December 6, 2016 Adopted by Community Benefits Committee, Community Memorial Health System Board of Trustees

Community Health Needs Assessment:

San Buenaventura and Ojai December 2016

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Table of Contents

Table of Contents......................................................................................................................... 2

Executive Summary of the Community Health Needs Assessment ......................................................... 4

1. Service Areas ...................................................................................................................................... 5

1.1 Hospital Service Areas .......................................................................................................... 5

1.2 Service Area Demographics – Health Matters in VC ........................................................ 7

2. Community Health Needs Assessment Process ................................................................................ 7

2.1 Let’s Get Healthy California ................................................................................................ 7 Healthy Beginnings - Laying the foundation for a healthy life .......................................................... 8

Living Well - Preventing and Managing Chronic Disease ................................................................. 9

End of Life - Maintaining Dignity and Independence ........................................................................ 9

Redesigning the Health System - Efficient, Safe, and Patient-Centered Care.................................... 9

Creating Healthy Communities - Enabling Healthy Living ............................................................... 9

Lowering the Cost of Care - Making Coverage Affordable and Aligning Financing to Health Outcomes ............................................................................................................................................ 9

2.2 Goal One - Healthy Beginnings: Laying the Foundation for a Healthy Life ................. 10 Education .......................................................................................................................................... 10

Single Parent Households ................................................................................................................. 15

Mothers who Received Early Prenatal Care ..................................................................................... 15

Babies with Low Birth Weight ......................................................................................................... 16

Age-Adjusted Hospitalization Rate due to Pediatric Asthma ........................................................... 17

Mental Health.................................................................................................................................... 18

Substance Abuse ............................................................................................................................... 20

Fitness and Poverty ........................................................................................................................... 21

2.3 Goal 2. Living Well: Preventing and Managing Chronic Disease .................................. 22 Age-adjusted ER Rate due to Dental Problems ................................................................................ 22

Mental Health.................................................................................................................................... 22

Nutrition ............................................................................................................................................ 23

Physical Activity ............................................................................................................................... 25

Adults with Diabetes ......................................................................................................................... 25

Disability ........................................................................................................................................... 26

Tobacco Use...................................................................................................................................... 28

2.4 Goal 3. End of Life: Maintaining Dignity and Independence ........................................ 30 ICU use on terminal admission – California 2022 Target 17% ........................................................ 30

Percent of Medicare decedents enrolled in hospice within three days of death, 2012 ..................... 31

Geri-Psychiatric Acute Care ............................................................................................................. 32

2.5 Goal 4. Redesigning the Health System: Efficient, Safe, and Patient-Centered Care . 33 Preventable Hospitalizations – 2022 Target 727 per 100,000 Population ........................................ 33

Ambulatory Care Sensitive Conditions Discharge Rate ................................................................... 33

Adults Delayed or Difficulty Obtaining Care ................................................................................... 34

Recuperative Care ............................................................................................................................. 34

2.6 Goal 5. Creating Healthy Communities: Enabling Healthy Living ................................ 35 Grocery Store Access ........................................................................................................................ 35

Physical Environment ....................................................................................................................... 37

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2.7 Goal 6. Lowering the Cost of Care: Making Coverage Affordable and Aligning Financing to Health Outcomes. ...................................................................................................................... 38

Access to Health Insurance ............................................................................................................... 38

3. Community-Reported Health Needs .................................................................................................... 43

3.1 Well-Being Index ................................................................................................................. 43

3.2 Locally Derived Community Input .................................................................................... 44 Defining a Healthy Community ........................................................................................................ 45

Community Health Needs ................................................................................................................. 50

4. Prioritized Significant Health Needs ................................................................................................... 59

4.1 Ojai Community-Reported Health Needs ......................................................................... 59

4.2 West Ventura Community-Reported Health Needs......................................................... 59

4.3 Prioritized List ..................................................................................................................... 59

5. Potentially Available Resources .......................................................................................................... 60

5.1 Ventura County Health Care Agency ............................................................................... 60 Ventura County Medical Center ....................................................................................................... 60

Santa Paula Hospital ......................................................................................................................... 60

Medical Clinics ................................................................................................................................. 61

Behavioral Health Department ......................................................................................................... 61

5.2 Dignity Health ...................................................................................................................... 61 St. John’s Regional Medical Center.................................................................................................. 61

