2020 – 2022 Implementation Strategy Based on findings of the 2019 Community Health Needs Assessment UCHealth University of Hospital Table of Contents

Introduction and overview

Introduction...... 3 Our mission, vision and values ...... 3 University of Colorado Hospital overview ...... 3 Communities served ...... 3

Implementation strategy

Implementation strategy process, development and approval...... 4 Board of Directors approval...... 4

Community health needs

Identified community health needs...... 5 Assessment and prioritization process...... 5 Prioritized health issues...... 5

2020 – 2022 implementation strategies

Mental and behavioral health and substance use disorder...... 6-7 Access to care ...... 8-9 Cardiovascular disease (and related risk factors) ...... 10 Social determinants of health (employment and education)...... 11

Conclusion ...... 12

Appendix

Organizations engaged during the CHNA and implementation strategy processes ...... 13

2 UCHealth Introduction and overview

Introduction. University of Colorado Hospital (UCH) aims to improve the lives of its patients by providing access to high-quality, comprehensive health care services. UCH has engaged many partners and organizations to promote health and prevent illness in the local community with a focus on serving the community’s most vulnerable populations. These efforts not only focus on providing emergency services and charity care, they also aim to develop and offer programs that promote health, prevent illness and, ultimately, address the social determinants of health. This report summarizes UCH planned activities to support the identified community health needs.

Our mission. We improve lives. In big ways through learning, healing and the highest quality medical care with an exceptional patient discovery. In small, personal ways through human connection. experience. With more than 150 locations throughout the But in all ways, we improve lives. region, UCHealth pushes the boundaries of medicine, providing advanced treatments and clinical trials to ensure Our vision. excellent care and outcomes for 1.7 million patients each and From health care to health every year. UCHealth is also the largest provider of Medicaid services in Colorado and has cared for 691,000 inpatient Our values. admissions and outpatient visits for Medicaid patients during Patients first fiscal year 2019, an increase of 239% since fiscal year 2013. Integrity Excellence Communities served. The UCH community is defined as Adams, Arapahoe, University of Colorado Hospital overview. Denver and Douglas counties. Residents from these counties UCH is the region’s only academic medical center and has comprised 65% of UCH patients cared for during 2018. The been a part of the local community since 1921. UCH has 678 following map illustrates the UCH community. licensed hospital beds and is supported by 40 additional locations throughout the Metro Denver area. As the state’s only comprehensive transplant center and American Burn Association verified center, UCH offers the most advanced services throughout Colorado. UCH is committed to improving the lives of the community’s most vulnerable residents and has cared for more than 208,000 inpatient admissions and outpatient visits for Medicaid patients in fiscal year 2019, a 171% increase from fiscal year 2013. Faculty of the University of Adams Colorado School of Medicine (CU SOM), part of the University Denver Arapahoe of Colorado, are the exclusive physicans at UCH.

UCH is part of University of Colorado Health (UCHealth), a Colorado-based health system that offers the most advanced Douglas care throughout the Rocky Mountain Region, extending from Colorado to Wyoming and western . As Colorado’s only integrated community and academic health system, we are dedicated to improving lives and providing

3 UCHealth Implementation strategy

Implementation strategy process, development and approval. The Implementation Strategy (IS) report for the University of Colorado Hospital is based on the findings and health-issue priorities established through the University of Colorado Hospital Community Health Needs Assessment (CHNA).

Implementation strategy process. An implementation strategy summarizes a hospital’s plans to The development of the implementation strategy was based address identified community-health needs and is intended on an assessment of available community resources as well as to satisfy the requirements set forth in the Patient Protection a review of UCH clinical support services, community-health and Affordable Care Act (PPACA), passed in 2010. The improvement programs and sponsorships and contributions implementation strategy process is intended to align the to community organizations that align with identified health hospital’s resources and programs with goals, objectives and needs within the community. metrics for how the hospital plans to address the identified health needs in the local community. The activities described in this report also rely on collaboration and partnerships with many of the same The implementation strategy was developed by the University organizations and stakeholders that participated in the of Colorado Hospital Internal Advisory Group (IAG), which is CHNA process. The strategies listed represent the combined comprised of senior leaders at UCH and represents a broad input from key community leaders, public health experts, range of departments and services across the organization. local health care providers and UCH leadership. Appendix A includes a list of the organizations engaged during the CHNA and implementation-strategy processes.

