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Title: Holy Cross Hospitals Community Benefit Plan and FY05 Annual Work Plan


1
Holy Cross Hospitals Community Benefit Plan and
FY05 Annual Work Plan
  • Approved by the Holy Cross Hospital Board of
    Trustees
  • October 14, 2004

2
Holy Cross Hospitals Community Benefit
PlanContents
  • Holy Cross Hospitals Community Benefit Plan,
    including the annual work plan, articulates
    overarching strategic
  • objectives and annual initiatives for meeting
    identified community healthcare needs. The focus
    of this plan is on promoting
  • access and improving community health deploying
    resources toward that end and involving the
    community. The plan
  • provides methods for reporting and evaluation.
  • Contents Page
  • Executive summary of Holy Cross Hospitals
    community benefit ministry......3
  • I. Statements of commitment to community
    benefit.7
  • II. Identification of unmet community healthcare
    needs and link to Holy Cross Hospitalsstrategic
    priorities and mission commitments.....
    ...8
  • III. Description of fit of community benefit plan
    within overall planning process...16
  • IV. Methods for evaluation.
    ........23
  • V. FY04 accomplishments
    25
  • VI. Annual work plan for FY05.
    .28
  • Data Supplement..
    ..32

3
Executive Summary of Holy Cross Hospitals
Community Benefit Ministry
  • The overarching goal of Holy Cross Hospitals
    community benefit ministry is to ensure access
    and improve health status, especially for the
    most vulnerable and underserved, and to be a
    leader in community service
  • Holy Cross Hospitals community benefit ministry
    is rooted in our identity and is an integral part
    of our mission our commitment is evidenced by
  • written statements (e.g., mission and role
    operating plan target for community benefit),
  • organizational structures (e.g.,
    interdepartmental CEO Review Committee on
    Community Benefit Mission and Planning Committee
    of the board of trustees),
  • policies (e.g., charity care policy
    comprehensive coverage by hospital and
    hospital-based physicians), and
  • the allocation of institutional resources (e.g.,
    9.7 million in FY04)
  • Holy Cross Hospitals community benefit
    activities focus on access and community health
    improvement especially for women and children
    seniors and racial, ethnic and linguistic
    minorities
  • We leverage our strengths and match our strategic
    priorities to identified community needs
  • We strive to maintain our leadership position in
    community benefit activity and monitor and
    evaluate our progress through integrated
    management and governance processes
  • We provided 9.6 million in community benefit
    activity during FY04

4
Executive Summary (cont.)
  • We work in partnership with community
    organizations for example
  • Our parish nurse program has relationships with
    36 faith communities plus 10 under development
  • Our senior fit program is offered in partnership
    with Kaiser Permanente, Montgomery County
    Department of Recreation, and Maryland National
    Capital Parks and Planning Commission during
    FY05, we are partnering with the National Council
    on the Aging to carry out an impact study
  • We have an exclusive Maternity Partnership
    program with Montgomery County Department of
    Health and Human Services, which served 1,596
    uninsured women during FY04
  • During FY04, we expanded our partnership with
    Montgomery County around ethnic health promotion.
    With grant funding from the State of Maryland,
    Minority Office and Technical Assistance
    Cigarette Restitution Fund, the Community
    Ministries of Rockville, and CASA of Maryland
    will partner with us to provide technical
    assistance and train 30 ethnic health promoters
  • We have partnered with the Housing Opportunities
    Commission of Montgomery County, Montgomery
    County Department of Health and Human Services,
    and the State of Marylands Department of Aging
    to provide our senior source in a Section 8,
    Housing and Opportunities senior housing facility
    adjacent to the Elizabeth House in Silver Spring

5
Executive Summary (cont.)
  • During FY04, our accomplishments included
  • Improved access
  • Provided 6.3 million in charity care (5.3
    million at cost) and raised the income level for
    charitable assistance
  • Provided prenatal and obstetrical care to 1,596
    maternity partnership admissions and secured
    additional supplemental funding for FY04 and
    removal of the cap on the number of
    county-funded enrollees going forward
  • Opened Holy Cross Health Center at Montgomery
    College
  • Increased the number of foreign and sign language
    interpretations
  • Increased the number of parish nurse screenings,
    visitations, and newsletter mailings
  • Referred 48 uninsured patients to 23 specialty
    physicians
  • Provided clinical breast examinations, diagnostic
    studies, and links to treatment for medically
    underserved women who are ineligible for county
    cancer control programs
  • Reached targeted populations
  • Seniors Increased participation in senior
    exercise programs
  • Women/Children Increased participation in
    perinatal programs
  • Racial and Ethnic Minorities Increased
    participation in ethnic health promotion program
  • Improved monitoring via better data collection
  • Provided leadership
  • Selected for national longitudinal study on the
    impact of senior exercise programs
  • Became project director in a partnership to build
    ethnic health promotion capacity in the county
  • Initiated conversation with county hospital CEOs
    about additional hospital-owned primary care
    health centers