St. John’s Pleasant Valley Hospital .................................................................................................. 61

5.3 Community Memorial Health System ............................................................................... 62 Community Memorial Hospital ........................................................................................................ 64

Ojai Valley Community Hospital ..................................................................................................... 65

Centers for Family Health and Midtown Medical Group ................................................................. 66

6. Evaluation of Impact ........................................................................................................................... 66

7. Implementation Strategies ................................................................................................................... 66

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Executive Summary of the Community Health Needs Assessment This report looks at the health needs of communities served by Community Memorial Health System (CMHS) through its Community Memorial Hospital (CMH) and Ojai Valley Community Hospital (OVCH). CMHS coordinated its health needs assessment with those of the Ventura County Department of Public Health and Kaiser Health Plan, Foundation Hospitals and the Permanente Medical Group. It is the intent of CMHS to more closely collaborate with these and other health care and community service organizations in future needs assessments and delivering community benefit. CMHS thanks the County of Ventura and Kaiser for sharing their work and resources which are cited throughout this report. The Community Benefits Committee of the CMHS Board of Trustees identified and prioritized community health needs. The committee followed the Let’s Get Healthy California program in assessing health needs. Ojai West Ventura

Substance abuse Substance abuse

Mental health Mental health

Growing senior population and related service needs Education and poverty

Chronic and acute health conditions (diabetes, heart disease, cancer)

Poverty and nutrition

Healthcare service availability in Ojai Chronic and acute health conditions (diabetes, heart disease, cancer)

Transportation out of Ojai (healthcare and other services) Obesity/overweight- at risk populations

Education and poverty Senior population and related service needs

Poverty and nutrition Access to health care services

Obesity/overweight youth Oral health

Oral health Homeless health issues

Senior access to adult day health care Geri-Psychiatric inpatient care

Safe homes and families (child abuse domestic violence) Tobacco and vaping

Tobacco and vaping

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1. Service Areas This section of the report identifies the Community Memorial Hospital and Ojai Valley Community Hospital service areas for purposes of assessing community health needs.

1.1 Hospital Service Areas CMHS defines the service area of each hospital according to the zip codes in which 75% of inpatient encounter patients live. For Community Memorial Hospital those zip codes are:

93001 Ventura 93003 Ventura 93004 Ventura 93010 Camarillo 93030 Oxnard 93033 Oxnard 93035 Oxnard 93036 Oxnard 93060 Santa Paula

For Ojai Valley Community Hospital the zip codes are 93022 and 93023 which contain communities including:

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Ojai Miramonte Meiner’s Oaks Oakview Matilja Springs Ojala Wheeler Springs

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1.2 Service Area Demographics – Health Matters in VC The County of Ventura provides a rich source of community data through its website “Health Matters in VC”. To encourage community use of this highly valuable resource CMHS provides the following links and will not clutter this report with data that becomes outdated well before the next CHNA is published. http://www.healthmattersinvc.org/index.php City Profiles

Camarillo http://tinyurl.com/havbuss Ojai http://tinyurl.com/h8ysmsj Oxnard http://tinyurl.com/z9e99hf Santa Paula http://tinyurl.com/j397qwr Ventura http://tinyurl.com/h28xxwx

Demographics

Zip code http://tinyurl.com/j6f42jq The demographics page includes a wide variety of data summaries including: Population by age, sex, ethnicity, ancestry, educational attainment Households by number of people, presence of people under 18, household income Housing Units by year structure built, vehicles available Families by poverty status

2. Community Health Needs Assessment Process 2.1 Let’s Get Healthy California The State of California started the Let’s Get Healthy California (LGHC) Task Force in 2012 with the objective to make California the healthiest state in the nation. LGHC presents a compelling vision for improving the health of Californians, controlling health care costs, promoting personal responsibility for individual health, and advancing health equity. CMHS substantially follows LGHC in this CHNA and will work towards similarly modeling future community benefit initiatives. The Framework of LGHC is summarized in the following image.

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Figure 1 - https://letsgethealthy.ca.gov/goals/

As stated on the Let’s Get Healthy California website, the underlying objectives of each section are as follows:

Healthy Beginnings - Laying the foundation for a healthy life Getting a healthy start sets the stage for health and wellbeing for a person’s entire life. This includes:

Living in a healthy environment before and while mom is pregnant, Having access to health care and health insurance for both mom and baby, Receiving care in a quality and coordinated health care system when the baby is born, Understanding health risks and benefits for different delivery methods, Receiving support for mom and baby when they come home.

