Executive Summary

2016 Community Health Needs Assessment Summary

Message to Community Excela Health is proud to present their 2016 Community Health Needs Assessment (CHNA) Report. The report was developed with research collaboration from the Center for Applied Research (CFAR) at the University of Pittsburgh at Greensburg and the Healthy Communities Initiative (HCI) of Xerox Corporation. This report provides findings at multiple levels of analyses. Data was collected and analyzed from primary data sources such as: key stakeholder interviews, focus groups with demographically representative community members, and a community survey. Also, secondary data sources were collected and analyzed using data sources from HCI as a starting point for the analyses conducted by CFAR. The CHNA process then included a data review with the CHNA Steering Committee followed by developing a detailed implementation plan. This plan was then crafted to allow for the implementation of best practices toward issues most concerning Excela Health in their service of Westmoreland County. The Executive Summary for the 2016 Community Health Needs Assessment for Excela Health and its three hospitals, Westmoreland, Latrobe and Frick is included below. This CHNA allows Excela Health to meet the requirements of the IRS 990, a federal requirement for non-profit health organizations and hospitals. However, the main purpose of the CHNA is to identify the health strengths and weaknesses of Westmoreland County to determine opportunities and threats, which may impact developing and enacting an implementation plan. The CHNA also provides business leaders, community groups, public health and health care providers, educational and religious institutions, policy makers and social service agencies, and Westmoreland County residents with detailed information to allow for improving community health. Developing an implementation plan will further permit these stakeholders to work toward health care outcomes based on strategic decision making. For Excela Health and other stakeholders in Westmoreland County, improving the health of the community remains an important priority. Providing education on health care, improving patient care, and implementing program improvements are ways in which Excela Health is working toward providing community resources in efforts to strengthen community health. Executive Summary In December of 2014, The IRS issued final regulations providing guidance regarding the requirements for charitable hospitals added by the Patient Protection and Affordable Care Act of 2010. The requirements include the completion and implementation of a Community Health Needs Assessment (CHNA). The initial CHNA for Excela Health was approved by the Board in May, 2013 and focused on the Community Health concern of Obesity which has been linked to Diabetes, Hypertension and Coronary Heart Disease. To address this Community Health

concern, Excela Health entered into partnerships with our Excela Health Medical Group physicians, Regional Employers, School Districts and Community -based organizations. These partnerships focused on primary physician support of lifestyle changes, healthy eating, and improved access to exercise and fitness support. Improvements have been measured and these initiatives will continue. Excela Heath has worked closely with the Center for Applied Research (CFAR) with University of Pittsburgh, Greensburg to complete the next CHNA, which will include the time period from July 2016 through June 2019. With the expertise and support of the CFAR, we have reviewed Secondary Data provided through our partnership with the Healthy Communities Institute and Primary Data through surveys, focus groups and interviews. As a result of this data and input from our diverse and very knowledgeable Community Health Steering Committee, in May, 2016 the Excela Health Board of Trustees approved that the next CHNA focus on three Community Health Issues as priorities:

1) Build on our present community partnership initiatives and continue our focus on reducing “Obesity” and the negative impacts of Diabetes, Hypertension and Coronary Heart Disease. Implementation Initiates will include continued partnerships with our Excela Health Medical Group with a focus on prevention and medical management of Diabetes. It will also include continued Partnerships with Regional Employers to provide wellness services, School Districts to support Project Fit America Programs and Regional YMCA ‘s to expand the Diabetes Prevention Programs and continued outreach programs such as Mall Walkers.

2) Add a focus on “Substance Abuse”. Implementation Initiatives will include Partnerships with Westmoreland County and the Drug Task Force and efforts from our Excela Health Medical Group and professional staff regarding developed guidelines and education for our physicians to follow and to support their medical decision in the hope of reducing the prescribing of these medications.

3) Add a focus on Women’s Health primarily related to reducing the” Incidence of Breast Cancer”. These Implementation Initiatives will include documentation and measurement of many of the initiatives presently under way through Excela Health to improve access to the diagnoses and treatment of this health concern.

