2013 – 2015 Implementation Strategy
Responding to the 2013 Community Health Needs Assessment

Introduction ........................................................................................................................ 3
About Sutter Health ........................................................................................................... 3
2013 Community Health Needs Assessment Summary .................................................. 4
Definition of Community Served by the Hospital ....................................................... 4
Significant Health Needs Identified ........................................................................... 5
2013 – 2015 Implementation Strategy ............................................................................... 7
Limited Access to Healthcare & Lack of Preventative Care ....................................... 8
Poor Diet & Obesity/Physical Activity/Policies That Don’t Support Health and Wellbeing
............................................................................................................................... 12
Poverty ................................................................................................................... 14
Needs Sutter Surgical Hospital - North Valley Plans Not to Address ........................... 15
Approval by Governing Board ........................................................................................ 16
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This implementation strategy describes how Sutter Surgical Hospital - North Valley, a Sutter Health affiliate, plans to address significant needs identified in the Community Health Needs Assessment
(CHNA) published by the hospital on October 5, 2013. The document describes how the hospital plans to address identified needs in calendar (tax) years 2013 through 2015.
The 2013 CHNA and this implementation strategy were undertaken by the hospital to understand and address community health needs, and in accordance with proposed Internal Revenue Service (IRS) regulations pursuant to the Patient Protection and Affordable Care Act of 2010.
This implementation strategy addresses the significant community health needs described in the CHNA that the hospital plans to address in whole or in part. The hospital reserves the right to amend this implementation strategy as circumstances warrant. For example, certain needs may become more pronounced and merit enhancements to the described strategic initiatives. Alternately, other organizations in the community may decide to address certain community health needs, and the hospital may amend its strategies and refocus on other identified significant health needs. Beyond the initiatives and programs described herein, the hospital is addressing some of these needs simply by providing health care to the community, regardless of ability to pay.
Sutter Surgical Hospital - North Valley is affiliated with Sutter Health, a not-for-profit network of hospitals, physicians, employees and volunteers who care for more than 100 Northern California towns and cities.
Together, we’re creating a more integrated, seamless and affordable approach to caring for patients.
The hospital’s mission is to enhance the health and well-being of people in the communities we serve, through a not-for-profit commitment to compassion and excellence in health care services.
Vision
Sutter Health leads the transformation of health care to achieve the highest levels of quality, access and affordability.
Values
Excellence and Quality
Caring and Compassion
Honesty and Integrity
Teamwork
Community
At Sutter Health, we believe there should be no barriers to receiving top-quality medical care. We strive to provide access to excellent health care services for Northern Californians, regardless of ability to pay.
As part of our not-for-profit mission, Sutter Health invests millions of dollars back into the communities we serve – and beyond. Through these investments and community partnerships, we’re providing and preserving vital programs and services, thereby improving the health and well-being of the communities we serve.
In 2012, our network of physician organizations, hospitals and other health care providers invested $795 million (compared to $756 million in 2011) in health care services for low-income people, community health improvement services, and other community benefits.
For more facts and information about Sutter Surgical Hospital - North Valley, please visit http://www.suttersurgicalhospitalnorthvalley.org/
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Sutter Surgical Hospital - North Valley (SSHNV) of Yuba City, California conducted a CHNA of the hospital service area (HSA). Valley Vision, Inc. conducted the CHNA over a period of months. Valley
Vision (www.valleyvision.org) is a nonprofit 501(c)(3) consulting firm serving a broad range of communities across Northern California. The organization’s mission is to improve quality of life through the delivery research on important topics such as healthcare, economic development, and sustainable environmental practices. Valley Vision has conducted multiple CHNAs across an array of communities for over seven years. As the lead consultant, Valley Vision assembled a team of experts from multiple sectors to conduct the assessment that included: 1) a public health expert with over a decade of experience in conducting CHNAs, 2) a geographer with expertise in using GIS technology to map healthrelated characteristics of populations across large geographic areas, and 3) additional public health practitioners and consultants to collect and analyze data.