As that baby grows into childhood and adolescence, factors such as the following will impact their life as an adult:

Being physically active and learning in safe schools and neighborhoods, Having access to and eating and drinking healthy food and beverages, Living in a home and community where youth are emotionally supported

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Living Well - Preventing and Managing Chronic Disease Health is a state of complete physical, mental, and social well-being and not merely the absence of disease. Ways that Californians can get and stay healthy include:

Consuming enough fruits and vegetables during childhood and adolescence, Living in a safe community where people can exercise and easily access healthy foods, Using active transportation to get where they need to go, Promoting tobacco education and prevention, in addition to help to quit smoking or use of

tobacco and/or e-cigarettes, Living, working and playing in places where community members are emotionally supported,

can connect with their neighbors, and can get help with mental health when needed, Getting affordable health insurance coverage, Easily receiving high quality health care that meets physical, cultural, and language needs.

End of Life - Maintaining Dignity and Independence Making medical decisions about the end of our lives is just as essential as other health care choices we make. Important actions that Californians can take to maintain quality of life during advanced illness include:

Having access to health care and health insurance, Easily accessing health care providers and high quality health care that meet physical, cultural

and language needs, Communicating choices and preferences for what we want at the end of life is just as essential as

communicating how we want to live, Encouraging physicians to have open and early communication, Coordinating outpatient care that reaches a patient where they are, addressing their transportation

needs, and other health conditions.

Redesigning the Health System - Efficient, Safe, and Patient-Centered Care Being the healthiest state in the country will require California’s health care system to be focused on health, not just illness, and become truly patient-centered. In redesigning the health system, we must include activities such as:

Coordinating outpatient care in order to reach patients where they are, addressing their transportation needs and other health conditions,

Honoring a person’s end of life choices in a culturally appropriate way, Providing adequate access to providers in the community.

Health care that supports health includes: Providing access to health insurance that rewards innovations like coordinated care, Providing health and health care for both mom and baby.

Creating Healthy Communities - Enabling Healthy Living Where we live makes a difference in our health – physical and environmental determinants either enhance or create barriers to health.

Lowering the Cost of Care - Making Coverage Affordable and Aligning Financing to Health Outcomes As stated on the Let’s Get Healthy California website, the rise of health care costs places financial burdens on families, businesses, and the state, making decreasing costs an important goal.

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2.2 Goal One - Healthy Beginnings: Laying the Foundation for a Healthy Life The first goal, “Healthy Beginnings: Laying the Foundation for a Healthy Life”, focuses on getting a healthy start from prenatal care through the teen years. The goal’s performance indicators establish a recurring theme throughout LGHC of access to well-coordinated care and healthy foods, positive lifestyle choices, mental health, and living in a socially and environmentally safe community. These themes present a cycle across three stages of life where opportunities and choices define the path that individuals follow towards their individual health outcomes and quality of life.

Education Educational attainment as measured by adults age 18+ who did not graduate high school or receive a GED varies significantly in West Ventura. Education can be an important factor in future income as shown by the following charts comparing education attainment and Federal Poverty Level.

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Figure 2 - http://maps.communitycommons.org/viewer/

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Figure 3 - http://assessment.communitycommons.org/Footprint/

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County-wide educational attainment is in line with overall California performance but significantly lags Top U.S. Performers.

Figure 4 - http://www.countyhealthrankings.org

Single Parent Households

Figure 5 - source: www.healthmattersinvc.org

Mothers who Received Early Prenatal Care

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Figure 6 - source: www.healthmattersinvc.org

Babies with Low Birth Weight

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Age-Adjusted Hospitalization Rate due to Pediatric Asthma

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Mental Health

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Some data, e.g., Age-Adjusted Hospitalization Rate due to Adolescent Suicide and Intentional Self-inflicted Injury, is only available on a county-wide basis.

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Figure 7 - source: www.healthmattersinvc.org

Substance Abuse Overdose deaths of Ventura County youth involving heroin:

2015 33 2014 23

The rate of overdoses from heroin, prescription pain killers and other opioids is consistently higher in Ventura County than across California. Casa Pacifica Centers for Children & Families will construct a new 16 patient treatment center in 2017. Source: Ventura County Star, December 6, 2016.