This report describes hospital-based resources directed toward programs and services that will impact the priority health issues and are also aligned with federal community- benefit guidelines for non-profit hospitals. Given the ever- changing landscape of health care, the initiatives in this implementation strategy could change, and new ones may be added or others eliminated based on the community needs during the 2020 through 2022 timeframe. On an annual basis, the UCH IAG will review this implementation strategy to determine if changes should be made to better address the health needs of the community.

Board of Directors approval. During the October 2019 meeting, the UCH Board of Directors was apprised of and approved this implementation strategy and related activities described within this report.

4 UCHealth Community health needs

Identified community health needs. UCH completed its 2019 CHNA during the timeframe of July 2018–June 2019. The CHNA process provided an opportunity for the hospital to engage public health experts, medical providers and community stakeholders to collectively identify the most critical health needs within the community.

Assessment and prioritization process. Prioritized health issues. A review of health data indicators, results from a health The prioritized health issues identified for impact within the care provider survey and community input were combined community served by UCH include: to generate a list of proposed priority health needs. The • Mental and behavioral health and substance use disorder comprehensive list of opportunities was presented to • Access to care UCH IAG for consideration and was prioritized based on the following criteria: • Cardiovascular disease prevention (and related risk factors including obesity) • Scope and severity of the health need. • Social determinants of health (employment and education) • Economic feasibility to address health need. • Potential for hospital to impact health need. Tables addressing prioritized health needs. • Alignment with UCHealth system strategies and local, state and national objectives. The following tables outline strategies, initiatives, anticipated impact, potential collaborations and partners and resources that the hospital will commit to address each of the prioritized health needs.

5 UCHealth 2020 – 2022 Implementation Strategy Priority health issue: Mental and behavioral health and substance use disorder. Goal: Improve access, identification and treatment of individuals with behavioral health issues.

Mental and behavioral health ranked high in every survey taken, and mental health challenges are prominent in health care discussions across the UCH community. Most of the emphasis is on the lack of care coordination and challenges with confidential-information sharing among agencies. Efforts are already underway to improve communication between agencies, share resources and enhance collaboration. Substance use is recognized as a separate, but companion issue to mental and behavioral health, as work in the mental health arena often extends to substance use. It is also worth noting that mental health focus can also include adverse childhood events and suicide prevention.

Programs and Activities Anticipated Outcome or Existing or Resources initiatives impact evaluation planned metric collaborations

Integrating Embed teams of Improved access Number of UCHealth Medical behavioral licensed clinical to behavioral behavioral Group and CU SOM health with social workers health services and health specialists primary care and psychologists resources. embedded into the into primary care primary care setting. Staff time to practices. support the implementation or perform assessment of the Tele-behavioral Implement tele- Improved access to Number of virtual UCHealth Virtual programs listed in health behavioral health behavioral health behavioral health Health Center the table. consultation consults through consultations. consultations. services the UCHealth Financial Virtual Health support/ Center. investment direct and via in-kind services. Alternatives to Implement Decreased Opioid prescribing The Colorado opioids protocols for pain administration in emergency Hospital management of opioids in departments, urgent Association, without the use emergency care facilities and Colorado Chapter of opioids in department and inpatient hospital of American College all UCHealth inpatient units. medicine services. of Emergency emergency Physicians, departments Colorado and urgent care Consortium for facilities. Adapt Prescription Drug the protocols for Abuse Prevention, use in hospitalized Telligen, Colorado medicine patients Emergency Nurses and roll out across Association UCHealth (starting with UCHA).

Opioid- Continue Increased Opioid prescribing UCHealth marketing awareness implementation awareness of risks patterns. and public relations campaign of system-wide associated with team opioid-awareness opioid use and campaign. alternatives to their use.