6
Executive Summary (cont.)
  • During FY05, we plan to
  • Create a plan to improve data collection and
    analysis and improve our ability to meet language
    needs
  • Monitor bilingual capacity by unit and recruit
    bilingual clinical and non-clinical staff in
    areas of high interpretation demand
  • Open Holy Cross Hospital Senior Source in Silver
    Spring
  • Work with Montgomery County hospital CEOs and
    Montgomery County government to create additional
    hospital-owned primary care capacity
  • Participate in the National Council on the
    Agings longitudinal study on the impact of
    senior exercise
  • In-service emergency center, hospitalists, and
    applicable units/departments regarding the health
    centers services and continue to understand
    relationship of health center visits to emergency
    center use
  • Secure additional outside grant funding
  • Serve as project director for State of Maryland
    Cigarette Restitution Grant, Minority Office and
    Technical Assistance grant to train 30 ethnic
    health promoters

7
I. Statements of Commitment to Community
BenefitHoly Cross Hospitals community benefit
ministry is rooted in our identity as a Catholic
healthcare provider and is an integral part of
our mission our commitment is evidenced by
written statements, organizational structures,
policies, programs, and especially the allocation
of institutional resources
  • The overarching goal of Holy Cross Hospitals
    community benefit ministry is to ensure access
    and improve health status, especially for the
    most vulnerable and underserved, and to be a
    leader in community service
  • Holy Cross Hospital is committed to a program of
    community benefit through our mission and role to
    be the most trusted provider of healthcare
    services, with special emphasis on access for the
    vulnerable and underserved (especially women
    children seniors and racial, ethnic and
    linguistic minorities) and improvements in health
    status
  • We have established and improved explicit charity
    care policies and procedures, and we encourage
    physician and employee participation in providing
    services for the needy and the broader community
  • Key elements of our charity care policy are
    active communication, comprehensive coverage of
    services provided by the hospital and
    hospital-based physicians, and a six month period
    of eligibility
  • We work to assess eligibility for public programs
    and provide enrollment support
  • We participate with other organizations in the
    community to leverage community resources toward
    mutual goals
  • We have established leadership accountability and
    an organizational infrastructure for ongoing
    planning, budgeting, implementation, and
    evaluation of community benefit activities, which
    are integrated into our multi-year strategic and
    annual operating planning processes

8
II. Identification of Unmet Community
Healthcare Needs and Link to Holy Cross
Hospitals Strategic Priorities and Mission
CommitmentsHoly Cross Hospital obtains
information about needs in our service area in a
variety of ways
  • Through participation in a variety of coalitions,
    committees, partnerships and panels
  • Employees contributed 2,293 leadership hours in
    the community
  • From our own internal patient data, and from
    purchased and publicly available data on the
    market, demographics and health service
    utilization
  • From residents in our service area
  • Through available needs assessments and reports
  • Program Prioritization to Control Chronic
    Diseases in African American Faith-Based
    Communities, April 2004
  • Community Ministries of Rockville Health Project
    Focus Groups Report, April 2004
  • National Healthcare Disparities Report, U.S.
    Department of Health and Human Services, Agency
    for Healthcare Research and Quality, July 2003
  • Blueprint for Latino Health in Montgomery County
    Maryland, 2002-2006
  • Improving the Health of Our Community, Montgomery
    County, Maryland, 2002 Progress Report
  • A Report on the Needs of Low Income Seniors,
    Montgomery County, Maryland, June 2002
  • Institute of Medicine Report, Unequal Treatment
    What Healthcare Providers Need to Know about
    Racial and Ethnic Disparities in Health Care,
    March 2002
  • Montgomery County Community Health Improvement
    Plan, July 2001
  • Community Health Indicators for the Washington
    Metropolitan Region, June 2001 (A Regional Report
    from the Metropolitan Washington Public Health
    Assessment Center)
  • Primary Care Coalition Enhancement of Safety Net
    Providers Final Report (December 12, 2000)

