AshtabulaCountyMedicalCenter

2016 Community Health Needs Assessment

Implementation Strategy

Adopted by

ACMC Healthcare System

Board of Trustees

March 29, 2017

This document describes how Ashtabula County Medical Center (ACMC) intends to address the needs found in the Community Health Needs Assessment (CHNA) published by ACMC on October 24, 2016.

The implementation strategy outlined will be initiated for calendar (tax) years 2017, 2018 and 2019.

The CHNA was conducted by ACMC to gain a better and more complete understanding of the health needs of its service area and in accordance with guidance issued by the Internal Revenue Service pursuant to the Patient Protection and Affordable Care Act of 2010, specifically Notice 2011-52.

The implementation strategy addresses specific community health needs describe in the CHNA that ACMC is able to meet in whole, in part, or in collaboration with other community organizations. ACMC recognizes that the CHNA and subsequent implementation strategy are required to meet current government regulations.

AshtabulaCountyMedicalCenter reserves the right to amend the implementation strategy as needed. For example, it may become evident that certain needs are more pronounced and require enhancements to the now-planned strategic initiatives. At some point during the years 2017 through 2019, other organizations in Ashtabula County may decide to address health needs identified in the CHNA, indicating that ACMC should re-focus its efforts and amend its strategy to concentrate on other health issues indentified in the CHNA.

Contained in this document is the following information:

  1. ACMC mission statement
  2. Definition of the community served by ACMC
  3. Selection and prioritization of community health needs
  4. Health needs that will be addressed by ACMC
  5. Implementation strategy to address the identified health needs
  6. Needs that will not be addressed by ACMC
  7. Role of ACMC in a healthy community

A. ACMC mission statement

AshtabulaCountyMedicalCenter is a private, not-for-profit, community-oriented medical center that provides the best possible medical care through all phases of life to those seeking help. The AshtabulaCountyMedicalCenter team is committed to preserving the human rights and dignity of those who receive our care and those who provide it.

AshtabulaCountyMedicalCenter is a 249-licensed bed acute care hospital providing care to the residents of the largest geographic county in the State of Ohio. The hospital was ‘born’ out of community need. At the time of the Great Train Disaster in 1876, there was no hospital in Ashtabula County. The community came together to raise money to build a hospital and in 1904, Ashtabula General Hospital (now known as Ashtabula County Medical Center) opened its doors.

ACMC is guided by the principals of honesty, compassion and respect. We are committed to being the provider and employer of choice in AshtabulaCounty by aligning our organizational strategy with the five pillars of excellence: Service, Quality, People, Financial and Growth.

B. Definition of the community served by ACMC

ACMC’s community includes AshtabulaCounty, the cities of Ashtabula, Conneaut and Geneva, and various townships and villages including Jefferson, Kingsville, North Kingsville, Austinburg, Pierpont, Andover, Orwell, and Rock Creek.

AshtabulaCounty is comprised of 14 zip codes: 44003, 44004/5, 44010, 44030, 44032, 44041, 44047, 44048/68, 44076, 44082, 44084, 44085, 44093, and 44099.

According to 2015population statistics, there were 101,450 residents in Ashtabula County. The community was defined based on the geographic origins of ACMC’s inpatients, from which virtually 100 percent originate from zip codes within Ashtabula County.

The ACMC community has comparatively unfavorable health status and socioeconomic indicators compared to both the State of Ohio and the United States.

Statistical information about ACMC’s community includes:

  • The community’s population continues to decline and is expected to decrease by 0.2% by 2020. However, the number of older adults (defined as 65 years of age and older) is expected to increase by 12.8% by 2020, which may create an additional strain on healthcare resources as older adults tend to have a higher utilization of healthcare services compared to those under age 65.
  • ACMC’s community has a higher percentage of residents age 25+ without a high school diploma (14.4%) compared to Ohio (11.2%) and the nation (13.7%).
  • There is a higher percentage of the ACMC community considered to have a disability (15%) compared to Ohio (13.5%) and the United States (12.3%).
  • Ashtabula County is favorably positioned with respect to the percentage of the population considered to be linguistically isolated, with only 1.6% compared to 2.4% in Ohio and 8.6% in the nation.
  • Poverty levels in the community exceed state and national statistics. In 2014, 19% of Ashtabula County residents lived at or below the federal poverty level, compared to 15.9% for Ohio and 15.6% for the United States. The percentages were higher for both the Black (40.6%/34.2%/27.3%) and Hispanic/Latino (44.1%/29%/24.8%) populations.
  • In 2014, 12.8% of ACMC’s community was uninsured. It is unclear how changes to the Affordable Care Act will impact those who obtained coverage through Ohio’s Medicaid expansion.
  • The unemployment rate at the end of 2015 was 6% in the community, compared to 4.9% in the state and 5.3% in the United States.
  • The racial diversity in the community is less than statewide and nationally. Community residents are primarily White. The highest percentages of Black residents can be found in zip codes 44004 and 44030.
  • In 2016, Ashtabula County ranked in the bottom half of Ohio counties for 24 of the 27 assessed Community Health Indicators; 15 of those were in the bottom quartile.
  • In 2015, Ashtabula County ranked in the bottom quartile in 19 of 44 Community Health Indicators compared to peer counties in the United States.
  • Ashtabula County is designated a Health Professional Shortage Area (HPSA) for both dental and mental health. There are 16 minor civil divisions in ACMC’s community designated a primary care HPSA.
  • Nine census tracts in Ashtabula County have been designated as Medically Underserved Populations.
  • Three census tracts in ACMC’s community have been designated food deserts, low-income areas located more than one mile from a supermarket in urban areas and more than 10 miles from a supermarket in rural areas.

