Annie Smith works as the Special Projects Manager, Community Health at St. John’s Health System in Oklahoma In her position as Special Projects Manager, Community Health, she has the operational responsibility for all aspects of community health and health equity initiatives for St. John Health System. One of her main responsibilities is to direct and oversee the completion of the health system’s six member hospital facilities’ community health needs assessments.
Thanks for talking with us Annie! Could you tell me a little bit about St. John Health System and your role within the organization?
St. John Health System is a fully integrated healthcare delivery system that was established in 1926 with the opening of St. John’s Hospital (now St. John Medical Center) in Tulsa, Oklahoma. It encompasses seven hospitals in northeastern Oklahoma and southern Kansas. We serve as an important safety net provider of a broad continuum of healthcare services to the citizens of northeastern Oklahoma and the surrounding region. The health system’s service area contains 260 ZIP codes in 32 counties in Oklahoma, Kansas, and Arkansas. The health system’s primary service area is approximately 1.1 million people. It’s organized as a tax-exempt integrated healthcare delivery system.
Our mission is to continue the healing ministry of Jesus Christ by providing medical excellence and compassionate care to all those we serve, especially persons living in poverty or who are otherwise deemed vulnerable. Now as part of Ascension Health, St. John Health System has access to additional resources to help us continue to transform the quality of care we provide to our patients.
So your focus, it seems, has a huge emphasis on community benefit. Is that what you would say differentiates you from other for-profit hospitals?
Yes, I do believe the shared mission of St. John Health System and Ascension set us apart from other healthcare organizations. St. John Health System is deeply committed to its local communities. St. John Health System has been an integral part of every community it serves—providing nationally recognized healthcare services and giving back through care for persons living in poverty, education of medical care professionals, medical research, and many other services that help make our communities better places to live. We provide more than $70 million per year in quantifiable community benefit, including care for persons living in poverty, support for graduate and allied health medical education, and community outreach.
Do you partner with any Catholic churches or charities in communities to help deliver some of the services?
Yes, we actively partner with Catholic churches, faith-based organizations, and charities in the communities we serve to deliver an array of services. Our health system also partners with non-profit agencies, schools and educational intuitions, law enforcement, community health centers, local health departments, and a number of other community-based organizations on community health and health equity initiatives. Through the creation of the Medical Access Program (MAP), St. John serves individuals living in poverty in numerous ways including the operation of the Rockford Medical Clinic in Tulsa, which offers free primary medical care; financial support of other organizations offering free primary medical care; and provision of free diagnostic imaging and specialty medical care. The estimated cost of this outreach program exceeds $5 million per year, which is provided by St. John and private donors. Many physicians in our community participate in this program by providing care at no cost to the patient.
The process of conducting community health needs assessments has served as an ideal opportunity for our health system to initiate and strengthen mutually beneficial relationships within the community we serve.
And the Community Health Needs Assessments are one of the requirements for the IRS?
These assessments have been widely used in the public health field for decades. However, community health needs assessments have received heightened attention among healthcare providers and organizations in recent years with the passage of the Patient Protection and Affordable Care Act (Affordable Care Act, ACA) in 2010. The ACA requires not-for-profit 501(c) (3) healthcare organizations to satisfy certain requirements in order to remain tax-exempt. To comply with federal tax-exemption requirements, a tax-exempt hospital facility must conduct a community health needs assessment every three years and adopt an implementation strategy to meet the community health needs identified through the assessment.
What led you to use Community Commons for Community Health Needs Assessments?
I began using Community Commons to compile secondary data for our hospitals facilities’ community health needs assessments in late 2015. I’m not certain, but I believe I first found out about Community Commons either through a national webinar or through information provided by Ascension. The site was also recommended to me by staff at from the Tulsa City-County Health Department. Some of our hospital facilities are located in rural areas and the health departments and other local sources of data in these areas are often times not as robust as in some of our more urban communities.
I really appreciated the fact that Community Commons has a variety of health indicators available from a multitude of reputable sources. The indicators are categorized into different categories that pertain to health such as demographics, social and economic factors, physical environment, clinical care, health behaviors, and health outcomes which I found to be very helpful. I also like that Community Commons has data and information available that pertain to health disparities and the social determinants of health.