The full 2013 Community Health Needs Assessment report conducted by Sutter Surgical Hospital - North
Valley is available at http://www.sutterhealth.org/communitybenefit/community-needs-assessment.html
Definition of Community
Served by the Hospital
The HSA was determined by analyzing patient discharge data where it was determined that approximately 74% of all patients resided in four
ZIP codes that were located in two counties. ZIP codes 95901
(Marysville and Linda areas) and 95961 (Olivehurst area) are both located in Yuba County. ZIP codes 95991 (south central Yuba City area) and 95933 (western Yuba City area) are both located in Sutter County. A map of the service area is shown in Figure 1. ZIP code boundaries in rural communities are sometimes not representative of population distributions across a ZIP code. To display where populations reside among the ZIP code boundaries note above, population density within each ZIP code is also shown in Figure 1 in the full CHNA report.
A key to understanding community health is understanding community vulnerability to poor or unwanted health outcomes. This is accomplished by examining certain socio-demographics, often referred to as the social determinants of health, in order to identify areas of the HSA with high vulnerability to unwanted health outcomes. To accomplish this, race and ethnicity, household makeup, income, and age variables were combined into a vulnerability index that described the level of vulnerability of each census tract. This index was then mapped for the entire HSA. A tract was considered more vulnerable, or more likely to have higher unwanted health outcomes than others in the HSA, if it had higher: 1) percent non-
White or Hispanic population; 2) percent single female parent headed households; 3) percent below 125% of the poverty level; 4) percent under five years old; and 5) percent 65 years of age or older living in the census tract. Figure 2 shows the vulnerability index for each census tract located all or in part of the SSHNV HSA. In the map, darker gradient colors indicate higher vulnerability.
The HSA is home to approximately 135,000 residents. The racial and ethnic makeup of the community is show in Table 3 in the full report.
Whites accounted for over half of the HSA’s residents (52.5% compared to all of CA 40.7%). Other groups that comprised the bulk of the HSA’s population included Hispanics (27.1%), Asians (12.3%), Multi-race
(2.4%), Blacks (2.3%), and American Indians (1.0%).
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A key to understanding community health is understanding community vulnerability to poor or unwanted health outcomes. This is accomplished by examining certain socio-demographics, often referred to as the social determinants of health, in order to identify areas of the HSA with high vulnerability to unwanted health outcomes. To accomplish this, race and ethnicity, household makeup, income, and age variables were combined into a vulnerability index that described the level of vulnerability of each census tract. This index was then mapped for the entire HSA. A tract was considered more vulnerable, or more likely to have higher unwanted health outcomes than others in the HSA, if it had higher: 1) percent non-
White or Hispanic population; 2) percent single female parent headed households; 3) percent below 125% of the poverty level; 4) percent under five years old; and 5) percent 65 years of age or older living in the census tract. Figure 2 in the full report shows the vulnerability index for each census tract located all or in part of the SSHNV HSA. In the map, darker gradient colors indicate higher vulnerability. Central Yuba City, the Linda area, and portions of Olivehurst were areas identified with the highest vulnerability in the HSA.
The 2013 county health rankings indicated that Yuba County ranked 50 out of 57 counties in California for overall health. Sutter County ranked
33. Mortality rankings showed Yuba County ranked 48 of 57, while Sutter
County ranked 36. As to overall morbidity, Yuba ranked 46 of 57, while
Sutter ranked 30. Data indicated that 22% and 23% of Yuba and Sutter
County residents, respectively, selfreported their health as “poor or fair,” compared to a California benchmark of 19%, and national benchmark of
10%. Further, Yuba and Sutter County residents reported that that on average they experienced 4.1 and 4.3 days, respectively, over a 30-day period that their physical health was “not good.” This compares to the state benchmark of 3.7 and national benchmark of 2.6 days.
Significant Health Needs
Identified
The following significant health needs were identified by the 2013 CHNA.