These initiatives will continue to help Excela Health to make connections with the Regional Employers and the populations that we serve in our communities improving the health and well-being of every life we touch while increasing our market share as the preferred provider of Health Services in the region. The 2016 Westmoreland County Community Health Needs Assessment (CHNA) examined strengths and weaknesses of the community to provide critical information with the goal of making positive improvements in the arena of community health. The findings of this work allow community agencies and providers discussed above to engage in strategic decision making toward the goal of

improving access to resources and developing interventions to improve the health of Westmoreland County residents. In collaboration with the Center for Applied Research (CFAR) at the University of Pittsburgh at Greensburg and the Healthy Communities Initiative (HCI) of Xerox Corporation, this version of the CHNA built on an earlier effort by Strategy Solutions, Inc. designed to ensure compliance with the current Internal Revenue Service (IRS) guidelines for charitable 501 (c) (3) tax-exempt hospitals. Consistent with IRS guidelines, the service area for the Excela CHNA is defined as Westmoreland County. This primary area of health service is broad in area, diverse in demographic and socio-economic indicators, and decentralized in the provision of health care services. These conditions add to the complexity of the CHNA. When possible, the Implementation Plan will address the needs for specific populations in high-risk areas in each of the service areas for the three Excela Health hospitals. This CHNA includes detailed data collection, analysis, and evaluation of the following relevant community health areas:

Access to Quality Health Care Chronic Disease Demographic and Socio-Economic Indicators Environmental Concerns and Constraints Infectious Disease Injury Mental Health Nutrition Older Adults and Aging Physical Activity and Nutrition Substance Use and Abuse Transportation Women’s Health

Process Data Collection and Methodology Primary qualitative data collected for the CHNA includes 9 focus groups, 10 stakeholder interviews, and 526 completed community surveys from May 2015 through April 2016. These individual and group interviews were held with respondents to include a variety of Westmoreland County resident’s interests and viewpoints based on demographic, educational, and socio-economic status. These included representation from specific populations such as the medically underserved, low-income or minority groups in each of the three hospital service areas for Westmoreland, Latrobe and Frick Excela Health hospitals.

Questions posed during these sessions allowed us to gather detailed information on knowledge and perceptions on the strengths and weaknesses of community health as well as ways in which opportunities could be utilized, and threats avoided. In addition to focus groups and interviews, a paper-based and online community survey was used to gather information from residents. Questions asked on the survey were designed to gather detailed information on knowledge and perceptions of community health in a similar design to the focus groups and interviews. Once these data were collected, data were sorted by theme and responses to questions were grouped into categories. This allowed for the content analysis of data, which was then presented to the CHNA Steering Committee for feedback and prioritization. The CHNA Steering Committee is composed of key stakeholders, directors, managers, and community health professionals with a vested interest in health care issues in Westmoreland County. Feedback and prioritization of topics from the CHNA Steering Committee, along with information from focus groups, interviews, and community survey from May 2015 through April 2016 were used to develop a CHNA Implementation Plan. The Steering Committee represented a number of community service providers including: Excela Health, Excela Health Physicians Practice, United Way of Southwestern Pennsylvania, Westmoreland Community Action, Westmoreland Chamber of Commerce, Westmoreland County Human Services, Westmoreland Area Agency on Aging, YMCAs of Greater Pittsburgh, Westmoreland Intermediate Unit, WeDAC, PA Department of Health, American Red Cross, Redstone Presbyterian Senior Care, and University of Pittsburgh at Greensburg. The CHNA Steering Committee helped to identify existing health care facilities and health and human services with the community available to respond to health needs of the community. The Pa 211 Southwest dataset is a very important in helping to identify existing resources based on need. These resources include skilled nursing facilities, personal care homes, meals on wheels providers, home health services and drug and alcohol providers. The participation of these committee members allowed for a richness of input from the local community on the most pressing needs on community health in these areas. CHNA Prioritization Criteria The table below contains the criteria used with the CHNA Steering Committee to establish which priorities would be set, which would best match the needs of the community with resources from Excela Health to address

Scoring Item Definition Low (1) Medium High (10) 1. Magnitude

of the problem

The degree to which the problem leads to death, disability or impaired quality of life and/or

Low numbers of people affected;

Moderate numbers/ % of people affected

High numbers/ % of people

Scoring Item Definition Low (1) Medium High (10)

could be an epidemic based on the rate or % of population that is impacted by the issue

no risk for epidemic

and/or moderate risk

affected and/or risk for epidemic

2. Impact on other health outcomes

The extent to which the issue impacts health outcomes and/or is a driver of other conditions

Little impact on health outcomes or other conditions

Some impact on health outcomes or other conditions

Great impact on health outcomes and other conditions

3. Capacity (systems and resources) to implement evidence based solutions

This would include the capacity to and ease of implementing evidence based solutions

