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Sanford Group Return

PO Box 5039 Rte 5218
Sioux Falls, SD 57117
EIN: 453791176
Individual Facility Details: Sanford Medical Center Canton
440 North Hiawatha Drive
Canton, SD 57013
Bed count11Medicare provider number431333Member of the Council of Teaching HospitalsNOChildren's hospitalNO

Sanford Group ReturnDisplay data for year:

Community Benefit Spending- 2019
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)
9.59%
Spending by Community Benefit Category- 2019
(as % of total functional expenses)
* = CBI denoted preventative categories
Community Benefit Spending Compared to Functional Expenses, 2010-2019
Additional data

Community Benefit Expenditures: 2019

  • All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.

    • Operating expenses$ 4,214,471,860
      Total amount spent on community benefits
      as % of operating expenses
      $ 404,267,887
      9.59 %
  • Amount spent in the following IRS community benefit categories:
      • Financial Assistance at cost
        as % of operating expenses
        $ 86,790,075
        2.06 %
        Medicaid
        as % of operating expenses
        $ 137,874,628
        3.27 %
        Costs of other means-tested government programs
        as % of operating expenses
        $ 0
        0 %
        Community health improvement services and community benefit operations
        as % of operating expenses
        Note: these two community benefit categories are reported together on the Schedule H, part I, line 7e.
        $ 12,396,403
        0.29 %
        Health professions education
        as % of operating expenses
        $ 21,618,900
        0.51 %
        Subsidized health services
        as % of operating expenses
        $ 95,917,476
        2.28 %
        Research
        as % of operating expenses
        $ 17,544,308
        0.42 %
        Cash and in-kind contributions for community benefit
        as % of operating expenses
        $ 32,126,097
        0.76 %
        Community building
        as % of operating expenses
        $ 209,518
        0.00 %
  • Community building activities details:
      • Did tax-exempt hospital report community building activities?YES
        Number of activities or programs (optional)0
        Physical improvements and housing0
        Economic development0
        Community support0
        Environmental improvements0
        Leadership development and training for community members0
        Coalition building0
        Community health improvement advocacy0
        Workforce development0
        Other0
        Persons served (optional)0
        Physical improvements and housing0
        Economic development0
        Community support0
        Environmental improvements0
        Leadership development and training for community members0
        Coalition building0
        Community health improvement advocacy0
        Workforce development0
        Other0
        Community building expense
        as % of operating expenses
        $ 209,518
        0.00 %
        Physical improvements and housing
        as % of community building expenses
        $ 0
        0 %
        Economic development
        as % of community building expenses
        $ 3,005
        1.43 %
        Community support
        as % of community building expenses
        $ 19,164
        9.15 %
        Environmental improvements
        as % of community building expenses
        $ 0
        0 %
        Leadership development and training for community members
        as % of community building expenses
        $ 2,228
        1.06 %
        Coalition building
        as % of community building expenses
        $ 54,884
        26.20 %
        Community health improvement advocacy
        as % of community building expenses
        $ 65,933
        31.47 %
        Workforce development
        as % of community building expenses
        $ 64,304
        30.69 %
        Other
        as % of community building expenses
        $ 0
        0 %
        Direct offsetting revenue$ 4,389
        Physical improvements and housing$ 0
        Economic development$ 0
        Community support$ 3,340
        Environmental improvements$ 0
        Leadership development and training for community members$ 0
        Coalition building$ 1,049
        Community health improvement advocacy$ 0
        Workforce development$ 0
        Other$ 0

Other Useful Tax-exempt Hospital Information: 2019

  • In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.

    • Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt
      as % of operating expenses
      $ 58,554,846
      1.39 %
      Is the tax-exempt hospital considered a “sole community hospital” under the Medicare program?NO
  • Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy

    The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2020 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.

    • Does the organization have a written financial assistance (charity care) policy?YES
      Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients?YES
      Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy
      as % of operating expenses
      $ 0
      0 %
  • Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:
    • Reported to credit agencyNot available
  • Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.

    • After enactment of the ACA, has the state in which this tax-exempt hospital is located expanded Medicaid?NO
  • The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.

    • If not, is the state's Medicaid threshold for working parents at or below 76% of the federal poverty guidelines?YES
  • In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.

    • Does the state in which the tax-exempt hospital is located have a mandatory community benefit reporting statute?NO

Community Health Needs Assessment Activities: 2019

  • The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.

    • Did the tax-exempt hospital report that they had conducted a CHNA?YES
      Did the CHNA define the community served by the tax-exempt hospital?YES
      Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital?YES
      Did the tax-exempt hospital make the CHNA widely available (i.e. post online)?YES
      Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA?YES