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Fitness and Poverty Percent of students overweight or needs improvement for body composition by school district.

Figure 8 – source: Community Commons

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2.3 Goal 2. Living Well: Preventing and Managing Chronic Disease

Age-adjusted ER Rate due to Dental Problems

Mental Health

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Nutrition

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Figure 9 – source: Community Commons

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Physical Activity

Adults with Diabetes

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Disability

Figure 10 - http://assessment.communitycommons.org/CHNA/report?reporttype=HE

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Figure 11 - http://assessment.communitycommons.org/CHNA/Map.aspx?mapid=11446&areaid=06111&reporttype=HE

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Tobacco Use

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Figure 12 – source: Community Commons

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2.4 Goal 3. End of Life: Maintaining Dignity and Independence

ICU use on terminal admission – California 2022 Target 17%

Figure 13 - source: http://www.dartmouthatlas.org/data/bar.aspx?ind=127&ch=32&loc=787,2684,3532,6&loct=4&tf=34&fmt=152

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Percent of Medicare decedents enrolled in hospice within three days of death, 2012

Figure 14 - source: http://www.dartmouthatlas.org/

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Geri-Psychiatric Acute Care Geri-Psychiatric acute care is inpatient mental health care in an area of a hospital specially designed and reserved for Seniors. There are no inpatient geri-psychiatric care services available in Ventura County and Seniors must travel out of the county to receive care. It is not unusual that they travel as far away as the San Gabriel Valley which also poses a hardship for family members.

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2.5 Goal 4. Redesigning the Health System: Efficient, Safe, and Patient-Centered Care

Preventable Hospitalizations – 2022 Target 727 per 100,000 Population

Figure 15 - source: www.healthmattersinvc.org

Ambulatory Care Sensitive Conditions Discharge Rate Ambulatory Care Sensitive Conditions

Discharge Rates Per 100,000 Beneficiaries ACAV ALL MSSP ACO

Chronic Obstructive Pulmonary Disease or Asthma

662 958

Congestive Heart Failure 1,112 1,312 Bacterial Pneumonia 662 774

Accountable Care Alliance of Ventura, Second Quarter 2016

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Adults Delayed or Difficulty Obtaining Care

Recuperative Care Homeless population recuperation following hospital care. A 2011 United Way Homeless Cost Study found that the chronically homeless population had a difficult time taking care of their mental and physical health while living on the streets or in emergency shelters. A 2015 Ventura County needs assessment by the National Health Foundation (NHF) and Healthcare Association of Southern California (HASC) found the following.

Recuperative Care Need Average monthly homeless inpatient discharges 379 Patients eligible for recuperative care 95 Projected recuperative program census 32 225-275 clients annually could benefit from recuperative care with an average length of stay at 10-14 days.

93003

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2.6 Goal 5. Creating Healthy Communities: Enabling Healthy Living

Grocery Store Access

Figure 16 - source: www.healthmattersinvc.org

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Figure 17 – source: Community Commons

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Physical Environment

Source: County Health Rankings & Roadmaps, 2013

Source: County Health Rankings & Roadmaps, 2016; http://www.countyhealthrankings.org/app/california/2016/rankings/ventura/county/outcomes/overall/snapshot

The measure set for Physical Environment has changed between 2013 and 2016.

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2.7 Goal 6. Lowering the Cost of Care: Making Coverage Affordable and Aligning Financing to Health Outcomes.

Access to Health Insurance

Ventura County 2020 Target 83.3%; US Average 86.9%

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Figure 18 – source: Community Commons

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Figure 19 – source: Community Commons

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County Health Rankings & Roadmaps Uninsured status is shown to significantly impact access to care. In Ventura County this is further compounded by the lack of primary care physician availability relative to California and the National Benchmark. The State Health Insurance Exchange has helped remedy the uninsured status issue but does not address the lack of primary care capacity in Ventura County. 2016

Source: County Health Rankings & Roadmaps, 2016

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2013

Source: County Health Rankings & Roadmaps, 2013

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3. Community-Reported Health Needs

3.1 Well-Being Index The Gallup-Healthways Well-Being Index (WBI), surveying 1,000 Americans a day, 350 days a year, is the first and most comprehensive survey of its kind, providing the largest database of behavioral economic metrics. It is the only measure of total well-being in existence today. Ventura County’s major cities of Oxnard, Thousand Oaks and Ventura have ranked well over the years.