6 UCHealth Priority health issue: Mental and behavioral health and substance use disorder. Continued from Page 6

Programs and Activities Anticipated Outcome or Existing or Resources initiatives impact evaluation planned metric collaborations

UCH Center for Facilitate Increased support Number of meetings UCH CeDAR dependency, Alcoholics for recovering held. addiction and Anonymous and patients. Increased Number of rehabilitation Al-Anon program support for families participants. recovery and meetings. of recovering meetings patients.

Addiction Assist pregnant Improved Number of patients UCH psychiatric treatment patients with outcomes for assisted. services and CeDAR during treatment of moms and babies. program, Aurora pregnancy addiction and Mental Health with connecting to addiction- treatment options. Staff time to support the implementation University Provide emotional Improved access Number of patients UCH Outpatient or perform of Colorado support and to behavioral served. Psychiatric Services, assessment of the Hospital community health services and Children’s Hospital programs listed in Promise Clinic contacts for women resources. Colorado, Aurora the table. who are receiving Mental Health pregnancy care Financial and who may support/ be experiencing investment direct perinatal mood and via in-kind disorders. services.

Metro Denver Collaborate with Increased access Development of MDPH includes Partnership for county health to mental health collaboration. Boulder, Broomfield, Health (MDPH) departments and social Number of patients Denver and Tri- participation and other health services. Improved served. County Health systems to address quality of care Hospital Agencies, Centura, mental health for mental health Transformation SCL, Children’s and substance- and substance Program (HTP) Hospital Colorado, use issues across use patients. measures. Health ONE, Denver Colorado. Increased mental Health and a number health disorder of other agencies awareness. and providers.

Prevent alcohol Sponsor and Reduce death and Number of programs UCHealth Trauma and risk-related facilitate one-day injury in alcohol, performed. Department trauma in youth injury awareness drug and risk- Number of students (P. A .R.T.Y) and prevention related crashes and attending. program programs for youth incidents. aged 15 and older.

“Let’s Talk Provide tools to Advance mental Number of Tri-County Health Colorado” discuss mental health awareness. impressions tracked Department mental health stigma. by Tri-County health stigma Encourage those through campaign campaign in need to seek website. treatment.

7 UCHealth 2020 – 2022 Implementation Strategy Priority health issue: Access to care. Goal: Improve access to comprehensive, quality health care services including both primary care and behavioral health.

The ability to access care varies widely across the UCH community; however, access consistently ranks as a major concern across all areas within the UCH community. Two of the counties served by UCH report uninsured percentages higher than the state average. In addition, community leaders both within and outside the health care industry frequently comment on the lack of access with emphasis on specialty services. Primary care providers have shared their frustration with the ability to connect patients with specialists.

Programs and Activities Anticipated Outcome or Existing or Resources initiatives impact evaluation planned metric collaborations

Urban Evaluate potential Improved quality Feasibility report on School of Medicine Underserved sponsorship of and access to implementation of Medically Track at CU student activities care in ZIP codes program. Underserved School of and development surrounding Track Medicine of resident care Anschutz Medical Staff time to program. Campus. support the implementation or perform assessment of the UCHealth Evaluate Increased access to Development UCHealth Medical programs listed in Medical opportunities to providers by those of physician- Group and the table. Group and CU recruit additional seeking care in the recruitment strategy. CU Medicine Medicine faculty physicians to the community. In-kind expenses recruitment of UCH community. associated new physicians with serving as fiscal agent for programs. Aurora Health Provide financial Educate residents Number of Aurora Health Alliance support for on health care impressions from Alliance, collaboration implementation of options. campaigns and Rubicon MD, community-based Explore care outreach. ECHO Colorado initiatives developed alternatives. Number of residents to identify and assist Engage new health guided and assisted. individuals with care providers. New or enhanced access to primary services developed. and specialty care services.

Extension for Explore Increased access Report on current ECHO Colorado Community opportunities to to care through state and feasibility Health partner with CU expanded use of expansion. Outcomes SOM to expand of telehealth Number of providers (ECHO) ECHO into new technology. added. service areas. Number of consults provided.

