection & Affordable Care Act and the Health Care Education Reconciliation Act (known together as the Affordable Care Act) mandated… • Development of a National Prevention & Health Promotion Strategy • Community Health Needs Assessment by Non-Profit Hospitals in conjunction with public health entities (Section 9007)

3. National Prevention Strategy • Vision: • Working together to improve the health and quality of life for individuals, families and communities by moving the nation from a focus on sickness and disease to one based on prevention and wellness. • Goal: • Increase the number of Americans who are healthy at every stage of life. • Strongest Predictors of health & well-being fall outside of the healthcare setting- social, economic and environmental factors all influence health. • Encourages Partnerships among State & Local Government, Businesses, Community organizations and everyday Americans.

4. Maryland Health Care Reform Coordinating Council • Established to proactively plan for pending changes at federal level • Directed State Health Department to develop State Health Improvement Plan in coordination with hospitals under Health Services Cost Review Commission • Recommended development of interconnected state and local strategic plans to achieve improved health outcomes • Maryland’s Health Improvement Plan 2011-2014 will provide a framework to support improvements in the health of Marylanders and their communities. • Improving the health of all Marylanders through population planning requires commitment of local partnerships such as the hospital, local health department, private sector, etc.

5. Community Health Needs Assessment • Expands Community Benefit Report to Health Services Cost Review Commission (HSCRC) • Required by Internal Revenue Service 990-Schedule H to justify non-profit status • Guides decision making for community and allows us to engage effectively with State and Federal Initiatives • Leads to development of Local Health Improvement Plan in partnership between the hospital and the local health department

7. National & State Plans Include: • Engagement of Partners • Alignment of Policies and Programs • Utilization of Evidence Based Research & Best Practices • Accountability

8. WMHS Community Health Needs Assessment FY11 FY12 FY13 FY14 Complete Remaining

9. WMHS Service Area

10. Patient Residence July 2009-June 2010

11. Demographics of Community • Poverty • Less Educated (Fewer college graduate and illiteracy) • Limited Diversity • Elderly Population • Single Parents and Responsible Grandparents American Community Survey 2010

12. Community Needs Index 5= Greater Community Need Based on socio-economic barriers including income, culture, education, insurance & housing. Comparison of CNI scores to hospital utilization shows a strong correlation between high need and high use. Greatest Need Lowest Need 21502- Cumberland - 3.8 26726 - Keyser - 3.8 26757- Romney– 3.8 21562 – Westernport – 3.6 21539 – Lonaconing- 3.6 21531 – Friendsville- 3.6 21536 – Grantsville – 3.6 21532 – Frostburg -3.6 21557 –Rawlings – 2.2 26753 – Ridgeley – 1.8 26710 – Burlington – 2.2 15539 – Fishertown – 1.2 15559 – Schellsburg – 2 15535 – Clearville - 2 Catholic Healthcare West and Thomson Reuters

13. Lifestyle & Environment • Unhealthy Behaviors • Tobacco Use • Substance Abuse • Limited Fruits and Vegetables • No Physical Activity • Poor Access to Healthy Food • Lack of Emotional and Social Support

14. Tobacco & Alcohol Use County Health Ranking 2011 (U of Wisconsin)

15. Food Choices and Access County Health Ranking 2011 (U of Wisconsin) and Health Indicator Warehouse

16. Physical Activity & Social Support County Health Ranking 2011 (U of Wisconsin)

17. Well Being Index Ranking of 436 Congressional Districts 2010 www.well-beingindex.com

18. Health Needs & Disease Status • Birth Measures • Health Status • Death Rates • Incidence • Usage

19. Birth Factors Kids Count 2005-2011 & Vital Statistics

20. Tobacco & Drug Use During Pregnancy MD Prenatal Risk Assessment FY10 & WV/PA Vital Statistics

21. Birth Weight & Infant Mortality Kids Count 2005-2011 & Vital Statistics

22. Health Factors County Health Ranking, 2008 CDC Trends, & Community Health Status Indicators

23. Self-Reported Health Status County Health Ranking 2011 (U of Wisconsin)

24. Mental Health Prevalence • In Allegany County, there is a 6% prevalence of mental disorders in adults and 13% prevalence among children ages 13-18 • During the first three quarters of fiscal year 2011, mental disorders have grown to be the fourth largest category of admissions at 8.01%. • Severe depression was the 6th most prevalent reason for hospital admission in past year.

25. Death Rates MD Vital Statistics & BRFSS 2009

26. Death Rates Vital Statistics 2007-2009

27. Cancer Death Rates & Incidence

28. Injuries DHMH Injuries 2005-2008

29. Top 10 Diagnoses • 2010 WMHS Emergency Department • Chest Pain • Abdominal Pain • Urinary Tract Infections • Acute Bronchitis • Sprain of Ankle • Noninfectious Gastroenteritis • Head Injury • Otitis Media (Ear Infection) • Sprain of Neck • Headache

30. Most Prevalent Diagnoses for WMHS Admissions • Natural Birth • Coronary Atherosclerosis • Pneumonia • Rehabilitation Process • Obstructive Chronic Bronchitis • Recurring Depressive Disorder • Osteoarthritis • Cesarean Birth • Chest Pain • Atrial Fibrillation • Acute Chronic Systolic Heart Failure • Septicemia • July 2010-April 2011

31. Access to Care • Payor Mix • Providers • Barriers

32. Payor Mix 2011 County Health Ranking & Community Health Status Indicators

33. Payor Mix

34. Payor Mix ACHD Mental Health Clinic Report 2010 PharmaCare Network 2010

35. Providers Needed • Top Needs: • Primary Care • Psychiatry • Other needs: • Medical Oncology • Gastroenterology • Vascular Surgery • Urology Dentists to provide care for adults with no insurance or Medical Assistance. WMHS Foundation 2011

36. Continuum of Care & Utilization County Health Ranking 2011

37. Barriers • Transportation • 11% of Allegany households are without vehicles • Allegany County Transit does not run on weekends or major holidays. • Health Literacy • US Department of Education claims only 12% of English speaking adults in the US have proficient health literacy skills • Health literacy disproportionately impacts lower socioeconomic groups • Other? American Community Survey 2010

38. Overall Needs to Consider • Economy • Education Level • Elderly Population • Lifestyle Choices • Emotional & Mental Health • Lack of Insurance • Transportation • Provider Shortages • Chronic Diseases & Risk Factors • Healthy Pregnancy & Birth

39. Current Strategies

40. Top Community Health Priorities to Address • Tobacco Cessation (especially during pregnancy) • Emotional & Mental Health (suicide rate and self diagnosed depression) • Prenatal Care – Healthy Start • Access to Care & Providers • Health Literacy • Screening & Prevention-Diabetes, Hypertension, Cancer • Substance Abuse (alcohol & drugs) • Obesity • Immunization (flu) • Heart disease & Stroke • Cancer (narrow types?) • Chronic Respiratory Disease • Dental

41. Thank you! For more information: Nancy Forlifer WMHS Community Health & Wellness 240-964-8422 Dr. Sue Raver Allegany County Health Department 301-759-5000