9
The two most recent reports provide
affirmation about what we have been doing
  • Faith-based Communities Study
  • Larger African American congregations are an
    effective vehicle by which health promotion
    messages can diffuse however, the leadership
    must be provided with skills to assess health
    needs before selecting programs most beneficial
    to their congregations Mechanisms by which small
    congregation leaders can participate need
    development
  • Community Ministries of Rockville Report
  • Most pressing needs identified by medical
    providers, caregivers and recipients
  • Regarding Health Conditions Asthma and
    respiratory disease cancer diabetes
    hypertension/cardiovascular disease mental
    health oral health obesity substance abuse
  • Regarding the Health Care System Access to
    health care complicated and gruesome system
    expensive health care help with medications
  • Regarding Case Management and Customer Service
    Efficient case management and customer service
    help to navigate the system cultural
    competence/language appropriate services
  • Regarding Health Services Information/prevention
    infant care/care for children long-term care
  • Regarding Infrastructure and Equipment More
    community clinics
  • Regarding Supportive Services More hours of
    availability transportation

10
As a leader, Holy Cross Hospital sometimes
identifies and responds to community needs before
the needs are identified in available needs
assessments
  • The Senior Fit exercise program was developed
    seven years ago by Holy Cross Hospital in
    partnership with Kaiser Permanente, Montgomery
    County Department of Recreation, and the Maryland
    National Capital Parks and Planning in Prince
    Georges County
  • Three years after its development, the program
    was identified as a recommended strategy by
    Montgomery County in its July 2001 Needs
    Assessment
  • During FY03, the National Council on the Aging in
    a national competition judged Senior Fit to be
    one of 10 award-winning national programs
  • During FY04, the National Council on Aging
    selected Senior Fit as one of only three programs
    nationally to participate in a longitudinal study
    to measure the impact of fitness activities on
    the health and quality of life of older
    participants during FY05
  • The Parish Nurse program, developed in 1993, was
    a pioneer in preventive health services and
    promotion in partnership with faith communities
  • Our program was the first in the area and is a
    widely replicated model we have partnered with
    36 faith communities with over 70,000 members in
    Montgomery County, Prince Georges County, and
    the District of Columbia, with 10 additional
    congregational relationships under development
  • Holy Cross Hospital continues to serve as a
    local, regional and national model and resource
    for others

11
Leadership (cont.)
  • The ethnic health promoter program began during
    2002 with funding from Montgomery County through
    the Cigarette Restitution Fund and matched by
    Holy Cross Hospitals community benefit fund
  • This approach has been identified by experts in
    community health as powerful and Holy Cross
    Hospital is at the forefront locally
  • During FY05, Holy Cross Hospital will serve as
    the project director on a grant funded by the
    State of Maryland, Minority Office and Technical
    Assistance to build capacity in ethnic health
    promotion and cancer control and tobacco
    prevention with key partners Montgomery Countys
    African American Health Program, Latino Health
    Initiative, and the Asian American Cancer
    Program community-based organizations CASA of
    Maryland, and Community Ministries of Rockville
  • During FY04, Holy Cross Hospital took the lead
    and engaged the Montgomery County hospital chief
    executive officers in a conversation about
    creating additional community health centers
    funded by the hospitals and in part by Montgomery
    County
  • An outline of the Montgomery County hospitals
    response to serve the uninsured has been
    developed a position paper will be developed and
    follow-up will take place with key
    representatives of Montgomery County government
    to talk about implementation and shared financing

12
Demographic analysis (detail is included in
attached data supplement) reveals that areas
close to the hospital have a large number of
people who are...
  • Poor
  • Child-bearing age
  • Elderly
  • Racially and ethnically diverse
  • Limited English speaking

13
To select outreach priorities, Holy Cross
Hospital linked identified community healthcare
needs to our strengths and own mission commitments
  • Needs Identified in Montgomery County
  • and Valid in Prince Georges County
  • Infant mortality
  • Asthma
  • Colorectal cancer
  • Cardiovascular disease
  • Diabetes
  • HIV/AIDS
  • Identified barriers to access
  • Financial access
  • Geographic access
  • Cultural access
  • Identified need to improve data, especially
    cultural
  • Holy Cross Hospitals Strategic Priorities
  • Women/children
  • Cancer
  • Cardiac
  • Seniors
  • Holy Cross Hospitals Mission Commitments
  • Access, especially for vulnerable and underserved
  • Outreach to targeted populations
  • Demonstrated improvements in health status

