Providence Northern California annual community report

Debbie Gibson: 

Good afternoon and welcome to our broadcast. Thank you so much for joining us today to learn more about community benefit in Northern California. My name is Debbie Gibson and I have the pleasure to lead operations for our integrated community investments at Providence. With me today is Victor Jordan, the regional chief executive for Northern California and Dana Codorn, our regional director for Northern California Community Health investment. With the release of our system wide 2020 annual report to the community just this past May, I'm hoping that many of you saw both the financial results for community benefit, and also the amazing collage of stories that highlights our different programs, initiatives and investments that we made last year, to serve individuals and communities in proactive and strategic ways that address unmet and critical Community Health things. We know, however, that this is more than just a typical report, because it really is about our goal, but more broadly as a health system to create health for a better world. And it's also about the very localized work that we do to make a difference in individuals lives, and impacting communities in incremental but significant ways. They and report to our community demonstrates this work in a very unique way, which allows us to really connect these community initiatives to our strong missionary heritage, as well as the social determinants of health, and demonstrates how this work extends beyond the walls of our hospitals, and can also play an important role in improving patient outcomes, as well as overall health and well being. So today, we're going to focus in on some of these details about the Northern California region, with both Victor and Dana here with us, and the work that's going on in their specific communities. So Victor, I'll start with you and ask you to first tell us a little bit about yourself. What brought you to your leadership position at Providence in Northern California, and maybe a little brief overview of the different markets that make up your region? 

Victor Jordan: 

Very good. Thank you. Victor Jordan, I am the regional chief executive for Northern California on an interim basis. Happy to be up here. I've been serving in this role about two months now. And I've already learned a lot about what we're doing with community benefits, and really am pleased that we're getting the word out today to our communities about the great work we do. For the past four years, I've been the regional Chief Operating Officer for Providence down in Southern California, and I live down there in Orange County with my wife, and I have two kids a little bit older one in college and one in Miami, who's 23 so many years of healthcare leadership experience at the regional level, and hospital level. I'd like to tell you a little bit about the regional overview up here in Northern California and what I've learned so far in our three distinct markets. We provide services in Humboldt County, through Redwood Memorial Hospital in St. Joseph Hospital, Eureka. St. Joseph hospitals and acute care hospital founded in 1920. So, they just celebrated their 100th anniversary of being a hospital up in Eureka. The service area for us is the entire Humboldt County, everybody up there and every part of the county, including more than 100,000 people. in Humboldt County, we offer variety of community-based programs that meet the needs of vulnerable populations and our focus in this area is equitable access to healthcare for everyone that lives. Primary care, health promotion and community building are all very important in Humboldt County. Moving to Napa County, we provide services through Queen the valley Medical Center UPMC is an acute care hospital founded in 1958 and located in Napa, California. The hospital service area is the entire county of Napa. It's approximately 140,000 people. We dedicate resources in this community with a special emphasis on the poor and vulnerable and this meets our mission at Providence. And then finally going down to Sonoma County Santa Rosa Memorial Hospital, Petaluma Valley Hospital and Healdsburg hospital are part of our county by network encompassing Sonoma County. Providence also has urgent care facilities, hospice, home health, and other facilities for treating the healthcare needs of the community in Sonoma County. We are moving toward a health delivery system versus being a hospital company and really being more holistic about what we do out in the communities. I'd also like to mention the great physician network that we have in all three of these counties through our Providence Medical Foundation, and also through the great medical staffs that we have Each hospital taking care of our patients. So that's the overview of the 

Debbie Gibson: 

Thank you. Thank you. So, I'll ask Dana to do the same. Can you please give us a little bit about background about yourself, as well as how you're organized in the northern California region to really support this community health investment work? And also, high level? What were your big takeaways from 2020 in terms of community needs, and the challenges as a result of that? 