Supplemental Information: 2019

This section presents qualitative information submitted by the hospital, verbatim from the 990H record.
  • Statement of Program Service Accomplishments
    Description of the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
  • 4A (Expenses $ 3887131247 including grants of $ 32125097) (Revenue $ 4331651670)
    Sanford is the nation's largest not-for-profit integrated rural health system providing medical services at every level from critical access hospitals to tertiary and quaternary care. The Sanford footprint includes over 220,000 square miles with a nine state service area including a network of children's primary care clinic locations across the country and the world. Sanford operates full-time emergency centers and provides emergency care to everyone regardless of their ability to pay. Sanford facilities and clinics provide services to remote and medically underserved areas that would otherwise not have access to even primary care services. Sanford financially supports health and wellness, education and community development activities to improve the quality of life and strengthen communities throughout the region. Each of Sanford's facilities promotes health and healing that responds to the unique needs of the patients in the communities that Sanford serves, ensuring access to comprehensive and specialized services. A recently completed and published community health needs assessment indicated the important need for behavioral health services for our community members. Sanford is meeting this need through an integrated delivery system providing behavioral health within the medical home structure.Please see Schedule H for a description of additional services, community benefit activities, and the full spectrum of charity care that Sanford provides within the community.
    4B (Expenses $ 225333978 including grants of $ 0) (Revenue $ 3715078)
    Medical education is an important service for Sanford. Sanford provides the medical community with high quality educational and professional development that is evidence and research based; accredited for physicians, nurses, pharmacists, and Allied Health Professionals and scientists; inclusive of cultural diversity and addresses the need for specialty training.Sanford is dedicated to preparing health care professionals for the future. The Sanford PROMISE program connects students, educators and communities with science and research in health care at a secondary education age. Sanford works in partnership with the University of South Dakota - Sanford School of Medicine, and the University of North Dakota - School of Medicine to provide rotations for medical students, residencies and fellowships. Sanford works in partnership with an extensive group of higher learning organizations to provide student training and learning opportunities in many venues across our region.
    4C (Expenses $ 34899651 including grants of $ 1000) (Revenue $ 5024213)
    Sanford Research and Sanford Research North are both non-profit health research organizations. Combined, both entities have more than 200 scientists and staff as well as centers, including: Children's Health, focused on pediatric rare diseases and cancer; The Sanford Project, seeking a cure for type 1 diabetes through the body's natural ability to regenerate cells; Health Outcomes and Prevention focusing on sudden infant death syndrome and birth-related disorders at study sites including United States Native American Reservations and South Africa; Genomic and Molecular Medicine with an emphasis on genomics, molecular biology, biobanking and immunotherapy; Edith Sanford Breast Cancer focusing on advanced molecular research and personalized treatment; Neurosciences, focused on the area of eating disorders, obesity and bariatric surgery outcomes as well as physiological aspects of eating and addiction and Clinical Research including participation in drug and device studies, the National Cancer Institute Community Clinical Oncology Program and the National Community Cancer Center Pilot Project.Sanford Research and Sanford Research North offer exciting challenges for researchers both in well-established projects and ever expanding research opportunities. Sanford offers opportunities to participate in clinical trials and to be a part of the changing face of medicine.
    Facility Information
    Schedule H (Form 990) Section C. Supplemental Information for Part V, Section B.
    Part V, Section B
    Facility Reporting Group A
    Facility Reporting Group A consists of:
    - Facility 1: Sanford USD Medical Center, - Facility 3: Sanford Broadway Medical Center Fargo, - Facility 4: Sanford Medical Center South University, - Facility 5: Sanford Bismarck Medical Center, - Facility 6: Sanford Bemidji Medical Center, - Facility 7: Sanford Medical Center Thief River Falls, - Facility 8: Sanford Aberdeen Medical Center, - Facility 9: Sanford Worthington Medical Center, - Facility 10: Sanford Sheldon Medical Center, - Facility 11: Sanford Vermillion Medical Center, - Facility 12: Sanford Chamberlain Medical Center, - Facility 13: Sanford Luverne Medical Center, - Facility 14: Sanford Canby Medical Center, - Facility 15: Sanford Jackson Medical Center, - Facility 16: Sanford Tracy Medical Center, - Facility 17: Sanford Rock Rapids Medical Center, - Facility 18: Sanford Hillsboro Medical Center, - Facility 19: Sanford Medical Center Mayville, - Facility 20: Sanford Webster Medical Center, - Facility 21: Sanford Medical Center Wheaton, - Facility 22: Sanford Bagley Medical Center, - Facility 23: Sanford Canton-Inwood Medical Center, - Facility 24: Sanford Clear Lake Medical Center, - Facility 25: Sanford Westbrook Medical Center, - Facility 2: Sanford Medical Center Fargo
    Group A-Facility 1 -- Sanford USD Medical Center Part V, Section B, line 5:
    "Sanford conducted a community health needs assessment (CHNA) during 2018 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2018 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County in North Dakota and Clay County in Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding economic well-being, transportation, children and youth, the aging population, safety, healthcare and wellness, mental health and substance abuse. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during 2019-2021. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and responses to the community health needs assessment and the implementations strategies are welcome on the Sanford website under ""About Sanford"" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA"
    Group A-Facility 1 -- Sanford USD Medical Center Part V, Section B, line 6a:
    Sanford Medical Center FargoSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
    Group A-Facility 1 -- Sanford USD Medical Center Part V, Section B, line 7d:
    Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
    Group A-Facility 1 -- Sanford USD Medical Center Part V, Section B, line 11:
    The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Economic Well-Being - Skilled Labor ForceThe Council on Social Work Education reports that economic well-being may be achieved by individuals, families, and communities through public policies that ensure the ability to build financial knowledge and skills, access to safe and affordable financial products and economic resources, and opportunities for generating income and asset building. It occurs within a context of economic justice within which labor markets provide opportunities for secure full employment with adequate compensation and benefits for all. Sanford has made economic well-being a significant priority and has developed a strategic plan to provide workforce and skilled labor opportunities in the Sioux Falls area and across the system. Priority 2: Mental Health/Behavioral Health and Substance AbuseMental health is important at every stage of life and affects how people think, feel, and act. According to the National Institute of Mental Health, depression is one of the most common mental disorders in the U.S. Current research suggests that depression is caused by a combination of genetic, biological, environmental, and psychological factors. Depression is among the most treatable of mental disorders. Sanford has made mental health a significant priority and has developed strategies to reduce mortality and morbidity from mental health, behavioral health and substance abuse. It is Sanford's goal to reduce the number of individuals whose overall well-being is negatively impacted by addiction and mental illness.Addressing of Significant Needs during Current Year: Priority 1: Economic Well-Being: Workforce DevelopmentSanford USD Medical Center is committed to the economic well-being of the Sioux Falls community. To this end, we are continually working to recruit, support, and develop a skilled workforce through partnerships with higher education organizations for internships, LPN sponsorships, scholarships, residencies, and fellowships. In addition to the medical residencies and scholarships, we have created scholarships for licensed practical nurses (LPNs) and medical assistants (MAs) to help meet the patient care demands in our ambulatory locations. These scholarships give individuals an opportunity to have all or a majority of their education paid for by entering one of these in-demand healthcare fields. For calendar year 2019, we had 80 LPN's and 10 MA's individuals on scholarships.The Sanford Sons and Daughters program has 226 individuals in physician education on scholarship. The Heart of Tomorrow program provided scholarships of $1,000 each to 100 high school or college aged children of Sanford employees. In addition, Sanford continues to solely support residency education in pediatrics and general surgery and fellowship education in cardiology and interventional cardiology. We partner with other health care facilities to support residencies in the following: internal medicine, pathology, transitional year and family medicine. All such programs are in good standing and are at capacity. Priority 2: Behavioral Health and Mental Health AccessAs demand for behavioral and mental health services continues to grow, Sanford USD Medical Center aims to ensure availability of necessary services for patients and community members. This work will include embedding Integrated Health Therapists (IHT) in primary care centers, formalizing a recruitment plan for behavioral health specialty services, reducing depression through PHQ-9 screening, and collaborating on a community triage program. Integrative Health Therapists continue to be embedded in each primary care clinic. In the past year, we have added an additional psychiatrist, one additional psychologist, three psychiatric advanced practice clinicians, and four therapists. Our goal is to recruit two additional psychologists. We also continue to provide PHQ-9 depression remission performance exceeding the national benchmark - ensuring consistent screening for depression across the patient population.Sanford has also collaborated with the City of Sioux Falls, Minnehaha County, and Avera Health to create the Community Triage Center (CTC). The (CTC) will be a voluntary and involuntary commitment (IVC) mid-level care alternative for those with substance/alcohol abuse with potential mental illness co-morbidities who are not violent in their behavior. The target population is individuals in a co-morbid mental health and/or substance use disorder crisis, regardless of socio-economic background. The partnership collaborative, led by Minnehaha County, the City of Sioux Falls, Avera Health, and Sanford Health, aims to create a front-line service for a population that needs immediate care delivered with respect, dignity, and understanding. The CTC project has been investigated since 2014. Strategic community partners collaborated to determine if a triage center would be appropriate for Minnehaha and Lincoln Counties. In order to inform the conceptual plan, data was collected and analyzed to determine need, a sequential intercept model mapping was conducted to determine interventions, and model community sites visited to identify operational best practices. The report Community Triage Center Conceptual Plan issued in June 2018 summarized the work completed during the planning phase. Currently, individuals who are experiencing a mental health or substance use crisis arrive at the emergency room department and Detox Facility and Sobering Center at the Minnehaha County jail. Once the CTC is operational, the Minnehaha County jail will cease operations of the Detox Facility and Sobering Center. When the CTC is operational, individuals in crisis will be routed to the CTC through self-referral, law enforcement, and other agencies (jail, ER, behavioral health, medical-surgical units, and SUD providers). The CTC staff will complete the intake information and decide whether to send the individual to the CTC's Observation, Detox, or Stabilization service, make a referral and a warm hand-off to a partner agency, or send to the hospital. If stabilized, the individual may be sent home. The CTC purpose is not to duplicate services but act as an intermediary to bridge individuals to long-term care providers.Identified needs not directly addressed by this facility include: Economic - Need for affordable housing, housing that accepts people with chemical dependency, mental health problems, criminal history or victims of domestic violence, and concern for homelessnessTransportation - Need for door-to-door transportation for community members who do not drive, and the availability of public transportationAging - Cost of long term care and memory careChild and Youth - Substance abuse by youth, childhood obesity, availability of services for at-risk youth, bullying, crime committed by youth, and teen suicideSafety - Abuse of prescription drugsAccess to Health Care - Availability of behavioral health providers, availability of mental health providers, access to affordable prescription drugs, and access to affordable healthcare
    Group A-Facility 1 -- Sanford USD Medical Center Part V, Section B, line 13h:
    Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
    Group A-Facility 1 -- Sanford USD Medical Center Part V, Section B, line 16j:
    Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
    Group A-Facility 3 -- Sanford Broadway Medical Center Fargo Part V, Section B, line 5:
    "Sanford conducted a community health needs assessment (CHNA) during 2018 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2018 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County in North Dakota and Clay County in Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding economic well-being, transportation, children and youth, the aging population, safety, healthcare and wellness, mental health and substance abuse. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during 2019-2021. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and responses to the community health needs assessment and the implementations strategies are welcome on the Sanford website under ""About Sanford"" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA"
    Group A-Facility 3 -- Sanford Broadway Medical Center Fargo Part V, Section B, line 6a:
    Sanford USD Medical Center Sioux FallsSanford Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
    Group A-Facility 3 -- Sanford Broadway Medical Center Fargo Part V, Section B, line 7d:
    Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
    Group A-Facility 3 -- Sanford Broadway Medical Center Fargo Part V, Section B, line 11:
    "The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Healthcare AccessAccording to the County Health Rankings for Clinical Care, access to affordable health care is important to physical, social, and mental health. Health insurance, local care options, and a usual source of care help to ensure access to health care. Having access to care allows individuals to enter the health care system, find care easily and locally, pay for care, and get their health needs met.Sanford has made healthcare access a significant priority and has developed strategies to promote and improve access to services. It is Sanford's goal that all patients requiring access to healthcare are successful in securing timely appointments.Priority 2: Mental Health/Behavioral Health and Substance AbuseSanford has made mental health a significant priority and has developed strategies to reduce mortality and morbidity from mental health and behavioral health and substance abuse. It is Sanford's goal to reduce the number of individuals whose overall well-being is negatively impacted by addiction and mental illness. Addressing of Significant Needs during Current Year: Priority 1: Healthcare AccessIncrease availability of mental health/behavioral health providers Sanford Health improved access to behavioral health services in 2019 through a series of initiatives and targeted recruiting. A recruitment plan is in place to add behavioral health care providers in the Fargo setting.In 2019, Sanford Health's Fargo Region successfully implemented a long-term post-doctoral candidate training program in adult psychology. This ""grow our own"" program brought in the first candidate in 2019 and is expanding in 2020. Promote role expansion of Advanced Practice Providers to improve accessSanford added primary care walk-in services with Advanced Practice Providers to all of the neighborhood primary care clinics to accommodate growing patient needs. Advanced Practice Providers have designated pre-op clinics to improve access to care for patient's needing surgery. Same day access/walk-in services were added at the five primary care clinic locations. Improve access to mental health services for children in rural school districts.Sanford Health began collaborating with Fargo Public Schools and Moorhead Public Schools to research and develop a tele-behavioral health program.Improve access through primary care, emergency department and walk-in urgent care clinics.Designated nurse practitioners and physicians assistants are located in four of the seven family medicine clinics to cover walk-in urgent care services. Sanford expanded our West Fargo clinic and opened Veterans Clinic to improve primary care access. Provide non-traditional hours in primary care and walk-in urgent care clinics.Instituted Saturday hours for walk-in care at West Fargo clinic. Offer extended hours on Mondays at Veteran's Square Clinic and Tuesday at Southpointe Clinic. Walk in care in all primary care neighborhood clinics Monday through Friday 8:00 a.m. to 5:00 p.m. Three locations available for urgent care 7 days per week. Decrease the use of emergency services for primary health care.Sanford Health expanded the Community Paramedic (CP) Program in 2020 by 1.0 FTE. 2.0 FTE currently allocated to seeing patients who are at high-risk for readmission. Monitor ED usage to determine acuity and admit percentage for appropriateness of utilization.Because of targeted education, support of new social and healthcare programs, and improved pre-hospital partnerships, progress continued towards making sure the most appropriate patients are seeking care in the emergency department (ED). Educate patients (decision path) on primary care and walk-in urgent care clinic options.Signage posted indicating where to go for severity of symptoms in all exam rooms, elevators as well main corridors. Scheduling and triage nurses provide real-time education for patients as to where to receive care at most appropriate setting. Provide care coordination/care plan development and referral to internal/external services.We provide longitudinal care plans and assignment of nurse care managers to all high risk patients as outlined by outpatient risk stratification tool. Priority 2: Mental Health and Substance Abuse Reduce the opportunity for drug use and abuse.In September 2019, Sanford Health implemented the use of a substance abuse and chemical dependency screening tool for pediatric trauma patients called SBIRT (Screening, Brief Intervention. Screening). Beginning September 1, 2019, the outcome goal for SBIRT completion on pediatric trauma patients of 80% has been met every month.Continue prescription stewardship initiative to reduce opioid/narcotic prescriptions.Discharge order sets - our pharmacy and provider teams worked to standardize (and default) minimum quantity and day supply of opioids. Prescribing decision support and documentation support - Implemented acute pain opiate script system defaults to follow the rules of less than 50 MME per day, less than 100 MME per script. Prevention of unnecessary opioid dispensing - We removed daisy chain orders for opiates to follow newer rules of dispensing. Over 2019, total opioid tablet count prescribed remained at 50% less in the Fargo region versus 2016. Explore medication assisted treatment by increasing the number of certified providers.Four family medicine physicians and one Internal Medicine physician have waivers to prescribe suboxone. This program was launched in early 2020. Patients with alcohol use and abuse receive services through internal or external services. Sanford Health began collaborating with a Fargo-based peer-to-peer substance abuse support program provider, F5, in 2019. The program will be offered to inpatients who are detoxing.IHT services are provided in all Sanford primary care settings.Integrated health therapist's (IHT) are located in all primary care clinics. All IHT's have immediate, same day access available for our patients. Reduce the severity of depression for patients with a PHQ-9 score greater than 9.PHQ's are deployed by the panel assistant. Primary care physician receives elevated PHQ and places appropriate referrals to IHT for intervention. Patient's assessment is in place to determine the patients' risk of suicide. PHQ is given to patient based on outlined criteria. If positive, Columbia Suicide Severity Rating Scale is administered by nursing. Results are elevated to physician/APP for disposition of treatment interventions. The Columbia Suicide Severity Rating Scale is executed across primary care clinics in the Fargo market. Education provided to all clinical staff in primary care regarding the Columbia Suicide Severity Rating Scale. Mental Health First Aid Training.Education provided to clinical and non-clinical staff. Goal is to provide the knowledge and skill set that healthcare professionals can use to intervene in the event of a mental health crisis.Identified needs not directly addressed by this facility include:Economics - Availability of affordable housing, hunger, homelessness, and need for housing that accepts people with chemical dependency, mental health problems, criminal history or victims of domestic violenceTransportation - Need for door-to-door transportation for community members.Aging - Cost of long-term care and memory care, cost of in-home services, availability of resources for family and friends caring for elders, availability of resources to help the elderly stay safe in their homesChildren and Youth - Availability and cost of services for at-risk youth, cost and availability of quality childcare, substance abuse by youth, teen suicide, childhood obesity, and bullyingSafety - Abuse of prescription drugs, culture of excessive and binge drinking, domestic violence, child abuse and neglect, sex trafficking, and presence of street drugsSanford is not developing strategies to address the cost of long term care and memory care in the Fargo-Moorhead area. Long-term care cost and access is an area of care that Sanford is not directly addressing because there are organizations in the community that are working on these needs. The results of the CHNA have been shared with community leaders, and those who have expertise in the areas."
