2017-08-09T17:48:54-05:00 2016-09-30 ERNST & YOUNG US LLP 560 MISSION ST STE 1600 SAN FRANCISCO CA 94105 990 2015-10-01 951684089 Scripps Health % RICHARD ROTHBERGER SCRI 8586787901 10140 Campus Point Drive San Diego CA 92121 RICHARD ROTHBERGER EXECUTIVE VP / CFO 2017-08-08 EVA NITTA P01286320 4158948000 2015 2021-01-29 14:40:06Z X CHRISTOPHER VAN GORDER SAME AS C ABOVE SAN DIEGO CA 92121 3243717915 false X WWW.SCRIPPSHEALTH.ORG X 1924 CA FOUNDED IN 1924 BY PHILANTHROPIST ELLEN BROWNING SCRIPPS, SCRIPPS HEALTH IS A $2.9 BILLION, PRIVATE NOT-FOR- PROFIT INTEGRATED HEALTH SYSTEM IN SAN DIEGO, CA. (SEE SCH O) 14 12 16371 3186 6703532 39110316 34089147 2635312765 2622932919 211934974 21688960 57229925 81980854 2943587980 2760691880 938981 637925 0 0 1179375553 1168033283 0 0 8729947 1391979608 1426602227 2572294142 2595273435 371293838 165418445 4463807760 4938384870 1381809214 1564728331 3081998546 3373656539 X FOUNDED IN 1924 BY PHILANTHROPIST ELLEN BROWNING SCRIPPS, SCRIPPS HEALTH IS A $2.9 BILLION, PRIVATE NOT-FOR-PROFIT INTEGRATED HEALTH SYSTEM IN SAN DIEGO, CALIFORNIA. (CONTINUED IN SCHEDULE O). false false 2266893586 637925 2698798285 SEE SCHEDULE O. 2266893586 true true false true false false true false true true true true false false true true false true false true true false false false true false true true true false true true false false false false false true false false true true true true false false true true true true false false true 1082 0 true 16371 true true true true MX false false false true true false false false false X 14 12 false false false false false false false true true false false true true true true true true true true true true CA X RICHARD ROTHBERGER 8586786828 10140 CAMPUS POINT DRIVE SAN DIEGO CA 92121 X MARY JO ANDERSON CHS VICE CHAIR/TRUSTEE 12.0 3.0 X 0 0 0 RICHARD C BIGELOW TRUSTEE 12.0 3.0 X 0 0 0 DOUGLAS A BINGHAM ESQ TRUSTEE 12.0 3.0 X 0 0 0 JEFF BOWMAN TRUSTEE 12.0 3.0 X 0 0 0 JAN CALDWELL TRUSTEE 12.0 3.0 X 0 0 0 JUDY CHURCHILL PH D TRUSTEE 12.0 3.0 X X 0 0 0 GORDON R CLARK CHAIRMAN/TRUSTEE 12.0 3.0 X X 0 0 0 NICOLE A CLAY TRUSTEE 12.0 3.0 X 0 0 0 ADOLFO GONZALES TRUSTEE 12.0 3.0 X 0 0 0 KATHERINE A LAUER TRUSTEE 12.0 3.0 X 0 0 0 MARTY J LEVIN TRUSTEE 12.0 3.0 X 0 0 0 MAUREEN STAPLETON TRUSTEE (PART YEAR) 12.0 3.0 X 0 0 0 ROBERT TJOSVOLD TRUSTEE (PART YEAR) 12.0 3.0 X 0 0 0 CHRISTOPHER VAN GORDER PRESIDENT & CEO/TRUSTEE 57.0 3.0 X X 2137950 0 1247162 RICHARD VORTMANN TRUSTEE 12.0 3.0 X 0 0 0 ABBY SILVERMAN WEISS TRUSTEE 12.0 3.0 X 0 0 0 GALE D KEEL ASSISTANT SECRETARY 39.0 1.0 X 102511 0 17537 RICHARD ROTHBERGER TREASURER/EXECUTIVE VP/CFO 53.0 2.0 X 1960422 0 323867 RICHARD R SHERIDAN SEC/CORP SR VP, GEN COUNSEL 53.0 2.0 X 793545 0 354388 ROBIN BROWN CHIEF EXECUTIVE, SR VP 50.0 0.0 X 762282 0 400491 VICTOR V BUZACHERO CORP SR VP INNOVAT/HR/PERF MGT 50.0 0.0 X 1069241 0 262796 SUSAN CAMPBELL EXEC DIR, EXTERNAL AFFAIRS 50.0 0.0 X 543618 0 80425 MARY ELLEN DOYLE CORP VP, NURSING OPS 50.0 0.0 X 541492 0 87965 JOHN ENGLE CORP SR VP, CHIEF DEVELOPMENT 50.0 0.0 X 607733 0 103642 CARL ETTER CHIEF EXECUTIVE, SR VP 50.0 0.0 X 787306 0 122514 SHIRAZ FAGAN CHIEF EXECUTIVE, SR VP 50.0 0.0 X 877840 0 159085 GARY FYBEL CHIEF EXECUTIVE, SR VP 50.0 0.0 X 982283 0 147032 THOMAS GAMMIERE CHIEF EXECUTIVE, SR VP 50.0 0.0 X 944943 0 178544 JUNE KOMAR CORP EXEC VP, STRATEGY & ADMIN 50.0 0.0 X 921693 0 228340 JAMES LABELLE MD CORP SR VP, CHIEF MED OFFICER 50.0 0.0 X 1025418 0 173523 BARBARA PRICE CORP SRVP BUS & SERV LINE DEV 50.0 0.0 X 763181 0 137826 MARC A REYNOLDS CORP SR VP, PAYER RELATIONS 30.0 20.0 X 692882 0 121410 DAVID COHN CORP VP, REVENUE CYCLE 50.0 0.0 X 529749 0 42236 ROBERT T HOFF CORP VP, HORIZONTAL OPS 50.0 0.0 X 535155 0 91122 ANIL KESWANI CORPORATE VP, CMO SHPS 50.0 0.0 X 690944 0 117214 RICHARD NEALE CORP SVP, CORP DEVELOPMENT 50.0 0.0 X 643593 0 38731 PATRIC THOMAS CORP VP, INFORMATION SVCS 50.0 0.0 X 638974 0 98428 ARNOLD BRENT EASTMAN MD FORMER KEY EMPLOYEE 0.0 0.0 X 1196617 0 -87257 19749372 0 4447021 2848 true true false SCRIPPS CLINIC MEDICAL GROUP 10666 N TORREY PINES ROAD LA JOLLA CA 92037 PHYSICIAN SERVICES 269821985 SCRIPPS COASTAL MEDICAL GROUP 501 WASHINGTON AVENUE SAN DIEGO CA 92103 PHYSICIAN SERVICES 39675649 MCCARTHY BUILDING COMPANIES 20401 SW BIRCH ST 300 NEWPORT BEACH CA 92006 CONSTRUCTION 64338249 SCRIPPS HOSPITAL INPATIENT PROVIDER 10010 CAMPUS POINT DRIVE SAN DIEGO CA 92121 PHYSICIAN SERVICES 13441662 EMERGENCY ACUTE CARE MEDICAL GROUP 440 STEVENS AVE STE 150 SAN DIEGO CA 92075 PHYSICIAN SERVICES 12440585 161 1725575 32363572 548021 34089147 HEALTHCARE DELIVERY REV 622110 2351035718 2349677131 1358587 0 CAPITATION PREMIUM 622110 133613743 133613743 0 0 PROVIDER FEE REVENUE 622110 89278708 89278708 0 0 MEANINGFUL USE INCENTIVE 900099 2396379 2396379 0 0 RENTAL INCOME - 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SOME ACTIVITY IS INDIVIDUALLY OR COLLECTIVELY CONDUCTED BY SCRIPPS HEALTH PERSONNEL DIRECTLY ON THE ORGANIZATION'S BEHALF. OTHER ACTIVITY IS CONDUCTED MORE DIRECTLY BY THE ORGANIZATIONS IN WHICH SCRIPPS HEALTH PARTICIPATES AND IS SUPPORTED BY SCRIPPS HEALTH INVOLVEMENT. THIS ACTIVITY INCLUDES BRIEFING OF LEGISLATORS AND LEGISLATIVE STAFF MEMBERS (FEDERAL, STATE AND LOCAL) ON MATTERS AFFECTING HEALTH CARE AND HEALTH CARE OPERATIONS. MEETINGS OCCUR IN PUBLIC OFFICIAL OFFICES, AT SCRIPPS FACILITIES AND IN VARIOUS OTHER VENUES OF OPPORTUNITY. ACTIVITY IS ON FEDERAL, STATE AND LOCAL LEVELS AND LOCATIONS. SUCH MATTERS INCLUDE: ACCOUNTABLE CARE ACT (HEALTH REFORM); BUDGET AND FISCAL POLICY IMPACTS; REIMBURSEMENT MATTERS; PROVIDER FEES AND OTHER ASSESSMENTS; DATA MANAGEMENT AND REPORTING; QUALITY AND PATIENT SAFETY MATTERS, HEALTH INFORMATION TECHNOLOGY AND THE IMPLEMENTATION OF ELECTRONIC HEALTH RECORDS, EMERGENCY DEPARTMENT OPERATIONS AND IMPACTS; UNINSURED, COST SHIFT IMPACTS AND OTHER SAFETY NET ISSUES; COMMUNITY BENEFIT PROGRAMS; GRADUATE MEDICAL EDUCATION; SITE-NEUTRAL PRICING, VALUE-BASED PURCHASING; BUNDLED PAYMENTS; ACCOUNTABLE CARE ORGANIZATIONS, MEDICARE, MEDICAID. THE ORGANIZATION STAFFS A GOVERNMENT RELATIONS DEPARTMENT THAT COORDINATES INFORMATION AND EDUCATION PROGRAMS ON PUBLIC POLICY AND ADVOCACY MATTERS. ALL WORK IS FOCUSED ON ISSUES. NO ACTIVITY ADDRESSES PARTISAN MATTERS, CANDIDATES OR POLITICAL ACTIVITIES. NO CORPORATE ACTIVITY ADDRESSED PARTISAN CAMPAIGNS. NATIONAL, STATE & LOCAL ORGANIZATIONS WITH WHICH SCRIPPS HEALTH PARTICIPATES IN PART IN LOBBY ACTIVITIES: AMERICAN HOSPITAL ASSOCIATION CALIFORNIA HOSPITAL ASSOCIATION HOSPITAL ASSOCIATION OF SAN DIEGO & IMPERIAL COUNTIES HEALTH MANAGEMENT ACADEMY PRIVATE ESSENTIAL ACCESS COMMUNITY HOSPITALS ALLIANCE FOR CATHOLIC HEALTH CARE PROTON THERAPY CONSORTIUM SAN DIEGO REGIONAL CHAMBER OF COMMERCE SAN DIEGO TAXPAYERS ASSOCIATION SAN DIEGO ECONOMIC DEVELOPMENT CORPORATION COMMUNITY HEALTH IMPROVEMENT PARTNERS X 2 16.00 2 1 true 70.00 true false false 108926000 6315759 7473883 1437223 3833012 1121407 116324000 117167000 1388206 -3512026 1345734 3632176 1139270 108926000 112290000 1480000 9068000 871000 3853000 947000 117167000 103819000 -1051000 14066000 874000 2707000 963000 112290000 94354000 745000 12924000 798000 2496000 910000 103819000 0.00000 1.00000 0.00000 false false 21490333 103401792 124892125 1651452481 609266746 1042185735 0 91626894 62548991 29077903 1198489420 866347940 332141480 149991268 1860893 148130375 1676427618 Multi-strategy funds 371739000 F Private equity funds 41627000 F 413366000 0 Self Insured Worker's Compensation Liability 43057995 Deferred Retirement Liability 13925641 Self Insured Malpractice Liability 23012977 Asset Retirement Obligation 14871394 Annuity and Unitrusts 10716296 Deposits and Contingencies 120015 Intercompany Liabilites -14228398 91475920 X SCHEDULE D, PART II, LINE 3 CHANGES TO CONSERVATION EASEMENTS THERE WERE NO MODIFIED, TRANSFERRED, RELEASED, EXTINGUISHED, OR TERMINATED CONSERVATIVE EASEMENTS IN FY16. SCHEDULE D, PART II, LINE 9 CONSERVATION EASEMENT THE HISTORICAL STRUCTURE THAT IS CONSIDERED TO BE A CONSERVATIVE EASEMENT IS REPORTED IN THE MERCY HOSPITAL ENTITY OF THE CONSOLIDATED FINANCIAL STATEMENTS. SCHEDULE D, PART V, LINE 4 INTENDED USES OF THE ORGANIZATION'S ENDOWMENT FUNDS CONTRIBUTIONS RECEIVED FOR CAPITAL PROJECTS, INCLUDING BUILDING PROJECTS, MAJOR RENOVATIONS, AND EQUIPMENT PURCHASES: $1,086,131. CONTRIBUTIONS RECEIVED TO FUND GRADUATE MEDICAL EDUCATION PROGRAMS, FELLOWS, AND LECTURE SERIES: $19,349,390 CONTRIBUTIONS RECEIVED FOR USE IN SPECIFIC DEPARTMENTS OR DIVISIONS IN THE HOSPITALS AND/OR CLINICS: $36,320,617 CONTRIBUTIONS RECEIVED TO COVER THE COST OF HEALTHCARE PROVIDED TO INDIVIDUALS WITHOUT INSURANCE OR THE MEANS FOR PAYING FOR THEIR CARE: $13,167,659 CONTRIBUTIONS RECEIVED TO FUND RESEARCH PROJECTS IN SPECIFIC AREAS OR DIVISIONS: $17,381,463 SCHEDULE D, PART X, LINE 2 UNCERTAIN TAX POSITIONS UNDER ASC 740 (AKA FIN 48) SCRIPPS HEALTH IS GENERALLY NOT SUBJECT TO FEDERAL OR STATE INCOME TAXES. HOWEVER, SCRIPPS HEALTH IS SUBJECT TO INCOME TAXES ON ANY NET INCOME THAT IS DERIVED FROM A TRADE OR BUSINESS, REGULARLY CARRIED ON, AND NOT IN FURTHERANCE OF THE PURPOSE FOR WHICH IT WAS GRANTED EXEMPTION. UNDER FASB ASC 740, INCOME TAXES, THE TAX BENEFIT FROM UNCERTAIN TAX POSITIONS MAY BE RECOGNIZED ONLY IF IT IS MORE LIKELY THAN NOT THE TAX POSITION WILL BE SUSTAINED, BASED SOLELY ON ITS TECHNICAL MERITS, WITH THE TAXING AUTHORITY HAVING FULL KNOWLEDGE OF ALL RELEVANT INFORMATION. THE ORGANIZATION RECORDS A LIABILITY FOR UNRECOGNIZED TAX BENEFITS FROM UNCERTAIN TAX POSITIONS AS DISCRETE TAX ADJUSTMENTS IN THE FIRST INTERIM PERIOD THAT THE MORE-LIKELY-THAN-NOT THRESHOLD IS NOT MET. THE ORGANIZATION RECOGNIZES DEFERRED TAX ASSETS AND LIABILITIES FOR TEMPORARY DIFFERENCES BETWEEN THE FINANCIAL REPORTING BASIS AND THE TAX BASIS OF ITS ASSETS AND LIABILITIES ALONG WITH NET OPERATING LOSS AND TAX CREDIT CARRYOVERS ONLY FOR TAX POSITIONS THAT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION CRITERIA. NO SIGNIFICANT TAX LIABILITY FOR TAX BENEFITS, INTEREST, OR PENALTIES WAS ACCRUED AT SEPTEMBER 30, 2016 OR 2015. SCRIPPS HEALTH CURRENTLY FILES FORM 990 (INFORMATIONAL RETURN OF ORGANIZATIONS EXEMPT FROM INCOME TAXES) AND FORM 990-T (BUSINESS INCOME TAX RETURN FOR AN EXEMPT ORGANIZATION) IN THE U.S. FEDERAL JURISDICTION AND THE STATE OF CALIFORNIA. SCRIPPS HEALTH IS NOT SUBJECT TO INCOME TAX EXAMINATIONS PRIOR TO 2012 IN MAJOR TAX JURISDICTIONS. North America 117 Program services RECONSTRUCTIVE SURGERY 263577 East Asia and the Pacific 4 Program services MED CARE & TRAINING 11126 121 121 274703 274703 true false false false true false SCHEDULE F, PART I, LINE 3, COLUMN F ACCOUNTING METHOD THE ACCRUAL METHOD OF ACCOUNTING WAS USED TO DETERMINE THE AMOUNTS IN COLUMN F. 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X X X X true true X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE SECTION C X X X X X X true X false X X X X true X X false false SCHEDULE H, PART V, LINE 5 REPORTING GROUP A HEALTH EXPERT, COMMUNITY LEADER AND RESIDENT FEEDBACK COMMUNITY ENGAGEMENT ACTIVITIES WERE CONDUCTED IN THE 2016 CHNA WITH A BROAD RANGE OF PEOPLE INCLUDING HEALTH EXPERTS, COMMUNITY LEADERS, AND SAN DIEGO RESIDENTS, IN AN EFFORT TO GAIN A MORE COMPLETE UNDERSTANDING OF THE TOP IDENTIFIED HEALTH NEEDS IN THE SAN DIEGO COMMUNITY. INDIVIDUALS WHO WERE CONSULTED INCLUDED REPRESENTATIVES FROM STATE, LOCAL, TRIBAL, OR OTHER REGIONAL GOVERNMENTAL PUBLIC HEALTH DEPARTMENTS (OR EQUIVALENT DEPARTMENT OR AGENCY) AS WELL AS LEADERS, REPRESENTATIVES, OR MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS. COMMUNITY INPUT WAS GATHERED THROUGH THE FOLLOWING ACTIVITIES: - COMMUNITY PARTNER DISCUSSIONS - KEY INFORMANT INTERVIEWS - HEALTH ACCESS AND NAVIGATIONS SURVEY - SAN DIEGO COUNTY HEALTH AND HUMAN SERVICES AGENCY SURVEY - BEHAVIORAL HEALTH DISCUSSIONS THE OVERALL PURPOSE OF COLLECTING COMMUNITY INPUT WAS TO GATHER INFORMATION ABOUT THE HEALTH NEEDS AND SOCIAL DETERMINANTS SPECIFIC TO SAN DIEGO COUNTY. SPECIFIC OBJECTIVES INCLUDED: - GATHER IN-DEPTH FEEDBACK TO AID IN THE UNDERSTANDING OF THE MOST SIGNIFICANT HEALTH NEEDS IMPACTING SAN DIEGO COUNTY. - CONNECT THE IDENTIFIED HEALTH NEEDS WITH ASSOCIATED SOCIAL DETERMINANTS OF HEALTH. - AID IN THE PROCESS OF PRIORITIZING HEALTH NEEDS WITHIN SAN DIEGO COUNTY. - GAIN INFORMATION ABOUT THE SYSTEM AND POLICY CHANGES WITHIN SAN DIEGO COUNTY THAT COULD POTENTIALLY IMPACT THE HEALTH NEEDS AND SOCIAL DETERMINANTS OF HEALTH. COMMUNITY PARTNER DISCUSSIONS COMMUNITY PARTNER DISCUSSIONS WERE CONDUCTED IN ALL REGIONS OF THE COUNTY BETWEEN JULY AND OCTOBER OF 2015, WITH 87 TOTAL PARTICIPANTS. NON-TRADITIONAL STAKEHOLDERS WERE RECRUITED THROUGH EXISTING COMMUNITY PARTNERSHIPS IN ORDER TO SOLICIT INPUT FROM THOSE WHO WORK DIRECTLY WITH MORE VULNERABLE POPULATIONS. A NON-TRADITIONAL STAKEHOLDER IS DEFINED AS AN INDIVIDUAL OR GROUP WHO HAS NOT BEEN CONSISTENTLY INVOLVED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS THROUGHOUT PREVIOUS CYCLES OF THE CHNA. THESE STAKEHOLDERS (COMMUNITY PARTNERS) WERE COMPRISED OF INDIVIDUALS FROM A VARIETY OF BACKGROUNDS INCLUDING: CARE COORDINATORS, OUTREACH WORKERS, COMMUNITY EDUCATION SPECIALISTS, WELLNESS COORDINATORS, SCHOOL NURSES, BEHAVIORAL HEALTH MANAGERS AND WORKERS, CALFRESH OUTREACH COORDINATORS, AND CALFRESH CAPACITY COORDINATORS (CAPACITY COORDINATORS HELP TO BUILD CAPACITY AND COMMUNITY SUPPORT, IMPLEMENT NEW PROJECTS AND PROVIDE TECHNICAL SUPPORT TO BETTER ADDRESS POVERTY AND HUNGER). BEHAVIORAL HEALTH DISCUSSIONS THREE BEHAVIORAL HEALTH DISCUSSIONS TOOK PLACE BETWEEN DECEMBER 2015 AND JANUARY 2016. THE COMBINED TOTAL NUMBER OF ATTENDEES WAS ROUGHLY 58 PEOPLE BETWEEN THE TWO MEETINGS. DUE TO THE COMPLEXITY OF BEHAVIORAL HEALTH, ADDITIONAL DISCUSSIONS WERE HELD SPECIFICALLY TO ENSURE THE QUANTITATIVE DATA THAT WAS GATHERED ACCURATELY REFLECTED CURRENT TRENDS AND AREAS OF TRUE NEED. THE PURPOSE OF THE BEHAVIORAL HEALTH DISCUSSIONS WAS TO GATHER FEEDBACK FROM BEHAVIORAL HEALTH EXPERTS TO AID IN THE UNDERSTANDING OF THE MOST SIGNIFICANT HEALTH NEEDS IMPACTING SAN DIEGO COUNTY AND AID IN THE PROCESS OF PRIORITIZING HEALTH NEEDS WITHIN BEHAVIORAL HEALTH. MEETINGS FOCUSED ON BEHAVIORAL HEALTH WERE TARGETED TO SOLICIT FEEDBACK FROM STAKEHOLDERS INCLUDING PATIENT ADVOCATES AS WELL AS REPRESENTATIVES FROM HOSPITALS, CLINICS, COUNTY HEALTH & HUMAN SERVICES AGENCY (HHSA), SMALLER BEHAVIORAL OR MENTAL HEALTH FACILITIES, AND HEALTH PLANS. THE BEHAVIORAL HEALTH DISCUSSION TEMPLATE WAS DEVELOPED BASED ON HOSPITAL DISCHARGE DATA ANALYSIS AND INCORPORATED A SYNTHESIS OF THE COMMUNITY PARTNER DISCUSSION DATA. A SUMMARY OF DATA AS IT RELATES TO BEHAVIORAL HEALTH NEEDS WAS PROVIDED TO THE BEHAVIORAL HEALTH EXPERTS PRIOR TO GAINING THEIR FEEDBACK. KEY INFORMANT INTERVIEWS IN RESPONSE TO FEEDBACK FROM THE 2013 CHNA, THE NUMBER OF KEY INFORMANT INTERVIEWS CONDUCTED AS PART OF THE 2016 CHNA WAS EXPANDED TO INCLUDE EXPERTS WORKING WITH A WIDER VARIETY OF PATIENT POPULATIONS. PARTICIPANTS WERE SELECTED BASED ON THEIR EXPERTISE IN A SPECIFIC CONDITION, AGE GROUP, AND/OR POPULATION. MORE SPECIFICALLY, INDIVIDUALS WHO PARTICIPATED IN THE 2016 CHNA HAD KNOWLEDGE IN AT LEAST ONE OF THE FOLLOWING AREAS: CHILDHOOD ISSUES, SENIOR HEALTH, NATIVE AMERICANS, LATINOS, ASIAN AMERICANS, REFUGEE AND FAMILIES, HOMELESS, LESBIAN, GAY, BISEXUAL, TRANSGENDER AND QUEER (LGBTQ) POPULATION, VETERANS, ALCOHOL AND DRUG ADDICTION, CARDIOVASCULAR HEALTH, BEHAVIORAL HEALTH, DIABETES, OBESITY, AND FOOD INSECURITY. IN ADDITION, THERE WAS REPRESENTATION ACROSS MULTIPLE AGENCIES AND ORGANIZATIONS INCLUDING THE SAN DIEGO COUNTY HHSA, LOCAL SCHOOLS, YOUTH PROGRAMS, COMMUNITY CLINICS, AND COMMUNITY-BASED ORGANIZATIONS. THE DEVELOPMENT OF THE KEY INFORMANT INTERVIEW TOOL BEGAN WITH THE RESULTS FROM THE HOSPITAL ASSOCIATION OF SAN DIEGO & IMPERIAL COUNTIES (HASD&IC) 2013 CHNA. THE INTERVIEW QUESTIONS WERE DESIGNED TO PROVIDE IN-DEPTH DETAIL ON THE TOP FOUR HEALTH NEEDS. NINETEEN KEY INFORMANT INTERVIEWS TOOK PLACE EITHER IN-PERSON OR VIA PHONE INTERVIEW BETWEEN JULY 2015 AND FEBRUARY 2016. EACH INTERVIEW LASTED NO LONGER THAN ONE HOUR. SIX QUESTIONS WERE ASKED DURING THE INTERVIEWS, WITH A PARTICULAR FOCUS ON THE TOP FOUR HEALTH NEEDS THAT WERE IDENTIFIED IN THE 2013 CHNA. ALTHOUGH THERE WERE SPECIFIC QUESTIONS ASKED, THE FORMAT OF THE INTERVIEWS ALLOWED FOR AMPLE OPPORTUNITY FOR OPEN DISCUSSION ON HEALTH NEEDS THAT THE KEY INFORMANTS FELT WERE MOST IMPORTANT IN SAN DIEGO COUNTY, INCLUDING THOSE NOT DIRECTLY RELATED TO THE TOP FOUR HEALTH NEEDS. SOME IMPORTANT STRATEGIES THAT KEY INFORMANTS SUGGESTED INCLUDED BEHAVIORAL HEALTH PREVENTION AND STIGMA REDUCTION, EDUCATION ON DISEASE MANAGEMENT AND FOOD INSECURITY, IMPROVING CULTURAL COMPETENCY AND DIVERSITY, AND INTEGRATING PHYSICAL AND MENTAL HEALTH, COORDINATING SERVICES ACROSS THE CONTINUUM, AND ENGAGING CASE MANAGERS AND PATIENT NAVIGATORS IN THE COMMUNITY AND INCORPORATING THEM AS A ROUTINE PART OF THE CONTINUUM OF CARE. SURVEYS TWO DIFFERENT SURVEYS WERE DEVELOPED AND DISSEMINATED THROUGH DIFFERENT AVENUES AS PART OF THE 2016 CHNA PROCESS THE HEALTH ACCESS AND NAVIGATION SURVEY AND THE COLLABORATIVE SAN DIEGO COUNTY HEALTH AND HUMAN SERVICES AGENCY SURVEY. HEALTH ACCESS AND NAVIGATION SURVEY THE HEALTH ACCESS AND NAVIGATION SURVEY WAS DEVELOPED IN PARTNERSHIP WITH THE SAN DIEGO COUNTY RESIDENT LEADERSHIP ACADEMY (RLA). AFTER COMPARING RESULTS OF THE RLAS 2014 COMMUNITY NEEDS ASSESSMENT AND WITH THE FINDINGS FROM THE HASD&IC 2013 CHNA, ACCESS AND NAVIGATION OF HEALTH CARE EMERGED AS A COMMON BARRIER IDENTIFIED BY THE SAN DIEGO COMMUNITY. THE CHNA COMMITTEE COLLABORATED WITH THE RLAS TO DESIGN A SURVEY TOOL THAT COULD IDENTIFY SPECIFIC BARRIERS RESIDENTS FACE WHEN THEY TRY TO ACCESS HEALTH CARE SERVICES. RLA LEADERS AGREED TO DISSEMINATE THE HEALTH ACCESS AND NAVIGATION SURVEY TO RESIDENTS IN THEIR NEIGHBORHOODS. THE ROADMAP SURVEY WAS DESIGNED TO IDENTIFY PARTICULAR AREAS IN WHICH RESIDENTS STRUGGLE WHEN THEY ARE USING THE HEALTH SYSTEM. THE SURVEYS WERE FIELDED ON SEPTEMBER 22, 2015 AND CLOSED NOVEMBER 2, 2015. SURVEY RESPONSES WERE COLLECTED BOTH ELECTRONICALLY AND VIA PAPER AND PENCIL FORMAT FROM COMMUNITY RESIDENTS. PAPER AND ELECTRONIC COPIES OF THE SURVEY WERE MADE AVAILABLE TO THE RLA LEADERS IN SPANISH, ENGLISH, AND ARABIC. AN ONLINE SURVEY LINK WAS ALSO EMAILED OUT IN BOTH SPANISH AND ENGLISH. A TOTAL OF 235 SURVEYS WERE COMPLETED WITH THE MAJORITY BEING COMPLETED ON PAPER (181) AND 54 COMPLETED VIA THE ONLINE SURVEY. ONE HUNDRED AND ELEVEN PAPER SURVEYS AND ZERO ONLINE SURVEYS WERE COMPLETED IN SPANISH. SEVENTY PAPER AND 54 ONLINE SURVEYS WERE COMPLETED IN ENGLISH. NO ARABIC SURVEYS WERE COLLECTED OR COMPLETED. SURVEY PARTICIPANTS WERE ASKED TO CHOOSE THE TOP FIVE BARRIERS THE PARTICIPANTS OR THE POPULATION THEY WORK WITH EXPERIENCE, AND TO RANK THE FIVE BARRIERS FROM ONE TO FIVE, WITH ONE BEING THE MOST TROUBLESOME. MOST STRIKING WAS THAT THE TOP FOUR BARRIERS CITED AS MOST TROUBLESOME WERE ALL PRECURSORS TO SEEING A HEALTH CARE PROVIDER, INDICATING THAT COMMUNITY MEMBERS ARE OFTEN STRUGGLING TO MAKE IT PAST THE FIRST STEPS OF ACCESSING HEALTHCARE. BASED ON THE SURVEY RESPONSES, THE TOP FIVE BARRIERS TO ACCESSING HEALTH CARE WERE: - UNDERSTANDING HEALTH INSURANCE - GETTING HEALTH INSURANCE - USING HEALTH INSURANCE - KNOWING WHERE TO GO FOR CARE - FOLLOW UP CARE AND/OR APPT. AS THE NUMBER OF INDIVIDUALS WHO HAVE HEALTH INSURANCE IN THE NATION AND WITHIN SAN DIEGO COUNTY HAS INCREASED, SO HAS THE IMPORTANCE OF HELPING PEOPLE UNDERSTAND HOW TO OBTAIN HEALTH INSURANCE, USE HEALTH INSURANCE, AND ACCESS CARE THAT IS APPROPRIATE FOR THEIR HEALTH NEEDS. RESIDENTS ABILITY TO ACCESS HEALTH CARE IS A CRITICAL FIRST STEP TOWARD IMPROVING THE OVERALL HEALTH OF SAN DIEGO COMMUNITY. 'UNDERSTANDING HEALTH INSURANCE' WAS THE TOP CITED BARRIER IN ALL REGIONS WITH THE EXCEPTION OF EAST REGION WHICH FOUND 'FOLLOW-UP CARE AND/OR APPOINT SCHEDULE H, PART V, LINE 6A REPORTING GROUP A GROUNDED IN A LONGSTANDING COMMITMENT TO ADDRESS COMMUNITY HEALTH NEEDS IN SAN DIEGO, SEVEN HOSPITALS AND HEALTHCARE SYSTEMS CAME TOGETHER UNDER THE AUSPICES OF THE HOSPITAL ASSOCIATION OF SAN DIEGO AND IMPERIAL COUNTIES (HASD&IC) TO CONDUCT A TRIENNIAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) THAT IDENTIFIES AND PRIORITIZES THE MOST CRITICAL HEALTH-RELATED NEEDS OF SAN DIEGO COUNTY RESIDENTS. PARTICIPATING HOSPITALS WILL USE THE FINDINGS TO GUIDE THEIR COMMUNITY PROGRAMS AND TO MEET IRS REGULATORY REQUIREMENTS. SCRIPPS CONDUCTED ONE CHNA FOR THE SYSTEM. BEGINNING IN MAY 2015 WITH COMPLETION IN APRIL 2016, THE INSTITUTE FOR PUBLIC HEALTH AT SAN DIEGO STATE UNIVERSITY MANAGED THE DESIGN, IMPLEMENTATION AND INTERPRETATION OF THE CHNA PROCESS. PARTICIPATING HOSPITALS AND HEALTHCARE SYSTEMS WERE ALL REPRESENTED IN THE CHNA ADVISORY WORKGROUP: - KAISER FOUNDATION HOSPITAL - SAN DIEGO - PALOMAR HEALTH - RADY CHILDREN'S HOSPITAL - SAN DIEGO - SCRIPPS HEALTH - SHARP HEALTHCARE - TRI-CITY MEDICAL CENTER - UNIVERSITY OF CALIFORNIA SAN DIEGO HEALTH SYSTEM SCHEDULE H, PART V, LINE 6B IN MAY 2015, THE HOSPITAL ASSOCIATION FOR SAN DIEGO AND IMPERIAL COUNTIES CONTRACTED WITH THE INSTITUTE FOR PUBLIC HEALTH AT SAN DIEGO STATE UNIVERSITY TO PROVIDE ASSISTANCE WITH THE COLLABORATIVE HEALTH NEEDS ASSESSMENT THAT WAS OFFICIALLY CALLED THE HASD&IC 2016 COMMUNITY HEALTH NEEDS ASSESSMENT. SCRIPPS CONDUCTED ONE COMMUNITY HEALTH NEEDS ASSESSMENT FOR THE SYSTEM. SCHEDULE H, PART V, LINE 7A REPORTING GROUP A THE COMMUNITY HEALTH NEEDS ASSESSMENT IS AVAILABLE TO THE PUBLIC USING THE FOLLOWING URL: HTTPS://WWW.SCRIPPS.ORG/ABOUT-US__SCRIPPS-IN-THE-COMMUNITY__ASSESSING-COMM UNITY-NEEDS SCHEDULE H, PART V, LINE 10A REPORTING GROUP A THE IMPLEMENTATION STRATEGY IS AVAILABLE TO THE PUBLIC USING THE FOLLOWING URL: HTTPS://WWW.SCRIPPS.ORG/ABOUT-US__SCRIPPS-IN-THE-COMMUNITY__ASSESSING-COMM UNITY-NEEDS SCHEDULE H, PART V, LINE 11 REPORTING GROUP A IN RESPONSE TO IDENTIFIED UNMET HEALTH NEEDS IN THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT SCRIPPS HEALTH IS FOCUSING ON THE FOUR PRIORITIZED HEALTH NEEDS (CARDIOVASCULAR DISEASE, AND STROKE, DIABETES TYPE 2, BEHAVIORAL HEALTH, AND OBESITY. SCRIPPS HAS DEVELOPED VARIOUS INITIATIVES, STRATEGIES AND METRICS TO MEASURE AND EVALUATE THE EFFECTIVENESS OF THE PROGRAMS. THIS COMMUNITY HEALTH NEEDS ASSESSMENT AND ITS CORRESPONDING IMPLEMENTATION PLAN IS AVAILABLE TO THE PUBLIC USING THE FOLLOWING URL: HTTPS://WWW.SCRIPPS.ORG/ABOUT-US__SCRIPPS-IN-THE-COMMUNITY__ASSESSING-COMM UNITY-NEEDS SCRIPPS HEALTH HAS A LONG HISTORY OF RESPONDING TO THE HEALTH NEEDS OF THE COMMUNITIES IT SERVES, EXTENDING BEYOND TRADITIONAL HOSPITAL CARE TO PROVIDE COMMUNITY BENEFIT PROGRAMS THAT ADDRESS THE HEALTH CARE NEEDS OF THE REGIONS MOST VULNERABLE POPULATIONS. SCRIPPS STRIVES TO IMPROVE COMMUNITY HEALTH THROUGH COLLABORATION. WORKING WITH OTHER HEALTH SYSTEMS, COMMUNITY GROUPS, GOVERNMENT AGENCIES, BUSINESSES AND GRASSROOTS MOVEMENTS, SCRIPPS IS BETTER ABLE TO BUILD UPON EXISTING ASSETS TO ACHIEVE BROAD COMMUNITY HEALTH GOALS. THE 2016 CHNA IDENTIFIED BEHAVIORAL HEALTH AS THE NUMBER ONE HEALTH NEED IN SAN DIEGO COUNTY. IN ADDITION, CARDIOVASCULAR DISEASE, DIABETES (TYPE 2), AND OBESITY WERE IDENTIFIED AS HAVING EQUAL IMPORTANCE DUE TO THEIR INTERRELATEDNESS. HEALTH NEEDS WERE FURTHER BROKEN DOWN INTO PRIORITY AREAS DUE TO THE OVERWHELMING AGREEMENT AMONG ALL DATA SOURCES AND IN RECOGNITION OF THE COMPLEXITIES WITHIN EACH HEALTH NEED. WITHIN THE CATEGORY OF BEHAVIORAL HEALTH, ALZHEIMERS DISEASE, ANXIETY, DRUG AND ALCOHOL ISSUES, AND MOOD DISORDERS ARE SIGNIFICANT HEALTH NEEDS WITHIN SAN DIEGO COUNTY. AMONG THE OTHER CHRONIC HEALTH NEEDS, HYPERTENSION WAS CONSISTENTLY FOUND TO BE A SIGNIFICANT PRIORITY AREA RELATED TO CARDIOVASCULAR DISEASE, UNCONTROLLED DIABETES WAS AN IMPORTANT FACTOR LEADING TO COMPLICATIONS RELATED TO DIABETES, AND OBESITY WAS OFTEN FOUND TO CO-OCCUR WITH OTHER CONDITIONS AND CONTRIBUTE TO WORSENING HEALTH STATUS. THE IMPACT OF THE TOP HEALTH NEEDS DIFFERED AMONG AGE GROUPS; WITH TYPE 2 DIABETES, OBESITY, AND ANXIETY AFFECTING ALL AGE GROUPS, DRUG AND ALCOHOL ISSUES AFFECTING TEENS AND ADULTS, AND ALZHEIMERS DISEASE, CARDIOVASCULAR DISEASE, AND HYPERTENSION AFFECTING OLDER ADULTS. WITH THE 2016 CHNA COMPLETE AND HEALTH PRIORITY AREAS IDENTIFIED, SCRIPPS HEALTH HAS DEVELOPED A CORRESPONDING IMPLEMENTATION STRATEGY -- A MULTI-FACETED, MULTI-STAKEHOLDER PLAN THAT ADDRESSES THE COMMUNITY HEALTH NEEDS IDENTIFIED IN THE CHNA. THE IMPLEMENTATION PLAN TRANSLATES THE RESEARCH AND ANALYSIS PRESENTED IN THE ASSESSMENT INTO ACTUAL, MEASURABLE STRATEGIES AND OBJECTIVES THAT CAN BE CARRIED OUT TO IMPROVE COMMUNITY HEALTH OUTCOMES. SCRIPPS HEALTH ANTICIPATES THE IMPLEMENTATION STRATEGIES MAY EVOLVE DUE TO THE FAST PACE AT WHICH THE COMMUNITY AND HEALTH CARE INDUSTRY CHANGE. THEREFORE, A FLEXIBLE APPROACH IS BEST SUITED FOR THE DEVELOPMENT OF ITS RESPONSE TO THE SCRIPPS HEALTH COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). ON AN ANNUAL BASIS SCRIPPS HEALTH EVALUATES THE IMPLEMENTATION STRATEGY AND ITS RESOURCES AND INTERVENTIONS; AND MAKES ADJUSTMENTS AS NEEDED TO ACHIEVE ITS STATED GOALS AND OUTCOME MEASURES AS WELL AS TO ADAPT TO THE CHANGES AND RESOURCES AVAILABLE. SCRIPPS DESCRIBES ANY CHALLENGES ENCOUNTERED TO ACHIEVE THE OUTCOMES DESCRIBED AND MAKES MODIFICATIONS AS NEEDED. SCHEDULE H, PART V, LINE 13H REPORTING GROUP A OTHER CRITERIA TO DETEMRINE FINANCIAL ASSISTANCE ELIGIBILITY IF IT IS DETERMINED THAT THE FAMILY INCOME IS ABOVE 400% OF THE FPL, SCRIPPS MAY CONSIDER THE PATIENT ELIGIBLE FOR FINANCIAL ASSISTANCE BASED ON EXTENUATING CIRCUMSTANCES SUCH AS CATASTROPHIC MEDICAL EVENTS OR OTHER SPECIAL SITUATIONS WE WILL NOT CHARGE PATIENTS QUALIFIED FOR FINANCIAL ASSISTANCE MORE THAN SCRIPPSS DISCOUNTED FINANCIAL ASSISTANCE AMOUNT, WHICH REPRESENTS SCRIPPS AGB AS CALCULATED WITH THE PROSPECTIVE METHOD. EVERY EFFORT IS MADE TO IDENTIFY PATIENTS WHO MAY BENEFIT FROM FINANCIAL ASSISTANCE AS SOON AS POSSIBLE AND PROVIDE COUNSELING AND LANGUAGE INTERPRETATION WHEN NEEDED. PATIENTS WHO DO NOT QUALIFY FOR FINANCIAL ASSISTANCE BUT NEED HELP WITH PAYMENTS WILL BE OFFERED A NO-INTEREST PAYMENT PLAN CONSISTENT WITH THEIR NEEDS AND ALL UNFUNDED PATIENTS RECEIVE A MINIMUM OF A 20% DISCOUNT TAKEN AUTOMATICALLY AT BILLING. IN ADDITION, SCRIPPS DOES NOT APPLY WAGE GARNISHMENT OR LIENS ON PRIMARY RESIDENCES AS A WAY OF COLLECTING UNPAID HOSPITAL BILLS. SCHEDULE H, PART V, LINES 16A, 16B, & 16C REPORTING GROUP A THE FINANCIAL ASSISTANCE POLICY, APPLICATION FORM, AND PLAIN LANGUAGE SUMMARY IS WIDELY AVAILABLE ON THE SCRIPPS HEALTH WEBSITE AT: HTTPS://WWW.SCRIPPS.ORG/PATIENTS-AND-VISITORS__FINANCIAL-ASSISTANCE SCHEDULE H, PART V, LINE 16I REPORTING GROUP A THE AVAILABILITY OF THE FINANCIAL ASSISTANCE POLICY THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE UPON REQUEST. PAPER COPIES OF OUR FINANCIAL ASSISTANCE POLICY, FINANCIAL ASSISTANCE APPLICATIONS, AND A PLAIN LANGUAGE SUMMARY OF THE POLICY IS MADE AVAILABLE UPON REQUEST AND WITHOUT CHARGE AT ALL SCRIPPS PATIENT REGISTRATION AREAS AND BY MAIL. IN ADDITION, THE AVAILABILITY OF FINANCIAL ASSISTANCE IS POSTED AT ALL POINTS OF REGISTRATION AREAS (I.E. EMERGENCY DEPARTMENT, BILLING OFFICE, MAIN ADMISSION AREAS AND ANCILLARY SERVICE LOCATIONS). PLAIN LANGUAGE SUMMARIES ARE STOCKED AS A PATIENT HANDOUT IN BOTH ENGLISH AND SPANISH. FOR INPATIENTS, THE INFORMATION IS INCLUDED IN THE ESSENTIAL HANDBOOK, A COMPREHENSIVE BROCHURE COVERING MANY ASPECTS OF HOSPITALIZATION. UNFUNDED PATIENTS ARE NOT ALWAYS REFERRED TO FINANCIAL COUNSELORS. SOME SITES DO NOT USE FINANCIAL COUNSELORS, BUT THE STAFF MEMBER WHO REGISTERS THE PATIENT CAN DISCUSS FINANCIAL ASSISTANCE AND THE PLAIN LANGUAGE SUMMARY PROVIDES PATIENTS WITH CONTACT INFORMATION FOR FINANCIAL COUNSELORS. SCRIPPS MAKES EVERY REASONABLE EFFORT TO ASSIST PATIENTS IN MEETING THEIR FINANCIAL OBLIGATION TO PAY FOR HOSPITAL SERVICES, INCLUDING EMERGENCY AND OTHER MEDICALLY NECESSARY HOSPITAL CARE. SCRIPPS FINANCIAL ASSISTANCE IS DESIGNED TO SUPPORT PATIENTS WITH DEMONSTRATED FINANCIAL NEED AND IS NOT INTENDED TO SUPPLEMENT OR CIRCUMVENT THIRD-PARTY COVERAGE INCLUDING MEDICARE. PATIENT COMMUNICATION AND COMMUNITY OUTREACH AND COMMUNICATION REGARDING SCRIPPS FINANCIAL ASSISTANCE IS ACHIEVED THROUGH THE FOLLOWING MEASURES, TO INCLUDE BUT NOT LIMITED TO; - POSTERS IN CONSPICUOUS REGISTRATION AREAS I.E. EMERGENCY DEPARTMENT, BILLING OFFICE, MAIN ADMISSION AREAS AND ANCILLARY SERVICE LOCATIONS. - PAPER COPIES OF SCRIPPS FINANCIAL ASSISTANCE POLICY, FINANCIAL ASSISTANCE APPLICATIONS, AND A PLAIN LANGUAGE SUMMARY OF THE POLICY ARE AVAILABLE UPON REQUEST AND WITHOUT CHARGE AT ALL SCRIPPS HOSPITAL EMERGENCY DEPARTMENTS AND ADMISSION AREAS. PATIENTS MAY ALTERNATIVELY REQUEST COPIES OF THESE DOCUMENTS BE SENT TO THEM ELECTRONICALLY. - THE FINANCIAL ASSISTANCE POLICY, A PLAIN LANGUAGE SUMMARY, AND FINANCIAL ASSISTANCE APPLICATIONS ARE CONSPICUOUSLY POSTED ON SCRIPPS WEB SITE TO VIEW, DOWNLOAD AND PRINT FREE OF CHARGE. THE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY CONTAINS THE WEB SITE ADDRESS WHERE THESE DOCUMENTS ARE POSTED IN ADDITION TO THE PHYSICAL LOCATION IN THE HOSPITAL WHERE PAPER COPIES MAY BE OBTAINED. - THE FINANCIAL ASSISTANCE SUMMARY IS OFFERED TO ALL PATIENTS AT REGISTRATION OR PRIOR TO DISCHARGE AS PART OF THE AGREEMENT OF SERVICES AT A SCRIPPS FACILITY. - ALL BILLING STATEMENTS INCLUDE A STATEMENT ON THE AVAILABILITY OF FINANCIAL ASSISTANCE INCLUDING A TELEPHONE NUMBER FOR SCRIPPS HOSPITAL STAFF THAT PROVIDES ASSISTANCE WITH THE APPLICATION PROCESS AND THE WEBSITE ADDRESS WHERE THE FAP, FAP SUMMARY AND FINANCIAL ASSISTANCE APPLICATION CAN BE FOUND. - THE FAP, FAP SUMMARY AND FINANCIAL ASSISTANCE APPLICATION ARE AVAILABLE IN THE PRIMARY LANGUAGES OF SIGNIFICANT PATIENT POPULATIONS WITH LIMITED ENGLISH PROFICIENCY (LEP). - A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE AT COMMUNITY EVENTS AND IS PROVIDED TO LOCAL AGENCIES THAT PROVIDE CONSUMER ASSISTANCE. SCRIPPS HEALTH WORKED WITH THE CALIFORNIA HOSPITAL ASSOCIATION (CHA) TO INFORM AND NOTIFY MEMBERS OF THE COMMUNITY SERVED BY THE HOSPITAL ABOUT THE FAP AND TO REACH THOSE MEMBERS WHO ARE MOST LIKELY TO REQUIRE FINANCIAL ASSISTANCE. - SCRIPPS PROVIDES A COPY OF ITS POLICY AND RELATED INFORMATION TO THE CALIFORNIA OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT AS REQUIRED BY LAW. IN ADDITION, SCRIPPS POLICY IS AVAILABLE TO THE PUBLIC FOR REVIEW UPON REQUEST MADE THROUGH PATIENT FINANCIAL SERVICES CUSTOMER SERVICE. REVIEW IS FACILITATED THROUGH THE USE OF INTERPRETERS (LANGUAGE, VISION, AND HEARING) OR WRITTEN MATERIALS AS REQUESTED BY THE INDIVIDUAL. SCHEDULE H, PART V, LINE 22 CHARGES TO INDIVIDUALS ELIGIBLE FOR FINANCIAL ASSISTANCE THE HOSPITAL FACILITY DETERMINED THE AMOUNT GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE USING A PROSPECTIVE METHODOLOGY OF ESTIMATING THE AMOUNT THE HOSPITAL WOULD BE PAID BY MEDICARE AND A MEDICARE BENEFICIARY IF THE FAP-ELIGIBLE INDIVIDUALS WERE MEDICARE FEE-FOR-SERVICE BENEFICIARIES. THE LOWEST MEDICARE REIMBURSEMENT, REPRESENTED AS A SINGLE AVERAGE PERCENTAGE OF GROSS CHARGES, IS USED AS THE MAXIMUM AMOUNT A FAP-ELIGIBLE INDIVIDUAL IS EXPECTED TO PAY. 41 SCRIPPS CLINIC - TORREY PINES 10666 N TORREY PINES ROAD LA JOLLA CA 92037 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCRIPPS CLINIC - RANCHO