Limited access to healthcare
No health insurance, Isolation in foothills, Limited transportation, Chronic diseases
– diabetes, hypertension, Respiratory problems – asthma, Mental and emotion health issues – depression, low self-esteem, trauma and Dental issues
Tobacco use
Ease of acquiring tobacco and an abundance of tobacco shops
Poor Diet
Unaffordable fresh foods, Unavailability of fresh foods and High concentration of fast food restaurants
Obesity/physical inactivity
Limited parks and recreation opportunities and Lack of walk-able communities
Yes
No
Yes
Yes
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Lack of preventative care
Substance Abuse
Ease of access of alcohol and Self-medication to treat depression
Policies that do not support health and wellbeing
Smoking and Nutrition
Agricultural Community
Dust and other particulates in air
Education
Low attainment (formal) and Limited health literacy
Poverty
High unemployment and Generational
Yes
No
Yes
No
No
Yes
Health data used in the CHNA were both primary and secondary data. Primary data included key informant interviews with local area experts. Secondary data included quantitative data that addressed both health outcomes and behavioral and environmental variables described as health drivers. All indicators were examined at the ZIP code level unless noted otherwise. National, county, state, and
Healthy People 2020 targets (when available) were used as benchmarks to determine severity. Rates above any benchmark are denoted by bold text in the tables. All rates are reported as per 10,000 of population unless noted otherwise. Health outcome indicator data were adjusted using Empirical Bayes
Smoothing, where possible, to increase the stability of estimates by reducing the impact of the small number problem. To provide relative comparison across ZIP codes, rates of ED visits and hospitalization rates for heart disease, diabetes, hypertension, and stroke were age-adjusted to reduce the influence of age.
In the full CHNA report, a health need was defined as a poor health outcome and its associated driver, where a health driver was defined as a behavioral, environmental, and/or clinical factor, as well as more upstream social economic factors, that impact health. Table 15 in the full report, articulates the SSHNV
HSA health needs by identifying health issues (outcomes) that were pointed out by community health experts, the specific populations in the community most affected by these health issues, and, again, turning to community’s health experts, many of the drivers of specific health issues are identified. The above table is not presented as all-inclusive; rather it contains a summary of key findings that emerged from the key informant interviews that were conducted as a part of this health assessment.
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This implementation strategy describes how Sutter Surgical Hospital - North Valley plans to address significant health needs identified in its 2013 Community Health Needs Assessment and consistent with its charitable mission. The strategy describes:

Actions the hospital intends to take, including programs and resources it plans to commit;

Anticipated impacts of these actions and a plan to evaluate impact; and

Any planned collaboration between the hospital and other organizations.
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Name of Program, Initiative or Activity
Continued partnerships with Ampla Health and Peach Tree Health
Description SSHNV partners with Ampla and Peach Tress, the local Federally
Qualified Health Centers (FQHC), to offer the following services to their patients: OB/Gyn, Peds/Adult Cardio and Radiology, ENT, Surgery,
Urology, Podiatry, Ophthalmology, Gastro, and Ortho. SSHNV also collaborates and partners with Peach Tree Health for the annual
Women’s Health Screening event.
We are consistently looking at creative ways to strengthen the relationship between SSHNV and Peach Tree and Ampla Health Clinics, as building both the capacity and sustainability of FQHCs continues to be of critical importance not only to Sutter, but is vital to the overall health and wellbeing of the community. Our 2013 CHNA reports show that lack of access to care is one of the most dire health related challenges facing our region. If we don’t make strategic investments in our FQHCs, we are going to be left with thousands of newly insured
Medi-Cal patients in 2014, with no medical home. Therefore, it is our goal to tighten the partnership with these important health clinics, and make sure that both are involved with our WHS, Prostate Screening and
Pink October efforts, to provide a linkage to primary and mental health services to those who need it the most.
Anticipated Impact and Plan to Evaluate
Our continued partnerships with the local FQHCs are anticipated to improve access to care for uninsured, medically indigent people residing in the community. The hospital will continually evaluate our partnerships with the local FQHCS annually tracking the number of people served, and by assessing the community’s access to care needs in its next
Community Health Needs Assessment. Additionally, we will consistently look for new and innovative ways to expand our relationship with the
FQHCs and partner on more impactful programs that serve the underserved community, and address health needs as identified in the
CHNA.