Dana Codorn: 

Sure, Debbie, thank you. began my healthcare career as a nurse more than 35 years ago, it was definitely a calling for me I knew as a young girl that I wanted to be a nurse. And about midway through my career, I moved from taking care of patients in the hospital to home health where I would meet patients in their homes. And it was there that I discovered my passion for community health, I could see really firsthand how certain socio economic conditions interfered with someone's ability to live a healthy and healthy life and a high quality life. For example, if someone is concerned about keeping a roof over their head or food in the refrigerator, they were less likely to be able to prioritize co pays for doctor's visits or to purchase prescriptions. So then we see this ripple effect in terms of poor health outcomes. And so I went back to school to get my master's degree in Public Health. And here I am so very proud to be a leader and a caregiver for community health for Providence here in Northern California. Yes, in terms of our how we're organized in our region to support community health, there are multiple ways that we contribute to our communities. One, of course, is through cash contributions or donations. Another way that we also provide here in Northern California is by providing direct services such as a mobile dental clinic or mobile health clinic. We have our footprint in elementary schools and in high needs areas providing health outreach, and education. So across our region, we have approximately 120 Community Health caregivers for us in Northern California, and that they really range from dentists to nurse practitioners, nurses, social workers, community health workers, health educators, just to name a few. And, yes, that definitely the kind of investments that we made in 2020 changed in a strategic way as a result of the pandemic. One example is that we decreased our traditional cash donations and sponsorships in order to increase grants and dollars that focused on COVID response and emergent needs. We really looked at increasing equitable access to care, especially with regard to COVID testing, treatment and outreach. also addressing significant spikes in food insecurity brought on by the very high unemployment rate and economic impacts of the pandemic. And we addressed critical needs among the unstably housed in particular providing PPE assisting people to become temporarily housed and to quarantine safely. We did need to change our response given the pandemic last year in those ways. But in general, aside from the pandemic, our work is driven by priorities that come from a very robust Community Health Needs Assessment, we conduct a Community Health Needs Assessment every three years. And then based on those priorities that are indicated by the needs assessment that really informs how and how strategically and where we'll invest our dollars and resources into the communities we serve. Our last needs assessment was just conducted. And in across our region, we have four priority areas that we'll be focusing our energies on, and resources on. One is mental health and substance use. Another is homelessness and housing instability. And then another one is access to health services. And we saw during the pandemic that not everyone has equal access to health services. And then the fourth one is really calling out health equity as a priority for us to address and that is encompassing racism, discrimination, LGBTQ needs, anything that has to do with equitable access to care, and services and quality of life. 

Debbie Gibson: 

Thank you, both Victor and Dana, for that background, listening to your talk, Dana, all of these needs seem pretty significant given the issues in 2020, not just from COVID, but also from the social unrest that we experienced, as well as the wildfires that, you know, really were prominent for us, especially here in the West. So, Victor, I guess the next question I'll ask of you, given all of these significant needs and the information that Dana just shared with you tell us specifically about the Northern California regions financial commitment to community benefit. And how did it compare to the year before that? 

Victor Jordan: 

Well, I can tell you that Dana and the team have educated me. Well, on what we've been doing up here. So, I'd be happy to share some of this information, the total community benefits band in 2020 was approximately $112 million, which is significant investment represents 10 million more than last year then in 2019. And I think that's significant to because of the critical community needs brought on by COVID-19, as well as the financial challenges within our own health system caused by COVID-19. part of this community benefit includes charity care, and uncompensated Medicaid, or what we call Medi Cal in California, and that is for that program for Medi Cal. The cost of providing care to these patients actually exceeds the reimbursement that we received from the government. And so that is part of a community benefit to them when we provide those services. Then we have proactive investments where we get out ahead of the curve, and those total $29 million last year. It includes different categories such as grants, donations, community building initiatives, community health programs, subsidized health services, health professionals, education and research. Providence sets an internal target for this financial commitment as part of our overall system plan each year, we have set targets for all of our regions and at the system level based on spending a certain percentage of our net revenue. And when I say net service revenue, that means the amount of money we expect to collect in total, for all the services we provide to the patients. We reinvest part of that back into our community benefits at a certain percentage. We monitor the progress regularly within our regional leadership team and our local community boards. So, community benefit is part of a formal roadmap to achieving our vision of health for a better world. And that is our vision within Providence health for a better world. It clearly reflects our collective commitment to address the inequities that Dana mentioned earlier health inequities, and disparities in health care, as well as the social determinants of health. These are the kinds of investments that are needed to level the playing field for those who don't have as much resources, some others. And then also, finally, community benefit is a form of public trust that our communities need to have in us because of our nonprofit tax status. 