BERNARDO 15004 INNOVATION DRIVE SAN DIEGO CA 92128 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCRIPPS CLINIC - CARMEL VALLEY 3811 VALLEY CENTER DRIVE SAN DIEGO CA 92130 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCRIPPS MEDICAL LAB 9235 WAPLES ST 150 SAN DIEGO CA 92121 LABORATORY SERVICES IMAGING HEALTHCARE SPECIALISTS LLC 150 WEST WASHINGTON STREET SAN DIEGO CA 92103 MEDICAL IMAGING SERVICES SCRIPPS CLINIC - ENCINITAS 310 SANTA FE DRIVE ENCINITAS CA 92024 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCMC CEDAR 130 CEDAR ROAD VISTA CA 92083 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCRIPPS HOME HEALTH SERVICES 9619 CHEASPEAKE DRIVE 300 SAN DIEGO CA 92123 HOME HEALTH SERVICES SCRIPPS CLINIC-LA JOLLA MEMORIAL CAMPUS 9850 GENESSEE AVE XIMED BLDG 600 SAN DIEGO CA 92121 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCRIPPS CLINIC - MISSION VALLEY 7565 MISSION VALLEY ROAD SAN DIEGO CA 92108 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCMC - CARLSBAD 2176 SALK AVENUE CARLSBAD CA 92008 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCRIPPS CLINIC - RANCHO SAN DIEGO 10862 CALLE VERDE LA MESA CA 91941 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCRIPPS CLINIC ANDERSON MEDICAL PAVILION 9898 GENESEE AVENUE LA JOLLA CA 92037 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCMC - HILLCREST 501 WASHINGTON ST 525 600 SAN DIEGO CA 92103 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCMC - ENCINITAS 477 N EL CAMINO REAL A208 B305 ENCINITAS CA 92024 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT ENCINITAS SURGERY CENTER LLC 320 SANTA FE DRIVE LL1-2 ENCINITAS CA 92024 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCMC - OCEANSIDE 4318 MISSION AVENUE OCEANSIDE CA 92057 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT MERCY ASC 550 WASHINGTON STREET 1ST FLOOR SAN DIEGO CA 92103 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCRIPPS CLINIC - DEL MAR 12395 EL CAMINO REAL 317 112 12 DEL MAR CA 92130 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCRIPPS CL RADIATION THERAPY CTR - VISTA 916 SYCAMORE AVE STE 100 VISTA CA 92082 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCRIPPS HOSPITAL MEDICAL SERVICES 10140 CAMPUS POINT DRIVE SAN DIEGO CA 92121 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCMC - EASTLAKE 971 LANE AVE CHULA VISTA CA 91914 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCRIPPS CARDIO & THORACIC SURGERY CENTER 9850 GENESSEE AVE 560 LA JOLLA CA 92037 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCRIPPS PHARMACY - GREEN 10666 NORTH TORREY PINES ROAD LA JOLLA CA 92037 MEDICAL PHARMACY SCMC - ENCINITAS OBGYN 332 SANTA FE DR 115 ENCINITAS CA 92024 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCMC - VISTA WAY OBGYN 3998 VISTA WAY 202C VISTA CA 92056 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCMC - SOLANA BEACH 380 STEVENS AVE 100 DEL MAR CA 92024 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCRIPPS CLINIC - SANTEE 278 TOWN CENTER PKWY 105 SANTEE CA 92071 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCMC - ESCONDIDO 488 E VALLEY PKWY 411 ESCONDIDO CA 92025 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCRIPPS CLINIC - LA JOLLA OBGYN 9850 GENESEE AVE 170 SAN DIEGO CA 92121 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCRIPPS CLINIC - SAN DIEGO OBGYN 2918 FIFTH AVE STE 100 SAN DIEGO CA 92103 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCRIPPS CL RADIATION THRPY CTR ENCINITAS 477 NORTH EL CAMINO REAL STE D100 ENCINITAS CA 92024 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCMC - ALVARADO 6386 ALVARADO CT 130 SAN DIEGO CA 92120 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCRIPPS CLINIC - MERCY CAMPUS 4020 FIFTH AVE 401 SAN DIEGO CA 92103 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCRIPPS CARDIO & THOR SURG CTR HILLCREST 501 WASHINGTON ST 525 600 SAN DIEGO CA 92103 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCRIPPS CARDIO & THOR SRG CTR - PREBYS 9896 GENESSEE AVE LA JOLLA CA 92037 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCRIPPS PHARMACY - ENCINITAS 354 SANTA FE DRIVE ENCINITAS CA 92024 MEDICAL PHARMACY SCRIPPS PHARMACY - MERCY 4077 FIFTH AVENUE SAN DIEGO CA 92103 MEDICAL PHARMACY SCRIPPS CLINIC - CORONADO 1317 A YNES PLACE CORONADO CA 92118 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCRIPPS CLINIC - MENTAL HEALTH 15004 INNOVATION DRIVE SAN DIEGO CA 92128 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCRIPPS CLINIC - UTC 9333 GENESSEE AVE STE 170 SAN DIEGO CA 92121 PRIMARY AND SPECIALTY CARE SERVICES IN AN AMBULATORY ENVIRONMENT SCHEDULE H, PART I, LINE 3C SCRIPPS MAKES EVERY REASONABLE EFFORT TO ASSIST PATIENTS IN MEETING THEIR FINANCIAL OBLIGATION TO PAY FOR HOSPITAL SERVICES, INCLUDING EMERGENCY AND OTHER MEDICALLY NECESSARY HOSPITAL CARE, AND PROVIDES FULL OR PARTIAL FINANCIAL ASSISTANCE TO QUALIFIED PATIENTS. SCRIPPS FAP IS DESIGNED TO SUPPORT PATIENTS WITH DEMONSTRATED FINANCIAL NEED AND IS NOT INTENDED TO SUPPLEMENT OR CIRCUMVENT THIRD PARTY COVERAGE, INCLUDING MEDICARE. ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON FAMILY INCOME AND EXPENSES. FOR LOW-INCOME, UNINSURED PATIENTS WHO EARN LESS THAN TWICE THE FEDERAL POVERTY LEVEL (FPL), WE WILL FULLY FORGIVE THE ENTIRE BILL. FOR THOSE PATIENTS WHO EARN BETWEEN TWO AND FOUR TIMES THE FPL, WE WILL FORGIVE A PORTION OF THE BILL. IF IT IS DETERMINED THAT THE FAMILY INCOME IS ABOVE 400% OF THE FPL, SCRIPPS MAY CONSIDER THE PATIENT ELIGIBLE FOR FINANCIAL ASSISTANCE BASED ON EXTENUATING CIRCUMSTANCES SUCH AS CATASTROPHIC MEDICAL EVENTS OR OTHER SPECIAL SITUATIONS. SCRIPPS DOES NOT CHARGE PATIENTS QUALIFIED FOR FINANCIAL ASSISTANCE MORE THAN SCRIPPS DISCOUNTED FINANCIAL ASSISTANCE AMOUNT, WHICH REPRESENTS SCRIPPS AGB AS CALCULATED WITH THE PROSPECTIVE METHOD. EVERY EFFORT IS MADE TO IDENTIFY PATIENTS WHO MAY BENEFIT FROM FINANCIAL ASSISTANCE AS SOON AS POSSIBLE AND PROVIDE COUNSELING AND LANGUAGE INTERPRETATION WHEN NEEDED. PATIENTS WHO DO NOT QUALIFY FOR FINANCIAL ASSISTANCE BUT NEED HELP WITH PAYMENTS WILL BE OFFERED A NO-INTEREST PAYMENT PLAN CONSISTENT WITH THEIR NEEDS AND ALL UNFUNDED PATIENTS RECEIVE A MINIMUM OF A 20% DISCOUNT TAKEN AUTOMATICALLY AT BILLING. IN ADDITION, SCRIPPS DOES NOT APPLY WAGE GARNISHMENT OR LIENS ON PRIMARY RESIDENCES AS A WAY OF COLLECTING UNPAID HOSPITAL BILLS. PATIENTS DETERMINED TO BE "HOMELESSNOT PARTICIPATING IN ANOTHER FINANCIAL ASSISTANCE PROGRAM WILL BE GRANTED 100% FINANCIAL ASSISTANCE. IF THE HOSPITAL IS UNABLE TO OBTAIN ADEQUATE INFORMATION AFTER ATTEMPTS TO ESTABLISH ABILITY TO PAY, THE PATIENT MAY BE GRANTED FINANCIAL ASSISTANCE ONLY AFTER BILLING AND/OR OTHER ATTEMPTS TO COLLECT INFORMATION HAVE BEEN MADE. SCHEDULE H, PART I, LINE 6A SCRIPPS HEALTH COMMUNITY BENEFIT REPORT IS PREPARED FOR THE HEALTH SYSTEM AS A WHOLE AND CAN BE FOUND AT HTTPS://WWW.SCRIPPS.ORG/ABOUT-US__SCRIPPS-IN-THE-COMMUNITY SCHEDULE H, PART I, LINE 7, COLUMN F A COST-TO-CHARGE RATIO FROM THE COST ACCOUNTING SYSTEM WAS USED TO DETERMINE THE COST OF ALL PATIENT SEGMENTS REPORTED AS CHARITY CARE AND OTHER COMMUNITY BENEFITS AT COST. SCHEDULE H, PART I, LINE 7G SUBSIDIZED HEALTH SERVICES ARE CLINICAL PROGRAMS PROVIDED DESPITE A FINANCIAL LOSS SO SIGNIFICANT THAT NEGATIVE MARGINS REMAIN EVEN AFTER REMOVING THE EFFECTS OF CHARITY CARE, BAD DEBT AND MEDI-CAL SHORTFALLS. SCRIPPS PROVIDES SUCH SERVICES BECAUSE THEY MEET AN IDENTIFIED COMMUNITY NEED AND, IF NO LONGER OFFERED, THEY WOULD EITHER BE UNAVAILABLE IN THE AREA OR FALL TO GOVERNMENT OR ANOTHER NOT-FOR-PROFIT ORGANIZATION TO PROVIDE. SUBSIDIZED SERVICES DO NOT INCLUDE SUCH ANCILLARY SERVICES AS LAB WORK AND RADIOLOGY. IF THESE SERVICES ARE PROVIDED TO LOW-INCOME PERSONS, THEY ARE REPORTED AS CHARITY CARE/FINANCIAL ASSISTANCE. SCRIPPS' TOTAL NET COST FOR SUBSIDIZED HEALTH SERVICES FOR FY16 WAS $5,524,808. THIS INCLUDES SCRIPPS INPATIENT AND OUTPATIENT BEHAVIORAL HEALTH SERVICES AND MERCY CLINIC. MERCY CLINIC OF SCRIPPS MERCY HOSPITAL SAN DIEGO - FACILITY A-1 FOUNDED IN 1944 AND ADOPTED BY THE SISTERS OF MERCY IN 1961, MERCY CLINIC OF SCRIPPS MERCY HOSPITAL IS A PRIMARY CARE CLINIC THAT TREATS MORE THAN 1,000 PATIENTS EACH MONTH. TOTAL PATIENT VISITS FOR PRIMARY AND SUBSPECIALTY CARE AT THE CLINIC IN FY16 WERE 10,351. A FULL TIME CLINIC STAFF OF NURSES AND OTHER PERSONNEL WORK HAND-IN-HAND WITH PHYSICIANS FROM SCRIPPS MERCY HOSPITAL. AS AN INTEGRAL PART OF TREATING ITS PATIENTS, MERCY CLINIC SERVES AS A TRAINING GROUND FOR NEARLY 100 RESIDENTS EACH YEAR FROM THE SCRIPPS MERCY HOSPITAL GRADUATE MEDICAL EDUCATION PROGRAM. ESTABLISHED WITH THE INTENT OF CARING FOR THE POOR, MERCY CLINIC HAS BECOME A CRITICAL SOURCE OF MEDICAL CARE FOR SAN DIEGO'S "WORKING AND DISABLED POOR". EACH YEAR, 90 PERCENT OF PATIENT VISITS ARE PAID THROUGH MEDI-CAL, MEDICARE OR SOME OTHER INSURANCE PLAN. THE REMAINING 10 PERCENT PAY WHAT, AND IF, THEY CAN. THOUSANDS OF PEOPLE IN THE REGION RELY ON MERCY CLINIC; MOST ARE LOW-INCOME, MEDICALLY UNDERSERVED ADULTS AND SENIORS WHO OTHERWISE WOULD HAVE NO ACCESS TO HEALTH CARE. THE TOTAL SUBSIDIZED NET COST FOR MERCY CLINIC FOR FY16 WAS $2.4 MILLION (EXCLUDES MEDI-CAL, BAD DEBT AND CHARITY CARE). SCHEDULE H, PART I, LINE 7 FINANCIAL SUPPORT REFLECTS THE COST (LABOR, SUPPLIES, OVERHEAD, ETC) ASSOCIATED WITH THE PROGRAMS/SERVICE LESS DIRECT REVENUE. THE FIGURE DOES NOT INCLUDE A CALCULATION FOR PHYSICIAN AND STAFF VOLUNTEER LABOR HOURS. IN SOME INSTANCES, AN ENTIRE COMMUNITY BENEFIT PROGRAM COST CENTER HAS BEEN DIVIDED BETWEEN SEVERAL INITIATIVES. SCRIPPS EMPLOYEES TRACK COMMUNITY BENEFIT PROGRAMS/ACTIVITIES VIA LYON SOFTWARE'S COMMUNITY BENEFIT INVENTORY FOR SOCIAL ACCOUNTABILITY (CBISA). THE CBISA WAS DEVELOPED IN COOPERATION WITH LYON SOFTWARE, THE CATHOLIC HEALTH ASSOCIATION (CHA) AND THE VETERANS HEALTH ADMINISTRATION. THE SOFTWARE SUPPLEMENTED THE ORIGINAL SOCIAL ACCOUNTABILITY BUDGET: A PROCESS FOR PLANNING AND REPORTING COMMUNITY SERVICE IN A TIME FOR FISCAL CONSTRAINT, PUBLISHED IN 1989, AND HAS BEEN REGULARLY UPGRADED AS COMMUNITY BENEFIT ACCOUNTING AND REPORTING METHODS HAVE EVOLVED AND AS COMMUNITY BENEFIT REPORTING HAS BECOME A FEDERAL REPORTING REQUIREMENT. THE CBISA DATABASE HELPS COLLECT, TRACK AND REPORT COMMUNITY BENEFIT EFFORTS AND IS ALIGNED TO THE SCHEDULE H 990 CATEGORIES AND REPORTING CRITERIA. THE DATABASE IS USED TO RECORD INFORMATION FOR EACH ACTIVITY (SERVICE OR PROGRAM) WHICH PROVIDES COMMUNITY BENEFIT. THIS DATABASE IS USED TO RECORD ACTUAL EXPENSES AND FUNDING/OFFSETTING REVENUE FOR SINGLE OR MULTIPLE OCCURRENCES OF AN "ACTIVITY". FINANCE WORKS TO RECONCILE UNCOMPENSATED CARE NUMBERS ACCORDING TO THE SCHEDULE H METHODOLOGY. FINANCIAL PLANNING EXCEL WORKSHEETS ARE USED TO RECONCILE COMMUNITY BENEFIT NUMBERS INCLUDING UNCOMPENSATED CARE NUMBERS. WHERE COST ACCOUNTING IS USED, SCRIPPS HEALTH ADDRESSES ALL PATIENT SEGMENTS FOR HOSPITAL FACILITIES. SCRIPPS UNCOMPENSATED CARE FY2016 METHODOLOGY SCRIPPS CONTINUES TO CONTRIBUTE RESOURCES TO PROVIDE LOW- AND NO-COST HEALTH CARE SERVICES TO POPULATIONS IN NEED. CALCULATIONS FOR CHARITY CARE ARE ESTIMATED BY EXTRACTING THE GROSS WRITE-OFFS OF CHARITY CARE CHARGES AND APPLYING THE HOSPITAL RATIO OF COST TO CHARGES (RCC) TO ESTIMATE THE COST OF CARE. CALCULATIONS FOR MEDI-CAL AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS AND MEDICARE SHORTFALL ARE DERIVED USING THE PAYOR-BASED COST ALLOCATION METHODOLOGY. HOSPITAL FEE PROGRAM (REFLECTED IN PART I, LINE 7B & 7I) THIRTY-MONTH HOSPITAL FEE PROGRAM DURING THE YEAR ENDED SEPTEMBER 30, 2016, SCRIPPS HEALTH RECOGNIZED SUPPLEMENTAL PROVIDER FEE AMOUNTS OF $89,279,000. THIS AMOUNT WAS RECOGNIZED AS NET PATIENT REVENUE IN THE CONSOLIDATED STATEMENT OF OPERATIONS. SCRIPPS HEALTH RECOGNIZED QUALITY ASSURANCE FEES OF $69,682,000. THIS AMOUNT WAS RECORDED AS PROVIDER FEE EXPENSES IN THE CONSOLIDATED STATEMENT OF OPERATIONS. SCRIPPS HEALTH RECORDED $302,000 FOR CHARITABLE CONTRIBUTIONS TO CHFT IN THE STATEMENT OF OPERATIONS. THE NET OPERATING INCOME RECOGNIZED BY SCRIPPS HEALTH FROM PROVIDER FEE WAS $19,295,000 IN FISCAL YEAR 2016. CALENDAR YEAR 2014 - CALENDAR YEAR 2016 HOSPITAL FEE PROGRAM IN SEPTEMBER 2013, SB 239 WAS APPROVED AND CREATED A THREE-YEAR HOSPITAL FEE PROGRAM EFFECTIVE JANUARY 1, 2014 THROUGH DECEMBER 31, 2016. ON DECEMBER 10, 2014, CALIFORNIA HOSPITAL ASSOCIATION (CHA) ANNOUNCED THAT CMS APPROVED THE FEE-FOR-SERVICE PAYMENTS FOR THE PERIOD JANUARY 1, 2014 TO DECEMBER 31, 2016. ON JUNE 30, 2015, CMS APPROVED THE NON-EXPANSION MANAGED CARE RATES FOR THE FIRST SIX MONTHS OF THE THIRTY-SIX MONTH HOSPITAL FEE PROGRAM. DURING THE YEAR ENDED SEPTEMBER 30, 2016, SCRIPPS HEALTH RECOGNIZED SUPPLEMENTAL PROVIDER FEE AMOUNTS OF $89,279,000. THIS AMOUNT WAS RECOGNIZED AS NET PATIENT REVENUE IN THE CONSOLIDATED STATEMENT OF OPERATIONS. SCRIPPS HEALTH RECOGNIZED QUALITY ASSURANCE FEES OF $69,682,000. THIS AMOUNT WAS RECORDED AS PROVIDER FEE EXPENSES IN THE CONSOLIDATED STATEMENT OF OPERATIONS. IN ADDITION, SCRIPPS HEALTH WAS ASSESSED AND ACCRUED REVENUE FROM THE CHFT OF $128,000 IN THE STATEMENT OF OPERATIONS. THE NET OPERATING INCOME RECOGNIZED BY SCRIPPS HEATH FROM PROVIDER FEE WAS $19,725,000 IN FISCAL YEAR 2016. SCHEDULE H, PART II COMMUNITY BUILDING ACTIVITIES PHYSICAL IMPROVEMENTS AND HOUSING - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 1: SCRIPPS MERCY HOSPITAL LEADERSHIP RETREAT VOLUNTEER SERVICE DAY FOUR HOURS OF VOLUNTEER SERVICE THAT ENTAILED PAINTING, CLEANING AND ENHANCING NOT-FOR-PROFIT, HOMELESS SERVICE PROVIDER AGENCY BUILDINGS. SPECIALLY, PROJECTS OF CATHOLIC CHARITIES AND ST. VINCENT DE PAUL AND JOAN KROC CENTER. ECONOMIC DEVELOPMENT - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 2: EXECUTIVE LEADERSHIP EXECUTIVE LEADERSHIP, SPONSORED BY THE OFFICE OF THE PRESIDENT, DONATES TIME ON NOT-FOR PROFIT BOARDS REPRESENTING SCRIPPS HEALTH, INCLUDING THE FOLLOWING ORGANIZATIONS AND BOARDS: SAN DIEGO REGIONAL CHAMBER OF COMMERCE (CHAMBER BOARD, CHAMBER CEO ROUNDTABLE AND POLICY COMMITTEE ASSIGNMENTS); SAN DIEGO COUNTY TAXPAYERS ASSOCIATION (SDCTA BOARD, EXECUTIVE COMMITTEE AND HEALTH COMMITTEE WORK ASSIGNMENTS); SAN DIEGO REGIONAL ECONOMIC DEVELOPMENT CORPORATION (EDC BOARD AND POLICY COMMITTEE ASSIGNMENTS); AND THE DOWNTOWN SAN DIEGO PARTNERSHIP (DSDP BOARD AND WORKING COMMITTEE ASSIGNMENTS). COMMUNITY SUPPORT - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 3: HOSPITAL ADMIN SUPPORT UNIT & SCRIPPS MED RESPONSE TEAM (SMRT) HOSPITAL ADMINISTRATIVE SUPPORT UNIT & SCRIPPS MEDICAL RESPONSE TEAM (SMRT) HAVING THE ABILITY TO PROVIDE EMERGENCY SERVICES FOR THOSE INJURED IN THE STATE OF CALIFORNIA DISASTER WHILE CONTINUING TO CARE FOR HOSPITALIZED PATIENTS IS A CRITICAL COMMUNITY NEED. SCRIPPS MAINTAINS ACTIVE READINESS FOR THE SCRIPPS HOSPITAL ADMINISTRATIVE UNIT AND THE SCRIPPS MEDICAL RESPONSE TEAM. BOTH ARE TEAMS FOR THE STATE OF CALIFORNIA IF THERE WAS AN ALTERNATE CARE SITE DEPLOYMENT AND IF THERE WAS USAID TRAUMA SURGICAL DEPLOYMENT UNIT DEPLOYED. OUR TEAMS ARE ALSO AT THE READY FOR DEPLOYMENT IF THE INTERNATIONAL MEDICAL CORPS REQUESTS ASSISTANCE. SAN DIEGO COUNTY & NATIONAL COMMUNITY SUPPORT & OUTREACH EDUCATION THE GOAL IS TO PARTICIPATE IN COMMUNITY EDUCATION LOCALLY AND NATIONALLY AS AN ORGANIZATIONAL LEADER IN DISASTER PREPAREDNESS AND PLANNING. IN FISCAL YEAR 2016, SCRIPPS PARTICIPATED IN THE SAN DIEGO BUSINESS CONSORTIUM AND LED MULTIPLE LECTURES TO GOVERNMENT AND COMMUNITY AUDIENCES. SCRIPPS IN-LIEU OF FUNDS SCRIPPS IN-LIEU OF FUNDS ARE USED FOR UNFUNDED OR UNDERFUNDED PATIENTS AND THEIR POST-DISCHARGE NEEDS INCLUDING BOARD AND CARE, SKILLED NURSING FACILITIES, LONG-TERM ACUTE CARE AND HOME HEALTH. IN ADDITION, THE FUNDS MAY BE USED FOR MEDICATIONS, EQUIPMENT AND TRANSPORTATION SERVICES. AMERICAN HEART ASSOCIATION HEART WALK SPONSORSHIP GIVEN TO THE AMERICAN HEART ASSOCIATION, SCRIPPS ALLOCATED $10,000 IN OPERATIONAL FUNDS AND OVER $30,000 IN IN-KIND DONATIONS TO SUPPORT THE AMERICAN HEART ASSOCIATION'S EFFORTS TO FIGHT HEART DISEASE AND STROKE, IN ADDITION, SCRIPPS EMPLOYEE VOLUNTEERS COORDINATED WALKER PARTICIPATION AND FUNDRAISING EFFORTS. IN 2016, MORE THAN 2,300 SCRIPPS HEART WALK PARTICIPANTS - EMPLOYEES, FAMILIES, AND FRIENDS - WALKED TO HELP RAISE MORE THAN $110,000 ADDITIONALLY, SCRIPPS REACHED OUT TO THE COMMUNITY AT THE EVENT BY PROVIDING HEALTH EDUCATION MATERIALS AND MORE. SPONSORED BY SCRIPPS HEALTH COMMUNITY BENEFIT SERVICES. SAN DIEGO POLICE FOUNDATION - GOLD SHIELD GALA TO SUPPORT THE SAN DIEGO POLICE FOUNDATION TO ESNURE THAT THOSE WHO PROTECT AND SERVE HAVE WHAT THEY NEED TO DO THEIR JOBS SAFELY AND WITH EXCELLENCE. SUSAN G. KOMEN RACE FOR THE CURE - EVENT FUNDRAISING EVENT TO SUPPORT BREAST CANCER RESEARCH AND LOCAL BREAST HEALTH INITIATIVES. THE KOMEN RACE FOR THE CURE SERIES RAISES SIGNIFICANT FUNDS AND AWARENESS FOR THE FIGHT AGAINST BREAST CANCER, CELEBRATES BREAST CANCER SURVIVORSHIP, AND HONORS THOSE WHO HAVE LOST THEIR BATTLE WITH THE DISEASE. SUSAN G. KOMEN 3 DAY BREAST CANCER WALK - SUPPORT SCRIPPS IS THE OFFICIAL PHYSICAL THERAPY SPORTS MEDICINE CREW. THE FOLLOWING TREATMENTS ARE PROVIDED AT THE EVENT: WOUND CARE, ORTHOPEDIC EVALUATION TREATMENTS, INCLUDING LIMB AND JOINT TAPING, ASSISTANCE WITH STRETCHING AND EDUCATION FOR SELF-CARE. DISASTER PREPAREDNESS - COMMUNITY OUTREACH AND EDUCATION HAVING THE ABILITY TO PROVIDE EMERGENCY SERVICES TO THOSE INJURED IN A LOCAL DISASTER WHILE CONTINUING TO CARE FOR HOSPITALIZED PATIENTS IS A CRITICAL COMMUNITY NEED. SCRIPPS PARTICIPATES IN SAN DIEGO COUNTY AND STATE OF CALIFORNIA ADVISORY GROUPS TO PLAN, IMPLEMENT, AND EVALUATE KEY DISASTER PREPAREDNESS RESPONSE PLANS AND FUNDING EFFORTS.IN ADDITION, SCRIPPS MAINTAINS ACTIVE READINESS FOR THE SCRIPPS HOSPITAL MEDICAL RESPONSE TEAM OR THE SCRIPPS HOSPITAL ADMINISTRATION UNIT. BOTH ARE LEAD TEAMS FOR THE STATE OF CALIFORNIA MOBILE FIELD HOSPITAL DEPLOYMENT. THESE EFFORTS ARE LED BY THE DISASTER PREPAREDNESS PROGRAM UNDER THE DIRECTION OF THE CHIEF MEDICAL OFFICER. MASS RESCUE OPERATION EXERCISE FULL SCALE EXERCISE PLANNED FOR EIGHT HOURS, SPANNING ONE HALF MILE OFF OF OCEAN BEACH AND INTO MISSION BAY. EXERCISE PLAY IS LIMITED TO THE RESCUE, TRANSPORT, AND TREATMENT OF A SIMULATED, SURVIVABLE AIRLINER CRASH. ASSESSMENT OF THE EXERCISE WILL BE A COORDINATED RESPONSE FROM FEDERAL, STATE AND LOCAL AGENCIES, ALONG WITH U.S COAST GUARD, SAN DIEGO FIRE LIFE GUARD SERVICES, SCRIPPS HEALTH, AND THE SAN DIEGO POLICE DEPARTMENT. SAN DIEGO HUNGER COALITION - FOOD STAMP ASSISTANCE - CITY HEIGHTS WELLNESS CENTER - COMMUNITY SUPPORT THE CITY HEIGHTS WELLNESS CENTER (CHWC) HOSTS ELIGIBILITY WORKERS FROM THE SAN DIEGO HUNGER COALITION WHO ARE AVAILABLE TO COUNSEL PEOPLE AND HELP FILL OUT APPLICATIONS FOR FOOD STAMP ASSISTANCE. CHWC NOT ONLY PROVIDES THE NEEDED SPACE FOR THIS ACTIVITY, BUT ALSO ACTIVELY PARTICIPATES BY DEVELOPING OUTREACH FLYERS, SCHEDULING COMMUNITY RESIDENTS, AND OVERALL COORDINATION FOR THE CLASS. LATINOS Y LATINAS EN ACCION LATINOS Y LATINAS EN ACCION IS A GRASSROOTS LEADERSHIP DEVELOPMENT PROJECT THAT SEEKS TO INCREASE THE CAPACITY OF THE LATINO COMMUNITY OF MID-CITY TO ADVOCATE FOR ISSUES IMPORTANT TO THEM. LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY MEMBERS - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 5: CITY HEIGHTS EAST AFRICAN ALLIANCE-CHEA - HEALTH ADVOCACY PROJECT THE CITY HEIGHTS WELLNESS CENTER HEALTH ADVOCACY PROJECT IS SUPPORTED BY A GRANT FROM THE CALIFORNIA ENDOWMENT FOUNDATION AND IS DESIGNED TO STRENGTHEN THE CAPACITY TO DELIVER CULTURALLY AND RELIGIOUSLY COMPETENT HEALTH PROMOTION SERVICES TO SOMALI AND EAST AFRICAN WOMEN AND THEIR FAMILIES. THIS PROGRAM ADDRESSES UNMET NEEDS LIKE PRENATAL OUTREACH AND EDUCATION, CULTURALLY ADAPTED NUTRITION AND FITNESS EDUCATION, BREASTFEEDING EDUCATION, EARLY CHILDHOOD HEALTH, AND NUTRITION AND SAFETY CLASSES. THE PROJECT IS SPONSORED BY SCRIPPS MERCY HOSPITAL SAN DIEGO COMMUNITY BENEFIT SERVICES. COALITION BUILDING - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 6: SAN DIEGO COUNTY PRESCRIPTION DRUG ABUSE TASK FORCE COMMUNITY EDUCATION, MEDIA MESSAGING, INTERDICTION, PREVENTION, TREATMENT AND POLICY MAKING TO COMBAT GROWING PROBLEM OF PRESCRIPTION DRUG ABUSE IN SAN DIEGO COUNTY. CASTLE PARK ELEMENTARY WELLNESS COMMITTEE MEETING CASTLE PARK ELEMENTARY WELLNESS COMMITTEE PLANS AND FACILITATES WELLNESSE VENTS, SCHOOL READINESS PRESENTATIONS, HEALTH RELATED CLASSES, AND ACTIVITIES FOR PARENTS, SCHOOL STAFF, AND STUDENTS TO INCREASE HEALTH AWARENESS AND HEALTHY LIFESTYLES IN CASTLE PARK AREA. SPONSORED BY SCRIPPS CHULA VISTA WELL-BEING CENTER. CHULA VISTA COMMUNITY COLLABORATIVE - SCRIPPS MERCY HOSPITAL CHULA VISTA COALITION - A COALITION OF AGENCIES THAT COME TOGETHER TO SHARE PROGRESS, SERVICES, AND NETWORK. THE CHULA VISTA COMMUNITY COLLABORATIVE (CVCC) DRAWSTOGETHER ALL SECTORS OF THE LOCAL COMMUNITY TO DEVELOP COORDINATEDSTRATEGIES AND SYSTEMS THAT PROTECT THE HEALTH AND SAFETY OF RESIDENTS, DEVELOP ECONOMIC RESOURCES, PROMOTE LOCAL LEADERSHIP, ENHANCE THE ENVIRONMENT, AND CONTRIBUTE TO THE CELEBRATION OF AND RESPECT FOR CULTURAL DIVERSITY. THE CVCC CURRENTLY HAS OVER 150 MEMBER ORGANIZATIONS AND OVER 600 MEMBERS. CVCC ACTS AS A PLATFORM FROM WHICH TO LAUNCH EFFECTIVE NEW INITIATIVES TO IMPROVE QUALITY OF LIFE. THE CVCC IS THE UMBRELLA FOR A VARIETY OF PROGRAMS AND COMMITTEES. THE MOST NOTABLE INFRASTRUCTURE OF THE CVCC IS THE NETWORK OF FAMILY RESOURCE CENTERS THAT HAVE BEEN CREATED AND SUSTAINED BY COLLECTIVE EFFORT. HEALTHY DEVELOPMENT SERVICES (HDS) PROVIDER MEETING COLLABORATION OF HDS PARTNERS AND SERVICE PROVIDERS COMING TOGETHER TO DISCUSS AND REVIEW SPECIFIC CASE OF THOSE RECEIVING SERVICES FROM PESE, CARE COORDINATION AND DEVELOPMENTAL AND BEHAVIORAL HEALTH SERVICES OF CHILDREN AGES ZERO 5 YEARS OF AGE. SCRIPPS MERCY HOSPITAL CHULA VISTA - HEALTHY WEIGHT COLLABORATIVE HEALTHY WEIGHT COLLABORATIVE IS A PROJECT OF THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) AND THE NATIONAL INITIATIVE FOR CHILDREN'S HEALTHCARE QUALITY ( SCHEDULE H, PART III, LINE 2 METHODOLOGY FOR CALCULATING BAD DEBT UNCOMPENSATED COST IS ESTIMATED BY APPLYING RATIO-COST-TO-CHARGE (RCC) PERCENTAGES FOR THE HOSPITAL TO THE GROSS BAD-DEBT ADJUSTMENTS, LESS RECOVERIES. THE FOLLOWING COSTS ARE EXCLUDED: BAD DEBT ADJUSTMENTS AT COST FOR MEDI-CAL AND CMS PATIENTS, COMMUNITY HEALTH SERVICES, PROFESSIONAL EDUCATION AND RESEARCH, AND EXPENSES EXCLUDED IN THE MEDICARE COST REPORT. THE AMOUNT ON PART III, LINE 2 REPRESENTS PATIENT CARE CHARGES WRITTEN OFF TO BAD DEBT WHERE THE PATIENT HAD THE ABILITY TO PAY. WHERE A PATIENT QUALIFIED FOR PARTIAL OR FULL CHARITY CARE, THE UNPAID AMOUNT IS NOT CONSIDERED BAD DEBT. WE BELIEVE THAT BAD DEBT PERTAINING TO PATIENT CARE CHARGES SHOULD BE INCLUDED AS A COMMUNITY BENEFIT BECAUSE THESE PATIENTS RECEIVE TREATMENT REGARDLESS OF WHETHER WE COLLECT PAYMENT FOR THE SERVICES PERFORMED. SCHEDULE H, PART III, LINE 4 FOOTNOTE FOR BAD DEBT EXPENSE THE ORGANIZATION ADOPTED THE ACCOUNTING STANDARD ADDRESSING THE PRESENTATION OF THE PROVISION FOR BAD DEBTS AS OF THE CURRENT REPORTING PERIOD AND AS SUCH, NET PATIENT SERVICE REVENUES ARE REPORTED NET OF THE PROVISION FOR BAD DEBTS ON THE STATEMENTS OF OPERATIONS. THE ORGANIZATION RECORDS ITS PROVISION FOR DOUBTFUL ACCOUNTS BASED UPON HISTORICAL EXPERIENCE, AS WELL AS COLLECTION TRENDS FOR MAJOR PAYOR TYPES. SCHEDULE H, PART III, LINE 8 MEDICARE AND MEDICARE HMO: HOSPITALS MEDICARE ALLOWABLE COSTS ARE DETERMINED USING A COST TO CHARGE RATIO. THE FOLLOWING COSTS ARE EXCLUDED: CHARITY AND BAD DEBT ADJUSTMENTS AT COST FOR MEDICARE AND MEDICARE SENIOR PATIENTS, COMMUNITY HEALTH SERVICES, PROFESSIONAL EDUCATION AND RESEARCH, SUBSIDIZED HEALTH SERVICES PROVIDED TO MEDICARE PATIENTS AND EXPENSES EXCLUDED IN THE MEDICARE COST REPORT. AS A NOT-FOR-PROFIT, COMMUNITY BENEFIT 501(C)(3) ORGANIZATION, SCRIPPS HEALTH'S PURPOSE IS TO MEET THE MEDICAL NEEDS OF THE COMMUNITIES SERVED. MEDICARE COVERS A SIGNIFICANT PROPORTION OF THE SAN DIEGO COMMUNITY PATIENT POPULATION, INPATIENT AND OUTPATIENT. THE LEVEL OF QUALITY AND ACCESS TO CARE IS THE SAME, REGARDLESS OF PAYER. HOSPITALS DO NOT DETERMINE THE LEVEL OF PAYMENT FOR MEDICARE; RATHER, IT IS SUBJECT TO GOVERNMENT REIMBURSEMENT POLICY. THERE IS A WELL-DOCUMENTED MEDICARE REIMBURSEMENT SHORTFALL OF PAYMENT FOR CARE NOT MEETING THE COST OF DELIVERING CARE. THAT SHORTFALL IS AN UNREIMBURSED AMOUNT THAT MUST BE ACCOUNTED FOR IN THE HOSPITAL'S FINANCIAL STATEMENTS. IT IS REAL AND SUBSTANTIAL. IT SHOULD BE ACCEPTED AS A SHORTFALL IN IRS REPORTING STANDARDS. SCRIPPS MUST ACCEPT THE PATIENTS REGARDLESS OF REIMBURSEMENT RATES FROM MEDICARE AND IF PATIENTS ARE NOT CARED FOR BY SCRIPPS IT IS LIKELY THAT ANOTHER COMMUNITY OR GOVERNMENT AGENCY WOULD HAVE TO COVER THE CARE OF THE PATIENT. SCHEDULE H, PART III, LINE 9B COLLECTION POLICY ALL PATIENT FINANCIAL RESOURCES ARE EXPLORED PRIOR TO USING A COLLECTION AGENCY OR OTHER MEANS TO COLLECT ON ACCOUNTS. THE ORGANIZATION ALSO SCREENS PATIENTS WHO CANNOT AFFORD TO PAY CO-INSURANCE AND DEDUCTIBLES TO SEE WHETHER THEY QUALIFY FOR FINANCIAL ASSISTANCE. IF THE PATIENT DOES NOT QUALIFY, OR IF THERE IS A LACK OF INFORMATION AVAILABLE TO MAKE A DETERMINATION AND NO CONTACT IS ESTABLISHED WITH THE PATIENT, THEN THE ORGANIZATION MAY USE A COLLECTION AGENCY OR INTERNAL STAFF TO COLLECT THE ACCOUNT. WHEN A COLLECTION AGENCY OR THE ORGANIZATION STAFF DETERMINES THAT A PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE, THE ORGANIZATION WRITES THE ACCOUNT OFF IN WHOLE OR PART AS CHARITY. SHOULD A PATIENT MAKE A PAYMENT ON AN ACCOUNT THAT HAS BEEN WRITTEN OFF TO BAD-DEBT EXPENSE, BAD-DEBT EXPENSE IS REDUCED TO THE EXTENT OF THE PAYMENT. ACCOUNTS BEING EVALUATED FOR FINANCIAL ASSISTANCE WILL NOT BE TURNED OVER TO A COLLECTION AGENCY UNTIL THE CONCLUSION OF THE FINANCIAL ASSISTANCE EVALUATION OR THE PATIENT FAILS TO COOPERATE IN PURSUING HIS OR HER REQUEST FOR ASSISTANCE. SCHEDULE H, PART VI, LINE 2 NEEDS ASSSESSMENT IN SAN DIEGO COUNTY, THE LONG HISTORY OF COLLABORATION AMONG HOSPITALS, HEALTHCARE SYSTEMS AND COMMUNITY PARTNERS HAS RESULTED IN SUCCESSFUL PARTNERSHIP ON PAST CHNAS. WHILE PUBLIC INSTITUTIONS AND DISTRICT HOSPITALS DO NOT HAVE TO REPORT UNDER SB 697, THESE INSTITUTIONS HAVE BECOME AN INTEGRAL PART OF THE CHNA IN SAN DIEGO COUNTY. INFORMATION IS GATHERED THROUGH THE CHNA FOR THE PURPOSES OF REPORTING COMMUNITY BENEFIT, DEVELOPING STRATEGIC PLANS, CREATING ANNUAL REPORTS, PROVIDING INPUT ON LEGISLATIVE DECISIONS, AND INFORMING THE GENERAL COMMUNITY OF HEALTH ISSUES AND TRENDS. SCRIPPS STRIVES TO IMPROVE COMMUNITY HEALTH THROUGH COLLABORATION WITH A WIDE RANGE OF PARTNERS AND LIKE-MINDED ORGANIZATIONS. WORKING WITH OTHER HEALTH SYSTEMS, COMMUNITY GROUPS, GOVERNMENT AGENCIES, BUSINESSES AND GRASSROOTS MOVEMENTS, SCRIPPS IS BETTER ABLE TO BUILD UPON EFFORTS TO ACHIEVE BROAD COMMUNITY HEALTH GOALS. THE 2016 SCRIPPS HEALTH CHNA IS DESIGNED TO PROVIDE A DEEPER UNDERSTANDING OF BARRIERS TO HEALTH IMPROVEMENT IN SAN DIEGO COUNTY. WHILE THIS IS A FEDERALLY MANDATED EXERCISE, SCRIPPS HEALTH HOPES TO LEVERAGE THE INFORMATION COLLECTED FOR THE REPORT TO BENEFIT THE COMMUNITY AT-LARGE IN OTHER FUTURE PLANNING INITIATIVES. THIS REPORT COMPLIES WITH FEDERAL TAX LAW REQUIREMENTS SET FORTH IN INTERNAL REVENUE CODE SECTION 501(R) REQUIRING HOSPITAL FACILITIES OWNED AND OPERATED BY AN ORGANIZATION DESCRIBED IN CODE SECTION 501(C)(3) TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT AT LEAST ONCE EVERY THREE YEARS. FOR MORE DETAILED INFORMATION ON THE CHNA REGULATORY REQUIREMENTS AND IMPLEMENTATION STRATEGY SEE: HTTPS://WWW.SCRIPPS.ORG/ABOUT-US__SCRIPPS-IN-THE-COMMUNITY__ASSESSING-COMM UNITY-NEEDS SAN DIEGO COUNTY COMMUNITY HEALTH NEEDS: THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) COMMITTEE DESIGNED THE 2016 CHNA PROCESS BASED ON THE FINDINGS FROM THE 2013 CHNA AND RECOMMENDATIONS FROM THE COMMUNITY. THE AIM OF THE 2016 CHNA METHODOLOGY WAS TO PROVIDE A MORE COMPLETE UNDERSTANDING OF THE TOP FOUR IDENTIFIED HEALTH NEEDS AND ASSOCIATED SOCIAL DETERMINANTS OF HEALTH IN THE SAN DIEGO COMMUNITY. IN MAY 2015, HASD&IC CONTRACTED WITH THE INSTITUTE FOR PUBLIC HEALTH (IPH) AT SAN DIEGO STATE UNIVERSITY (SDSU) TO PROVIDE ASSISTANCE WITH THE COLLABORATIVE HEALTH NEEDS ASSESSMENT THAT WAS OFFICIALLY CALLED THE HASD&IC 2016 COMMUNITY HEALTH NEEDS ASSESSMENT (2016 CHNA). THE OBJECTIVE OF THE 2016 CHNA IS TO IDENTIFY AND PRIORITIZE THE MOST CRITICAL HEALTH RELATED NEEDS IN SAN DIEGO COUNTY BASED ON FEEDBACK FROM COMMUNITY RESIDENTS IN HIGH NEED NEIGHBORHOODS AND QUANTITATIVE DATA ANALYSIS. THE 2016 CHNA INVOLVED A MIXED METHODS APPROACH USING THE MOST CURRENT QUANTITATIVE DATA AVAILABLE AND MORE EXTENSIVE QUALITATIVE OUTREACH. THROUGHOUT THE PROCESS, THE IPH MET BI-WEEKLY WITH THE HASD&IC CHNA COMMITTEE TO ANALYZE, REFINE, AND INTERPRET RESULTS AS THEY WERE BEING COLLECTED. THE RESULTS OF THE 2016 CHNA WILL BE USED TO INFORM AND ADAPT HOSPITAL PROGRAMS AND STRATEGIES TO BETTER MEET THE HEALTH NEEDS OF SAN DIEGO COUNTY RESIDENTS. WHEN THE RESULTS OF ALL OF THE DATA AND INFORMATION GATHERED IN 2013 WERE COMBINED, FOUR CONDITIONS EMERGED CLEARLY AS THE TOP COMMUNITY HEALTH NEEDS IN SAN DIEGO COUNTY (IN ALPHABETICAL ORDER): - BEHAVIORAL/MENTAL HEALTH - CARDIOVASCULAR DISEASE - DIABETES (TYPE 2) - OBESITY THE CHNA COMMITTEE COMPLETED A COLLABORATIVE FOLLOW-UP PROCESS (PHASE 2) TO ENSURE THE 2013 CHNA FINDINGS ACCURATELY REFLECTED THE HEALTH NEEDS OF THE COMMUNITY. PHASE 2 COLLECTED COMMUNITY FEEDBACK ON BOTH THE PROCESS AND FINDINGS OF THE 2013 CHNA, AS WELL AS RECOMMENDATIONS FOR THE NEXT CHNA PROCESS. 87% OF RESPONDENTS AGREED THE 2013 CHNA IDENTIFIED THE TOP HEALTH NEEDS OF SAN DIEGO COUNTY RESIDENTS. 