I imagine it’ll be different just based on the location of all the hospitals, but do you see any overarching health issues that are dominant in rural communities?
Each of the communities we serve has unique heath needs and assets. However, affordability and access to care, unmet behavioral health, chronic disease management needs, health education and literacy needs, economic development, and healthy behavior supports are recurring themes for our communities. There are four overarching health needs that were identified, as priority health needs to address:
- Wellness and Chronic Disease Prevention
- Access to Care
- Behavioral Health
- Health Literacy
The data from our assessments demonstrated that Oklahoma continues to rank near the bottom in multiple key health status indicators. Many of these outcomes are related to conditions that Oklahomans must live with every day. Poverty, lack of insurance, limited access to primary care, and inadequate prenatal care, along with risky health behaviors associated with these determinants, such as low fruit/vegetable consumption, low physical activity, and a high prevalence of smoking contributes to the poor health status of our citizens. Diabetes, hypertension, obesity, physical activity and nutrition, and tobacco use are risk factors associated with heart disease and cancer, the leading causes of death in Oklahoma. Greater socioeconomic need and health impacts are found among certain populations and geographic areas. These areas and populations with high socioeconomic need are also the most affected by health problems, as evidenced by significantly worse health outcome measures, higher hospitalization rates, and myriad health challenges. Though these health issues occur throughout our state, many of these health issues are exacerbated in our rural communities due to lack of access.
Access to health care is challenging in many counties, especially those that are rural, due to shortages of primary and specialty care. Access challenges also exist for those with no or limited insurance, cultural differences, or complicated needs. Federally designated underserved areas and populations cover nearly the entirety of Oklahoma. To make matters worse, many of our rural hospitals and healthcare facilities have closed or are struggling to keep their doors open.
We’re seeing the impact of the opioid epidemic across the country, especially in rural areas where people lack insurance coverage or are geographically isolated from treatment facilities. Does there seem to be an uptake in substance abuse and mental health issues in communities you serve?
Yes. Behavioral health is a health issue that was identified as a priority health need to address among all the communities we serve. In fact, mental health and substance abuse issues are among the most pressing concerns facing our state. Oklahoma consistently ranks among the highest in the region, and nationally, for rates of mental illness and addiction, as well as prescription drug abuse, underage drinking and suicide. Our secondary data review and input from community members and representatives reveal an uptake in substance abuse and mental health issues as well as increasing concerns regarding these issues in the communities we serve, especially among rural communities. We have one area, Creek County, OK, where the community quickly pointed out that opioid abuse and overdoses is a significant health issue. This issue was further confirmed by our secondary data review of the area.
What groups are being most affected?
There was a higher proportion of teens 12-17 years reporting illicit drug dependence or abuse in Oklahoma (3.0%) than adults 18 years and older (2.3%) in 2013-2014. However, overdose deaths appear to be more prevalent among adults. According to the Oklahoma State Department of Health, Tulsa County adults age 35-54 had the highest rate of unintentional poisoning death in 2007-2012. Additionally, Tulsa County adults age 45-54 were more than 2.5 times as likely to die of an unintentional poisoning compared to teens and young adults age 15-24 in 2007-2012.
You work with a lot of rural communities, do they typically have to travel far to receive treatment?
Yes, we see a lot of people who need to travel great distances just to access care. Lack of transportation prevents certain patients from receiving preventative care and continuing an established course of treatment. Recognizing this barrier to accessing health care, St. John Health System has negotiated a transportation services agreement with Morton Comprehensive Health Services Inc. (Morton). Morton is one of Oklahoma’s largest community health centers in the state of Oklahoma and is a federally qualified health center. Morton possesses a Transportation Services department which assists both registered patients and the community with safe and dependable services.
It sounds like you’re being proactive to reverse a lot of these trends.
Yes, St. John Health System and Ascension are dedicated to transformation through innovation across the continuum of care. Accordingly, we are working proactively to address the health needs identified in our communities. Our community health needs assessment process has been a critical step in our efforts to transform the quality of care we provide to our patients, reduce high costs, and improve poor health outcomes. This process, especially the focus on community engagement, has provided us with opportunity to work towards meaningful and measurable health improvement in the communities we serve.