Debbie Gibson: 

Thank you, Victor, you mentioned several times we talked about proactive investments, and that certainly is a significant financial commitment that you that you just discussed. But you talk to us a little bit more about what is proactive, really mean? Why do we focus on it? And how does that translate into the investments that we make and the programs that we create for the community? 

Victor Jordan: 

Sure, you know, thinking about proactive investments, as I mentioned earlier, getting ahead of the curve, and not being so reactive. And so those are the actions we can take to help our community to get and stay healthy before they would need otherwise seek treatment in our hospitals, especially in the emergency department. By the time you get to the emergency department, things are probably pretty bad if you haven't had access to primary care, or other preventive services. One example of this is the mobile health van that we have. I had the opportunity to go out there and visit it just last week, down in Petaluma. And it's more than a health van. It's more like an RV, it's a very large RV. It's a rolling physician's office. Basically, there's a medical assistant in there, and a nurse practitioner, and they drive this thing around to homeless shelters and churches. And those are the kind of proactive services I'm talking about where they do health screenings and take care of folks before things get too serious, and they have to go to the emergency department. Another common term is to focus on upstream interventions, which means creating ways to transform a person's quality of life so that their health outcomes are improved as well. Health Education and Outreach about chronic conditions, wellness and exercise programs, housing solutions, and community based mental health and substance use programs are all good examples of proactive investments. How do we connect these concepts to the investments? Dana talked earlier about our community health needs assessments are what we call CHNA, that's where we go out and we do an assessment of the community to identify what are their top health needs, and critical access issues. Then we create an integrated community health improvement plan with prioritized proactive initiatives. So that our investment strategies on our funds are targeting those identified needs. Also, there are hospital-based programs that are considered proactive community benefit, subsidized health services, which are basically clinical programs, even when they operate at a financial loss. These programs are very key to our communities, if we did not provide them in our Providence ministries, I'm not sure who would, to tell you the truth as part of our mission. In Northern California, Dana and her team had been working closely with our finance partners in the past year or so to be sure we're capturing reporting all these opportunities when we report out on community benefits. So, in contrast to the proactive things that I just mentioned, charity care and other government subsidized programs are what we call reactive. So, we're taking care of these folks when they come into our hospitals. But it's not an it's more reacted to what they're experiencing versus proactive, and going out into the community, it's still considered a community benefit, because it's a safety net for the uninsured, and the underinsured individuals when they do see or need treatment in our facilities. 

Debbie Gibson: 

Thank you, Victor. So now, we know about your financial commitment. And we know a lot more about what the proactive investments me, I'm going to turn it over to Dana and ask her to share some a little bit more about some of the specific regional Community Health investment programs to highlight and demonstrate for all of you listening, help me bring this work to life in our communities? 

Dana Codorn: 

Absolutely. Thank you again, Debbie. The the programs and investments that we make in our communities do vary community to community, because each community has different needs and assets. So I will share with you some of our larger programs, understanding that this is not inclusive, there are quite a few activities and, and ways that we work with and in our communities through community health investment. I first will start with just in general, our COVID response, because meeting the needs of the communities is what we do and community health investment. We were very fortunate in our region to have such a wide cadre of caregivers that are really already in the community boots on the ground and could pivot on a dime to respond to the pandemic. And that's exactly what we did. We had, nurses and social workers and nurse practitioners that were able to support County Public Health efforts by conducting COVID testing by providing outreach and education. So many of our caregivers are bilingual, English, Spanish, we have a large community of farmworkers and agricultural workers and hospitality workers in Northern California. And it's very important for us to ensure equitable access and education for everyone. So we were able to do that and support the county public health needs and also our federally qualified health centers. Human Resources were probably one of the most scarce resources that we had during the pandemic, both inside the hospital walls and in the community. So this was very, very valuable that we were able to do that. We also at the very beginning of the pandemic simply just worked with our community partners and assembled and purchased items for COVID kits, we called them, thermometers, PPE masks, sanitizing supplies, and made sure that they were distributed in high need areas. So that farm worker, housing sites and agricultural sites and other areas where we had essential workers that would have difficulty isolating and needed that extra help. I would also speak to the food distribution that we did in Eureka in Humboldt County, we have five community resource centers that we operate and staff. And those simply turned into food distribution sites, and PPE distribution sites. We also ended up when testing was available testing people there. So they were a trusted place in the community for people to go for help when they needed help. And we just flipped the switch and responded to COVID at all of those sites up in Humboldt County. 