78% OF RESPONDENTS AGREED THE METHODOLOGY FOR THE NEXT CHNA SHOULD INCLUDE A DEEPER DIVE INTO THE TOP FOUR HEALTH ISSUES MENTIONED ABOVE. BASED ON THE FINDINGS AND FEEDBACK FROM BOTH PHASES OF THE 2013 CHNA, THE CHNA COMMITTEE MADE A DEEPER ANALYSIS OF THE TOP FOUR IDENTIFIED COMMUNITY HEALTH NEEDS (BEHAVIORAL HEALTH, CARDIOVASCULAR DISEASE, TYPE 2 DIABETES AND OBESITY). PRIOR TO DESIGNING THE 2016 METHODOLOGY, THE CHNA COMMITTEE MET WITH LEADERS FROM COMMUNITY PARTNER ORGANIZATIONS WHO PARTICIPATED IN THE PRIOR ASSESSMENT. THEY ADVISED THE COMMITTEE ON WAYS TO ENGAGE THEIR STAFF WHO WORK WITH LARGE NUMBERS OF RESIDENTS IN HIGH NEED AND VULNERABLE COMMUNITIES. THE 2016 PROCESS BEGAN WITH A COMPREHENSIVE SCAN OF RECENT COMMUNITY HEALTH STATISTICS IN ORDER TO VALIDATE THE REGIONAL SIGNIFICANCE OF THE TOP FOUR HEALTH NEEDS IDENTIFIED IN THE 2013 CHNA. BASED ON THE RESULTS OF THE SCAN AND FEEDBACK FROM COMMUNITY PARTNERS RECEIVED DURING THE 2016 PLANNING PROCESS, A NUMBER OF COMMUNITY ENGAGEMENT ACTIVITIES WERE CONDUCTED TO PROVIDE A MORE COMPREHENSIVE UNDERSTANDING OF THE IDENTIFIED HEALTH NEEDS, INCLUDING THEIR ASSOCIATED SOCIAL DETERMINANTS OF HEALTH AND POTENTIAL SYSTEM AND POLICY CHANGES THAT MAY POSITIVELY IMPACT THEM. IN ADDITION, A DETAILED ANALYSIS OF HOW THE TOP FOUR NEEDS IMPACT THE HEALTH OF SAN DIEGO RESIDENTS WAS CONDUCTED. QUANTITATIVE DATA COLLECTION AND ANALYSIS CALIFORNIAS OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT (OSHPD) IS RESPONSIBLE FOR COLLECTING DATA AND DISSEMINATING INFORMATION ABOUT THE UTILIZATION OF HEALTH CARE IN CALIFORNIA. AS PART OF THE 2016 CHNA DATA COLLECTION PROCESS, 2013 OSHPD DEMOGRAPHIC DATA FOR HOSPITAL INPATIENT, EMERGENCY DEPARTMENT, AND AMBULATORY CARE ENCOUNTERS FROM ALL HOSPITALS WITHIN SAN DIEGO COUNTY WERE ANALYZED TO UNDERSTAND THE HOSPITAL PATIENT POPULATION. CLINIC DATA WAS ALSO GATHERED FROM OSHPDS WEBSITE AND INCORPORATED IN ORDER TO PROVIDE A MORE HOLISTIC VIEW OF HEALTH CARE UTILIZATION IN SAN DIEGO, AS HOSPITAL DISCHARGES MAY NOT REPRESENT ALL THE HEALTH CONDITIONS IN THE COMMUNITY. AFTER COMPARING RESULTS OF THE QUANTITATIVE ANALYSES OF THE SAN DIEGO COUNTY MORTALITY DATA, KP COMMUNITY BENEFIT DATA ANALYSIS TOOL, AND HOSPITAL DISCHARGE DATA, THE FINDINGS DEMONSTRATED THAT BEHAVIORAL HEALTH, CARDIOVASCULAR DISEASE, DIABETES, AND OBESITY CONTINUE TO BE AMONG THE TOP PRIORITY HEALTH NEEDS IN SAN DIEGO COUNTY ACROSS DIFFERENT QUANTITATIVE DATA SOURCES. QUALITATIVE AND COMMUNITY ENGAGEMENT ACTIVITIES COMMUNITY ENGAGEMENT ACTIVITIES WERE CONDUCTED WITH A BROAD RANGE OF COMMUNITY MEMBERS, INCLUDING HEALTH EXPERTS, COMMUNITY LEADERS, AND SAN DIEGO RESIDENTS, IN AN EFFORT TO GAIN A MORE COMPLETE UNDERSTANDING OF THE TOP IDENTIFIED HEALTH NEEDS IN THE SAN DIEGO COMMUNITY. INDIVIDUALS WHO WERE CONSULTED INCLUDED REPRESENTATIVES FROM STATE, LOCAL, TRIBAL, OR OTHER REGIONAL GOVERNMENTAL PUBLIC HEALTH DEPARTMENTS (OR EQUIVALENT DEPARTMENT OR AGENCY) AS WELL AS LEADERS, REPRESENTATIVES, OR MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS. FOR MORE INFORMATION ON THE COMMUNITY ENGAGEMENT ACTIVITIES SEE QUESTION 5, SCHEDULE H PART V, SECTION B. 2016 PRIORITIZATION OF THE TOP FOUR IDENTIFIED HEALTH NEEDS THE PURPOSE OF THIS CHNA WAS TO IDENTIFY AND PRIORITIZE HEALTH ISSUES AND NEEDS IN SAN DIEGO COUNTY USING MULTIPLE SOURCES OF INFORMATION. THE ANALYSIS OF SECONDARY DATA INCORPORATED THE FOLLOWING CRITERIA FOR INCLUSION AS AN IDENTIFIED COMMUNITY HEALTH NEED: 1. MAGNITUDE OR PREVALENCE: THE HEALTH NEED AFFECTS A LARGE NUMBER OF PEOPLE IN ALL REGIONS OF SAN DIEGO. 2. SEVERITY: THE HEALTH NEED HAS SERIOUS CONSEQUENCES (MORBIDITY, MORTALITY, AND/OR ECONOMIC BURDEN). 3. HEALTH DISPARITIES: THE HEALTH NEED DISPROPORTIONATELY IMPACTS THE HEALTH STATUS OF ONE OR MORE VULNERABLE POPULATION GROUPS. 4. TRENDS: THE HEALTH NEED IS EITHER STABLE OR CHANGING OVER TIME, E.G., IMPROVING OR GETTING WORSE. 5. COMMUNITY CONCERN: STAKEHOLDERS, COMMUNITY MEMBERS, AND VULNERABLE POPULATIONS WITHIN THE COMMUNITY VIEW THE HEALTH NEED AS A PRIORITY. USING THESE CRITERIA, A SUMMARY MATRIX TRANSLATING THE 2016 CHNA FINDINGS WAS CREATED FOR REVIEW BY THE CHNA COMMITTEE. TAKING INTO ACCOUNT THE RESULTS OF THE QUANTITATIVE DATA COLLECTION AND THE FINDINGS FROM THE COMMUNITY ENGAGEMENT ACTIVITIES, A RANK FROM 1 TO 4, WITH 1 BEING THE MOST SIGNIFICANT, WAS APPLIED TO EACH CRITERION. AN OVERALL SCORE WAS GIVEN TO EACH HEALTH NEED BY AVERAGING THE RANKINGS ACROSS ALL FIVE CRITERIA. IN ADDITION, THE SOCIAL DETERMINANTS OF HEALTH WERE ANALYZED AND IDENTIFIED ACROSS ALL HEALTH NEEDS. THE CHNA COMMITTEE IDENTIFIED BEHAVIORAL HEALTH AS THE NUMBER ONE HEALTH NEED IN SAN DIEGO COUNTY. IN ADDITION, CARDIOVASCULAR DISEASE, DIABETES, AND OBESITY WERE IDENTIFIED AS HAVING EQUAL IMPORTANCE DUE TO THEIR INTERRELATEDNESS. HEALTH NEEDS WERE FURTHER BROKEN DOWN INTO PRIORITY AREAS DUE TO THE OVERWHELMING AGREEMENT AMONG ALL DATA SOURCES AND IN RECOGNITION OF THE COMPLEXITIES WITHIN EACH HEALTH NEED. WITHIN THE CATEGORY OF BEHAVIORAL HEALTH, ALZHEIMERS DISEASE, ANXIETY, DRUG AND ALCOHOL ISSUES, AND MOOD DISORDERS ARE SIGNIFICANT HEALTH NEEDS WITHIN SAN DIEGO COUNTY. AMONG THE OTHER CHRONIC HEALTH NEEDS, HYPERTENSION WAS CONSISTENTLY FO SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SCRIPPS ACTIVELY SCREENS, MONITORS AND IDENTIFIES PATIENT ACCOUNTS THAT MAY BENEFIT FROM FINANCIAL ASSISTANCE, PROVIDES COUNSELING, INFORMATION AND LANGUAGE INTERPRETATION AND MAKES EVERY REASONABLE EFFORT TO ASSIST PATIENTS IN MEETING FINANCIAL OBLIGATIONS. WHEN NECESSARY, SCRIPPS ALSO HELPS PATIENTS UNDERSTAND AND PARTICIPATE IN FINANCIAL ASSISTANCE OPTIONS. THIS INCLUDES BILLING STATEMENTS THAT ALERT PATIENTS TO THE AVAILABILITY OF ASSISTANCE AS WELL AS LIMITS ON ACCOUNT COLLECTION ACTIVITIES. (SCRIPPS DOES NOT, FOR EXAMPLE, APPLY WAGE GARNISHMENT OR LIENS ON PRIMARY RESIDENCES AS A MEANS OF COLLECTING UNPAID HOSPITAL BILLS.) ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON AN EVALUATION OF INCOME AND EXPENSE INFORMATION. FOR LOW-INCOME, UNINSURED PATIENTS EARNING LESS THAN 200 PERCENT OF THE FEDERAL POVERTY GUIDELINES (FPG), SCRIPPS FULLY FORGIVES THE ENTIRE BILL. FOR INDIVIDUALS WHO EARN BETWEEN 201-400 PERCENT OF THE FPG, FINANCIAL ASSISTANCE IS BASED ON A SCHEDULE WITH SHARE-OF-COST DISCOUNTS. SCRIPPS POSTS A SUMMARY OF ITS FINANCIAL ASSISTANCE POLICY ON THE SCRIPPS WEBSITE AND FINANCIAL ASSISTANCE CONTACT INFORMATION IN ADMISSIONS AREAS, EMERGENCY ROOMS, AND OTHER AREAS OF THE ORGANIZATION'S FACILITIES WHERE ELIGIBLE PATIENTS ARE LIKELY TO BE PRESENT. THE FINANCIAL ASSISTANCE POLICY SETS FORTH SCRIPPS POLICIES REGARDING DISCOUNT PAYMENTS AND 100 PERCENT FINANCIAL ASSISTANCE FOR QUALIFIED PATIENTS AND IS IN WRITTEN FORM TO DIRECT AND GUIDE STAFF, AND EFFECTIVELY COMMUNICATE HOW OUR COMMITMENT WILL BE APPLIED CONSISTENTLY TO ALL PATIENTS. THE POLICY INITIALLY ESTABLISHED IN 2001 WAS REVISED TO BE CONSISTENT WITH STATE AND FEDERAL LEGISLATION. THE PRACTICES ESTABLISHED IN THE POLICY REFLECT SCRIPPS CONTINUING COMMITMENT TO ASSISTING LOW-INCOME UNINSURED PATIENTS WITH DISCOUNTED HOSPITAL CHARGES, CHARITY CARE, BILLING AND DEBT COLLECTION PRACTICES. POLICY HIGHLIGHTS INCLUDE: - SCRIPPS HEALTH WILL RESPECT THE DIGNITY OF EACH PATIENT, ACT ETHICALLY IN ALL PATIENT FINANCIAL MATTERS AND COMMUNICATE EFFECTIVELY TO ASSIST PATIENTS IN RESOLVING THEIR FINANCIAL OBLIGATIONS. EVERY REASONABLE EFFORT IS MADE TO ASSIST PATIENTS IN MEETING THEIR FINANCIAL OBLIGATION TO PAY FOR HOSPITAL SERVICES. SCRIPPS FINANCIAL ASSISTANCE IS DESIGNED TO SUPPORT PATIENTS WITH DEMONSTRATED FINANCIAL NEED AND IS NOT INTENDED TO SUPPLEMENT OR CIRCUMVENT THIRD PARTY COVERAGE INCLUDING MEDICARE. - PATIENT COMMUNICATION AND COMMUNITY OUTREACH AND COMMUNICATION REGARDING SCRIPPS FINANCIAL ASSISTANCE IS ACHIEVED THROUGH THE FOLLOWING MEASURES, TO INCLUDE BUT NOT LIMITED TO: 1. POSTERS ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE ARE POSTED IN REGISTRATION AREAS IN THE HOSPITAL (I.E. EMERGENCY DEPARTMENT AND MAIN ADMISSION AREAS.) PAPER COPIES OF SCRIPPS FAP, FINANCIAL ASSISTANCE APPLICATION AND A PLAIN LANGUAGE SUMMARY OF THE FAP ("FAP SUMMARY") ARE AVAILABLE UPON REQUEST AND WITHOUT CHARGE IN ALL SCRIPPS HOSPITAL EMERGENCY DEPARTMENTS AND ADMISSIONS AREAS. PATIENTS MAY ALTERNATIVELY REQUEST THAT COPIES OF THESE DOCUMENTS BE SENT TO THEM ELECTRONICALLY. 2. THE FAP, FAP SUMMARY, AND FINANCIAL ASSISTANCE APPLICATIONS ARE POSTED ON THE SCRIPPS WEBSITE TO VIEW, DOWNLOAD AND PRINT FREE OF CHARGE. THE FAP SUMMARY WILL CONTAIN THE WEBSITE ADDRESS WHERE THESE DOCUMENTS CAN BE FOUND ONLINE, IN ADDITION TO THE PHYSICAL LOCATION IN THE HOSPITAL WHERE PAPER COPIES MAY BE OBTAINED. 3. THE FAP SUMMARY IS OFFERED TO ALL PATIENTS AT REGISTRATION OR PRIOR TO DISCHARGE AS PART OF THE AGREEMENT FOR SERVICES AT A SCRIPPS FACILITY. 4. ALL BILLING STATEMENTS INCLUDE A STATEMENT ON THE AVAILABILITY OF FINANCIAL ASSISTANCE, INCLUDING A TELEPHONE NUMBER FOR SCRIPPS HOSPITAL STAFF THAT PROVIDE ASSISTANCE WITH THE APPLICATION PROCESS AND THE WEBSITE ADDRESS WHERE THE FAP, FAP SUMMARY AND FINANCIAL ASSISTANCE APPLICATION CAN BE FOUND. 5. THE FAP, FAP SUMMARY AND FINANCIAL ASSISTANCE APPLICATION ARE AVAILABLE IN THE PRIMARY LANGUAGES OF SIGNIFICANT PATIENT POPULATIONS WITH LIMITED ENGLISH PROFICIENCY (LEP). 6. THE FAP SUMMARY WILL BE AVAILABLE AT COMMUNITY EVENTS AND WILL BE PROVIDED TO LOCAL AGENCIES THAT OFFER CONSUMER ASSISTANCE. SCRIPPS HEALTH WORKED WITH THE CALIFORNIA HOSPITAL ASSOCIATION (CHA) TO INFORM AND NOTIFY MEMBERS OF THE COMMUNITY SERVED BY THE HOSPITAL ABOUT THE FAP AND TO REACH THOSE MEMBERS WHO ARE MOST LIKELY TO REQUIRE FINANCIAL ASSISTANCE. 7. THE FAP AND RELATED INFORMATION WILL ALSO BE PROVIDED TO THE OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT AS REQUIRED BY LAW. - SELF-PAY PATIENTS ARE PROVIDED WITH COUNSELING AND WRITTEN INFORMATION REGARDING FINANCIAL ASSISTANCE. THE PATIENT FINANCIAL ASSESSMENT STATEMENT IS AVAILABLE AND WILL BE PROVIDED TO PATIENTS WHO EXPRESS AN INTEREST IN, OR WHO HAVE BEEN IDENTIFIED AS, NEEDING FINANCIAL ASSISTANCE WHEN POSSIBLE. WRITTEN MATERIALS WILL BE AVAILABLE IN ENGLISH AND SPANISH. LANGUAGE INTERPRETIVE SERVICES ARE PROVIDED WHENEVER NECESSARY TO FACILITATE THE PATIENTS UNDERSTANDING AND PARTICIPATION IN OPTIONS FOR FINANCIAL ASSISTANCE. - PATIENT ACCOUNTS THAT MAY BENEFIT FROM FINANCIAL ASSISTANCE ARE ACTIVELY SCREENED, MONITORED AND IDENTIFIED AS SOON AS POSSIBLE. PATIENTS ARE SCREENED FOR THE ABILITY TO PAY AND/OR TO DETERMINE ELIGIBILITY FOR PAYMENT PROGRAMS INCLUDING THOSE OFFERED DIRECTLY THROUGH SCRIPPS HEALTH. OUR PERSONNEL WILL MAKE ALL REASONABLE EFFORTS TO OBTAIN INFORMATION FROM PATIENTS ABOUT WHETHER PRIVATE OR PUBLIC HEALTH INSURANCE MAY FULLY OR PARTIALLY COVER THE CHARGES FOR CARE. SCRIPPS WILL PROVIDE ASSISTANCE IN ASSESSING THE PATIENTS ELIGIBILITY FOR MEDI-CAL, COUNTY MEDICAL SERVICES (CMS) OR ANY OTHER-THIRD PARTY COVERAGE AS PART OF THE APPLICATION PROCESS FOR FINANCIAL ASSISTANCE. EVALUATION FOR FINANCIAL ASSISTANCE ELIGIBILITY IS BASED ON THE EVALUATION OF INCOME AND EXPENSE INFORMATION PROVIDED BY THE PATIENT. - SCRIPPS HEALTH WILL WORK TO ASSIST ANY PATIENT UNABLE TO PAY FOR SERVICES, WHO COOPERATIVELY PROVIDES INFORMATION ABOUT HIS/HER ABILITY TO PAY. FAILURE BY THE PATIENT TO COOPERATE MAY RESULT IN THE INABILITY OF THE HOSPITAL TO PROVIDE FINANCIAL ASSISTANCE DETERMINATION. - FINANCIAL ASSISTANCE APPLIES TO INDIVIDUALS WHOSE FAMILY INCOME LEVEL IS 400 PERCENT OF THE FEDERAL POVERTY GUIDELINES OR BELOW. DETERMINATION IS MADE ON AN ALL OR PARTIAL BASIS USING THE APPROVED DISCOUNT SCHEDULE. IF THE HOSPITAL IS UNABLE TO OBTAIN ADEQUATE INFORMATION AFTER DILIGENT EFFORTS REGARDING ABILITY TO PAY FOR ANY PATIENT TREATED IN THE EMERGENCY DEPARTMENT, THE PATIENT MAY BE GRANTED 100 PERCENT FINANCIAL ASSISTANCE ONLY AFTER APPROPRIATE BILLING AND/OR OTHER ATTEMPTS TO COLLECT INFORMATION HAVE BEEN MADE. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION FOR THE PURPOSES OF THE 2016 CHNA, THE SERVICE AREA IS DEFINED AS THE ENTIRE COUNTY OF SAN DIEGO DUE TO A BROAD REPRESENTATION OF HOSPITALS IN THE AREA. A HOSPITAL OR HEALTH CARE SYSTEM SERVICE AREA INCLUDES ALL RESIDENTS IN A DEFINED GEOGRAPHIC AREA SURROUNDING THE HOSPITAL AND DOES NOT EXCLUDE LOW INCOME OR UNDERSERVED POPULATIONS. ALTHOUGH THE STUDY AREA FOR THIS CHNA IS THE ENTIRE COUNTY, EACH HOSPITAL HAS THE ABILITY TO USE THE COUNTY-WIDE FINDINGS OR ADAPT THE FINDINGS TO REFLECT THE COMMUNITIES THEY SERVE, AS MUCH OF THE DATA IS AVAILABLE BY ZIP CODE LEVEL. MEETING THE CHALLENGES OF A DIVERSE BORDER COMMUNITY SAN DIEGO COUNTY IS AN INTERNATIONAL BORDER COMMUNITY COMPRISED OF 3.2 MILLION PEOPLE. GEOGRAPHICALLY DISPERSED OVER 4,300 SQUARE MILES, THE POPULATION REPRESENTS MULTIPLE ETHNIC GROUPS. THE SAN DIEGO ASSOCIATION OF GOVERNMENT'S (SANDAG) POPULATION GROWTH PROJECTIONS ARE JUST OVER 1 PERCENT PER YEAR, EXTENDING OUT 25 YEARS TO THE YEAR 2030. THE SANDAG 2050 SUB-REGIONAL GROWTH FORECAST PROJECTS POPULATION GROWTH TO 4.4 MILLION BY 2050. THIS IS A 40.0% INCREASE IN POPULATION GROWTH. RECOGNIZING THAT HEALTH NEEDS DIFFER ACROSS THE REGION AND THAT SOCIOECONOMIC FACTORS IMPACT HEALTH OUTCOMES, THE INSTITUTE FOR PUBLIC HEALTH USED THE DIGNITY HEALTH/TRUVEN HEALTH COMMUNITY NEED INDEX (CNI) TO IDENTIFY COMMUNITIES WITH THE HIGHEST LEVEL OF HEALTH DISPARITIES AND NEEDS. IN ADDITION, GEOGRAPHIC INFORMATION SYSTEMS (GIS) MAPS WERE CREATED, OVERLAYING CNI DATA AND THE HOSPITAL DISCHARGE RATE BY PRIMARY DIAGNOSIS FOR THE HEALTH CONDITIONS: TYPE 2 DIABETES, CARDIOVASCULAR DISEASE, AND BEHAVIORAL HEALTH. GIS MAPS WERE NOT CREATED FOR OBESITY DUE TO THE FACT THAT OBESITY IS NOT A COMMON PRIMARY DIAGNOSIS, BUT RATHER A SECONDARY CONDITION THAT CONTRIBUTES TO THE PRIMARY REASON FOR A HOSPITAL VISIT. DEMOGRAPHIC PROFILE OF SAN DIEGO COUNTY (SDC) CURRENT POPULATION DEMOGRAPHICS AND CHANGES IN DEMOGRAPHIC COMPOSITION OVER TIME PLAY A DETERMINING ROLE IN THE TYPES OF HEALTH AND SOCIAL SERVICES NEEDED BY COMMUNITIES. POPULATION SIZE, CHANGE IN POPULATION, RACE AND ETHNICITY, AND AGE OF A POPULATION ARE ALL IMPORTANT IN UNDERSTANDING COMMUNITIES AND ITS RESIDENTS. POPULATION: OVER 3 MILLION PEOPLE (3,138,265) LIVE IN THE 4,205 SQUARE MILE AREA OF SDC ACCORDING TO THE U.S. CENSUS BUREAU AMERICAN COMMUNITY SURVEY 2009-13, 5-YEAR ESTIMATES. THE POPULATION DENSITY FOR THIS AREA, ESTIMATED AT 746 PERSONS PER SQUARE MILE, IS GREATER THAN THE NATIONAL AVERAGE POPULATION DENSITY OF APPROXIMATELY 88 PERSONS PER SQUARE MILE. APPROXIMATELY 96.7% OF THE POPULATION LIVES IN AN URBAN AREA COMPARED TO JUST 3.3% LIVING IN RURAL AREAS. POPULATION CHANGE: ACCORDING TO THE U.S. CENSUS BUREAU DECENNIAL CENSUS, BETWEEN 2000 AND 2010 THE POPULATION IN SDC GREW BY 281,480 PERSONS, A CHANGE OF 10.0%.THIS IS SIMILAR TO THE PERCENTAGE POPULATION CHANGE SEEN DURING THE SAME TIME PERIOD IN CALIFORNIA (10.0%) AND THE UNITED STATES (9.7%). A SIGNIFICANT SHIFT IN TOTAL POPULATION OVER TIME IMPACTS THE DEMAND FOR HEALTH CARE PROVIDERS AND THE UTILIZATION OF COMMUNITY RESOURCES. RACE/ETHNICITY: IN THE AMERICAN COMMUNITY SURVEY, DATA FOR RACE AND ETHNICITY ARE COLLECTED SEPARATELY. OF THOSE WHO IDENTIFIED AS NON-HISPANIC (67.7%) IN SDC, THE MAJORITY IDENTIFIED THEIR RACE AS WHITE (70.9%), FOLLOWED BY ASIAN (16.1%), BLACK (7.1%), MULTIPLE RACES (4.5%), NATIVE HAWAIIAN/PACIFIC ISLANDER (0.6%), AND AMERICAN INDIAN/ALASKAN NATIVE (0.5%). OF THOSE WHO IDENTIFIED AS HISPANIC OR LATINO (32.4%) IN SDC, THE MAJORITY ALSO IDENTIFIED THEIR RACE AS WHITE (72.4%), FOLLOWED BY OTHER (19.9%), MULTIPLE RACES (5.1%), AMERICAN INDIAN/ALASKAN NATIVE (1.1%), BLACK (0.8%), ASIAN (0.6%), AND NATIVE HAWAIIAN/PACIFIC ISLANDER (0.1%). SCRIPPS SERVES THE ENTIRE SAN DIEGO COUNTY REGION WITH SERVICES CONCENTRATED IN NORTH COASTAL, NORTH CENTRAL, CENTRAL AND SOUTHERN REGION OF SAN DIEGO. COMMUNITY OUTREACH EFFORTS ARE FOCUSED IN THOSE AREAS WITH PROXIMITY TO A SCRIPPS FACILITY. SCRIPPS HOSTS, SPONSORS AND PARTICIPATES IN MANY COMMUNITY-BUILDING EVENTS THROUGHOUT THE YEAR. PER CALENDAR YEAR 2015 OSHPD ANNUAL FINANCIAL DATA THERE ARE 20 OTHER HOSPITAL FACILITIES SERVING THE SAN DIEGO COMMUNITY. SCRIPPS MERCY HOSPITAL (INCLUDING SAN DIEGO AND CHULA VISTA CAMPUSES) PROVIDES 57 PERCENT OF THE CHARITY CARE WITHIN THE SCRIPPS SYSTEM. SCRIPPS MERCY'S SERVICE AREA HAS A MORE ECONOMICALLY DISADVANTAGED POPULATION COMPARED TO THE COUNTY AS A WHOLE, WITH THE LOWEST NUMBERS OF INSURED ADULTS IN THE COUNTY AND A MUCH HIGHER PERCENTAGE OF ETHNIC MINORITIES, PRIMARILY HISPANIC AND ASIAN. AS A DISPROPORTIONATE-SHARE HOSPITAL, SCRIPPS MERCY SAN DIEGO AND CHULA VISTA CAMPUSES PLAY IMPORTANT HEALTH CARE SERVICE ROLES IN THE CENTRAL/SOUTHERN SAN DIEGO COUNTY SERVICE AREA (RANGING FROM INTERSTATE 8 TO THE UNITED STATES-MEXICO BORDER). MORE THAN HALF OF SCRIPPS MERCY SAN DIEGO AND CHULA VISTA PATIENTS ARE GOVERNMENT INSURED-MEDICARE AND MEDI-CAL. SCRIPPS HOSPITALS HOUSE 23.5% PERCENT OF THE COUNTY'S GENERAL ACUTE-CARE LICENSED BEDS. SCRIPPS PROVIDES SIGNIFICANT AND GROWING VOLUMES OF EMERGENCY, OUTPATIENT AND PRIMARY CARE. IN FY16, SCRIPPS PROVIDED 2,444,834 OUTPATIENT VISITS. NEARLY HALF (42.6%) OF SAN DIEGO COUNTY'S 78,840 SAFETY NET DISCHARGES ARE FROM CENTRAL AND SOUTH SUBURBAN REGIONS. SAFETY NET DISCHARGES INCLUDE COUNTY INDIGENT PROGRAMS, MEDI-CAL AND SELF PAY. OSHPD 2015 DATA (MOST RECENT YEAR AVAILABLE) SCRIPPS HAS A TOTAL OF 1,459 ACUTE CARE LICENSED BEDS. SAN DIEGO HAS A TOTAL OF 6,220 GENERAL ACUTE CARE LICENSED BEDS. % OF SCRIPPS BEDS IS 1,459/6,220 = 23.5% COUNTY SAFETY NET DISCHARGES CY15: SAFETY NET DISCHARGES INCLUDE PAYER CATEGORIES: COUNTY INDIGENT PROGRAMS, MEDI-CAL AND SELF PAY. - CENTRAL DISCHARGES 18,487 - SOUTH SUBURBAN DISCHARGES 15,082 SCRIPPS OSHPD SAFETY NET DISCHARGES CY15: - SCRIPPS CENTRAL DISCHARGES 5,628 - SCRIPPS SOUTH SUBURBAN DISCHARGES 4,332 THE HEALTH CARE SAFETY NET IN SAN DIEGO COUNTY IS HIGHLY DEPENDENT UPON HOSPITALS AND COMMUNITY HEALTH CLINICS TO CARE FOR UNINSURED AND MEDICALLY UNDERSERVED COMMUNITIES. FINDING MORE EFFECTIVE WAYS TO COORDINATE AND ENHANCE THE SAFETY NET IS A CRITICAL POLICY CHALLENGE. WHILE PUBLIC SUBSIDIES (E.G., COUNTY MEDICAL SERVICES) HELP FINANCE SERVICES FOR SAN DIEGO COUNTY'S UNINSURED POPULATIONS, THESE SUBSIDIES DO NOT COVER THE FULL COST OF CARE. COMBINED WITH MEDI-CAL AND MEDICARE FUNDING SHORTFALLS, SCRIPPS AND OTHER LOCAL HOSPITALS ARE LEFT TO ABSORB THE COST INVOLVED IN CARING FOR UNINSURED PATIENTS INTO THEIR OPERATING BUDGETS. THE FINANCIAL BURDEN PLACED ON HOSPITALS AND PHYSICIANS CARING FOR UNINSURED PATIENTS IS SIGNIFICANT. SAN DIEGO MEDI-CAL REIMBURSEMENT IS AMONG THE LOWEST IN CALIFORNIA, ALREADY THE STATE WITH THE NATION'S LOWEST MEDICAID REIMBURSEMENT RATE. SAN DIEGOS UNINSURED THE LACK OF HEALTH INSURANCE IS CONSIDERED A KEY DRIVER OF HEALTH STATUS. BETWEEN 2010 AND 2013 UNINSURED RATE WAS RELATIVELY STABLE IN THE UNITED STATES, CALIFORNIA AND IN SAN DIEGO COUNTY. IN 2014, THE UNINSURED RATE SHARPLY DECREASED TO 12.3%, WHICH WAS THE LARGEST CHANGE IN THE UNINSURED RATE THROUGHOUT THIS PERIOD. THIS DECREASE CAN BE ATTRIBUTED IN LARGE PART TO THE AFFORDABLE CARE ACT (ACA). SOURCE: U.S. CENSUS BUREAU, 2010 TO 2014 1-YEAR AMERICAN COMMUNITY SURVEYS. ACS UNINSURED RATE IS BASED ON WHETHER AN INDIVIDUAL HAD INSURANCE AT THE TIME OF THE SURVEY. NOTE: THE AMERICAN COMMUNITY SURVEY, ESTIMATES ARE FOR THE CIVILIAN NONINSTITUTIONALIZED POPULATION. THERE ARE THREE INDICATORS DETERMINED TO BE THE MOST POWERFUL PREDICTORS OF POPULATION HEALTH: POVERTY RATE, PERCENT OF POPULATION UNINSURED, AND EDUCATIONAL ATTAINMENT. LOW-INCOME, UNINSURED, AND UNDEREDUCATED INDIVIDUALS HAVE BEEN FOUND TO BE MOST AT RISK FOR POOR HEALTH STATUS. FIVE-YEAR ESTIMATES FROM THE 2009-2013 AMERICAN COMMUNITY SURVEY (ACS) SHOW HOW THESE INDICATORS IMPACT THE SAN DIEGO COMMUNITY. EVALUATING THESE RISK FACTORS IS IMPORTANT FOR IDENTIFYING COMMUNITIES WITH THE MOST SIGNIFICANT HEALTH NEEDS AND HEALTH DISPARITIES. POVERTY: WITHIN SDC, 14.5% OR 441,648 INDIVIDUALS ARE LIVING IN HOUSEHOLDS WITH INCOME BELOW 100% OF THE FEDERAL POVERTY LEVEL (FPL). FOR CHILDREN 0-17, THE PERCENTAGE LIVING 100% BELOW THE FPL INCREASES TO 18.8%. FOR A HOUSEHOLD SIZE OF 3 THE 100% POVERTY LEVEL IS $20,090 PER YEAR. POVERTY CREATES BARRIERS TO ACCESSING SERVICES THAT PROMOTE WELL-BEING INCLUDING HEALTH SERVICES, HEALTHY FOOD, AND OTHER NECESSITIES THAT CONTRIBUTE TO IMPROVED HEALTH STATUS. UNINSURED: BETWEEN 2010 AND 2013 UNINSURED RATE WAS RELATIVELY STABLE IN THE UNITED STATES, CALIFORNIA AND IN SDC. IN 2014, THE UNINSURED RATE SHARPLY DECREASED, WHICH WAS THE LARGEST CHANGE IN THE UNINSURED RATE THROUGHOUT THIS PERIOD. THIS DECREASE CAN BE ATTRIBUTED IN LARGE PART TO THE AFFORDABLE CARE ACT (ACA). LACK OF INSURANCE IS A PRIMARY BARRIER TO HEALTH CARE ACCESS INCLUDING REGULAR PRIMARY CARE, SPECIALTY CARE, AND OTHER HEALTH SERVICES THAT CONTRIBUTES TO POOR HEALTH STATUS. EDUCATIONAL SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH FOUNDED IN 1924 BY PHILANTHROPIST ELLEN BROWNING SCRIPPS, SCRIPPS HEALTH IS A $2.9 BILLION, PRIVATE, NOT-FOR-PROFIT COMMUNITY HEALTH SYSTEM IN SAN DIEGO, CALIFORNIA. SCRIPPS TREATS MORE THAN 700,000 PATIENTS ANNUALLY THROUGH THE DEDICATION OF 3,000 AFFILIATED PHYSICIANS AND 15,000 EMPLOYEES AMONG ITS FIVE ACUTE-CARE HOSPITAL CAMPUSES, HOME HEALTH CARE, HOSPICE CARE, AND AN AMBULATORY CARE NETWORK OF CLINICS, PHYSICIAN OFFICES AND OUTPATIENT CENTERS THROUGHOUT THE SAN DIEGO REGION. SCRIPPS IS A RECOGNIZED LEADER IN THE PREVENTION, DIAGNOSIS AND TREATMENT OF DISEASE AND IS AT THE FOREFRONT OF CLINICAL RESEARCH AND GRADUATE MEDICAL EDUCATION. AS A TAX EXEMPT HEALTH CARE SYSTEM, SCRIPPS TAKES PRIDE IN ITS SERVICE TO THE COMMUNITY. THE SCRIPPS SYSTEM IS GOVERNED BY A 14-MEMBER VOLUNTEER BOARD OF TRUSTEES. THIS SINGLE POINT OF AUTHORITY FOR ORGANIZATIONAL POLICY ENSURES A UNIFIED APPROACH TO SERVING PATIENTS ACROSS THE REGION. THE BOARD IS RESPONSIBLE FOR PROMOTING CORPORATE PURSUIT OF ITS MISSION, APPROVAL OF THE BUDGET AND ASSURING THROUGH OVERSIGHT THE EFFECTIVE FUNCTIONING OF THE CORPORATION. ITS PURPOSE IS TO ESTABLISH AND MAINTAIN A NONPROFIT PUBLIC BENEFIT CORPORATION ORGANIZED EXCLUSIVELY FOR CHARITABLE, SCIENTIFIC AND EDUCATIONAL PURPOSES, WHOSE ACTIVITIES ARE CONDUCTED IN SUCH A MANNER THAT NO PART OF ITS NET EARNINGS WILL BENEFIT ANY TRUSTEE, OFFICER OR OTHER INDIVIDUAL. THESE VOLUNTEERS GIVE COUNTLESS HOURS OF SERVICE TO THE HOSPITAL SYSTEM IN THEIR OVERSIGHT ROLE, PARTICIPATION IN VARIOUS BOARD COMMITTEES AND GENERAL STEWARDSHIP. ALL FIVE ACUTE-CARE HOSPITAL CAMPUSES HAVE AN OPEN MEDICAL STAFF FOR ALL QUALIFIED PHYSICIANS. THE BOARD OF TRUSTEES HAS AUTHORITY TO APPROVE BYLAWS, RULES AND REGULATIONS FOR THE MEDICAL STAFF OF EACH HOSPITAL, SURGERY CENTER OR SIMILAR FACILITY, AND TO APPOINT, SUSPEND OR REMOVE ANY PHYSICIAN FROM THE MEDICAL STAFF. ALL FIVE ACUTE-CARE HOSPITAL CAMPUSES PARTICIPATE IN MEDI-CAL AND MEDICARE CONTRACTS. SCRIPPS SURPLUS FUNDS ARE REINVESTED BACK INTO THE SAN DIEGO COMMUNITY. SURPLUS FUNDS ARE UTILIZED FOR NEW FACILITIES, EQUIPMENT, SEISMIC RETROFITTING, PROFESSIONAL EDUCATION AND HEALTH RESEARCH, ACCESS TO PATIENT CARE AND COMMUNITY BENEFIT PROGRAMS. EACH YEAR, SCRIPPS ALLOCATES RESOURCES TO ADVANCE HEALTH CARE SERVICES THROUGH CLINICAL RESEARCH AND MEDICAL EDUCATION PROGRAMS. DURING FY16 (OCTOBER 2015 TO SEPTEMBER 2016), SCRIPPS INVESTED $24,201,857 IN PROFESSIONAL TRAINING PROGRAMS AND HEALTH RESEARCH TO ENHANCE SERVICE DELIVERY AND TREATMENT PRACTICES FOR SAN DIEGO COUNTY. QUALITY HEALTH CARE DEPENDS ON HEALTH EDUCATION SYSTEMS AND MEDICAL RESEARCH PROGRAMS. WITHOUT THE ABILITY TO TRAIN AND INSPIRE A NEW GENERATION OF HEALTH CARE PROVIDERS OR TO OFFER CONTINUING EDUCATION TO EXISTING HEALTH CARE PROFESSIONALS, THE QUALITY OF HEALTH CARE WOULD BE GREATLY DIMINISHED. MEDICAL RESEARCH ALSO PLAYS AN IMPORTANT ROLE IN IMPROVING THE COMMUNITY'S OVERALL HEALTH THROUGH THE DEVELOPMENT OF NEW AND INNOVATIVE TREATMENT OPTIONS. PROFESSIONAL EDUCATION AND HEALTH RESEARCH REFLECTS CLINICAL RESEARCH, AS WELL AS PROFESSIONAL EDUCATION FOR NON-SCRIPPS EMPLOYEES INCLUDING GRADUATE MEDICAL EDUCATION, NURSING RESOURCE DEVELOPMENT AND OTHER HEALTH CARE PROFESSIONAL EDUCATION. RESEARCH TAKES PLACE PRIMARILY AT SCRIPPS CLINICAL RESEARCH SERVICES, SCRIPPS WHITTIER DIABETES INSTITUTE, SCRIPPS GENOMIC MEDICINE AND SCRIPPS TRANSLATIONAL SCIENCE INSTITUTE. CALCULATIONS ARE BASED ON TOTAL PROGRAM EXPENSES LESS APPLICABLE DIRECT-OFFSETTING REVENUE, WHICH INCLUDES ANY REVENUE GENERATED BY THE ACTIVITY OR PROGRAM, SUCH AS PAYMENT OR REIMBURSEMENT FOR SERVICES PROVIDED TO PROGRAM PATIENTS. ACCORDING TO THE 2015 SCHEDULE H 990 IRS GUIDELINES; "DIRECT OFFSETTING REVENUE" ALSO INCLUDES RESTRICTED GRANTS OR CONTRIBUTIONS THAT THE ORGANIZATION USES TO PROVIDE A COMMUNITY BENEFIT. BECAUSE OF THIS NEW PROVISION, SCRIPPS SAW A SUBSTANTIAL DECREASE IN RESEARCH FOR FY15 AND FY16. A LACK OF HEALTH INSURANCE AND ACCESS TO SPECIALTY AND PRIMARY CARE PROVIDERS ARE TWO OF THE PRIMARY BARRIERS TO HEALTH CARE ON BOTH A LOCAL AND NATIONAL LEVEL. WITHOUT ACCESS TO BASIC HEALTH CARE SERVICES, INDIVIDUALS SUFFER FROM MORE ACUTE EPISODES OF ILLNESS, INJURY AND MORTALITY. LACK OF INSURANCE ALSO INCREASES THE BURDEN ON HOSPITALS AND HEALTH PROVIDERS. IN AN EFFORT TO PROVIDE FOR POPULATIONS IN NEED, SCRIPPS ASSISTED IN FY16 WITH THE FOLLOWING HEALTH CARE PROGRAMS AND PROJECTS. MERCY OUTREACH SURGICAL TEAM (MOST) REACHING OUT TO THOSE WHO HAVE LIMITED ACCESS TO HEALTH CARE, THE MERCY OUTREACH SURGICAL TEAM (MOST) PROVIDES MEDICAL AND SURGICAL CARE TO UNDERPRIVILEGED CHILDREN AND ADULTS FROM OTHER COUNTRIES. THE VOLUNTEER GROUP OF PHYSICIANS, NURSES, TECHNICIANS AND OTHERS PERFORM LIFE-CHANGING SURGERIES TO CORRECT CLEFT LIPS, CLEFT PALATES, BURN SCARS, CROSSED EYES, HERNIAS AND A VARIETY OF OTHER CONDITIONS. DURING FY16, THE MOST TEAM SERVED IN TWO OUTREACH TRIPS. THE MOST TEAM VOLUNTEERED 4,088 HOURS TO PROVIDE RECONSTRUCTIVE SURGERIES FOR MORE THAN 400 CHILDREN. GRADUATE MEDICAL EDUCATION STAFF SUPPORT TO ST. VINCENT DE PAUL VILLAGE MEDICAL CENTER AND ST. LEO'S MISSION COMMUNITY CLINIC. THE GRADUATE MEDICAL EDUCATION (GME) PROGRAM AT SCRIPPS GREEN HOSPITAL AND SCRIPPS CLINIC FOCUSES ON PHYSICIAN TRAINING AND CLINICAL RESEARCH, WITH 40 RESIDENTS AND 36 FELLOWS. THE PROGRAM ALSO GIVES BACK TO THE COMMUNITY BY STAFFING EVENING CLINICS AT ST. VINCENT DE PAUL VILLAGE AND ST. LEO'S MISSION COMMUNITY CLINIC. SCRIPPS RESIDENTS AND STAFF PROVIDED MEDICAL CARE TO APPROXIMATELY 800 OF OUR COUNTY'S MOST VULNERABLE RESIDENTS DURING FY16. SCRIPPS RECUPERATIVE CARE PROGRAM (RCU) THE SCRIPPS RESCUE MISSION PROJECT PROVIDES A SAFE DISCHARGE FOR CHRONICALLY HOMELESS PATIENTS WITH ONGOING MEDICAL NEEDS. ALL PATIENTS ARE UNFUNDED OR UNDERFUNDED. MOST HAVE SUBSTANCE ABUSE AND/OR MENTAL HEALTH ISSUES. THE LACK OF FUNDING, AND MENTAL ILLNESS, ALONG WITH ALCOHOL AND/OR SUBSTANCE ABUSE, MAKE POST-ACUTE PLACEMENT OF THESE HOMELESS PATIENTS DIFFICULT. RN CASE MANAGEMENT OVERSIGHT IS PROVIDED BY SCRIPPS WITH PHYSICIAN BACKUP TO ENSURE COMPLETION OF THEIR MEDICAL RECOVERY GOALS. SCRIPPS PAYS THE RESCUE MISSION A DAILY RATE FOR HOUSING AND SERVICES PROVIDED TO THE PATIENT. THEY PROVIDE A SAFE, SECURE ENVIRONMENT WITH 24 HOUR SUPERVISION, MEDICATION OVERSIGHT, MEALS, CLOTHING, COUNSELING, ASSISTANCE WITH COUNTY MEDICAL SERVICES, MEDI-CAL AND DISABILITY APPLICATIONS, PLUS HELP FIND PERMANENT OR TRANSITIONAL HOUSING. PATIENT TRANSPORTATION NEEDS ARE COORDINATED AND PROVIDED BY BOTH THE RESCUE MISSION AND SCRIPPS. TO MAINTAIN THE PATIENTS MEDICAL STABILITY, MEDICATIONS, DME AND OTHER SERVICES ARE PROVIDED BY SCRIPPS UNTIL INSURANCE FUNDING HAS BEEN ESTABLISHED. PATIENTS WITH PSYCHIATRIC DISORDERS ARE ESTABLISHED WITH A PSYCHIATRIST IN THE COMMUNITY AND ALL PATIENTS ARE CONNECTED WITH A MEDICAL HOME IN THE COMMUNITY. FOR FY16, TOTAL COST SAVINGS FOR SCRIPPS HAS BEEN OVER $3.4 MILLION. IN 2016, 68 PATIENTS HAD A CUMULATIVE 2,321 HOSPITAL DAYS OF STAY BEFORE GOING TO THE RCU. THE RCU HAS TAKEN MEDICALLY COMPLEX PATIENTS, INCLUDING THOSE WITH: TRACHEOTOMIES, FEEDING TUBES, IV ANTIBIOTICS, WOUND VACS, MULTIPLE FRACTURES, ABSCESS, OSTEOMYELITIS, PARAPLEGIA, ESRD ON DIALYSIS, END STAGE LIVER DISEASE, HEART VALVE REPLACEMENT, DIABETES, TRAUMATIC BRAIN INJURY OR ENCEPHALOPATHY, OSTOMIES, CRANIOTOMY, COMPLEX TRAUMA, CVA, CANCER, HIV/AIDS, AND A PATIENT WITH AN EXTERNAL DEFIBRILLATOR, THE LIFE VEST. OF RCU PATIENTS, 44% HAD STANDARD MEDI-CAL INSURANCE. 19% HAD MEDI-CAL HPE (HEALTH PRESUMPTIVE ELIGIBILITY). 12% HAD MEDI-CAL HMOS (MOLINA 4.4%, COMMUNITY HEALTH GROUP MCAL-6% AND HEALTH NET MEDI-CAL 1.5%). CARE 1ST MEDI-CAL CONTRACTS DIRECTLY WITH THE RCU TO SUPPORT THEIR PATIENTS. 9% OF SCRIPPS PATIENTS THAT WENT TO THE RCU WERE WITHOUT INSURANCE, EITHER SELF-PAY OR MEDI-CAL PENDING. 7% HAD RESTRICTED MEDI-CAL, 7% HAD OUT OF STATE OR OUT OF COUNTY MEDICAID/MEDI-CAL INSURANCE; 1% HAD MEDICARE. SLIGHTLY OVER 25% WERE INVOLVED WITH A SOCIAL WORKER TO SECURE INCOME FROM GOVERNMENT PROGRAMS. 