There is little or no capacity (systems and resources) to implement evidence based solutions

Some capacity (system and resources) exist to implement evidence based solutions

There is solid capacity (system and resources) to implement evidence based solutions in this area

Following the CHNA Steering Committee Meeting, three important topics were selected for focus. These were:

1. Obesity, Exercise, and Nutrition 2. Substance Abuse 3. Women’s Health

Secondary Data Sources Secondary data sources of data were obtained from Healthy Communities Initiative of Xerox Corporation. These data were from a variety of public data sources on a large number of topics relevant to community public health. Sources of data include:

American Community Survey American Lung Association Annie E. Casey Foundation—KIDS Count Center for Medicare and Medicaid Services County Health Rankings Environmental Protection Agency Feeding America Institute for Health Metrics and Evaluation Local Initiatives Support Corporation National Cancer Institute

National Center for Educational Statistics Pennsylvania Behavioral Risk Factor Surveillance System PA Department of Education PA Department of Health PA Uniform Crime Reporting System US Bureau of Labor Statistics US Department of Agriculture

Topics of community health interest include:

Access to Quality Health Services Built Environment Chronic Diseases Communicable Diseases and Immunizations Economy Education Family Planning Food Safety Injury and Violence Prevention Maternal, Fetal, and Infant Health Mental Health and Mental Disorders Older Adults and Aging Oral Health Nutrition, Physical Activity, and Weight Social Environment Substance and Tobacco Use Transportation Wellness and Lifestyle

Findings Highlights of Findings from Primary Data Sources Structured Interviews with Key Stakeholders

• Most Salient Issues Raised – Poverty is a key issue: came up in every single interview, younger

people moving away due to lack of jobs, extreme poverty in places, and high levels of unemployment

– Substance Abuse: county has a large problem with heroin and prescription opioid abuse, drug problems are coupled with crime, violence, depression and mental health issues, overdoses are predominately white middle aged people

– Transportation: rural areas, poverty and income is the real issue, few reliable forms of public transportation

– Insurance: Affordable Care Act—deductibles too high for services, underinsured and uninsured residents is a problem, stigma for lack of insurance, and drug addiction programs poorly covered

– Prevention/Safety: food support, better emergency services are needed, more leadership and collaboration needed on prevention

– Women’s Health: high levels of gender violence and associated trauma – Other Issues: aging population, lack of diversity, diabetes and

cardiovascular health – Exercise/Weight/Nutrition: poor food choices, and high levels of

obesity Focus groups with Participants from Various Demographic Groups and Interests

• Most Salient Issues Raised – Substance abuse: heroin—a huge problem, but use of Narcan and new

Drug Court shows potential to help – Economic issues: lack of jobs, large pockets of poverty county-wide,

and homelessness for children – Transportation: big problem in rural parts of county, transporting and

taking clients to appointments and clinics—mobile van would help – Insurance Acceptance: problematic disconnects among UPMC,

Highmark and Excela on this issue, co-pays are not clear to clients – Prevention/Safety: more preventative cancer screenings, better

geriatric care, good county parks and programs for county kids – Exercise/Weight/Nutrition: too many fast food places, not enough

healthy food options Online and In-person Community Survey The following services, needs, and health concerns were ranked by how much of a problem the participants feel that they are in their community. The answers are categorized as the following: VS: Very Serious Problem (1); S: Serious Problem (2); SW: Somewhat of a Problem (3); SP: Small Problem (4); N: Not a Problem at All (5)