    Group A-Facility 3 -- Sanford Broadway Medical Center Fargo Part V, Section B, line 13h:
    Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
    Group A-Facility 3 -- Sanford Broadway Medical Center Fargo Part V, Section B, line 16j:
    Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
    Group A-Facility 4 -- Sanford Medical Center South University Part V, Section B, line 5:
    "Sanford conducted a community health needs assessment (CHNA) during 2018 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2018 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County in North Dakota and Clay County in Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding economic well-being, transportation, children and youth, the aging population, safety, healthcare and wellness, mental health and substance abuse. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during 2019-2021. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and responses to the community health needs assessment and the implementations strategies are welcome on the Sanford website under ""About Sanford"" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA"
    Group A-Facility 4 -- Sanford Medical Center South University Part V, Section B, line 6a:
    Sanford USD Medical Center Sioux FallsSanford Medical Center FargoSanford Broadway Medical Center FargoSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
    Group A-Facility 4 -- Sanford Medical Center South University Part V, Section B, line 7d:
    Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
    Group A-Facility 4 -- Sanford Medical Center South University Part V, Section B, line 11:
    "The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Healthcare AccessAccording to the County Health Rankings for Clinical Care, access to affordable health care is important to physical, social, and mental health. Health insurance, local care options, and a usual source of care help to ensure access to health care. Having access to care allows individuals to enter the health care system, find care easily and locally, pay for care, and get their health needs met.Sanford has made healthcare access a significant priority and has developed strategies to promote and improve access to services. It is Sanford's goal that all patients requiring access to healthcare are successful in securing timely appointments.Priority 2: Mental Health/Behavioral Health and Substance AbuseSanford has made mental health a significant priority and has developed strategies to reduce mortality and morbidity from mental health and behavioral health and substance abuse. It is Sanford's goal to reduce the number of individuals whose overall well-being is negatively impacted by addiction and mental illness. Addressing of Significant Needs during Current Year: Priority 1: Healthcare AccessIncrease availability of mental health/behavioral health providers Sanford Health improved access to behavioral health services in 2019 through a series of initiatives and targeted recruiting. A recruitment plan is in place to add behavioral health care providers in the Fargo setting.In 2019, Sanford Health's Fargo Region successfully implemented a long-term post-doctoral candidate training program in adult psychology. This ""grow our own"" program brought in the first candidate in 2019 and is expanding in 2020. Promote role expansion of Advanced Practice Providers to improve accessSanford added primary care walk-in services with Advanced Practice Providers to all of the neighborhood primary care clinics to accommodate growing patient needs. Advanced Practice Providers have designated pre-op clinics to improve access to care for patient's needing surgery. Same day access/walk-in services were added at the five primary care clinic locations. Improve access to mental health services for children in rural school districts.Sanford Health began collaborating with Fargo Public Schools and Moorhead Public Schools to research and develop a tele-behavioral health program.Improve access through primary care, emergency department and walk-in urgent care clinics.Designated nurse practitioners and physicians assistants are located in four of the seven family medicine clinics to cover walk-in urgent care services. Sanford expanded our West Fargo clinic and opened Veterans Clinic to improve primary care access. Provide non-traditional hours in primary care and walk-in urgent care clinics.Instituted Saturday hours for walk-in care at West Fargo clinic. Offer extended hours on Mondays at Veteran's Square Clinic and Tuesday at Southpointe Clinic. Walk in care in all primary care neighborhood clinics Monday through Friday 8:00 a.m. to 5:00 p.m. Three locations available for urgent care 7 days per week. Decrease the use of emergency services for primary health care.Sanford Health expanded the Community Paramedic (CP) Program in 2020 by 1.0 FTE. 2.0 FTE currently allocated to seeing patients who are at high-risk for readmission. Monitor ED usage to determine acuity and admit percentage for appropriateness of utilization.Because of targeted education, support of new social and healthcare programs, and improved pre-hospital partnerships, progress continued towards making sure the most appropriate patients are seeking care in the emergency department (ED). Educate patients (decision path) on primary care and walk-in urgent care clinic options.Signage posted indicating where to go for severity of symptoms in all exam rooms, elevators as well main corridors. Scheduling and triage nurses provide real-time education for patients as to where to receive care at most appropriate setting. Provide care coordination/care plan development and referral to internal/external services.We provide longitudinal care plans and assignment of nurse care managers to all high risk patients as outlined by outpatient risk stratification tool. Priority 2: Mental Health and Substance Abuse Reduce the opportunity for drug use and abuse.In September 2019, Sanford Health implemented the use of a substance abuse and chemical dependency screening tool for pediatric trauma patients called SBIRT (Screening, Brief Intervention. Screening). Beginning September 1, 2019, the outcome goal for SBIRT completion on pediatric trauma patients of 80% has been met every month.Continue prescription stewardship initiative to reduce opioid/narcotic prescriptions.Discharge order sets - our pharmacy and provider teams worked to standardize (and default) minimum quantity and day supply of opioids. Prescribing decision support and documentation support - Implemented acute pain opiate script system defaults to follow the rules of less than 50 MME per day, less than 100 MME per script. Prevention of unnecessary opioid dispensing - We removed daisy chain orders for opiates to follow newer rules of dispensing. Over 2019, total opioid tablet count prescribed remained at 50% less in the Fargo region versus 2016. Explore medication assisted treatment by increasing the number of certified providers.Four family medicine physicians and one Internal Medicine physician have waivers to prescribe suboxone. This program was launched in early 2020. Patients with alcohol use and abuse receive services through internal or external services. Sanford Health began collaborating with a Fargo-based peer-to-peer substance abuse support program provider, F5, in 2019. The program will be offered to inpatients who are detoxing.IHT services are provided in all Sanford primary care settings.Integrated health therapist's (IHT) are located in all primary care clinics. All IHT's have immediate, same day access available for our patients. Reduce the severity of depression for patients with a PHQ-9 score greater than 9.PHQ's are deployed by the panel assistant. Primary care physician receives elevated PHQ and places appropriate referrals to IHT for intervention. Patient's assessment is in place to determine the patients' risk of suicide. PHQ is given to patient based on outlined criteria. If positive, Columbia Suicide Severity Rating Scale is administered by nursing. Results are elevated to physician/APP for disposition of treatment interventions. The Columbia Suicide Severity Rating Scale is executed across primary care clinics in the Fargo market. Education provided to all clinical staff in primary care regarding the Columbia Suicide Severity Rating Scale. Mental Health First Aid Training.Education provided to clinical and non-clinical staff. Goal is to provide the knowledge and skill set that healthcare professionals can use to intervene in the event of a mental health crisis.Identified needs not directly addressed by this facility include:Economics - Availability of affordable housing, hunger, homelessness, and need for housing that accepts people with chemical dependency, mental health problems, criminal history or victims of domestic violenceTransportation - Need for door-to-door transportation for community members.Aging - Cost of long-term care and memory care, cost of in-home services, availability of resources for family and friends caring for elders, availability of resources to help the elderly stay safe in their homesChildren and Youth - Availability and cost of services for at-risk youth, cost and availability of quality childcare, substance abuse by youth, teen suicide, childhood obesity, and bullyingSafety - Abuse of prescription drugs, culture of excessive and binge drinking, domestic violence, child abuse and neglect, sex trafficking, and presence of street drugsSanford is not developing strategies to address the cost of long term care and memory care in the Fargo-Moorhead area. Long-term care cost and access is an area of care that Sanford is not directly addressing because there are organizations in the community that are working on these needs. The results of the CHNA have been shared with community leaders, and those who have expertise in the areas."
    Group A-Facility 4 -- Sanford Medical Center South University Part V, Section B, line 13h:
    Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
    Group A-Facility 4 -- Sanford Medical Center South University Part V, Section B, line 16j:
    Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
    Group A-Facility 5 -- Sanford Bismarck Medical Center Part V, Section B, line 5:
    "Sanford conducted a community health needs assessment (CHNA) during 2018 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2018 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County in North Dakota and Clay County in Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding economic well-being, transportation, children and youth, the aging population, safety, healthcare and wellness, mental health and substance abuse. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during 2019-2021. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and responses to the community health needs assessment and the implementations strategies are welcome on the Sanford website under ""About Sanford"" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA"
    Group A-Facility 5 -- Sanford Bismarck Medical Center Part V, Section B, line 6a:
    Sanford USD Medical Center Sioux FallsSanford Medical Center FargoSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
    Group A-Facility 5 -- Sanford Bismarck Medical Center Part V, Section B, line 7d:
    Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
    Group A-Facility 5 -- Sanford Bismarck Medical Center Part V, Section B, line 11:
    "The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Healthcare AccessAccording to the County Health Rankings for Clinical Care, access to affordable health care is important to physical, social, and mental health. Health insurance, local care options, and a usual source of care help to ensure access to health care. Having access to care allows individuals to enter the health care system, find care easily and locally, pay for care, and get their health needs met.Sanford has made healthcare access a significant priority and has developed strategies to promote and improve access to services. It is Sanford's goal that barriers to accessing health insurance coverage is reduced.Priority 2: Behavioral Health and Substance AbuseThe Substance Abuse and Mental Health Services Administration reports that ""Mental and substance use disorders can have a powerful effect on the health of individuals, their families, and their communities. In 2014, an estimated 22.5 million Americans age 12 and older self-reported needing treatment for alcohol or illicit drug use, and 11.8 million adults self-reported needing mental health treatment or counseling in the past year.""Sanford has made behavioral health a significant priority and has developed strategies to reduce mortality and morbidity from behavioral health and substance abuse. It is Sanford's goal to reduce the number of individuals whose overall well-being is negatively impacted by substance abuse. Addressing of Significant Needs during Current Year Priority 1: Access to Affordable CareTo help community members who are uninsured and underinsured secure access to healthcare services, Sanford Health has integrated fulltime, onsite financial advocates who specialize in healthcare coverage enrollment. They help Sanford patients as well as community referrals. Individuals unable to secure healthcare coverage and facing medical bills they cannot afford are referred to Sanford's financial assistance program. FAP works with patients and their families to reduce medical bills by eliminating some or all charges for services. We wrote off $31 million dollars in 2019. To help homeless individuals access healthcare services and prescription medications, Sanford works with shelter residents to apply for and secure healthcare coverage through the state's Medicaid program.Through partnerships with Mandan Public Health, Bismarck/Burleigh Public Health, United Way and the local homeless shelter coalition, we have helped at-risk community members secure healthcare coverage, healthcare services and prescription medications.Often, patients who do not qualify for public assistance do not make enough money to afford the prescriptions they need to get well and stay well. In these circumstances, we have helped patients enroll in Marketplace health plans and provided financial assistance to help cover income gaps. As an example, we helped a newly employed young man recently released from incarceration who could not afford his medications for a chronic heart condition. He needed to get his first paychecks before he could pay for health insurance and his medications. He is now working fulltime and has private health insurance.We have helped more than 900 individuals secure healthcare coverage. Sanford's patient assistance program donated services that totaled more than $31 million to patients and their families who could not afford the services. Services were donated to 9,867 patient encounters.When a patient temporarily is unable to afford the medications, they need due to extenuating circumstances, e.g. sudden loss of employment, Sanford's Foundation established a fund to help community members. Established internal workflow processes to help individuals unable to afford prescriptions receive the medication free of charge.Sanford helped 742 patients get the prescription medicine they needed but could not afford. Perhaps more importantly, Sanford helped these individuals connect to vital community services necessary to regain their health, wellbeing and financial independence. Also provided meal vouchers, lodging, gas cards and transportation for 232 patients. Through our partnership with Great Plains Food Bank, we screen expecting and new moms for access to food. We are able to continue to help with emergency food during their pregnancy as well as connecting them to resources in the community. For moms at-risk for food scarcity, sent an additional 18 packages of five meals (90) meals home plus connectivity to sustainable food sources.Priority 2: Behavioral Health and Substance Use Disorder Continuum of CarePartnered with the Reducing Pharmaceutical Narcotics Task Force to increase use of naloxone and reduce overdose-related deaths. We also partnered with Bismarck/Burleigh County behavioral health task force, a stakeholder group established to identify and address gaps in the community's substance abuse and behavioral health continuum of care.Partnered with Face It Together, a community-based approach to helping those suffering with the disease of addiction get well and stay well. Face It Together offers coaching services to clients to help address all social determinants of health, an approach proving successful with a growing number of community members. Coaches help clients secure employment, housing, food, and other supports. Sanford provides in-kind support including grant writing, meeting space, access to healthcare and employment supports.Established a drug takeback location in main campus pharmacy.Collaborated with Heartview, an addiction service provider, to support certified Medication-Assisted Treatment programs in central and western North Dakota.Partnered with Bismarck Public Schools to provide behavioral health service onsite. A pilot program launched in the Fall of 2019 entails a Sanford psychologist seeing patients in person at Simle Middle School. The goal of the project is to establish a program scalable to additional schools via telemedicine.To reduce the number of opioid prescriptions, improved ease of access to the N.D. Prescription Drug Monitoring Program and worked with providers treating chronic pain to incorporate best practice guidelines.Successfully helped 133 community members suffering from the disease of addiction secure coaching support to get well and stay well.Successfully helped 10 expectant moms suffering from substance use disorder participate in medication-assisted treatment programming. Provided 60 behavioral health visit for at-risk middle school students. Reduced the number of opioid tablets prescribed by 25 percent. Provided four grand round education presentations to increase provider awareness on opioid prescribing best practice and CMS guidelines.Identified needs not directly addressed by this facility include:Economic - Homelessness, need for housing that accepts people with chemical dependency, mental health problems, criminal history or victims of domestic violence, affordable housing and hunger Aging Population - Cost of long term care, cost of memory care, and the cost of in-home servicesChildren and Youth - Cost and availability of quality childcare, substance abuse by youth, childhood obesity, teen suicide, availability and cost of services for at-risk youth, bullying, and teen tobacco use Crime/Safety - Abuse of prescription drugs, culture of excessive and binge drinking, domestic violence, presence of street drugs, child abuse and neglect, sex trafficking, and criminal activity"
    Group A-Facility 5 -- Sanford Bismarck Medical Center Part V, Section B, line 13h:
    Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
    Group A-Facility 5 -- Sanford Bismarck Medical Center Part V, Section B, line 16j:
    Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
    Group A-Facility 6 -- Sanford Bemidji Medical Center Part V, Section B, line 5:
    "Sanford conducted a community health needs assessment (CHNA) during 2018 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2018 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County in North Dakota and Clay County in Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding economic well-being, transportation, children and youth, the aging population, safety, healthcare and wellness, mental health and substance abuse. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during 2019-2021. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and responses to the community health needs assessment and the implementations strategies are welcome on the Sanford website under ""About Sanford"" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA"
    Group A-Facility 6 -- Sanford Bemidji Medical Center Part V, Section B, line 6a:
    Sanford USD Medical Center Sioux FallsSanford Medical Center FargoSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
    Group A-Facility 6 -- Sanford Bemidji Medical Center Part V, Section B, line 7d:
    Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
    Group A-Facility 6 -- Sanford Bemidji Medical Center Part V, Section B, line 11:
    "The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Economic Well-BeingThe Robert Wood Johnson Foundation's Commission to Build a Healthier America reports that good physical and mental health depends on having homes that are safe and free from physical hazards. Adequate housing should protect individuals and families from harmful exposures and provides them with a sense of privacy, security, stability and control, and can make important contributions to health. In contrast, poor quality and inadequate housing contributes to health problems such as infectious and chronic diseases, injuries, and poor childhood development. Sanford Health has made economic well-being a significant priority and has developed a strategic plan to work with community leaders to collaborate on housing and support services development.Priority 2: Mental Health/Behavioral Health and Substance AbuseMental health is important at every stage of life and affects how people think, feel, and act. According to the National Institute of Mental Health, depression is one of the most common mental disorders in the U.S. Current research suggests that depression is caused by a combination of genetic, biological, environmental, and psychological factors. Sanford has made mental health a significant priority and has developed strategies to reduce mortality and morbidity from mental health and behavioral health and substance abuse. It is Sanford's goal to reduce the number of individuals whose overall well-being is negatively impacted by addiction and mental illness. Addressing of Significant Needs during Current YearPriority 1: Economic Well-BeingWork with community collaborative on housing and support service development.Leaders from our emergency department and case management met with board members from the local homeless shelters to discuss safe & proper discharge planning for those who are homeless. Working through the Collaborative, an additional 32 unit subsidized housing complex will open soon called Conifer Estates, owned by the Headwaters Regional Development Corporation, a local non-profit serving the region. This facility is housing for people with low income that includes coordination of other services for residents. The coordination professional (case manager) can help residents identify resources and navigate systems.Every year Sanford provides donations and sponsorship to area groups, including - but not limited to Evergreen Youth & Family Services, Boys & Girl's Club, Bemidji Food Shelf, Habitat for Humanity, Battered Women's Shelter, Blue Ox Marathon, Headwater Science Center, Bemidji State University, Bemidji Independent School District, Area Arts Endowment, American Indian Resource Center, American Red Cross, Dragon Boars, Bemidji Symphony, Boys and Girl Scouts, Family Advocacy Center, United Way, Northwest Technical College, St. Philips, Youth Soccer, Youth Baseball, Bemidji Lumberjack Athletics, Peacemakers, Paul Bunyan Playhouse, Bemidji Community Theater, Youth Hockey, and many other organizations.Assure children and youth have access to healthy food.Continued to develop the Sanford Health Kids Initiative to address programmatic opportunities and partnerships for at-risk youth.No Hungry Kids: While we are blessed to live in wonderful communities surrounded by beautiful natural resources, a staggering one in five local children do not get enough to eat. Sanford Health, Bemidji Independent School District 31 and United Way of Bemidji took steps to change that. The three organizations worked together through a public-private partnership to create a new program called No Hungry Kids. As part this program Sanford Health made a $405,000 commitment over the next five years to the program to ensure that no student goes hungry. In addition, as a result of our partnership the United Way was able to expand the program to all elementary schools in the district, coordinate a summer program with the Boys & Girls Club and initiate a ""pantry"" program at the Bemidji High School. Through this project we also developed supporting strategies to support youth - they include: Reach Out & Read: Through the Sanford Healthy Kids Initiative, the organization also launched a program in their Children's Clinic called Reach Out and Read to specifically address literacy. Social Emotional Learning: Partnering with Peacemaker Resources, Bemidji Area Service Collaborative (BASK) and Bemidji Area Schools. Sanford Health was able to help in the expansion of SEL skills, ensuring that all ISD 31 Kindergarten and first grade teachers and classes received both training and classroom time for the 2018-2019 school year.Work collaboratively with community resources on economic development opportunities for the region.Over the past year we have played an active role in positioning the Bemidji community for enhanced economic growth and development. We have strategically been part of partnerships to align Greater Bemidji, the Bemidji Chamber of Commerce, Downtown Business Alliance and Visit Bemidji and played a role in sponsoring the Bemidji 2030 visioning process. We have met with entrepreneurs and business developers who have an interest in relocating to Bemidji to discuss how Sanford Health can help- whether it is providing land or space for a building or simply to just welcome them to Bemidji while they are on a community site visit.Sanford Health was also recently the local title sponsor of Hockey Day in Minnesota, Bemidji, which was televised throughout the state and nationally. Priority 2: Mental Health and Substance AbuseOpened residential crisis center for the provision of mental health and detoxification treatment.Sanford - through a partnership with Beltrami County, the sheriff's department and Prime West Health opened a residential support center, offering detox and residential treatment services for those in crisis in our community. In July remodeling was completed and the 6,800 square-foot, 14-bed center opened - this includes: 5 beds for crisis residential stabilization providing short-term individualized mental health services for patients who would otherwise be at risk of hospitalization if they did not receive these services. 5 beds for intensive residential treatment services (IRTS) assisting patients in need of more focused structure.In 2018 alone, more than 300 patients were transferred out of our facilities here in Bemidji across and even out of the state to receive services they needed that were not available here.Expand Medication Assisted Therapy and associated chemical dependency treatment programs to serve adults.The medication assisted therapy (MAT) program expanded to include adult men and women needing ongoing medication as an alternative to illegal substance abuse. This program continues to grow the number of participants. A Licensed Alcohol and Drug Counselor (LADC) has been co-located with the MAT Clinic. Outpatient treatment in both individual and group modalities are being provided for existing and new MAT patients. One Psychiatrist and three Advanced Practice Nurses are currently certified to provide MAT. Recruit additional behavioral health treatment practitioners, including psychiatry, psychology and psychiatric nurse practitionerIn 2017, Sanford Health and Upper Mississippi Mental Health Center, Inc. (UMMHC) completed the final steps necessary to move forward with merging. They also completed acquisition of an independent psychology practice to add capacity to the therapy services and recruited several mental health therapy providers.Since then we have been able to recruit nine new behavioral health providers, develop an adult MAT clinic and build programs and services that provide critical services to our community.Identified needs not directly addressed by this facility include:Children and Youth - substance abuse by youth, and teen suicideAging - Cost of long term care, and availability of memory careSafety - Abuse of prescription drugs, child abuse and neglect, presence of street drugs, presence of drug dealers, criminal activity, and domestic violenceHealth care - Availability of mental health providers, availability of behavioral health (substance abuse) providers, and use of emergency room services."
    Group A-Facility 6 -- Sanford Bemidji Medical Center Part V, Section B, line 13h:
    Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
    Group A-Facility 6 -- Sanford Bemidji Medical Center Part V, Section B, line 16j:
    Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
    Group A-Facility 7 -- Sanford Medical Center Thief River Falls Part V, Section B, line 5:
    "Sanford conducted a community health needs assessment (CHNA) during 2018 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2018 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County in North Dakota and Clay County in Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding economic well-being, transportation, children and youth, the aging population, safety, healthcare and wellness, mental health and substance abuse. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during 2019-2021. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and responses to the community health needs assessment and the implementations strategies are welcome on the Sanford website under ""About Sanford"" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA"
    Group A-Facility 7 -- Sanford Medical Center Thief River Falls Part V, Section B, line 6a:
    Sanford USD Medical Center Sioux FallsSanford Medical Center FargoSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
    Group A-Facility 7 -- Sanford Medical Center Thief River Falls Part V, Section B, line 7d:
    Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
    Group A-Facility 7 -- Sanford Medical Center Thief River Falls Part V, Section B, line 11:
    "The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Mental Health/Behavioral Health and Substance AbuseMental health is important at every stage of life and affects how people think, feel, and act. According to the National Institute of Mental Health, depression is one of the most common mental disorders in the U.S. Current research suggests that depression is caused by a combination of genetic, biological, environmental, and psychological factors. Depression is among the most treatable of mental disorders. Sanford has made mental health a significant priority and has developed strategies to reduce mortality and morbidity from mental health and behavioral health and substance abuse. It is Sanford's goal to reduce the number of individuals whose overall well-being is negatively impacted by addiction and mental illness. Priority 2: Children and YouthThe U.S. Census Bureau estimates that in 2014, 74% of Minnesota households with children under age 6 had all parents in the workforce. This is the third highest state in the nation for working parents, falling behind Iowa and South Dakota at 75%.According to a report by Child Care Aware of America, states face various challenges in exploring childcare supply and demand and directing precious resources to ensure accessibility to quality child care. Child Care Aware describes quality childcare as ""the emotional and academic support children need to be school-ready by the time they enter Kindergarten. Quality childcare should be culturally and linguistically responsive and should be provided by engaged and caring child care providers. Quality childcare incorporates physical activity time and developmental screening practices, and follows food safety guidelines. In addition, quality child care should be easily accessible for all families, regardless of location or socioeconomic status."" Sanford has made quality childcare a significant priority and has developed strategies to work in collaboration with community leaders to improve the availability of quality childcare in the community. The intent of the strategies is to create more opportunities for quality childcare in the community and to support childcare providers with educational program opportunities. Addressing of Significant Needs during Current YearPriority 1: Mental Health and Substance AbuseThief River Falls (TRF) leadership developed a new service line proposal, to include an ROI analysis for presentation to Sanford leadership. After considerable review, TRF received approval to move forward with development and implementation of a SUDS (substance use disorder) program.The SUDS program is currently under development in preparation for opening in the Fall 2020.Currently the home that will house the program is being renovated and license applications with the MN Department of Human Services are being prepared for submission.The BHS-6 behavioral health screening tool is one of several depression screening tools available to providers to assess a patient's mental health relative to depression. Currently only Sanford One Care Clinics are using the BHS-6 screening tool and all other Sanford clinics are using the PHQ-9 patient health screening tool. TRF is using the PHQ-9 which has been incorporated into the EMR medical record as a screening prompt for providers on an annual basis for all primary care patients.In CY19 TRF's primary care provider teams achieved an overall administration percentage rate in excess of 90% for the PHQ-9; well above the target of 80%. Upon completion of the PHQ-9 screening and based on the individuals score, the provider may recommend additional screenings and further clinical follow-up with a mental health professional. Sanford has an algorithm that outlines each step in the process.Priority 2: Children and YouthTRF behavioral health staff make themselves available and participate with law enforcement educating school age children regarding the Drug Abuse Resistance Education (DARE) program every year. Children's Therapeutic Support Services (CTSS) is a flexible package of mental health services for children who require varying therapeutic and rehabilitative levels of intervention. This program is provided in all TRF schools and will address the dangers of drugs in addition to other mental health issues.TRF has expanded the CTSS program from one school to all three this past year; providing behavioral health professionals in each school five days a week.Identified needs not directly addressed by this facility include:Economics - Availability of affordable housing, household budgeting and money management, need for housing that accepts people with chemical dependency, mental health problems, criminal history or victims of domestic abuse, and a skilled labor workforce Aging - Cost of long-term care and the cost and availability of memory care, cost of in-home care, and the availability of resources for grandparents caring for their grandchildrenChildren and Youth - Childhood obesity, substance abuse by youth, availability and cost of services for at-risk youth, teen tobacco use, bullying, crime committed by youth, and opportunities for youth-adult mentoring Safety - Abuse of prescription drugs, presence of drug dealers, presence of street drugs, child abuse and neglect, criminal activity, and domestic violenceHealth care - access to affordable health insurance coverage, access to affordable healthcare, access to affordable prescription drugs, use of emergency room services for primary health care, availability of specialist physicians, availability of non-traditional hours, availability of behavioral health (substance abuse) providers, access to affordable dental coverage, and availability of mental health providersSanford serves as a partner in many community groups that have the expertise to address these unmet needs. Sanford has shared the findings of the CHNA and the needs with community leaders and public health agencies in the area."
    Group A-Facility 7 -- Sanford Medical Center Thief River Falls Part V, Section B, line 13h:
    Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
    Group A-Facility 7 -- Sanford Medical Center Thief River Falls Part V, Section B, line 16j:
    Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
    Group A-Facility 8 -- Sanford Aberdeen Medical Center Part V, Section B, line 5:
    "Sanford conducted a community health needs assessment (CHNA) during 2018 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2018 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County in North Dakota and Clay County in Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding economic well-being, transportation, children and youth, the aging population, safety, healthcare and wellness, mental health and substance abuse. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during 2019-2021. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and responses to the community health needs assessment and the implementations strategies are welcome on the Sanford website under ""About Sanford"" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA"
    Group A-Facility 8 -- Sanford Aberdeen Medical Center Part V, Section B, line 6a:
    Sanford USD Medical Center Sioux FallsSanford Medical Center FargoSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
    Group A-Facility 8 -- Sanford Aberdeen Medical Center Part V, Section B, line 7d:
    Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
    Group A-Facility 8 -- Sanford Aberdeen Medical Center Part V, Section B, line 11:
    The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Healthcare AccessAccording to the County Health Rankings for Clinical Care, access to affordable health care is important to physical, social, and mental health. Health insurance, local care options, and a usual source of care help to ensure access to health care. Having access to care allows individuals to enter the health care system, find care easily and locally, pay for care, and get their health needs met.Sanford has made healthcare access a significant priority and has developed strategies to promote and improve access to services. It is Sanford's goal that all patients requiring access to healthcare are successful in securing timely appointmentsPriority 2: Mental Health/Behavioral Health and Substance AbuseMental health is important at every stage of life and affects how people think, feel, and act. According to the National Institute of Mental Health, depression is one of the most common mental disorders in the U.S. Current research suggests that depression is caused by a combination of genetic, biological, environmental, and psychological factors. Depression is among the most treatable of mental disorders. Sanford has made mental health a significant priority and has developed strategies to reduce mortality and morbidity from mental health and behavioral health and substance abuse. It is Sanford's goal to reduce the number of individuals whose overall well-being is negatively impacted by addiction and mental illness. Addressing of Significant Needs during Current YearPriority 1: Health Care AccessSanford Aberdeen Medical Center (SAMC) is committed to helping community members understand their health care insurance options. Our goal is that no one in our service area is denied necessary health care services due to lack of coverage and/or insufficient coverage. In 2019, SAMC staff utilized Sanford Health Plan's website and related information and resources to provide relevant insurance information for individuals and companies as needed. This information on coverage options allows consumers to compare Sanford Health Plan's options to see what is right for them. In addition, our staff has been working more closely with both Sanford Health Plan representatives as well as various local insurance agents regarding access to a range of insurance products and services for anyone in need. Priority 2: Mental Health and Substance AbuseSAMC seeks to ensure that mental health services are available in Aberdeen and the surrounding area. Additionally, we aim to achieve a reduction in opioid prescriptions. To this end, Sanford Aberdeen Clinic is offering telemedicine options for psychiatry services to increase overall access to mental health care. SAMC is also currently evaluating outreach opportunities for these services for broader reach across the service area. To identify need and ensure access to appropriate care, PCP visits include a questionnaire assessment tool that is aligned with Sanford Health enterprise protocols for screening. To approach are in a more holistic manner, we have embedded an Integrated Health Therapist (IHT) in our primary care clinics. Our IHT also offers ongoing education on services offered through primary care. In 2019, our Integrated Health Therapist saw a total of 284 patients (note: IHT was on leave a portion of the year so this number is expected to increase for 2020). Finally, our staff and providers are routinely given updates to Sanford enterprise best practices regarding opioid prescribing. Many of these updates appear as prompts in a patient's Electronic Medical Record (EMR). The EMR prompts providers to do the following: check PDMP (Prescription Drug Monitoring Program) before prescribing opioids, perform routine yearly Urine Drug Screen tests, provide educational resources in dealing with prescribing opioids, and give Controlled Substance Agreements for patients using opioids chronically. Identified needs not directly addressed by this facility include:Economics - Need for a skilled labor forceChildren and Youth - Childhood obesity, and substance abuse by youthAging - Cost of long term care, cost of memory careSafety - abuse of prescription drugsSanford serves as a partner in many community groups that have the expertise to address these unmet needs. Sanford has shared the results of the CHNA and the unmet needs with community leaders.
    Group A-Facility 8 -- Sanford Aberdeen Medical Center Part V, Section B, line 13h:
    Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
    Group A-Facility 8 -- Sanford Aberdeen Medical Center Part V, Section B, line 16j:
    Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
    Group A-Facility 9 -- Sanford Worthington Medical Center Part V, Section B, line 5:
    "Sanford conducted a community health needs assessment (CHNA) during 2018 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2018 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County in North Dakota and Clay County in Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding economic well-being, transportation, children and youth, the aging population, safety, healthcare and wellness, mental health and substance abuse. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during 2019-2021. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and responses to the community health needs assessment and the implementations strategies are welcome on the Sanford website under ""About Sanford"" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA"
    Group A-Facility 9 -- Sanford Worthington Medical Center Part V, Section B, line 6a:
    Sanford USD Medical Center Sioux FallsSanford Medical Center FargoSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical Center
    Group A-Facility 9 -- Sanford Worthington Medical Center Part V, Section B, line 7d:
    Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
    Group A-Facility 9 -- Sanford Worthington Medical Center Part V, Section B, line 11:
    The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Healthcare AccessAccording to the County Health Rankings for Clinical Care, access to affordable health care is important to physical, social, and mental health. Health insurance, local care options, and a usual source of care help to ensure access. Having access to care allows individuals to enter the health care system, find care easily and locally, pay for care, and get their health needs met.Sanford has made healthcare access a significant priority and has developed strategies to promote and improve access to services. It is Sanford's goal that all patients requiring healthcare are successful in securing timely appointments.Priority 2: WellnessThe Centers for Disease Control and Prevention reports that Americans use preventive services at about half the recommended rate. Chronic diseases account for 7 of 10 deaths among Americans annually and for 75% of U.S. health spend. These diseases are largely preventable through close partnership with a healthcare team, or can be detected through appropriate screenings, when treatment works best.Eating healthy, exercising regularly, avoiding tobacco, and receiving preventive services such as cancer screenings, preventive visits and vaccinations help people stay healthy. The right preventive care at every stage of life helps individuals to avoid or delay the onset of disease, keep diseases they have from becoming worse or debilitating, lead productive lives, and reduce cost.Sanford has made wellness and chronic disease prevention a significant priority and has developed strategies to promote and improve cancer and chronic disease screening in the community. Addressing of Significant Needs during Current YearPriority 1: Healthcare AccessSanford Worthington intends to develop a community task force to improve dental care access for children. Progress thus far includes collaboration with Nobles County Community Services as a joint agency goal. We will continue collaboration through the next assessment period. Sanford Worthington hired Christine Bullerman in December 2018 as Lead Community Specialist to be a liaison for Sanford with the community. We formed a small task force with representation from Nobles County Community Services and Sanford Worthington. Ann March, Public Health Assessment Planner from the Center for Public Health Practice from the Minnesota Department of Health, was consulted to assist development of collaborative strategies to address this goal. Christine established a list of community members who were contacted to inform them of the small work group to assess solutions to this issue. In October 2019, we began to form the Dental Coalition. Sanford Worthington and Nobles County Community Services, with guidance from Ann March, began to engage the community. Ann introduced the results-based accountability planning model to engage the community stakeholder group to identify priority areas. The following month, Sanford Worthington hosted the first stakeholder session with 35 Nobles County attendees. The scope of the problem was presented specifically in relation to Nobles County. A representative from MN DOH reviewed successful programs from across the state that address similar concerns. A summary document of ideas was created listing factors helping/hurting this goal in the community. These were combined into 15 key tactics for discussion at the next meeting to develop action items. In January 2020, the stakeholder group conducted the 2nd results-based accountability session to identify 3-4 priority strategies.Our second initiative focused on the use of the emergency department (ED) for primary care to reduce patient recidivism. Sanford Worthington collaborated with Sanford Enterprise Value Improvement Program, Sanford Health Population Health leaders, and JBS to decrease the use of the ED among Nobles County residents. JBS is a local business for which Sanford Worthington Medical Center is their 4000 employees' (and families) preferred provider and narrow network insurance plan. In 2019 metrics were established regarding the rate of ED usage per 1000 health plan members for the JBS narrow network participants. These metrics are a shared goal with JBS and Sanford Worthington. We developed a local Care Management group consisting of our Clinic RN Care Manager, Hospital Discharge Planner, Quality Manager, and Director of Nursing and Clinical Services. The group meets monthly to review and develop strategies to impact this issue including: Clinic RN Care manager receives ED Discharge data through a system report. The report is reviewed daily to identify individuals showing trends for increased ED usage for non-emergent concerns. These individuals are contacted for follow-up to assess barriers or social determinant of health causing ED overuse. They are invited to participate in an integrative care plan to assist with their health care access and care needs. 12 longitudinal care plans were completed by the Clinic RN Care Manager for patients with complex social/medical needs for improvement of health access and management.Sanford Worthington has begun to examine the impact of ED recidivism locally to prepare a proposal for additional Social Services care management resources within the hospital allowing for better collaboration with the Clinic RN Care Manager.Sanford Health has begun collaboration with a telehealth crisis intervention service to complement local crisis intervention services for early intervention for individuals presenting with mental health concerns in the ED. Additional telehealth mental health practitioners have been credentialed through this collaboration pilot for increased access for patients with mental health medication maintenance needs. Priority 2: WellnessSanford Worthington aims to improve cancer and chronic disease screening in the community. We set a goal to develop a lung cancer screening program for the community. In 2019 Sanford Worthington invested in and installed a new CT scanner that will provide up-to-date technology for this screening program. Program development meetings began with Sanford Cancer Center and Sanford Pulmonology. Three meetings occurred in 2019 to explore implementation of a lung cancer screening service. We also aim to collaborate with a large community employer to assess and evaluate disease prevention measure outcomes among health plan benefit members. Sanford Health collaborated with Sanford Health Plan population health team to develop health screening metrics specific to a population in the community at risk for health disparities. Sanford Worthington Clinic focused on colorectal screening access in 2019. This increased colorectal screenings completed from 68% to 73% of eligible population in our clinic, and an additional 70 screening colonoscopies over 2018 total at Sanford Worthington Medical Center.Sanford Worthington partnered with MNRAAA to bring Living Well With Chronic Conditions: Better Choices Better Health classes in both English and Spanish to our community. Staff completed layperson educator training for classes to begin in 2020. Identified needs not directly addressed by this facility include:Economics - Availability of affordable housingTransportation - Availability of public transportationAging - Cost of long term care, availability of memory care, and the cost of in-home servicesChildren and Youth - Availability and cost of quality childcare, availability of services for at-risk youth, teen pregnancy, childhood obesity, bullying, substance abuse by youth and the availability of activities for children and youthMental Health - drug use and abuse, depression, stress, and alcohol use and abuseSanford will not develop strategy to address the availability of affordable housing, the availability of public transportation, the cost and availability of long-term care, memory care. However, Sanford serves as a partner in many community groups that have the expertise to address these unmet needs. Sanford has shared the assessed needs with community leaders that have expertise in the various needs of the community.
    Group A-Facility 9 -- Sanford Worthington Medical Center Part V, Section B, line 13h:
    Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
    Group A-Facility 9 -- Sanford Worthington Medical Center Part V, Section B, line 16j:
    Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
    Group A-Facility 10 -- Sanford Sheldon Medical Center Part V, Section B, line 5:
    "Sanford conducted a community health needs assessment (CHNA) during 2018 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2018 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County in North Dakota and Clay County in Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding economic well-being, transportation, children and youth, the aging population, safety, healthcare and wellness, mental health and substance abuse. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during 2019-2021. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and responses to the community health needs assessment and the implementations strategies are welcome on the Sanford website under ""About Sanford"" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA"
    Group A-Facility 10 -- Sanford Sheldon Medical Center Part V, Section B, line 6a:
    Sanford USD Medical Center Sioux FallsSanford Medical Center FargoSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
    Group A-Facility 10 -- Sanford Sheldon Medical Center Part V, Section B, line 7d:
    Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
    Group A-Facility 10 -- Sanford Sheldon Medical Center Part V, Section B, line 11:
    The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Children and YouthAccording the Center for Disease Control, Obesity is a complex health issue to address. Obesity can be caused from a combination of contributing factors such as behavior and genetics. Behaviors can include dietary patterns, physical activity, inactivity, medication use, and other exposures. Additional contributing factors in our society include the food and physical activity environment, education and skills, and food marketing and promotion.Obesity is a serious concern because it is associated with poorer mental health outcomes, reduced quality of life, and is associated with morbidity and illnesses including diabetes, heart disease, stroke, and some types of cancer.Substance abuse is another high raking concern for community members. The risk factors for substance abuse among youth include boredom, stress, curiosity, the desire to feel grown up, or to lessen peer pressure. Protective factors include: Having high self-esteem Attending a school with policies against using alcohol and drugs Having an adult role model who doesn't use tobacco or drugs or misuse alcohol Participating in athletic, community, or faith-based groups Living in a community with youth activities that prohibit drugs and alcohol Sanford has made children and youth a significant priority and has developed strategies to offer support programs that provide children and youth with safe and healthy environments.Priority 2: Mental Health and Substance Abuse Mental health is important at every stage of life and affects how people think, feel and act. According to the National Institute of Mental Health, depression is one of the most common mental disorders in the U.S. Current research suggests that depression is caused by a combination of genetic, biological, environmental and psychological factors. Depression is among the most treatable of mental disorders. Sanford has made mental health a significant priority and has developed strategies to reduce mortality and morbidity from mental health and behavioral health and substance abuse. It is Sanford's goal to reduce the number of individuals whose overall well-being is negatively impacted by addiction and mental illness.Addressing of Significant Needs during Current YearPriority 1: Children and YouthAt Sanford Sheldon we take great pride in supporting the youth of the community in various events. We provide backpacks to the Shop with a Cop program, which provides children in need with the opportunity to go back to school with new school supplies. We order 75 backpacks. We support the summer lunch program, which is facilitated at a local church, which provides meals to students in need during the summer months when school is not in session. We teach farm safety to all children in the 2nd grade of all Sheldon school, with approximately 97 children participating. We invited 3rd grade students of all Sheldon schools and other nearby community schools to tour our facility. This increases their comfort level with the facility and staff that work here. The tours were given to 240 children.Priority 2: Mental Health and Substance AbuseSanford Sheldon Medical Center is strongly committed to meeting the mental health and substance abuse needs of our patients and all community residents. We have expanded access to mental health counseling available with the addition Dr. Matthew Eggers, Psychiatrist, via telemedicine video visits as well as with Mark Daniels, integrated health specialist, via telemedicine video visits. Having access to Dr. Eggers and Mr. Daniels has helped us to address immediate needs for mental health counseling at Sanford Clinic Sheldon. Identified needs not directly addressed by this facility include:Economic - Need for skilled labor force, affordable housing, housing that accepts people with chemical dependency, mental health problems, criminal history or victims of domestic violence, and household budgeting and money managementAging - Cost of long term care, cost of memory care, and the cost of in-home services Safety - Abuse of prescription drugsHealth Care - Availability of mental health providers, availability of behavioral health providers, access to affordable health insurance coverage, access to affordable health care, access to affordable prescription drugs, and access to affordable vision insurance
    Group A-Facility 10 -- Sanford Sheldon Medical Center Part V, Section B, line 13h:
    Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
    Group A-Facility 10 -- Sanford Sheldon Medical Center Part V, Section B, line 16j:
    Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
    Group A-Facility 11 -- Sanford Vermillion Medical Center Part V, Section B, line 5:
    "Sanford conducted a community health needs assessment (CHNA) during 2018 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2018 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County in North Dakota and Clay County in Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding economic well-being, transportation, children and youth, the aging population, safety, healthcare and wellness, mental health and substance abuse. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during 2019-2021. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and responses to the community health needs assessment and the implementations strategies are welcome on the Sanford website under ""About Sanford"" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA"
    Group A-Facility 11 -- Sanford Vermillion Medical Center Part V, Section B, line 6a:
    Sanford USD Medical Center Sioux FallsSanford Medical Center FargoSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
    Group A-Facility 11 -- Sanford Vermillion Medical Center Part V, Section B, line 7d:
    Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
    Group A-Facility 11 -- Sanford Vermillion Medical Center Part V, Section B, line 11:
    The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Economic Well Being Resources that enhance quality of life can have a significant influence on population health outcomes. Examples of these resources include safe and affordable housing, access to education, public safety, availability of healthy foods, local emergency/health services, and environments free of life-threatening toxins. Sanford Vermillion has made affordable housing and economic well-being a significant priority and has developed strategies to work with community partners and community leaders to improve the availability of affordable housing in the community.Priority 2: Mental Health/Behavioral Health and Substance AbuseMental health is important at every stage of life and affects how people think, feel, and act. According to the National Institute of Mental Health, depression is one of the most common mental disorders in the U.S. Current research suggests that depression is caused by a combination of genetic, biological, environmental, and psychological factors. Depression is among the most treatable of mental disorders. Sanford has made mental health a significant priority and has developed strategies to reduce mortality and morbidity from mental health and behavioral health and substance abuse. It is Sanford's goal to reduce the number of individuals whose overall well-being is negatively impacted by addiction and mental illness. Addressing of Significant Needs during Current YearPriority 1: Economic Well-Being - Availability of Affordable Housing and FoodThe intent of this implementation strategy is that our community would see at least an increase in the awareness of the availability of affordable housing units in Vermillion. To achieve this aim, Sanford Vermillion will request and participate in a housing inventory, encourage collaboration in housing development, and request an inventory and subsequently increase awareness of food assistance programs.Sanford Vermillion has requested a Housing Inventory to include the number of reduced income units currently available in Vermillion. Vermillion saw one of the largest increases in additional housing units added to the community during 2019 including permits for a multi-family dwelling, twin homes, single-family dwelling permits and two large apartment complexes that were completed. In 2019, the City of Vermillion issued permits for:o 1 multi-family dwellingo 4 single family attached dwellings (twin homes at Bliss Pointe)o The Quarters at Vermillion apartment complex - 74 units providing 235 bedroomso The Heights apartment complex - 169 units providing 496 bedroomsSanford Vermillion has also continued to collaborate with the Vermillion Chamber & Development Company for the second phase of housing development at Bliss Pointe development as well as their NOW 3 campaign for Vermillion. Sanford Vermillion provided a major investor in the NOW 3 Campaign to assist towards its goal of raising $1.75 million for 2019 for the purpose of funding changes and improvements in the infrastructure of Vermillion. The Vermillion NOW 3 Campaign raised $2.01 million by October 2019 exceeding their goal for infrastructure improvements in the Vermillion Community.Sanford Vermillion has requested an inventory of the food assistance programs available in the community which includes programs such as the Vermillion Food Pantry, Welcome Table weekly free meal, Vermillion Weekend Backpack Program, Tanager Take Out program, Dakota Senior Meals, SNAP and WIC available through the Department of Social Services and participating with Feeding SD Food Giveaway programs. The Community Connection Center also opened in 2019 to house the United Way, Welcome Table, Vermillion Food Pantry, Weekend Backpack Program and Salvation Army services all under one roof in downtown Vermillion for a one-stop shop for their clients. The Community Connection Center works with the Clay County Poverty Task force to identify community needs and awareness of their programs.Priority 2: Mental Health - Substance Abuse and Binge Drinking By increasing mental health services in the community and working with its community partners,Sanford Vermillion intends to have a positive impact on the percentage of its community that report abusing alcohol and drugs. In particular, Sanford Vermillion will increase the number of mental health services available in the community.Sanford Vermillion was able to increase Mental Health services offered to the Vermillion Community adding a full-time Integrated Behavioral Therapist/Psychologist in April 2018 to work at our clinic. We also continue to provide a monthly Psychiatric specialty outreach clinic and a Mental Health counselor who is on site two days per week. The number of completed Mental Health visits at Sanford Vermillion increased by 422 visits in 2019 as compared to 2018. This was a total of 1349 completed visits for 2019 showing a 31% increase from 2018.In the community, a private counselor is available as well. Additionally, Lewis & Clark Behavioral Health purchased a building in Vermillion where local counselors including a licensed alcohol and addiction counselor is housed for serving the Vermillion Community.Identified needs not directly addressed by this facility include:Aging - Cost of long term care, cost of memory care, and cost of in-home servicesChildren and Youth - Substance abuse by youth, and childhood obesitySafety - Culture of excessive drinkingHealth Care - Access to affordable health insurance, access to affordable health care, and cost of affordable prescription drugs
    Group A-Facility 11 -- Sanford Vermillion Medical Center Part V, Section B, line 13h:
    Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
    Group A-Facility 11 -- Sanford Vermillion Medical Center Part V, Section B, line 16j:
    Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
    Group A-Facility 12 -- Sanford Chamberlain Medical Center Part V, Section B, line 5:
    "Sanford conducted a community health needs assessment (CHNA) during 2018 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2018 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County in North Dakota and Clay County in Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding economic well-being, transportation, children and youth, the aging population, safety, healthcare and wellness, mental health and substance abuse. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during 2019-2021. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and responses to the community health needs assessment and the implementations strategies are welcome on the Sanford website under ""About Sanford"" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA"
    Group A-Facility 12 -- Sanford Chamberlain Medical Center Part V, Section B, line 6a:
    Sanford USD Medical Center Sioux FallsSanford Medical Center FargoSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
    Group A-Facility 12 -- Sanford Chamberlain Medical Center Part V, Section B, line 7d:
    Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
    Group A-Facility 12 -- Sanford Chamberlain Medical Center Part V, Section B, line 11:
    The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Mental Health/Behavioral Health and Substance AbuseMental health is important at every stage of life and affects how people think, feel, and act. According to the National Institute of Mental Health, depression is one of the most common mental disorders in the U.S. Current research suggests that depression is caused by a combination of genetic, biological, environmental, and psychological factors. Depression is among the most treatable of mental disorders. Sanford has made mental health a significant priority and has developed strategies to reduce mortality and morbidity from mental health and behavioral health and substance abuse. It is Sanford's goal to reduce the number of individuals whose overall well-being is negatively impacted by addiction and mental illness. Priority 2: Children and YouthAccording the Center for Disease Control, Obesity is a complex health issue to address. Obesity can be caused from a combination of contributing factors such as behavior and genetics. Behaviors can include dietary patterns, physical activity, inactivity, medication use, and other exposures. Additional contributing factors in our society include the food and physical activity environment, education and skills, and food marketing and promotion.Obesity is a serious concern because it is associated with poorer mental health outcomes, reduced quality of life, and is associated with morbidity and illnesses including diabetes, heart disease, stroke, and some types of cancer.Substance abuse is another high raking concern for community members. The risk factors for substance abuse among youth include boredom, stress, curiosity, the desire to feel grown up, or to lessen peer pressure. Protective factors include: Having high self-esteem Attending a school with policies against using alcohol and drugs Having an adult role model who doesn't use tobacco or drugs or misuse alcohol Participating in athletic, community, or faith-based groups Living in a community with youth activities that prohibit drugs and alcohol Sanford has made children and youth a significant priority and has developed strategies to offer support programs that provide children and youth resources for healthy living.Addressing of Significant Needs during Current YearPriority 1: Mental Health/Behavioral Health and Substance AbuseTo increase community safety and decrease substance abuse, Sanford Chamberlain Medical Center (SCMC) is training community members on Mental Health First Aid. In 2019, three Mental Health First Aid sessions were offered in Chamberlain, training a total of 34 community members. SCMC also provides education on substance abuse prevention and behavioral health for students and parents of local schools. Sanford Chamberlain has engaged in work with the Chamberlain school district, embedding a licensed mental health counselor in the high school/middle school and elementary school one day per week. Additionally, we are working with the Chamberlain middle school in supporting a curriculum around social/emotional well-being. The curriculum is live in classrooms. In 2019, Sanford Chamberlain also helped to sponsor wellness support grab bags for all Chamberlain Middle school students. Priority 2: Children and YouthSanford Chamberlain intends to make the Sanford fit wellness program available to local schools as well as parents of students. SCMC hosted Sanford FIT night in conjunction with parent teacher conferences at the Chamberlain elementary school. Approximately 200 people attended the event. Expanding this opportunity to other districts is currently under consideration.Camp FUEL is a summer camp for area youth where healthy eating, exercise, and health outcomes are explored. The camp took place in summer 2019 and plans are underway to hold a Camp FUEL again in 2020. The 2020 camp strategy will include reaching out to St. Joseph's Indian School as well.Identified needs not directly addressed by this facility include:Economic - Need for a skilled labor forceAging - Cost of long-term care, and the cost of memory care Safety - presence of drug dealers, presence of street drugs, and abuse of prescription drugs Health Care - Access to affordable health care, and access to affordable health insurance coverageSanford serves as a partner in many community groups that have the expertise to address these unmet needs. Sanford shared the findings of the CHNA research and these unmet needs with community leaders and community stakeholders.
    Group A-Facility 12 -- Sanford Chamberlain Medical Center Part V, Section B, line 13h:
    Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
    Group A-Facility 12 -- Sanford Chamberlain Medical Center Part V, Section B, line 16j:
    Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
    Group A-Facility 13 -- Sanford Luverne Medical Center Part V, Section B, line 5:
    "Sanford conducted a community health needs assessment (CHNA) during 2018 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2018 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County in North Dakota and Clay County in Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding economic well-being, transportation, children and youth, the aging population, safety, healthcare and wellness, mental health and substance abuse. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during 2019-2021. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and responses to the community health needs assessment and the implementations strategies are welcome on the Sanford website under ""About Sanford"" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA"
    Group A-Facility 13 -- Sanford Luverne Medical Center Part V, Section B, line 6a:
    Sanford USD Medical Center Sioux FallsSanford Medical Center FargoSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
    Group A-Facility 13 -- Sanford Luverne Medical Center Part V, Section B, line 7d:
    Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
    Group A-Facility 13 -- Sanford Luverne Medical Center Part V, Section B, line 11:
    The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Healthcare AccessAccording to the County Health Rankings for Clinical Care, access to affordable health care is important to physical, social, and mental health. Health insurance, local care options, and a usual source of care help to ensure access to health care. Having access to care allows individuals to enter the health care system, find care easily and locally, pay for care, and get their health needs met.Sanford has made healthcare access a significant priority and has developed strategies to promote and improve access to services. It is Sanford's goal that all patients requiring access to healthcare are successful in securing timely appointments.Priority 2: Mental Health/Behavioral Health and Substance AbuseMental health is important at every stage of life and affects how people think, feel, and act. According to the National Institute of Mental Health, depression is one of the most common mental disorders in the U.S. Current research suggests that depression is caused by a combination of genetic, biological, environmental, and psychological factors. Depression is among the most treatable of mental disorders. Sanford has made mental health a significant priority and has developed strategies to reduce mortality and morbidity from mental health and behavioral health and substance abuse. It is Sanford's goal to reduce the number of individuals whose overall well-being is negatively impacted by addiction and mental illness. Addressing of Significant Needs during Current YearPriority 1: Improving Health Care AccessSanford Luverne set three primary goals around improving access to care in our community. The first is improved access to primary care providers through recruitment, telemedicine, and outreach. The second goal focuses on improved price transparency through pricing estimates and help with affordable drug coverage. Finally, we aim to enhance access to dental health for area residents. Primary care access - with the retirement of a primary care provider, a new primary care provider was recruited to the practice (began in August 2019) and a second physician has signed to join the practice in two years (starting 2022). In addition, we have promoted e visits and video visits as appropriate for patients. Our Lead RN has championed the use of telehealth to area nursing homes, but support thus far is minimal. Expanding hours at satellite clinics has been limited due to access to primary care providers. We plan to revisit this when fully staffed with providers.Price transparency - our Finance department has continued to focus on price transparency. We continue to share our phone number for pricing estimates for services. Our health coach continues to work one-on-one with patients as needed on assistance for drug coverage. The top 25 codes used in the clinic are posted for clinic patients, as required per the Minnesota State Legislature. Additionally, the current hospital charge master is posted on the website.Dental care access - Sanford Luverne clinic providers and nursing staff continue to focus on applying dental varnish. Sanford has supported a mobile dental clinic that has begun coming to Luverne for lower income residents through sponsorship support; we also provide breakfast and lunch for the staff. The mobile dental clinic is a partnership between Luv1LuvAll community initiative, Southwest Health and Human Services, and Delta Dental. Mobile dental clinics are 100% full each month. From Sept 2019 - March 2020 the dental clinic has serviced 74 patients during six dates of service in Luverne. Of the 74 patients, 70 were children and four were adults.Priority 2: Improving the Mental Health of the CommunitySanford Luverne aims to improve mental health in our community through enhanced access to services as well as decreasing depression and anxiety scores through regular screening for depression and anxiety with preventative medicine visits. Improved access - Sanford Luverne has two integrative therapists assisting more one-on-one with patients. The Luverne site is second highest utilizer for telehealth psych services within the clinic and ER setting. Our Lead RN has accepted a role to support tele psychology services. Integrative health therapists are involved with the Luv1LuvAll community group working on mental health and evening educational series. Our facility has sponsored several presenters including integrative health therapist, physician, and substance use supervisor. We continue to stress importance of utilizing the county crisis response team in the ER or accessing tele psych services to assist with mental health triage and holds. We had 148 completed tele psychiatry visits in 2019, plus additional 24 no show visits scheduled for patients within the clinic setting. Since go-live date of Feb 28, 2019, Sanford Luverne has had 23 emergent tele psychiatry visits from the emergency room. Finally, we co-sponsor a monthly brain health series whereby 20-25 individuals have attended each session.Decreased depression and anxiety scores - our clinic continues to focus on assessment of depression and anxiety with preventative medicine visits. Our Care Coordinator assistant focuses on scores and recalling patients who have scored high to ensure reassessment is completed and diagnosis is properly controlled. Our RN Care Manager assists with resource and medication management, referrals to telehealth psychology services, and other local behavioral health providers. Our RN Care manager also works closely with physicians and patients to fill gaps in care. As of Dec 31, 2019, Sanford Luverne clinic depression quality measure at six months was 17% at the end of 2018, and achieved 24.1% ( goal is 11%) optimal care at the end of 2019. In addition, the 12 month quality measure was 14.6% at the end of 2018, and achieved 16.2% (goal is 11%). This is a measure of depression management related to patient perceived depression indicators. Identified needs not directly addressed by this facility include:Economic - Need for a skilled labor force, affordable housing, and employment optionsAging - Cost of long term care, availability of memory care, and cost of in-home servicesChildren and Youth - availability and cost of quality childcare, availability and cost of services for at-risk youth, substance abuse by youth, bullying, and teen suicide.Sanford will not develop strategy to address the cost of long term care, the availability of memory care, the availability and cost of quality child care. However, Sanford shared the results of the CHNA research with community leaders and agencies with expertise to the identified needs. Sanford serves as a partner in many community groups that have the expertise to address these unmet needs.
    Group A-Facility 13 -- Sanford Luverne Medical Center Part V, Section B, line 13h:
    Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
    Group A-Facility 13 -- Sanford Luverne Medical Center Part V, Section B, line 16j:
    Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
    Group A-Facility 14 -- Sanford Canby Medical Center Part V, Section B, line 5:
    "Sanford conducted a community health needs assessment (CHNA) during 2018 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2018 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County in North Dakota and Clay County in Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding economic well-being, transportation, children and youth, the aging population, safety, healthcare and wellness, mental health and substance abuse. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during 2019-2021. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and responses to the community health needs assessment and the implementations strategies are welcome on the Sanford website under ""About Sanford"" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA"
    Group A-Facility 14 -- Sanford Canby Medical Center Part V, Section B, line 6a:
    Sanford USD Medical Center Sioux FallsSanford Medical Center FargoSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
    Group A-Facility 14 -- Sanford Canby Medical Center Part V, Section B, line 7d:
    Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
    Group A-Facility 14 -- Sanford Canby Medical Center Part V, Section B, line 11:
    The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Physical Health According the Center for Disease Control, Obesity is a complex health issue to address. Obesity can be caused from a combination of contributing factors such as behavior and genetics. Behaviors can include dietary patterns, physical activity, inactivity, medication use, and other exposures. Additional contributing factors in our society include the food and physical activity environment, education and skills, and food marketing and promotion.Obesity is a serious concern because it is associated with poorer mental health outcomes, reduced quality of life, and is associated with morbidity and illnesses including diabetes, heart disease, stroke, and some types of cancer.Sanford Health Canby has made physical health specific to obesity a significant priority and has developed strategy to improve physical health and reduce the negative health effects of obesity.Priority 2: Mental Health Mental health is important at every stage of life and affects how people think, feel and act. According to the National Institute of Mental Health, depression is one of the most common mental disorders in the U.S. Current research suggests that depression is caused by a combination of genetic, biological, environmental and psychological factors. Depression is among the most treatable of mental disorders. Sanford has made mental health a significant priority and has developed strategies to reduce mortality and morbidity from mental health and behavioral health and substance abuse. It is Sanford's goal to reduce the number of individuals whose overall well-being is negatively impacted by addiction and mental illness. Addressing of Significant Needs during Current YearPriority 1: Physical HealthTo improve physical health for the greater Canby, Minnesota community, Sanford Canby Medical Center (SCMC) is working to reduce the negative health outcomes associated with obesity. SCMC has provided sponsorship support to various activities and events in the community. Donation requests are reviewed at administrative council meetings; events/activities aligning with the promotion of healthy living are given strong consideration. In 2019, approximately $5,600 was donated to events/organizations of the Canby community including the Canby Golf Course, Canby 4 Kids, and Canby YAMS among others.SCMC also continues to sustain the Sanford fit Kids program with school-age youth throughout the community. In March and April 2019, Sanford Canby staff brought the fit Kids program to both St. Peter's Elementary School and Canby Public Elementary School. Grades K-6th were able to take part with approximately 350 kids impacted by the program. On August 6, 2019, SCMC sponsored a fit Kids pool noodle obstacle course at the National Night Out event at Sylvan Lake Park area. Approximately 85 kids ages 2-12 completed the obstacle course.We continue to promote healthy living with our valued employees at SCMC. In April 2019, Sanford Profile presented a demonstration on their weight loss/nutrition program to Sanford Canby staff. Employee Health staff also routinely sends informational emails and resources to our staff on various physical health topics such as self-care.Priority 2: Mental HealthBecause of the close relationship between physical and mental health, especially for those with chronic illness, Sanford Canby Medical Center aims to increase awareness of resources for mental health care. The Sanford Canby Pathways Support Group offers support, resources, and routes to thrive and better manage life with chronic conditions. This group provides strategies, solutions, and resources to aid members along an empowered pathway in living life after diagnosis of a chronic disease. The group is open to anyone with, or caregiving for, a person with, a chronic medical condition including Parkinson's, memory loss, vision loss, cancer, heart disease, mental health, grief/loss, or pain. Sanford Canby hosted the Pathways support group quarterly in 2019 on 02/28/2019, 04/25/2019, 8/22/19, and 10/24/19.To expand identification of patients in need of mental health services, SCMC utilizes the PHQ-9 screening tool within the electronic medical record. Through the medical home program, RN care manager, and PHQ-9 screening, we can offer and refer mental health services to those with scores indicative of depression. In January 2019, 13.7% of patients recorded remission in six months and 0% of patients recorded remission in 12 months. In January 2020, 9.5% of patients recorded remission in six months and 11% recorded remission in 12 months. Identified needs not directly addressed by this facility include:Economic - Employment options, and skilled labor forceAging - Cost of long term care and memory care, and cost of in-home servicesChildren and Youth - Bullying, and availability of quality childcareHealth Care - Access to affordable health insurance, cost of affordable vision insurance, access to affordable prescription drugs, cost of affordable dental insurance coverage, and access to affordable healthcare
    Group A-Facility 14 -- Sanford Canby Medical Center Part V, Section B, line 13h:
    Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
    Group A-Facility 14 -- Sanford Canby Medical Center Part V, Section B, line 16j:
    Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
    Group A-Facility 15 -- Sanford Jackson Medical Center Part V, Section B, line 5:
    "Sanford conducted a community health needs assessment (CHNA) during 2018 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2018 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County in North Dakota and Clay County in Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding economic well-being, transportation, children and youth, the aging population, safety, healthcare and wellness, mental health and substance abuse. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during 2019-2021. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and responses to the community health needs assessment and the implementations strategies are welcome on the Sanford website under ""About Sanford"" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA"
    Group A-Facility 15 -- Sanford Jackson Medical Center Part V, Section B, line 6a:
    Sanford USD Medical Center Sioux FallsSanford Medical Center FargoSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
    Group A-Facility 15 -- Sanford Jackson Medical Center Part V, Section B, line 7d:
    Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
    Group A-Facility 15 -- Sanford Jackson Medical Center Part V, Section B, line 11:
    "The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Children and Youth According to the Centers for Disease Control, obesity is a complex health issue to address. Obesity can be caused from a combination of contributing factors such as behavior and genetics. Behaviors can include dietary patterns, physical activity, inactivity, medication use, and other exposures. Additional contributing factors in our society include the food and physical activity environment, education and skills, and food marketing and promotion. Obesity is a serious concern because it is associated with poorer mental health outcomes, reduced quality of life, and is associated with morbidity and illnesses including diabetes, heart disease, stroke, and some types of cancer. Sanford Jackson has made physical health specific to obesity a significant priority and has developed strategy to improve physical health and reduce the negative health effects of obesity. Priority 2: Mental Health/Behavioral Health and Substance AbuseMental health is important at every stage of life and affects how people think, feel, and act. According to the National Institute of Mental Health, depression is one of the most common mental disorders in the U.S. Current research suggests that depression is caused by a combination of genetic, biological, environmental, and psychological factors. Depression is among the most treatable of mental disorders. Sanford has made mental health a significant priority and has developed strategies to reduce mortality and morbidity from mental health and behavioral health and substance abuse. It is Sanford's goal to reduce the number of individuals whose overall well-being is negatively impacted by addiction and mental illness.Addressing of Significant Needs during Current YearPriority 1: Children and YouthSanford Jackson Medical Center is working to create awareness of health behaviors for children and parents in our community through a number of initiatives. Tri for Health Sponsorship - our Marketing Specialist continues to strengthen relationships with community members specifically for Jackson's annual Kids Tri for Health. Our Marketing Specialist attended five meetings related to planning and set up for the June 2019 event. Sanford Jackson was again the title sponsor for Tri for Health in June 2019 - an event that served 100 youth from the community. All attendees received Sanford Fit Kids curriculum information in athletic bags. Our next Tri for Health will take place mid-June, 2020. Fit Kids in the Community - we utilize the Sanford Fit Kids curriculum at various community events, speaking engagements, and in the resource bags for participants in Tri for Health. Supporting Families in the Community - in 2019, we sponsored organizations such as Jackson County Libraries, Jackson County Food 4 Kids, the new Jackson City Splash Pad, and Kirby's closet (a newer nonprofit that served over 200 during the 2019 Christmas season). In September 2019, we hosted trivia and educational resources for families at JCC's Community Resource Fair, at which over 250 parents and children attended. In July, our RN Care Manger gave a presentation to the community at the Jackson County Fair. JCC Middle School hosted an event in December where we spoke with students about healthcare career paths. Priority 2: Mental Health and Substance AbuseMental and behavioral health care continues to be a pressing need for our community. Our goal at Sanford Jackson Medical Center is to decrease patients presenting to the emergency room with mental and behavioral health issues as well as to decrease substance abuse within the community. Sanford