Identified priority health problems based on
substantial racial or ethnic disparity county
rate higher than state rate and/or county rate
higher than national rate targeted by Healthy
People 2010, Community Health Improvement Plan
2001 and 2002 Progress Report
14
We developed a set of principles to help
determine our highest priorities and guide our
decision making about community benefit
  • Be focused on geographically close (vs. distant)
    locations, especially in the core area
  • Meet Holy Cross Hospitals strategic focus and
    identified community need
  • Women/children (particularly infant mortality,
    asthma)
  • Cancer (particularly in racial and ethnic
    minorities)
  • Cardiovascular disease (particularly in racial
    and ethnic minorities)
  • Seniors (particularly cardiovascular disease,
    obesity and diabetes)
  • Meet Holy Cross Hospitals overall commitment to
    access and identified community need
  • Financial access (particularly charity care
    policy)
  • Geographic access (particularly offsite locations
    including Piccard Clinic and Health Center 20
    senior exercise sites 36 parish nursing sites)
  • Cultural access (particularly multicultural
    access program and ethnic health promotion
    program)
  • Meet Holy Cross Hospitals commitment to health
    status improvement and build upon our strengths
  • Have measurable outcomes and be integrated with
    planning and budgeting
  • Reflect partnership

15
After reviewing the range of information about
community need, we have concluded that identified
community needs are consistent with our overall
strategic plan
  • The priorities identified in earlier needs
    assessments remain valid
  • The community benefit plan is an extension of the
    strategic plan, with particular emphasis on our
    mission commitments of access and health status
    improvements to leverage our strengths, it links
    to clinical priorities as well
  • Ongoing community outreach efforts will respond
    to emerging unmet community healthcare needs,
    especially as identified through our ethnic
    health promotion program

16
III. Description of Fit of Community Benefit
Plan within Overall Planning ProcessThe
Community Benefit Plan is a key planning document
in Holy Cross Hospitals portfolio of plans
  • Holy Cross Hospitals strategic plan is the key
    planning document that provides the vision and
    multi-year direction for accomplishing our
    mission within our environment and focuses on
  • working with physicians to grow volume
    (especially through program development in six
    programmatic areas women and children cancer
    care seniors emergency surgery, and cardiac
    services),
  • ensuring our ability to grow (through strategies
    in key areas workforce, efficiency,
    philanthropy, information, and facility),
  • providing the best possible outcome in a safe and
    caring environment (through nursing excellence,
    patient safety, quality and patient
    satisfaction), and
  • demonstrating commitment to community health
    improvement (through financial access targeted
    outreach leadership/advocacy and
    monitoring/evaluation)
  • The community benefit plan includes statements of
    organizational commitment identification of
    unmet community needs a description of the fit
    of the plan within the overall planning process
    methods for evaluation and an annual work plan
    based on accomplishments achieved to date. The
    community benefit plan receives the same level of
    senior management attention and governance
    oversight as the organizations budget, human
    resources plan, and quality plan.
  • The annual operating plan highlights special
    fiscal year initiatives for achieving specific
    organizational targets in community benefit,
    growth, human resources, budget and finance,
    quality and service, philanthropy, and facility.

17
Holy Cross Hospitals planning process integrates
community benefit planning within the overall
strategic and operating planning processes
MISSION AND ROLE Most trusted provider high
quality and efficiency access outreach and
health status improvements caring spirit
ENVIRONMENT Population,
utilization, births, uninsured, physicians,
workforce, quality (safety, clinical
outcomes, satisfaction), costs, rate regulation
VISION Working with physicians to grow volume,
with a particular emphasis on developing complex
services Ensuring our ability to grow Providing
the best possible outcome in a safe and caring
environment Demonstrating our commitment to
community health improvement
STRATEGIC PLAN Growth
Ability to Grow
Quality Community Health Program market
Workforce Evidence-based
practice Financial access development
Efficiency Nursing
excellence Targeted outreach Physician relations
Fundraising Patient safety
Facility
Patient satisfaction
Information systems
ANNUAL OPERATING PLAN includes select initiatives
and annual targets from
Community Benefit
Budget and Finance
Quality and Service
Human Resources
Growth
Facility
Philanthropy
Human Resources Plan
Capital and Operating Budget Info. Sys. Plan
Performance Improvement Plan Plan for Nursing
Excellence
Strategic Plan Growth Plan Phys. Dev. Plan
Master Facility Plan
Fund Development Plan
Community Benefit Plan / Annual Target
Key Planning Documents
Holy Cross Hospital Community Benefit Plan and
FY05 Annual Work Plan
17
18
Mission and Role Statement Holy Cross
Hospitals planning process begins with our
mission, which guides all that we do
  • We serve together in Trinity Health, in the
    spirit of the Gospel, to heal body, mind and
    spirit, to improve the health of our communities,
    and to steward the resources entrusted to us
  • Respect
  • Social justice
  • Compassion
  • Care of the poor and underserved
  • Excellence
  • Holy Cross Hospital of Silver Spring exists to
    support the health ministry of Trinity Health and
    to be the most trusted provider of healthcare and
    related services in our area through
  • The high quality and efficiency of the services
    we provide in partnership with our physicians and
    others
  • The accessibility of those services to people
    living within our service area, especially the
    most vulnerable and underserved
  • The breadth of our community outreach and our
    demonstrated commitment to improve health status,
    and
  • The friendly, caring spirit we extend to every
    individual

