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By VERITÉ HEALTHCARE CONSULTING, LLC

And COMMUNITY HEALTH ADVISORS, LLC

COMMUNITY HEALTH NEEDS ASSESSMENT Executive Summary

- 2013 -

CS135507

Prepared for BAYSTATE FRANKLIN MEDICAL CENTER

Executive Summary │ Community Health Needs Assessment 2013

INTRODUCTION

This community health needs assessment (CHNA) was conducted by Baystate Franklin Medical Center (Baystate Franklin or the hospital) because the hospital wants to understand better community health needs and to develop an effective implementation strategy to address priority needs. The hospital also has assessed community health needs to respond to community benefit regulatory requirements.

Baystate Franklin is a member of the Coalition of Western Massachusetts Hospitals (Coalition) which also includes Baystate Medical Center, Mercy Medical Center, Baystate Franklin Medical Center, Baystate Mary Lane Hospital, Cooley Dickinson Hospital, and Wing Memorial Hospital. The Coalition hospitals collaborated in preparing their CHNAs along with a “Design Team” established by the Coalition. Information about this collaboration is included in this report.

Federal regulations require that tax‐exempt hospitals provide and report community benefits to demonstrate that they merit exemption from taxation. As specified in the instructions to IRS Form 990, Schedule H, community benefits are programs or activities that provide treatment and/or promote health and healing as a response to identified community needs.

Community benefit activities or programs seek to achieve objectives, including:

 improving access to health services,

 enhancing public health,

 advancing increased general knowledge, and

 relief of a government burden to improve health.1

To be reported, community need for the activity or program must be established. Need can be established by conducting a community health needs assessment.

The 2010 Patient Protection and Affordable Care Act (PPACA) requires each tax‐exempt hospital to “conduct a [CHNA] every three years and adopt an implementation strategy to meet the community health needs identified through such assessment.”

CHNAs seek to identify priority health status and access issues for particular geographic areas and populations by focusing on the following questions:

 Who in the community is most vulnerable in terms of health status or access to care?

 What are the unique health status and/or access needs for these populations?

 Where do these people live in the community?

 Why are these problems present?

The question of how the organization can best use its limited charitable resources to address priority needs will be the subject of the hospital’s separate Implementation Strategy.

This assessment considers multiple data sources, including secondary data (regarding demographics, health status indicators, and

1Instructions for IRS Form 990, Schedule H, 2012.

measures of health care access), assessments prepared by other organizations in recent years, and primary data derived from a community survey and from interviews with persons who represent the broad interests of the community, including those with expertise in public health. A list of interviewees is included in Exhibits 69 through 72 of the CHNA report.

The following topics and data are assessed in this report:

 Demographics, e.g., numbers and locations of vulnerable people;

 Economic issues, e.g., poverty and unemployment rates, and the impact of healthcare reform in Massachusetts;

 Community issues, e.g., homelessness, lack of affordable housing, environmental concerns, crime, and availability of social services;

 Health status indicators, e.g. morbidity rates for various diseases and conditions, and mortality rates for leading causes of death;

 Health access indicators, e.g., uninsurance rates, discharges for ambulatory care sensitive conditions (ACSC), and use of emergency departments for non‐emergent care;

 Health disparities indicators; and

 Availability of healthcare facilities and resources.

The assessment identifies a prioritized list of community health needs.Baystate Franklin will be preparing an Implementation Strategy that describes how the hospital plans to address the identified needs.

Executive Summary │ Community Health Needs Assessment 2013

EXECUTIVE SUMMARY

Baystate Franklin Community By the Numbers

 33 ZIP codes in Franklin and Worcester counties

 Population (2012): 87,984  Projected population change (2012‐

2017): o Growth of 1% overall; 16%

increase in the 65+ population  15% of Baystate Franklin’s discharges for

ambulatory care sensitive conditions (ACSC)

 ACSC discharges most common among Medicare patients

 Disparities for Black and Hispanic (or Latino) residents:

o More likely to be living in poverty o Higher rates of chronic disease

mortality (including stroke, diabetes, and heart disease) in Worcester County

o Comparatively high rates of infant mortality in Worcester County

Executive Summary │ Community Health Needs Assessment 2013

The Baystate Franklin community, which contains 33 ZIP codes in 30 towns in Franklin County and parts of Worcester County, benchmarks favorably on a number of health indicators.However, health status and access problems are present, and this assessment seeks to identify the most pressing issues.

A person’s health is influenced by complex (and interconnected) social and economic factors, including income, education, race/ethnicity, and local environment. Racial and ethnic minority groups, children, the elderly, and those with special needs are more likely to lack the social and economic resources necessary to maintain optimal health. Such inequalities can create barriers to access (to health services, employment, quality education, healthy food, housing, and other necessities and opportunities) and thus contribute to poor health.

A community survey was conducted as a major element of the CHNA methodology. 679 responses were received from residents of Baystate Franklin’s community. Survey results were post‐stratified to help assure that they accurately reflect the community’s demographics. Responses also were assessed by race, insurance status, and education status.

Survey results indicate that the community has difficulty accessing prevention, wellness, and mental health services. MassHealth (Medicaid) and Medicare recipients are more likely to rely on free or low‐cost clinics and emergency room visits for basic primary care needs, or they indicate that “no routine healthcare is received.”

The community perceives top health issues to include low income/financial challenges, obesity, mental health, substance abuse/addiction, and insufficient exercise. Commonwealth Connector and MassHealth

(Medicaid) recipients identify unemployment and dental health as additional issues.