12% WERE SOCIAL SECURITY DISABILITY INSURANCE (SSDI) WITH NO FUNDS OR NO ACCESS TO THEIR FUNDS (SEVERAL WITH LOST OR STOLEN BANK CARD) WHO RESOLVED THEIR ISSUES; 7% HAVE STARTED OR HAVE PENDING SSDI APPLICATIONS; 2% GOT SSDI AND STARTED RECEIVING A MONTHLY BENEFIT, 2% MADE CA SHORT TERM DISABILITY APPLICATION TO EDD; 5% STARTED RECEIVING MEDICARE AND SOCIAL SECURITY BENEFITS MONTHLY FOLLOWING THEIR APPLICATION. ONE HUNDRED PERCENT OF PATIENTS WERE CONNECTED TO A PRIMARY CARE PROVIDER AT ONE OF THE COMMUNITY CLINICS WITH AN APPOINTMENT MADE. 65% OF THE RCU DISCHARGED PATIENTS DID NOT RETURN TO THE STREETS. THEY WENT EITHER TO A RECOVERY PROGRAM (20%), BACK TO THE HOSPITAL OR HOSPICE AND THEN RETURNED TO THE RCU (16%), TO FAMILY OR FRIEND (12%), OR TRANSITIONAL HOUSING (6%), SRO OR APARTMENT (4.5%), BOARD AND CARE (4.5%) AND BACK TO MEXICO (1%). TWO CLIENTS ARE DECEASED. THIS YEAR 35% OF SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM FOUNDED IN 1924 BY PHILANTHROPIST ELLEN BROWNING SCRIPPS, SCRIPPS HEALTH IS A $2.9 BILLION, PRIVATE NOT-FOR-PROFIT INTEGRATED HEALTH SYSTEM BASED IN SAN DIEGO, CALIFORNIA. SCRIPPS TREATS MORE THAN 700,000 PATIENTS ANNUALLY THROUGH THE DEDICATION OF 3,000 AFFILIATED PHYSICIANS AND 15,000 EMPLOYEES AMONG ITS FIVE ACUTE-CARE HOSPITAL CAMPUSES, HOME HEALTH CARE SERVICES, HOSPICE CARE, AND AN AMBULATORY CARE NETWORK OF PHYSICIAN OFFICES AND 28 OUTPATIENT CENTERS AND CLINICS. IN 2013, SCRIPPS HEALTH PROGRAM WAS ESTABLISHED AND PROVIDES END OF LIFE CARE. SCRIPPS PROVIDES A COMPREHENSIVE RANGE OF INPATIENT AND AMBULATORY SERVICES THROUGH OUR SYSTEM OF HOSPITALS AND CLINICS. IN ADDITION, SCRIPPS PARTICIPATES IN DOZENS OF PARTNERSHIPS WITH GOVERNMENT AND NOT-FOR-PROFIT AGENCIES ACROSS OUR REGION TO IMPROVE OUR COMMUNITYS HEALTH. AND OUR PARTNERSHIPS DONT STOP AT OUR LOCAL BORDERS. OUR PARTICIPATION AT THE STATE, NATIONAL AND INTERNATIONAL LEVELS INCLUDES WORK WITH GOVERNMENT AND PRIVATE DISASTER PREPAREDNESS AND RELIEF AGENCIES, THE STATE COMMISSION ON EMERGENCY MEDICAL SERVICES, NATIONAL HEALTH ADVOCACY ORGANIZATIONS; AS WELL AS INTERNATIONAL PARTNERSHIPS FOR PHYSICIAN EDUCATION AND TRAINING, AND DIRECT PATIENT CARE. IN ALL THAT WE DO, WE ARE COMMITTED TO QUALITY PATIENT OUTCOMES, SERVICE EXCELLENCE, OPERATING EFFICIENCY, CARING FOR THOSE WHO NEED US TODAY AND PLANNING FOR THOSE WHO MAY NEED US IN THE FUTURE. SCHEDULE H, PART VI, LINE 7 CALIFORNIA. SCRIPPS HEALTH COMMUNITY BENEFIT REPORT CAN BE FOUND AT: HTTP://WWW.SCRIPPS.ORG/ABOUT-US__SCRIPPS-IN-THE-COMMUNITY true CALIFORNIA HEALTH FOUNDATION & TRUST (CHFT) 1215 K STREET STE 800 SACRAMENTO CA 95814 941498697 501(c)(3) 302000 CA HOSP FEE PROGRAM 211 San Diego - HealthCare Navigation 5251 Viewridge Court Ste 30 San Diego CA 92123 331029843 501(c)(3) 12000 Program Support Alzhiemer's Association 6632 Convoy Court San Diego CA 92111 133039601 501(c)(3) 25000 PROGRAM SUPPORT ACS Making Strides Against Breast Cancer 2655 Camino del Rio N Ste 100 San Diego CA 92108 131788491 501(c)(3) 10000 3200 FMV EVENT SUPPLIES PROGRAM SUPPORT AMERICAN HEART ASSOCIATION - Sponsorship 9404 Genesee Ave Ste 240 La Jolla CA 92037 135613797 501(c)(3) 10000 PROGRAM SUPPORT AMERICAN HEART ASSOCIATION In-Kind Donation 9404 Genesee Ave Ste 240 La Jolla CA 92037 135613797 501(c)(3) 25725 FMV SUPPLIES PROGRAM SUPPORT AMERICAN HEART ASSOCIATION 2015 Heart Ball 9404 Genesee Ave Ste 240 La Jolla CA 92037 135613797 501(c)(3) 7500 PROGRAM SUPPORT Catholic Charities 349 Cedar Street San Diego CA 92101 237334012 501(c)(3) 70000 PROGRAM SUPPORT CMTY HLTH IMPRVMT PTNRS CREW RENDEVOUS 9370 Chesapeake Dr Ste 220 San Diego CA 92123 330496092 501(c)(3) 12500 PROGRAM SUPPORT CONSUMER CNTR OF LEGAL AID SOCIETY OF SD 1764 San Diego Ave Ste 200 San Diego CA 92110 981869806 501(c)(3) 120000 PROGRAM SUPPORT Eric Paredes Save a Life Foundation PMB79 2514 Jamacha Rd Ste 502 El Cajon CA 92019 800636157 501(c)(3) 15000 PROGRAM SUPPORT Mama's Kitchen 3960 Home Ave San Diego CA 92105 330434246 501(c)(3) 10000 PROGRAM SUPPORT 12 0 SCHEDULE I, PART I, LINE 2 DESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS Grantee shall submit to Scripps Health, attention Manager of Community Benefit Services at 10140 Campus Point Court, CPA 308, San Diego, CA 92121, the following: A. A semi-annual summary progress report and a line item financial accounting of the grant disbursement is required. Reports shall include, but not be limited to, progress made toward meeting objectives outlined in the grant application. B. Within thirty (30) days following the expiration date of the grant a final progress report shall be submitted to Scripps Health. In addition to the progress made toward meeting the objectives outlined in the grant application, the Final Report should include quantitative and qualitative results of the program against its stated goals and objectives. A line item financial accounting of the grant disbursement against the budget must be included as part of this final report. C. The Grantee shall provide Scripps Health with any additional information or progress updates, relative to grant project, as reasonably requested. D. Scripps Health reserves the right to audit expenditures and supporting documentation. X X true true X X X X X X true true false false false false false false false ROBIN BROWN CHIEF EXECUTIVE, SR VP 510276 0 220070 0 31936 0 380058 0 20433 0 1162773 0 0 0 VICTOR V BUZACHERO CORP SR VP INNOVAT/HR/PERF MGT 595324 0 291774 0 182143 0 237817 0 24979 0 1332037 0 151588 0 SUSAN CAMPBELL EXEC DIR, EXTERNAL AFFAIRS 327757 0 122566 0 93295 0 45100 0 35325 0 624043 0 59834 0 DAVID COHN CORP VP, REVENUE CYCLE 356403 0 118122 0 55224 0 13250 0 28986 0 571985 0 30818 0 MARY ELLEN DOYLE CORP VP, NURSING OPS 358269 0 125314 0 57909 0 59657 0 28308 0 629457 0 42858 0 ARNOLD BRENT EASTMAN MD FORMER KEY EMPLOYEE 0 0 0 0 1196617 0 -87257 0 0 0 1109360 0 0 0 JOHN ENGLE CORP SR VP, CHIEF DEVELOPMENT 373476 0 163749 0 70508 0 78210 0 25432 0 711375 0 40732 0 CARL ETTER CHIEF EXECUTIVE, SR VP 485483 0 204384 0 97439 0 101880 0 20634 0 909820 0 59279 0 SHIRAZ FAGAN CHIEF EXECUTIVE, SR VP 551636 0 227719 0 98485 0 129040 0 30045 0 1036925 0 86429 0 GARY FYBEL CHIEF EXECUTIVE, SR VP 559679 0 248078 0 174526 0 121727 0 25305 0 1129315 0 0 0 THOMAS GAMMIERE CHIEF EXECUTIVE, SR VP 580608 0 255583 0 108752 0 148686 0 29858 0 1123487 0 86987 0 ROBERT T HOFF CORP VP, HORIZONTAL OPS 344730 0 120427 0 69998 0 58955 0 32167 0 626277 0 43925 0 ANIL KESWANI CORPORATE VP, CMO SHPS 428106 0 141424 0 121414 0 82604 0 34610 0 808158 0 85707 0 JUNE KOMAR CORP EXEC VP, STRATEGY & ADMIN 574296 0 311886 0 35511 0 216868 0 11472 0 1150033 0 0 0 JAMES LABELLE MD CORP SR VP, CHIEF MED OFFICER 626381 0 260884 0 138153 0 146140 0 27383 0 1198941 0 109552 0 RICHARD NEALE CORP SVP, CORP DEVELOPMENT 417700 0 142450 0 83443 0 10600 0 28131 0 682324 0 69565 0 BARBARA PRICE CORP SRVP BUS & SERV LINE DEV 462675 0 205851 0 94655 0 106310 0 31516 0 901007 0 83964 0 MARC A REYNOLDS CORP SR VP, PAYER RELATIONS 374679 0 164609 0 153594 0 101061 0 20349 0 814292 0 134142 0 RICHARD ROTHBERGER TREASURER/EXECUTIVE VP/CFO 750964 0 402682 0 806776 0 291815 0 32052 0 2284289 0 321162 0 RICHARD R SHERIDAN SEC/CORP SR VP, GEN COUNSEL 518942 0 225714 0 48889 0 327196 0 27192 0 1147933 0 36972 0 PATRIC THOMAS CORP VP, INFORMATION SVCS 436041 0 144554 0 58379 0 86741 0 11687 0 737402 0 39507 0 CHRISTOPHER VAN GORDER PRESIDENT & CEO/TRUSTEE 1246481 0 847669 0 43800 0 1212208 0 34954 0 3385112 0 0 0 SCHEDULE J, PART I, LINE 1A SUPPLEMENTAL COMPENSATION INFORMATION SCRIPPS HEALTH INCURS THE COST OF A MEMBERSHIP FOR A BUSINESS NETWORKING CLUB IN SAN DIEGO FOR THE CHIEF EXECUTIVE OFFICER. THIS MEMBERSHIP IS USED 100% FOR BUSINESS PURPOSES AND ACCORDINGLY, NO PART OF THIS BENEFIT IS INCLUDED WITHIN THE CHIEF EXECUTIVE OFFICER'S TAXABLE COMPENSATION. THE MEMBERSHIP FEE IS $129 PER MONTH. CERTAIN EXECUTIVES REPORTED ON FORM 990, PART VII AND SCHEDULE J, PART II RECEIVE AN AUTOMOBILE ALLOWANCE. THE ALLOWANCE IS INCLUDED IN TAXABLE WAGES AND REPORTED ON THEIR W-2S. SCHEDULE J, PART I, LINE 4A RECEIVE A SEVERANCE PAYMENT OR CHANGE-OF-CONTROL PAYMENT THE FOLLOWING INDIVIDUAL RECEIVED SEVERANCE PAY IN CALENDAR YEAR 2015: ARNOLD BRENT EASTMAN $100,000 SCHEDULE J, PART I, LINE 4B SCRIPPS HEALTH SUPPLEMENTAL RETIREMENT PLAN SCRIPPS HEALTH SUPPLEMENTAL RETIREMENT PLAN (SERP) PROVIDES SUPPLEMENTAL RETIREMENT BENEFITS TO CERTAIN KEY EMPLOYEES. IT HAS BEEN CLOSED TO NEW PARTICIPANTS SINCE 2001. ACCRUAL OF BENEFITS UNDER THIS PLAN HAVE BEEN FROZEN AND NO ADDITIONAL BENEFITS HAVE BEEN ACCRUED AFTER 2014. THE PLAN PROVIDES A BENEFIT DETERMINED BY A FORMULA DRIVEN BY THE EXECUTIVE'S AVERAGE OF THE FIVE HIGHEST YEARS OF PAY AND TAKES INTO CONSIDERATION TENURE AT SCRIPPS HEALTH, AGE AND LIFE EXPECTANCY AND ASSUMES MAXIMUM PARTICIPATION IN OTHER RETIREMENT PROGRAMS. SCRIPPS HEALTH EXECUTIVE BENEFITS PROGRAM PROVIDES A 457F PLAN WITH A FLEXIBLE BENEFIT ALLOWANCE THAT CAN BE USED TO PURCHASE ADDITIONAL INSURANCE COVERAGE FOR CERTAIN EXECUTIVE LEVEL EMPLOYEES. ANY REMAINING BENEFIT ALLOWANCE CAN BE DEPOSITED INTO THE SUPPLEMENTAL ACCUMULATION RETIREMENT ACCOUNT (SARA) WITH A FUTURE VESTING DATE. THE FOLLOWING INDIVIDUALS RECEIVED PAYMENTS FROM THE SARA PLAN IN CALENDAR YEAR 2015: RICHARD ROTHBERGER - $321,162 RICHARD SHERIDAN - $36,972 VICTOR V. BUZACHERO - $151,588 ANIL KESWANI - $85,707 THOMAS GAMMIERE - $86,987 BARBARA PRICE - $83,964 JAMES LABELLE, MD - $109,552 CARL ETTER - $59,279 MARC A. REYNOLDS - $134,142 JOHN ENGLE - $40,732 SHIRAZ FAGAN - $86,429 PATRIC THOMAS - $39,507 SUSAN CAMPBELL - $59,834 MARY ELLEN DOYLE - $42,858 ROBERT HOFF - $43,925 RICHARD NEALE - $69,565 DAVID COHN - $30,818 SCRIPPS HEALTH PROVIDED DEFERRED COMPENSATION ARRANGEMENTS TO FOUR EXECUTIVES IN THE FORM OF LOANS TO PURCHASE LIFE INSURANCE PRODUCTS TO FUND POST-RETIREMENT INCOME. A California Statewide Communities Development Auth 680164610 1309116Y1 2007-03-02 49995000 SEE PART IV false false true B CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY 521643828 13033F5A4 2008-08-14 99830304 SEE PART VI false false false C CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY 521643828 13033F5L0 2008-08-14 221230000 SEE PART VI false false false D California Health Facilities Financing Authority 521643828 13033FWK2 2005-06-02 40975000 SEE PART VI false false false A 0 0 49995000 0 0 0 146070 0 0 49848930 0 0 2005 true false true true B 9265000 0 99830304 9902000 0 0 0 0 0 0 0 0 2008 true false true true C 52735000 0 221230000 0 0 0 0 5544 0 0 0 0 2008 true false true true D 30825000 0 40975000 0 0 0 280659 918283 0 0 0 0 2008 false true true true A false false true true true true 0.00000 0.00000 0.00000 false false false true B 0 C false false true true true true 0 false false false true D 0 A true true false 0 false 0 true true B false false false true false false 0 false 0 false true C false false false true true true Wells Fargo UBOC 26. false false false 0 false true D false false false true true true Wells Fargo 14. false false false 0 true true A true B true C true D true SCHEDULE K, PART I, COLUMN (C) - CUSIP NUMBER BOND ISSUE D (2005A/2008G): The Series 2005A Bonds, CUSIP 13033FWK2, were exchanged for the California Health Facilities Finance Authority Variable Rate Revenue Bonds, Series 2008G, CUSIP 13033F5M8 (Scripps Health), on August 14, 2008. SCHEDULE K, PART I, COLUMN (E) - ISSUE PRICE BOND ISSUE A (2007A): The stated par of $49,995,000 differs from the $149,875,000 reported on the 8038 tax form as the $49,995,000 amount represents only Scripps Health's portion in a pool bond loan program. BOND ISSUE B (2008A): The stated par of $99,020,000 differs from the $99,830,304 listed in form 8038 Part III line 21 (b) because of an $810,304 original issue premium. SCHEDULE K, PART I, COLUMN (F) - DESCRIPTION OF PURPOSE BOND ISSUE A (2007A): POOL BOND. PROCEEDS WERE USED TO REFUND COMMERCIAL PAPER REVENUE NOTES, SERIES 2005A, WHICH WERE USED TO PURCHASE EQUIPMENT. BOND ISSUE B (2008A): REFUNDING OF PRIOR ISSUES 07/07/2005 BOND ISSUE C (2008B-F): The $221,230,000 (2008B - F) refunded the 2005B - F bonds. The issue date for the 2005 B - F was 6/17/2005. BOND ISSUE D (2005A/2008G): The $40,975,000 (2008G) exchanged the 2005A bond. The issue date for the 2005A was 6/2/2005. The proceeds of the California Health Facilities Finance Authority Variable Rate Revenue Bonds, Series 2005A (Scripps Health), were issued for the purpose, together with other available funds, of advance refunding the Organizations Series 1998C Bonds. The Series 2005A Bonds, were exchanged for the California Health Facilities Finance Authority Variable Rate Revenue Bonds, Series 2008G (Scripps Health), on August 14, 2008. Based on the advice of bond counsel, the Organization is treating the Series 2008G Bonds as the same issue as the Series 2005A Bonds for federal income tax purposes. Further information regarding the Series 2008G Bonds: - Issuer Name: California Health Facilities Financing Authority; - Issuer EIN: 52-1643828; - CUSIP #: 13033F5M8; - Date Exchanged: 8/14/2008; - Issue Price: N/A; - Description of Purpose: Exchange for Series 2005A Bonds (same issue). BOND ISSUE 2-A (2010A): PROCEEDS USED FOR CAPITAL EXPENDITURES FOR HEALTHCARE BUILDINGS, RENOVATION AND EQUIPMENT. BOND ISSUE 2-B (2010B & C): PROCEEDS USED FOR CAPITAL EXPENDITURES FOR HEALTHCARE BUILDINGS, RENOVATION AND EQUIPMENT. BOND ISSUE 2-C (2012A-C): PROCEEDS USED FOR CAPITAL EXPENDITURES FOR HEALTHCARE BUILDINGS, RENOVATION AND EQUIPMENT. BOND ISSUE 2-D (2016A/B): PROCEEDS USED FOR CAPITAL EXPENDITURES FOR HEALTHCARE BUILDINGS, RENOVATION AND EQUIPMENT. SCHEDULE K, PART II, LINE 3 BOND ISSUE 2-C (2012A-C): The amount shown in Part II, Line 3 consists of the issue price of the bonds $288,143,095 plus investment earnings of $17,234. SCHEDULE K, PART III - PRIVATE BUSINESS USE BOND ISSUE B (2008A): The Series 2008A bonds refunded prior bonds originally issued before 2003. Accordingly, Part III reporting is not required. BOND ISSUE D (2005A/2008G): The Series 2005A Bonds refunded prior bonds originally issued before 2003. Accordingly, Part III reporting is not required. SCHEDULE K, PART III, LINE 3B THE OBLIGOR'S LEGAL DEPARTMENT REVIEWS CONTRACTS AND AGREEMENTS TO ENSURE COMPLIANCE WITH PRIVATE BUSINESS USE REGULATIONS, ENGAGING OUTSIDE LEGAL COUNSEL, AS NECESSARY. SCHEDULE K, PART IV, LINE 2C BOND ISSUE B (2008A): The 2008A rebate computation was recently performed on August 14, 2015. No rebate amount has accrued as of the end of the computation period. BOND ISSUE C (2008B-F): The 2008B-F rebate computation was recently performed on August 14, 2015. No rebate amount has accrued as of the end of the computation period. BOND ISSUE D (2005A/2008G): The 2005A/2008G rebate computation was recently performed on June 2, 2015. No rebate amount has accrued as of the end of the computation period. BOND ISSUE 2-A (2010A): The 2010A rebate computation was recently performed on February 4, 2015. No rebate amount has accrued as of the end of the computation period. BOND ISSUE 2-B (2010B/C): The 2010B/C rebate computation was recently performed on February 4, 2015. No rebate amount has accrued as of the end of the computation period. BOND ISSUE 2-C (2012A-C): The 2012A-C rebate computation was recently performed on February 1, 2015. No rebate amount has accrued as of the end of the computation period. BOND ISSUE 2-D (2016A/B): THE ONE-YEAR ANNIVERSARY OF THE BOND ISSUANCE HAS JUST OCCURED. THE 2016A/B REBATE COMPUTATION IS IN PROCESS OF BEING PERFORMED. SCHEDULE K, PART IV, LINE 3 BOND ISSUE 2-C (2012A-C): THE 2012A ISSUE TOTALING $188,143,094.65 IS A FIXED RATE ISSUE WHEREAS THE 2010B&C TOTALING $100,000,000 IS A VARIABLE RATE ISSUE. BOND ISSUE C (2008B-F): ON SEPTEMBER 18, 2012 THE ORGANIZATION ENTERED INTO INTEREST RATE SWAP NOVATIONS WITH WELLS FARGO BANK, N.A. AND UNION BANK, N.A., AS COUNTERPARTY, REPLACING THEN-EXISTING INTEREST RATE SWAPS WITH CITIBANK, N.A. BOND ISSUE D (2005A/2008G): ON SEPTEMBER 18, 2012 THE ORGANIZATION ENTERED INTO INTEREST RATE SWAP NOVATIONS WITH WELLS FARGO BANK, N.A., AS COUNTERPARTY, REPLACING THEN-EXISTING INTEREST RATE SWAPS WITH CITIBANK, N.A. SCHEDULE K, PART IV, LINE 6 BOND ISSUE A (2007A): AN AMOUNT IN THE COSTS OF ISSUANCE FUND NOT EXCEEDING $100,000 WAS NOT DISBURSED UNTIL MAY 2008. BOND ISSUE D (2005A/2008G): THE ISSUE DATE FOR THE 2005A WAS 6/17/2005. THE COST OF ISSUANCE WAS NOT EXPENDED UNTIL 1/4/2006. PER THE TAX CERTIFICATE IT WAS EXPECTED TO BE EXPENDED WITHIN 180 DAYS. SCHEDULE K, PART V PROCEDURES TO UNDERTAKE CORRECTIVE ACTION THE ORGANIZATION HAS ADOPTED TAX-EXEMPT BOND COMPLIANCE PROCEDURES, INCLUDING PROCEDURES TO MONITOR PRIVATE BUSINESS USE OF FINANCED PROPERTY AND TAKING REMEDIAL ACTIONS, IF NECESSARY. THE ORGANIZATION IS AWARE OF THE SERVICE'S VOLUNTARY CLOSING AGREEMENT PROGRAM FOR TAX-EXEMPT BONDS, AND HAS DISCUSSED THAT PROGRAM WITH COUNSEL. THE ORGANIZATION IS SUPPLEMENTING ITS WRITTEN PROCEDURES TO SPECIFICALLY MAKE REFERENCE TO THE SERVICE'S VOLUNTARY CLOSING AGREEMENT PROGRAM FOR TAX-EXEMPT BONDS. A California Health Facilities Financing Authority 521643828 13033LFH5 2010-02-04 119458924 SEE PART VI false false false B California Health Facilities Financing Authority 521643828 13033LFL6 2010-02-04 100000000 SEE PART VI false false false C California Health Facilities Financing Authority 521643828 13033LVZ7 2012-02-01 288143095 SEE PART VI false false false D California Health Facilities Financing Authority 521643828 000000000 2016-02-29 150000000 SEE PART VI false false false A 8275000 0 119581432 0 0 0 0 0 0 119458924 0 122508 2011 false false true true B 0 0 100005060 0 0 0 0 0 0 100002530 0 2530 2011 false false true true C 0 0 288160329 0 0 0 0 0 0 288160329 0 17234 2013 false false true true D 0 0 150000000 0 0 0 0 0 0 150000000 0 0 2016 false false true true A false false true true true true 0 false false false true B false false true true true true 0 false false false true C false false true true true true 0 false false false true D false false true true true true 0 false false false true A false false false true false false 0 false 0 false true B false false true false true false 0 false 0 false true C false false false true true false 0 false 0 false true D false true false false false false 0 false 0 false true A true B true C true D true 0 CHRISTOPHER VAN GORDER OFFICER DEFERRED COMPENSATIO X 10023866 10876556 false true true JUNE KOMAR EXECUTIVE DEFERRED COMPENSATIO X 2769010 3004559 false true true RICHARD SHERIDAN OFFICER DEFERRED COMPENSATIO X 4063606 4409280 false true true ROBIN BROWN EXECUTIVE DEFERRED COMPENSATIO X 2668899 2895931 false true true 21186326 MATTHEW BALOGH SEE PART V 118287 SEE PART V false SCHEDULE B DONOR SUBSTANTIAL CONTRIBUTOR 71739469 MEDICAL SERVICES false SCHEDULE B DONOR SUBSTANTIAL CONTRIBUTOR 37936616 CONSTRUCTION SERVICES false SCHEDULE B DONOR SUBSTANTIAL CONTRIBUTOR 15454384 MEDICAL SERVICES false SCHEDULE B DONOR SUBSTANTIAL CONTRIBUTOR 8674959 MEDICAL SERVICES false SCHEDULE B DONOR SUBSTANTIAL CONTRIBUTOR 8535030 MEDICAL SERVICES false SCHEDULE B DONOR SUBSTANTIAL CONTRIBUTOR 7000530 MEDICAL SERVICES false SCHEDULE B DONOR SUBSTANTIAL CONTRIBUTOR 2391510 EQUIPMENT RENTAL false SCHEDULE B DONOR SUBSTANTIAL CONTRIBUTOR 2146362 MEDICAL SERVICES false SCHEDULE B DONOR SUBSTANTIAL CONTRIBUTOR 1681048 CONSTRUCTION SERVICES false SCHEDULE B DONOR SUBSTANTIAL CONTRIBUTOR 1103186 CONSTRUCTION SERVICES false SCHEDULE B DONOR SUBSTANTIAL CONTRIBUTOR 695633 LEGAL SERVICES false SCHEDULE B DONOR SUBSTANTIAL CONTRIBUTOR 691225 MEDICAL SERVICES false SCHEDULE B DONOR SUBSTANTIAL CONTRIBUTOR 600079 MEDICAL SERVICES false SCHEDULE B DONOR SUBSTANTIAL CONTRIBUTOR 367282 PAYROLL false SCHEDULE B DONOR SUBSTANTIAL CONTRIBUTOR 322680 FINANCIAL SERVICES false SCHEDULE B DONOR SUBSTANTIAL CONTRIBUTOR 300005 PAYROLL false SCHEDULE B DONOR SUBSTANTIAL CONTRIBUTOR 217453 PAYROLL false SCHEDULE B DONOR SUBSTANTIAL CONTRIBUTOR 143814 PAYROLL false SCHEDULE B DONOR SUBSTANTIAL CONTRIBUTOR 139920 MEDICAL SERVICES false SCHEDULE B DONOR SUBSTANTIAL CONTRIBUTOR 135683 PAYROLL false SCHEDULE L, PART II LOANS TO AND FROM INTERESTED PERSONS EFFECTIVE JANUARY 1, 2014, SCRIPPS HEALTH FROZE ALL BENEFITS UNDER THE EXISTING SERP PLAN FOR FOUR PLAN PARTICIPANTS. EFFECTIVE APRIL 1, 2014, SCRIPPS HEALTH PROVIDED DEFERRED COMPENSATION AGGRANGEMENTS TO THOSE FOUR EXECUTIVES IN THE FORM OF LOANS TO PURCHASE LIFE INSURANCE PRODUCTS TO FUND POST-RETIREMENT INCOME. SCHEDULE L, PART IV MATTHEW BALOGH, SON-IN-LAW OF BOARD MEMBER GORDON R. CLARK, IS EMPLOYED BY SCRIPPS HEALTH. X 1 12000 OPINION OF EXPERTS X 31 418021 COST/SELLING PRICE X 2 8000 OPINION OF EXPERTS X IRA ACCOUNT CHAR TRANSFER 9 110000 VALUE TRANSFERRED 2 false true true SCHEDULE M, PART I, COLUMN (B) CONTRIBUTIONS REPORTED THE NUMBER OF TRANSACTIONS, WHICH MOST CLOSELY APPROXIMATES THE NUMBER OF ITEMS CONTRIBUTED, IS BEING REPORTED IN COLUMN B. SCHEDULE M, PART I, LINE 32B THIRD PARTIES ENGAGED TO SOLICIT, PROCESS, AND SELL NON-CASH CONTRIBUTIONS GIFTS GIFTS OF SECURITIES ARE LIQUIDATED THROUGH LICENSED SECURITIES BROKERS. FORM 990, PART I AND PART III, LINE 1 MISSION STATEMENT FOUNDED IN 1924 BY PHILANTHROPIST ELLEN BROWNING SCRIPPS, SCRIPPS HEALTH IS A $2.9 BILLION, PRIVATE NOT-FOR-PROFIT INTEGRATED HEALTH SYSTEM IN SAN DIEGO, CALIFORNIA. SCRIPPS TREATS MORE THAN 700,000 PATIENTS ANNUALLY THROUGH THE DEDICATION OF 3,000 AFFILIATED PHYSICIANS AND 15,000 EMPLOYEES AMONG ITS FIVE ACUTE-CARE HOSPITAL CAMPUSES, HOME HEALTH CARE, HOSPICE CARE, AND AN AMBULATORY CARE NETWORK OF CLINICS, PHYSICIANS' OFFICES AND OUTPATIENT CENTERS THROUGHOUT THE SAN DIEGO REGION. IN 2013, SCRIPPS HOSPICE PROGRAM WAS ESTABLISHED AND PROVIDES END OF LIFE CARE. RECOGNIZED AS A LEADER IN THE PREVENTION, DIAGNOSIS AND TREATMENT OF DISEASE, SCRIPPS IS ALSO AT THE FOREFRONT OF CLINICAL RESEARCH, GENOMIC MEDICINE, WIRELESS HEALTH AND GRADUATE MEDICAL EDUCATION. WITH THREE HIGHLY RESPECTED GRADUATE MEDICAL EDUCATION PROGRAMS, SCRIPPS IS A LONG STANDING MEMBER OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES. MORE INFORMATION CAN BE FOUND AT WWW.SCRIPPS.ORG. TODAY, THE HEALTH SYSTEM EXTENDS FROM CHULA VISTA TO OCEANSIDE, WITH 26 PRIMARY AND SPECIALTY CARE OUTPATIENT CENTERS. A LEADER IN THE PREVENTION, DIAGNOSIS AND TREATMENT OF DISEASE, SCRIPPS HAS BEEN RANKED FOUR TIMES AS ONE OF THE NATION'S BEST HEALTH CARE SYSTEMS BY TRUVEN HEALTH ANALYTICS. ON THE FOREFRONT OF GENOMIC MEDICINE AND WIRELESS HEALTH TECHNOLOGY, THE ORGANIZATION IS DEDICATED TO IMPROVING COMMUNITY HEALTH WHILE ADVANCING MEDICINE THROUGH CLINICAL RESEARCH AND GRADUATE MEDICAL EDUCATION. SCRIPPS HAS ALSO EARNED A NATIONAL REPUTATION AS A PREMIER EMPLOYER, NAMED BY FORTUNE MAGAZINE AS ONE OF AMERICA'S "100 BEST COMPANIES TO WORK FOR" EVERY YEAR SINCE 2008. SCRIPPS HEALTH'S MISSION STATEMENT IS AS FOLLOWS: SCRIPPS STRIVES TO PROVIDE SUPERIOR HEALTH SERVICES IN A CARING ENVIRONMENT AND TO MAKE A POSITIVE MEASURABLE DIFFERENCE IN THE HEALTH OF INDIVIDUALS IN THE COMMUNITIES WE SERVE. WE DEVOTE OUR RESOURCES TO DELIVERING QUALITY, SAFE, COST-EFFECTIVE, AND SOCIALLY RESPONSIBLE HEALTH CARE SERVICES. WE ADVANCE CLINICAL RESEARCH, HEALTH EDUCATION, EDUCATION OF PHYSICIANS AND HEALTH CARE PROFESSIONALS, AND SPONSOR GRADUATE MEDICAL EDUCATION. WE COLLABORATE WITH OTHERS TO DELIVER THE CONTINUUM OF CARE THAT IMPROVES THE HEALTH OF OUR COMMUNITY. FORM 990, PART III, LINE 4A PROGRAM SERVICE ACCOMPLISHMENTS FULFILLING THE SCRIPPS MISSION DURING THIS FISCAL YEAR, SCRIPPS DEVOTED $368,982,312 TO COMMUNITY BENEFIT PROGRAMS AND SERVICES IN THE AREAS OF UNCOMPENSATED CARE, COMMUNITY HEALTH SERVICES, PROFESSIONAL EDUCATION AND HEALTH RESEARCH. OUR PROGRAMS EMPHASIZE COMMUNITY-BASED PREVENTION EFFORTS AND USE INNOVATIVE APPROACHES TO REACH RESIDENTS AT GREATEST RISK FOR HEALTH PROBLEMS. WE MAKE COMMITMENTS TO IMPROVE THE HEALTH OF OUR PATIENTS AND OUR SAN DIEGO COMMUNITIES. AS A LONG-STANDING MEMBER OF THESE COMMUNITIES, AND AS A NOT-FOR-PROFIT COMMUNITY RESOURCE, OUR GOAL AND RESPONSIBILITY ARE TO PROVIDE HELP AND ASSISTANCE FOR ALL WHO COME TO US FOR CARE, AND TO REACH OUT ESPECIALLY TO THOSE WHO FIND THEMSELVES VULNERABLE AND WITHOUT SUPPORT. THIS RESPONSIBILITY IS AN INTRINSIC PART OF OUR MISSION. THROUGH OUR CONTINUED ACTIONS AND COMMUNITY PARTNERSHIPS, WE STRIVE TO RAISE THE QUALITY OF LIFE IN THE COMMUNITY AS A WHOLE. ASSESSING COMMUNITY NEED SCRIPPS HEALTH HAS A LONG HISTORY OF RESPONDING TO THE HEALTH NEEDS OF THE COMMUNITIES IT SERVES, EXTENDING BEYOND TRADITIONAL HOSPITAL CARE TO ADDRESS THE HEALTH CARE NEEDS OF THE REGIONS MOST VULNERABLE POPULATIONS. COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) ORIGINATED FROM CALIFORNIA STATE WIDE LEGISLATION IN THE EARLY 1900S. SB 697 TOOK EFFECT IN 1995, WHICH REQUIRED PRIVATE NON-PROFIT HOSPITALS TO SUBMIT DETAILED INFORMATION TO THE OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT (OSHPD) ON THEIR COMMUNITY BENEFIT CONTRIBUTIONS. ANNUAL HOSPITAL COMMUNITY BENEFIT REPORTS ARE SUMMARIZED BY OSHPD IN A REPORT TO THE LEGISLATURE, WHICH PROVIDES VALUABLE INFORMATION FOR GOVERNMENT OFFICIALS TO ASSESS THE CARE AND SERVICES PROVIDED TO THEIR CONSTITUENTS. AS PART OF THE COMMUNITY BENEFIT REPORTS FILED, NON-PROFIT HOSPITALS ARE REQUIRED TO CONDUCT A CHNA EVERY THREE YEARS. THIS COMPREHENSIVE ACCOUNT OF HEALTH NEEDS IN THE COMMUNITY IS DESIGNED FOR HOSPITALS TO PLAN THEIR COMMUNITY BENEFIT PROGRAMS TOGETHER WITH OTHER LOCAL HEALTH CARE INSTITUTIONS, COMMUNITY BASED ORGANIZATIONS, AND CONSUMER GROUPS. SCRIPPS STRIVES TO IMPROVE COMMUNITY HEALTH THROUGH COLLABORATION. WORKING WITH OTHER HEALTH SYSTEMS, COMMUNITY GROUPS, GOVERNMENT AGENCIES, BUSINESSES AND GRASSROOTS MOVEMENTS, SCRIPPS IS BETTER ABLE TO BUILD UPON EXISTING ASSETS TO ACHIEVE BROAD COMMUNITY HEALTH GOALS. IN SAN DIEGO COUNTY, THE LONG HISTORY OF COLLABORATION AMONG HOSPITALS, HEALTHCARE SYSTEMS AND COMMUNITY PARTNERS HAS RESULTED IN SUCCESSFUL PARTNERSHIP ON PAST CHNAS. WHILE PUBLIC INSTITUTIONS AND DISTRICT HOSPITALS DO NOT HAVE TO REPORT UNDER SB 697, THESE INSTITUTIONS HAVE BECOME AN INTEGRAL PART OF THE CHNA IN SAN DIEGO COUNTY. INFORMATION IS GATHERED THROUGH THE CHNA FOR THE PURPOSES OF REPORTING COMMUNITY BENEFIT, DEVELOPING STRATEGIC PLANS, CREATING ANNUAL REPORTS, PROVIDING INPUT ON LEGISLATIVE DECISIONS, AND INFORMING THE GENERAL COMMUNITY OF HEALTH ISSUES AND TRENDS. IT ALSO ALLOWS INTERESTED PARTIES AND MEMBERS OF THE COMMUNITY, A MECHANISM TO ACCESS THE FULL SPECTRUM OF INFORMATION RELATIVE TO THE DEVELOPMENT OF THE SCRIPPS HEALTH 2016 COMMUNITY HEALTH NEEDS ASSESSMENT REPORT. BACKGROUND/REQUIRED COMPONENTS OF THE ASSESSMENT SCRIPPS HEALTH HAS A LONG HISTORY OF RESPONDING TO THE HEALTH NEEDS OF THE COMMUNITIES IT SERVES, EXTENDING BEYOND TRADITIONAL HOSPITAL CARE TO ADDRESS THE HEALTH CARE NEEDS OF THE REGIONS MOST VULNERABLE POPULATIONS. SINCE 1994, THESE PROGRAMS HAVE BEEN CREATED BASED ON AN ASSESSMENT OF NEEDS IDENTIFIED THROUGH HOSPITAL DATA, COMMUNITY INPUT, AND MAJOR TRENDS. PREVIOUS COLLABORATIONS AMONG NON-PROFIT HOSPITALS, HEALTHCARE SYSTEMS, AND OTHER COMMUNITY PARTNERS HAVE RESULTED IN NUMEROUS WELL-REGARDED COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNA) REPORTS. THE PATIENT PROTECTION AND AFFORDABLE CARE ACT ("AFFORDABLE CARE ACT"ACA") OF 2010 BROUGHT ABOUT SIGNIFICANT REGULATORY CHANGES IN THE HEALTHCARE INDUSTRY. SCRIPPS HEALTH WAS GIVEN THE TASK OF CONDUCTING AN EXPANDED COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) THAT MET THE NEW FEDERAL REQUIREMENTS. AS A NONPROFIT HOSPITAL, SCRIPPS HEALTH FULFILLED THIS REQUIREMENT THROUGH THE DEVELOPMENT AND DISTRIBUTION OF THIS ASSESSMENT. WHILE THIS IS A FEDERALLY MANDATED EXERCISE, SCRIPPS HEALTH HOPES TO LEVERAGE THE INFORMATION COLLECTED FOR THIS REPORT TO BENEFIT THE COMMUNITY AT-LARGE IN OTHER FUTURE PLANNING INITIATIVES. THE IRS ALSO REQUIRED HOSPITAL ORGANIZATIONS THAT CONDUCT A CHNA TO MAKE THE REPORT WIDELY AVAILABLE BY POSTING IT ON A PUBLICLY ACCESSIBLE WEBSITE. VIEW THE FULL SUMMARY OF THE SCRIPPS HEALTH 2016 COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AT HTTPS://WWW.SCRIPPS.ORG/ABOUT-US__SCRIPPS-IN-THE-COMMUNITY__ASSESSING-COMM UNITY-NEEDS REQUIRED COMPONENTS OF THE ASSESSMENT PER IRS REQUIREMENTS THERE ARE FIVE COMPONENTS THE CHNA MUST INCLUDE: - A DESCRIPTION OF THE COMMUNITY SERVED BY THE HEALTH SYSTEM AND HOW IT WAS DETERMINED. - A DESCRIPTION OF THE PROCESSES AND METHODS USED TO CONDUCT THE ASSESSMENT. - A DESCRIPTION OF HOW THE HOSPITAL ORGANIZATION TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY. - A PRIORITIZED DESCRIPTION OF ALL OF THE COMMUNITY HEALTH NEEDS IDENTIFIED THROUGH THE CHNA, AS WELL AS A DESCRIPTION OF THE PROCESS AND CRITERIA USED IN PRIORITIZING SUCH HEALTH NEEDS. - A DESCRIPTION OF THE EXISTING HEALTH CARE FACILITIES AND OTHER RESOURCES WITHIN THE COMMUNITY AVAILABLE TO MEET THE COMMUNITY HEALTH NEEDS IDENTIFIED THROUGH THE CHNA. EXECUTIVE SUMMARY GROUNDED IN A LONGSTANDING COMMITMENT TO ADDRESS COMMUNITY HEALTH NEEDS IN SAN DIEGO, SEVEN HOSPITALS AND HEALTHCARE SYSTEMS CAME TOGETHER UNDER THE AUSPICES OF THE HOSPITAL ASSOCIATION OF SAN DIEGO AND IMPERIAL COUNTIES (HASD&IC) TO CONDUCT A TRIENNIAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) THAT IDENTIFIES AND PRIORITIZES THE MOST CRITICAL HEALTH-RELATED NEEDS OF SAN DIEGO COUNTY RESIDENTS. PARTICIPATING HOSPITALS WILL USE THE FINDINGS TO GUIDE THEIR COMMUNITY PROGRAMS AND TO MEET IRS REGULATORY REQUIREMENTS THAT NOT FOR PROFIT (TAX EXEMPT) HOSPITALS CONDUCT A HEALTH NEEDS ASSESSMENT IN THE COMMUNITY ONCE EVERY THREE YEARS. PER GUIDANCE FROM AN ADVISORY GROUP OF HOSPITAL REPRESENTATIVES, HASD&IC CONTRACTED WITH THE INSTITUTE OF PUBLIC HEALTH (IPH) AT SAN DIEGO STATE UNIVERSITY TO DESIGN AND IMPLEMENT THE CHNA. THE IPH EMPLOYED A RIGOROUS METHODOLOGY USING BOTH COMMUNITY INPUT (PRIMARY DATA SOURCES) AND QUANTITATIVE ANALYSIS (SECONDARY DATA SOURCES) TO IDENTIFY AND PRIORITIZE THE TOP HEALTH CONDITIONS IN SAN DIEGO COUNTY. IN MAY 2015, HASD&IC CONTRACTED WITH THE INSTITUTE FOR PUBLIC HEALTH (IPH) AT SAN DIEGO STATE UNIVERSITY (SDSU) TO PROVIDE ASSISTANCE WITH THE COLLABORATIVE HEALTH NEEDS ASSESSMENT THAT WAS OFFICIALLY CALLED THE HASD&IC 2016 COMMUNITY HEALTH NEEDS ASSESSMENT (2016 CHNA). THE OBJECTIVE OF THE 2016 CHNA IS TO IDENTIFY AND PRIORITIZE THE MOST CRITICAL HEALTH-RELATED NEEDS IN SAN DIEGO COUNTY BASED ON FEEDBACK FROM COMMUNITY RESIDENTS IN HIGH NEED NEIGHBORHOODS AND QUANTITATIVE DATA ANALYSIS. THE 2016 CHNA INVOLVED A MIXED METHODS APPROACH USING THE MOST CURRENT QUANTITATIVE DATA AVAILABLE AND MORE EXTENSIVE QUALITATIVE OUTREACH. THROUGHOUT THE PROCESS, THE IPH MET BI-WEEKLY WITH THE HASD&IC CHNA COMMITTEE TO ANALYZE, REFINE, AND INTERPRET RESULTS AS THEY WERE BEING COLLECTED. THE RESULTS OF THE 2016 CHNA WILL BE USED TO INFORM AND ADAPT HOSPITAL PROGRAMS AND STRATEGIES TO BETTER MEET THE HEALTH NEEDS OF SAN DIEGO COUNTY RESIDENTS. SAN DIEGO COUNTY IS A SOCIALLY AND ETHNICALLY DIVERSE COMMUNITY WITH A POPULATION OF 3.2 MILLION PEOPLE. ALTHOUGH THE STUDY AREA FOR THIS CHNA IS THE ENTIRE COUNTY, EACH HOSPITAL HAS THE ABILITY TO USE THE COUNTY-WIDE FINDINGS OR ADAPT THE FINDINGS TO REFLECT THE COMMUNITIES THEY SERVE, AS MUCH OF THE DATA IS AVAILABLE AT ZIP CODE LEVEL. HOSPITALS AND HEALTH CARE SYSTEMS DEFINE THE COMMUNITY SERVED AS THOSE INDIVIDUALS RESIDING WITHIN ITS SERVICE AREA. A HOSPITAL OR HEALTH CARE SYSTEM SERVICE AREA INCLUDES ALL RESIDENTS IN A DEFINED GEOGRAPHIC AREA SURROUNDING THE HOSPITAL. SCRIPPS SERVES THE ENTIRE SAN DIEGO COUNTY REGION WITH SERVICES CONCENTRATED IN NORTH COASTAL, NORTH CENTRAL, CENTRAL AND SOUTHERN REGION OF SAN DIEGO. COMMUNITY OUTREACH EFFORTS ARE FOCUSED IN THOSE AREAS WITH PROXIMITY TO A SCRIPPS FACILITY. SCRIPPS HOSTS, SPONSORS AND PARTICIPATES IN MANY COMMUNITY-BUILDING EVENTS THROUGHOUT THE YEAR. THE 2016 PROCESS BEGAN WITH A COMPREHENSIVE SCAN OF RECENT COMMUNITY HEALTH STATISTICS IN ORDER TO VALIDATE THE REGIONAL SIGNIFICANCE OF THE TOP FOUR HEALTH NEEDS IDENTIFIED IN THE 2013 CHNA. THE AIM OF THE 2016 CHNA METHODOLOGY WAS TO PROVIDE A MORE COMPLETE UNDERSTANDING OF THE TOP FOUR IDENTIFIED HEALTH NEEDS AND ASSOCIATED SOCIAL DETERMINANTS OF HEALTH IN THE SAN DIEGO COMMUNITY. FOR A COMPLETE DESCRIPTION OF THE HASD&IC 2016 PROCESS AND FINDINGS, SEE FULL REPORT AVAILABLE AT http://hasdic.org/2016-chna/ FORM 990, PART III, LINE 4A (CONTINUED) WHEN THE RESULTS OF ALL OF THE DATA AND INFORMATION GATHERED IN 2013 WERE COMBINED, FOUR CONDITIONS EMERGED CLEARLY AS THE TOP COMMUNITY HEALTH NEEDS IN SAN DIEGO COUNTY (IN ALPHABETICAL ORDER). 