19
Environment Holy Cross Hospital pursues its
mission in the context of the environment
  • The population in the market that we serve has
    grown the past few years and is expected to
    continue to grow and become more diverse both
    racially and ethnically.
  • Inpatient and outpatient utilization rates have
    been rising nationally and locally. We
    anticipate use rates will continue to grow,
    although the pace of growth will slow.
  • The number of births in the area will continue to
    increase, with a high rate of births to immigrant
    women.
  • The problem of the uninsured will continue for at
    least the current planning horizon.
  • Holy Cross has a very large medical staff. These
    physicians will continue to practice at multiple
    hospitals and to seek ways to be more efficient
    when in the hospital to allow more time for
    office visits.
  • Clinical workforce shortages will continue to
    exist. Holy Cross will continue to have a very
    diverse workforce.
  • Quality (safety, clinical outcomes and
    satisfaction) will continue to be an important
    source of differentiation and increasingly will
    be monitored by regulatory bodies, purchasers and
    the public.
  • Costs to deliver high quality care will continue
    to rise, particularly driven by labor and
    pharmaceutical costs.
  • Rate regulation will remain in effect at least
    through the current planning horizon.

20
VisionHoly Cross Hospital will succeed in its
environment and accomplish its mission of
becoming the most trusted provider of healthcare
and related services in our area by...
  • Working with physicians to grow volume, with a
    particular emphasis on developing selected
    complex services
  • program and market development
  • physician relations
  • Ensuring our ability to grow
  • workforce effectiveness and commitment
  • efficiency of our people and processes
  • fundraising
  • facility
  • information systems
  • Providing the best possible outcome in a safe and
    caring environment
  • evidence-based practice
  • nursing excellence
  • patient safety
  • patient satisfaction
  • Demonstrating our commitment to community health
    improvement
  • financial access
  • targeted outreach
  • leadership
  • monitoring and evaluation

21
Three-Year Strategic PlanThe FY04-06 strategic
plan outlines four broad community health
strategies, which are the overarching objectives
of the FY05 community benefit annual work plan
  • FY04-06 community health strategies
  • Provide general financial access to the poor and
    vulnerable
  • Do so in accordance with our mission and charity
    care policy
  • Target populations for special outreach,
    especially in the core market area, in
    partnership with others enhance geographic and
    cultural access and improve health status
  • Increase access to primary care for uninsured and
    underinsured people and address use of emergency
    department for urgent/primary care by uninsured
    people
  • Increase capabilities to understand and meet
    needs of diverse patient population
  • Maintain leadership/advocacy position in
    community benefit activity
  • Increase advocacy regarding the uninsured
  • Increase role as a resource for health
    information
  • Monitor and evaluate progress

22
Annual Operating PlanHoly Cross Hospitals
FY05 operating plan (the second year of our
three-year planning horizon) identifies a
specific organizational target for community
benefit
  • Community benefit target
  • Improve data collection to establish a baseline
    related to interpretation needs, set improvement
    target and meet it
  • Special initiative for FY05
  • Targeting Racial and Ethnic Minorities and
    Cultural Access
  • Evaluate and respond to special needs of our
    diverse population special focus on meeting
    language difficulties

23
IV. Methods for EvaluationHoly Cross Hospital
has developed specific methods for monitoring and
evaluating progress toward community benefit
objectives
  • The annual hospital budgeting process includes a
    charity care target and designated operating
    funds for the Community Benefit Fund, community
    health, parish nursing, OB/GYN clinic, the Holy
    Cross Health Center at Montgomery College,
    multicultural services, and the senior source
  • The interdepartmental CEO Review Committee on
    Community Benefit develops the community benefit
    plan, including the annual work plan and monitors
    progress on a quarterly basis the senior
    management team reviews progress semi-annually
  • The Mission and Planning Committee of the board
    of trustees provides governance oversight and
    monitors selected community benefit performance
    indicators on a quarterly basis
  • The Community Benefit Plan, including the annual
    work plan, is presented for full board of
    trustees discussion and approval in October of
    each year a subset of the community benefit
    performance indicators are shared with the board
    of trustees on a quarterly basis

