Community Benefits Plan
For Clinton Hospital
FY2016 – FY2020
An affiliate of
UMass Memorial Health Care, Inc.
Table of Contents
Executive Summary……………………………………………………………………………………………………….3
Priority Areas and Goals…………………………………………………………………………………………………4/5
Community Benefits Mission……………………………………………………………………………………………..6
Targeted Geography and Vulnerable Populations………………………………………………………..……………7
Background…………………………………………………………………………………………………………………8
Methods……………………………………………………………………………………………………………………..9
Appendix CHA Advisory Committee Members
Appendix B: Data Sources
Appendix C: Community Input, Key Informant Interviews, Focus Groups and Community Dialogues
Behavioral Risk Factor Surveillance System (BRFSS)
I. Executive Summary
Clinton Hospital is committed to improving the health status of all those it serves and to addressing the health problems of the poor and other medically underserved populations, as well as nonmedical conditions that negatively impact the health and wellness of our community.
Community Benefits Program
Community Benefits are programs, activities, or services that improve the health of the community by providing treatment or promoting health as a response to an identified community need and meet at least one of the following criteria:
· Improve access to health care to the medically-underserved
· Enhance the public health of the community; or respond to the needs of the underserved
· Advance medical or health care knowledge through education or research
· Reduce or relieve the financial burden of government; or support programs that would otherwise be discontinued because they operate at a financial loss
· Are done in collaboration with the community
Target populations for Clinton Hospital’s Community Benefits initiatives are identified through a community input and planning process, collaborative efforts, and a Community Health Needs Assessment (CHNA) which is conducted every three years.
Clinton Hospital collaborated with two other hospitals in conducting The 2015 Community Health Assessment of North Central Massachusetts is a joint effort between the Massachusetts Department of Public Health’s Community Health Network Area of North Central Massachusetts (CHNA 9) and the Joint Coalition on Health (JCOH). They include HealthAlliance, an affiliate of UMass Memorial Health Care and Heywood Hospital. Together, these entities have capitalized on their complementary expertise and have produced a document that can be used by stakeholders from every sector of the community to better the health and welfare of residents of North Central Massachusetts. The assessment is designed to provide information and analyses relative to the health status, issues, concerns, and assets of the North Central Region of Massachusetts.
The Community Health Network of North Central Massachusetts (CHNA 9) is one of 17 CHNAs across Massachusetts, created by the Department of Public Health in 1992. CHNA-9 mission brings together and supports diverse voices to promote health equity in our communities. The CHNA 9 area includes the communities of Ashburnham, Ashby, Ayer, Barre, Berlin, Bolton, Clinton, Fitchburg, Gardner, Groton, Hardwick, Harvard, Hubbardston, Lancaster, Leominster, Lunenburg, New Braintree, Oakham, Pepperell, Princeton, Rutland, Shirley, Sterling, Templeton, Townsend, Westminster, and Winchendon. CHNAs are an initiative to improve health through local collaboration.
Clinton Hospital then assisted in the Montachusett Public Health Network (MPHN) Community Health Assessment (CHNA) in 2014, in collaboration with, the Joint Coalition on Health of North Central Massachusetts (JCOH) and Community Health Network Area 9 (CHNA9). The Montachusett Public Health Network (MPHN) is a collaborate committee of all the board of health’s covering the Montachusett region (Athol, Gardner, Fitchburg, Leominster, Westminster, Princeton, Sterling, Royalston, Phillipston, Templeton and Clinton) the stated goal of the MPHN is “raising the health status of the residents of our communities to the highest levels anywhere in the country”. The JCOH is a group of committed individuals and organizations working collaboratively as catalysts for change and as advocates for the underserved to improve the health and well-being of everyone in North Central Massachusetts.
Clinton hospital took into account input from both health assessments, representatives of the community, including diverse members who were interviewed in the Community Health Assessment Focus groups. Clinton Hospital utilized the information in the both CHA to collaborate with other community based organizations to adopt implementation strategies that address the unmet health needs of Clinton Hospital’s catchment area.
Our target populations focus on medically-underserved and vulnerable groups of all ages, as follows:
• Elderly
• Youth/children
• Populations living in poverty
• Underserved/uninsured
• Ethnic and Linguistic Minorities
Clinton Hospital’s Community Benefits Program strives to meet and exceed the Schedule H/Form 990 IRS mandate to “promote health for a class of persons sufficiently large so the community as a whole benefits.” Our programs mirror the five core principles outlined by the Public Health Institute in terms of the “emphasis on communities with disproportionate unmet health-related needs; emphasis on primary prevention; building a seamless continuum of care; building community capacity; and collaborative governance.” Target populations for Clinton Hospital’s Community Benefits initiatives are identified through a community input and planning process, collaborative efforts, and a CHA which is conducted every three years.