# Question VS S SW SP N Total

Responses Mean Variance

Standard Deviation

1 Access to mental health services

55 96 132 68 119 470 3.21 1.77 1.34

2 Access to dental care 29 58 111 109 165 472 3.68 1.53 1.24

3 Access to medical care providers

15 37 126 110 185 473 3.87 1.24 1.11

4 Availability of specialists 18 51 153 108 141 471 3.64 1.28 1.13

5 Prescription drug availability and access

22 46 105 112 187 472 3.84 1.41 1.19

6 Affordable health care (related to co-pays and deductibles)

83 117 112 61 97 470 2.94 1.91 1.38

7 Insurance coverage 73 99 128 66 102 468 3.05 1.85 1.36

8 Affordable and adequate housing

72 82 140 78 93 465 3.08 1.76 1.33

9 Employment/economic opportunities in general

64 123 153 64 59 463 2.85 1.45 1.20

10 Employment/economic opportunities for women

61 103 167 55 73 459 2.95 1.51 1.23

11 Early childhood development/child care

25 60 160 95 115 455 3.47 1.35 1.16

12 Quality of public education

38 64 127 112 124 465 3.47 1.55 1.25

13 Recreation opportunities 32 68 110 109 143 462 3.57 1.58 1.26

14 Poverty 75 144 130 64 49 462 2.71 1.45 1.20

15 Access to high quality affordable foods

68 104 137 77 79 465 2.99 1.66 1.29

16 Obesity and Overweight 126 182 91 29 37 465 2.29 1.35 1.16

17 Diabetes 82 162 131 34 52 461 2.59 1.42 1.19

18 Heart Disease 47 156 171 40 42 456 2.72 1.14 1.07

19 Mortality from Heart Disease

41 132 180 57 45 455 2.85 1.15 1.07

20 High Cholesterol 48 181 148 41 41 459 2.66 1.15 1.07

21 Cardiovascular Disease and Stroke

41 156 178 42 37 454 2.73 1.05 1,03

22 Hypertension/High Blood Pressure

55 191 138 40 38 462 2.60 1.14 1.07

23 Stroke 37 137 192 50 40 456 2.82 1.05 1.03

24 Asthma 36 115 201 66 38 456 2.90 1.04 1.02

25 Delinquency/Youth Crime 96 142 141 57 31 467 2.54 1.30 1.14

26 Tobacco Use 137 159 114 27 30 467 2.26 1.28 1.13

27 Drug Abuse 271 112 47 10 25 465 1.72 1.18 1.08

28 Tobacco Use in Pregnancy 76 116 153 76 35 456 2.73 1.32 1.15

29 Transportation 136 112 111 63 45 467 2.51 1.68 1.30

The following table lists the top and bottom eight concerns within the community and the concerns with the most and least variance in responses.

Most Concerning Least Concerning Highest Variance Lowest Variance

Drug Abuse Access to medical care providers

Affordable health care (related to co-pays and deductibles)

Asthma

Tobacco Use Prescription drug availability and access

Insurance coverage Stroke

Obesity and Overweight Access to dental care Access to mental health services

Cardiovascular Disease and Stroke

Transportation Availability of specialists Affordable and adequate housing

1Hypertension/High Blood Pressure

Delinquency/Youth Crime Recreation opportunities Transportation 1Heart Disease

Diabetes *Early childhood development/child care

Access to high quality affordable foods

2Mortality from Heart Disease

Hypertension/High Blood Pressure

*Quality of public education Recreation opportunities 2High Cholesterol

High Cholesterol Access to mental health services

Quality of public education Drug Abuse

*same mean 1same variance 2same variance High Cholesterol, Hypertension/High Blood Pressure, and Drug Abuse were the three concerns in which respondents feel that they were the greatest problem in their community while having the least mixed feelings about it.

Highlights of Findings from Secondary Data Sources

The tables above show the scores and trends for Westmoreland County compared to both state and national indicators on community health indicators. These indicators were grouped by topic to show which topics were more salient in Westmoreland County. These data, provided by HCI, are consistent with findings in the primary data supporting substance abuse, prevention and safety, transportation, women’s health and exercise, nutrition, and weight management as the top five issues. These findings in the secondary data are similar in both scope and topic to interviews, focus groups, and a community survey with Westmoreland County residents.

Highlights of Implementation Plan in Progress for 2013 CHNA GOAL – Reduce overweight and obesity through screening, education, healthy eating and physical activity initiatives. These initiatives will continue to be conducted through partnerships with primary care physicians, employers, school districts and community organizations. Work in this area began in 2012 and is continuing. This goal will be enhanced and modified in continuing and future CHNA efforts. NOTE: Excela Health includes three acute care hospitals; Excela Westmoreland, Excela Latrobe and Excela Frick Hospitals. The CHNA initiatives related to each of these three hospital service areas have been identified in this implementation plan. Other initiatives will be supported system-wide and will be implemented to improve community health in all three Excela Health hospital service areas. Partnerships with Primary Care Physicians: Diabetes and cardiac disease patients have a high incidence of co-morbid depression. The COMPASS program (Care of Mental, Physical, and Substance Abuse Syndromes) is a collaborative care model aligned with NCQA PCMH standards and Chronic Care Model. The COMPASS program is a 3 year initiative funded by CMS’ Healthcare Innovation Challenge. The program integrates mental health services into the primary care setting. The program includes PHQ-9 screening, a care manager working with the primary care physician and a consulting psychiatrist. Eligible adults are those with Medicare and/or Medicaid insurance and sub-optimally managed diabetes and/or cardiovascular disease. Nine percent of Westmoreland County residents have been diagnosed with diabetes. According to the National Standards for Diabetes (2012) diabetes self-management education is a critical element of care for all people with diabetes. Self-management education is key in providing patients with support to encourage behavior change and to maintain healthy diabetes-related behaviors, as well as addressing psychosocial concerns.