1. BEHAVIORAL/MENTAL HEALTH 2. CARDIOVASCULAR DISEASE 3. DIABETES (TYPE 2) 4. OBESITY FOR THE COLLABORATIVE HASD&IC CHNA PROCESS, THE IPH IMPLIED A RIGOROUS METHODOLOGY USING BOTH COMMUNITY INPUT AND QUANTITATIVE ANALYSIS TO PROVIDE A DEEPER UNDERSTANDING OF BARRIERS TO HEALTH IMPROVEMENT IN SDC. FOR THE PURPOSES OF THE CHNA, A "HEALTH NEED" IS DEFINED AS A HEALTH OUTCOME AND/OR THE RELATED CONDITIONS THAT CONTRIBUTE TO A DEFINED HEALTH OUTCOME. THE 2016 CHNA PROCESS BEGAN WITH A COMPREHENSIVE SCAN OF RECENT COMMUNITY HEALTH STATISTICS IN ORDER TO VALIDATE THE REGIONAL SIGNIFICANCE OF THE TOP FOUR HEALTH NEEDS IDENTIFIED IN THE 2013 CHNA. QUANTITATIVE DATA FOR BOTH THE HASD&IC 2016 CHNA AND SMH 2016 CHNA INCLUDED 2013 OSHPD DEMOGRAPHIC DATA FOR HOSPITAL INPATIENT, EMERGENCY DEPARTMENT (ED), AND AMBULATORY CARE ENCOUNTERS TO UNDERSTAND THE HOSPITAL PATIENT POPULATION. CLINIC DATA WAS ALSO GATHERED FROM OSHPDS WEBSITE AND INCORPORATED IN ORDER TO PROVIDE A MORE HOLISTIC VIEW OF HEALTH CARE UTILIZATION IN SDC. THE VARIABLES ANALYZED WERE ANALYZED AT THE ZIP CODE LEVEL WHEREVER POSSIBLE. IDENTIFY VULNERABLE COMMUNITIES RECOGNIZING THAT HEALTH NEEDS DIFFER ACROSS THE REGION AND THAT SOCIOECONOMIC FACTORS IMPACT HEALTH OUTCOMES, THE IPH USED THE DIGNITY HEALTH/TRUVEN HEALTH COMMUNITY NEED INDEX (CNI) TO IDENTIFY COMMUNITIES WITHIN SAN DIEGO COUNTY WITH THE HIGHEST LEVEL OF HEALTH DISPARITIES AND NEEDS. THE CNI SCORE IS AN AVERAGE OF FIVE DIFFERENT BARRIER SCORES THAT MEASURE VARIOUS SOCIOECONOMIC INDICATORS OF EACH COMMUNITY USING THE 2013 SOURCE DATA. COMMUNITY ENGAGEMENT ACTIVITIES COMMUNITY ENGAGEMENT ACTIVITIES WERE CONDUCTED WITH A BROAD RANGE OF PEOPLE INCLUDING HEATH EXPERTS, COMMUNITY LEADERS, AND SAN DIEGO RESIDENTS, IN AN EFFORT TO GAIN A MORE COMPLETE UNDERSTANDING OF THE TOP IDENTIFIED HEALTH NEEDS IN THE SAN DIEGO COMMUNITY. INDIVIDUALS WHO WERE CONSULTED INCLUDED REPRESENTATIVES FROM STATE, LOCAL TRIBAL, OR OTHER REGIONAL GOVERNMENTAL PUBLIC HEALTH DEPARTMENTS (OR EQUIVALENT DEPARTMENT OR AGENCY) AS WELL AS LEADERS, REPRESENTATIVES, OR MEMBERS OF MEDICALLY UNDERSERVED, LOW INCOME, AND MINORITY POPULATIONS. COMMUNITY INPUT WAS GATHERED THROUGH THE FOLLOWING ACTIVITIES: - BEHAVIORAL HEALTH DISCUSSIONS - COMMUNITY PARTNER DISCUSSIONS - KEY INFORMANT INTERVIEWS - HEALTH ACCESS AND NAVIGATION SURVEY - SAN DIEGO COUNTY HHSA SURVEY THE OVERALL PURPOSE OF COLLECTING COMMUNITY INPUT WAS TO GATHER INFORMATION ABOUT THE HEALTH NEEDS AND SOCIAL DETERMINANTS SPECIFIC TO SAN DIEGO COUNTY. SPECIFIC OBJECTIVES INCLUDED: - GATHER IN DEPTH FEEDBACK TO AID IN THE UNDERSTANDING OF THE MOST SIGNIFICANT HEALTH NEEDS IMPACTING SAN DIEGO COUNTY. - CONNECT THE IDENTIFIED HEALTH NEEDS WITH ASSOCIATED SOCIAL DETERMINANTS OF HEALTH. - AID IN THE PROCESS OF PRIORITIZING HEALTH NEEDS WITHIN SAN DIEGO COUNTY. - GAIN INFORMATION ABOUT THE SYSTEM AND POLICY CHANGES WITHIN SAN DIEGO COUNTY THAT COULD POTENTIALLY IMPACT THE HEALTH NEEDS AND SOCIAL DETERMINANTS OF HEALTH. FINDINGS AND PRIORITIZED HEALTH CONDITIONS THE COLLABORATIVE, HASD&IC 2016 CHNA PRIORITIZED THE TOP HEALTH NEEDS FOR SAN DIEGO COUNTY OVERALL THROUGH THE APPLICATION OF THE FOLLOWING FIVE CRITERIA: 1. MAGNITUDE OR PREVALENCE 2. SEVERITY 3. HEALTH DISPARITIES 4. TRENDS 5. COMMUNITY CONCERN USING THESE CRITERIA, A SUMMARY MATRIX TRANSLATING THE 2016 CHNA FINDINGS WAS CREATED FOR REVIEW BY THE CHNA COMMITTEE. AS A RESULT OF THIS REVIEW, THE CHNA COMMITTEE IDENTIFIED BEHAVIORAL HEALTH AS THE NUMBER ONE HEALTH NEED IN SDC. IN ADDITION, CARDIOVASCULAR DISEASE, DIABETES, AND OBESITY WERE IDENTIFIED AS HAVING EQUAL IMPORTANCE DUE TO THEIR INTERRELATEDNESS. HEALTH NEEDS WERE FURTHER BROKEN DOWN INTO PRIORITY AREAS DUE TO THE OVERWHELMING AGREEMENT AMONG ALL DATA SOURCES AND IN RECOGNITION OF THE COMPLEXITIES WITH EACH HEALTH NEED. WITHIN THE CATEGORY OF BEHAVIORAL HEALTH, ALZHEIMERS DISEASE, ANXIETY, DRUG AND ALCOHOL ISSUES, AND MOOD DISORDERS ARE SIGNIFICANT HEALTH NEEDS WITH SAN DIEGO COUNTY. AMONG THE OTHER CHRONIC HEALTH NEEDS, HYPERTENSION WAS CONSISTENTLY FOUND TO BE A SIGNIFICANT PRIORITY AREA RELATED TO CARDIOVASCULAR DISEASE, UNCONTROLLED DIABETES WAS AN IMPORTANT FACTOR LEADING TO COMPLICATION RELATED TO DIABETES, AND OBESITY WAS OFTEN FOUND TO CO-OCCUR WITH OTHER CONDITIONS AND CONTRIBUTE TO WORSENING HEALTH STATUS. THE IMPACT OF THE TOP HEALTH NEEDS DIFFERED AMONG AGE GROUPS; WITH TYPE 2 DIABETES, OBESITY, AND ANXIETY AFFECTING ALL AGE GROUPS, DRUG AND ALCOHOL ISSUES AFFECTING TEENS AND ADULTS, AND ALZHEIMERS DISEASE, CARDIOVASCULAR DISEASE, AND HYPERTENSION AFFECTING OLDER ADULTS. SOCIAL DETERMINANTS OF HEALTH IN ADDITION TO THE HEALTH OUTCOME NEEDS THAT WERE IDENTIFIED, SOCIAL DETERMINANTS OF HEALTH WERE A KEY THEME IN ALL OF THE COMMUNITY ENGAGEMENT ACTIVITIES. ANALYSIS OF RESULTS FROM THE COMMUNITY PARTNER DISCUSSIONS AND KEY INFORMANT INTERVIEWS REVEALED THE MOST COMMONLY ASSOCIATED SOCIAL DETERMINANTS OF HEALTH FOR EACH OF THE TOP HEALTH NEEDS ABOVE. TEN SOCIAL DETERMINANTS WERE CONSISTENTLY REFERENCED ACROSS THE DIFFERENT COMMUNITY ENGAGEMENT ACTIVITIES. THE IMPORTANCE OF THESE SOCIAL DETERMINANTS WAS ALSO CONFIRMED BY QUANTITATIVE DATA. HOSPITAL PROGRAMS AND COMMUNITY COLLABORATIONS HAVE THE POTENTIAL TO IMPACT THESE SOCIAL DETERMINANTS, WHICH ARE OUTLINED BELOW IN ORDER OF PRIORITY. - FOOD INSECURITY AND ACCESS TO HEALTHY FOOD - ACCESS TO CARE OR SERVICES - HOMELESSNESS/HOUSING ISSUES - PHYSICAL ACTIVITY - EDUCATION/KNOWLEDGE - CULTURAL COMPETENCY - TRANSPORTATION - INSURANCE ISSUES - STIGMA - POVERTY PHASE 2 OF THE 2016 CHNA THE CHNA COMMITTEE IS IN THE PROCESS OF WORKING ON PHASE 2 OF THE 2016 CHNA, WHICH INCLUDES GATHERING COMMUNITY FEEDBACK ON THE 2016 CHNA PROCESS AND STRENGTHENING PARTNERSHIPS AROUND THE IDENTIFIED HEALTH NEEDS AND SOCIAL DETERMINANTS. IN NOVEMBER 2016, THE HASD&IC CHNA WORKGROUP AND IPH CONDUCTED AN ELECTRONIC SURVEY TO DETERMINE WHETHER OR NOT THE BROADER COMMUNITY AGREES WITH THE 2016 CHNA FINDINGS. OF THE 132 RESPONDENTS THAT COMPLETED THE SURVEY, 30 WORKED IN HOSPITALS OR HOSPITAL-BASED SETTINGS, WHILE THE REMAINING 102 RESPONDENTS SELF-IDENTIFIED AS WORKING FOR A RANGE OF ENTITIES INCLUDING BUT NOT LIMITED TO COMMUNITY CLINICS, NON-PROFITS, COMMUNITY BASED ORGANIZATIONS, LOCAL GOVERNMENT, AND HEALTH INSURANCE PLANS. A SUMMARY OF KEY FINDINGS FROM THE SURVEY IS PRESENTED IN THE FOLLOWING SECTION. IN ADDITION TO SOLICITING FEEDBACK ON THE FINDINGS, THE SURVEY ALSO INCLUDED QUESTIONS SEEKING TO DETERMINE WHETHER THE INTEGRATION OF BEHAVIORAL HEALTH AND PHYSICAL HEALTH IS BEING INTEGRATED LOCALLY, AS WELL AS WHETHER ORGANIZATIONS ARE SCREENING FOR AND ADDRESSING SOCIAL DETERMINANTS OF HEALTH. NINETY NINE RESPONDENTS STATED THAT THEIR ORGANIZATION SCREENS PATIENTS AND CLIENTS ABOUT THEIR SOCIAL DETERMINANTS OF HEALTH. ACCESS TO CARE OF SERVICES TOPPED THE LIST, ALONG WITH HOMELESS/HOUSING ISSUES AND INSURANCE ISSUES. NINETY FOUR RESPONDENTS SHARED INFORMATION ABOUT HOW THEY SCREEN PATIENTS AND DOCUMENT THE INFORMATION. FINDINGS CLEARLY INDICATE THAT THESE ORGANIZATIONS ARE SCREENING PATIENTS FOR SOCIAL DETERMINANTS AND MAKING REFERRALS, BUT INDICATIONS ARE THAT FOLLOW-UP IS SOMEWHAT LIMITED. THERE IS STRONG INTEREST ON THE PART OF RESPONDENTS IN LEARNING MORE ABOUT THE WAYS THAT OUR COMMUNITY PARTNERS ARE SCREENING CLIENTS AND PATIENTS. NEXT STEPS THE CHNA COMMITTEE IS CONTINUING WORK ON PHASE 2 OF THE CHNA. THE RESULTS OF THE COMMUNITY SURVEY WILL GUIDE INDIVIDUAL HOSPITAL PROGRAMS AND PLANS, AND WILL ALSO HELP REFINE THE CHNA PROCESS FOR 2019. HOSPITAL AND HEALTHCARE SYSTEMS THAT PARTICIPATED IN THE HASD&IC 2016 CHNA PROCESS HAVE VARYING REQUIREMENTS FOR NEXT STEPS. PRIVATE, NOT-FOR-PROFIT (TAX EXEMPT) HOSPITALS AND HEALTHCARE SYSTEMS ARE REQUIRED TO DEVELOP HOSPITAL OR HEALTHCARE SYSTEM COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS AND IMPLEMENTATION STRATEGY PLANS TO ADDRESS SELECTED IDENTIFIED HEALTH NEEDS. THE PARTICIPATING PUBLIC HOSPITALS AND HEALTHCARE SYSTEMS DO NOT HAVE FEDERAL OR STATE CHNA REQUIREMENTS, BUT WORK VERY CLOSELY WITH THEIR PATIENT COMMUNITIES TO ADDRESS HEALTH NEEDS BY PROVIDING PROGRAMS, RESOURCES, AND OPPORTUNITIES FOR COLLABORATION WITH PARTNERS. EVERY PARTICIPATING HOSPITAL AND HEALTHCARE SYSTEM WILL REVIEW THE CHNA DATA AND FINDINGS IN ACCORDANCE WITH THEIR OWN PATIENT COMMUNITIES AND PRINCIPAL FUNCTIONS, AND EVALUATE OPPORTUNITIES FOR NEXT STEPS TO ADDRESS THE TOP IDENTIFIED HEALTH NEEDS IN THEIR RESPECTIVE PATIENT COMMUNITIES. THE CHNA REPORT IS MADE AVAILABLE AS A RESOURCE TO THE BROADER COMMUNITY AND MAY SERVE AS A USEFUL RESOURCE TO BOTH RESIDENTS AND HEALTHCARE PROVIDERS TO FURTHER COMMUNITYWIDE HEALTH IMPROVEMENT EFFORTS. SCRIPPS HEALTH IMPLEMENTATION PLAN WITH THE 2016 CHNA COMPLETE AND HEALTH PRIORITY AREAS IDENTIFIED, SCRIPPS FORM 990, PART III, LINE 4A (CONTINUED) SCRIPPS HEALTH ANTICIPATES THE IMPLEMENTATION STRATEGIES MAY EVOLVE DUE TO THE FAST PACE AT WHICH COMMUNITY AND HEALTH CARE INDUSTRY CHANGE. THEREFORE, A FLEXIBLE APPROACH IS BEST SUITED FOR THE DEVELOPMENT OF ITS RESPONSE TO THE SCRIPPS HEALTH COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). ON AN ANNUAL BASIS SCRIPPS HEALTH EVALUATES THE IMPLEMENTATION STRATEGY AND ITS RESOURCES AND INTERVENTIONS; AND MAKES ADJUSTMENTS AS NEEDED TO ACHIEVE ITS STATED GOALS AND OUTCOME MEASURES AS WELL AS TO ADAPT TO CHANGES AND RESOURCES AVAILABLE. SCRIPPS DESCRIBES ANY CHALLENGES ENCOUNTERED TO ACHIEVE THE OUTCOMES AND MAKES MODIFICATIONS AS NEEDED. IN RESPONSE TO IDENTIFIED UNMET HEALTH NEEDS IN THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT, DURING FY17-FY19 SCRIPPS HEALTH IS FOCUSING ON THE STRATEGIES AND INITIATIVES, THEIR MEASURES OF IMPLEMENTATION AND THE METRICS USED TO EVALUATE THEIR EFFECTIVENESS. SCRIPPS WILL MONITOR AND EVALUATE THE STRATEGIES LISTED IN THE IMPLEMENTATION PLAN FOR THE PURPOSE OF TRACKING THE IMPLEMENTATION OF THOSE STRATEGIES AS WELL AS DOCUMENT THE ANTICIPATED IMPACT. PLANS TO MONITOR WILL BE TAILORED TO EACH STRATEGY AND WILL INCLUDE THE COLLECTION AND DOCUMENTATION OF TRACKING MEASURE. THE COMPLETE FY17-FY19 IMPLEMENTATION PLAN REPORT IS AVAILABLE ONLINE AT SCRIPPS.ORG. IN SUPPORT OF THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT, AND ONGOING COMMUNITY BENEFIT INITIATIVES, A DETAILED DESCRIPTION OF SCRIPPS STRATEGIES AND CORRESPONDING MEASURES/METRICS FOR THE FOUR HEALTH PRIORITY AREAS IDENTIFIED IN THE CHNA CAN BE FOUND AT SCRIPPS.ORG/COMMUNITYBENEFIT. METRICS ARE AS CURRENT AS FY16. DURING THIS FISCAL YEAR, SCRIPPS INVESTED $2,670,655 IN COMMUNITY HEALTH SERVICES. THIS FIGURE REFLECTS THE COST ASSOCIATED WITH PROVIDING SUCH ACTIVITIES, INCLUDING SALARIES, MATERIALS AND SUPPLIES, MINUS REVENUE. IN AN EFFORT TO PROVIDE FOR PEOPLE IN NEED, SCRIPPS SPONSORED/ENGAGED IN THE FOLLOWING PROGRAMS IN FISCAL YEAR 2016. ACCESS TO CARE TWO PRIMARY BARRIERS TO OBTAINING HEALTH CARE, ON BOTH THE LOCAL AND NATIONAL LEVEL, ARE LACK OF HEALTH INSURANCE AND ACCESS TO SPECIALTY AND PRIMARY CARE PROVIDERS. REDUCED ACCESS TO BASIC HEALTH CARE SERVICES INCREASES ILLNESS, INJURY AND MORTALITY AND IS A MAJOR BURDEN ON HOSPITALS AND HEALTH PROVIDERS, WHO MUST PROVIDE UNCOMPENSATED CARE FOR THE UNINSURED. MORE PEOPLE WITHOUT INSURANCE TRANSLATES INTO HIGHER USE OF EMERGENCY DEPARTMENTS, WHICH BY LAW MUST PROVIDE STABILIZING CARE TO ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY. MERCY OUTREACH SURGICAL TEAM WORKING IN MEXICO, THE MERCY OUTREACH SURGICAL TEAM (M.O.S.T) PROVIDES RECONSTRUCTIVE SURGERIES FOR CHILDREN SUFFERING FROM BIRTH DEFECTS OR ACCIDENTS. IN SPECIAL CIRCUMSTANCES, SURGERIES ARE ALSO PROVIDED FOR ADULTS. DURING FISCAL YEAR 2016, THE M.O.S.T TEAM SERVED IN TWO OUTREACH MISSION TRIPS. THE M.O.S.T TEAM VOLUNTEERED 4,088 HOURS TO PROVIDE RECONSTRUCTIVE SURGERIES FOR MORE THAN 800 PEOPLE SERVED. (SPONSORED BY SCRIPPS MERCY HOSPITAL, SAN DIEGO AND AFFILIATED PHYSICIANS). SCRIPPS RECUPERATIVE CARE PROGRAM (RCU) THE SCRIPPS RESCUE MISSION PROJECT PROVIDES A SAFE DISCHARGE FOR CHRONICALLY HOMELESS PATIENTS WITH ONGOING MEDICAL NEEDS. ALL PATIENTS ARE UNFUNDED OR UNDERFUNDED. MOST HAVE SUBSTANCE ABUSE AND/OR MENTAL HEALTH ISSUES. THE LACK OF FUNDING AND MENTAL ILLNESS, ALONG WITH ALCOHOL AND/OR SUBSTANCE ABUSE, MAKE POST-ACUTE PLACEMENT OF THESE HOMELESS PATIENTS DIFFICULT. RN CASE MANAGEMENT OVERSIGHT IS PROVIDED BY SCRIPPS WITH PHYSICIAN BACK UP TO ENSURE COMPLETION OF THEIR MEDICAL RECOVERY GOALS. SCRIPPS PAYS THE RESCUE MISSION A DAILY RATE FOR HOUSING AND SERVICES PROVIDED TO THE PATIENT. THEY PROVIDE A SAFE, SECURE ENVIRONMENT WITH 24 HOUR SUPERVISION, MEDICATION OVERSIGHT, MEALS, CLOTHING, AND COUNSELING ASSISTANCE WITH COUNTY MEDICAL SERVICES, MEDI-CAL AND DISABILITY APPLICATIONS, PLUS HELP FIND PERMANENT OR TRANSITIONAL HOUSING. PATIENT TRANSPORTATION NEEDS ARE COORDINATED AND PROVIDED BY BOTH THE RESCUE MISSION AND SCRIPPS. TO MAINTAIN THE PATIENTS MEDICAL STABILITY, MEDICATIONS, DME AND OTHER SERVICES ARE PROVIDED BY SCRIPPS UNTIL INSURANCE FUNDING HAS BEEN ESTABLISHED. PATIENTS WITH PSYCHIATRIC DISORDER ARE ESTABLISHED WITH A PSYCHIATRIST IN THE COMMUNITY AND ALL PATIENTS ARE CONNECTED WITH A MEDICAL HOME IN THE COMMUNITY. IN 2016, 68 PATIENTS HAD A CUMULATIVE 1,518 HOSPITAL DAYS OF STAY BEFORE GOING TO THE RCU. THE RCU HAS TAKEN MEDICALLY COMPLEX PATIENTS, INCLUDING THOSE WITH TRACHEOTOMIES, FEEDING TUBES, IV ANTIBIOTICS, WOUND VACS, MULTIPLE FRACTURES, ABSCESS, OSTEOMYELITIS, PARAPLEGIA, ESRD ON DIALYSIS, END STAGE LIVER DISEASE, HEART VALVE REPLACEMENT, DIABETES, TRAUMATIC BRAIN INJURY OR ENCEPHALOPATHY, OSTOMIES, CRANIOTOMY, COMPLEX TRAUMA, CVA, CANCER, HIV/AIDS, AND A PATIENT WITH AND EXTERNAL DEFIBRILLATOR, THE LIFE VEST. OF RCU PATIENTS, 44% HAD STANDARD MEDI-CAL INSURANCE. 19% HAD MEDI-CAL HPE (HEALTH PRESUMPTIVE ELIGIBILITY). 12% HAD MEDI-CAL HMOS (MOLINA 4.4%, COMMUNITY HEALTH GROUP MCAL 6% AND HEALTH NET MEDI-CAL 1.5%). CARE 1ST MEDI-CAL CONTRACTS DIRECTLY WITH THE RCU TO SUPPORT THEIR PATIENTS. 9% OF SCRIPPS PATIENTS THAT WENT TO THE RCU WERE WITHOUT INSURANCE, EITHER SELF-PAY OR MEDI-CAL PENDING. 7% HAD RESTRICTED MEDI-CAL, 7% HAD OUT OF STATE OR OUT OF COUNTY MEDICAID/MEDI-CAL INSURANCE, 1% HAD MEDICARE. SLIGHTLY OVER 25% WERE INVOLVED WITH A SOCIAL WORKER TO SECURE INCOME FROM GOVERNMENT PROGRAMS. 12% WERE SOCIAL SECURITY DISABILITY INSURANCE (SSDI) WITH NO FUNDS OR NO ACCESS TO THEIR FUNDS (SEVERAL WITH LOST OR STOLEN BANK CARD) WHO RESOLVED THEIR ISSUES, 7% HAVE STARTED OR HAVE PENDING SSDI APPLICATIONS, 2% GOT SSDI AND STARTED RECEIVING A MONTHLY BENEFIT, 2% MADE CA SHORT TERM DISABILITY APPLICATION TO EDD, 5% STARTED RECEIVING MEDICARE AND SOCIAL SECURITY BENEFITS MONTHLY FOLLOWING THEIR APPLICATION. ONE HUNDRED PERCENT OF PATIENTS WERE CONNECTED TO A PRIMARY CARE PROVIDER AT ONE OF THE COMMUNITY CLINICS WITH AN APPOINTMENT MADE. 65% OF THE RCU DISCHARGED PATIENTS DID NOT RETURN TO THE STREETS. THEY EITHER WENT TO A RECOVERY PROGRAM (20%), BACK TO THE HOSPITAL OR HOSPICE AND BACK TO THE RCU (16%), TO FAMILY OR FRIEND (12%), OR TRANSITIONAL HOUSING, (6%), SRO OR APARTMENT (4.5%) BOARD AND CARE (4.5%) AND BACK TO MEXICO (1%). TWO CLIENTS ARE DECEASED. THIS YEAR 35% OF CLIENTS DID RETURN TO THE STREETS OR LEFT THE FACILITY WITHOUT DISCLOSING THEIR PLAN. (SPONSORED BY SCRIPPS MERCY HOSPITAL SAN DIEGO) GRADUATE MEDICAL EDUCATION STAFF SUPPORT ST. VINCENT DE PAUL VILLAGE MEDICAL CENTER AND ST. LEO'S CLINIC THE GRADUATE MEDICAL EDUCATION (GME) PROGRAM AT SCRIPPS GREEN HOSPITAL AND SCRIPPS CLINIC FOCUSES ON PHYSICIAN TRAINING AND CLINICAL RESEARCH, WITH 36 RESIDENTS AND 38 FELLOWS. WEEKLY COMMUNITY CLINICS WERE HELD AT THE ST. VINCENT DE PAUL AND ST. LEOS CLINICS. STAFFED BY SCRIPPS GREEN HOSPITAL AND SCRIPPS CLINIC INTERNAL MEDICINE RESIDENTS, THESE CLINICS CARED FOR APPROXIMATELY 800 OF OUR COUNTYS MOST VULNERABLE RESIDENTS DURING FISCAL YEAR 2016. (SPONSORED BY SCRIPPS CLINIC/GREEN HOSPITAL) FIJI ALLIANCE PROJECT IN PARTNERSHIP WITH THE INTERNATIONAL RELIEF TEAMS OF SAN DIEGO AND THE LOLOMA FOUNDATION, SCRIPPS EMPLOYEES, SCRIPPS CLINIC PHYSICIANS AND OTHER SCRIPPS-AFFILIATED PHYSICIANS PROVIDED MEDICAL AND SURGICAL SERVICES IN FIJI. AS ONE OF THEIR ROTATIONS, RESIDENTS FROM SCRIPPS CLINIC AND SCRIPPS GREEN HOSPITAL HAVE THE OPPORTUNITY TO PARTICIPATE IN THESE MEDICAL MISSIONS. THE TEAM PERFORMS PROCEDURES TO REMEDY CLEFT LIPS AND PALATES, EYELID, FACE AND FEET DEFORMITIES, BURN SCARS, BREAST MASSES AND HERNIAS, AS WELL AS PROVIDING DIABETES MANAGEMENT. ALL SURGICAL SUPPLIES WERE DONATED BY PROFESSIONAL HOSPITAL SUPPLY CORPORATION (PHS), THE SUPPLIER FOR SCRIPPS HEALTH. THE SUPPLIES INCLUDED SURGICAL GOWNS, GLOVES, DRAPES, DRESSINGS, BANDAGES, SUTURES, ETC. CARDINAL HEALTH SYSTEMS, WHICH PROVIDES PHARMACEUTICALS AND OTHER SUPPLIES FOR SCRIPPS HEALTH, DONATED ALL MEDICATIONS. (SPONSORED BY SCRIPPS CLINIC/GREEN HOSPITAL) SCRIPPS HEALTH COMMUNITY BENEFIT (CB) FUND IN FISCAL YEAR 2016, SCRIPPS HEALTH CONTINUED TO DEEPEN ITS COMMITMENT TO PHILANTHROPY WITH ESTABLISHMENT OF ITS COMMUNITY BENEFIT FUND. OVER THE COURSE OF THE YEAR, IT AWARDED $212,000 IN COMMUNITY GRANTS TO PROGRAMS IN SAN DIEGO (FIVE GRANTS RANGING FROM $10,000 TO $120,000). THE FUNDED PROJECTS ADDRESS SOME OF SAN DIEGO COUNTYS HIGH PRIORITY HEALTH NEEDS, SEEKING TO IMPROVE ACCESS TO VITAL HEALTH CARE SERVICES FOR AT RISK POPULATIONS, INCLUDING THE HOMELESS, ECONOMICALLY DISADVANTAGED, MENTALLY ILL AND OTHERS. FORM 990, PART III, LINE 4A (CONTINUED) SINCE THE COMMUNITY BENEFIT FUND BEGAN, SCRIPPS HAS AWARDED $3.3 MILLION. PROGRAMS FUNDED DURING FISCAL YEAR 2016 INCLUDE: CONSUMER CENTER FOR HEALTH EDUCATION AND ADVOCACY (CCHEA) FUNDING PROVIDES LOW-INCOME, UNINSURED MERCY CLINIC AND BEHAVIORAL HEALTH PATIENTS HELP OBTAINING HEALTH CARE BENEFITS, SSI AND RELATED SERVICES, WHILE REDUCING UNCOMPENSATED CARE EXPENSES AT MERCY. THE PROJECT PROVIDES ADVOCACY SERVICES FOR TIME-INTENSIVE GOVERNMENT BENEFIT CASES. (SPONSORED BY SCRIPPS MERCY HOSPITAL ADMINISTRATION) CATHOLIC CHARITIES FUNDING PROVIDES SHORT TERM EMERGENCY SHELTER FOR MEDICALLY FRAGILE HOMELESS PATIENTS BEING DISCHARGED FROM SCRIPPS MERCY HOSPITAL, SAN DIEGO. THE PROGRAM IS BEING EXPANDED TO SCRIPPS MERCY HOSPITAL, CHULA VISTA. CASE MANAGEMENT AND SHELTER ARE PROVIDED FOR HOMELESS PATIENTS DISCHARGED FROM SCRIPPS MERCY HOSPITAL. WHILE THESE PATIENTS NO LONGER REQUIRE HOSPITAL CARE, THEY DO NEED A SHORT TERM RECUPERATIVE ENVIRONMENT. PATIENTS WHO DEMONSTRATE A WILLINGNESS TO CHANGE RECEIVE ONE WEEK IN A HOTEL, ALONG WITH FOOD AND BUS FARE TO PURSUE A CASE PLAN. THE FOCUS OF THE CASE MANAGEMENT IS TO STABILIZE THE CLIENT BY HELPING THEM CONNECT TO MORE PERMANENT SOURCES OF INCOME, HOUSING AND OTHER SELF-RELIANCE MEASURES. THE PARTNERSHIP SEEKS TO REDUCE EMERGENCY ROOM RECIDIVISM IN THIS POPULATION AND IMPROVE THEIR QUALITY OF LIFE. (SPONSORED BY SCRIPPS CORPORATE COMMUNITY BENEFITS) 2-1-1 HEALTH CARE NAVIGATION PROGRAM LOCALLY, 2-1-1 SAN DIEGO WAS LAUNCHED IN JUNE 2005 AS A MULTILINGUAL AND CONFIDENTIAL SERVICE COMMITTED TO PROVIDING 24/7 ACCESS. THERE WAS AN OVERWHELMING NEED FOR A DEPENDABLE SERVICE TO HELP PEOPLE NAVIGATE TODAYS COMPLEX HEALTH CARE SYSTEM. SCRIPPS HEALTH HAS BEEN A LONGTIME SUPPORTER OF 2-1-1 SAN DIEGOS HEALTH NAVIGATION PROGRAM WHICH CREATES A RECORD FOR EVERY PERSON WHO CALLS, SO AS TO PROVIDE A SERVICE THAT NAVIGATES CLIENTS THROUGH DIFFERENT REFERRALS AND TRACKS THEIR SUCCESS TOWARD ACHIEVING IMPROVED SOCIAL DETERMINANTS OF HEALTH. BETWEEN JULY 2, 2015 AND JUNE 30, 2016, THE PERCENTAGE OF CLIENTS WITH HEALTH INSURANCE WAS 82%, A THREE PERCENT INCREASE FROM THE PREVIOUS YEAR. AS MORE PEOPLE BEGIN TO HAVE HEALTH INSURANCE, 2-1-1 EXPECTS THAT CLIENT NEEDS WILL ALSO BEGIN TO SHIFT FROM SEEKING TO OBTAIN COVERAGE TO LEARNING HOW TO USE THEIR COVERAGE. MANY OF THE HEALTH NAVIGATION PROGRAMS CLIENTS ARE ALREADY SEEKING THE LATTER. THIS PAST YEAR, NAVIGATORS PROVIDED A DEEPER LEVEL OF CARE COORDINATION, PREVENTATIVE SUPPORT, AND ADVOCACY TO ABOUT 1,000 CLIENTS. COMPARED TO CLIENTS WHO RECEIVED BASIC INFORMATION AND REFERRAL SERVICES, CLIENTS WHO RECEIVED THE DEEPER LEVEL OF SUPPORT REPORTED A HIGHER RATE OF CONFIDENCE IN MANAGING THEIR HEALTH NEEDS (49% CONFIDENCE AMONG I&R CLIENTS, COMPARED TO 65% CONFIDENCE AMONG CARE COORDINATION CLIENTS). (SPONSORED BY SCRIPPS CORPORATE COMMUNITY BENEFITS) AMERICAN HEART ASSOCIATION SCRIPPS PROVIDED FUNDING FOR THE 2016 HEART WALK THROUGH CORPORATE SPONSORSHIP. HEART DISEASE AND STROKE ARE THE NUMBER ONE AND THREE CAUSES OF DEATH IN THE NATION. HEART DISEASE CLAIMS MORE THAN 950,000 AMERICANS EACH YEAR. SCRIPPS PARTNERS WITH THE AMERICAN HEART ASSOCIATION ON ITS ANNUAL HEART WALK TO RAISE FUNDS FOR RESEARCH, PROFESSIONAL AND PUBLIC EDUCATION AND ADVOCACY. (SPONSORED BY SCRIPPS CORPORATE COMMUNITY BENEFITS) FOSTERING VOLUNTEERISM SCRIPPS BELIEVES THAT HEALTH IMPROVEMENT BEGINS WHEN PEOPLE TAKE AN ACTIVE ROLE IN MAKING A POSITIVE IMPACT ON THEIR COMMUNITY. FOR THIS REASON, SCRIPPS SUPPORTS VOLUNTEER PROGRAMS FOR SCRIPPS EMPLOYEES AND AFFILIATED PHYSICIANS WHO WANT TO MAKE AN EVEN LARGER IMPACT ON THEIR COMMUNITY. SCRIPPS MATCHES THE TALENTS AND INTERESTS OF EMPLOYEES AND PHYSICIANS WITH COMMUNITY NEEDS, SUCH AS MENTORING PARTNERSHIPS WITH LOCAL SCHOOLS AND PROVIDING FREE MEDICAL AND SURGICAL CARE FOR PATIENTS IN NEED. IN ADDITION TO THE FINANCIAL COMMUNITY BENEFIT CONTRIBUTIONS MADE DURING FISCAL YEAR 2016, SCRIPPS EMPLOYEES AND AFFILIATED PHYSICIANS DONATED A SIGNIFICANT PORTION OF THEIR PERSONAL TIME VOLUNTEERING TO SUPPORT SCRIPPS SPONSORED COMMUNITY BENEFIT PROGRAMS. WITH CLOSE TO 27,903 HOURS, THE ESTIMATED DOLLAR VALUE OF THIS VOLUNTEER LABOR IS $1,335,158.55*, WHICH IS NOT INCLUDED IN THE SCRIPPS FISCAL YEAR 2016 COMMUNITY BENEFIT PROGRAMS AND SERVICES TOTALS. (*CALCULATION BASED UPON AN AVERAGE HOURLY WAGE FOR THE SCRIPPS HEALTH SYSTEM PLUS BENEFITS) CANCER/ONCOLOGY CANCER IS A TERM USED TO DESCRIBE A GROUP OF DISEASES THAT CAUSE THE UNCONTROLLED GROWTH, INVASION, AND SPREAD (METASTASIS) OF ABNORMAL CELLS. CANCER IS CAUSED BY EXTERNAL FACTORS SUCH AS ENVIRONMENTAL CONDITIONS, RADIATION, INFECTIOUS ORGANISMS, POOR DIET AND LACK OF EXERCISE, AND TOBACCO USE, AS WELL AS INTERNAL FACTORS SUCH AS GENETIC MUTATIONS, AND HORMONES. CANCER IS THE SECOND LEADING CAUSE OF DEATH IN THE UNITED STATES. CANCER CAUSES ONE OUT OF EVERY FOUR DEATHS IN THE UNITED STATES. IN 2013 CANCER WAS THE LEADING CAUSE OF DEATH IN SDC, RESPONSIBLE FOR 24.4 PERCENT OF DEATHS. THERE WERE 5,030 DEATHS DUE TO CANCER (ALL SITES), AND AN AGE ADJUSTED DEATH RATE OF 155.6 DEATHS PER 100,000 POPULATION. ACCORDING TO A 2016 REPORT FROM THE AMERICAN CANCER SOCIETY, CALIFORNIA CANCER FACTS & FIGURES, CANCER SURVIVAL IS MORE LIKELY TO BE SUCCESSFUL IF THE CANCER IS DIAGNOSED AT AN EARLY STAGE. SUCH DIAGNOSIS IS AN INDICATION OF SCREENING AND EARLY DETECTION. REGULAR SCREENING THAT ALLOW FOR THE EARLY DETECTION AND REMOVAL OF PRECANCEROUS GROWTHS ARE KNOWN TO REDUCE MORTALITY FOR CANCERS OF THE CERVIX, COLON AND RECTUM. FIVE YEAR RELATIVE SURVIVAL RATES FOR COMMON CANCERS, SUCH AS BREAST, PROSTATE, COLON AND RECTUM, CERVIX, AND MELANOMA OF THE SKIN, ARE 93 PERCENT TO 100 PERCENT IF THEY ARE DISCOVERED BEFORE HAVING SPREAD BEYOND THE ORGAN WHERE THE CANCER BEGAN. IN 2013, THE PERCENTAGE OF CANCER CASES DIAGNOSED AT AN EARLY AGE IS LOWEST AMONG AFRICAN AMERICAN WOMEN FOR BREAST AND HISPANIC MALES FOR PROSTATE IN SDC. MOST COMMONLY DIAGNOSED CANCERS PROSTATE, LUNG, AND COLORECTAL CANCERS ARE THE MOST COMMONLY DIAGNOSED CANCERS AND THE LEADING CAUSES OF CANCER RELATED DEATH AMONG MEN. SIMILARLY, BREAST, LUNG, AND COLORECTAL CANCERS ARE THE MOST COMMONLY DIAGNOSED CANCERS AND THE LEADING CAUSES OF CANCER RELATED DEATH AMONG WOMEN. FOR BOTH SEXES COMBINED, MELANOMA OF THE SKIN IS THE FIFTH MOST COMMONLY DIAGNOSED CANCER AND PANCREATIC CANCER IS THE FOURTH LEADING CAUSE OF CANCER RELATED DEATH. CANCER DISPARITIES THE BURDEN OF CANCER DOES NOT FALL EQUALLY ON ALL CALIFORNIANS, AND RISK OF DEVELOPING CANCER VARIES CONSIDERABLY BY RACE/ETHNICITY. AMONG MEN, AFRICAN AMERICANS HAVE THE HIGHEST INCIDENCE AND MORTALITY FROM CANCER, FOLLOWED BY NON-HISPANIC WHITES. AMONG WOMEN, NON-HISPANIC WHITES HAVE THE HIGHEST INCIDENCE OF CANCER, BUT AFRICAN AMERICANS HAVE THE HIGHEST CANCER MORTALITY. IN GENERAL, PERSONS OF ASIAN/PACIFIC ISLANDER AND HISPANIC ORIGIN HAVE CANCER RATES THAT ARE ABOUT 30 TO 35 PERCENT LOWER THAN NON-HISPANIC WHITES. HOWEVER, ASIAN/PACIFIC ISLANDERS AND HISPANICS ARE TWO TO THREE TIMES MORE LIKELY THAN NON-HISPANIC WHITES TO DEVELOP STOMACH AND LIVER CANCER. HISPANIC WOMEN ALSO HAVE TWICE THE RISK OF BEING DIAGNOSED WITH INVASIVE CERVICAL CANCER RELATIVE TO NON-HISPANIC WHITE WOMEN. SCRIPPS HAS DEVELOPED A SERIES OF PREVENTION AND WELLNESS PROGRAMS TO EDUCATE PEOPLE ABOUT THE IMPORTANCE OF EARLY DETECTION AND TREATMENT FOR SOME OF THE MOST COMMON FORMS OF CANCER. AT SCRIPPS, CANCER CARE IS MORE THAN JUST MEDICAL TREATMENT, AND A WIDE ARRAY OF RESOURCES ARE PROVIDED SUCH AS COUNSELING, SUPPORT GROUPS, COMPLEMENTARY THERAPIES AND EDUCATIONAL WORKSHOPS. HERE ARE A FEW EXAMPLES OF SCRIPPS CANCER PROGRAMS DURING FISCAL YEAR 2016: SCRIPPS CANCER CENTER DIRECTORY OF COMMUNITY RESOURCES SCRIPPS COLLABORATES WITH THE COMMUNITY AND DEVELOPS A CANCER DIRECTORY OF A COMPREHENSIVE LIST OF RESOURCES AVAILABLE FOR CANCER SURVIVORS, THEIR FAMILIES, AND THE COMMUNITY. (SPONSORED BY SCRIPPS GREEN CANCER CENTER) SCRIPPS GREEN CANCER CENTER SUPPORT GROUPS SCRIPPS GREEN HOSPITAL SUPPORT GROUPS OFFER CANCER PATIENTS THE OPPORTUNITY TO EXPRESS THE EMOTIONS THAT COME WITH A CANCER DIAGNOSIS AND HELP THEM COPE MORE EFFECTIVELY WITH THEIR TREATMENT REGIMENS BY SUPPORT GROUPS THAT NURTURE THEIR PHYSICAL, EMOTIONAL AND SPIRITUAL WELL-BEING. CLASSES AT SCRIPPS GREEN CANCER CENTER, SUCH AS THE FREE CANCER WRITING WORKSHOP, "WHEN WORDS HEAL," USE EXPRESSIVE WRITING TO HELP PATIENTS NAVIGATE THEIR JOURNEY WITH CANCER. (SPONSORED BY SCRIPPS GREEN CANCER CENTER) HEALTH SCIENCE MIDDLE SCHOOL CITY HEIGHTS EDUCATIONAL TOUR HEALTH SCIENCE MID-HIGH SCHOOL (6TH TO 8TH GRADERS) FROM CITY HEIGHTS (40 STUDENTS AND 2 INSTRUCTORS) SPENT TWO HOURS AT SCRIPPS MERCY SAN DIEGO OTOOLE BREAST CARE CENTER. IT WAS AN EDUCATIONAL VISIT TO LEARN ABOUT CANCER CARE SERVICES FROM DR. PAUL GOLDFARB AND DR. WILLIAM STANTON. THE TOUR WAS PROVIDED BY THE OTOOLE BREAST CARE CENTERS STAFF. FORM 990, PART III, LINE 4A (CONTINUED) FIREFIGHTERS, LIFEGUARDS AND POLICE OFFICERS SKIN CANCER SCREENINGS A TOTAL OF 346 FIREFIGHTERS, LIFEGUARDS AND POLICE OFFICERS WERE SCREENED FOR SKIN CANCER. (SPONSORED BY SCRIPPS MARKET OUTREACH) HEALTHY WOMEN, HEALTHY LIFESTYLES: SCRIPPS MERCY BREAST HEALTH OUTREACH AND EDUCATION PROGRAM A PROMOTORA LED HEALTH AND WELLNESS PROGRAM THAT AIMS TO IMPROVE THE LIVES OF WOMEN IN SAN DIEGOS SOUTH BAY WITH BREAST CANCER EDUCATION, PREVENTION AND TREATMENT SUPPORT. PROMOTORAS TEACH BREAST HEALTH TO WOMEN WHO HAVE LIMITED OR NO ACCESS TO HEALTH CARE. PROMOTORAS TEACH WOMEN IN THEIR NATIVE LANGUAGE WITH SENSITIVITY TO A WOMANS ETHNIC AND CULTURAL NORMS. THE PROGRAM MODEL INCLUDES A PROMOTORA, CANCER SURVIVOR AND A NURSE NAVIGATOR. THE PROMOTORA HAS KNOWLEDGE OF BREAST CANCER, OFFERS EDUCATION AND EMOTIONAL SUPPORT. SHE ALSO PROVIDES REFERRALS IN CULTURALLY APPROPRIATE AND LANGUAGE SENSITIVE WAY. A BREAST CANCER SURVIVOR AND VOLUNTEER STRENGTHENS THE BENEFITS OF BREAST CANCER EDUCATION AND PREVENTION BY TALKING TO SOMEONE WHO HAS BEEN THERE AND CAN PROVIDE INSIGHT AND SUGGESTIONS, AND IS LIVING PROOF THAT THE DISEASE IS NOT FATAL. WORKING HAND-IN-HAND, THE PROMOTORA AND VOLUNTEER PRESENT A VERY STRONG FRONT FOR BREAST CANCER AWARENESS AND FULL SUPPORT SYSTEM FOR THOSE ALREADY DIAGNOSED. MOREOVER, THE FACT THEY ARE BI-LINGUAL LATINAS LEND AN AIR OF AUTOMATIC TRUST AMONG THE HISPANIC COMMUNITY AS THEY CAN CONNECT WITH THE RESIDENTS ON A CULTURAL LEVEL. SCRIPPS MERCY HOSPITAL, CHULA VISTA: BREAST HEALTH CLINICAL SERVICES A TOTAL OF 600 WOMEN ARE REFERRED TO CLINICAL BREAST HEALTH SERVICES AT COMMUNITY AND SCRIPPS MERCY HOSPITAL, CHULA VISTA RADIOLOGY SERVICES. MORE THAN 2,000 SERVICES WERE PROVIDED, INCLUDING TELEPHONE REMINDERS, OUTREACH AND EDUCATION, CASE MANAGEMENT AND A VARIETY OF PRESENTATIONS. (SPONSORED BY SCRIPPS MERCY HOSPITAL CHULA VISTA COMMUNITY BENEFITS) SCRIPPS MERCY HOSPITAL, CHULA VISTA RADIOLOGY LOSS TO FOLLOW UP SERVICES MORE THAN 50 SERVICES WERE PROVIDED, INCLUDING ENCOURAGEMENT FOR PATIENTS TO REPEAT EXAMS, ASSISTANCE TO GET PATIENTS HEALTH INSURANCE APPROVAL FOR REPEAT EXAMS, SOCIAL/EMOTIONAL SUPPORT AND EDUCATION ABOUT PREVENTING BREAST CANCER. (SPONSORED BY SCRIPPS MERCY HOSPITAL, CHULA VISTA COMMUNITY BENEFITS) SCRIPPS MERCY HOSPITAL, CHULA VISTA RADIOLOGY, POSITIVE BREAST CANCER PATIENT SUPPORT MORE THAN 850 SERVICES WERE PROVIDED INCLUDING PHONE CALLS, HOME VISITS, MAILED EDUCATIONAL MATERIALS AND SUPPLIES (WIGS, BRAS, PROSTHESIS AND MEDICAL RECORD ORGANIZER BINDER). A RESOURCE PACKAGE WITH EDUCATIONAL MATERIALS ON NUTRITION, TREATMENT OPTIONS, COMMONLY ASKED QUESTIONS AND LOCAL RESOURCES WERE ALSO PROVIDED. (SPONSORED BY SCRIPPS MERCY HOSPITAL, CHULA VISTA COMMUNITY BENEFITS) SCRIPPS MERCY HOSPITAL, CHULA VISTA BREAST CANCER SUPPORT GROUP TOGETHER PROMOTORAS AND CANCER SURVIVORS HOLD A BI-MONTHLY SUPPORT GROUP THAT HELPS INDIVIDUALS COPE WITH LIVING WITH CANCER. MORE THAN 20 WOMEN PARTICIPATE AS PART OF THIS GROUP. GROUP SUPPORT INCLUDING NAVIGATING THE CANCER SYSTEM AND EDUCATIONAL PRESENTATIONS BY LOCAL PROVIDERS ARE OFFERED. (SPONSORED BY SCRIPPS MERCY HOSPITAL, CHULA VISTA COMMUNITY BENEFITS) SCRIPPS POLSTER BREAST CARE CENTER (SPBCC) SCRIPPS POLSTER BREAST CARE CENTER (SPBCC) SPONSORS THE YOUNG WOMENS SUPPORT GROUP WHICH PROVIDE A VENUE FOR WOMEN UNDER THE AGE OF 40 TO COME TOGETHER, DISCUSS ISSUES RELATING TO DIAGNOSES AND RECEIVE SUPPORT. THE GROUPS ARE OFFERED TO WOMEN IN THE SAN DIEGO COMMUNITY. TOPICS RELATED TO BREAST HEALTH ARE ALSO OFFERED TO THE COMMUNITY. (SPONSORED BY SCRIPPS POLSTER BREAST CARE CENTER) AMERICAN CANCER SOCIETY (ACS) MAKING STRIDES AGAINST BREAST CANCER SCRIPPS HEALTH PARTICIPATES IN THIS FUNDRAISING EVENT TO RAISE MONEY FOR BREAST CANCER RESEARCH. SCRIPPS ALSO PARTICIPATES IN HOSTING LOOK GOOD FEEL BETTER CLASSES PUT ON BY THE ACS. (SPONSORED BY SCRIPPS CORPORATE) SUSAN G. KOMEN RACE FOR THE CURE SCRIPPS HEALTH PARTICIPATES IN THIS FUNDRAISING EVENT TO SUPPORT BREAST CANCER RESEARCH AND LOCAL BREAST HEALTH INITIATIVES. THE KOMEN RACE FOR THE CURE SERIES RAISES SIGNIFICANT FUNDS AND AWARENESS FOR THE FIGHT AGAINST BREAST CANCER, CELEBRATES BREAST CANCER SURVIVORSHIP AND HONORS THOSE WHO HAVE LOST THEIR BATTLE WITH THE DISEASE. (SPONSORED BY SCRIPPS CORPORATE) SUSAN G. KOMEN 3 DAY BREAST CANCER WALK SCRIPPS HEALTH WAS THE OFFICIAL PHYSICAL THERAPY SPORTS MEDICINE CREW AT THE EVENT. PROVIDED WOUND CARE, ORTHOPEDIC EVALUATIONS AND TREATMENTS, INCLUDING LIMB AND JOINT TAPING, ASSISTANCE WITH STRETCHING AND EDUCATION FOR SELF-CARE. NINE GIRLS ASK (FOR CURE FOR OVARIAN CANCER) SCRIPPS HEALTH PARTICIPATES IN THE FUNDRAISING EVENT TO SUPPORT OVARIAN CANCER RESEARCH AND INITIATIVES. (SPONSORED BY SCRIPPS CORPORATE) CANCER AWARENESS AND EDUCATIONAL EVENTS A SERIES OF EDUCATIONAL EVENTS ARE COORDINATED WITH THE AMERICAN CANCER SOCIETY AWARENESS MONTHS. THE EVENTS FOCUS ON VARIOUS TYPES OF CANCER, INCLUDING BREAST, LUNG, CERVICAL, COLORECTAL, SKIN, OVARIAN/GYNECOLOGICAL AND PROSTATE. A REGISTERED NURSE CLINICIAN ANSWERS QUESTIONS AND PROVIDES EDUCATIONAL MATERIALS. (SPONSORED BY SCRIPPS MEMORIAL LA JOLLA CANCER CENTER) ALOHA LOCK CANCER WIG PROGRAM THIS PROGRAM PROVIDES WIGS AND HAIR ACCESSORIES TO CANCER PATIENTS SUFFERING FROM ALOPECIA OR EXPECTED TO SUFFER FROM ALOPECIA. (SPONSORED BY SCRIPPS MEMORIAL HOSPITAL LA JOLLA CANCER CENTER) CANCER CENTER REGISTERED NURSE NAVIGATOR PROGRAM SCRIPPS PROVIDED A REGISTERED NURSE, DEDICATED TO ASSISTING CANCER PATIENTS AND THEIR FAMILIES WITH NAVIGATING THROUGH THE JOURNEY FROM DIAGNOSIS, TREATMENT AND SURVIVORSHIP FROM CANCER. THE FOCUS IS ON EDUCATION AND OUTREACH, AS WELL AS, SUPPORT SERVICES IN THIS POPULATION. (SPONSORED BY SCRIPPS CANCER CENTER) CANCER CENTER OUTPATIENT HEREDITY AND CANCER GENETIC COUNSELING PROGRAM THIS PROGRAM PROVIDES GENETIC TESTING AND COUNSELING TO CANCER PATIENTS, ALONG WITH PROVIDING EDUCATION TO HEALTH PROFESSIONALS AND CAREGIVERS. (SPONSORED BY SCRIPPS CANCER CENTER) CANCER CENTER OUTPATIENT SOCIAL WORKER & LIAISON PROGRAM SCRIPPS PROVIDED A SOCIAL WORKER, DEDICATED TO ASSISTING CANCER PATIENTS, ALONG WITH PROVIDING EDUCATION TO HEALTH PROFESSIONALS AND CAREGIVERS. (SPONSORED BY SCRIPPS CANCER CENTER) CANCER SURVIVORS DAY SCRIPPS HOLDS A CELEBRATORY EVENT AT EACH SCRIPPS HOSPITAL EACH YEAR TO PROVIDE AN OPPORTUNITY FOR THOSE THAT HAVE BATTLED CANCER TO COME TOGETHER AND ENJOY THE COMPANY OF FRIENDS, FAMILY AND THE CAMARADERIE OF FELLOW CANCER SURVIVORS. THROUGHOUT THE MONTH OF JUNE CANCER SURVIVORS AND OTHER GUESTS SHARE INSPIRATIONAL STORIES, LEARN ABOUT ADVANCES IN CANCER TREATMENT AND RESEARCH, AND ENJOY THE OPPORTUNITY TO CONNECT WITH CAREGIVERS AND FELLOW SURVIVORS. EACH YEAR THE CANCER SURVIVOR EVENT HELPS CELEBRATE LIFE, INSPIRE THOSE RECENTLY DIAGNOSED, OFFER SUPPORT TO FAMILY AND LOVED ONES AND RECOGNIZE ALL WHO PROVIDED SUPPORT ALONG THE WAY. THEY ALSO PROVIDE A FORUM FOR DISCUSSING THE PHYSICAL, FINANCIAL AND SOCIAL ISSUES THAT MANY CANCER SURVIVORS FACE FOLLOWING COMPLETION OF TREATMENT. (SPONSORED BY SCRIPPS CANCER CENTER) CARDIOVASCULAR DISEASE 'DISEASES OF THE HEART' WERE THE SECOND LEADING CAUSE OF DEATH IN SAN DIEGO COUNTY IN 2012. IN ADDITION 'CEREBROVASCULAR DISEASES' WERE THE FIFTH LEADING CAUSE OF DEATH, AND 'ESSENTIAL (PRIMARY) HYPERTENSION AND HYPERTENSIVE RENAL DISEASE' WAS THE TENTH. CORONARY HEART DISEASE IS THE MOST COMMON FORM OF HEART DISEASE. HIGH BLOOD PRESSURE, HIGH CHOLESTEROL, AND SMOKING ARE ALL RISK FACTORS THAT COULD LEAD TO CVD AND STROKE. ABOUT HALF OF AMERICANS (49%) HAVE AT LEAST ONE OF THESE THREE RISK FACTORS. RISK FACTORS FOR CARDIOVASCULAR DISEASE: BEHAVIORS: TOBACCO USE, OBESITY, POOR DIET