I'll share also that we're fortunate in Providence that the funding for some of these initiatives, some of these resources that we needed during the pandemic, did come from community health investment, but it also came from our St. Joseph community partnership Fund, which provides some funding support for our communities in times of need and natural disasters and pandemics and also from Providence health equity initiative, which is a large initiative across our system. And with those dollars, we were able to buy iPads that we could use at vaccination sites and in the community. We had bilingual kidney health workers that were assisting people to sign up in “My Turn” which is the platform, California used to get vaccinated. So lots of resources pulling into our communities from Providence. And so from COVID response, because we've talked a lot about COVID, we just have such a long history of providing services in our community. And this one program, in particular I'll share about is called the care network. And I believe Victor might have a store account network client story he'll share in a bit. But this program is such a good example of how we are living our mission and the heritage of our founding sisters. As this program has been in existence for well over 20 years. It started in Napa and scaling across our region. And we provide services directly in the community to the most vulnerable people that that we see that we need to care for. And it's absolutely without any costs or out of pocket expense to our clients. This is part of our community benefit, it's part of our giving back to our community.  

The care network uses a team approach. The model consists of a nurse, a social worker, and a community health worker. So those three people are one team. And we have many teams in each of our service areas. And those teams then have a caseload of clients or patients that they serve. These are people who have multiple complex medical conditions, but also are considered under insured or uninsured have really complex socio-economic conditions, including mental health issues and substance use addiction, and even homelessness. And we meet people where they are in the community, whether it's a home visit, or whether it's an a shelter, or an encampment, and we provide services, and we provide services for months for each individual because it takes months to help people get into stable housing, to help people get enrolled in health insurance to get enrolled in resources such as food access, and linking people with warm handoffs to multiple services, it does take months. And we know from what I said earlier that until our basic needs are stabilized, it's really hard to manage a chronic health condition, it's just not up there on the priority list. So, it takes it takes a while we help people get stable with their basic needs. And then we can be, make a little more progress with their health needs and really change that trajectory of improving health and quality of life. So, we serve 1000s of people through care network. And again, it is a gift to the to the community. And it's an extension of our mission and values and heritage. I want to be cognizant of time here Shall I share one other quick update on housing, we have invested in Northern California over the past 10 years, close to $10 million on housing by way of either permanent supportive housing or shelters or recuperative care, or also housing that is affordable. An example of that is in Eureka where we purchased the Humboldt in and it is going to become the Providence mother Burnett house and provide supportive housing and recuperative care for multiple people in that community a very much needed resource. Debbie, I just want to check with you on time, and I could continue on going. 

Debbie Gibson: 

That's great. Dana, thank you for the amazing and impactful programs that you described, that you and your team oversee. These examples. Certainly show to me, the strong, strong theme and connection that we have to community and collaboration. So, to take us back a little bit in history, we know that the Sisters of St. Joseph were a congregation of women founded in about 1650 in France. And the sisters eventually made their way to California from Illinois in about 1912 on the invitation of the Bishop of Sacramento to begin a new foundation and start a Catholic school in Eureka, California. So that essentially created the start of the Northern California region that has evolved to the Providence hospitals and all of the services that exist today. So based on this information, you alluded to the fact that that Victor has a story to share. Victor when you think about the Sisters of St. Joseph and the Sisters of Providence, and their dedication to community and collaboration, what similarities Can you draw between your work of the sisters back then, and the work being done now by Providence, health investment in Northern California? 

Victor Jordan: 

Sure. I think if you look at the work that the sisters did, it was all about reaching out into the communities and going out and Taking care of the needs of the communities wherever they were. And that was their mission. And that's what they did. And this topic we're talking about today with community health, investment and community benefits, is really in that great tradition of reaching out into our communities, identify the needs and then helping where we can. 

Debbie Gibson: 

Thank you, Victor, did you have a specific story that you wanted that you wanted to share with us as an example? 