Additional information regarding community demographics is included in the CHNA report.

C. Selection and prioritization of community health needs

Ashtabula County Medical Center contracted with Verite Healthcare Consulting, LLC, an independent firm with over 10 years of experience in conducting Community Health Needs Assessments. In addition to statistical data obtained by Verite through various sources, community engagement and feedback in the form of key stakeholder interviews conducted by ACMC were integral parts of the CHNA process.

The ACMC 2016 CHNA identified six significant community health needs:

  • Access to Affordable Healthcare
  • Chronic Disease and Other Health Conditions
  • Economic Development and Community Conditions
  • Health Professions Recruitment
  • Healthcare for the Elderly
  • Wellness

A committee comprised of ACMC leadership met to review the CHNA findings, determine the needs that would be addressed and develop the implementation strategy to address those needs.

The committee includes:

  • President and Chief Executive Officer
  • Chief Nursing Officer
  • Chief Financial Officer
  • Vice President, Medical Operations
  • Vice President, Quality and Operations
  • Vice President, Network Development and Administration
  • Vice President, Business Development

D. Health needs that will be addressed by ACMC

ACMC will attempt to address the following areas identified in the Community Health Needs Assessment, with an intent to address disparity among various population segments:

  • Access to Affordable Healthcare
  • Chronic Disease (specifically hypertension and pre-diabetes/diabetes)
  • Healthcare for the Elderly

Additionally, ACMC will attempt to address the following areas identified in Ohio’s State Health Assessment and State Health Improvement Plan, with an intent to address disparity among various population segments:

  • Maternal and Infant Health
  • Mental Health and Addiction

E. Implementation strategy to address the identified health needs

Ashtabula County Medical Center has a 112-year history of providing significant amounts of community benefit to the communities it serves. ACMC will continue this commitment by allocating appropriate human and financial resources to meet those needs through the implementation of the following strategy beginning in 2017 and continuing through 2019.

New Strategic Initiatives

  1. Access to Affordable Healthcare: Improve access to care, including both primary and specialty care by:
  2. Collaborating with community organizations to bring Remote Area Medical to Ashtabula County to provide a free three-day health event, including medical, dental and vision screenings
  3. Continuing to recruit primary care (family medicine, internal medicine, pediatrics, obstetrics & gynecology) physicians to the community and placing offices in shortage areas.{Correlates to Health Professions Recruitment need}
  4. Continuing to recruit specialty physicians to the community to ensure community residents do not have to leave the community to receive care from a specialist.{Correlates to Health Professions Recruitment need}
  5. Continuing to collaborate with Cleveland Clinic to provide specialty clinics for services not available in the community.
  6. Continuing to provide the ACMC Health Express free shuttle service.
  7. Continuing to offer ACMC Express Care, a low-cost, walk-in option for care of minor illness and injury.
  8. Chronic Disease: Decrease the percentage of adults with hypertension by:
  9. Offering free blood pressure screenings at ACMC Express Care locations.
  10. Launching a community awareness campaign detailing the risks of hypertension and ways to reduce high blood pressure.
  11. Participating in the Center for Health Affair’s 7-county regional obesity initiative.
  12. Chronic Disease: Decrease the percentage of adults with pre-diabetes and diabetes by:
  13. Exploring the incorporation of pre-diabetes screening at all primary care appointments.
  14. Launching a community awareness campaign detailing the risks of diabetes, how to prevent/slow onset of diabetes, and how to successfully manage diabetes to ensure high quality of life.
  15. Continuing to collaborate with Cleveland Clinic to offer Endocrinology and Pediatric Endocrinology specialty clinics.
  16. Participating in the Center for Health Affair’s 7-county regional obesity initiative.
  17. Chronic Disease: Increase the percentage of adults over age 50 who receive screening for colorectal cancer by:
  18. Participating in the American Cancer Society’s 80% by 2018 initiative.
  19. Launching a community awareness campaign detailing the importance of regular colonoscopy.
  20. Healthcare for the Elderly: Increase medication compliance and reduce unnecessary hospitalizations by:
  21. Exploring the creation/coordination of a volunteer “Adopt A Grandparent” program.
  22. Maternal and Infant Health: Decrease the percentage of low birth weight births by:
  23. Decreasing the incidence of women not receiving first trimester pre-natal care by offering in-office nurse visits.
  24. Offering a series of smoking cessation classes geared specifically to pregnant women.
  25. Providing free nicotine replacement patches to pregnant women under the care of an ACMC physician.
  26. Mental Health and Addiction: Decrease the number of suicides by:
  27. Exploring the incorporation of standardized depressions/suicide screening for all patients age 12 and older.
  28. Working with school districts to implement an SOS Signs of Suicide in middle and high schools.
  29. Working with Ashtabula County Health Department on various initiatives that result from the Ashtabula County Needs Assessment.
  30. Mental Health and Addiction: Decrease the percentage of persons age 12 and older who have used or are dependent on an illicit drug by:
  31. Providing training to providers on guidelines for prescribing opiates and use of OARRS.
  32. Exploring the incorporation of screening for drug use and abuse for all patients age 12 and older.