Diabetes Referrals Year One Year Two

Year Three Total/Average

# of Patients Referred 239 210 570

% of Patients Attending at Least One Session

53% 50% 69% 57.33%

Percent EHMG patients with diabetes achieving HEIDIS 75th percentile for: Pilot Offices vs All Other EHMG Offices

BP < 140/90 67.13/57.56 67.06/67.19 69.53/71.42 65.92/64.94

HbA1c < 8% 68.57/64.86 67.06/67.19 63.36/63.94 66.34/65.33

HbA1c >9% 13.03/13.84 9.94/9.84 11.52/9.89 11.50/11.19

LDL < 100 58.45/56.61 55.39/54.15 66.41/68.02 60.00/59.59

COMPASS Year One Year Two Total Goal Program Ended June 30, 2015.

# of patients enrolled 111 28 142

12/Quarter

Improve depression score for 40% of patients 52% 55% 55%

40% Absolute

Difference

A1c of < 8.0 9% 17% 17%

20% Absolute

Difference

BP < 139/89 30% 49% 49% 20%

Patient Satisfaction NA

Very Satisfied

Very Satisfied NA

Patients “very satisfied” with care relative to any other response at one year vs. baseline. Baseline vs. 1-year follow-up survey across the 18 Medical Groups in COMPASS

Physician Satisfaction NA

Very or Somewhat Satisfied

Very or Somewhat Satisfied NA

Clinicians “very” or “somewhat” satisfied with resources available relative to any other response at one year vs. baseline. Baseline vs. 1-year follow-up survey across the 18 Medical Groups in COMPASS

BMI

Goal was to improve compliance with documentation of BMI in patient medical record and increase referrals to education sources with abnormal BMI results.

EHMG working on correction of coding to demonstrate compliance with BMI measurement. Also looking at improving compliance with Plan of Care for abnormal results. It was determined by EHMG Primary Care Group that project was not indicated once coding is corrected.

EXERCISE IS MEDICINE

Goal was to evaluate the Exercise is Medicine Program to increase physical activity assessment and referrals to education services.

This program was not evaluated at this time due to a multitude of other projects needing to be implemented over the past three years.

Partnerships with Schools: Regular physical activity in childhood and adolescence improves strength and endurance, helps build healthy bones and muscles, helps control weight, reduces anxiety and stress, increases self-esteem, and may improve blood pressure and cholesterol levels (CDC, 2013). Project Fit America is a 2 year program designed to create new and sustainable opportunities for children to be active, fit and healthy as part of the everyday school

experience. This is accomplished through educational programs and equipment that will allow the school to successfully teach fitness year after year.

Project Fit America Fall

2014 Spring 2015 Fall 2015 Spring 2016 National Average

Annual Outcome Measures

Sit Ups 35 37 - 6% DUE 9/15/16 DUE 9/15/16 14%

Mile Run 10:39 9:56 - 7% DUE 9/15/16 DUE 9/15/16 5%

Flexed Arm Hand (seconds) 10 13 - 30% DUE 9/15/16 DUE 9/15/16 27%

Pull Ups 1.6 1.9 - 19% DUE 9/15/16 DUE 9/15/16 48%

15 Meter Pacer Run (laps) 65.5 79 - 21% DUE 9/15/16 DUE 9/15/16 18%

20 Meter Pacer Run (laps) 27.6 31 - 12% DUE 9/15/16 DUE 9/15/16 17%

Healthy Habits A-Z Education Series - Middle Schools Year One Year Two Year Three Total/Average

# of classrooms engaged in program 29 7 12 72

# of students engaged in program 925 196 825 1946 7 18 29

Average post-education knowledge score 8% Increase 10% Increase 16% increase

Behavioral goal - post-education

86% of students report a change

92% of students report a change

71% of students report a change

Golden Hour High School Project Year One Year Two Year Three Total

# of school districts engaged in program 12 11 18 41

# of students engaged in program 1189 1096 2412 4697

Healthy Habits Essay Program

Year One Total/Average Program was only done Year One

# of school districts engaged in program 11 11

# of students engaged in program 8000 8000

Partnerships with the Community: According to the Community Preventative Services Task Force effective community-wide campaigns to increase physical activity should involve many community sectors, include highly visible, broad-based, multicomponent strategies (e.g., social support, risk factor screening or health education) and may also address other cardiovascular disease risk factors, particularly diet and smoking. The Community Preventive Services Task Force recommends community-wide campaigns on the basis of strong evidence of effectiveness in increasing physical activity and improving physical fitness among adults and children.