The Community Benefit Strategic Implementation Plan
The focus areas of this Community Benefit Strategic Implementation Plan align well with the priorities identified by the CHA processes, as noted below:
Priority Area 1: Healthy Eating and Active Living- In the Study Area, adult respondents reported being overweight at a consistently higher percentage than in the State (59.3%) across all age groups, with reported percentages higher than 70% in the 45-54 age group (71.5%), the 55-64 age group (72.4%) and the 65-74 age group (73.6%). Childhood overweight and obesity is a concern as well, though percentages in children are more comparable to State percentages. However, 56% of Study Area residents report engaging in regular physical activity (defined as a 30 minute session at least 5 times a week), which is equal to the State percentage (though notably fewer college graduates in the Study Area reported regular physical activity, just 55.9% versus the State rate of 63.5%)
Priority Area 2: Individuals and Families in Healthy and Safe Relationships - Data on domestic violence (also referred to as “Intimate Partner Violence” or IPV) are limited for various reasons. However, other indicators, such as numbers of restraining orders, can help illuminate the scope of domestic violence occurring in a geographical area. In the Study Area, among selected courts, the total number of restraining orders has increased 39% from 1,786 in 2010 to 2,477 in 2013. These totals represent filings in the towns of Ayer, Clinton, Fitchburg, Gardner, Leominster, Orange, and Winchendon. Most of the increases range from 21% - 41%, but Fitchburg is noteworthy for its 76% increase, representing an increase to 659 orders filed in 2013 from 375 orders filed in 2010.
Priority Area 3: Behavioral Health and Substance Abuse - The Economy has exacerbated many issues associated with health and access to care – affecting everything from housing, food and healthcare to the stressors of job loss, reductions in hours and a sense of hopelessness that all contribute to poor mental and physical health and risk of substance abuse and domestic violence
Priority Area 4: Transportation and Access- Health Disparities and Social Determinants of Health are very real issues and concerns for the North Central Massachusetts region. While quantitative data is limited in its scope and ability to demonstrate the breadth of the concern, qualitative information obtained through focus groups and interviews highlights the extraordinary challenges faced by racial and ethnic minorities and other populations which contribute to a poorer health status and quality of life. Barriers to Optimal Health Status include, among others: Social and cultural isolation; Lack of adequate transportation resources; Difficulty navigating the complexities of the healthcare and health insurance systems; Difficulty affording the out-of-pocket costs of healthcare, and Language and cultural barriers.
All areas highlighted by the North Central MA Community Health Improvement Plan are being addressed by this 2016-2020 Clinton Hospital Community Benefits Plan. The issues addressed may be framed from a different perspective or may appear at a different hierarchical level of the plan, but the two plans are thematically consistent and intended to be implemented collaboratively and synergistically.
Community Benefit Priority Areas / GoalPriority Area 1: Healthy Eating and Active Living
/ Goal: Create an environment that supports people’s ability to make healthy eating and active living choices in their community.
Priority Area 2: Individuals and Families in Healthy and Safe Relationships / Goal: Improve and sustain the safety and overall security of the region’s children, families, and individuals.
Priority Area 3: Behavioral Health and Substance Abuse / Goal: Improve overall behavioral health and wellbeing, including preventing substance abuse, in a culturally diverse, responsive, and holistic manner.
Priority Area 4: Transportation and Access / Goal: Improve transportation services and systems to ensure equitable access for diverse communities.
Detailed action plans will be developed annually and tracked throughout the course of the year to monitor and evaluate progress and determine priorities for the next year. This plan is meant to be reviewed annually and adjusted to accommodate revisions that merit attention.
II. Community Benefits Mission
Mission Statement
UMass Memorial Health Care is committed to improving the health status of all those it serves and to addressing the health problems of the poor and other medically underserved populations. In addition, nonmedical conditions that negatively impact the health and wellness of our community are addressed.
The Mission incorporates the World Health Organization’s broad definition of health defined as “a state of complete physical, mental and social well being and not merely the absence of disease.” The UMass Memorial Health Care (UMMHC) Community Benefits Mission was developed and recommended by the Community Benefits Advisory Committee and approved by the UMass Memorial Health Care Board of Trustees.