Ongoing Initiatives

The addition of the new or expanded strategic initiatives to address community health needs will not diminish ACMC’s commitment to its current community benefit programs. These current programs include:

  1. Continue to participate in various economic development and community improvement initiatives to enhance the standard of living and quality of life for Ashtabula County residents {Correlates to Economic Development and Community Conditions}.
  2. Continue robust provider recruitment initiatives to meet the primary and specialty care gaps in Ashtabula County.{Correlates to Health Professions Recruitment}
  3. Continue to offer wellness programming through the hospital-owned fitness center and through collaborative initiatives with local businesses. {Correlates to Wellness}
  4. Continue to support a tobacco-free environment through ACMC’s Smoke Free Campus, hiring policies, and smoking cessation programs. {Correlates to Chronic Disease and Other Conditions; Wellness}
  5. Continue to provide inpatient and outpatient mental health services, as well as an intensive outpatient psychiatry program. {Correlates to Mental Health and Addiction}
  6. Continue relationship with Glenbeigh {Correlates to Mental Health and Addiction}
  7. Continue to provide free health screenings and referral for treatment.{Correlates to Access to Affordable Healthcare}
  8. Continue to provide financial counselor services to assist patients in qualifying for medical assistance.{Correlates to Access to Affordable Healthcare}
  9. Continue to offer a charity care program.{Correlates to Access to Affordable Healthcare}

Planned Collaborations

ACMC’s strategy will be implemented, as appropriate, with community partners including, but not limited to:

  • Ashtabula County Department of Health
  • Ashtabula County Commissioners
  • City Managers
  • School Districts
  • Center for Health Affairs
  • Cleveland Clinic
  • Glenbeigh
  • Faith-based organizations
  • Community-based (non-profit) organizations
  • Kent State University at Ashtabula

F. Needs that will not be addressed by ACMC

AshtabulaCountyMedicalCenter cannot address all of the health needs present in the community. To ensure ACMC remains financially viable and in a position to enhance current services, develop new services and continue to provide a wide range of community benefits, the hospital’s implementation strategy focus on the priorities outlined earlier in this document and will not address the following needs:

Dental Health: As an acute care hospital, ACMC does not have the expertise to address basic dental health.

Transportation: Other than continuing to operate ACMC Health Express, a free shuttle service available to patients seeking care at any ACMC location or provider location, transportation is a broader community issue and beyond the scope of the hospital.

Births to Unwed Mothers: This community health issue is beyond the scope of ACMC, and is being addressed by faith-based and social service agencies.

Pre-term Births: As of the timing of this Implementation Strategy, over 50% of babies born to women residing in Ashtabula County are not delivered at ACMC. There is little impact ACMC can make for patients not under our care.

G. Role of ACMC in a healthy community

The health of a community affects every resident who lives there. ACMC is committed to providing the highest quality of care to members of our community.

The Ashtabula County Medical Center Community Health Needs Assessment was approved by the Board of Directors on October 24, 2016. The Implementation Strategy was approved by the Board of Directors on March 29, 2017.

The Ashtabula County Medical Center Community Health Needs Assessment and the Implementation Strategy can be found on the ACMC website at

Ashtabula County Medical Center

2420 Lake Avenue

Ashtabula, OH44004

440-997-2262