Mall Walkers Year One Year Two Year Three

Total/Average Comments

Number of Programs 15 19 17 51

Number of Attendees 2566 2990 2941 8497

Blood Pressures Taken 2009 2415 2147 6571

Pedometer Program:

Contributing Members 279 256 206 741

Total Steps 174,934,201 154,030,942 164712540 493,677,683 Unable to count steps for Excela Square

Ave. Steps/Day 8569 8998 9969 27,536 Unable to count steps for Excela Square

Average weight loss 8.75 lbs. 9.25# 9.75 9.25

Healthy Dining Year One Year Two Year Three Total

# of New restaurants engaged in program. 5 0 6 11

Total restaurants engaged 19 19 25 25

Hunters Heart Check Year One Total/Average Only done in Year One.

# of Participants 186 186

Glucose results > 99 92 (52.8%) 92 (52.8%)

Cholesterol > 199 77 (43.5%) 77 (43.5%)

BP > 120/80 126 (85.7%) 126 (85.7%)

BMI > 24.99 131 (69.1%) 131 (69.1%)

Abnormal EKG 30 (16%) 30 (16%)

Golden Hour Year One Year Two Year Three Total

# of Programs provided 14 11 47 72

# of Participants 2684 1789 8105 12,578

Healthy Habits A-Z Greensburg YMCA Year One

Only asked to participate in YMCA summer program Year One.

# of Children educated 166

Average pre-education knowledge score

Average post-education knowledge score

5% Increase

Diabetes Prevention

Year One

Year Two

Year Three Total/Average

Implement program at 2 additional YMCAs 2

2 - Total 4 4

# of Participants 7 24 21 52

Average attendance/session 75% 69% 78% 74%

16 Week Outcomes

Average % body weight lost 6.14% 3.80% 5% 4.98%

National Average - 4.6% Regional Goal - 5%

Average minutes of exercise/week 74 105 110 96

National Average - 117 minutes Regional Goal - 90 minutes

Partnerships with Employers: According to the CDC, building workplace “cultures of health” can improve public health in the United States. This culture can be created when employers provide financial and organizational support for evidence-based health promotion interventions, consistent communication with workers that encourages positive health behaviors, social and organizational support from peers and supervisors, policies, practices, procedures and organizational norms that support a healthy

lifestyle, financial or other types of incentives for participation in health improvement activities and a common purpose that is dedicated to a healthier workforce (CDC, 2013). “Modifiable health risks that lead to disease can be decreased through workplace-sponsored health promotion and disease prevention programs. The importance of the worksite as a means for promoting health is underscored by its inclusion in Healthy People 2020” (CDC, 2013).

Excela Health Employee Wellness Year One Year Two Year Three Total/Average

Number Employees Screened 2851 2853 Data Due 10/12016

Data Due 10/12016

Number of Spouses Screened 957 952 Data Due 10/12016

Data Due 10/12016

Total Screened 3679 3803 Data Due 10/12016

Data Due 10/12016

Employee/Spouse Participation Rate 92% 93%

Data Due 10/12016

Data Due 10/12016

Average Lifestyle Score 63.70% 64.40% Data Due 10/12016

Data Due 10/12016

% High Cost Members 24.90% 0.7% 0.8% Norm 1.1%

Preventative Screenings:

Calendar Year 2013

Calendar Year 2014

Calendar Year 2015 Regional Norm

Colorectal 65% 68% 68.20% 61%

Mammography 84% 81% 78.60% 66%

PAP 76.40% 76% 75% 69%

Flu Shot 94.70% 92.46% 95% NA

Physical Exam 32% 35% 37.80% 24%

Prostate 41% 46% NA NA

Provide Annual Employer Health Care Symposium Year One Year Two Year Three Total/Average

# of attendees 114 120 135 369

# of employers represented 64 71 84 73 Ave.

Partner with Regional Employers to Provide Wellness Works Services Year One Year Two Year Three Total

# of New Employers Engaged 9 17 10 36

Enhance Employee Wellness Partnership with Westmoreland County Year One Year Two Year Three Total

# of Bio-Metric Screenings 886 803 908 2597

Consider development of a collective impact infrastructure to support community health improvement initiatives

Outcome

Evaluate 2 evidence-based shared measurement systems.