Jackson Medical Center is working internally and also with community partners to decrease substance abuse in the area via several projects.Jackson County Sheriff Education - we were unable to coordinate Jackson County Sheriff Education with providers in 2019. However, we plan to offer an education session in quarter three or four of 2020. We maintain a strong partnership with Jackson County Sheriff's Department. Education to Providers & Care Team - our RN Health Coach specializes in customized care plans for patients needing support in weight loss initiatives, diabetes management, smoking cessation, or assistance in navigating primary care. A key voice in our community, she has provided education resources at the 2019 Jackson Farm and Home Show, Jackson County Fair, and AGCO Health Fair. She also attended six monthly meetings in 2019 for the facilitation of the Weight Loss Support Group. She also coordinated this group for patients, for which there has been one participant in the latter months of 2019. In 2019, she attended a workshop in Worthington for the American Lung Association's Freedom from Smoking class. She has incorporated information from this training into her one-on-one meetings with patients, many of whom are referred to her for smoking cessation. She plans to offer classes as interest increases. Her meetings with patients involve helping them create an individualized quit plan. We often refer them to Quit Plan or MN Quit Fax Referral. In October 2019, we had one ""Ask the Expert"" newspaper column on ""Is Vaping Safe?"" featuring expertise from Martha Johnson, PA.Our providers discuss tobacco use rates and the impact on care for people with diabetes and vascular disease specifically. Our Performance Improvement team monitors these measurements quarterly and updates action plans for all members involved in patient care. The Sanford Health Network occasionally sends updates on best practices for care teams working with patients dealing with tobacco use or chronic disease. Opioid Prescribing Best Practices - our staff and providers are routinely given updates to Sanford enterprise best practices regarding opioid prescribing. Many of these updates appear as prompts in a patient's Electronic Medical Record (EMR). The EMR prompts providers to do the following: check PDMP (Prescription Drug Monitoring Program) before prescribing opioids, perform routine yearly Urine Drug Screen tests, provide educational resources in dealing with prescribing opioids, and give Controlled Substance Agreements for patients using opioids chronically. Minnesota Prescription Monitoring Program - at Sanford Jackson, all controlled substances that are sent home with the patient from the hospital are automatically reported to the Minnesota Hospital Prescription Monitoring Program (PMP) electronically via information entered on the Medication Administration Record (MAR). The provider enters the order, nurses chart on the MAR, and then that information is sent to the MN PMP electronically. Our Senior Pharmacist receives daily emailed reports of what has been sent to the MN PMP and also verifies that data with the paper copy of the prescriptions that were sent home with the patient. Overall, there have been changes within the state and also federal government in that prescribers are limited in the quantity of controlled substances that they can prescribe. A new feature in EPIC became available for the providers to choose acute or chronic pain. This is update is now a requirement in MN but not all states. Identified needs not directly addressed by this facility include:Children and Youth - Availability and cost of quality childcare, bullying, availability and cost of services for at-risk youth, substance abuse by youth, teen tobacco use, and opportunities for mentoringAging - Cost of long term care, availability and cost of memory careHealth Care - Availability of non-traditional hours, access to affordable health insurance, access to affordable health care, access to affordable prescription drugs, cost of affordable dental insurance coverage"
    Group A-Facility 15 -- Sanford Jackson Medical Center Part V, Section B, line 13h:
    Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
    Group A-Facility 15 -- Sanford Jackson Medical Center Part V, Section B, line 16j:
    Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
    Group A-Facility 16 -- Sanford Tracy Medical Center Part V, Section B, line 5:
    "Sanford conducted a community health needs assessment (CHNA) during 2018 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2018 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County in North Dakota and Clay County in Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding economic well-being, transportation, children and youth, the aging population, safety, healthcare and wellness, mental health and substance abuse. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during 2019-2021. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and responses to the community health needs assessment and the implementations strategies are welcome on the Sanford website under ""About Sanford"" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA"
    Group A-Facility 16 -- Sanford Tracy Medical Center Part V, Section B, line 6a:
    Sanford USD Medical Center Sioux FallsSanford Medical Center FargoSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
    Group A-Facility 16 -- Sanford Tracy Medical Center Part V, Section B, line 7d:
    Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
    Group A-Facility 16 -- Sanford Tracy Medical Center Part V, Section B, line 11:
    The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: WellnessAccording the Center for Disease Control, obesity is a complex health issue to address. Obesity can be caused from a combination of contributing factors such as behavior and genetics. Behaviors can include dietary patterns, physical activity, inactivity, medication use, and other exposures. Additional contributing factors in our society include the food and physical activity environment, education and skills, and food marketing and promotion.Obesity is a serious concern because it is associated with poorer mental health outcomes, reduced quality of life, and is associated with morbidity and illnesses including diabetes, heart disease, stroke, and some types of cancer.Sanford Health Tracy has made physical health specific to obesity a significant priority and has developed strategy to improve physical health and reduce the negative health effects of obesity.Priority 2: Health Care AccessAccording to the County Health Rankings for Clinical Care, access to affordable health care is important to physical, social, and mental health. Health insurance, local care options, and a usual source of care help to ensure access to health care. Having access to care allows individuals to enter the health care system, find care easily and locally, pay for care, and get their health needs met.Sanford has made health care access a significant priority and has developed strategies to promote and improve access to services. It is Sanford's goal that all patients requiring access to health care are successful in securing timely appointments.Addressing of Significant Needs during Current YearPriority 1: WellnessSanford Tracy Medical Center seeks to improve physical and chronic health and overall wellness of Tracy community members through dietician and RN health coach services, providing needed medical supplies to low income patients, and expanding Sanford fit programming.Dietician services - both Dietician and RN Health Coach services continued to be offered and referred to in 2019. Dietician services are now available via telemedicine, making access quicker and easier. Our Dietician had 11 visits in 2019 (9 in 2018). Our RN Health Coach had 182 visits in 2019.Medical supply availability - Sanford Tracy completed the grant period by providing pill caddies, digital thermometers, blood pressure monitors, glucometer test strips, medication spoons, scales and wellness center vouchers to in-need patients (with need determined by nurses/Health Coach/providers). The majority of our supplies were exhausted in 2019. In total, we provided medical supplies to 55 in-need patients in 2019 (some patients may have received more than one item). WE are currently discussing ways to continue project into 2020 and beyond. Sanford fit programming - staff continued the Sanford fit program, which focuses on health lifestyle choices to decrease childhood obesity, from January 2019 - May 2019. Staff also shared Sanford fit online resources with local school administration and teachers. Tracy Area Elementary School 4th grade students took a pre-test on first day of fitClub and a post-test on the final day. Students increased their test scores by more than 21% from the pre-test to the post-test.Priority 2: Health Care AccessOur staff is committed to improving access to health care through education and awareness. Specifically, additional awareness of mental health services is needed along with additional outreach services and medical supplies for low-income and in-need patients. Mental health awareness - to increase overall awareness of telemedicine services and local behavioral health services, Sanford Tracy developed marketing and social media campaigns in 2019. Also, referrals for behavioral health providers continued as needed in 2019. PCP providers were reminded of services available on site at the regularly scheduled provider meetings. Behavioral Health providers in Tracy saw 119 new referrals in 2019 and a grand total of 1181 visits for the year.Specialty outreach - work began in 2019 to obtain a Sanford orthopedic outreach provider as well as a dermatology outreach provider. Expected start date for these outreach services is spring 2020. Wound Care telemedicine services were added in 2019. Hospital outpatient dressing changes/wound care visits were 468 in 2019 (up from 151 in 2018). Outreach Clinic wound care telemedicine visits were five in 2019 (as a brand new service). Medical supply availability - grant period was completed by providing pill caddies, digital thermometers, blood pressure monitors, glucometer test strips, medication spoons, scales and wellness center vouchers to in-need patients (with need determined by nurses/Health Coach/providers). The majority of the supplies were exhausted in 2019. Sanford Tracy provided medical supplies to 55 in-need patients in 2019 (some patients may have received more than one item). Our staff is currently discussing ways to continue the project into 2020 and beyond.Identified needs not directly addressed by this facility include:Economic - Need for employment options, and availability of a skilled labor forceChildren and Youth - Availability of quality childcareAging - Cost of long term care, availability and cost of memory careMental Health and Substance Abuse - Depression, stress, dementia and Alzheimer's
    Group A-Facility 16 -- Sanford Tracy Medical Center Part V, Section B, line 13h:
    Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
    Group A-Facility 16 -- Sanford Tracy Medical Center Part V, Section B, line 16j:
    Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
    Group A-Facility 17 -- Sanford Rock Rapids Medical Center Part V, Section B, line 5:
    "Sanford conducted a community health needs assessment (CHNA) during 2018 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2018 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County in North Dakota and Clay County in Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding economic well-being, transportation, children and youth, the aging population, safety, healthcare and wellness, mental health and substance abuse. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during 2019-2021. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and responses to the community health needs assessment and the implementations strategies are welcome on the Sanford website under ""About Sanford"" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA"
    Group A-Facility 17 -- Sanford Rock Rapids Medical Center Part V, Section B, line 6a:
    Sanford USD Medical Center Sioux FallsSanford Medical Center FargoSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
    Group A-Facility 17 -- Sanford Rock Rapids Medical Center Part V, Section B, line 7d:
    Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
    Group A-Facility 17 -- Sanford Rock Rapids Medical Center Part V, Section B, line 11:
    The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: ObesityAccording the Center for Disease Control, Obesity is a complex health issue to address. Obesity can be caused from a combination of contributing factors such as behavior and genetics. Behaviors can include dietary patterns, physical activity, inactivity, medication use, and other exposures. Additional contributing factors in our society include the food and physical activity environment, education and skills, and food marketing and promotion.Obesity is a serious concern because it is associated with poorer mental health outcomes, reduced quality of life, and is associated with morbidity and illnesses including diabetes, heart disease, stroke, and some types of cancer.Sanford has made obesity reduction a significant priority and has developed strategies to offer support programs that can reduce obesity rates and improve overall health. Priority 2: Chronic DiseaseSanford has made chronic disease a significant priority and has developed strategies to reduce mortality and morbidity from chronic disease. It is Sanford's goal to reduce the number of individuals whose overall well-being is negatively impacted by chronic diseases.Addressing of Significant Needs during Current YearNOTE: Sanford no longer operates this facility as of 4/30/19. As such, the demonstrating impact narrative is pursuant only to the period from January 1, 2019 to April 30, 2019.Priority 1: ObesityTo promote health and wellness in the community, Sanford Rock Rapids worked on several strategies including promoting fitness center utilization and programs focusing on weight management. Our wellness committee promoted walking competitions and conducted lunch-and-learn events for employees to enhance physical and mental health. Additionally, our staff participated in the Glynlyon Health Fair and the Home & Farm show to take blood pressures, promote our wellness services, offer care and referrals, and share information about the wellness center. Priority 2: Chronic DiseaseOur initiative around improved community health focused on decreasing chronic health conditions. Strategies implemented include offering RN care management services to assist with education, care coordination, and resources. We also help patients in need of financial assistance with filling out the required paperwork; this keeps them coming in to see their provider regularly to talk about their chronic diseases, which ultimately enhances outcomes. Sanford Rock Rapids also offers monthly education and data sharing for our providers and nurses related to how well they care for our patients with diabetes, high BMI, and depression.We participated in several community partnership efforts including:Collaborate with Atlas to provide needed resources for food, housing, utilitiesCollaborate with Safenet RX to provide free medications to patients with limited incomes, high insurance copays, or no insuranceCollaborate with Lewis drug to offer cash paying patients less expensive medication for chronic disease by discounting with their primary pharmacistFinally, in light of the strong connection between physical and mental health, our staff met with public health, school nurses, and Area 4 to promote the availability of psychiatry and psychology services with Dr. Eggers and Dr. Daniels through telemedicine at our clinic.Identified needs not directly addressed by this facility include:Economics - Presence of food insecurityChildren and Youth - Use of seat belts and car seats for childrenHealth Care - Cost of affordable dental insurance, access to affordable health careMental Health and Substance Abuse - Presence of anxiety, depression and binge drinkingSanford will not directly develop strategy to address the unmet needs. However, Sanford serves as a partner in many community groups that have the expertise to address these unmet needs. Sanford will share the concerns and the results of the CHNA with community leaders who do have expertise in their areas.
    Group A-Facility 17 -- Sanford Rock Rapids Medical Center Part V, Section B, line 13h:
    Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
    Group A-Facility 17 -- Sanford Rock Rapids Medical Center Part V, Section B, line 16j:
    Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
    Group A-Facility 18 -- Sanford Hillsboro Medical Center Part V, Section B, line 5:
    "Sanford conducted a community health needs assessment (CHNA) during 2018 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2018 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County in North Dakota and Clay County in Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding economic well-being, transportation, children and youth, the aging population, safety, healthcare and wellness, mental health and substance abuse. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during 2019-2021. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and responses to the community health needs assessment and the implementations strategies are welcome on the Sanford website under ""About Sanford"" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA"
    Group A-Facility 18 -- Sanford Hillsboro Medical Center Part V, Section B, line 6a:
    Sanford USD Medical Center Sioux FallsSanford Medical Center FargoSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
    Group A-Facility 18 -- Sanford Hillsboro Medical Center Part V, Section B, line 7d:
    Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
    Group A-Facility 18 -- Sanford Hillsboro Medical Center Part V, Section B, line 11:
    The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Mental Health/Behavioral Health and Substance AbuseMental health is important at every stage of life and affects how people think, feel, and act. According to the National Institute of Mental Health, depression is one of the most common mental disorders in the U.S. Current research suggests that depression is caused by a combination of genetic, biological, environmental, and psychological factors. Depression is among the most treatable of mental disorders. Sanford has made mental health a significant priority and has developed strategies to reduce mortality and morbidity from mental health and behavioral health and substance abuse. It is Sanford's goal to reduce the number of individuals whose overall well-being is negatively impacted by addiction and mental illness. Priority 2: TransportationThe University of Minnesota's Rural Health Research Center reports that transportation is a concern for rural residents. A social determinant of health, affordable transportation is fundamental to mental, physical, and emotional well-being. Individuals with disabilities, those with low incomes, seniors, and others who may not have reliable access to transportation depend on public and private transportation to access health services, obtain food and other basic needs, and to engage with their communities.Sanford Health Hillsboro has made transportation a significant priority and has developed a strategy to work in collaboration with city and county leadership and the department of human services to explore options for the local community and county members.Addressing of Significant Needs during Current YearPriority 1: Mental Health Services We are using the PHQ-9 patient health questionnaire on initial and certain follow-up appointments and appropriate patients to ensure that we are able to identify and treat those in need of mental health services. Also, our panel management team is completing follow-up for new depression diagnosis. We have seen an increase in our local patient population and with the use of the PHQ-9 tool, expect that we will see a positive movement in depression management outcomes.Both Sanford Mayville and Sanford Hillsboro have implemented IHT (integrated health therapist) into the Clinics, mostly by tele-health. 1-3 patients per day are being seen by telehealth from each Clinic. Patients and Providers feel it is going well and it is used quite frequently. Sanford Hillsboro has contracted Senior Life Solutions to bring their outpatient group geriatric psych service to Traill County. Priority 2: TransportationBoth Sanford Hillsboro and Sanford Mayville worked with Traill County to provide public directory of transportation options. The directory is now available throughout the county.We worked with the City of Hillsboro as they submitted a grant to secure an autonomous bus to transport people throughout Hillsboro. The county does have a bus/van available for use.Go Live for Senior Life Solutions outpatient group therapy program is Summer of 2020 with an estimated 4-10 patients per day by end of 2020 year.Identified needs not directly addressed by this facility include:Economic - Need for affordable housing, and employment optionsAging - Cost of long term care and memory care, availability of resources for family and friends caring for elders the cost of in-home services, cost of in-home services, and help making out a will or healthcare directiveChildren and Youth - Availability of quality childcare, childhood obesity, cost of quality childcare, the availability of services for at-risk youth, bullying, substance abuse by youth, cost of activities, cost of services for at-risk youth, opportunities for youth-adult mentoring, and teen tobaccos useSafety - Culture of excessive drinking, and abuse of prescription drugsHealth Care - Access to affordable health insurance, access to affordable healthcare, access to affordable prescription drugs, access to affordable dental insurance, and access to affordable vision insurance Sanford will not develop strategy to address the cost of long term care and memory care because the state of North Dakota through the Department of Human Services controls the cost. Memory care cannot be added to the LTC facility. Safety issues such as the culture of excessive drinking, and abuse of prescription drugs are issues that the city council and the sheriff's office are issues that the community stakeholders are addressing. Sanford serves as a partner in many community groups that have the expertise to address these unmet needs.
    Group A-Facility 18 -- Sanford Hillsboro Medical Center Part V, Section B, line 13h:
    Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
    Group A-Facility 18 -- Sanford Hillsboro Medical Center Part V, Section B, line 16j:
    Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