DAWN clinic Provide Increased access Number of lab tests DAWN clinic interdisciplinary sponsorship to care through processed for DAWN student-run free of technical DAWN clinic. patients. clinic serving support for EPIC uninsured platform. Perform patients from processing of lab the Aurora specimens for community DAWN patients.

8 UCHealth Priority health issue: Access to care. Continued from Page 8

Programs and Activities Anticipated Outcome or Existing or Resources initiatives impact evaluation planned metric collaborations

UCHealth Provide program to Increased support Number of patients UCHealth Integrated assist transgender for transgender served. supporting clinical Transgender and gender- and gender-diverse departments Program diverse individuals adults to achieve with health their personal needs including health goals. initial evaluation hormonal therapy, surgical procedures and routine health maintenance.

Forensic nurse Provide program Increased access Number of patients Forensic nurse examination to perform forensic to support for served. examination program examinations victims. Increased program Staff time to of individuals collaboration with support the who have been law enforcement. implementation sexually assaulted or perform or otherwise assessment of the impacted by programs listed in violence. the table.

In-kind expenses associated UCHealth Provide uninsured Increased number Total number of UCH Pharmacy with serving as Prescription and underinsured of community participants in Department fiscal agent for Club patients with free members who are program. programs. and discounted able to fill their Total number of prescriptions. prescriptions. free or discounted prescriptions filled.

Hispanic Provide education, Improved Number of patients UCHealth transplant counseling education about and families using Transplant program and support to the transplant the program. Department Spanish-speaking process. Improved transplant patients quality of care and and their families. experience for Spanish-speaking transplant patients and families.

Facilitate Provide resources Increased number Value of resources CU Schools of education to promote and of qualified health provided. Medicine, Nursing, and training support the care professionals Number of medical Pharmacy and of medical education and available to the professionals trained. Dental; CU School professionals training of medical community. of Public Health professionals.

9 UCHealth 2020 – 2022 Implementation Strategy Priority health issue: Cardiovascular disease prevention (and related risk factors). Goal: Improve cardiovascular health and quality of life through prevention, detection and treatment of risk factors.

Cardiovascular disease remains the leading cause of mortality and hospitalizations, despite the substantial and ongoing progress being made in cardiovascular disease prevention and treatment over the past 30 years. Cardiovascular disease with an emphasis on obesity was identified as an issue in the UCH community. Education, screenings and outreach will be key in addressing the issue moving forward.

Programs and Activities Anticipated Outcome or Existing or Resources initiatives impact evaluation planned metric collaborations

Vaping Explore Improved Report on feasibility Community College education development education of of program. of Aurora, program of program to vaping impact. Number of Aurora Public provide accurate presentations Schools information on the performed. Staff time to dangers of vaping. Number of support the attendees. implementation or perform assessment of the programs listed in Telehealth Provide program Improved quality Number of consults UCHealth Diabetes the table. for diabetes allowing of care for diabetic performed. and Endocrinology education community- patients. Increased Number of patients practice In-kind expenses based primary access to specialty served. associated care physicians services. with serving as and patients fiscal agent for to consult with programs. UCHealth diabetes specialists through technology.

Mobile stroke- Provide community Improved Total number UCH Mobile Stroke education outreach including education of events. Unit, Aurora Health program lectures and and increased Total number Alliance, UCHealth e-communication awareness of of participants. Medical Group on topics that stroke-risk factors Total number focus on stroke and treatment. of impressions. and cardiovascular disease prevention.

American Provide financial Increase number Amount of AHA Hospital assistance to AHA of programs, sponsorship. Association to help support education or (AHA) programs and research related sponsorship initiatives designed to cardiovascular to improve disease. cardiovascular health.

10 UCHealth 2020 – 2022 Implementation Strategy Priority health issue: Social determinants of health with a focus on education and employment. Goal: Improve non-clinical factors related to quality of life and physical well-being.

Some research suggests socio-economic factors could account for 60% to 85% of health outcomes. Social Determinants of Health (SDOH) emerged as a consistent theme in the UCH CHNA surveys and forums and our implementation plan primarily focuses on education and employment opportunities.