THAT IS HIGH IN SATURATED FATS, AND EXCESSIVE ALCOHOL USE. CONDITIONS: HIGH CHOLESTEROL LEVELS, HIGH BLOOD PRESSURE AND DIABETES. HEREDITY: GENETIC FACTORS LIKELY PLAY A ROLE IN HEART DISEASE AND CAN INCREASE RISK. HEART DISEASE IS THE LEADING CAUSE OF DEATH IN THE UNITED STATES - HEART DISEASE IS THE LEADING CAUSE OF DEATH FOR PEOPLE OF MOST RACIAL/ETHNIC GROUPS IN THE UNITED STATES, INCLUDING AFRICAN AMERICANS, HISPANICS AND WHITES. PREVALENCE DATA - IN 2012, 11.1% OF ADULTS AGED 18 AND OVER HAD EVER BEEN TOLD BY A DOCTOR OR OTHER HEALTH PROFESSIONAL THAT THEY HAD HEART DISEASE. - IN 2012, 224% OF ADULTS 18 AND OVER HAD BEEN TOLD ON TWO OR MORE VISITS THAT THEY HAD HYPERTENSION. DISPARITIES AND CARDIOVASCULAR DISEASE - IN 2012, THIRTY FIVE PERCENT OF NON-HISPANIC BLACK WOMEN HAD HYPERTENSION COMPARED WITH 22% OF NON-HISPANIC WHITE WOMEN AND 22% OF HISPANIC WOMEN. THIRTY PERCENT OF NON-HISPANIC BLACK MEN HAD HYPERTENSION COMPARED WITH 25% OF NON-HISPANIC WHITE MEN AND 19% OF HISPANIC MEN. - MEN ARE MORE LIKELY THAN WOMEN TO HAVE EVER BEEN TOLD THEY HAVE CORONARY HEART DISEASE OR HYPERTENSION. - INDIVIDUALS WITH LOW INCOMES ARE MUCH MORE LIKELY TO SUFFER FROM HIGH BLOOD PRESSURE, HEART ATTACK, AND STROKE. - AMONG ADULTS AGED 65 AND OVER, THOSE COVERED BY MEDICARE AND MEDICAID WERE MORE LIK FORM 990, PART III, LINE 4A (CONTINUED) EDUCATING WOMEN ABOUT HEART HEALTH TOGETHER WITH WOMEN HEART NATIONAL HOSPITAL ALLIANCE, SCRIPPS CARDIOVASCULAR DEVELOPED A WOMEN AND HEART DISEASE EDUCATION PROGRAM. THE EFFORTS EDUCATE WOMEN ON THE IMPORTANCE OF HEART HEALTH, PROVIDE SUPPORT GROUPS AND ADVOCATE FOR RESEARCH FUNDING AND POLICIES. (SPONSORED BY SCRIPPS HEALTH FOUNDATION) SENIOR HEALTH CHATS A WIDE VARIETY OF SENIOR CHATS ARE OFFERED AT LOCAL SENIOR CENTERS IN SOUTH BAY TO ADDRESS EDUCATION AND PREVENTION OF HEART DISEASE. SOME TOPICS INCLUDE HEART HEALTH 101, STROKE AND A VARIETY OF PREVENTION. MORE THAN 6 TO 10 INDIVIDUALS ARE GIVEN THIS INFORMATION. (SPONSORED BY SCRIPPS MERCY HOSPITAL CHULA VISTA, COMMUNITY BENEFITS) THE ERIC PAREDES SAVE A LIFE FOUNDATION EACH YEAR, 7,000 TEENS LOSE THEIR LIVES DUE TO SUDDEN CARDIAC ARREST (SCA). SCA IS NOT A HEART ATTACK, IT IS CAUSED BY AN ABNORMALITY IN THE HEARTS ELECTRICAL SYSTEM THAT CAN EASILY BE DETECTED WITH A SIMPLE EKG. UNFORTUNATELY, HEART SCREENINGS ARE NOT PART OF A REGULAR, WELL-CHILD EXAM OR PRE-PARTICIPATION SPORTS PHYSICAL. THE FIRST SYMPTOM OF SCA COULD BE DEATH. SAN DIEGO ALONE LOSES THREE TO FIVE TEENS FROM SCA. AS A SPONSOR FOR THE ERIC PAREDES SAVE A LIFE FOUNDATION, SCRIPPS HAS HELD MORE THAN 20,000 FREE CARDIAC SCREENINGS TO LOCAL TEENS, INCLUDING THE HOMELESS, UNINSURED AND UNDERINSURED. IN 2016, SCRIPPS MADE A $15,000 DONATION TO HELP PAY FOR SCREENINGS. IN 2016, SCRIPPS SUPPORTED SCREENING EVENTS AT AREA HIGH SCHOOLS AND SCREENED 3,869 TEENS, IDENTIFYING 41 WITH ABNORMALITIES AND 16 WHO WERE AT RISK. (SPONSORED BY SCRIPPS MARKETING DEPARTMENT) SCREENING ATHLETES FOR SUDDEN CARDIAC ARREST EVERY YEAR, THREE TO FIVE STUDENT ATHLETES IN SAN DIEGO COUNTY DIE SUDDENLY AND UNEXPECTEDLY FROM SUDDEN CARDIAC ARREST/DEATH (SCA/D). SCA IS AN ABNORMALITY IN THE HEARTS ELECTRICAL SYSTEM THAT CAN HAPPEN WITHOUT SYMPTOMS OR WARNING SIGNS. HOWEVER, THIS LIFE-THREATENING CONDITION CAN BE DETECTED WITH A CARDIAC SCREENING EXAM. SCRIPPS MERCY HOSPITAL CHULA VISTA FAMILY MEDICINE RESIDENCY, SOUTHWEST SPORTS WELLNESS FOUNDATION AND THE SWEETWATER UNION HIGH SCHOOL DISTRICT PARTNER TO PREVENT SUDDEN CARDIAC ARREST AND DEATH AMONG HIGH SCHOOL STUDENTS BY INCREASING AWARENESS OF THE IMPORTANCE OF HEALTHY LIFESTYLES AND CARDIOVASCULAR SCREENINGS AMONG ACTIVE STUDENTS. FAMILY MEDICINE RESIDENTS OFFER YEARLY CARDIAC SCREENING AND SPORTS PHYSICALS BEFORE STUDENTS PARTICIPATE IN ORGANIZED SPORTS, AND IMPLEMENT AN INJURY CLINIC DURING FOOTBALL SEASON TO EVALUATE AND TREAT POSSIBLE CONCUSSIONS AND OTHER INJURIES. (SPONSORED BY SCRIPPS MERCY HOSPITAL CHULA VISTA, COMMUNITY BENEFITS) SU VIDA, SU CORAZON / YOUR LIFE, YOUR HEART COMMUNITY INTERVENTION TO IMPROVE EDUCATION AND AWARENESS OF HEART DISEASE HEART DISEASE IS ONE OF THE MOST WIDESPREAD AND COSTLY HEALTH PROBLEMS FACING OUR NATION, EVEN THOUGH ITS ALSO ONE OF THE MOST PREVENTABLE. HEART FAILURE AND STROKE ACCOUNT FOR MORE THAN $500 BILLION IN HEALTH CARE COSTS PER YEAR. HEART FAILURE IS A PROGRESSIVE DISEASE, PRIMARILY CAUSED BY HIGH BLOOD PRESSURE, HIGH CHOLESTEROL/LIPIDS AND DAMAGE TO THE HEART MUSCLE FROM CORONARY ARTERY DISEASE. SCRIPPS HEALTH OFFERS A FIVE WEEK EDUCATIONAL BASED COMMUNITY INTERVENTION PROGRAM TO SUPPORT IMPROVED QUALITY OF LIFE FOR PATIENTS DIAGNOSED WITH HEART DISEASE. TOBACCO USE, ALCOHOL ABUSE, LACK OF PHYSICAL ACTIVITY, POOR NUTRITION, STRESS AND DEPRESSION ARE SOME OF THE MAJOR CONTRIBUTING FACTORS LEADING TO HEART DISEASE, HEART FAILURE AND READMISSION. RECENT LITERATURE SUGGEST THAT A LACK OF POST DISCHARGE SOCIAL SUPPORT AND EDUCATION ARE IMPORTANT TO PREVENT READMISSION. GROUP SESSIONS PROVIDE EDUCATION AND SOCIAL SUPPORT. DISCHARGE PLANNING THAT USES TRANSITIONAL COACHES HAS BEEN PROVEN TO REDUCE READMISSION RATES. THE OVERALL GOAL OF YOUR LIFE, YOUR HEART IS TO DECREASE THE READMISSION RATES FOR HEART FAILURE PATIENTS, WHICH REDUCES MEDICAL COSTS FOR THE PATIENT AND IMPROVES THEIR QUALITY OF LIFE. A TOTAL OF 51 COMMUNITY MEMBERS HAVE PARTICIPATED IN THIS EDUCATIONAL SERIES FOR THOSE AFFECTED BY HYPERTENSION, ANGINA, CARDIAC HEART FAILURE OR ANY OTHER HEART HEALTH CONCERNS. TOPICS COVERED INCLUDE THE RISK OF HEART DISEASE, SIGNS OF HEART ATTACK, DIABETES, CHOLESTEROL, PHYSICAL ACTIVITY, HEALTHY EATING AND MUCH MORE. WITH 19 HEART HEALTH PARTICIPANTS STILL ACTIVE IN THE PROGRAM HEALTH ASSESSMENTS ARE REVIEWED INCLUDING WAIST CIRCUMFERENCE, WEIGHT, HEIGHT, BMI AND BLOOD PRESSURE. OVERALL, PARTICIPANTS HAVE IMPROVED THEIR BMI BY 6.9%, LOST A COMBINED 42 POUNDS TOGETHER, AND IMPROVED THEIR BLOOD PRESSURE AT AN AVERAGE OF 131/74 (THREE TIMES NORMALIZED AND MAINTAINED SINCE INITIAL ASSESSMENT). (SPONSORED BY SCRIPPS MERCY HOSPITAL CHULA VISTA, COMMUNITY BENEFITS) DIABETES DIABETES IS AN IMPORTANT HEALTH NEED BECAUSE OF ITS PREVALENCE, ITS IMPACT ON MORBIDITY AND MORTALITY, AND ITS PREVENTABILITY. AN ANALYSIS OF MORTALITY DATA FOR SAN DIEGO COUNTY FOUND THAT IN 2012 'DIABETES MELLITUS' WAS THE SEVENTH LEADING CAUSE OF DEATH. THE PERCENTAGE OF ADULTS AGED 20 AND OLDER WHO HAVE EVER BEEN DIAGNOSED WITH DIABETES WAS 7.2% IN 2012 IN SAN DIEGO COUNTY AND HAS BEEN STEADILY RISING SINCE 2005 ACCORDING TO THE NATIONAL CENTER FOR CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION. TYPE 2 DIABETES IS AN IMPORTANT TARGET FOR INTERVENTION BECAUSE HOSPITALIZATIONS DUE TO DIABETES RELATED COMPLICATIONS ARE POTENTIALLY PREVENTABLE WITH PROPER MANAGEMENT AND A HEALTHY LIFESTYLE. IN SAN DIEGO, APPROXIMATELY 1.5% OF DISCHARGES IN THE BLACK PATIENT POPULATION WERE ATTRIBUTABLE TO DIABETES COMPARED TO 0.7% OF DISCHARGES OF WHITES. THERE ARE THREE MAJOR TYPES OF DIABETES: TYPE 1, TYPE 2 AND GESTATIONAL. ALL THREE TYPES SHARE SIMILAR CHARACTERISTICS, THE BODY LOSES THE ABILITY TO EITHER MAKE OR TO USE INSULIN. WITHOUT ENOUGH INSULIN, GLUCOSE STAYS IN THE BLOOD, CREATING DANGEROUS BLOOD SUGAR LEVELS. OVER TIME, THIS BUILDUP DAMAGES KIDNEYS, HEART, NERVES, EYES AND OTHER ORGANS. TYPE 2 DIABETES, ONCE KNOWN AS ADULT ONSET OR NONINSULIN DEPENDENT DIABETES, IS A CHRONIC CONDITION THAT AFFECTS THE WAY YOUR BODY METABOLIZES SUGAR (GLUCOSE), WHICH IS YOUR BODYS MAIN SOURCE OF FUEL. WITH TYPE 2 DIABETES, YOUR BODY EITHER RESISTS THE EFFECTS OF INSULIN, A HORMONE THAT REGULATES THE MOVEMENT OF SUGAR INTO YOUR CELLS OR DOESNT PRODUCE ENOUGH INSULIN TO MAINTAIN A NORMAL GLUCOSE LEVEL. IF LEFT UNTREATED, TYPE 2 DIABETES CAN BE LIFE THREATENING. CLINICAL SYMPTOMS CAN INCLUDE: FREQUENT URINATION, EXCESSIVE THIRST, EXTREME HUNGER, SUDDEN VISION CHANGES, UNEXPLAINED WEIGHT LOSS, EXTREME FATIGUE, SORES THAT ARE SLOW TO HEAL, AND INCREASED NUMBER OF INFECTIONS. TYPE 2 DIABETES HAS REACHED EPIDEMIC PROPORTIONS, AND PEOPLE OF HISPANIC ORIGIN HAVE DRAMATICALLY HIGHER RATES OF THE DISEASE AND THE COMPLICATIONS THAT GO ALONG WITH ITS POOR MANAGEMENT, INCLUDING CARDIOVASCULAR DISEASE, EYE DISEASE AND LIMB AMPUTATION. IN FACT, IT IS ESTIMATED THAT ONE OUT OF EVERY TWO HISPANIC CHILDREN BORN IN 2000 WILL DEVELOP DIABETES IN ADULTHOOD. THIS IS ESPECIALLY TRUE IN THE SOUTH BAY COMMUNITIES IN SAN DIEGO. SPECIFICALLY, THE CITY OF CHULA VISTA IS HOME TO 26,000 LATINOS WITH DIAGNOSED DIABETES AND TENS OF THOUSANDS MORE WHO ARE UNDIAGNOSED, HAVE PRE- DIABETES AND ARE AT HIGH RISK OF DEVELOPING DIABETES. SOME ALARMING FACTS ABOUT TYPE 2 DIABETES: - ABOUT 1.7 MILLION PEOPLE AGED 20 OR OLDER WERE NEWLY DIAGNOSED WITH DIABETES IN 2012 IN THE U.S. - DIABETES IS A MAJOR CAUSE OF HEART DISEASE AND STROKE, AND IS THE 7TH LEADING CAUSE OF DEATH IN THE UNITED STATES AND CALIFORNIA. - MORE THAN 1 OUT OF 3 ADULTS HAVE PREDIABETES AND 15 TO 30% OF THOSE WITH PREDIABETES WILL DEVELOP TYPE 2 DIABETES WITHIN 5 YEARS. SOME RISK FACTORS FOR DEVELOPING DIABETES INCLUDE: - BEING OVERWEIGHT OR OBESE - HAVING A PARENT, BROTHER OR SISTER WITH DIABETES. - SMOKING - HAVING BLOOD PRESSURE MEASURING 140/90 OR HIGHER. - BEING PHYSICALLY INACTIVE, EXERCISING FEWER THAN THREE TIMES A WEEK. DISPARITIES AND DIABETES: - HISPANICS AND AFRICAN AMERICANS HAVE TWO TIMES HIGHER PREVALENCE: 1 IN 20 NON-HISPANIC WHITES HAVE TYPE 2 DIABETES, COMPARED WITH 1 IN 10 HISPANICS AND 1 IN 11 AFRICAN AMERICANS IN 2011 2012. - IN SAN DIEGO, WHITES AND BLACKS HAD THE HIGHEST DEATH RATES DUE TO DIABETES IN 2012. - THE PREVALENCE OF TYPE 2 DIABETES IS 13 PERCENT HIGHER IN MEN THAN WOMEN IN CALIFORNIA. - IN SAN DIEGO, MALES HAD A HIGHER DEATH RATE THAN FEMALES (22.5 PER 100,000 VERSUS 19.0 PER 100,000 IN 2012). - THE PERCENT OF ADULTS IN CALIFORNIA WITH DIABETES IS ALMOST TWO TIMES HIGHER IN THOSE WITH FAMILIES INCOMES BELOW 200 PERCENT OF THE FEDERAL POVERTY LEVEL COMPARED TO THOSE WHOSE INCOME IS 300 PERCENT ABOVE. - ADULTS WITH DIABETES ARE MORE LIKELY TO HAVE ARTHRITIS, HYPERTENSION AND CARDIOVASCULAR DISEASE THAN ADULTS WITHOUT DIABETES. - DIABETES IS A LEADING CAUSE OF LOWER LIMB AMPUTATION AND KIDNEY FAILURE IN THE UNITED STATES. FORM 990, PART III, LINE 4A (CONTINUED) MORE THAN 7 MILLION AMERICANS ARE UNAWARE THAT HAVE DIABETES. THE COMPLICATIONS RELATED TO DIABETES ARE SERIOUS AND CAN BE REDUCED WITH PREVENTIVE PRACTICES. DIABETES IS A SERIOUS COMMUNITY HEALTH PROBLEM, LEADING TO SCHOOL AND WORK ABSENTEEISM, ELEVATED HOSPITALIZATION RATES, FREQUENT EMERGENCY ROOM VISITS, PERMANENT PHYSICAL DISABILITIES AND SOMETIMES DEATH. DURING FISCAL YEAR 2016, SCRIPPS SPONSORED THE FOLLOWING DIABETES MANAGEMENT INITIATIVES: PROJECT DULCE PROJECT DULCE IS A COMPREHENSIVE, CULTURALLY SENSITIVE DIABETES MANAGEMENT PROGRAM FOR UNDERSERVED AND UNINSURED PEOPLE IN SAN DIEGO COUNTY. THE PROGRAM IS TEAM BASED AND INCORPORATES THE CHRONIC CARE MODEL. PROJECT DULCE HAS BEEN ACTIVE IN COMMUNITIES ACROSS SAN DIEGO FOR THE PAST 19 YEARS, PROVIDING DIABETES CARE AND SELF-MANAGEMENT EDUCATION. NURSE LED TEAMS STRIVE FOR MEASURABLE IMPROVEMENTS IN THEIR PATIENTS HEALTH, NURSE EDUCATORS LEAD MULTIDISCIPLINARY TEAMS THAT PROVIDE CLINICAL MANAGEMENT; AND PEER EDUCATORS FROM EACH CULTURAL GROUP, KNOWN AS PROMOTORAS, PROVIDE PUBLIC AND PATIENT EDUCATION FOR THEIR COMMUNITIES. THIS INNOVATIVE PROGRAM COMBINES STATE OF THE ART CLINICAL DIABETES MANAGEMENT WITH PROVEN EDUCATIONAL AND BEHAVIORAL INTERVENTIONS. ONE OF THE PRIMARY COMPONENTS OF THE PROGRAM IS RECRUITING PEER EDUCATORS FROM THE COMMUNITY TO WORK DIRECTLY WITH PATIENTS. THESE EDUCATORS REFLECT THE DIVERSE POPULATION AFFECTED BY DIABETES AND HELP TEACH OTHERS ABOUT CHANGING EATING HABITS, ADOPTING EXERCISE ROUTINES AND OTHER WAYS TO HELP MANAGE THIS CHRONIC DISEASE. IN FISCAL YEAR 2016, PROJECT DULCE PROVIDED 5,970 DIABETES CARE, RETINAL SCREENINGS AND EDUCATION VISITS FOR LOW INCOME AND UNDERSERVED INDIVIDUALS THROUGHOUT SAN DIEGO AND ENROLLED 1,327 NEW PROJECT DULCE PATIENTS. THE PROGRAM ALSO INITIATED FOUR NEW PROJECTS, DIABETES PREVENTION FOR WOMEN WITH A HISTORY OF GESTATIONAL DIABETES, REPLICATING PROJECT DULCE IN TIJUANA, DIABETES CARE COORDINATION AT SCRIPPS MERCY HOSPITAL CHULA VISTA AND THE DIABETES GENE BANK PROGRAM. (SPONSORED BY SCRIPPS WHITTIER DIABETES INSTITUTE) MEDICAL ASSISTANT HEALTH COACHING (MAC) DIABETES AFFECTS NEARLY 25 MILLION INDIVIDUALS IN THE U.S., AND IF CURRENT TRENDS CONTINUE, 1 OF 3 ADULTS WILL HAVE DIABETES BY 2050. DIABETES SELF-MANAGEMENT EDUCATION AND SUPPORT (DSME) IS A CORNERSTONE OF EFFECTIVE CARE THAT IMPROVES CLINICAL CONTROL AND HEALTH OUTCOMES; HOWEVER, DSME PARTICIPATION IS LOW, PARTICULARLY AMONG UNDERSERVED POPULATIONS, AND ONGOING SUPPORT IS OFTEN NEEDED TO MAINTAIN DSME GAINS. THE COMPLEX NEEDS OF INDIVIDUALS WITH DIABETES CANNOT BE ADEQUATELY ADDRESSED IN THE TYPICAL 15-MINUTE PRIMARY CARE VISIT. THEREFORE, THE SCRIPPS WHITTIER INSTITUTE WILL BE STUDYING THE USE OF SPECIALLY TRAINED MEDICAL ASSISTANTS AS DIABETES HEALTH COACHES. BY ADOPTING A "TEAM-BASED" APPROACH THAT IS INFORMED BY THE CHRONIC CARE MODEL, OTHER PRIMARY CARE PERSONNEL [E.G., MEDICAL ASSISTANTS (MAS)] CAN BE TRAINED AS HEALTH COACHES TO WORK IN TANDEM WITH PRIMARY CARE PROVIDERS TO DELIVER SELF-MANAGEMENT SUPPORT. (SPONSORED BY SCRIPPS WHITTIER DIABETES INSTITUTE) DIABETES PREVENTION THE UCLA CENTER FOR HEALTH POLICY AND RESEARCH RECENTLY PUBLISHED DATA THAT REVEALED NEARLY HALF OF CALIFORNIA ADULTS HAVE PREDIABETES OR DIABETES. WHILE THE SCRIPPS WHITTIER DIABETES INSTITUTE HAS BEEN PROVIDING THE BEST CARE FOR PEOPLE WITH DIABETES FOR DECADES, THIS YEAR THE INSTITUTE KICKED OFF THE SCRIPPS DIABETES PREVENTION PROGRAM (DPP), WHICH IS A YEARLONG INTERVENTION WHERE PEOPLE WITH PREDIABETES MEET WEEKLY FOR 16 WEEKS, THEN MONTHLY THEREAFTER. THE PRIMARY OBJECTIVE IS TO LOSE 5 TO 7% OF BODY WEIGHT THROUGH HEALTHY EATING AND PHYSICAL ACTIVITY. THE DIABETES PREVENTION PROGRAM (DPP) HAS BEEN THOROUGHLY EVALUATED IN NIH SPONSORED RANDOMIZED CONTROLLED TRIALS, AND HAS BEEN FOUND TO DECREASE THE NUMBER OF NEW CASES OF DIABETES AMONG THOSE WITH PREDIABETES BY 58%. AMONG PEOPLE OVER AGE 60, THERE WAS A 71% REDUCTION IN NEW CASES. IN 2016, 63 PATIENTS ATTENDED 21 SCRIPPS DPP ORIENTATION SESSIONS. MUCH OF THE EFFORT IS FOCUSED IN THE SOUTH BAY FOR THE LATINO POPULATION, WHICH IS AT HIGHER RISK OF GETTING DIABETES THAN THEIR WHITE COUNTERPARTS. (SPONSORED BY SCRIPPS WHITTIER DIABETES INSTITUTE) HEALTHY LIVING ANOTHER PREVENTION INITIATIVE OF THE INSTITUTE IS HEALTHY LIVING, A SERIES OF 3 CLASSES FOCUSED ON PROMOTING HEALTH BEHAVIORS THAT ARE DIRECTLY RELATED TO THE INCIDENCE OF CHRONIC DISEASE, SMOKING, NUTRITION, AND PHYSICAL ACTIVITY. 675 PEOPLE ATTENDED HEALTHY LIVING CLASSES THAT WERE PROVIDED THROUGHOUT THE COUNTY, AGAIN WITH SPECIAL ATTENTION TO THE LATINO COMMUNITY OF THE SOUTH BAY. (SPONSORED BY SCRIPPS WHITTIER DIABETES INSTITUTE) SCRIPPS WHITTIER DIABETES INSTITUTE PROFESSIONAL EDUCATION AND TRAINING SCRIPPS WHITTIER DIABETES INSTITUTE PROFESSIONAL EDUCATION TEAMS PROVIDE STATE OF THE ART EDUCATION AND TRAINING FOR PEOPLE WHO WISH TO INCREASE THEIR DIABETES MANAGEMENT KNOWLEDGE AND SKILLS. WITH THE RISE IN DIABETES RELATED DEVICES, THERE IS A GREAT NEED TO EQUIP CLINICIANS WITH THE LATEST INFORMATION AND CLINICAL SKILLS. THE WHITTIERS PROFESSIONAL EDUCATION PROGRAM IS LED BY A TEAM OF EXPERTS, INCLUDING: ENDOCRINOLOGISTS, NURSES, DIETICIANS, PSYCHOLOGISTS AND OTHER DIABETES SPECIALIST. THESE INDIVIDUALS TRAIN PRACTICING PROFESSIONALS TO DELIVER THE BEST POSSIBLE CARE FOR THEIR DIABETES PATIENTS. COURSES RESPOND TO THE NEEDS OF ALLIED HEALTH PROFESSIONALS SEEKING TO UNDERSTAND NEW AND COMPLEX CLINICAL TREATMENT OPTIONS FOR TYPE 1, TYPE 2 AND GESTATIONAL DIABETES. PROFESSIONAL EDUCATION WAS PROVIDED FOR 374 PEOPLE ON INSULIN MANAGEMENT, INCRETIN THERAPY, AND DIABETES DIET AND DIABETES BASICS. PARTICIPANTS CAME FROM LOCAL HEALTH INSTITUTIONS AND THROUGHOUT THE UNITED STATES TO LEARN FROM THE WHITTIER INSTITUTES MOST EXPERIENCED DIABETES EXPERTS. OVER THE LAST FISCAL YEAR, THE WHITTIER INSTITUTES PROFESSIONAL EDUCATION DEPARTMENT PROVIDED FOUR CME PROGRAMS FOR PHYSICIANS, NURSES, PHARMACISTS, DIETITIANS, MIDLEVEL PROVIDERS AND SOCIAL WORKERS AND MADE NUMEROUS ACADEMIC AND RESEARCH PRESENTATIONS AT PROFESSIONAL ASSOCIATION MEETINGS. (SPONSORED BY SCRIPPS WHITTIER DIABETES INSTITUTE) RETINAL SCREENING PROGRAM IT IS ESTIMATED THAT EVERY 24 HOURS, 55 PEOPLE WILL LOSE THEIR VISION AS A RESULT OF DIABETIC RETINOPATHY. WITH EARLY DIAGNOSIS AND APPROPRIATE TREATMENT, 95 PERCENT OF DIABETIC BLINDNESS COULD BE PREVENTED. FOR THE PAST DECADE, THE SCRIPPS DIABETES CARE RETINAL SCREENING PROGRAM HAS PROVIDED LOW COST OR FREE SCREENINGS TO THE COMMUNITY. ANNUALLY REACHING ABOUT 500 INDIVIDUALS DIRECTLY AND ABOUT 1,000 INDIRECTLY, THE PROGRAM IDENTIFIES THOSE AT HIGH RISK FOR RETINAL DAMAGE AND PROVIDES ACCESS TO EDUCATION, TREATMENT AND REFERRALS. THIS INNOVATIVE PREVENTION PROGRAM HAS EDUCATED AND SAVED THE VISION OF THOUSANDS. (SPONSORED BY SCRIPPS WHITTIER DIABETES INSTITUTE) HEALTH RELATED BEHAVIORS HEALTH RELATED BEHAVIOR IS ONE OF THE MOST IMPORTANT ELEMENTS IN PEOPLES HEALTH AND WELL-BEING. ITS IMPORTANCE HAS GROWN AS SANITATION HAS IMPROVED AND MEDICINE HAS ADVANCED. DISEASES THAT WERE ONCE INCURABLE CAN NOW BE PREVENTED OR SUCCESSFULLY TREATED. HEALTH RELATED BEHAVIORS, SUCH AS IMMUNIZATION, SMOKING CESSATION, IMPROVED NUTRITION, INCREASED PHYSICAL ACTIVITY, ORAL HEALTH AND INJURY PREVENTION, HAVE BECOME IMPORTANT COMPONENTS OF LONG TERM LIFE. THE RISK FACTORS FOR MANY CHRONIC DISEASES ARE WELL KNOWN. IN PARTICULAR, AN UNHEALTHY DIET, PHYSICAL INACTIVITY AND SUBSTANCE ABUSE HAVE NEED CITED BY THE WORLD HEALTH ORGANIZATION (HTTP://WWW.WHO.INT/CHP) AS IMPORTANT HEALTH BEHAVIORS THAT CONTRIBUTE TO ILLNESSES SUCH AS CARDIOVASCULAR DISEASE, CANCER, CHRONIC RESPIRATORY DISEASE, DIABETES, AND OTHERS INCLUDING MENTAL DISORDERS AND ORAL DISEASES. FRUIT/VEGETABLE CONSUMPTION: ACCORDING TO DATA FROM CALIFORNIA HEALTH INTERVIEW SURVEY, 48.3% OF CHILDREN AGE 2 AND OLDER REPORTED CONSUMING LESS THAN FIVE SERVINGS OF FRUITS AND VEGETABLES A DAY COMPARED TO 47.7% IN CALIFORNIA OVERALL. ADULTS AGE 18 AND OVER REPORTED EVEN LESS FRUIT AND VEGETABLE CONSUMPTION. APPROXIMATELY 70.5% OF ADULTS REPORTED EATING THE RECOMMENDED AMOUNT EACH DAY. UNHEALTHY EATING HABITS ARE A SIGNIFICANT CONTRIBUTING FACTOR TO FUTURE HEALTH ISSUES INCLUDING OBESITY AND DIABETES. PHYSICAL INACTIVITY: ACCORDING TO THE CDCS NATIONAL CENTER FOR CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION, 14.9% OF ADULTS AGE 20 AND OLDER SELF-REPORTED THAT THEY PERFORM NO LEISURE TIME PHYSICAL ACTIVITY. HIGHER RATES OF LIMITED LEISURE TIME ACTIVITY WERE REPORTED AT THE STATE AND NATIONAL LEVEL (16.6% AND 22.6% RESPECTIVELY). FOR YOUTH RESULTS OF THE FITNESSGRAM PHYSICAL FITNESS TEST SHOW THAT 29.35% OF CHILDREN 5,7 AND 9 RANKED WITHIN THE "HIGH RISK"NEEDS IMPROVEMENT" ZONES FOR AEROBIC CAPACITY FOR THE 2013 2014 YEAR. THE PERCENTAGE OF CHILDREN THAT ARE NOT IN THE HEALTHY FITNESS ZONE VARIES AMONG ETHNIC GROUPS WITH THE LOWEST BEING NON-HISPANIC ASIANS AT 20.6% AND THE HIGHEST BEING HISPANIC OR LATINOS AT 42.1%. ALTHOUGH T FORM 990, PART III, LINE 4A (CONTINUED) DURING FISCAL YEAR 2016, SCRIPPS SPONSORED A NUMBER OF HEALTH BEHAVIOR MODIFICATION EFFORTS: COMMUNITY PROGRAMS AND CLINICAL SERVICES OF SCRIPPS MERCY HOSPITAL CHULA VISTA COMMUNITY BENEFITS AND FAMILY MEDICINE RESIDENCY PROGRAMS HAVE DELIVERED EXTENSIVE VALUE WITH SUPERIOR OUTCOMES. COMMUNITY SERVICES COMBINED REACHED 10,608 PROGRAM PATIENTS AND PARTICIPANTS. THERE WERE MORE THAN 13,500 CLINICAL VISITS PROVIDED BY SCRIPPS FAMILY MEDICINE RESIDENCY (SPONSORED BY SCRIPPS MERCY HOSPITAL CHULA VISTA, COMMUNITY BENEFITS) COMMUNITY BASED HEALTH IMPROVEMENT ACTIVITIES EACH MONTH APPROXIMATELY 200 COMMUNITY MEMBERS PARTICIPATE IN CLASSES, PREVENTION LECTURES AND SUPPORT GROUPS HELD AT THE WELL BEING CENTER AND NORMAN PARK SENIOR CENTER. A TOTAL OF 3,000 COMMUNITY MEMBERS HAVE PARTICIPATED IN CLASSES AND SUPPORT GROUPS. (SPONSORED BY SCRIPPS MERCY HOSPITAL CHULA VISTA, COMMUNITY BENEFITS) YOUTH PROGRAM ACTIVITIES SCRIPPS CHULA VISTA COMMUNITY BENEFITS SERVICES IMPLEMENTED A WIDE VARIETY OF YOUTH IN HEALTH CAREER ACTIVITIES INCLUDING: CAMP SCRIPPS, MENTORING PROGRAMS, HOSPITAL TOURS, IN- CLASSROOM PRESENTATIONS AND SURGERY VIEWINGS. SCRIPPS FAMILY MEDICINE RESIDENTS ALSO PROVIDE FOOTBALL GAME COVERAGE, SPORT INJURY CLINICS AND PHYSICALS. A TOTAL OF 3,726 YOUTH PARTICIPATED IN THESE PROGRAMS. (SPONSORED BY SCRIPPS MERCY HOSPITAL CHULA VISTA, COMMUNITY BENEFITS) SENIOR PROGRAMS EACH MONTH A VARIETY OF SENIOR PROGRAMS ARE HELD WITH LOCAL SENIOR CENTERS, CHURCHES, AND SENIOR HOUSING. SOME OF THESE ACTIVITIES INCLUDE: SENIOR HEALTH CHATS AND MENS GROUP. MORE THAN 200 SENIORS PARTICIPATED IN RESIDENCY SENIOR ACTIVITIES INCLUDING GROUP VISITS. OVER 400 SENIORS PARTICIPATED IN THESE PROGRAMS. (SPONSORED BY SCRIPPS MERCY HOSPITAL CHULA VISTA, COMMUNITY BENEFITS) PATIENT COMMUNITY SERVICES SERVICES ARE OFFERED DIRECTLY TO PATIENTS AND THEIR FAMILY POST DISCHARGE TO DECREASE THE RISKS OF READMISSION AND TO INCREASE PATIENT CONTINUITY. SUPPORT SERVICES ARE REFERRAL BASED AND PROVIDE ASSISTANCE WITH THE FOLLOWING: HOUSING/HOMELESSNESS, SENIOR ISSUES, CHRONIC DISEASE ISSUES, DRUG/ALCOHOL AND MENTAL HEALTH, CANCER AND MORE. THIS SERVICE IS CURRENTLY ONLY AVAILABLE AT THE SCRIPPS MERCY HOSPITAL CHULA VISTA CAMPUS. SINCE THE START OF THE PROJECT IN JULY 2014, 709 REFERRALS HAVE BEEN RECEIVED. (SPONSORED BY SCRIPPS MERCY HOSPITAL CHULA VISTA, COMMUNITY BENEFITS) COMMUNITY HEALTH IMPROVEMENT PARTNERS (CHIP) AND RESIDENT LEADERSHIP ACADEMY MODEL SCRIPPS IS A PARTNER WITH CHIP AND COLLABORATIVELY WORKS ON A RESIDENT LEADERSHIP MODEL THAT HAS EMPOWERED 700+ CITIZENS ACROSS THE COUNTY (AND BEYOND) TO AFFECT CHANGE IN A WIDE RANGE OF COMMUNITY HEALTH AREAS SUCH AS PUBLIC SAFETY, ACCESS TO HEALTHY FOODS, AND INCREASED OPPORTUNITIES FOR PHYSICAL ACTIVITY. ASK A NURSE PUBLIC HEALTH NURSES ARE AVAILABLE TO PROVIDE INFORMATION TO PROMOTE AND ENCOURAGE HEALTHY CHOICES THAT LEAD TO BETTER LIVES. THE CENTRAL PUBLIC HEALTH NURSES PROVIDE INFORMATION TO ALL PARTICIPANTS AT THE CITY HEIGHTS WELLNESS CENTER ON MONTHLY TOPICS THAT INCLUDE ASTHMA, HEART HEALTH, SEASONAL HEALTH AND OTHER TOPICS. (SPONSORED BY CITY HEIGHTS WELLNESS CENTER) HEALTH EDUCATION AND SUPPORT GROUPS EDUCATION AND SUPPORT GROUPS ARE PROVIDED TO SAN DIEGO COUNTY RESIDENTS FOR A WIDE VARIETY OF HEALTH CONCERNS. TOPICS INCLUDE, PARKINSONS DISEASE, MENTAL ILLNESS, POSTPARTUM ISSUES, GYNECOLOGICAL CANCER, CHRONIC PAIN AND MULTIPLE SCLEROSIS. (SPONSORED BY TRAUMA DEPARTMENT AT SCRIPPS MEMORIAL HOSPITAL LA JOLLA) BRAIN AND HEAD GEAR PROTECTION EDUCATIONAL PROGRAM FOR HIGH SCHOOL STUDENTS TO STRESS THE IMPORTANCE OF BIKE SAFETY. BRAIN INJURY PROTECTION THROUGH THE PROPER USED OF HEAD GEAR. (SPONSORED BY TRAUMA DEPARTMENT AT SCRIPPS MEMORIAL HOSPITAL LA JOLLA) PRESCRIPTION TAKE BACK DAY SCRIPPS COLLABORATES WITH THE COUNTY OF SD ON THE PRESCRIPTION DRUG TAKE BACK DAY WHICH PROVIDES AN OPPORTUNITY FOR SAFE DISPOSAL OF LEFT OVER MEDICATIONS. (SPONSORED BY DISASTER PREPAREDNESS DEPARTMENT) DEMENTIA AND ALZHEIMERS DISEASE DEMENTIA IS A CLINICAL SYNDROME OF DECLINE IN MEMORY AND OTHER THINKING ABILITIES. IT IS CAUSED BY VARIOUS DISEASES AND CONDITIONS THAT RESULT IN DAMAGE TO BRAIN CELLS AND LEAD TO DISTINCT SYMPTOM PATTERNS AND DISTINGUISHING BRAIN ABNORMALITIES. ALZHEIMERS DISEASE (AD) IS A PROGRESSIVE BRAIN DISORDER THAT GRADUALLY DESTROYS A PERSONS MEMORY AND ABILITY TO LEARN, REASON, MAKE JUDGEMENTS, COMMUNICATE AND CARRY OUT DAILY ACTIVITIES SUCH AS BATHING AND EATING. ALZHEIMERS IS THE 6TH LEADING CAUSE OF DEATH IN THE UNITED STATES AND 3RD LEADING CAUSE OF DEATH IN SAN DIEGO COUNTY. IN 2013, AN ESTIMATED 62,000 SAN DIEGANS AGE 55 YEARS AND OLDER WERE LIVING WITH ALZHEIMERS DISEASE AND DEMENTIAS (ADOD), ACCOUNTING FOR 8.3% OF THE 55 YEARS AND OLDER POPULATION. THIS POPULATION WILL ROUGHLY DOUBLE IN LESS THAN 20 YEARS. IN 2013, MORE THAN 20,000 SAN DIEGANS AGE 55 AND OLDER WERE DISCHARGED FROM THE EMERGENCY DEPARTMENT (ED) OR HOSPITAL WITH A MENTION OF ADOD. FINANCIAL BURDEN: - IN 2013 NEARLY 141,000 CAREGIVERS PROVIDED UNPAID CARE FOR THE 62,000 PEOPLE LIVING WITH ADOD IN SAN DIEGO COUNTY. THESE CAREGIVERS PROVIDED NEARLY 161 MILLION HOURS OF UNPAID CARE, VALUED AT NEARLY $2 BILLION DOLLARS. DUE TO THE NEGATIVE EFFECTS OF CAREGIVING ON THEIR OWN HEALTH, THE COST OF PROVIDING HEALTH CARE TO THESE RESIDENTS IN 2013 WAS APPROXIMATELY $77.7 MILLION DOLLARS. PREVALENCE - THERE ARE MORE THAN 5.2 MILLION PEOPLE IN THE UNITED STATES LIVING WITH ADOD. AS THE POPULATION AGES THE NUMBER IS EXPECTED TO TRIPLE BY 2015. - IN CALIFORNIA THERE ARE 588,208 PEOPLE 55 YEARS AND OLDER LIVING WITH ADOD. ONE TENTH OF AD PATIENTS LIVE IN CALIFORNIA. - IN SAN DIEGO COUNTY, THE NUMBER OF THOSE 55 YEARS AND OLDER WITH ADOD IS EXPECTED TO INCREASE BY 51% BETWEEN 2012 AND 2030, FROM 60,000 TO NEARLY 94,000 RESIDENTS. CURRENTLY, THE EAST COUNTY REGION HAS THE GREATEST NUMBER (14,765) AND PROPORTION (12.4%) OF RESIDENTS 55 YEARS AND OLDER WITH ALZHEIMERS DISEASE AND OTHER DEMENTIAS. THE REGION WITH THE LARGEST ANTICIPATED INCREASE IN ADOD IN THE NORTH CENTRAL AREA, WITH A PROJECTED INCREASE OF 76.8% FROM 2012 TO 2030. HOWEVER, IT IS ESTIMATED THAT BY 2030, NEARLY ONE OUT OF FOUR SAN DIEGANS 55 YEARS AND OLDER WITH ADOD WILL LIVE IN EAST COUNTY. DURING FISCAL YEAR 2016, SCRIPPS ENGAGED IN THE FOLLOWING ALZHEIMERS AND DEMENTIA PREVENTION AND TREATMENT ACTIVITIES: SENIOR HEALTH AND WELL BEING PROGRAMS THE GOAL IS TO INCREASE HEALTH CARE INFORMATION AND PREVENTATIVE SERVICES FOR SENIORS/OLDER ADULTS IN THE SOUTH BAY. EACH MONTH A VARIETY OF SENIOR PROGRAMS ARE HELD AT LOCAL SENIOR CENTERS, CHURCHES AND SENIOR HOUSING. SOME OF THESE ACTIVITIES INCLUDED DEMENTIA, ALZHEIMERS AND PAIN MANAGEMENT, NUTRITION AND WELLNESS AND SPONSORSHIP OF THE ALZHEIMERS ASSOCIATION CAREGIVER CONFERENCE. MORE THAN 200 SENIORS PARTICIPATED IN THESE ACTIVITIES. (SPONSORED BY SCRIPPS MERCY HOSPITAL CHULA VISTA, COMMUNITY BENEFITS) THE ALZHEIMERS PROJECT SAN DIEGO UNITES FOR A CURE AND CARE THE ALZHEIMERS PROJECT IS A COUNTYWIDE INITIATIVE AIMED AT ACCELERATING THE SEARCH FOR A CURE AND HELPING THE ESTIMATED 60,000 SAN DIEGANS WITH THE DISEASE, ALONG WITH THEIR CAREGIVERS. PARTICIPANTS BEGAN MEETING IN EARLY 2014 TO CRAFT A REGIONAL ROADMAP TO ADDRESS THE DISEASE, FOCUSING ON CURE, CARE, CLINICAL, AND PUBLIC AWARENESS AND EDUCATION INITIATIVES. THE BOARD OF SUPERVISORS APPROVED THE ROADMAP IN DECEMBER 2014 AND LATER VOTED IN SUPPORT OF AN IMPLEMENTATION TIMETABLE. DR. MICHAEL LOBATZ FROM SCRIPPS HEALTH IS A LEADING PARTICIPANT OF THIS INITIATIVE AS A CO-CHAIRPERSON OF THE CLINICAL ROUND TABLE AND IS A MEMBER OF THE STEERING COMMITTEE. ALZHEIMERS SAN DIEGO PROGRAM SUPPORT ALZHEIMERS SAN DIEGO OFFERS A FREE HALF DAY EVENT. ATTENDEES LEARN THE BASICS OF ALZHEIMERS DISEASE, HOW TO PARTNER WITH YOUR DOCTOR AND GET A DIAGNOSIS, AND ADDRESSING BEHAVIOR THROUGH COMPASSIONATE COMMUNICATION. SCRIPPS DONATED $25,000 FOR PROGRAM SUPPORT. OBESITY, WEIGHT STATUS, NUTRITION, ACTIVITY AND FITNESS OBESITY IS AN IMPORTANT HEALTH NEED DUE TO ITS HIGH PREVALENCE IN THE U.S. AND SAN DIEGO. ALTHOUGH IT IS NOT A LEADING CAUSE OF DEATH, IT IS A SIGNIFICANT CONTRIBUTOR TO THE DEVELOPMENT OF OTHER CHRONIC CONDITIONS. ADULTS: 36.3% OF ADULTS AGED 18 AND OLDER SELF-REPORTED THEY HAVE A BMI BETWEEN 25.0 AND 30.0 (OVERWEIGHT) IN SAN DIEGO COUNTY ACCORDING TO 2011 2012 BRFSS DATA. AN ADDITIONAL 20.1% OF ADULTS AGED 20 YEARS AND OLDER SELF-REPORTED THEY HAVE A BMI GREATER THAN 30.0 (OBESE) IN SAN DIEGO COUNTY. THE PERCENTAGE OF RESIDENTS WHO ARE OBESE WAS HIGHER SLIGHTLY AMONG MEN (21.3%) THAN WOMEN (18.8%). EXCESS WEIGHT MAY INDICATE AN UNHEALTHY LIFESTYLE AND PUTS INDIVIDUALS AT RISK FOR FURTHER HEALTH ISSUES INCLUDING OBESITY, HEART DISEASE, DIABETES, AND OTHER HEALTH ISSUES. YOUTH: FITNESSGRAM IS THE REQUIRED PHYSICAL FITNESS TEST THAT SCHOOL DISTRICTS MUST ADMINISTER TO ALL CALIFORNIA STUDENTS IN GRADES 5, 7 AND 9. THE PERCENTAGE OF CHILDREN IN GRADES 5, 7 AND 9 RANKING WITHIN THE "HEALTH RISK" FORM 990, PART III, LINE 4A (CONTINUED) HEALTH CONSEQUENCES DUE TO OVERWEIGHT AND OBESITY: RESEARCH HAS SHOWN THAT AS WEIGHT INCREASES TO REACH THE LEVELS OF "OVERWEIGHT"OBESITY" THE RISKS FOR THE FOLLOWING CONDITIONS ALSO INCREASES: - CORONARY HEART DISEASE - TYPE 2 DIABETES - CANCERS (ENDOMETRIAL, BREAST AND COLON) - HYPERTENSION (HIGH BLOOD PRESSURE) - STROKE - LIVER AND GALLBLADDER DISEASE - SLEEP APNEA AND RESPIRATORY PROBLEMS - OSTEOARTHRITIS OVERWEIGHT AND OBESITY ASSOCIATED COSTS: - IN 2008, MEDICAL COSTS ASSOCIATED WITH OBESITY WERE ESTIMATED AT $147 BILLION, THE MEDICAL COSTS FOR PEOPLE WHO ARE OBESE WERE $1,429 HIGHER THAN THOSE OF NORMAL WEIGHT. DISPARITIES AND OBESITY OBESITY & RACE - ACCORDING TO THE BRFSS, FROM 2012 THROUGH 2014, NON-HISPANIC BLACKS HAD THE HIGHEST PREVALENCE OF SELF-REPORTED OBESITY (38.1%), FOLLOWED BY HISPANICS (31.3%) AND NON-HISPANIC WHITES (27.1%) - IN 2011 2012, THE PREVALENCE AMONG CHILDREN AND ADOLESCENTS WAS HIGHER AMONG HISPANICS (22.4%) AND NON-HISPANICS (20.2%) THAN AMONG NON-HISPANIC WHITES (14.1%) OBESITY & GENDER - AMONG MEN, 42% WERE CONSIDERED TO BE OVERWEIGHT COMPARED TO 29% OF WOMEN. THE MEDIAN PERCENTAGE OF OBESITY WAS SIMILAR AMONG MEN (28%) AND WOMEN (27%)IN THE U.S. OBESITY & INCOME - AMONG NON-HISPANIC BLACK AND MEXICAN AMERICAN MEN, THOSE WITH HIGHER INCOMES ARE MORE LIKELY TO HAVE OBESITY THAN THOSE WITH LOW INCOME. - HIGHER INCOME WOMEN AND WOMEN WITH HIGHER EDUCATIONAL ATTAINMENT ARE LESS LIKELY TO BE OBESE THAN LOW INCOME WOMEN. - OBESITY PREVALENCE WAS THE HIGHEST AMONG CHILDREN IN FAMILIES WITH AN INCOME TO POVERTY RATIO OF 100% OF LESS. OBESITY & QUALITY OF LIFE - OBESITY CAN AFFECT THE QUALITY OF LIFE THROUGH LIMITED MOBILITY AND DECREASED PHYSICAL ENDURANCE, IN ADDITION TO SOCIAL, ACADEMIC, AND JOB DISCRIMINATION. DURING FISCAL YEAR 2016, SCRIPPS ENGAGED IN THE FOLLOWING OBESITY PREVENTION AND TREATMENT ACTIVITIES: COMMUNITY HEALTH IMPROVEMENT PROJECT (CHIP) AND CHILDHOOD OBESITY INITIATIVE THE SAN DIEGO COUNTY CHILDHOOD OBESITY INITIATIVE (THE INITIATIVE) IS A PRIVATE PUBLIC PARTNERSHIP WITH THE MISSION OF REDUCING AND PREVENTING CHILDHOOD OBESITY THROUGH POLICY, SYSTEMS, AND ENVIRONMENT CHANGE. THE INITIATIVE IS FACILITATED BY COMMUNITY HEALTH IMPROVEMENT PARTNERS (CHIP). CORE FUNDING FOR THE INITIATIVE IS PROVIDED BY THE COUNTY OF SAN DIEGO, FIRST 5 COMMISSION OF SAN DIEGO COUNTY, THE CALIFORNIA ENDOWMENT, AND KAISER-PERMANENTE. SCRIPPS IS A STRONG PARTNER WITH CHIP AND THE OUTCOMES OF THE INITIATIVE HAVE SHOWN A DECREASED CHILDHOOD OBESITY FROM 4% FROM 2005-2010, THE LARGEST DROP IN SOUTHERN CALIFORNIA (MANY AREAS HAVE SEEN INCREASES). DIABETES PREVENTION PROGRAM (DPP) THE DIABETES PREVENTION PROGRAM IS A SCIENTIFICALLY VALIDATED LIFESTYLE INTERVENTION BASED MODEL. THE CENTERS FOR DISEASE CONTROL (CDC) AND THE NATIONAL INSTITUTES OF HEALTH (NIH) PROMOTE WIDESPREAD ADOPTION OF THE DPP DUE TO IS DEMONSTRATED EFFECTIVENESS. SCRIPPS AIMS TO DECREASE THE INCIDENCE OF TYPE 2 DIABETES BY MANAGING A MAJOR DIABETES RISK FACTOR, OBESITY IN THE UNDERSERVED, ETHNICALLY DIVERSE POPULATIONS BY TESTING THE EFFECTIVENESS