Figure 20 - source: http://www.healthways.com/wbi-thank-you?submissionGuid=b0b21d61-6082-487d-b831-cd75b993b2d5

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Figure 21 - 2014 Well-Being for 100 Largest Communities

3.2 Locally Derived Community Input Publicly reported data provides a backdrop for the stakeholder input that Community Memorial Health System has attained through community listening sessions in 2016 and from surveys conducted by the County of Ventura and focus groups conducted by Kaiser Permanente. The direct community input provides further insights in to the experience and needs of community residents in the primary service areas of Community Memorial Hospital and Ojai Valley Community Hospital. CMHS focus group sessions were conducted in Ojai and San Buenaventura. Kaiser Permanente conducted focus groups in 2015 and the County of Ventura collected survey responses through 2015 and 2016. Common themes came from the sessions with each community expressing differing priorities.

CMHS Ojai Focus Group October 20, 2016 Name Affiliation Adams, Tucker Help of Ojai

Brown, Jody Help of Ojai

Fenn, Christine Gables of Ojai

Wolfe, Terri Help of Ojai

CMHS West Ventura Focus Group October 17, 2016

Name Affiliation

Acklin, Jessica Select Home Care

Buck, Molly Los Robles Home Care

Clinton, Shelley TLC Home Hospice

Deharo, Fred Clinicas del Camino Real

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Fenn, Christine Gables of Ojai

Hull, Dylan Select Home Care

Jump, Victoria Ventura County Area Agency on Aging

Knight, Marianne California Senior Living

Rosati, Veronica Option Care

Sebring, Nansea Buena Vista Hospice Care

Tatangelo, Sue Camarillo Healthcare District

Zarate, Laura SeaView IPA Kaiser Permanente Focus Group Sessions Kaiser conducted focus group and key informant interview sessions during the months of August through December, 2015. Data from those sessions is included in this report. Ventura County Survey The County of Ventura received 900 survey responses from Ventura County residents through 2016. Responses that were from zip codes in the CHNA service area for CMHS are included in this report. The following charts present priority weighting as expressed by participating community members.

Defining a Healthy Community The Ventura County survey asked respondents to rate the health of their community and separately to rate the factors that make a healthy community. The following charts summarize those responses which are organized in the context of Let’s Get Healthy California goals.

Figure 22 - Ventura County community survey results for Ventura, Oxnard and Camarillo

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Figure 23 - Ventura County community survey results for Ojai Valley

The following charts reflect Ventura County community survey responses to identify factors that make a healthy community.

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Figure 24 - Survey responses for Ventura, Camarillo and Oxnard

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The following charts rank order specific factors in what makes a healthy community and their associated Let’s Get Healthy California category.

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Community Health Needs The following tables and charts summarize community input on health needs and issues for Ojai Valley and West Ventura. These responses are again organized in the context of Let’s Get Healthy California goals.

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Figure 25 - West Ventura responses

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Figure 26 - Ojai responses

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Figure 27 - CMHS focus group

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Figure 28 - Ventura County survey

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Figure 29 - CMHS focus group

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Figure 30 - Ventura County survey responses

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4. Prioritized Significant Health Needs 4.1 Ojai Community-Reported Health Needs Health needs reported for Ojai reflect a rural community with limited access to health care services. This circumstance is exacerbated by a population demographic that is aging more rapidly than most communities. The Ojai valley is known for illegal drug production and abuse which drives the concerns regarding substance abuse.

4.2 West Ventura Community-Reported Health Needs Health needs reported for West Ventura again reflect an aging demographic. Higher growth rates for the Hispanic population relative to non-Hispanics drives health care needs attendant to socio-economic issues, e.g., the relation between obesity and nutrition. Notable differences in the community need priorities for Ventura, Camarillo and Oxnard are significantly driven by demographic characteristics.