Victor Jordan: 

I do. I do. I have a very good story about caring for our dear neighbor. And we will just call this person Jose. But this is a true story. We've just changed the name. So Caring for Our Dear Neighbor, particularly the poor and vulnerable is core to the history and heritage of our founding sisters. As I just mentioned, one example of going to Great Lakes to impact the quality of life is a story of Jose, a 67-year-old Latino man, who after a significant accident left him in a skilled nursing facility in a neighboring county for over two years. He left the facility he returned to his hometown of Napa, however, without any money, belongings or housing. Our care network team received a referral the cm from the county homeless shelter. The nurse and social worker made a visit and learned that in addition to his complex social needs, he also had significant medical diagnoses, including unmanaged diabetes, and blindness, which was partly caused by his diabetes and partly due to a retinal detachment in both eyes. He was in desperate need of medical care. However, his Medicaid insurance was established in a different County. In addition to addressing Jose's basic needs, including clothing, food and shelter. For this medically fragile man, the care network team needed to get his Medicaid transferred to Napa County. The problem was that after his accident and over two years in a nursing home, Jose had no physical form of identification, no knowledge of a social security number, and was legally not identifiable. So just imagine being in that kind of situation. The care network social worker contacted Congressman Mike Thompson's office and work diligently to legally verify Jose's identity, obtaining his physical ID in less than two months, all the while ensuring that access to health care and basic means obtaining this ID allow for more medical care to be established, and for the care network team to open the client to additional services. He now qualified for home health. He met with a vascular surgeon, optometrist ophthalmologist and received second opinions at UC San Francisco. With a history of trauma, Jose was skeptical of the diagnosis he was receiving. But after time, and with the trusting relationship he had with his care network team, he agreed to the medical treatment plan. First doctor and surgeon on June 23, Jose moved into permanent housing to Napa County's project home key. He had no income but qualified for project home key because Providence care network agreed to sponsor his utility bills now permanently housed Jose qualifies and was approved for caregiver services. In addition, he will now receive assistance and training from the Earle Baum Center for the Blind to gain independent living skills and job training. This training and assistance was not available to him when he was not permanently housed. And I just sit here reading the story again, and just off by what this team does out in the community with these individuals that you can. So this example of how provenance cares for our most vulnerable with expertise, tenacity and advocacy is deeply rooted in our healthcare, culture, and our ministry. Our care network is fully funded through our community benefit program with no expense to those we serve. Jose is scheduled for surgery in July to address his attached detached retina and is on a completely different life trajectory, improved quality of life with the support expertise of the Providence care network. So that's just one example of the work that Dana and  the team do. 

Debbie Gibson: 

Major thank you for sharing about Jose. I love hearing about these stories because it always reinforces for me that we really are doing the right work at the right time. It always makes me so proud to serve in an organization that prioritize caring prioritizes caring for our communities, particularly the poor and the vulnerable in a way that demonstrates always our values of compassion, dignity, justice, excellence and integrity. So I think as we close out our time together today, I would ask the both of you one final quick question. And that is, now that we are well underway in 2021. What are your What are your visions and hopes for the post pandemic community health in Northern California? Dana, they'll start with you. Sure. 

Dana Codorn: 

As I was thinking about this question, the first thing that came to my mind was how the pandemic has allowed the concept of health inequities to be identified by the general population and not just the public health world we've known for years, there's health inequities and, and disparities. But now, it was in front of the world's eyes, the data showed the high COVID rates, the high death rates, in our populations with people of color and those people who have socio economic issue problems. I feel like it's there. We can't ignore it. And I'm hoping that my hope and vision is that we can work toward a system where we don't have health inequities where everybody has equal access to quality health care. 

Debbie Gibson: 

Absolutely. Thank you, Dana. How about you, Victor, what are your hopes and aspirations for this year looking forward? 

Victor Jordan: 

Well, I mean, addressing health inequities was one of them that Dana just mentioned, I think also working on greater access to primary care for our communities, there's a real need for more primary care, and then more outlets for care as an alternative to overuse of the hospital's emergency departments, especially in the area of mental health, for folks, so we really need to work on addressing some of these things so that care is given at the right time, and the right place, and then always, you know, living our mission. 

Debbie Gibson: 

Wonderful. Well, thank you both Dan and Victor from North Providence, Northern California for talking with me today, and to everyone listening and sending in your questions. If you're looking to learn more about community benefit and our programs in Northern California, or throughout Providence on our annual report, please visit www.providence.org/annualreport . And please be sure to follow us follow provenance on social media, on Twitter under the Providence health system, tab on Instagram, Facebook and LinkedIn. Thank you for being with us today. Have a good day.