OF LIFESTYLE CURRICULUM. SCRIPPS AIMS TO EXAMINE THE EFFECTIVENESS OF THE DPP PROGRAM IN IMPROVING BEHAVIORAL AND PSYCHOLOGICAL RISK PROFILES. (SPONSORED BY SCRIPPS WHITTIER DIABETES INSTITUTE) HEALTHY LIVING PROGRAM DIABETES, HEART DISEASE, CANCER AND RESPIRATORY DISEASE ARE THE FOUR MOST PREVALENT SERIOUS CHRONIC DISEASES IN CALIFORNIA. THESE DISEASES CAUSE 50 PERCENT OF ALL DEATHS IN SAN DIEGO AND THROUGHOUT THE U.S., AND MANY PEOPLE HAVE MORE THAN ONE OF THESE CONDITIONS. BECAUSE LIFESTYLE CAN PLAY A MAJOR ROLE IN PREVENTING THESE CHRONIC ILLNESSES, SCRIPPS INTRODUCED HEALTHY LIVING, A FREE, INTERACTIVE EDUCATION PROGRAM TO HELP THE SAN DIEGO COMMUNITY LEARN ABOUT AND ADOPT PRACTICAL WAYS TO IMPROVE THREE BEHAVIORS SMOKING, POOR DIET AND PHYSICAL INACTIVITY THAT CONTRIBUTE TO THESE FOUR DISEASES. PARTICIPANTS LEARN HOW TO MAKE HEALTHY FOOD CHOICES USING LOW COSTS OPTIONS, MAKE PHYSICAL ACTIVITY PART OF THEIR DAILY LIFE AND LEARN HOW TO STAY MOTIVATED AND MAINTAIN HEALTHY HABITS. SCRIPPS IMPLEMENTS A SERIES OF THREE FREE SESSIONS THAT ENCOURAGE PARTICIPANTS TO IDENTIFY AND ADOPT PRACTICAL WAYS TO IMPROVE THEIR HEALTH HABITS. SESSIONS ARE OFFERED THROUGHOUT SAN DIEGO COUNTY IN ENGLISH AND SPANISH, WITH SPECIAL EMPHASIS ON THE LATINO AND UNDERSERVED COMMUNITIES. SESSIONS INCLUDE HEALTH SCREENING, HEALTHY COOKING TIPS, AND MINDFUL EATING AND PRACTICE SESSIONS. PARTICIPANTS ALSO RECEIVE A PREDIABETES SCREENING; THOSE WHO SCORE HIGH ARE THEN REFERRED TO THE SCRIPPS DIABETES PREVENTION PROGRAM. (SPONSORED BY SCRIPPS WHITTIER DIABETES INSTITUTE) PROMISE NEIGHBORHOOD INITIATIVE SCRIPPS ALSO ADDRESSES CHILDHOOD OBESITY AT THE HIGH SCHOOL LEVEL IN SAN DIEGOS SOUTH BAY COMMUNITIES THROUGH ITS PARTNERSHIP WITH THE PROMISE NEIGHBORHOOD INITIATIVE, WHICH IMPLEMENTS ACTIVITIES RELATED TO THE NATIONAL 5-2-1-0 CAMPAIGN. SCRIPPS PARTNERS WITH THE PROMISE NEIGHBORHOOD INITIATIVE AND CASTLE PARK ELEMENTARY SCHOOL TO INCREASE EDUCATION AND AWARENESS ABOUT HEALTHY LIFESTYLES FOR STUDENTS, THEIR PARENTS AND SCHOOL STAFF. PROMISE NEIGHBORHOOD DEVELOPED A WELLNESS COMMITTEE COMPOSED OF THE SCHOOL PRINCIPAL, TEACHERS, PARENTS AND SCRIPPS STAFF AIMED TO IMPLEMENT ACTIVITIES THAT SUPPORT 5210: 5 FRUITS OR MORE A DAY, 2 HOURS OR LESS OF SCREEN TIME, 1 HOUR OF PHYSICAL ACTIVITY AND 0 SUGARY JUICES. SCHOOL ADMINISTRATORS AND STAFF ARE CLOSELY INVOLVED IN THE PROGRAM, WHICH INCLUDES FIVE EDUCATIONAL SESSIONS, A HEALTH ASSESSMENT SURVEY AND HEALTH PLAN, AND SUPPORT TO HELP THE STUDENTS PASS THEIR YEARLY PHYSICAL EDUCATION REQUIREMENTS. SINCE 2013, MORE THAN 400 CHILDREN AND 200 PATIENTS HAVE PARTICIPATED IN WELLNESS ACTIVITIES ON CAMPUS. AS A RESULT OF ACTIVITIES, LESSON PLANS AND ADVOCACY FOR HEALTHY LIVING, THE AMOUNT OF PHYSICAL ACTIVITY AND CONSUMPTION OF FRUITS AND VEGETABLES BY CHILDREN, PARENTS AND STAFF HAS INCREASED. BASED ON ANNUAL STUDENT SURVEYS, 60 PERCENT OF STUDENTS ARE MORE PHYSICALLY ACTIVE, COMPARED TO 26 PERCENT IN PREVIOUS YEARS. (SPONSORED BY SCRIPPS MERCY HOSPITAL CHULA VISTA, COMMUNITY BENEFITS) LETS GET COOKING IN JANUARY 2014 THE CITY HEIGHTS WELLNESS CENTER LAUNCHED "LETS GET COOKING," A HANDS ON COOKING CLASS FOR MOMS, DADS, CAREGIVERS AND THEIR KIDS (AGES EIGHT AND OLDER) WHO WANT TO LEARN SIMPLE, HEALTHY RECIPES FOR THE WHOLE FAMILY. "LETS GET COOKING" AIMS TO INSPIRE FAMILIES TO EAT FRESH, NUTRITIOUS, WHOLE FOODS AND TO MAKE HEALTHY LIFESTYLE CHOICES THROUGH COOKING, EDUCATION AND DISCUSSIONS. THE CLASSES ARE TAUGHT IN BOTH ENGLISH AND SPANISH BY BILINGUAL REGISTERED DIETICIANS. IN THE MID-CITY REGION OF SAN DIEGO, THERE ARE CURRENTLY NO OTHER HANDS ON COOKING/NUTRITION, EDUCATION/OBESITY PROGRAMS AVAILABLE. WHAT SETS THIS PROGRAM APART IS BEING ABLE TO OFFER THE HANDS ON COOKING EXPERIENCE IN A CERTIFIED TEACHING KITCHEN. THERE ARE CURRENTLY NUTRITION EDUCATION PROGRAMS OFFERED IN THE COMMUNITY. HOWEVER, NONE OF THEM IS OFFERING NUTRITION EDUCATION THROUGH COOKING. THE TEACHING KITCHEN PROVIDES NOT ONLY A HANDS ON LEARNING EXPERIENCE, BUT MORE IMPORTANTLY A PLACE FOR FAMILY INTERACTION AND BUILDING A SENSE OF COMMUNITY. (SPONSORED BY CITY HEIGHTS WELLNESS CENTER) SUPER CHEF PROGRAM AND CAMP JOINT PROGRAM OF THE CHWC AND LEAHS PANTRY THROUGH A GRANT FROM GENERAL MILLS, CITY HEIGHTS CHILDREN AND THEIR PARENTS MOVE, COOK AND LEARN TO ADOPT HEALTHIER BEHAVIORS THROUGHOUT THE YEAR BY PARTICIPATING IN FOOD SMARTS WORKSHOPS, A USDA/FNS APPROVED COOKING AND NUTRITION EDUCATION SERIES. THREE DAY SUMMER CAMPS ARE HELD FOR THREE AGE RANGES OF NEIGHBORHOOD CHILDREN, AND INCLUDED A FULL HOUR OF PHYSICAL ACTIVITY EACH DAY. COOKING AND NUTRITION WORKSHOPS TEACH THE BUILDING BLOCKS OF A BALANCED DIET, BASIC COOKING AND KITCHEN SAFETY SKILLS, DEVELOP INDIVIDUAL NUTRITION GOALS, AND SPEND TIME EXERCISING. (SPONSORED BY CITY HEIGHTS WELLNESS CENTER) VOCATIONAL ENGLISH SECOND LANGUAGE CULINARY TRAINING PROGRAM THE INTERNATIONAL RESCUE COMMITTEE (IRC) IN SAN DIEGO OFFERS AN INNOVATIVE VOCATIONAL ENGLISH AS A SECOND LANGUAGE (VESL) PLUS PROGRAM FOR REFUGEES. THESE NEWLY ARRIVING REFUGEES SPEND 32 HOURS A WEEK, 8 WEEKS FOR IRAQI REFUGEES OR 16 WEEKS FOR SWAHILI AND KAREN BURMESE SPEAKERS, LEARNING VALUABLE SKILLS THAT WILL HELP THEM FIND AND KEEP EMPLOYMENT TO SUPPORT THE ECONOMIC HEALTH OF THEIR FAMILIES. THE PROGRAM INCLUDES 60 HOURS OF KITCHEN BASED TRAINING IN A COMMERCIAL KITCHEN SPACE THAT THE CHWC PROVIDES. (SPONSORED BY CITY HEIGHTS WELLNESS CENTER) NUTRITION SERVICES AND PHYSICAL ACTIVITY ACCORDING TO THE 2013 BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) DATA FOR SAN DIEGO COUNTY, MORE THAN 63 PERCENT OF ADULTS ARE OVERWEIGHT OR OBESE. OBESITY INCREASES THE RISK FOR HEART DISEASE, TYPE 2 DIABETES, HIGH BLOOD PRESSURE, STROKE AND SOME FORMS OF CANCER. THE NATIONS LOW INCOME, MINORITY POPULATIONS ARE AT AN EVEN GREATER RISK. IN AN EFFORT TO ADDRESS THIS CRITICAL HEALTH CONCERN, STAFF MEMBERS AT THE C FORM 990, PART III, LINE 4A (CONTINUED) LA MAESTRA FAMILY CLINIC WILL BRING A NEW PERSPECTIVE TO THE PARTNERSHIP AS A COMMUNITY HEALTH CENTER AND PRIMARY CARE PROVIDER SERVING THE CULTURALLY DIVERSE POPULATIONS WITHIN THE CITY HEIGHTS COMMUNITY. LA MAESTRA IS COMMITTED TO MAINTAINING THE COLLABORATIVE NATURE OF THE PARTNERSHIP, AND WILL CONTINUE TO WORK WITH CURRENT CHWC AGENCIES AS WELL AS LOOK FOR OPPORTUNITIES TO EXPAND HEALTH PROMOTION SERVICES. THE SCRIPPS MERCY SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC), COLLOCATED IN THE WELLNESS CENTER, WILL CONTINUE TO PROVIDE WIC SERVICES AS ONE PROGRAM WITHIN THE CITY HEIGHTS WELLNESS CENTER. COLLABORATIVE FOR HEALTHY WEIGHT THIS ADVISORY GROUP MEETS MONTHLY. COLLABORATE FOR HEALTHY WEIGHT IS A PROGRAM OF THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) AND THE NATIONAL INITIATIVE FOR CHILDRENS HEALTHCARE QUALITY (NICHQ). THE SHARED VISION IS TO CREATE PARTNERSHIPS BETWEEN PRIMARY CARE, PUBLIC HEALTH, AND COMMUNITY ORGANIZATIONS TO DISCOVER SUSTAINABLE WAYS TO PROMOTE HEALTHY WEIGHT AND ELIMINATE HEALTH DISPARITIES IN COMMUNITIES ACROSS THE UNITED STATES. ALL THREE SECTORS COMPOSING OF 120 MEMBERS MUST COLLABORATE, USING EVIDENCE-BASED APPROACHES, TO REVERSE THE OBESITY EPIDEMIC AND IMPROVE THE HEALTH OF OUR COMMUNITIES. SEVERAL MANUSCRIPTS ARE UNDER DEVELOPMENT. (SPONSORED BY SCRIPPS MERCY HOSPITAL CHULA VISTA, COMMUNITY BENEFITS) MATERNAL CHILD HEALTH & HIGH RISK PREGNANCY MOTHERS, INFANTS AND CHILDREN MAKEUP A LARGE SEGMENT OF THE U.S. POPULATION AND THEIR WELL-BEING IS A HEALTH PREDICTOR FOR THE NEXT GENERATION. THERE IS TREMENDOUS FOCUS ON MATERNAL ILLNESS AND DEATH, AND INFANT HEALTH AND SURVIVAL, INCLUDING INFANT MORTALITY RATES, ACCESS TO PREVENTATIVE CARE, AND FETAL, PERINATAL AND OTHER INFANT DEATHS. MATERNAL AND INFANT HEALTH ISSUES INCLUDE: - ALCOHOL, TOBACCO AND ILLEGAL SUBSTANCES DURING PREGNANCY, WHICH ARE MAJOR RISK FACTORS FOR LOW BIRTH WEIGHT AND OTHER POOR OUTCOMES. - VERY LOW BIRTH WEIGHT ASSOCIATED WITH PRETERM BIRTH, SPONTANEOUS ABORTION, LOW PRE-PREGNANCY WEIGHT AND SMOKING. - INFANT DEATH RATES ARE HIGHEST AMONG INFANTS BORN TO YOUNG TEENAGERS AND MOTHERS 44 YEARS AND OLDER. BEING PREGNANT, OR TRYING TO BECOME PREGNANT, IS ONLY A SMALL PORTION OF A WOMANS LIFE. UNINTENDED PREGNANCY, EITHER MISTIMED OR UNWANTED AT THE TIME OF CONCEPTION, ACCOUNTS FOR AN ESTIMATED 49 PERCENT OF PREGNANCIES IN THE U.S. THESE PREGNANCIES ARE ASSOCIATED WITH INCREASED MORBIDITY, AS WELL AS BEHAVIORS LINKED TO ADVERSE HEALTH. WOMEN WHO CAN PLAN THE NUMBER AND TIMING OF THEIR CHILDREN EXPERIENCE IMPROVED HEALTH, FEWER UNPLANNED PREGNANCIES AND BIRTHS, AND LOWER ABORTION RATES. HIGH RISK PREGNANCY HIGH RISK PREGNANCY CAN BE THE RESULT OF A MEDICAL CONDITION PRESENT BEFORE PREGNANCY OR A MEDICAL CONDITION THAT DEVELOPS DURING PREGNANCY FOR EITHER MOM OR BABY AND CAUSES THE PREGNANCY TO BECOME HIGH RISK. A HIGH RISK PREGNANCY CAN POSE PROBLEMS BEFORE, DURING OR AFTER DELIVERY AND MIGHT REQUIRE SPECIAL MONITORING THROUGHOUT THE PREGNANCY. RISK FACTORS: - ADVANCED MATERNAL AGE: INCREASED RISK FOR MOTHERS 35 YEARS AND OLDER. - LIFESTYLE CHOICES: SMOKING, ALCOHOL CONSUMPTION, USE OF ILLEGAL DRUGS. - MEDICAL HISTORY: PRIOR HIGH RISK PREGNANCIES OR DELIVERIES, FETAL GENETIC CONDITIONS, FAMILY HISTORY OF GENETIC CONDITIONS. - UNDERLYING CONDITIONS: DIABETES, HIGH BLOOD PRESSURE AND EPILEPSY. - MULTIPLE PREGNANCY. - OBESITY DURING PREGNANCY THERE WERE 43,627 LIVE BIRTHS IN SDC OVERALL IN 2013 AND THE FETAL MORTALITY IN SDC WAS 4.56 DEATHS, MEETING THE HP 2020 NATIONAL TARGETS FOR ALL MATERNAL AND INFANT HEALTH INDICATORS INCLUDING THE TARGET OF LESS THAN 5.6 FETAL DEATHS PER 1,000 LIVE BIRTHS AND FETAL DEATHS. MATERNAL AND INFANT HEALTH INDICATORS BY SDC REGION, 2013 SDC REGIONS MET ALL HP 2020 NATIONAL TARGETS IN 2013. IN 2013, FETAL MORTALITY WAS 4.5 FETAL DEATHS PER 1,000 LIVE BIRTHS AND FETAL DEATHS IN THE NORTH COASTAL REGION, 4.3 IN THE NORTH CENTRAL REGION, 5.7 IN THE CENTRAL REGION, 3.1 IN THE SOUTH REGION, 5.6 IN THE EAST REGION, AND 4.1 IN THE NORTH INLAND REGION. SCRIPPS HEALTH CONTINUED TO ENHANCE PRENATAL EDUCATION FOR LOW INCOME WOMEN IN SAN DIEGO COUNTY IN FISCAL YEAR 2016. THE FOLLOWING ARE SOME EXAMPLES: SCRIPPS MEMORIAL HOSPITAL LA JOLLA COMMUNITY BENEFIT SERVICES - OFFERED MORE THAN 1,000 MATERNAL CHILD HEALTH CLASSES THROUGHOUT SAN DIEGO COUNTY TO ENHANCE PARENTING SKILLS. LOW INCOME WOMEN IN SAN DIEGO WHO WERE ELIGIBLE ATTENDED CLASSES AT NO CHARGE OR ON A SLIDING FEE SCHEDULE. - MAINTAINED EXISTING PRENATAL EDUCATION SERVICES IN ALL REGIONS OF THE COUNTY, ENSURING THAT PROGRAMS CONTINUED TO DEMONSTRATE A SATISFACTION RATING ABOVE 90 PERCENT - PROVIDED AND SUPPORTED WEEKLY BREASTFEEDING SUPPORT GROUPS AT SEVEN LOCATIONS THROUGHOUT SAN DIEGO COUNTY, INCLUDING TWO WITH BILINGUAL SERVICES. - OFFERED MATERNAL CHILD HEALTH CLASSES THROUGHOUT THE COMMUNITY, SUCH AS BASIC TRAINING FOR DADS, GETTING READY FOR THE BABY, INFANT CPR AND SAFETY, PARENT CONNECTION PROGRAMS AND REDIRECTING CHILDRENS BEHAVIOR. - OFFERED THE DOGS AND BABIES PROGRAMS QUARTERLY, WITH MORE THAN 40 ATTENDEES. - OFFERED WEEKLY MOMMY AND ME YOGA PROGRAMS FOR NEW PARENTS. - OFFERED A PRENATAL YOGA PROGRAM FOR EXPECTANT WOMEN IN SAN DIEGO COUNTY. - OFFERED A PREGNANCY NUTRITION PROGRAM QUARTERLY AT SCRIPPS MEMORIAL HOSPITAL LA JOLLA. - OFFERED CLASSES IN PELVIC FLOOR AND PREGNANCY CHANGES FOR EXPECTANT FAMILIES AT SCRIPPS MEMORIAL HOSPITAL LA JOLLA. - OFFERED CLASSES IN PELVIC FLOOR AND POSTPARTUM CHANGES FOR NEW MOTHERS THROUGHOUT THE COMMUNITY. FIRST 5 AND PROMISE NEIGHBORHOOD MORE THAN 350 SERVICES WERE RECEIVED FOR FIRST TIME MOTHERS INCLUDING: HOME VISITS, REFERRALS RECEIVED, DATA ENTRY, FOLLOW UP PHONE CALLS, PATENTING CLASSES AND OTHER SUPPORT SERVICES. A TOTAL OF 231 PARENTS PARTICIPATED IN PARENTING CLASSES, 213 SESSIONS PROVIDED. (SPONSORED BY SCRIPPS MERCY HOSPITAL CHULA VISTA, COMMUNITY BENEFITS) SCRIPPS MERCYS SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC) SCRIPPS MERCY HOSPITAL IS ONE OF FIVE REGIONAL ORGANIZATIONS THAT ADMINISTER THE STATE FUNDED WIC PROGRAM. THE PROGRAM SERVES SIX LOCATIONS CONVENIENTLY SITUATED NEAR COMMUNITY CLINICS AND/OR HOSPITALS IN THE CENTRAL SAN DIEGO AREA. WIC TARGETS LOW INCOME PREGNANT AND POSTPARTUM WOMEN, INFANTS AND CHILDREN (AGES 0 TO 5 YEARS). SCRIPPS MERCY WIC SERVES APPROXIMATELY 7,500 WOMEN AND CHILDREN ANNUALLY, 44 PERCENT IN THE CITY HEIGHTS COMMUNITY. IN CITY HEIGHTS CLIENTS ARE 91 PERCENT HISPANIC AND INCLUDE PREGNANT AND POSTPARTUM WOMEN (24%), INFANTS (20%) AND CHILDREN (56%). IN FISCAL YEAR 2016, THE PROGRAM PROVIDED NUTRITION SERVICES, COUNSELING AND FOOD VOUCHERS FOR 80,049 WOMEN AND CHILDREN IN SOUTH AND CENTRAL SAN DIEGO. THE SCRIPPS MERCY WIC PROGRAM PLAYS A KEY ROLE IN MATERNITY CARE BY REACHING LOW INCOME WOMEN TO PROMOTE PRENATAL CARE, GOOD NUTRITION AND BREASTFEEDING DURING PREGNANCY AND OFFER LACTATION SUPPORT (ONE ON ONE AND GROUP), AS WELL AS SUPPLIES, PUMPS AND BREAST PADS, DURING THE POSTPARTUM PERIOD. (SPONSORED BY SCRIPPS MERCY HOSPITAL SAN DIEGO) CITY HEIGHTS EAST AFRICAN ALLIANCE HEALTH ADVOCACY PROJECT THE CITY HEIGHTS WELLNESS CENTER HEALTH ADVOCACY PROJECT IS SUPPORT BY A GRANT FROM THE CALIFORNIA ENDOWMENT FOUNDATION AND IS DESIGNED TO STRENGTHEN THE CAPACITY TO DELIVER CULTURALLY AND RELIGIOUSLY COMPETENT HEALTH PROMOTION SERVICES TO SOMALI AND EAST AFRICAN WOMEN AND THEIR FAMILIES. THE PROGRAM ADDRESSES UNMET NEEDS LIKE PRENATAL OUTREACH AND EDUCATION, CULTURALLY ADAPTED NUTRITION AND FITNESS EDUCATION, BREASTFEEDING EDUCATION, EARLY CHILDHOOD HEALTH, AND NUTRITION AND SAFETY CLASSES. (SPONSORED BY SCRIPPS MERCY HOSPITAL SAN DIEGO, COMMUNITY BENEFITS) CENTERING PREGNANCY, SCRIPPS FAMILY MEDICINE RESIDENCY RAISING HEALTHY FAMILIES AND CARING FOR THE NEXT GENERATION OF SAN DIEGANS BEFORE THEYRE BORN HELP CREATE A HEALTHIER COMMUNITY FOR YEARS TO COME. THE SCRIPPS FAMILY MEDICINE PROGRAM AT SCRIPPS MERCY HOSPITAL CHULA VISTA, IS PROVIDING ACCESS, EDUCATION AND CLINICAL SERVICES TO NEARLY 200 PREGNANT WOMEN IN SOUTH SAN DIEGO COUNTY. THE GOAL OF THE PROGRAM, "IMPROVING PERINATAL CARE FOR UNDERSERVED LATINA WOMEN - HEALTHY WOMEN, HEALTHY BABIES", IS TO PROVIDE ACCESS TO PERINATAL CARE FOR UNDERSERVED LATINA WOMEN IN ORDER TO IMPROVE BIRTH OUTCOMES. THE PROGRAM APPLIES THE PRINCIPLES OF THE CENTER HEALTH CARE INSTITUTE AND FOCUSES ON CHANGING THE WAY PATIENTS EXPERIENCE THEIR CARE THROUGH ASSESSMENT, EDUCATION AND GROUP SUPPORT. CENTERING PREGNANCY IS THE INSTITUTES MODEL DEVOTED SPECIFICALLY TO IMPROVING MATERNAL AND CHILD HEALTH, AND HAS BEEN SHOWN TO RESULT IN INCREASED PRENATAL VISITS, GREATER LEVELS OF BREASTFEEDING AND STRONGER RELATIONSHIPS BETWEEN MOTHERS AND THEIR HEALTHCARE PROVIDERS BEFORE, DURING AND AFTER PREGNANCY. THE RESULTS ARE PROMISING. WOMEN WHO GAVE BIRTH REPORTED AN ENHANCED PRENATAL EXPERIENCE, GAINED LESS WEIGHT THROUGHOUT THEIR PREGNANCY AND SHOWED IMPROVED HEALTHCARE KNOWLEDGE. AS THE PROGRAM CONTIN FORM 990, PART III, LINE 4A (CONTINUED) EVERY 15 MINUTES ALCOHOL CAN BE ATTRIBUTED TO MORE THAN 100,000 DEATHS IN THE U.S. ANNUALLY, INCLUDING 41% OF ALL TRAFFIC FATALITIES. THE EVERY 15 MINUTES PROGRAM IS A TWO-DAY IMMERSION EXPERIENCE FOR TEENS ON THE REALISTIC CONSEQUENCES OF DRINKING AND DRIVING, WHICH INVOLVES THE SCHOOLS, LAW ENFORCEMENT, COURTS, EMERGENCY SERVICE PROVIDERS, AND THE MORTUARY. THE "INJURED" STUDENTS ARE TAKEN TO SCRIPPS MERCY TRAUMA CENTER. THIS PROGRAM IS SPONSORED JOINTLY BY LOCAL HIGH SCHOOLS, COUNTY POLICE AND SHERIFFS DEPARTMENTS, AMBULANCE SERVICES, AND EMERGENCY DEPARTMENTS. (SPONSORED BY SCRIPPS MERCY HOSPITAL) BEACH AREA COMMUNITY COURT PROGRAM THE PROGRAM IS AN EDUCATIONAL PROGRAM FOR FIRST TIME OFFENDERS FOR QUALITY OF LIFE CRIMES. THIS IS A COLLABORATION WITH THE SAN DIEGO POLICE DEPARTMENT, PARKS AND RECREATION, DISTRICT ATTORNEYS OFFICE AND DISCOVER PACIFIC BEACH. EDUCATION IS PROVIDED TO THE PARTICIPANTS REGARDING THESE QUALITY OF LIFE CRIMES AND THEIR EFFECTS ON THE COMMUNITY, THE EFFECTS OF SMOKING AND ALCOHOL CONSUMPTION AND THE RULES AND REGULATIONS FOR THE BEACH COMMUNITY. (SPONSORED BY SCRIPPS MEMORIAL HOSPITAL LA JOLLA, TRAUMA DEPARTMENT) CAR SEAT CHECK SCRIPPS PROVIDES A SAFETY ASSESSMENT OF THE INSTALLATION OF A CHILDS CARE SEAT. OFFERED AT NO COST TO LOW/MEDIAN INCOME AND REFUGEE FAMILIES. (SPONSORED BY SCRIPPS MERCY HOSPITAL SAN DIEGO) BEHAVIORAL HEALTH BEHAVIORAL HEALTH IS AN IMPORTANT HEALTH NEED BECAUSE IT IMPACTS AN INDIVIDUALS OVERALL HEALTH STATUS AND IS A COMORBIDITY OFTEN ASSOCIATED WITH MULTIPLE CHRONIC CONDITIONS, SUCH AS DIABETES, OBESITY AND ASTHMA. BEHAVIORAL HEALTH ENCOMPASSES MANY DIFFERENT AREAS INCLUDING MENTAL HEALTH, MENTAL ILLNESS AND SUBSTANCE ABUSE. BECAUSE OF ITS BROADNESS, IT IS OFTEN DIFFICULT TO CAPTURE THE NEED FOR BEHAVIORAL HEALTH SERVICES WITH A SINGLE MEASURE. AN ANALYSIS OF MORTALITY DATA IN SAN DIEGO COUNTY FOUND THAT IN 2012, ALZHEIMERS DISEASE WAS THE THIRD LEADING CAUSE OF DEATH AND INTENTIONAL SELF-HARM (SUICIDE) WAS THE EIGHTH. HOSPITAL EMERGENCY DEPARTMENT ENCOUNTERS AND INPATIENT DISCHARGE DATA FOR PATIENTS WITH A PRIMARY DIAGNOSIS OF BEHAVIORAL HEALTH-ASSOCIATED ICD 9 CODE IN 2013 WAS USED TO PROVIDE AN OVERVIEW OF MAIN REASONS INDIVIDUALS SOUGHT CARE RELATED TO BEHAVIORAL HEALTH BY AGE GROUP. A SUMMARY OF THE TRENDS FOUND WERE AS FOLLOWS: - OSHPD ED DISCHARGE DATA: ANXIETY DISORDERS WERE THE TOP PRIMARY DIAGNOSIS FOR ED DISCHARGE AMONG THOSE AGED 5 THROUGH 44 AND THOSE 65 AND OLDER. FOR THOSE AGED 45-64, THE TOP ED DISCHARGE FOR BEHAVIORAL HEALTH WAS ALCOHOL-RELATED DISORDER FOLLOWED BY ANXIETY AND MOOD DISORDERS. ALCOHOL RELATED DISORDERS WAS THE NUMBER TWO PRIMARY DIAGNOSIS FOR DISCHARGE FOR THOSE AGED 15 THROUGH 44 AND THOSE 65 YEARS AND OLDER. - OSHPD INPATIENT DISCHARGE DATA REVEALED THAT WHEN EXAMINING THE ICD 9 CODES RELATED TO BEHAVIORAL HEALTH, 'MOOD DISORDERS' WAS THE TOP PRIMARY DIAGNOSIS FOR INPATIENT DISCHARGE FOR AGES 5 THROUGH 24 AND 45 AND OVER. FOR THOSE AGED 25 THROUGH 44, THE TOP BEHAVIORAL HEALTH PRIMARY DIAGNOSIS WAS 'SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS' FOLLOWED BY MOOD DISORDERS. - FEEDBACK FROM THE BEHAVIORAL HEALTH DISCUSSIONS IN THE 2016 CHNA FOUND THAT HIGH RATES OF PSYCHOTIC DISCHARGES IN AGES 25 TO 44 WERE LIKELY LINKED TO UNDERLYING SUBSTANCE ABUSE PROBLEMS. ALTHOUGH PARTICIPANTS AGREED WITH THE FINDINGS, IT WAS FOUND THAT HOSPITAL CODING MAY POTENTIALLY UNDERREPRESENT THE PREVALENCE OF UNDERLYING ISSUES AND MISS CERTAIN CONDITIONS. MOST NOTABLY MISSING FROM OSHPD DATA WAS DEVELOPMENTAL DISORDERS. THE GROUPS ALSO POINTED OUT THE IMPORTANCE OF EMERGING DATA TRENDS. IN RECENT YEARS, DISCUSSION PARTICIPANTS CITED A SIGNIFICANT INCREASE IN DRUG-RELATED DISCHARGES, PARTICULARLY METHAMPHETAMINE (~OVER 100%). IN THE 2016 CHNA MENTAL HEALTH ISSUES AND ALCOHOL/DRUG ABUSE ISSUES WERE CONSISTENTLY SELECTED BY THE HIGHEST NUMBER OF HHSA SURVEY PARTICIPANTS IN ALL REGIONS AS HEALTH PROBLEMS THAT HAVE THE GREATEST IMPACT ON OVERALL COMMUNITY HEALTH. IN ADDITION, AGING CONCERNS INCLUDING ALZHEIMERS DISEASE WAS CITED AMONG THE TOP FIVE MOST IMPORTANT HEALTH NEEDS IN ALL REGIONS IN SDC EXCEPT THE CENTRAL REGION. THE FOLLOWING CATEGORIES WERE FOUND TO BE IMPORTANT HEALTH NEEDS WITH BEHAVIORAL HEALTH IN SDC: - ALZHEIMERS DISEASE (SENIORS) - ANXIETY (ALL AGE GROUPS) - DRUG AND ALCOHOL ISSUES (TEENS AND ADULTS) - MOOD DISORDERS (ALL AGE GROUPS) ANXIETY: ANXIETY IS A NORMAL REACTION TO STRESS BUT CAN BECOME EXCESSIVE, DIFFICULT TO CONTROL, AND ULTIMATELY INTERFERE WITH NORMAL DAY-TO-DAY LIVING. THERE ARE WIDE VARIETY OF ANXIETY DISORDERS INCLUDING POST-TRAUMATIC STRESS DISORDER. NATIONAL PREVALENCE DATA ESTIMATES THAT 18% OF THE POPULATION HAD AN ANXIETY DISORDER, WITH PHOBIAS AND GENERALIZED ANXIETY BEING THE MOST COMMON. IN SAN DIEGO COUNTY, THERE HAS BEEN A STEADY INCREASE IN THE RATE OF ED DISCHARGES WITH A PRIMARY DIAGNOSIS OF ANXIETY. IN PARTICULAR, THERE HAS BEEN A 64.2% INCREASE IN CHILDREN UP TO AGE 14 FROM 25 PER 100,000 IN 2010 TO 41 PER 100,000 IN 2013. SUBSTANCE ABUSE: THE SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (SAMHSA) DEFINES SUBSTANCE USE DISORDERS AS THE RECURRENT USE OF ALCOHOL AND/OR DRUGS WHICH CAUSES CLINICALLY AND FUNCTIONALLY SIGNIFICANT IMPAIRMENT, SUCH AS HEALTH PROBLEMS, DISABILITY, AND FAILURE TO MEET MAJOR RESPONSIBILITIES AT WORK, SCHOOL, OR HOME. THE PERCENTAGE OF ADULTS AGED 18 AND OLDER IN SAN DIEGO COUNTY WHO SELF-REPORT HEAVY ALCOHOL CONSUMPTION (DEFINED AS MORE THAN TWO DRINKS PER DAY ON AVERAGE FOR MEN AND ONE DRINK PER DAY ON AVERAGE FOR WOMEN) IS 17.2%, ADDITIONALLY, 12.1% REPORTED CURRENTLY SMOKING CIGARETTES SOME DAYS OR EVERYDAY ACCORDING TO THE BRFSS. ACUTE SUBSTANCE ABUSE HOSPITALIZATION RATES INCREASED 37.4% FROM 2010 TO 2013 AND INCREASED MOST AMONG 15-24 YEAR OLDS (58%). ACUTE ALCOHOL HOSPITALIZATION RATES GREW MOST AMONG 25-44 YEAR OLDS WITH A 45.9% INCREASE BETWEEN 2010 AND 2013. FINALLY, CHRONIC ALCOHOL ED VISITS AMONG SENIORS AGED 65 AND OLDER INCREASED 89.7% DURING THE SAME PERIOD. ALZHEIMERS DISEASE: ALZHEIMERS IS THE MOST COMMON FORM OF DEMENTIA ALTHOUGH ALL DEMENTIAS ARE CHARACTERIZED BY A DECLINE IN MEMORY, THINKING SKILLS, AND ABILITY TO PERFORM EVERYDAY ACTIVITIES. ACCORDING TO THE 2015 SAN DIEGO COUNTY SENIOR HEALTH REPORT, ROUGHLY 60,000 INDIVIDUALS IN SAN DIEGO ARE LIVING WITH ALZHEIMERS DISEASE OR OTHER DEMENTIA (ADOD) IN 2012. IT IS PROJECTED THAT THE NUMBER OF SAN DIEGO ADULTS AGED 55 AND OLDER WITH ADOD WILL INCREASE BY 55.9% BETWEEN 2012 AND 2030. THE LARGEST MAJORITY OF INDIVIDUALS LIVE IN THE EAST REGION THOUGH THE LARGEST PERCENTAGE IS PROJECTED IN THE NORTH CENTRAL. ADOD ALSO AFFECTS CAREGIVERS PHYSICALLY AND EMOTIONALLY SO SIGNIFICANT INCREASES IN THE NUMBER OF PEOPLE LIVING WITH ADOD WILL HAVE AN IMPACT THAT EXTENDS BEYOND THOSE AFFECTED. MOOD DISORDERS: MOOD DISORDERS ARE PARTICULARLY PREVALENT IN THE COMMUNITY AND INCREASING. DATA FROM THE CENTERS FOR MEDICARE AND MEDICAID SHOW THAT AMONG THE FEE-FOR-SERVICE POPULATION, 14.5% SUFFER FROM DEPRESSION COMPARED TO 13.4% IN CALIFORNIA IN 2012. IN ADDITION, AN ANALYSIS OF OSHPD DATA SHOWS THAT THE RATE OF ED DISCHARGES PER 100,000 INDIVIDUALS WITH A PRIMARY DIAGNOSIS OF MOOD DISORDERS INCREASED BY 38.7% FROM 2010 TO 2013 FOR CHILDREN UP TO AGE 14, HOSPITALIZATIONS ALSO WENT UP BY 26.8% IN THIS AGE GROUP. MOOD DISORDERS ARE OFTEN ASSOCIATED WITH COMORBIDITIES INCLUDING DIABETES, OBESITY AND ASTHMA. SUICIDE IS ALSO AN INDICATOR OF POOR MENTAL HEALTH AND IS ONE OF THE MAJOR COMPLICATIONS OF DEPRESSION. IN SAN DIEGO COUNTY, THE SUICIDE RATE ACCORDING TO THE CALIFORNIA DEPARTMENT OF PUBLIC HEALTH IS 11.3 PER 100,000 POPULATION WHICH IS ABOVE THE STATE SUICIDE RATE OF 9.8 PER 100,000 AND ABOVE THE HP2020 BENCHMARK OF 10.2 PER 100,000 POPULATION. IT IS ALSO THE EIGHTH LEADING CAUSE OF DEATH IN SAN DIEGO COUNTY. WHEN ADJUSTING FOR RACE/ETHNICITY, NON-HISPANIC WHITES ARE MORE LIKELY TO COMMIT SUICIDE FOLLOWED BY NATIVE HAWAIIAN/PACIFIC ISLANDERS. COMPARING SUICIDE RATES BY RACE, NON-HISPANIC, BLACK, ASIAN, NATIVE HAWAIIAN/PACIFIC ISLANDERS, AND THOSE OF MULTIPLE RACES WERE ALL ABOVE STATE LEVELS. MENTAL AND BEHAVIOR HEALTH COVERS A BROAD RANGE OF TOPICS: - SUBSTANCE ABUSE AND MISUSE ARE ONE SET OF BEHAVIORAL HEALTH PROBLEMS. OTHERS INCLUDE (BUT NOT LIMITED TO) SERIOUS PSYCHOLOGICAL DISTRESS, SUICIDE, AND MENTAL ILLNESS. - BARRIERS CAN EXIST FOR PATIENTS ACROSS THE LIFESPAN. THE NATIONAL SURVEY FOR CHILDRENS HEALTH (HRSA, 2010) SHOWED THAT AMONG CHILDREN WITH EMOTIONAL, DEVELOPMENTAL, OR BEHAVIORAL CONDITIONS, 45.6% WERE RECEIVING NEEDED MENTAL HEALTH SERVICES. - IN 2014, AMONG THE 20.2 MILLION ADULTS WITH A PAST YEAR SUBSTANCE USE DISORDER, 7.9 MILLION (39.1%) HAD ANY MENTAL ILLNESS IN THE PAST YEAR. DEPRESSION: - DEPRESSION IS THE LEADING CAUSE OF DISABILITY WORLDWIDE AND IS A MAJOR CONTRIBUTOR OF GLOBAL BURDEN OF DISEASE. - IN 2014, 11.4% OF ADOLESCENTS AGED 12 TO 17 HAD A MAJOR DEPRESSIVE EPISODE. THE PERCENTAGE WHO USED ILLICIT DRUGS FORM 990, PART III, LINE 4A (CONTINUED) SCRIPPS HEALTH BEHAVIORAL HEALTH INPATIENT PROGRAMS INDIVIDUALS SUFFERING FROM ACUTE PSYCHIATRIC DISORDERS ARE SOMETIMES UNABLE TO LIVE INDEPENDENTLY OR MAY EVEN POSE A DANGER TO THEMSELVES OR OTHERS. IN SUCH CASES, HOSPITALIZATION MAY BE THE MOST APPROPRIATE ALTERNATIVE. THE BEHAVIORAL HEALTH INPATIENT PROGRAM AT SCRIPPS MERCY HOSPITAL HELPS PATIENTS AND THEIR LOVED ONES WORK THROUGH SHORT-TERM CRISES, MANAGE MENTAL ILLNESS AND RESUME THEIR DAILY LIVES. CHALLENGES - LIKE MANY BEHAVIORAL HEALTH PROGRAMS ACROSS THE COUNTRY, FUNDING IS DIFFICULT, AS PAYMENT RATES HAVE NOT KEPT PACE WITH THE COST TO PROVIDE CARE. - IN 2016, THE SCRIPPS MERCY BEHAVIORAL HEALTH PROGRAM LOST $2.9 MILLION. - IN 2016, 1.9 PERCENT OF PATIENTS IN THE INPATIENT UNIT WERE UNINSURED. BEHAVIORAL HEALTH OUTPATIENT PROGRAMS SCRIPPS BEHAVIORAL HEALTH ENTERED INTO AN AGREEMENT IN MAY 2016 TO TRANSITION THE INTENSIVE BEHAVIORAL HEALTH OUTPATIENT PROGRAM TO THE FAMILY HEALTH CENTERS OF SAN DIEGO AND EXPAND OUTPATIENT BEHAVIORAL HEALTH OFFERINGS TO THE POPULATION SERVED. SCRIPPS MERCY AND FAMILY HEALTH CENTERS BEHAVIORAL HEALTH PARTNERSHIP SCRIPPS MERCY HAS ESTABLISHED AN INITIATIVE WITH FAMILY HEALTH CENTERS OF SAN DIEGO (FHCSD) TO CREATE A MORE ROBUST BEHAVIORAL HEALTH CARE SYSTEM FOR MEDI-CAL PATIENTS THAT RECEIVE CARE AT SMH. THE GOAL IS TO STRENGTHEN THE CONTINUUM OF INTEGRATED PRIMARY AND MENTAL HEALTH SERVICES FOR PATIENTS DISCHARGED FROM VARIOUS HOSPITAL SETTINGS (MEDICAL AND BEHAVIORAL HEALTH INPATIENT AND EMERGENCY CARE) THROUGH A VARIETY OF TIMELY PATIENT ENGAGEMENT STRATEGIES INCLUDING THE EXPANSION OF COMMUNITY-BASED BEHAVIORAL HEALTH SERVICES ADJACENT TO THE HOSPITAL. THE ULTIMATE GOAL IS TO INVOLVE PATIENTS IN APPROPRIATE OUTPATIENT CARE BEFORE THEIR BEHAVIORAL HEALTH ISSUES BECOME ACUTE SO THEY DO NOT RETURN TO THE EMERGENCY DEPARTMENT. MENTAL HEALTH OUTREACH SERVICES, A-VISONS VOCATIONAL TRAINING PROGRAM BEHAVIORAL HEALTH SERVICES AT SCRIPPS MERCY HOSPITAL, IN PARTNERSHIP WITH THE SAN DIEGO CHAPTER OF MENTAL HEALTH OF AMERICA ESTABLISHED THE A-VISONS VOCATIONAL TRAINING PROGRAM (SOCIAL REHABILITATION AND PREVOCATIONAL SERVICES FOR PEOPLE LIVING WITH MENTAL ILLNESS) TO HELP DECREASE THE STIGMA OF MENTAL ILLNESS AND OFFER VOLUNTEER AND EMPLOYMENT OPPORTUNITIES TO PERSONS WITH MENTAL ILLNESS. THIS SUPPORTIVE EMPLOYMENT PROGRAM PROVIDES VOCATIONAL TRAINING FOR PEOPLE RECEIVING MENTAL HEALTH TREATMENT, POTENTIALLY LEADING TO GREATER INDEPENDENCE. THIS YEAR, BEHAVIORAL HEALTH SERVICES CONTINUED PARTICIPATING IN THE A-VISIONS PROGRAM. SINCE ITS INCEPTION, 484 CLIENTS HAVE BEEN ENROLLED AND 91 HAVE BEEN SCRIPPS VOLUNTEERS AND 46 HAVE BEEN EMPLOYED AT SCRIPPS HEALTH. CURRENTLY, THERE ARE A TOTAL OF 29 ACTIVE CANDIDATES, 25 EMPLOYEES AND FOUR VOLUNTEERS PARTICIPATING IN THIS SUPPORTIVE EMPLOYMENT PROGRAM. A-VISIONS PARTICIPANTS HAVE BEEN EMPLOYED ON A CASUAL/PER DIEM BASIS BY SCRIPPS ENVIRONMENTAL SERVICES, FOOD SERVICES AND CLERICAL SUPPORT FOR HEALTH AND INFORMATION SERVICES, EMERGENCY SERVICES, NURSING RESEARCH, HUMAN RESOURCES AND PALLIATIVE CARE SERVICES. PAID A-VISIONS CANDIDATES TYPICALLY LIMIT THEIR WORK TO EIGHT HOURS PER WEEK, WHICH ALLOWS THEM TO MAINTAIN ELIGIBILITY FOR THE DISABILITY BENEFITS, MEDICATIONS AND ONGOING BEHAVIORAL HEALTHCARE THAT SUPPORTS THEIR WORK. INCREASING AWARENESS OF MENTAL HEALTH ISSUES IN FISCAL YEAR 2016, SCRIPPS BEHAVIORAL HEALTH SERVICES IMPROVED AWARENESS OF MENTAL HEALTH ISSUES BY PROVIDING INFORMATION AND SUPPORTIVE SERVICES FOR MORE THAN 1,000 PEOPLE AT COMMUNITY EVENTS. (SPONSORED BY SCRIPPS MERCY BEHAVIORAL HEALTH DEPARTMENT) COMMUNITY HEALTH IMPROVEMENT PARTNERS (CHIP) AND SUICIDE PREVENTION COUNCIL SCRIPPS IS A STRONG PARTNER OF CHIP. CHIP TRAINED APPROXIMATELY 8,000 COMMUNITY MEMBERS IN SUICIDE PREVENTION TO HELP ADDRESS RISING RATES OF SUICIDE IN THE COUNTY. PSYCHIATRIC LIAISON TEAM (PLT) THE PSYCHIATRIC LIAISON TEAM IS A MOBILE PSYCHIATRIC ASSESSMENT TEAM. CLINICIANS PROVIDE MENTAL HEALTH EVALUATION AND TRIAGE SERVICES TO ACCURATELY ASSESS PATIENTS AND PROVIDE THEM WITH BEST AND SAFEST COMMUNITY RESOURCES TO PROMOTE ONGOING CARE. THE TEAM AIMS TO HELP PEOPLE ADHERE TO TREATMENT PLANS, REDUCE HOSPITAL READMISSION RATES, RELIEVE SYMPTOMS AND ULTIMATELY ENSURE THE LONG-TERM STABILIZATION OF THE PATIENTS MENTAL HEALTH. SCRIPPS WILL CONTINUE TO PROVIDE A DEDICATED PSYCHIATRIC LIAISON TEAM AT ALL SCRIPPS HOSPITALS EMERGENCY DEPARTMENTS AND URGENT CARE SETTINGS (RANCHO BERNARDO AND TORREY PINES). SCRIPPS DRUG AND ALCOHOL RESOURCES NURSES SCRIPPS HAS IMPLEMENTED THE ROLE OF A MOBILE GROUP OF SPECIALLY TRAINED DRUG AND ALCOHOL RESOURCE NURSES THAT PROVIDE EDUCATION, INTERVENTIONS AND DISCHARGE PLACEMENT ASSISTANCE TO PATIENTS IN THE SCRIPPS HOSPITALS. THE RESOURCE NURSES WORK DIRECTLY WITH THE NURSING STAFF AT EACH OF THE HOSPITALS IN SEARCH OF PATIENTS WHO MAY BE AT RISK FOR ALCOHOL/DRUG WITHDRAWAL AND ASSIST WITH IMPLEMENTING A STANDARDIZED PROTOCOL WITHDRAWAL PROCESS. THROUGH A CONTRACT WITH VOLUNTEERS OF AMERICA (VOA), THE SCRIPPS RESOURCE NURSE IN COLLABORATION WITH CASE MANAGEMENT IS ABLE TO OFFER A LIMITED NUMBER PATIENTS IN NEED OF DETOX RESIDENTIAL PLACEMENT AT THE VOA FACILITY IN NATIONAL CITY. MI PUENTE/MY BRIDGE-SCRIPPS MERCY HOSPITAL CHULA VISTA INDIVIDUALS OF LOW SOCIOECONOMIC (SES) AND ETHNIC MINORITY STATUS, INCLUDING HISPANICS, THE LARGEST U.S. ETHNIC MINORITY GROUP ARE DISPROPORTIONATELY BURDENED BY CHRONIC CARDIOVASCULAR AND METABOLIC CONDITIONS ("CARDIOMETABOLIC" E.G. OBESITY, DIABETES, HYPERTENSION, HEART DISEASE). HIGH LEVELS OF UNMET BEHAVIORAL HEALTH IN THIS POPULATION CONTRIBUTE TO STRIKING DISPARITIES IN DISEASE PREVALENCE AND OUTCOMES. MI PUENTE APPLIES A RN PLUS VOLUNTEER APPROACH, AND BUILDS UPON A STRONG COLLABORATIVE PARTNERSHIP BETWEEN INPATIENT ("REFERRING") AND OUTPATIENT ("RECEIVING") CARE SETTINGS. MI PUENTE AIMS TO IMPROVE CONTINUITY OF CARE AND ADDRESS THE (PHYSICAL AND BEHAVIORAL) HEALTH NEEDS OF THE AT-RISK HISPANIC POPULATION. THIS PROGRAM HOLDS PROMISE FOR IMPACTFUL EXPANSION TO OTHER CONDITIONS AND UNDERSERVED POPULATIONS. (SPONSORED BY SCRIPPS WHITTIER DIABETES INSTITUTE) BEHAVIORAL HEALTH INTEGRATION PROGRAM (BHIP) IN DIABETES BEHAVIORAL HEALTH INTEGRATION PROGRAM (BHIP) IN DIABETES IS AN INTEGRATED, INTERDISCIPLINARY APPROACH TO MANAGING THE EMOTIONAL AND BEHAVIORAL NEEDS OF INDIVIDUALS WITH TYPE 1 AND TYPE 2 DIABETES. THE COLLOCATION OF MEDICAL AND BEHAVIORAL HEALTH SERVICES IN THE SAME FACILITY ALLOW FOR CONVENIENT, WARM HAND-OFF FROM PHYSICIAN TO BEHAVIORAL HEALTH SPECIALIST. IT ALSO AFFORDS OPPORTUNITIES FOR PHYSICIANS, DIABETES EDUCATORS AND OTHERS TO RECEIVE CONSULTATION ON BEHAVIORAL HEALTH CONCERNS, AND IN TURN, MORE COMPREHENSIVELY ADDRESS THE MULTI-FACETED NEEDS OF THEIR PATIENTS WITH DIABETES. (SPONSORED BY SCRIPPS WHITTIER DIABETES INSTITUTE) GUIDING VETERANS TO MENTAL HEALTH SERVICES SAN DIEGO IS HOME TO MORE THAN 250,000 VETERANS. A SUBSTANTIAL NUMBER OF OUR SERVICE MEMBERS HAVE SUFFERED OR ARE STRUGGLING WITH POST-TRAUMATIC STRESS DISORDER (PTSD), DEPRESSION, ANXIETY AND OTHER PSYCHOLOGICAL CONDITIONS RELATED TO MILITARY SERVICE AND REPEATED DEPLOYMENTS. PARTNERING WITH COMMUNITY-BASED ORGANIZATIONS, SCRIPPS IS ACTIVELY WORKING TO ASSIST THESE VETERANS THROUGH INFORMATIONAL SESSIONS DESIGNED TO IMPROVE KNOWLEDGE OF VETERANS MENTAL HEALTH ISSUES AND ACCESS TO COMMUNITY-BASED SERVICES. SCRIPPS IS WORKING WITH SAN DIEGO STATE