III. Targeted Geography and Vulnerable Populations
Clinton Hospital aims to address both the letter and the spirit of the IRS Community Health Needs Assessment (CHNA) regulation in that it will be addressing the health needs and concerns of the region’s most underserved populations. The IRS mandate gives hospitals flexibility in how they define the community discussed in the CHNA. The community could be defined by a specific geographic area or target populations (e.g., children, elderly), as long as the definition still captures the interests of more vulnerable groups such as the underserved, low income, or minority populations.
Geography:
Clinton Hospital primarily serves the communities of Clinton, Berlin, Bolton, Lancaster and Sterling with populations of 13,606, 2,866, 4,897, 7,582 and 9,564 respectively. The population of the total service area is 36,759. Clinton has a population of 13,606. The majority of Clinton residents are White Non-Hispanic (84%), followed by Hispanic (11.6%) and Black Non- Hispanic (1.80%). The Clinton Hospital Service Area is also primarily White Non-Hispanic (88%), followed by Hispanic (6.4%), and Black Non-Hispanic (2.8%). Clinton Hospital’s Community Benefits Plan focuses on the needs of Clinton due to its large concentration of diverse, vulnerable populations.
Vulnerable Populations:
Target populations for Clinton Hospital’s Community Benefits initiatives are identified through a community input and planning process, collaborate efforts, and a Community Health Assessment (CHA) which is conducted every three years. Our target populations focus on medically underserved and vulnerable groups of all ages in Clinton and surrounding towns. Our most vulnerable populations include youth, elders, ethnic and linguistic minorities and those living in poverty. These populations often become isolated and disenfranchised due to negligence, misperceptions and even fear. Five targeted subpopulations have been defined as follows:
Elderly - With respect to households composed of elderly persons aged 65 and older living alone, the State average is 30%. Among
the Study Area cities and towns, the highest percentages in this category were found in Hardwick (37%), Clinton (34%),
and Gardner and Winchendon (both at 33%). Lowest percentages were found in Harvard and Bolton (both at 17%).
Clinton reported having the highest percentage of persons 65+ lived alone in the year 2000
Youth/children- The CNA showed Clinton having the 3rd highest percentage of low-income students in school 2008-2009, at
41.4%. Three Study Area school districts also reported a significant student body for which English is not their
first language. Compared to the State percentage of 15.4%, Fitchburg reported that English was not the first
language for 29.4% of its students, with 19.5% of Clinton’s students’ and18.2% of Leominster’s reported the same.
Populations living in poverty - One-third of the Study Area cities and towns reported higher percentages of
population living in poverty than the overall State percentage of 11.4%, with the highest
percentages of poverty, ranging from 14.4% to 15.8% in Gardner, Wendell, Fitchburg, Ayer
and Athol. Likewise, the percentage of children living in families below 100% of the poverty
level was higher than the State’s (14.9%) in Lancaster, Warwick, Wendell, Athol, Gardner,
Shirley, Royalston, most notably Fitchburg at 31.5%. Percentages of persons aged 65 and
over living below 100% of the poverty level were also higher than the State’s (9.3%),
ranging from 12.5% to 16.8% in Gardner, Fitchburg, Clinton and Templeton.
Underserved/uninsured- Consistently, all groups pointed to the cost of healthcare as a barrier to seeking treatment. Participants
frequently complained about “co-pays” and the total monthly cost for healthcare (i.e., co-pays, premiums,
medications, childcare, and transportation). Some reported that these costs reached $600 or more for
one month. They also noted that insufficient/limited insurance coverage was a barrier to healthcare. For
those without health insurance, out-of-pocket costs often prohibited access to care.
Ethnic and Linguistic Minorities- The Study Area population comprises primarily non-Hispanic, Caucasians
(91%). Latinos are the largest racial/ethnic group (8.5%) in the Study Area, representing a
slight increase from 2000 to 2010. Notably, three Study Area cities have higher
percentages of population that identify as Latino: Fitchburg at 21.6%, Clinton at 15% and
Leominster at 14.5%. The percentage of the Study Area population that is non-Hispanic,
Black/African American is 3%, as compared with 6.6% in the State overall. Three percent
(3%) of the Study Area population identifies as “Some Other Race.” Two percent (2%) of
the Study Area population are Asian, compared with the State percentage of 5.3%. Three