24
Evaluation MethodologyEvaluation of Holy Cross
Hospitals community benefit plan is integrated
into seniormanagement and governance oversight
processes
ANNUAL OPERATING PLAN includes select initiatives
and annual targets from
Community Benefit
Budget and Finance
Quality and Service
Human Resources
Growth
Facility
Philanthropy
Human Resources Plan
Capital and Operating Budget/ Info. Sys. Plan
Performance Improvement Plan/Plan for
Nursing Excellence
Strategic Plan / Growth Plan/Phys.Dev. Plan
Master Facility Plan
Fund Development Plan
Community Benefit Plan / Annual Target
Key Planning Documents
Management
Governance
24
Holy Cross Hospital Community Benefit Plan and
FY05 Annual Work Plan
25
V. FY04 AccomplishmentsProgress on last
years initiatives sets the stage for the FY05
work plan
  • During FY04 (and compared to FY03), our
    accomplishments included
  • Improved access
  • Provided 6.3 million in charity care (5.3
    million at cost), an increase of 18 percent and
    972,000
  • Raised the income level for charitable assistance
    at Holy Cross Hospital to 300 percent of poverty
    from 200 percent of poverty and secured
    hospital-based physician participation
  • Provided prenatal, obstetrical and newborn care
    to 1,596 maternity partnership admissions (a 12
    percent increase from 1,431) with 85 entering in
    the first and second trimesters, and secured an
    additional 211,000 in supplemental funding for
    FY04 and removal of the cap on the number of
    county-funded enrollees going forward
  • Opened Holy Cross Health Center at Montgomery
    College on February 2, 2004 and saw 400 patients
    during the first five months of operation
  • Improved the collection of registration data on
    racial, ethnic, and linguistic minorities by
    altering the registration screens to reflect
    Census categories, primary language, and need for
    an interpreter
  • Reported 8,683 foreign and sign language
    interpretations, an increase of 73 percent from
    5,017
  • Increased the number of parish nurse screenings
    to 320 from 200, the number of visitations to 150
    from 100, and the number of newsletter mailings
    to 1,200 from 1,105
  • Referred 48 uninsured patients to 23 specialty
    physicians (with 31 physicians participating in
    the safety net) primarily through the ethnic
    health promotion program, community health
    outreach, Cancer Education Day, and
    Back-to-Health (Spine) Day
  • Provided clinical breast examinations, diagnostic
    studies (i.e., mammograms, ultrasounds, and MRI),
    and links to treatment (i.e., surgery, oncology
    and radiation therapy) for medically underserved
    women who are ineligible for county cancer
    control programs with additional financial
    support from Maryland Regional Cancer Care and
    Susan G. Komen Breast Cancer Foundation

26
FY04 Accomplishments (cont.)
  • Reached targeted populations
  • Seniors
  • Enrolled 5,464 participants in senior exercise
    programs with 46,045 encounters (an increase from
    5,213 and 42,739 respectively)
  • Oversaw renovation of space in a Housing
    Opportunities Commission site in Silver Spring,
    and planned for the relocation of our senior
    source activities to Silver Spring from Bethesda
  • Women/Children
  • Enrolled 9,469 participants in perinatal
    programs, an increase of 10 percent increase and
    824 participants from 8,645
  • Served as health resource by registering 1,200
    parents for our parent e-newsletter, the highest
    in the country and an increase from 200
  • Racial and Ethnic Minorities
  • We increased the number of participants in our
    ethnic health promotion program to 10,984 from
    3,325, with 72 percent and 7,873 participants of
    targeted ethnic origin the number of screenings
    increased to 1,092 from 73 and the number of
    teachings increased to 500 from 77
  • Increased community health outreach grant funding
    38 percent to 313,000 from 226,000

27
FY04 Accomplishments (cont.)
  • Improved monitoring
  • Data collection maintained and improved for range
    of community benefit activities, including
    Maternity Partnership, registrations by primary
    language, interpretations, senior exercise
    programs, community health programs, perinatal
    programs, parish nursing programs, and ethnic
    health promotion
  • Established data collection systems for Holy
    Cross Health Center at Montgomery College
  • Provided leadership
  • Selected by the National Council on the Aging as
    one of only three sites nationally to participate
    in a longitudinal study on the impact of senior
    exercise programs and received Institutional
    Review Board approval to proceed
  • Increased the number of parish nursing
    relationships to 46 churches (including 36
    established relationships and 10 under
    development (and added our first Hispanic
    congregation to 12 African American
    congregations) with the number of church members
    increasing to 87,000 from 70,000
  • Became project director in a partnership with
    county government and community based
    organizations to build capacity and cultural
    competence, facilitated by ethnic health
    promoters under a state-funded grant
  • Initiated conversation with Montgomery County
    hospital CEOs about additional hospital-owned
    primary care health centers
  • Need more/continued work on
  • Re-application for Foster McGaw award the
    application process strengthened our ability to
    quantify major activities and demonstrate
    integration of community benefit with hospital
    governance, management and operations
  • Developing better charity care monitoring to
    track applications and improve understanding of
    charity care profile
  • Development of health status indicators to be
    monitored