UNIVERSITY TO IMPLEMENT A VETERANS MENTAL HEALTH COURSE IN THE SOCIAL WORK DEPARTMENT. (SPONSORED BY SCRIPPS MERCY HOSPITAL CHULA VISTA, COMMUNITY BENEFITS) MENTAL HEALTH SUPPORT SERVICES AT LOCAL SCHOOL-BASED CLINICS SCRIPPS FAMILY MEDICINE RESIDENCY AND SCRIPPS MERCY HOSPITAL CHULA VISTA WELL-BEING CENTER HAVE PARTNERED TO OFFER CLINICAL TRAINING OPPORTUNITIES FOR MASTER SOCIAL WORK STUDENTS IN TRAINING FROM SAN DIEGO STATE UNIVERSITY AT SOUTHWEST AND PALOMAR HIGH SCHOOLS. THESE STUDENTS WORK WITH LOCAL PROVIDERS THAT ADDRESS THE MENTAL HEALTH NEEDS OF VULNERABLE ADOLESCENTS. A VARIETY OF MENTAL HEALTH ISSUES ARE PRESENT FOR LOCAL HIGH SCHOOL STUDENTS. MANY OF THESE ISSUES INCLUDE DEPRESSION, ANXIETY AND SUICIDE RELATED CONCERNS. THE PROGRAM WORKS TO IMPROVE OVERALL MENTAL HEALTH CARE FOR LOCAL STUDENTS THROUGH A SCHOOL-BASED CLINIC. APPROXIMATELY 240 HOURS WERE SPENT IN THE SCHOOL-BASED CLINICS OFFERING SERVICES FOR ADOLESCENTS TO AN AVERAGE OF 12 STUDENTS PER WEEK. (SPONSORED BY SCRIPPS MERCY HOSPITAL CHULA VISTA, COMMUNITY BENEFITS) LATINOS Y LATINAS EN ACCIN LATINOS Y LATINAS EN ACCIN IS AN ORGANIZATION THAT WORKS WITH THE LATINO COMMUNITY THROUGH EDUCATION ON RIGHTS AND HEALTH OPPORTUNITIES. THE NEED FOR MENTAL HEALTH COUNSELING WAS IDENTIFIED IN THE LATINO COMMUNITY SO A SERIES OF CLASSES WERE FORMULATED TO MEET THE IDENTIFIED NEEDS OF LATINOS IN CENTRAL SAN DIEGO. THE SERIES WAS CALLED "EMOTIONAL HEALING TO MAINTAIN EMOTIONAL HEALTH". THE SIX WEEK SERIES INCLUDED THE FOLLOWING TOPICS: ANXIETY, DEPRESSIONS, STRESS, CO-DEPENDENCY, EM FORM 990, PART III, LINE 4A (CONTINUED) FOOD INSECURITY FOOD INSECURITY WAS PRIORITIZED AS THE NUMBER ONE SOCIAL DETERMINANTS OF HEALTH IN THE 2016 CHNA. FOOD INSECURITY IS THE INABILITY TO AFFORD ENOUGH FOOD FOR AN ACTIVE, HEALTHY LIFE. ONE IN SIX SAN DIEGANS ARE "FOOD INSECURE". AN ESTIMATED 485,521 SAN DIEGO COUNTY RESIDENTS, OR 15.7 PERCENT OF THE COUNTYS POPULATION, DO NOT HAVE ENOUGH FOOD FOR AN ACTIVE, HEALTHY LIFE. THE CALFRESH PROGRAM, FEDERALLY KNOWN AS THE SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP), ISSUES MONTHLY ELECTRONIC BENEFITS THAT CAN BE USED TO BUY FOODS AT PARTICIPATING MARKETS AND STORES. MORE THAN 290,000 SAN DIEGANS RECEIVE CALFRESH. STUDIES DEMONSTRATE THAT HUNGER SIGNIFICANTLY IMPACTS HEALTH. LACK OF ACCESS TO HEALTHY FOOD, OFTEN DUE TO AVAILABILITY AND COST, ARE STRESSORS THAT CONTRIBUTE TO DIABETES, HEART DISEASE, OBESITY, AND OTHER BEHAVIORAL HEALTH ISSUES IN A MYRIAD OF WAYS: - FOOD INSURE ADULTS WITH DIABETES HAVE HIGHER AVERAGE BLOOD SUGARS. - FOOD INSURE ADULTS ARE MORE LIKELY TO BE OBESE. - FOOD INSECURITY IS SIGNIFICANTLY MORE PREVALENT IN ADULTS WITH MOOD DISORDERS. - FOOD INSECURITY IS ASSOCIATED WITH INCREASED RISK OF SUICIDAL THOUGHTS AND SUBSTANCE ABUSE IN ADOLESCENTS. - FOOD INSECURE SENIORS HAVE A SIGNIFICANTLY HIGHER LIKELIHOOD OF HEART DISEASE, DEPRESSION AND LIMITED ACTIVITIES OF DAILY LIVING. - FOOD INSECURE ADULTS DELAY BUYING FOOD IN ORDER TO PURCHASE MEDICATIONS. THE CITY HEIGHTS WELLNESS CENTER (CHWC) HOSTS ELIGIBILITY WORKERS FROM LA MAESTRA FAMILY CLINIC ARE AVAILABLE TO COUNSEL PEOPLE AND ASSIST FILLING OUT APPLICATIONS FOR FOOD STAMP ASSISTANCE. CHWC NOT ONLY PROVIDES THE NEEDED SPACE FOR THE ACTIVITY, BUT ALSO ACTIVELY PARTICIPATES BY DEVELOPING OUTREACH FLYERS, SCHEDULING COMMUNITY RESIDENTS, AND OVERALL COORDINATION FOR THE CLASS. APPLICATIONS AND ASSISTANCE FOR CALFRESH TO SUPPLEMENT FOOD BUDGET AND ALLOW FAMILIES/INDIVIDUALS TO BUY NUTRITIOUS FOOD. HEALTH INSURANCE ENROLLMENT ASSISTANCE ASSIST COMMUNITY MEMBERS WITH HEALTH INSURANCE ELIGIBILITY AND APPLICATIONS HEALTH EDUCATION AND PARENTING CLASSES WORKING WITH A VARIETY OF COMMUNITY-BASED ORGANIZATION, THE CHWC PROVIDES A BROAD ARRAY OF HEALTH EDUCATION, PARENTING, NUTRITION AND COOKING CLASSES. SCRIPPS MERCY WIC PROGRAM THE CHWC IS HOME TO THE SMH-WIC PROGRAM THAT PROVIDES NUTRITION EDUCATION AND COUNSELING, BREASTFEEDING EDUCATION AND SUPPORT AND FOOD VOUCHERS TO PREGNANT AND PARENTING WOMEN, AND CHILDREN 0-5 YEARS OF AGE. IN ADDITION TO THE CHNA AND IMPLEMENTATION PLAN, SCRIPPS HEALTH WILL CONTINUE TO MEET COMMUNITY NEEDS BY PROVIDING CHARITY CARE AND UNCOMPENSATED CARE, PROFESSIONAL EDUCATION AND COMMUNITY BENEFIT PROGRAMS. SCRIPPS OFFERS COMMUNITY BENEFIT SERVICES THROUGH OUR FIVE ACUTE-CARE HOSPITAL CAMPUSES, HOME HEALTH SERVICES, WELLNESS CENTERS AND CLINICS. SCRIPPS SERVES A QUARTER OF THE TOTAL COUNTY POPULATION, CONCENTRATING SERVICES IN THE NORTH COASTAL, NORTH CENTRAL, CENTRAL AND SOUTH REGIONS OF SAN DIEGO COUNTY WHERE SCRIPPS FACILITIES ARE LOCATED. UNCOMPENSATED HEALTH CARE SCRIPPS CONTRIBUTES SIGNIFICANT RESOURCES TO PROVIDE LOW AND NO-COST HEALTH CARE FOR OUR PATIENTS IN NEED. DURING FISCAL YEAR 2016, SCRIPPS CONTRIBUTED $335,093,576 IN UNCOMPENSATED HEALTH CARE, INCLUDING $23,824,941 IN CHARITY CARE, $304,933,898 IN MEDI- CAL AND MEDICARE SHORTFALL, AND $6,334,737 IN BAD DEBT. SCRIPPS PROVIDES HOSPITAL SERVICES FOR ONE-QUARTER OF THE COUNTY'S UNINSURED PATIENTS. SCRIPPS MERCY HOSPITAL, SAN DIEGO AND SCRIPPS MERCY HOSPITAL, CHULA VISTA PROVIDE 57 PERCENT OF SCRIPPS' CHARITY CARE. THE HEALTH CARE SAFETY NET IN SAN DIEGO COUNTY IS HIGHLY DEPENDENT UPON HOSPITALS AND COMMUNITY HEALTH CLINICS TO CARE FOR UNINSURED AND MEDICALLY UNDERSERVED COMMUNITIES. FINDING MORE EFFECTIVE WAYS TO COORDINATE AND ENHANCE THE SAFETY NET IS A CRITICAL POLICY CHALLENGE. WHILE PUBLIC SUBSIDIES (E.G., COUNTY MEDICAL SERVICES) HELP FINANCE SERVICES FOR SAN DIEGO COUNTY'S UNINSURED POPULATIONS, THESE SUBSIDIES DO NOT COVER THE FULL COST OF CARE. COMBINED WITH MEDI-CAL AND MEDICARE FUNDING SHORTFALLS, SCRIPPS AND OTHER LOCAL HOSPITALS ABSORB THE COST OF CARING FOR UNINSURED PATIENTS IN THEIR OPERATING BUDGETS. THIS PLACES A SIGNIFICANT FINANCIAL BURDEN ON HOSPITALS AND PHYSICIANS. DEMOGRAPHIC PROFILE OF SAN DIEGO COUNTY CURRENT POPULATION DEMOGRAPHICS AND CHANGES IN DEMOGRAPHIC COMPOSITION OVER TIME PLAY A DETERMINING ROLE IN THE TYPES OF HEALTH AND SOCIAL SERVICES NEEDED BY COMMUNITIES. POPULATION SIZE, CHANGE IN POPULATION, RACE AND ETHNICITY, AND AGE OF A POPULATION ARE ALL IMPORTANT IN UNDERSTANDING COMMUNITIES AND ITS RESIDENTS. POPULATION: OVER THREE MILLION PEOPLE (3,138,265) LIVE IN THE 4,205 SQUARE MILE AREA OF SDC ACCORDING TO THE U.S. CENSUS BUREAU AMERICAN COMMUNITY SURVEY 2009-13, 5-YEAR ESTIMATES. THE POPULATION DENSITY FOR THIS AREA, ESTIMATED AT 746 PERSONS PER SQUARE MILE, IS GREATER THAN THE NATIONAL AVERAGE POPULATION DENSITY OF APPROXIMATELY 88 PERSONS PER SQUARE MILE. APPROXIMATELY 96.7% OF THE POPULATION LIVES IN AN URBAN AREA COMPARED TO JUST 3.3% LIVING IN RURAL AREAS. POPULATION CHANGE: ACCORDING TO THE U.S. CENSUS BUREAU DECENNIAL CENSUS, BETWEEN 2000 AND 2010 THE POPULATION IN SDC GREW BY 281,480 PERSONS, A CHANGE OF 10.0%.THIS IS SIMILAR TO THE PERCENTAGE POPULATION CHANGE SEEN DURING THE SAME TIME PERIOD IN CALIFORNIA (10.0%) AND THE UNITED STATES (9.7%). A SIGNIFICANT SHIFT IN TOTAL POPULATION OVER TIME IMPACTS THE DEMAND FOR HEALTH CARE PROVIDERS AND THE UTILIZATION OF COMMUNITY RESOURCES. RACE/ETHNICITY: IN THE AMERICAN COMMUNITY SURVEY, DATA FOR RACE AND ETHNICITY ARE COLLECTED SEPARATELY. OF THOSE WHO IDENTIFIED AS NON-HISPANIC (67.7%) IN SDC, THE MAJORITY IDENTIFIED THEIR RACE AS WHITE (70.9%), FOLLOWED BY ASIAN (16.1%), BLACK (7.1%), MULTIPLE RACES (4.5%), NATIVE HAWAIIAN/PACIFIC ISLANDER (0.6%), AND AMERICAN INDIAN/ALASKAN NATIVE (0.5%). OF THOSE WHO IDENTIFIED AS HISPANIC OR LATINO (32.4%) IN SDC, THE MAJORITY ALSO IDENTIFIED THEIR RACE AS WHITE (72.4%), FOLLOWED BY OTHER (19.9%), MULTIPLE RACES (5.1%), AMERICAN INDIAN/ALASKAN NATIVE (1.1%), BLACK (0.8%), ASIAN (0.6%), AND NATIVE HAWAIIAN/PACIFIC ISLANDER (0.1%). SAN DIEGOS UNINSURED THE LACK OF HEALTH INSURANCE IS CONSIDERED A KEY DRIVER OF HEALTH STATUS. BETWEEN 2010 AND 2013 UNINSURED RATE WAS RELATIVELY STABLE IN THE UNITED STATES, CALIFORNIA AND IN SAN DIEGO COUNTY. IN 2014, THE UNINSURED RATE SHARPLY DECREASED TO 12.3% WHICH WAS THE LARGEST CHANGE IN THE UNINSURED RATE THROUGHOUT THIS PERIOD. THIS DECREASE CAN BE ATTRIBUTED IN LARGE PART TO THE AFFORDABLE CARE ACT (ACA). THE CHANGING LANDSCAPE UNDER THE AFFORDABLE CARE ACT* THE AFFORDABLE CARE ACT (ACA) HAS PLAYED A SIGNIFICANT ROLE IN INCREASING ACCESS TO HEALTHCARE. IN 2014, A NUMBER OF CHANGES TOOK EFFECT IN CALIFORNIA INCLUDING: - THE EXPANSION OF MEDI-CAL TO INDIVIDUALS MAKING LESS THAN 138% OF THE POVERTY LEVEL - THE ESTABLISHMENT OF COVERED CALIFORNIA FOR INDIVIDUALS WHO MAKE UP TO 400% OF THE POVERTY LEVEL TO PURCHASE SUBSIDIZED HEALTH INSURANCE - THE ELIMINATION OF DISCRIMINATION DUE TO PRE-EXISTING CONDITIONS - THE REQUIREMENT TO OBTAIN HEALTH INSURANCE COVERAGE THESE HEALTHCARE REFORMS HAVE RESULTED IN A LARGE NUMBER OF NEWLY INSURED INDIVIDUALS. RECENT DATA FROM THE US CENSUS BUREAU DEMONSTRATES THE FOLLOWING CHANGES IN COVERAGE AS OF 2014: - DECREASE IN THE PERCENTAGE OF UNINSURED OVERALL IN THE US FROM 13.3% IN 2013 TO 10.4% IN 2014 - DECREASE IN THE PERCENTAGE OF UNINSURED CHILDREN UNDER AGE 19 FROM 7.5% TO 6.2% - DECREASE IN THE PERCENTAGE OF UNINSURED ACROSS ETHNIC GROUPS TO 19.9%, 11.8%, 9.3% AND 7.6% FOR HISPANICS, BLACKS, ASIANS, AND NON-HISPANICS WHITES, RESPECTIVELY. STILL, DISCREPANCIES REMAIN WITH THOSE AGED 19-64 LEAST LIKELY TO BE INSURED AND ROUGHLY 1 IN 5 HISPANICS STILL LACKING HEALTH INSURANCE. (*SOURCE: SMITH, JESSICA C. AND CARLA MEDALIA, U.S. CENSUS BUREAU, CURRENT POPULATION REPORTS, P60-253, HEALTH INSURANCE COVERAGE IN THE UNITED STATES: 2014, U.S. GOVERNMENT PRINTING OFFICE, WASHINGTON, DC, 2015.) THERE ARE THREE INDICATORS DETERMINED TO BE THE MOST POWERFUL PREDICTORS OF POPULATION HEALTH: POVERTY RATE, PERCENT OF POPULATION UNINSURED, AND EDUCATIONAL ATTAINMENT. LOW-INCOME, UNINSURED, AND UNDEREDUCATED INDIVIDUALS HAVE BEEN FOUND TO BE MOST AT RISK FOR POOR HEALTH STATUS. FIVE-YEAR ESTIMATES FROM THE 2009-2013 AMERICAN COMMUNITY SURVEY (ACS) SHOW HOW THESE INDICATORS IMPACT THE SAN DIEGO COMMUNITY. EVALUATING THESE RISK FACTORS IS IMPORTANT FOR IDENTIFYING COMMUNITIES WITH THE MOST SIGNIFICANT HEALTH NEEDS AND HEALTH DISPARITIES. POVERTY: WITHIN SDC, 14.5% OR 441,648 INDIVIDUALS ARE LIVING IN HOUSEHOLDS WITH INCOME BELOW 100% OF THE FEDERAL POVERTY LEVEL (FPL). FOR CHILDREN 0-17, THE PERCENTAGE LIVING 100% BELOW THE FPL INCREASES TO 18.8%. FOR A HOUSEHOLD SIZE OF 3 THE 100% POVERTY LEVEL IS $20,090 PER YEAR. POVERTY CREATES BARRIERS TO ACCESSING SERVICES THAT PROMOTE WELL-BEING INCLUDING HEALTH SERVICES, HEALTHY FOOD, AND OTHER NECESSITIES THAT CONTRIBUTE TO IMPROVED HEALTH STATUS. FORM 990, PART III, LINE 4A (CONTINUED) UNEMPLOYMENT: ACCORDING TO THE BUREAU OF LABOR STATISTICS, TOTAL UNEMPLOYMENT IN SDC FOR THE MONTH OF JULY 2015 WAS 106,822, OR 6.9%, OF THE CIVILIAN NON-INSTITUTIONALIZED POPULATION AGE 16 AND OLDER (NON-SEASONALLY ADJUSTED). UNEMPLOYMENT CREATES FINANCIAL INSTABILITY AND BARRIERS TO ACCESSING NECESSITIES SUCH AS HEALTH SERVICES AND HEALTHY FOOD THAT CONTRIBUTE TO IMPROVED HEALTH STATUS. FINANCIAL ASSISTANCE ASSISTING LOW-INCOME, UNINSURED PATIENTS ASSISTING LOW-INCOME, UNINSURED PATIENTS THE SCRIPPS FINANCIAL ASSISTANCE POLICY IS CONSISTENT WITH THE LANGUAGE OF BOTH STATE (AB774) CALIFORNIA HOSPITAL FAIR PRICING POLICY LEGISLATION AND THE INTERNAL REVENUE CODE (IRC) 501(R) REGULATIONS. THESE PRACTICES REFLECT OUR COMMITMENT TO ASSISTING LOW-INCOME AND UNINSURED PATIENTS WITH DISCOUNTED HOSPITAL CHARGES, CHARITY CARE AND FLEXIBLE BILLING AND DEBT COLLECTION PRACTICES. THESE PROGRAMS ARE AVAILABLE TO EVERYONE IN NEED, REGARDLESS OF THEIR RACE, ETHNICITY, GENDER, RELIGION OR NATIONAL ORIGIN. SCRIPPS MAKES EVERY EFFORT TO IDENTIFY PATIENTS WHO MAY BENEFIT FROM FINANCIAL ASSISTANCE AS SOON AS POSSIBLE AND PROVIDE COUNSELING AND LANGUAGE INTERPRETATION WHEN NEEDED. IN ADDITION, SCRIPPS DOES NOT APPLY WAGE GARNISHMENT OR LIENS ON PRIMARY RESIDENCES AS A WAY OF COLLECTING UNPAID HOSPITAL BILLS. ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON FAMILY INCOME AND EXPENSES. FOR LOW-INCOME, UNINSURED PATIENTS WHO EARN LESS THAN TWICE THE FEDERAL POVERTY LEVEL (FPL), SCRIPPS FORGIVES THE ENTIRE BILL. FOR THOSE PATIENTS WHO EARN BETWEEN TWO AND FOUR TIMES THE FPL, A PORTION OF THE BILL IS FORGIVEN. PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE ARE NOT CHARGED MORE THAN SCRIPPS DISCOUNTED FINANCIAL ASSISTANCE AMOUNT. FOR 2016, THE DEPARTMENT OF HEALTH AND HUMAN SERVICES DEFINED A FAMILY OF FOUR'S 200 PERCENT FEDERAL POVERTY LEVEL AS $48,600. PROFESSIONAL EDUCATION & HEALTH RESEARCH QUALITY HEALTH CARE IS HIGHLY DEPENDENT UPON HEALTH EDUCATION SYSTEMS AND MEDICAL RESEARCH PROGRAMS. WITHOUT THE ABILITY TO TRAIN AND INSPIRE A NEW GENERATION OF HEALTH CARE PROVIDERS, OR TO OFFER CONTINUING EDUCATION TO EXISTING HEALTH CARE PROFESSIONALS, THE QUALITY OF HEALTH CARE WILL BE GREATLY DIMINISHED. MEDICAL RESEARCH ALSO PLAYS AN IMPORTANT ROLE IN IMPROVING THE COMMUNITY'S OVERALL HEALTH BY DEVELOPING NEW AND INNOVATIVE TREATMENTS. EACH YEAR, SCRIPPS ALLOCATES RESOURCES TO ADVANCE HEALTH CARE SERVICES THROUGH CLINICAL RESEARCH, MEDICAL EDUCATION AND HEALTH PROFESSIONAL EDUCATION. DURING FISCAL YEAR 2016 (OCTOBER 2015 TO SEPTEMBER 2016), SCRIPPS INVESTED $24,201,857 IN PROFESSIONAL TRAINING PROGRAMS AND CLINICAL RESEARCH TO ENHANCE SERVICE DELIVERY AND TREATMENT PRACTICES IN SAN DIEGO COUNTY. THIS SECTION HIGHLIGHTS SOME OF OUR PROFESSIONAL EDUCATION AND HEALTH RESEARCH ACTIVITIES. HEALTH PROFESSIONS TRAINING: INTERNSHIPS SCRIPPS' COMMITMENT TO ONGOING LEARNING AND HEALTH CARE EXCELLENCE EXTENDS BEYOND OUR ORGANIZATION. OUR INTERNSHIP PROGRAMS HELP PROMOTE HEALTH CARE CAREERS TO A NEW GENERATION, SHAPE THE FUTURE WORKFORCE AND DEVELOP FUTURE LEADERS IN OUR COMMUNITY. INTERACTING WITH HEALTH CARE PROFESSIONALS IN THE FIELD EXPANDS EDUCATION OUTSIDE THE CLASSROOM. SCRIPPS EMPLOYEES PLAY AN IMPORTANT ROLE AS PRECEPTORS BY INVESTING THEIR TIME TO CREATE A VALUABLE EXPERIENCE FOR THE COMMUNITY. IN FISCAL YEAR 2016, SCRIPPS HOSTED 2,406 INTERNS WITHIN OUR SYSTEM AND PROVIDED 344,084 DEVELOPMENT HOURS SPANNING NURSING AND ANCILLARY SETTINGS. COLLEGE AND UNIVERSITY AFFILIATIONS SCRIPPS COLLABORATES WITH LOCAL HIGH SCHOOLS, COLLEGES AND UNIVERSITIES TO HELP STUDENTS EXPLORE HEALTH CARE ROLES AND GAIN FIRSTHAND EXPERIENCE AS THEY WORK WITH SCRIPPS PROFESSIONALS. SCRIPPS IS AFFILIATED WITH MORE THAN 110 SCHOOLS AND PROGRAMS, INCLUDING CLINICAL AND NONCLINICAL PARTNERSHIPS. LOCAL SCHOOLS INCLUDE, BUT ARE NOT LIMITED TO, POINT LOMA NAZARENE UNIVERSITY (PLNU), UNIVERSITY OF CALIFORNIA SAN DIEGO (UCSD), CALIFORNIA STATE UNIVERSITY SAN MARCOS (CSUSM), SAN DIEGO STATE UNIVERSITY (SDSU), UNIVERSITY OF SAN DIEGO (USD), MESA COLLEGE, SAN DIEGO CITY COLLEGE, GROSSMONT COLLEGE, PALOMAR COLLEGE AND MIRA COSTA COLLEGE. SCRIPPS IS REGULARLY ACCEPTING NEW PARTNERSHIPS, BASED ON COMMUNITY AND WORKFORCE NEEDS, AND MAINTAINS AN AFFILIATION AGREEMENT COMMITTEE TO REVIEW ALL REQUESTS AND PROVIDE A SYSTEMWIDE APPROACH TO SECURING NEW STUDENTS PLACEMENTS. THIS INTERDISCIPLINARY COMMITTEE REPRESENTS EDUCATION AND DEPARTMENT LEADERSHIP ACROSS THE SCRIPPS SYSTEM ENSURING A PROACTIVE APPROACH TO BUILDING A CAREER PIPELINE FOR TOP TALENT. TO ENSURE STUDENTS FROM HEALTH CARE PROFESSIONS PROGRAMS HAVE ACCESS TO APPROPRIATE EDUCATIONAL EXPERIENCES AT SCRIPPS AND FOSTER A SMOOTH, EFFICIENT PROCESS FOR STUDENT PLACEMENT REQUESTS RECEIPT AND MANAGEMENT, SCRIPPS IS A MEMBER OF THE SAN DIEGO NURSING AND ALLIED HEALTH SERVICE EDUCATION CONSORTIUM. RESEARCH STUDENTS SCRIPPS SUPPORTS GRADUATE RESEARCH FOR MASTERS AND DOCTORAL STUDENTS AT UNIVERSITIES WITH AFFILIATION AGREEMENTS. SCRIPPS CENTER FOR LEARNING & INNOVATION OVERSEES THE STUDENT PLACEMENT PROCESS. NON-PHYSICIAN STUDENTS WHO CONDUCT RESEARCH AT SCRIPPS REPRESENT A VARIETY OF HEALTH CARE DISCIPLINES, INCLUDING PUBLIC HEALTH, PHYSICAL THERAPY, PHARMACY AND NURSING. IN FISCAL YEAR 2016, SCRIPPS RESEARCH INCLUDED STUDENTS FROM USD, WESTERN GOVERNORS UNIVERSITY, SDSU, PLNU, LOMA LINDA UNIVERSITY AND POSTDOCTORAL PHARMACY RESIDENCY PROGRAMS, INCLUDING THE PGY1 PHARMACY RESIDENCY PROGRAM. HIGH SCHOOL PROGRAMS SCRIPPS IS DEDICATED TO PROMOTING HEALTH CARE AS A REWARDING CAREER, COLLABORATING WITH A NUMBER OF HIGH SCHOOLS TO OFFER STUDENTS OPPORTUNITIES TO EXPLORE A ROLE IN HEALTH CARE AND GAIN FIRSTHAND EXPERIENCE WORKING WITH SCRIPPS HEALTH CARE PROFESSIONALS. BELOW IS A SUMMARY OF THE HIGH SCHOOL PROGRAMS SCRIPPS MADE AVAILABLE TO THE COMMUNITY. SCRIPPS HIGH SCHOOL EXPLORATION PROGRAM HEALTH AND SCIENCE PIPELINE IMITATIVE (HASPI) THIS PROGRAM REACHES OUT TO SCAN DIEGO HIGH SCHOOL STUDENTS INTERESTED IN EXPLORING A CAREER IN HEALTH CARE. IN FISCAL YEAR 2016, 22 STUDENTS PARTICIPATED IN THE PROGRAM. DURING THEIR FIVE-WEEK ROTATION, THE STUDENTS WERE EXPOSED TO DIFFERENT DEPARTMENTS, EXPLORING CAREER OPTIONS AND LEARNING VALUABLE LIFE LESSON ABOUT HEALTH AND HEALING. UC HIGH SCHOOL COLLABORATION UC HIGH SCHOOL AND SCRIPPS PARTNERED TO PROVIDE A REAL-LIFE CONTEXT TO THE SCHOOLS HEALTH CARE ESSENTIALS COURSE. FOR FISCAL YEAR 2016, SIXTEEN STUDENTS WERE SELECTED TO ROTATE THROUGH FIVE DIFFERENT SCRIPPS LOCATIONS, DURING THE SPRING SEMESTER, TO INCREASE THEIR AWARENESS OF HEALTH CARE CAREERS. UC HIGH STUDENTS VISITED SCRIPPS CLINIC TORREY PINES, CARMEL VALLEY, RANCHO BERNARDO, MERCY SAN DIEGO, SCRIPPS MEMORIAL HOSPITAL LA JOLLA AND GREEN HOSPITAL. THE STUDENTS WERE ABLE TO VIEW SURGERIES AND SHADOWING HEALTHCARE PROFESSIONALS IN THE EMERGENCY DEPARTMENT, ICU, PHARMACY, URGENT CARE, INTERNAL MEDICINE, PEDIATRICS, AMBULATORY SERVICES, REHAB THERAPY, PATIENT LOGISTICS, LAB AND TRAUMA. YOUNG LEADER IN HEALTH CARE AN OUTREACH PROGRAM AT SCRIPPS HOSPITAL ENCINITAS, YOUNG LEADERS IN HEALTH CARE TARGETS LOCAL HIGH SCHOOLS STUDENTS INTERESTED IN EXPLORING HEALTH CARE CAREERS. STUDENTS GRADES 9-12 PARTICIPATE IN THE PROGRAM, WHICH PROVIDES A FORUM FOR HIGH SCHOOL STUDENTS TO LEARN ABOUT THE HEALTH CARE SYSTEM AND ITS CAREER OPPORTUNITIES. THIS COMBINED EXPERIENCE INCLUDES WEEKLY MEETING AT LOCAL SCHOOLS FACILITATED BY TEACHERS AND ADVISORS, AS WELL AS MONTHLY MEETINGS AT SCRIPPS HOSPITAL ENCINITAS. THE PROGRAM MENTORS STUDENTS ON LEADERSHIP AND PROVIDES TOOLS FOR DAILY CHALLENGES. YOUNG LEADERS IN HEALTH CARE ALSO INCLUDES A SERVICE PROJECT TO MEET HIGH SCHOOL REQUIREMENTS AND MAKE A POSITIVE IMPACT ON THE COMMUNITY. THE PROGRAM CLOSES THE YEAR WITH A PRESENTATION ALIGNED WITH THE YEARLY FOCUS. MORE THAN 100 STUDENTS, COMMUNITY MEMBERS AND HEALTH CARE SPECIALISTS ATTENDED THE YOUNG LEADER IN HEALTH CARE FINAL MEETING, CULMINATING WITH STUDENT PRESENTATIONS ON TYPES OF CANCER AND TREATMENTS. STUDENTS THAT PARTICIPATE IN THE PROGRAM ARE ELIGIBLE TO APPLY TO THE HIGH SCHOOL EXPLORER SUMMER INTERNSHIP PROGRAM. SCRIPPS HEALTH GRADUATE MEDICAL EDUCATION FOR MORE THAN 70 YEARS PHYSICIANS IN SCRIPPS GRADUATE MEDICAL EDUCATION PROGRAMS HAVE HELPED CARE FOR UNDERSERVED POPULATIONS THROUGHOUT THE REGION. SCRIPPS HAS A COMPREHENSIVE RANGE OF GRADUATE MEDICAL EDUCATION PROGRAMS AT SCRIPPS MERCY HOSPITAL, SCRIPPS FAMILY PRACTICE RESIDENCY PROGRAM AND SCRIPPS GREEN HOSPITAL. SCRIPPS GRADUATE MEDICAL EDUCATION PROGRAMS ARE WELL-RECOGNIZED FOR EXCELLENCE, PROVIDE A HANDS-ON CURRICULUM THAT FOCUSES ON PATIENT CENTERED CARE AND OFFER RESIDENCIES IN A VARIETY OF PRACTICES, INCLUDING INTERNAL MEDICINE, FAMILY MEDICINE, PODIATRY, PHARMACY AND PALLIATIVE CARE. SCRIPPS HAS A PHARMACY RESIDENCY PROGRAM WHICH TRAIN RESIDENTS WITH DOCTOR OF PHARMACY DEGREES. IN 2016, SCRIPPS HAD A TOTAL OF 140 RESIDENTS AND 36 FELLOWS ENROLLED THROUGHOUT THE SCRIPPS HEALTH SYSTEM. MORE DETAILS ON THESE PROGRA FORM 990, PART VI, LINE 11 990 REVIEW PROCESS WITH THE GOVERNING BODY THE FORM 990 WAS PREPARED BY AN OUTSIDE ACCOUNTING FIRM WITH THE SUPPORT OF THE CORPORATE FINANCE TEAM WITH INPUT FROM HUMAN RESOURCES, FOUNDATION, AND THE LEGAL OFFICE. THE FORM 990 WAS REVIEWED BY THE PRESIDENT, LEGAL COUNSEL, CHIEF FINANCIAL OFFICER, AUDIT COMMITTEE, HUMAN RESOURCES AND COMPENSATION COMMITTEE PRIOR TO FILING. IN ADDITION, A FULL COPY OF THE 990 WAS PROVIDED TO THE BOARD OF TRUSTEES VIA EMAIL IN ADVANCE OF FILING FORM 990 WITH THE IRS. FORM 990, PART VI, LINE 12C COMPLIANCE POLICY MONITORING WITHIN 60 DAYS OF HIRE AND ANNUALLY THEREAFTER ALL SUPERVISORS AND ABOVE; ALL EMPLOYEES IN THE SUPPLY CHAIN MANAGEMENT DEPARTMENT, AUDIT & COMPLIANCE SERVICES DEPARTMENT, AND CASE MANAGEMENT DEPARTMENT OR FUNCTION; AND ANY OTHER EMPLOYEE WHO IS IN A POSITION TO REFER PATIENTS THAT ARE FEDERALLY FUNDED HEALTHCARE BENEFICIARIES TO OTHER PROVIDERS AND SERVICES; AND OTHERS AS DETERMINED BY THE CONFLICTS AND BUSINESS PRACTICES REVIEW COMMITTEE WILL BE REQUIRED TO COMPLETE AND SIGN THE CONFLICT OF INTEREST COMMITMENT DISCLOSURE FORM. IT IS THE RESPONSIBILITY OF ANY EMPLOYEE WHO HAS A CHANGE IN OUTSIDE PROFESSIONAL ACTIVITIES, SIGNIFICANT FINANCIAL INTERESTS, OR POTENTIAL OR ACTUAL CONFLICT OF INTEREST, OR COMMITMENT SITUATIONS THAT ARISE DURING THE YEAR TO DISCLOSE THE INFORMATION TO THEIR SUPERVISORS AS SOON AS THE EMPLOYEE BECOMES AWARE OF THE POTENTIAL OR ACTUAL SITUATION CREATING A POSSIBLE CONFLICT OF INTEREST OR CONFLICT COMMITMENT. SUPERVISORS WILL ASSESS THE SITUATION AND REFER TO THEIR BUSINESS UNIT MANAGEMENT AND/OR THE CONFLICTS AND BUSINESS PRACTICES REVIEW COMMITTEE, AS APPROPRIATE. IN ADDITION, EACH PERSON ENTRUSTED WITH A POSITION OF RESPONSIBILITY IN THE GOVERNANCE AND MANAGEMENT IS REQUIRED TO COMPLETE AND SUBMIT DISCLOSURE STATEMENTS AS FOLLOWS: 1. INITIAL CONFLICT OF INTEREST AND 990 TAX RETURN DISCLOSURE STATEMENT (INITIAL DISCLOSURES) 2. ANNUAL CONFLICT OF INTEREST AND 990 TAX RETURN DISCLOSURE STATEMENT 3. SUBSEQUENT OCCURRENCES REPORTING UPON THE OCCURRENCE OF ANY NEW POTENTIAL CONFLICT OF INTEREST ACTUAL OR POTENTIAL CONFLICT DISCLOSURES REGARDING EMPLOYEES ARE REVIEWED BY THE CONFLICTS AND BUSINESS PRACTICES REVIEW COMMITTEE. DISCLOSURES REQUIRING MITIGATION ARE DISCUSSED WITH THE BUSINESS UNIT CHIEF EXECUTIVE AND EMPLOYEE'S SUPERVISOR. LEGAL COUNSEL REVIEWS EACH BOARD OF TRUSTEES MEETING AGENDA PRIOR TO THE MEETING AND POTENTIAL CONFLICTS OF INTERESTS ARE IDENTIFIED, CONSIDERED AND AN APPROPRIATE COURSE OF ACTION IS DETERMINED BY THE MEMBER AND LEGAL COUNSEL WITH THE INVOLVEMENT OF THE PRESIDENT AND BOARD CHAIR, WHERE APPROPRIATE. COURSE OF ACTION MAY INCLUDE THE CONFLICTED BOARD MEMBER RECUSING THEMSELVES, ABSTAINING FROM VOTING AND/OR READING A STATEMENT INTO THE BOARD MINUTES REGARDING SUCH CONFLICT. AS IT RELATES TO BOARD OF TRUSTEES, WHEN A DETERMINATION IS THAT AN ACTUAL CONFLICT OF INTEREST EXISTS AND A COVERED INDIVIDUAL IS AN "INTERESTED PERSON" UNDER CALIFORNIA LAW, THE TRANSACTION BEING CONSIDERED WILL COMPLY WITH APPLICABLE STATUTORY REQUIREMENTS TO AVOID PARTICIPATION IN THE DECISION MAKING PROCESS BY THE COVERED INDIVIDUAL. THE MINUTES OF BOARD MEETINGS SHALL DOCUMENT ALL RECUSALS FROM DISCUSSION AND VOTING. IT IS THE RESPONSIBILITY OF ANY EMPLOYEE WHO HAS A CHANGE IN OUTSIDE PROFESSIONAL ACTIVITIES, SIGNIFICANT FINANCIAL INTERESTS, OR POTENTIAL OR ACTUAL CONFLICT OF INTEREST, OR COMMITMENT SITUATIONS THAT ARISE DURING THE YEAR TO DISCLOSE THE INFORMATION TO THEIR SUPERVISORS AS SOON AS THE EMPLOYEE BECOMES AWARE OF THE POTENTIAL OR ACTUAL SITUATION CREATING A POSSIBLE CONFLICT OF INTEREST OR CONFLICT COMMITMENT. SUPERVISORS WILL ASSESS THE SITUATION AND REFER TO THEIR BUSINESS UNIT MANAGEMENT AND/OR THE CONFLICTS AND BUSINESS PRACTICES REVIEW COMMITTEE, AS APPROPRIATE. FORM 990, PART VI, LINE 15A & 15B OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN PURSUANT TO PROCEDURES REQUIRED BY TAX EQUITY AND FISCAL RESPONSIBILITY ACT OF 1983 (TEFRA), SCRIPPS HEALTH'S PROCEDURES ARE AS FOLLOWS: THE BOARD OF TRUSTEES REVIEWS EXECUTIVE COMPENSATION FOR OFFICERS AND ALL KEY EMPLOYEES ON AN ANNUAL BASIS UTILIZING COMPARABILITY DATA OBTAINED BY AN EXTERNAL CONSULTANT. IT IS THE PHILOSOPHY OF THE SCRIPPS BOARD OF TRUSTEES TO COMPENSATE THE CORPORATION'S EXECUTIVES FAIRLY RELATIVE TO THE MEDIAN COMPENSATION OF PEER ORGANIZATIONS, CONSIDERING AND MAKING APPROPRIATE ADJUSTMENTS FOR THE COST OF LIVING IN SAN DIEGO, CALIFORNIA AND OTHER RELEVANT FACTORS. TO ACCOMPLISH THIS, THE BOARD HAS ADOPTED A PHILOSOPHY OF TARGETING EXECUTIVE SALARIES AT APPROXIMATELY THE 65TH PERCENTILE OF A NATIONAL PEER GROUP OF ORGANIZATIONS AS DETERMINED THROUGH AN INDEPENDENT OUTSIDE CONSULTANT ENGAGED BY THE BOARD AND WILL RELY ON THEIR RECOMMENDATIONS USING A DATABASE OF INDEPENDENTLY COLLECTED DATA. THE PHILOSOPHY STATES: - FOR PURPOSES OF EXECUTIVE COMPENSATION COMPARISONS, SCRIPPS WILL USE A NATIONAL PEER GROUP OF MEDICAL DELIVERY SYSTEMS OF SIMILAR REVENUE SIZE AND COMPLEXITY. THE PEER GROUP WILL BE REVIEWED AND APPROVED BY THE HUMAN RESOURCES AND COMPENSATION COMMITTEE. - SALARIES ARE TARGETED AT APPROXIMATELY THE 65TH PERCENTILE OF THE PEER GROUP AND WILL REFLECT THE PERFORMANCE OF THE INDIVIDUAL. - TOTAL CASH COMPENSATION IS POSITIONED AT APPROXIMATELY THE 75TH PERCENTILE OF THE PEER GROUP WHEN MAXIMUM LEVEL INCENTIVES ARE PAID FOR ACHIEVEMENT OF MAXIMUM LEVEL OF PREDETERMINED OBJECTIVES AGREED UPON BY THE BOARD. - THE BOARD SELECTS THE 65TH PERCENTILE FOR BASE COMPENSATION OF PEER GROUP ADJUSTED FOR COST OF LIVING OF URBAN WEST COAST MARKET AT THE 50TH PERCENTILE (I.E. THE 50TH PERCENTILE OF CALIFORNIA MARKET IS THE 65TH PERCENTILE OF NATIONAL PEER MARKET AS OUR EXECUTIVE RECRUITMENT MARKET IS NATIONAL). - ANNUALLY, TOTAL CASH COMPENSATION FOR EACH POSITION WILL NOT EXCEED THE BASE SALARY ESTABLISHED FOR THE PERIOD PLUS THE MAXIMUM INCENTIVE PERCENTAGE PAYOUT ALLOWABLE AS DETERMINED BY THE SCRIPPS MANAGEMENT INCENTIVE PLAN APPROVED BY THE BOARD OF TRUSTEES FOR THE RESPECTIVE POSITION. THE REPORTS FROM THE EXTERNAL CONSULTANT ENGAGED TO REVIEW EXECUTIVE COMPENSATION IS PRESENTED TO THE HUMAN RESOURCES AND COMPENSATION COMMITTEE ON AN ANNUAL BASIS AND THE MOST RECENT REPORTS WERE REVIEWED ON JANUARY 27, 2016 AND MARCH 30, 2016. REVIEW AND DISCUSSION OF SUCH REPORTS ARE DOCUMENTED IN THE MINUTES. FORM 990, PART VI, LINE 16 JOINT VENTURES SCRIPPS HEALTH HAS MAINTAINED A LONG STANDING PRACTICE OF REVIEWING ALL POTENTIAL JOINT VENTURE OR SIMILAR ARRANGEMENTS TO ENSURE THAT CONTRACT TERMS ARE CONSISTENT WITH THE PROTECTION OF ITS TAX-EXEMPT STATUS. FORM 990, PART VI, LINE 19 AVAILABILITY OF DOCUMENTS TO THE GENERAL PUBLIC FINANCIAL STATEMENTS ARE POSTED QUARTERLY ON THE DAC (DIGITAL ASSURANCE CERTIFICATION) WEBSITE AND THE MUNICIPAL SECURITIES RULEMAKING BOARD'S (MSRB) ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA) WEBSITE IN SATISFACTION OF CONTINUING DISCLOSURE REQUIREMENTS RELATING TO THE ORGANIZATION'S TAX-EXEMPT DEBT ISSUANCES. THE AUDITED FINANCIAL STATEMENTS ARE ALSO ATTACHED TO THIS FORM 990, IN ACCORDANCE WITH THE IRS INSTRUCTIONS. SCRIPPS HEALTH'S CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS OTHER (869,241) CHANGE IN VALUE IN DEFERRED GIFTS 514,070 JOINT VENTURES DISTRIBUTION 1,717,551 ROUNDING 1 ------------ TOTAL 1,362,381 FORM 990 PART IX LINE 11G DESCRIPTION:PHYS FEES-PROVIDER SVS AGRMENT TOTAL FEES:XXX-XX-XXXX FORM 990 PART IX LINE 11G DESCRIPTION:OTHER PURCHASED SVS - NON MED TOTAL FEES:69676115 FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICIAN FEES TOTAL FEES:58974901 FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED MEDICAL SERVICES TOTAL FEES:25325055 FORM 990 PART IX LINE 11G DESCRIPTION:ALL OTHER FEES FOR SERVICES TOTAL FEES:26900436 SCRIPPS MERCY BILLING LLC 10140 CAMPUS POINT DRIVE SAN DIEGO CA 92121 870737748 HLTHCR ADMIN CA 49595390 0 SCRIPPS HLTH IHS HOLDING COMPANY LLC 10140 CAMPUS POINT DRIVE SAN DIEGO CA 92121 473437677 HLTHCR ADMIN CA 0 35890367 SCRIPPS HLTH IMAGING HEALTHCARE SPECIALISTS LLC 10140 CAMPUS POINT DRIVE SAN DIEGO CA 92121 203872122 HLTHCR ADMIN CA 17569162 30806606 IHS HOLDING SCRIPPS CARDIO&THORACIC SURGERY BILLING 10140 CAMPUS POINT COURT SAN DIEGO CA 92121 270620996 HLTHCR ADMIN CA 5470337 0 SCRIPPS HLTH SCRIPPS HOSPITAL BILLING SERVICES LLC 10140 CAMPUS POINT DRIVE SAN DIEGO CA 92121 611677183 HLTHCR ADMIN CA 3019683 0 SCRIPPS HLTH SCRIPPS CLINIC BILLING LLC 10140 CAMPUS POINT DRIVE SAN DIEGO CA 92121 870737749 HLTHCR ADMIN CA 336000708 0 SCRIPPS HLTH SCRIPPS ACCOUNTABLE CARE ORGANIZATION 10140 CAMPUS POINT DRIVE SAN DIEGO CA 92121 364837441 HLTHCR ADMIN CA 0 0 SCRIPPS HLTH MAXWELL H & MURIEL GLUCK CHILD CARE CTR 10140 CAMPUS POINT DRIVE SAN DIEGO CA 92121 350504809 CHILDCARE CA 501(c)(3) 2 SCRIPPS HLTH true MERCY HOSPITAL FOUNDATION 10140 CAMPUS POINT COURT SAN DIEGO CA 92121 942958094 FUNDRAISING CA 501(c)(3) 11,I SCRIPPS HLTH true SCRIPPS HEALTH PLAN SERVICES INC 10140 CAMPUS COURT DRIVE SAN DIEGO CA 92121 330782099 HEALTHCARE SV CA 501(c)(3) 11,I SCRIPPS HLTH true HORIZON HOSPICE 10140 CAMPUS POINT DRIVE SAN DIEGO CA 92121 330220777 HOSPICE CARE CA 501(c)(3) 9 SCRIPPS HLTH true SCRIPPS ENCINITAS SURGERY CENTER LLC 15305 DALLAS PARKWAY STE 1600 LB ADDISON TX 75001 205942958 AMBUL SURGERY CA SCRIPPS HEALTH Related 1820189 229120 false 0 false 0.55500 SCRIPPSUSP SURGERY CENTERS 15305 DALLAS PARKWAY STE 1600 LB ADDISON TX 75001 205942911 AMBUL SURGERY CA NA Related 636094 1003583 false 0 false 0.50000 SCRIPPS MERCY AMBUL SURGERY CENTER 10140 CAMPUS POINT DRIVE SAN DIEGO CA 92121 450503246 AMBUL SURGERY CA SCRIPPS HEALTH Related 1000892 3279074 false 0 true 0.73500 SCRIPPS IDN MANAGEMENT LLC 10140 CAMPUS POINT DRIVE SAN DIEGO CA 92121 454557426 HEALTHCARE SVCS CA NA Related 0 16126 false 0 false 0.50000 XIMED MEDICAL CENTER LP 9850 Genesee Ave Ste 900 La Jolla CA 92037 REAL ESTATE CA SCRIPPS HEALTH RELATED 697997 3198401 false 0 true 0.15304 SCRIPPS HEALTH & HEALING CENTER 10140 CAMPUS POINT DRIVE SAN DIEGO CA 92121 205156965 PATIENT EDUCATION CA SCRIPPS HEALTH C Corp 0 0 1.00000 true SCRIPPSCARE 10140 CAMPUS POINT DRIVE SAN DIEGO CA 92121 452870638 HEALTHCARE SRVCS CA SCRIPPS HEALTH C Corp 0 0 1.00000 true SCRIPPS CLINICAL SCIENCE CENTER 10140 CAMPUS POINT DRIVE SAN DIEGO CA 92121 264479543 RESEARCH CA SCRIPPS HEALTH C Corp 0 0 1.00000 true CHARITABLE REMAINDER TRUST (56) 10140 CAMPUS POINT DRIVE SAN DIEGO CA 92121 205156965 HOSPITAL SUPPORT CA NA Trust CHARITABLE LEAD TRUST (2) 10140 CAMPUS POINT DRIVE SAN DIEGO CA 92121 330796247 HOSPITAL SUPPORT CA NA Trust true true false false false false false false false true false true true false false false true false false SCRIPPS HEALTH PLAN SERVICES (SHPS) m 130307578 ACCRUAL SCRIPPS HEALTH PLAN SERVICES (SHPS) q 34358287 ACCRUAL SCRIPPS ENCINITAS SURGERY CENTER a(IV) 362125 ACCRUAL SCRIPPS MERCY AMBULATORY SURGERY CENTER a(IV) 564799 ACCRUAL HORIZON HOSPICE q 2110399 ACCRUAL SCRIPPS HEALTH PLAN SERVICES (SHPS) b 4700000 ACCRUAL SCRIPPS HEALTH PLAN SERVICES (SHPS) j 136088 ACCRUAL SCRIPPS HEALTH PLAN SERVICES (SHPS) l 227019191 ACCRUAL SCHEDULE R, PART III RELATED ORGANIZATIONS TAXABLE AS PARTNERSHIPS SCRIPPS ENCINITAS SURGERY CENTER, LLC EIN: 20-5942958 ADDRESS: 15305 DALLAS PKWY, STE 1600, LB 28, ADDISON, TX 75001 SCRIPPS/USP SURGERY CENTERS, LLC EIN: 20-5942911 ADDRESS: 15305 DALLAS PKWY, STE 1600, LB 28, ADDISON, TX 75001 SCRIPPS MERCY AMBULATORY SURGERY CENTER, LLC EIN: 45-0503246 ADDRESS: 10140 CAMPUS POINT DRIVE, SAN DIEGO, CA 92121 SCRIPPS IDN MANAGEMENT, LLC EIN: 45-4557426 ADDRESS: 10140 CAMPUS POINT DRIVE, SAN DIEGO, CA 92121 SCRIPPS MEMORIAL - XIMED MEDICAL CENTER, LP EIN: 33-0475481 ADDRESS: 9850 GENESEE AVE, STE 900, LA JOLLA, CA 92037