Following is a brief summary of health issues in the community served by Baystate Franklin Medical Center. The summary is based on an assessment of all study data sources, including community interviews, the community survey, and the wide array of secondary data – all of which are described and assessed in the report.

Demographics. Fifteen percent of the community is 65 years of older and 94 percent of the community is White. However, the community is aging and diversifying, driven by growth in elderly and in Asian, Black, and Hispanic (or Latino) populations.

Franklin County reports comparatively high rates of disability, particularly among youth. Disability can contribute to poverty, health care access barriers, and poor health.

Economics. Financial hardship (particularly in Sunderland, Montague, and Greenfield) is a concern throughout the community. Pediatric poverty and unemployment also are comparatively high. Unemployment and financial hardship disparities exist for non‐White populations in the community.

Lack of access to affordable, healthy food and housing insecurity also are concerns for vulnerable populations.

Social Factors. Social and physical isolation and lack of adequate transportation create barriers to accessing care. Many residents must travel outside the community for specialty care, a need complicated by a lack of reliable transportation. Due to the North Quabbin region’s distance from Greenfield, Worcester, and Springfield (where many services are

Executive Summary │ Community Health Needs Assessment 2013

located), these residents are especially impacted by issues of poverty, isolation, and transportation.

The community would benefit from increased integration and coordination of healthcare and related human servicesacross different programs and providers.

Child abuse also is a concern in the community; additional early intervention is needed.

Behavioral Factors. High rates of smoking during pregnancy and other infant health risk factors are present in Franklin County. Low rates of healthy food consumption and exercise andcomparatively high rates of obesity also are present. Prevalent substance abuse (including tobacco, alcohol, and drugs) across the community is complicated by resident difficulty in accessing substance abuse treatment.

Mortality and Morbidity. Poor mental health and poor access to mental health care affect many in the community, particularly vulnerable populations.

Some community residents experience a lack of access to dental care. Many dentists will not see MassHealth (Medicaid) patients, there are long waiting times at local clinics,

and many residents do not have dental insurance. Asthma and air quality are community health issues, particularly for children in Franklin County.

Care Access and Delivery. Cost and an undersupply of certain healthcare providers in the communityare resulting in barriers to accessing primary, mental health, and dental care.

Community residents also need additional support in improving health literacy and knowledge of available community services.

Discharges for Ambulatory Care Sensitive Conditions (ACSCs, which are potentially preventable if patients access primary care resources at optimal rates), were about 15 percent of Baystate Franklin’s discharges.The top four conditions were: bacterial pneumonia, congestive heart failure, chronic obstructive pulmonary disease or asthma, and urinary tract infection.

The community has a variety of resources working to address access barriers. There are 5 Federally Qualified Health Centers (FQHC) located in the community: one community health center, with three locations, and two programs for the homeless. All serve medically underserved areas and populations.

Priority Health Needs

This assessment begins by identifying the communities served by Baystate Franklin. Findings are based on various quantitative analyses regarding health‐related needs in those areas, a review of health assessments conducted by other organizations in recent years, information obtained from interviews, and findings from a community survey. Preliminary assessment findings were discussed with community stakeholders during a series of “listening sessions” and feedback from participants helped validate findings. Finally, Verité applied a ranking methodology to help prioritize the community health needs identified by the assessment.

Including multiple data sources and stakeholder views is important when assessing the level of consensus that exists regarding priority community health needs. If alternative data sources including interviews support similar conclusions, then confidence is increased regarding the most problematic health needs in a community.

Further information about the analytic methods and prioritization process and criteria can be found in the CHNA report.

The table that follows describes the health needs identified throughout the assessment as priorities in the community served by Baystate Franklin Medical Center. These needs are presented in alphabetical order, by category. The prioritized list identifies the 13 most problematic community health needs found by this assessment. Needs were determined by synthesizing findings from multiple data sources; this exhibit also illustrates the sections of the report on which each community health need is primarily based. For example, although the report assesses a variety of data related to obesity and its causes, Exhibits 31 and 39, and findings from other assessments, interviews, and the survey were key contributors to identifying high rates of obesity as a priority need.

Executive Summary │ Community Health Needs Assessment 2013

List of Priority Community Health Needs

Access to Care  Lack of Affordable and Accessible Medical Care (52, 53, 56, I, S)  Need for Increased Care Coordination (OA, I)  Health Literacy and Knowledge of Available Services (OA, I, S) Dental Health  Lack of Access to Dental Care (52, 53, 56, I) Health Behaviors  High Rates of Alcohol, Tobacco, and Drug Use, and Need for Additional Treatment (31, OA,I, S) Maternal and Child Health  Smoking During Pregnancy (42, 46)  Child Abuse (I)  Pediatric Disability (Franklin County) (14) Mental Health  Lack of Access to Mental Health Services and Poor Mental Health Status (52, 53, 56, OA, I, S) Morbidity and Mortality  High Obesity Rate (31, 39, OA, I, S)  High Rates of Asthma in Schoolchildren (Franklin County) (40) Social and Economic Factors  Basic Needs Insecurity: Financial Hardship, Housing, and Food Access (15, 17, 23, OA, I, S)  Physical and Social Isolation (OA, I, S)

Key # (i.e., 2, 33, 54) Full Report Exhibit # OA Other Assessments I Interviews S Survey

Executive Summary │ Community Health Needs Assessment 2013

INTRODUCTION
EXECUTIVE SUMMARY