28
VI. FY05 Annual Work Plan 1. Provide
general financial access to the poor and
vulnerable and do so in accordance with our
mission and charity care policy
  • Priorities to be addressed Financial Access and
    Women/Children
  • Initiatives
  • Ensure financial access through the charity care
    program, especially the ob/gyn clinic and the
    health center at Montgomery College
  • Track charity care applications, approvals, and
    referrals to other programs and improve
    understanding of charity care profile
    (participants, inpatient/outpatient mix, service
    line, and referral source)
  • Review impact of ethnic health promotion program
    on enhancing access and links to treatment
  • Work with Holy Cross Hospital physicians and
    Project Access to improve access to specialty
    physician safety net

29
2. Target populations for special outreach,
especially in the core market area, in
partnership with others enhance geographic and
cultural access and improve health status
  • Priorities to be addressed Uninsured and
    Racial/Ethnic Minorities, Geographic and Cultural
    Access
  • Seniors, Cancer and Cardiac
  • Operating Plan Item
  • Create a plan to improve data and improve our
    ability to meet language needs and enhance
    cultural access
  • Establish a monthly reporting system on
    non-English registrations, identified need for
    interpreter, and number of interpretations
    provided Analyze baseline data and improve data
    collection process Improve understanding of
    hospital and community demographics Review best
    practices on data collection and meeting language
    needs Assess current capability and determine
    gaps and methods for closing the gaps
  • Establish multidisciplinary committee to focus on
    this issue engage foreign born physicians
  • Identify and enroll key clinical individuals,
    including physicians, in Command Spanish course
  • Develop methods to monitor interpretation demands
    and bilingual capacity by unit Recruit bilingual
    staff (clinical and non-clinical) in areas of
    high interpretation demand
  • Other Initiatives
  • Open Holy Cross Hospital Senior Source in Silver
    Spring
  • In-service emergency center, hospitalists, and
    applicable hospital units and departments
    regarding health center capabilities and
    services pursue additional funding and full time
    provider relationships
  • Identify opportunities to leverage Parish Nursing
    relationships
  • Develop plan to carry out research related to
    health center, parish nursing, ethnic health
    promotion, and senior fit as described in
    Certificate of Need for open heart surgery
  • Review restricted and unrestricted funds for
    community benefit and establish plan for
    expenditure
  • Create four new Senior Fit sites for the National
    Council on the Aging Impact Study

30
3. Maintain leadership/advocacy position in
community benefit activity
  • Priorities to be addressed Overall Commitment
    to Access and Identified Community Need and
    Reflect Partnership
  • Initiatives
  • Lead conversation with Montgomery County hospital
    CEOs and key individuals to plan for additional
    primary care health centers in Montgomery County
    sponsored by the hospitals and supported in part
    by the County
  • Explore and consider innovations in charity care
    reimbursement under Marylands rate system to
    encourage improvements in access
  • Serve as project director for Minority Outreach
    and Technical Assistance grant to train 30 ethnic
    health promoters with community partners
  • Re-submit qualified application for Foster McGaw
    Prize
  • Explore partnering with area baccalaureate
    nursing schools clinical rotations on two levels
    1) perinatal education (e.g., program
    development and teaching), and 2) addressing the
    unmet needs in the community (e.g., health
    screening, health fairs, education and awareness)

31
4. Monitor and evaluate progress
  • Priorities to be addressed Measurable Outcomes
  • Initiatives
  • Continue to improve monitoring of health center
    activity, especially with respect to emergency
    department use
  • Explore better methods of ensuring house-wide
    participation in quarterly community benefit data
    collection effort hold in-service explore
    automation or web-based approach to data
    collection
  • Write and print FY04 Community Benefit Report
    understand differences in community benefit
    activity compared with FY03 understand
    expectations for first year peer reporting in
    Maryland and submit report
  • Participate in National Council on the Agings
    longitudinal study on senior exercise and report
    progress and results
  • Explore new software tool and develop methods to
    improve data collection on parish nursing and
    community health activities and ascertain
    improvements in health status and consistency
    with current methods
  • Establish charitable gifts and grants policy and
    comply with review process as determined for
    outreach grants
  • Evaluate performance toward goals of outreach
    grants
  • Maintain CEO Review, operating plan, and board
    monitoring and evaluation processes and develop
    new or alternative performance indicators as
    needed