4.3 Prioritized List Ojai West Ventura

Substance abuse Substance abuse

Mental health Mental health

Growing senior population and related service needs Education and poverty

Chronic and acute health conditions (diabetes, heart disease, cancer)

Poverty and nutrition

Healthcare service availability in Ojai Chronic and acute health conditions (diabetes, heart disease, cancer)

Transportation out of Ojai (healthcare and other services) Obesity/overweight- at risk populations

Education and poverty Senior population and related service needs

Poverty and nutrition Access to health care services

Obesity/overweight youth Oral health

Oral health Homeless health issues

Senior access to adult day health care Geri-Psychiatric inpatient care

Safe homes and families (child abuse domestic violence) Tobacco and vaping

Tobacco and vaping

Community Memorial Health System established a Community Benefits Committee of its Board of Trustees. This committee first convened in June, 2016, meeting again in November and December, 2016 to discuss CHNA findings. Based on publicly reported health data and community input the committee approved the rank ordering of specific issues for each community.

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5. Potentially Available Resources 5.1 Ventura County Health Care Agency

Ventura County Medical Center Ventura County Medical Center (VCMC) is a fully-integrated, comprehensive system of hospital, clinic and specialty services. The system provides access to high quality, compassionate health care to residents throughout Ventura County.

While VCMC provides access to health care to all residents of our county, special emphasis is placed on providing access to care for the underserved and those facing barriers to access. Referred to as the “safety net” population, these individuals comprise over three quarters of the care provided by VCMC.

VCMC is noted for its renowned Family Medicine Residency Program, and is distinguished as the only Ventura County academic teaching hospital with a residency affiliated with UCLA School of Medicine. VCMC is the designated Level II Trauma Center for the west county and is known for its extraordinary trauma team, which includes skilled and talented surgeons covering neurosurgery, orthopedic and general surgery cases. Additionally, our award-winning neonatal intensive care unit and pediatric unit are unique to a county this size; VCMC boasts the only pediatric hospitalist in the county as well as having the county’s first and only Pediatric Intensive Care Unit (PICU).

Services Provided at VCMC Full-Service Acute Care Hospital 24-hour Emergency Center Intensive Care Unit and Definitive Observation Unit Obstetrics and Gynecology Neonatal Intensive Care Unit and Intermediate Care

Unit Pediatric Specialty Care

o Pediatric Intensive Care Unit Medical and Surgical Specialty Care

o Cardiology o Respiratory Services o Orthopedic Services o Imaging and Clinical Screening o Clinical Laboratory Testing and analysis o Pathology – Anatomical Laboratory

Inpatient Psychiatric Unit Telemetry and Oncology Unit Ancillary and Support Services ACE/LIHP Admitting and application assistance for Medicare,

Medi-Cal, MIA, and CCS Auxiliary Volunteer Service Department of Food and Nutrition Infection Control Services HIM (Medical Records) Nursing Education and Professional Training Palliative Care Patient Advocacy Patient Counseling Physical, Occupational and Speech Therapy

Santa Paula Hospital Santa Paula is an acute, 49 bed general community hospital providing compassionate care to all Santa Clara Valley residents. Santa Paula Hospital offers a comprehensive list of inpatient and outpatient services and full-service departments for diagnostic procedure, treatment, aftercare and ongoing care. Services Provided Ancillary and Support Services

Full-Service Acute Care Hospital 24-hour Emergency Department- Base Station Intensive Care Unit Definitive Observation Unit Obstetrics and Gynecology

Cardiology Services Respiratory Services Orthopedic Services Imaging and Clinical Screening Rehab Services

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Neonatal Intensive Care Unit and Intermediate Care Unit 16 Bed Pediatric Unit Medical and Surgical Care Inpatient Psychiatric Unit Telemetry and Oncology Unit Surgical Services Case Management Social Services Infection Control Services Nursing Education and Professional Training

Clinical Laboratory Testing and analysis Pathology – Anatomical Laboratory Patient Advocacy Admitting and application assistance for Medicare,

Medi-Cal, MIA, CCS Physical, Occupational and Speech Therapy Department of Food and Nutrition Medical Records Auxiliary Volunteer Services Translation Services

Medical Clinics The health care agency operates a system of primary care and specialty care medical clinics located throughout the County of Ventura. Clinics are located in Ventura, Thousand Oaks, Fillmore, Oxnard, Moorpark, Piru, Santa Paula, Simi Valley and Camarillo.