Two measurement systems were evaluated. The Healthy Communities Institute platform was purchased in March 2016 and will be integrated into the Excela Health public website

Educate Steering Committee members on types and essential functions of backbone organization.

Ongoing.

Other Needs Identified in the CHNA But Not Addressed in This Plan: Each of the five identified overall community health needs is important and is addressed by numerous program and initiatives operated by the health system and other community partners. However, limited resources and the need to allocate significant resources to the priority needs listed in the above plan does not permit inclusion of the additional needs of elderly access to care and mental health/substance abuse concerns in this implementation plan. Additionally, several initiatives to address these needs have been recently implemented or are scheduled for implementation within the next several months by Excela Health. Mental Health/ Substance Abuse:

Excela Health recently opened a Behavioral Health Crisis Response Center that will serve residents on a 24/7 basis.

All Excela Health Behavioral Health staff have completed the Mental Health CPR certification class. Goal is to expand training to all clinical staff at Excela Health.

The Youth Suicide Prevention in Primary Care program will be implemented in at least one Excela Health primary care office in the next fiscal year.

Excela Health, in partnership with the Westmoreland Drug & Alcohol Commission and Southwestern Pennsylvania Human Services, will implement the Mobile Case Manager program to expedite the disposition and treatment of emergency department patients presenting with substance abuse issues. The program will be implemented within the next fiscal year.

Elderly Access to Care: Excela Health is currently participating in the Western Pennsylvania

Community Care Transitions program in collaboration with the Southwestern Area Agency on Aging. This evidence-based program provides a transitions coach at each of Excela’s three hospitals to work with Medicare beneficiaries with specific chronic illnesses and/or frequent readmission. The coach works closely with the hospital discharge planning team to develop the discharge plan and also informs participants of available community resources and provides access to long term living services. The two year pilot program resulted in demonstrated reductions in 30 day readmission rates.

Project RED (Re-engineered Discharge), funded by the Agency for Healthcare Research and Quality, has demonstrated a 30% reduction in post-discharge readmissions rate and emergency room visits as well as improving patient satisfaction. Project RED is comprised of 12 mutually reinforcing actions including organizing post-discharge services and medical equipment, patient education on diagnosis and medications and telephone follow up conducted by discharge educators.

Implementation Plan—Areas of Development for the 2016 CHNA In addition to increased support and monitoring of the initiatives discussed above regarding the obesity community health concern which began in 2012 and will continue into the 2016 CHNA Implementation Plan, there are two new areas of development moving forward with the 2016 CHNA Implementation Plan First, Excela Health is collaborating with Westmoreland County Human Services Drug Overdose Task Force (DOTF) to support their priorities and objectives. The DOTF goals and strategies include: Priority I: Education and Training Objective 1: Provide community education to increase public awareness of the risks of prescription drug abuse, safe use/storage/disposal, and available resources for help. Objective 2: Educate and train health care professionals (e.g., physicians and pharmacists) on best practice guidelines for safe prescribing and identifying prescription drug misuse through screenings. Objective 3: Promote increased utilization of the statewide Prescription Drug Monitor Program (PDMP) to decrease misuse and diversion of prescription drugs (Fall 2016). Objective 4: Coordinate and advise Community Coalitions efforts to reduce overdoses. (Use PL principles)