Name of Program, Initiative or Activity
Low Cost Mammograms and Women’s Health Screening
Description Throughout the entire month of October, and in honor of Breast Cancer
Awareness month, SSHNV partners with community organizations like the Geweke Foundation to offer low cost mammograms. In 2012, the
Pink October effort was another resounding success, with 312
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uninsured/underinsured women receiving low-cost mammograms at our
Sutter facilities in the Yuba-Sutter service area. This effort served as a best practices model, and gave way to a SHSSR-wide free mammography event, which took place every Saturday throughout
October, across the SHSSR region. Between these two crucial Breast
Cancer Awareness efforts, SHSSR provided a total of 670 free and lowcost mammograms.
We will have to examine the current model of this program in 2014, as under the Affordable Care Act, all women (with the exception of undocumented immigrants) will have insurance; therefore, we will reassess our process moving forward, as these low cost mammograms have typically targeted the uninsured only.
The Women’s Health Screening day (WHS) remains a key initiative for
SSHNV and a cornerstone event for the entire Yuba/Sutter community.
In 2012, the Women’s Health Screen event provided screenings for more than 250 underserved women. In 2013, we saw nearly 200 patients for low cost health screenings, providing that there is still a great need in our
HSA for services of this kind. SSHNV partners with other community partners like Peach Tree Health to provide and advertise these important screenings.
Our goal is not only to screen the un and underinsured women, but we also use these events as a connection point for the un and underinsured members of our community, to link them with a primary care provider and follow up resources if needed, as well as insurance enrollment information. New in 2013, we integrated insurance enrollment specialists from Covered California to provide insurance education, outreach and enrollment to the women who need it most.
Anticipated Impact and Plan to Evaluate
SSHNV will continue evaluate the impact of our Low Cost
Mammography screenings and Women’s Health Screenings on an annual basis, by tracking the number of people served, number of linkages to other referrals and insurance enrollment, and by assessing the community’s access to care needs in its next Community Health
Needs Assessment. We will also reexamine these programs with a critical eye in 2014, to ensure it evolves with the needs of the community after the implementation of the ACA.
Name of Program, Initiative or Activity
Prostate Screening Event
Description The annual Prostate Screening Event takes place in September, in honor of Prostate Awareness Month. This event targets underinsured men, and provides a physical exam and a blood test called PSA
(Prostate Specific Antigen) for $15. Our goal is not only to screen the un
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and underinsured men, but we also use these events as a connection point for the underserved members of our community, to link them with a primary care provider and follow up resources if needed, as well as insurance enrollment information. New in 2013, we integrated insurance enrollment specialists from Covered California to provide insurance education, outreach and enrollment to the women who need it most.
Anticipated Impact and Plan to Evaluate
SSHNV will continue evaluate the impact of our Prostate Screening event on an annual basis, by tracking the number of people served, number of linkages to other referrals and insurance enrollment, and by assessing the community’s access to care needs in its next Community
Health Needs Assessment.
Name of Program, Initiative or Activity
Expanded Insurance Enrollment
Description With the help of a small grant, Sacramento Covered will be spearheading a major outreach effort to connect with the underserved population in many of the SHSSR counties, including Yuba, to enroll them in insurance coverage through Covered California. This effort by
Sacramento Covered and other community partners throughout SHSSR program is vitally important, as Covered California, the new health insurance exchange and a critical piece of the Affordable Care Act, will launch October 1, 2013. As a result, enrolling the un- and underinsured population will be a major component of our CHNA implementation planning, as this is the first step to connecting patients with primary care and medical homes. We have the opportunity to link Sacramento
Covered insurance navigators with SNCS’s important efforts, including
WHS and Prostate Screening events. These events will provide a great opportunity for us to connect with the underserved population and enroll them in insurance.
Anticipated Impact and Plan to Evaluate
SSHNV will evaluate the impact of our insurance enrollment/education outreach by tracking the number of people served, number of linkages to other referrals and insurance enrollment, and by assessing the community’s access to care needs in its next Community Health Needs
Assessment.
Name of Program, Initiative or Activity
Other investments
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Description SSHNV will continue to invest in many of the organizations and events it’s historically supported, and recommend expanding the scope of the key community benefits initiatives that have become so important to the underserved community and directly address the top health needs identified by the CHNA in the Yuba/Sutter HSA.