32
Data Supplement
33
Holy Cross Hospital serves a four-area market in
Montgomery and Prince Georges Counties (with 56
of patients residing in the core service area and
the Northern Prince Georges County service area)
Montgomery Referral
Core
Northern Prince Georges
Primary Service Area
Prince Georges Referral
Patient Origin
Washington D.C.
Core (45)
Northern Prince Georges (11)
Prince Georges Referral (10)
Montgomery Referral (18)
Source Inforum
33
Holy Cross Hospital Community Benefit Plan and
FY05 Annual Work Plan
34
Demographic analysis reveals that Areas close to
the hospital generally have a greater number of
poor households
Number of Households with Income the top 10 ZIP codes are in our primary service
area
Number of Medicaid, Charity, and Self Pay
Discharges 6 of the top 10 ZIP codes are in our
primary service area
Source Inforum (2002 Demographic Data from
Claritas)
35
Areas close to the hospital generally have a
greater number of seniors and women of
childbearing age
Number of Seniors (Ages 65) 5 of the top 10 ZIP
codes are in our primary service area
Number of Women of Childbearing Years (Ages
18-44) 5 of the top 10 ZIP codes are in our
primary service area
Source Inforum (2002 Demographic Data from
Claritas)
35
36
Montgomery and Prince Georges Counties are
racially diverse
White Population 1 of the top 10 ZIP codes is in
our primary service area
Black Population 1 of the top 10 ZIP codes is in
our primary service area (3 of the ZIP codes in
Montgomery Co. with the greatest number of
African Americans are in our core market area)
Source Inforum (2002 Demographic Data from
Claritas)
36
37
Areas close to the hospital have the highest
numbers of foreign born and linguistic minorities
Number of Foreign Born 6 of the top 10 ZIP codes
are in our primary service area
Number that Speak Limited English 7 of the top 10
ZIP codes are in our primary service area
Source U. S. Census Bureau (Census 2000,
Summary File 3, QT-P15)
37
Holy Cross Hospital Community Benefit Plan and
FY05 Annual Work Plan
38
Areas near the hospital are ethnically diverse,
with the highest numbers of Hispanic persons
Hispanic Population 7 of the top 10 ZIP codes are
in our primary service area
Source Inforum (2002 Demographic Data from
Claritas)
39
Non-English Speaking Inpatient Registrations in
Montgomery and Prince Georges Counties
FY03 Inpatient Registrations
FY04 Inpatient Registrations
39
Source Clinstar
40
Non-English Speaking ED Registrations in
Montgomery and Prince Georges Counties
FY03 ED Registrations
FY04 ED Registrations
40
Source Clinstar
41
Healthcare needs identified in Montgomery
County are valid in Prince Georges County as
well -- especially racial and ethnic disparities
  • Infant Mortality Rate Deaths per 1,000 births
  • Prince Georges County - 12.6
  • Montgomery County - 6.5
  • Washington, DC - 13.6
  • US average - 7.2
  • Healthy People 2010 Target - 4.5
  • Adults, 50 and Older, Having a Fecal Occult Blood
    Test in Past 2 Years ()
  • Prince Georges County - 29
  • Montgomery County - 42
  • Washington, DC - 41
  • US average - 35
  • Healthy People 2010 Target - 50
  • Coronary heart disease Age-Adjusted Death Rate
    (per 100K)
  • Prince Georges County - 228
  • Montgomery County - 142
  • Washington, DC - 213
  • US average - 216
  • Healthy People 2010 Target - 166
  • Diabetes-related DeathsAge-adjusted Death Rate
    (per 100K)
  • Prince Georges County - 120
  • Montgomery County - 60
  • Washington, DC - 99
  • US average - 75
  • Healthy People 2010 Target - 45

Note Although Montgomery Countys rates are
better that the US average and/or Healthy People
target in some cases, the County
selected these priorities based on racial and
ethnic disparities
Source Community Health Indicators for the
Washington Metropolitan Region,
Metropolitan Washington Public Health Assessment
Center, June 2001
41
Holy Cross Hospital Community Benefit Plan and
FY05 Annual Work Plan
42
Holy Cross Hospital offers clinical and outreach
programs beyond the Silver Spring campus but
focuses nearby
Clinical and Outreach Services in Montgomery and
Prince Georges Counties and the District of
Columbia
Montgomery County
Rockville
?
Bethesda
Prince Georges County
District of Columbia
?
Holy Cross Hospital
?
Parish Nurse Program
?
Senior Fit
?
Holy Cross Off Site Locations
42
Holy Cross Hospital Community Benefit Plan and
FY05 Annual Work Plan
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