Priority II: Treatment and Overdose Prevention Objective 5: Provide timely access to continuum of care for individuals addicted to prescription /street drugs. Objective 6: Expand access to naloxone for overdose prevention. See Training /Distribution plan. Objective 7: Prioritize and implement prevention programs for targeted high risk populations within the county Priority III: Tracking, Monitoring, and Data Exchange Objective 8: Increase data collection and information sharing across organizations to enhance data driven practices Priority IV: Partnership with Law Enforcement & Corrections Objective 9: Achieve 100% Police Department participation in Narcan program. Objective 10: Collaborate with law enforcement to identify and initiate a “warm hand off” system for overdose cases. Priority V: Community Advocacy for needed support in reducing drug epidemic. Create awareness of critical issues and develop resources to fund needed programs. Objective 11: Positively influence policy, at the Westmoreland, State, and Federal levels, by identifying and communicating community factors that are contributing to prescription drug abuse. Objective 12: Develop resources to fund effective prevention and treatment programs in collaboration with public and private sources. Based on these identified priorities and objectives, Excela Health will support several of these through the CHNA Implementation Plan. These include: Objective 1: Provide community education to increase public awareness of the risks of prescription drug abuse, safe use/storage/disposal, and available resources for help. Excela Health (EH) will help to increase public awareness through our EH Sponsored Employer Symposiums on Substance Abuse in the Workplace, Youth Suicide Prevention Program, and our Behavioral Health Crisis Response Center with appropriate referral for treatment.

Objective 2: Educate and train health care professionals (e.g., physicians and pharmacists) on best practice guidelines for safe prescribing and identifying prescription drug misuse through screenings. Excela Health will support this objective through our Peer to Peer Education Program for our Physicians, Mental Health CPR Certification Classes, Mobile Case Manager Program with the County Drug and Alcohol Commission. Objective 3: Promote increased utilization of the statewide Prescription Drug Monitor Program (PDMP) to decrease misuse and diversion of prescription drugs (Fall 2016). Excela health will support this objective through our Peer to Peer Education Program discussed above and Physician protocols for ordering prescription drugs. Objective 5: Provide timely access to continuum of care for individuals addicted to prescription /street drugs. Excela Health will suppor5t this objective through our Inpatient and Emergency services, Behavioral Health and Crisis Center services and our new partnership with Gateway and all that this provides in terms of continuum of care. Objective 8: Increase data collection and information sharing across organizations to enhance data driven practices. Excela Health will provide data support from our data collection from patient encounters on a bundled basis to ensure patient privacy. Objective 12: Develop resources to fund effective prevention and treatment programs in collaboration with public and private sources Excela Health will provide documentation and support of the need for funding to support effective prevention and treatment programs. The second area of the 2016 CHNA implementation plan development will be in the area of breast cancer. Improvements in awareness, access, diagnosis, and treatment initiatives are under development. One immediate improvement is to allow texting in order to make a mammography appointment. TEXT FOR A MAMMOGRAPHY APPOINTMENT Now there’s one less excuse to skip your 3D mammogram. Skip the phone call and text MAMMO to 245-87 only at Excela Health. First in the region with 3D mammography, Excela Health is now the first to bring you text for mammograms. Text us for your appointment, we’ll do the rest and text you back when your appointment is confirmed. So really there is no excuse. At Excela Health, you can walk in on a Wednesday or text MAMMO to 245-87.

2016 CHNA Implementation Plan Action Steps Excela Health is proud to present their 2016 Community Health Needs Assessment (CHNA) Report. The report was developed with research collaboration from the Center for Applied Research (CFAR) at the University of Pittsburgh at Greensburg and the Healthy Communities Initiative (HCI) of Xerox Corporation. This report provides findings at multiple levels for existing community efforts in obesity, and discusses the additional work in Substance Abuse and Women’s Health, specifically Breast Cancer with a focus on Screening Access, Diagnosis and Treatment. The Excela Health Board of Trustees initially approved efforts in obesity, and now work is being extended into Substance Abuse and Women’s Health. The 2016 CHNA Process and Health Needs Priorities were approved by the Excela Health Board of Trustees in May, 2016. The Board will approve the 2016 CHNA Implementation Plan in October, 2016 and following approval, this 2016 CHNA Implementation Plan will also be made available to the public for questions, review, and comments. Acknowledgments We would like to acknowledge the efforts of those who contributed to the development and completion of the 2016 Excela CHNA. These include: Excela Health: Ron Ott, Senior Vice President of Community and Government Relations Nancy Urick, Manager of Community and Government Relations HCI of Xerox Corporation: University of Pittsburgh, Greensburg: Dr. Sharon P. Smith, President; Dr. Geoffrey L. Wood, Director of the Center for Applied Research; Dr. Franklin D. Wilson, Faculty Affiliate; Ms. Diane Cheek, Faculty Affiliate; Ms. Victoria Causer, Faculty Affiliate; CFAR Research Assistants—Emily Gernhardt, Rachel Haras, Nichole Johnson, Mitchell Kirk, Kaleigh Murphy, Taylor Szczepankowski, and Joshua Watson.