Programs and Activities Anticipated Outcome or Existing or Resources initiatives impact evaluation planned metric collaborations

Community Explore Enhanced Report on feasibility Community College College of development of employment of program. of Aurora, CU Aurora (CCA) an apprenticeship opportunities School of Medicine, Apprenticeship pipeline between for the Aurora Children’s Hospital Anschutz Medical community. Colorado, Center program Staff time to Campus and CCA. for Work Education support the and Employment implementation or perform assessment of the programs. Community Provide support Increased Number of Aurora Public for the hire-local employment residents served Schools, Campus In-kind expenses program focused and advanced and employed in Community College Partnership associated on employment of education in identified ZIP codes. of Aurora. (CCP) program with serving as residents from ZIP underserved areas fiscal agent for codes surrounding of the community. programs. Anschutz Medical Campus

Provide support for learn-local program focused on preparing residents for careers in health care fields.

Center Provide support Enhanced Number of staff CWEE for Work, for education preparation hours dedicated to Education and and employment for low-income CWEE activities. Employment programming residents for Number of graduates (CWEE) designed to secondary from each phase of partnership advance low- education and the program. income participants employment through basic opportunities. and advanced education and skills preparation.

Homeless Provide financial Increased access Number of nights Comitis Crisis medical respite support for five to temporary provided. Shelter program beds at the Comitis shelter for Aurora Number of homeless Crisis Shelter. homeless. served.

11 UCHealth Conclusion

UCH’s implementation strategy for 2020–2022 will serve as one of the numerous ways that UCH and UCHealth support the local community. This report summarizes our plan to impact our patients and the communities we serve through a focus on the prioritized areas of need identified within the CHNA. UCH will regularly identify ways to refine this implementation strategy over the next three years, including collaboration with leaders from across UCHealth to explore policies, practices and programs that might be implemented within the UCH community. UCH will continue to focus its efforts in the community to facilitate collaboration among organizations promoting health improvement and, ultimately, achieve the mission of improving the lives of those we serve.

12 UCHealth Appendix A Organizations engaged during the CHNA and implementation strategy processes:

• Aurora Chamber of Commerce • Aurora Mental Health • Aurora Health Alliance, which includes the following • Center for Work Education and Employment member organizations: • City of Aurora –– Adams County Human Services • Colorado Health Institute –– Advanced Healthcare • Community Campus Partnership –– Alzheimer’s Association Colorado Chapter • Community College of Aurora –– Arapahoe–Douglas-Elbert Medical Society • DAWN Clinic • Denver County Health –– ArapahoeDouglas Mental Health Network • Denver Public Health –– Asian Pacific Development Center • ECHO Colorado –– AuroraAdams County Medical Society • MCPN/STRIDE –– Aurora Commission for seniors • Metro Denver Partnership for Health –– Aurora Denver Cardiology • Salud Family Health Centers –– Aurora Fire Department • Tri-County Health –– Aurora’s Commission on Aging • University of Colorado School of Medicine –– Boulder County Health Improvement Coalition –– Colorado Academy of Family Physicians –– Colorado Access –– Colorado Consumer Health Initiative –– Colorado Department of Public Health –– Colorado Department of Health Care Policy and Financing –– Colorado Language Connection –– Colorado Medical Society –– Colorado Primary Care Clinic –– Colorado Refugee Wellness Center –– CORHIO –– DentaQuest –– Doctors Care –– AF Williams Family Medicine –– Futurity First –– HealthOne –– InnovAge –– Kaiser Permanente –– Level Chiropractic –– Mercy Housing –– Mile High Health Alliance –– New Horizons Primary Care Clinic –– NextCare Urgent Care –– Parker Adventist Hospital –– PASCO –– Peoples House –– Porter Adventist Hospital Behavioral Health –– Primary Care Programs, Fields Foundation –– Rubicon MD –– SCL Home Health –– The Colorado Health Foundation –– The Medical Center of Aurora

13 UCHealth