We recognize that we can’t address all of the health needs in our community alone, we also provide funding and support to various organizations throughout the community to help us meet the needs of patients as it relates to preventative care, access to care, nutrition, education and economic development.
Anticipated Impact and Plan to Evaluate
We will review these investments on a yearly basis and evaluate their impact on the needs identified in the CHNA and measurable outcomes.
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Name of Program, Initiative or Activity
Be STRONG/FitQuest
Description In early 2013, SSHNV re-launched be STRONG (formerly known as
KidShape) in the SSHNV service area. Be STRONG is a six-week program for any child ages 6-14 and their families that teaches easy ways to incorporate healthy choices into daily living. Each class is instructed by a registered dietician, mental health professional, physical activity instructor, and program coordinator who craft lessons designed to improve overall health in a fun and meaningful way. Through increasing accessibility to the “Be STRONG” program, focusing on whole health stability, and incorporating feedback from parents, this program is experiencing tremendous growth and success.
In 2014, the successful Be Strong program will merge with the thriving
Fit Quest curriculum, for a pilot program that will include all 5th and 6th grade Yuba and Sutter county students participating in the Shady Creek
Outdoor Program. In addition to the class based program, the expansion will include a new Fit Quest Family Camp, a weekend long health, wellness, and fitness education program for families of students participating in the Fit Quest program to be held at Shady Creek.
Students will participate in appropriate grade standard based nutrition and physical fitness experiential learning program which will include instruction in the classroom and extensive instruction during their time at
Shady Creek.
Anticipated Impact and Plan to Evaluate
SSHNV will continue evaluate the impact of our Be Strong/Fit Quest programs, by tracking the number of children and families we reach and the impact they make and by assessing the community’s diet and opportunity for physical activity in its next Community Health Needs
Assessment.
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Name of Program, Initiative or Activity
PE Specialists for Yuba City Unified School District
Description SSHNV continues to provide grant funding to supplement the salary for a
Physical Education Specialist that services the Yuba City Unified School
District, grades K-8. Without this grant, there would only be one PE specialist, which is not enough to support the PE programs in the local schools, which would further contribute to childhood obesity, lack of exercise and establishing a pattern of unhealthy habits for the youth in the SSHNV HSA.
Anticipated Impact and Plan to Evaluate
SSHNV will continue evaluate the impact of our PE Specialists, by tracking the number of children these specialists reach and the impact they make and by assessing the community’s diet and opportunity for physical activity in its next Community Health Needs Assessment.
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Name of Program, Initiative or Activity
Tats Off
Description Tats Off is a local low-cost program, aimed to help inmates, parolees and people on probation better their chances of staying on the straight and narrow by removing tattoos. Tats Off also will treat people without a criminal record, though the program's main focus is on those with gangrelated markings. This program helps people leave gang and criminal activity behind, and gives them a better chance of gaining employment and moving forward in their lives.
Anticipated Impact and Plan to Evaluate
Tats Off helps provide a better future for many in our community who’ve experienced a life of crime and poverty. A program of this nature provides support for people attempting to turn their lives around and gives patients a shot at obtaining work and better economic opportunities, and in turn, stopping the cycle of poverty and bettering the life of the patient and their family. The hospital will continue to analyze t he number of patients served each year and the program’s overall impact in the community.
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No hospital can address all of the health needs present in its community. Sutter Surgical Hospital - North
Valley is committed to serving the community by adhering to its mission, using its skills and capabilities, and remaining a strong organization so that it can continue to provide a wide range of community benefits. This implementation strategy does not include specific plans to address the following significant health needs that were identified in the 2013 Community Health Needs Assessment:
Tobacco use: Tobacco use is a serious problem, but SSHNV plans to dedicate our limited resources to meeting other needs outlined in the CHNA.
Substance Abuse: This is not something that SSHNV has the expertise to effectively address.
Agricultural Community: Not only is there a lack of effective interventions to address this need, this is not something that we are able to greatly affect through community benefit; therefore, we are focusing our resources elsewhere.
Education: While this is important, this need is not as our primary focus, which is expanding access to care and building the capacity we so desperately need in the SSHNV HSA.
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This implementation strategy was approved by the Governing Board of Sutter Surgical Hospital - North
Valley on December 18, 2013.
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