Behavioral Health Department The health care agency operates behavioral health clinics in Simi Valley, Oxnard, Ventura and Fillmore. Services include screening, crisis intervention, individual, group and family counseling, HIV education, assessment and evaluation, referrals to community based services, and outreach to the community. Specialized programs provide services for pregnant and parenting women, adolescents, and persons who have been dually diagnosed with substance use and mental health problems. Mental Health services include psychiatric assessment, medication services, psychological testing, individual and group therapy, crisis intervention, rehabilitation services, and case management services. All of the programs strive to insure continuity of appropriate care in the least restrictive environment and prevent out of home placement.

5.2 Dignity Health

St. John’s Regional Medical Center 265 beds, including a 23-bed acute rehabilitation center Services Provided Bariatric Surgery 24-hour Emergency Services Cancer Care and Support Diabetes Program Health and Wellness Programs Heart Health Imaging Procedures Intensive Care Surgery - Inpatient and Outpatient Maternity and Birth Services Neonatal Intensive Care Orthopedic Care Palliative Care Patient and Family Education Primary Care Rehabilitation Services Spiritual Care Women’s Services

St. John’s Pleasant Valley Hospital 81 acute care beds and a 99 bed extended care unit.

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Services Provided 24-hour Emergency Services Cancer Care and Support Diabetes Program Health and Wellness Programs Heart Health Imaging Procedures Intensive Care Orthopedic Care Palliative Care Patient and Family Education Primary Care Rehabilitation Services Spiritual Care Subacute Care Surgery - Inpatient and Outpatient Weight Loss Surgery Women’s Services Wound Healing and Oxygen Therapy Primary Care The Dignity Health Medical Group offers same-day access to primary care appointments, as well as evening hours two days a week. Offices are located in both Camarillo and Oxnard.

5.3 Community Memorial Health System

What originated in 1901 as a single hospital serving its neighbors has today grown into an expansive healthcare system that touches the lives of individuals throughout Ventura County, California and beyond.

Community Memorial Health System, established in 2005 when Community Memorial Hospital in Ventura merged with Ojai Valley Community Hospital, is comprised of these two hospitals along with the Centers for Family Health, eleven family-practice health centers serving various communities within Ventura County.

Our health system is a community-owned, not-for-profit organization. As such, we are not backed by a corporate or government entity, nor do we answer to shareholders. Rather, we depend on and answer to the communities we serve.

Guiding us on this esteemed mission is a volunteer and diverse Board of Trustees that represents a cross section of leaders in our community, and who govern Community Memorial Health System with a focus aimed on what is best for our citizenry.

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Community Memorial Health System provides a wide range of highly regarded services that provide patients the best in specialized care.

Bariatric Weight Loss Center Breast Center Cancer Program Cancer Resource Center Cardiac Catheterization Lab Cardiac Rehabilitation Cardiovascular Surgery Clinical Laboratory Coastal Communities Cancer

Center Electrophysiology Emergency Department FASTRAC Fitness Center Gastrointestinal Lab Health Assessments HealthAware Healthy Women’s Program Heart & Vascular Program Imaging Industrial Health Intensive Care Unit Keeler Center for Headache Laser Surgery Lifeline Lung Cancer Screening Program Maternal Child Health Migraine Treatment Neonatal Intensive Care Unit Neurology & Neurosurgery Occupational Therapy Oncology Orthopaedics Outpatient Lab Pain Management Palliative Care Consult Service Pathology Laboratory Patient Centered Medical Home Pediatrics Pharmacy Physical Therapy Prostate Institute Pulmonary Services Robotic Surgery San Buenaventura Urology Center

Same Day Surgery Skilled Nursing

Snoring/Sleep Apnea Social Services Speech Therapy Spiritual Care Stroke Program Thoracic Surgery TMJ/TMD Transfusion Free Program Ultrasound Urology Vascular Surgery Wound Care Following extensive study and research with physicians, staff, professional advisors, and community leaders, the Board of Trustees and Administration of Community Memorial Health System are undertaking two important projects that will expand and enhance healthcare services at both the Ventura and Ojai campuses. These projects are needed to meet a state seismic mandate, but more importantly, they are needed to update outdated facilities so that our healthcare professionals are able to practice modern medicine in modern facilities that will benefit the residents of the communities we serve.

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Community Memorial Hospital For over a century, Community Memorial Hospital (CMH) has served as the healthcare leader in Ventura County. Today, the eight-story, 242-bed nonprofit facility has become a state-of-the-art regional hospital and health center, providing a vast array of medical services and programs. CMH is also at the forefront of medical development. With an extensive array of specialists serving almost any medical need, CMH has developed a team of internists and family practice physicians that work together with specialists to provide the very best in medical care. The award-winning hospital is licensed by the California Department of Health Services, and Accredited by DNV. 2015 Statistics Total Admissions 12,251 Births 2,978 Patient Days 95,119 Average Daily Census 261 Outpatient Visits 198,464 Center for Family Health Visits 234,834 Emergency Room Visits 48,591 Pharmacy Prescriptions 3,342,279 Surgical Procedures 11,734 Radiological Procedures 131,357 Physical Therapy Treatments 97,719 Laboratory Tests 1,025,754 Meals Served 313,379 Pounds of Laundry 2,142,751 The new Community Memorial Hospital will be a six-story facility located on land adjacent to the current hospital. Connected by a central tower, the two wings of the building will encompass more than 325,000 net square feet, making it 60 percent larger than the current hospital. The new hospital provides the professional staff and patients with advanced diagnostic technologies, including 10 state-of-the-art surgical suites. The new facility includes an expanded Emergency Department, a dedicated Pediatric Unit to care for the hospital’s very young patients, and improved capabilities for dealing with critically ill patients. The hospital will be completed in 2017.

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Ojai Valley Community Hospital Ojai Valley Community Hospital (OVCH), built in 1960, is a nonprofit, community-based acute care facility serving the over 28,000 residents of the Ojai Valley. The 91-bed facility provides inpatient and outpatient care, skilled nursing services, and a 24-hour standby Emergency Room. OVCH is licensed by the California Department of Health Services and has met the stringent requirements for full accreditation by DNV. Highly trained physicians and specialists work closely with our full staff of healthcare professionals, management and volunteers to bring a high level of care to the residents in the Ojai Valley. 2015 Statistics Total Admissions 897 Births N/A Patient Days 17,900 Average Daily Census (Includes Skilled Nursing Facility) 49

Outpatient Visits 25,813 Centers for Family Health Visits 12,082 Emergency Room Visits 8,973 Pharmacy Prescriptions 228,315 Surgical Procedures 553 Radiologic Procedures 19,391 Physical Therapy Treatments 31,397 Laboratory Tests 71,942 Meals Served 122,684 Pounds of Laundry 341,324 The Ojai modernization and expansion completed its first phase with the opening of a new Emergency Department in 2009. The hospital is proceeding with the replacement of its continuing care center.

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Centers for Family Health and Midtown Medical Group The Centers for Family Health and Midtown Medical Group offer complete family healthcare, a comprehensive referral network of doctors and specialists, and access to state-of-the-art healthcare technologies at Community Memorial Hospital. The medical staff are here to provide you with the highest level of care for all your medical needs. Located in Oxnard, Ventura, Oak View, Ojai, Port Hueneme, Camarillo, Santa Paula and Fillmore, the Centers are staffed by board-certified physicians and compassionate medical professionals - many who are bilingual. Urgent Care services are provided at three locations. The Midtown Medical Group is located adjacent to Community Memorial Hospital. Midtown consists of an established group of physicians, along with resident physicians who are part of the Community Memorial Health System Residency Program.

6. Evaluation of Impact Community need priorities identified from the 2013 health needs assessments for the Ojai Valley and Ventura community were addressed by CMHS through ongoing activities. Access to Primary Care Services – The Graduate Medical Education program at CMHS provides resident training in primary care. To help attract and retain primary care physicians, CMHS provides income support to practices. Graduating residents are choosing to stay in Ventura County, accepting positions at practices in West Ventura and the Ojai Valley. CMHS has added Centers for Family Health sites and expanded existing sites. Access to Specialty Physician Services – The Centers for Family Health practice sites also provide specialty physician services. To improve access to care for Medi-Cal HMO enrollees, Clinicas del Camino Real patients are able to see specialists at CFH sites. CMHS provides income support to help independent practices attract new physicians. Behavioral Health – CMHS provided income support to attract two psychiatrists to West Ventura, bringing the total number of psychiatrists available through the CFH sites to three. As it prepares to open a replacement hospital in Ventura, CMHS is continuing work on plans to provide inpatient geriatric psychiatric care in the current Ventura hospital space.

7. Implementation Strategies The Community Benefits Committee has approved implementation strategies to address certain community health needs. Those strategies are provided in a separate report.