    Group A-Facility 19 -- Sanford Medical Center Mayville Part V, Section B, line 5:
    "Sanford conducted a community health needs assessment (CHNA) during 2018 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2018 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County in North Dakota and Clay County in Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding economic well-being, transportation, children and youth, the aging population, safety, healthcare and wellness, mental health and substance abuse. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during 2019-2021. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and responses to the community health needs assessment and the implementations strategies are welcome on the Sanford website under ""About Sanford"" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA"
    Group A-Facility 19 -- Sanford Medical Center Mayville Part V, Section B, line 6a:
    Sanford USD Medical Center Sioux FallsSanford Medical Center FargoSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
    Group A-Facility 19 -- Sanford Medical Center Mayville Part V, Section B, line 7d:
    Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
    Group A-Facility 19 -- Sanford Medical Center Mayville Part V, Section B, line 11:
    The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Mental Health/Behavioral Health and Substance AbuseMental health is important at every stage of life and affects how people think, feel, and act. According to the National Institute of Mental Health, depression is one of the most common mental disorders in the U.S. Current research suggests that depression is caused by a combination of genetic, biological, environmental, and psychological factors. Depression is among the most treatable of mental disorders. Sanford has made mental health a significant priority and has developed strategies to reduce mortality and morbidity from mental health and behavioral health and substance abuse. It is Sanford's goal to reduce the number of individuals whose overall well-being is negatively impacted by addiction and mental illness. Priority 2: TransportationThe University of Minnesota's Rural Health Research Center reports that transportation is a concern for rural residents. A social determinant of health, affordable transportation is fundamental to mental, physical, and emotional well-being. Individuals with disabilities, those with low incomes, seniors, and others who may not have reliable access to transportation depend on public and private transportation to access health services, obtain food and other basic needs, and to engage with their communities.Sanford Health Mayville has made transportation a significant priority and has developed a strategy to work in collaboration with city and county leadership and the department of human services to explore options for the local community and county members. Addressing of Significant Needs during Current YearPriority 1: Mental Health Services We are using the PHQ-9 patient health questionnaire on initial and certain follow-up appointments and appropriate patients to ensure that we are able to identify and treat those in need of mental health services. Also, our panel management team is completing follow-up for new depression diagnosis. We have seen an increase in our local patient population and with the use of the PHQ-9 tool, expect that we will see a positive movement in depression management outcomes.Both Sanford Mayville and Sanford Hillsboro have implemented IHT (integrated health therapist) into the Clinics, mostly by tele-health. 1-3 patients per day are being seen by telehealth from each Clinic. Patients and Providers feel it is going well and it is used quite frequently. Sanford Hillsboro has contracted Senior Life Solutions to bring their outpatient group geriatric psych service to Traill County. Priority 2: TransportationBoth Sanford Hillsboro and Sanford Mayville worked with Traill County to provide public directory of transportation options. The directory is now available throughout the county.We worked with the City of Hillsboro as they submitted a grant to secure an autonomous bus to transport people throughout Hillsboro. The county does have a bus/van available for use.Go Live for Senior Life Solutions outpatient group therapy program is Summer of 2020 with an estimated 4-10 patients per day by end of 2020 year.Identified needs not directly addressed by this facility include:Economic - Need for affordable housing, and employment optionsAging - Cost of long term care and memory care, availability of resources for family and friends caring for elders, cost of in-home services, and help making out a will or healthcare directiveChildren and Youth - Bullying, availability and cost of quality childcare, childhood obesity, cost of activities for children and youth, availability and cost of services for at-risk youth, substance abuse by youth, opportunities for youth-adult mentoring, and teen tobacco useSafety - Concerned about the culture of excessive drinking, and abuse of prescription drugsHealth Care - Access to affordable health insurance, cost of affordable vision insurance, access to affordable prescription drugs, cost of affordable dental insurance coverage, and access to affordable healthcareSanford will not directly develop strategy to address the cost of long term care and memory care because the state of North Dakota through the Department of Human Services controls the cost. Sanford has deferred to the local nursing home which does have an Alzheimer's unit. Sanford serves as a partner in many community groups that have the expertise to address these unmet needs.
    Group A-Facility 19 -- Sanford Medical Center Mayville Part V, Section B, line 13h:
    Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
    Group A-Facility 19 -- Sanford Medical Center Mayville Part V, Section B, line 16j:
    Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
    Group A-Facility 20 -- Sanford Webster Medical Center Part V, Section B, line 5:
    "Sanford conducted a community health needs assessment (CHNA) during 2018 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2018 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County in North Dakota and Clay County in Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding economic well-being, transportation, children and youth, the aging population, safety, healthcare and wellness, mental health and substance abuse. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during 2019-2021. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and responses to the community health needs assessment and the implementations strategies are welcome on the Sanford website under ""About Sanford"" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA"
    Group A-Facility 20 -- Sanford Webster Medical Center Part V, Section B, line 6a:
    Sanford USD Medical Center Sioux FallsSanford Medical Center FargoSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
    Group A-Facility 20 -- Sanford Webster Medical Center Part V, Section B, line 7d:
    Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
    Group A-Facility 20 -- Sanford Webster Medical Center Part V, Section B, line 11:
    The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Mental Health/Behavioral Health and Substance AbuseMental health is important at every stage of life and affects how people think, feel, and act. According to the National Institute of Mental Health, depression is one of the most common mental disorders in the U.S. Current research suggests that depression is caused by a combination of genetic, biological, environmental, and psychological factors. Depression is among the most treatable of mental disorders. Sanford has made mental health a significant priority and has developed strategies to reduce mortality and morbidity from mental health and behavioral health and substance abuse. It is Sanford's goal to reduce the number of individuals whose overall well-being is negatively impacted by addiction and mental illness. Priority 2: Aging ServicesAccording to the Administration for Community Living, families are the major provider of long-term care for older adults and people with disabilities in the U.S. Research indicates that caregiving also exacts a significant emotional, physical, and financial toll. With nearly half of all caregivers older than age 50, many are vulnerable to a decline in their own health. Studies have shown that coordinated support services can reduce caregiver depression, anxiety, and stress, and enable them to provide care longer, which avoids or delays the need for costly institutional care.Sanford has made the aging population a significant priority and has developed strategies to support caregivers through community services. The creation of collaborative partners will provide the necessary support to make a positive impact on caregivers and to provide the tools to support their work.Addressing of Significant Needs during Current YearPriority 1: Mental HealthAs need continues to increase, we aim to ensure that access to mental health services are available for the community of Webster. We will achieve this through improved access for mental health specialty care, psychiatry outreach services, and the Bridging Health and Home program. Bridging Health and Home is offered to support older adults in our rural areas. Bridging Health and Home services are free for adults age 55 and older and offers compassion and care to those wishing to remain at home as long as possible.Sanford Webster is currently offering telehealth psychology services. Dr. Mark Daniels who is a psychologist and integrated health therapist out of Vermillion, SD has been offering his services to the community. He is seeing an average of 10 patients per month via telehealth in the clinic. Additionally, Dr. Nuss is a licensed psychiatrist and credentialed to offer services to our community. Dr. Eggers who is also a licensed psychiatrist is being utilized for telehealth services as well. Dr. Nuss and Dr. Eggers are seeing an average of 15 patients per month via telehealth at the clinic.Finally, Dr. Daniels has been involved in the interdisciplinary team to make sure we are offering a physical and mental health approach with our patients. Dr. Daniels has been involved in offering an integrated approach to metal health services for 223 patients in the Bridging Health and Home program. Priority 2: Aging PopulationSanford Webster is committed to supporting caregivers through community service providers. We have collaborated with our local caregiver support group to offer resources and education. Vanessa Bloom and Lori Reetz have been actively involved with providing these resources. In 2019, supportive services were offered to 59 local caregivers. Our staff has also started the Better Balance program to prevent falls in the community. Kyle Hubsch led the first sessions to get the program underway. Now, the program is facilitated by community volunteers, with Sanford Webster coordinating the locations and volunteer schedule. In 2019, approximately 300 local residents have participated in Better Balance training.Identified needs not directly addressed by this facility include:Economic - Need for affordable housing, need to maintain energy efficient homes, household budgeting and money management skills, and skilled labor forceChildren and Youth - Bullying, availability of activities for children and youth, childhood obesity, substance abuse by youth, availability and cost of services for at-risk youth, opportunities for adult-youth mentoring, teen tobacco use, and education about birth controlSafety - Presence of street drugs, culture of excessive drinking, presence of drug dealers, abuse of prescription drugs, domestic violence, crime, and child abuse and neglectHealth Care - Access to affordable health insurance, access to affordable vision insurance, access to affordable health care, and access to affordable prescription drugs
    Group A-Facility 20 -- Sanford Webster Medical Center Part V, Section B, line 13h:
    Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
    Group A-Facility 20 -- Sanford Webster Medical Center Part V, Section B, line 16j:
    Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
    Group A-Facility 21 -- Sanford Medical Center Wheaton Part V, Section B, line 5:
    "Sanford conducted a community health needs assessment (CHNA) during 2018 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2018 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County in North Dakota and Clay County in Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding economic well-being, transportation, children and youth, the aging population, safety, healthcare and wellness, mental health and substance abuse. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during 2019-2021. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and responses to the community health needs assessment and the implementations strategies are welcome on the Sanford website under ""About Sanford"" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA"
    Group A-Facility 21 -- Sanford Medical Center Wheaton Part V, Section B, line 6a:
    Sanford USD Medical Center Sioux FallsSanford Medical Center FargoSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Worthington Medical Center
    Group A-Facility 21 -- Sanford Medical Center Wheaton Part V, Section B, line 7d:
    Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
    Group A-Facility 21 -- Sanford Medical Center Wheaton Part V, Section B, line 11:
    The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Mental Health Mental health is important at every stage of life and affects how people think, feel, and act. According to the National Institute of Mental Health, depression is one of the most common mental disorders in the U.S. Current research suggests that depression is caused by a combination of genetic, biological, environmental, and psychological factors. Depression is among the most treatable of mental disorders. Sanford has made mental health a significant priority and has developed strategies to reduce mortality and morbidity from mental health and depression. All patients in the primary care setting will have a Patient Health Questionnaire (PHQ-9) completed at each visit. The PHQ-9 is an assessment tool used for screening, diagnosing, measuring, and monitoring the severity of depression. Patients are evaluated to determine if there is a need to provide additional services. Sanford is providing on-site mental health services and has implemented telehealth services to improve access to psychiatry services. Priority 2: Economic Well BeingFood security means access by all people at all times to enough food for an active, healthy life. Food insecurity describes a household's inability to provide enough food for every person to live an active, healthy life. According to United States Department of Agriculture, an estimated 12.3 percent of American households were food insecure at least some time during the year in 2016, meaning they lacked access to enough food for an active, healthy life for all household members. That is essentially unchanged from 12.7 percent in 2015. The prevalence of very low food security also essentially unchanged, at 4.9 percent in 2016 and 5.0 percent in 2015. Sanford has made economic well-being specific to food security a significant priority and has developed a strategic plan to sustain the backpack program and food distribution for students in the community.Addressing of Significant Needs during the Current YearPriority 1: Mental HealthImproved PHQ patient health questionnaire scores in 2018 starting with a score of 2.3% ending with a score of 9.3% and continuation of improvement through 2019. January 2019 started with 12.9% and ended with 16.1%. The enterprise goal for depression score is 11%. The panel specialist and RN health coach review the charts and complete follow up to ensure these are being met when able.All patients that are currently under the care of the telehealth psychiatrist receive a PHQ 9 on each visit. The remainder of patients are screened when deemed necessary by the provider, after med changes and to fall into the measured goal need to be done at 4-6 month and 11-13 months. The RN health coach helps patients in navigating the system, assisting with referrals, appointments and follow up.We have added a psychologist and additional psychiatrist, so access is no longer much of an issue. This is a large population of non-compliant patients that don't always present to their appointments.We have improved access and encourage patients to keep appointments. Priority 2: Economic Well-BeingOur Backpack Program is sustained with the partnership between Sanford Wheaton, Bethlehem Covenant, North Country food bank and Wheaton area schools.We currently have 43 children signed up receiving and 4 pounds bag of snacks and entrees every other week.We also collect food for the local food bank. In 2019, 40 pounds of food has been collected during the year for local food bank.Identified needs not directly addressed by this facility include:Children and Youth - opportunities for youth-adult mentoring, bullying, availability of activities for children and youth, childhood obesity, and teen tobacco use Aging - Cost of long term care, availability of memory care, cost of in-home services, and the availability of activities for seniors.Safety - Abuse of prescription drugs, presence of drug dealers and street drugs, child abuse and neglect, crime, culture of excessive and binge drinking, and domestic violenceHealth Care - Access to affordable health insurance coverage, availability of mental health and substance abuse providers, access to affordable health care, availability of specialist physicians, access to affordable prescription drugs, use of emergency room services for primary health care, access to affordable vision insurance coverage, availability of doctors, physician assistants or nurse practitioners, and availability of non-traditional hours.
    Group A-Facility 21 -- Sanford Medical Center Wheaton Part V, Section B, line 13h:
    Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
    Group A-Facility 21 -- Sanford Medical Center Wheaton Part V, Section B, line 16j:
    Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
    Group A-Facility 22 -- Sanford Bagley Medical Center Part V, Section B, line 5:
    "Sanford conducted a community health needs assessment (CHNA) during 2018 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2018 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County in North Dakota and Clay County in Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding economic well-being, transportation, children and youth, the aging population, safety, healthcare and wellness, mental health and substance abuse. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during 2019-2021. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and responses to the community health needs assessment and the implementations strategies are welcome on the Sanford website under ""About Sanford"" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA"
    Group A-Facility 22 -- Sanford Bagley Medical Center Part V, Section B, line 6a:
    Sanford USD Medical Center Sioux FallsSanford Medical Center FargoSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
    Group A-Facility 22 -- Sanford Bagley Medical Center Part V, Section B, line 7d:
    Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
    Group A-Facility 22 -- Sanford Bagley Medical Center Part V, Section B, line 11:
    "The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Mental Health/Behavioral Health and Substance AbuseMental health is important at every stage of life and affects how people think, feel, and act. According to the National Institute of Mental Health, depression is one of the most common mental disorders in the U.S. Current research suggests that depression is caused by a combination of genetic, biological, environmental, and psychological factors. Depression is among the most treatable of mental disorders. Sanford has made mental health a significant priority and has developed strategies to reduce mortality and morbidity from mental health and behavioral health and substance abuse. It is Sanford's goal to reduce the number of individuals whose overall well-being is negatively impacted by addiction and mental illness. Priority 2: Children and YouthAccording the U.S. Department of Drug Enforcement Administration (DEA), nationally almost 20 percent of students surveyed admit to using marijuana at least once during the last 30 days, and 13 percent of students surveyed admitted driving when they used marijuana within the last 30 days.Researchers have identified risk factors that can increase a person's chances for misuse, and protective factors that can reduce the risk. However, many people with risk factors do not abuse substances. The risk factors for substance abuse among youth include boredom, stress, curiosity, the desire to feel grown up, or to lessen peer pressure. Youth may also be more likely to try drugs because of circumstances or events called risk factors. Examples of risk factors include: Poor grades in school Engaging in alcohol or drug use at a young age Friends and peers who engage in alcohol or drug use Persistent, progressive, and generalized substance use, misuse, and use disorders by family members Conflict between parents or between parents and children, including abuse or neglect BullyingProtective factors include:Having high self-esteem Attending a school with policies against using alcohol and drugs Having an adult role model who doesn't use tobacco or drugs or misuse alcohol Participating in athletic, community, or faith-based groups Living in a community with youth activities that prohibit drugs and alcohol Sanford Health Bagley has made children and youth a significant priority and has developed strategies to expand education for healthy lifestyle choices, provide opportunities for local employment and careers, and provide outreach for teen and adolescent behavioral health services.Addressing of Significant Needs during Current YearPriority 1: Mental Health and Substance AbuseAs Identified on our community needs assessment, Mental Health care is a gap in our community that we have addressed. We selected a current Family Medicine Nurse Practitioner and sent them back to school for Psychiatric Nurse Practitioner Certification. This allows us to have an expert in Psychiatric Medication Management in our local community. The Psychiatric Nurse Practitioner is done with his clinical rotations and is now able to see Psychiatric patients. The Psychiatric Nurse Practitioner has both family medicine and psychiatric certification, so they are now able to see patients for both medical concerns and mental health concerns. In addition to providing this service to the Bagley Community, we are having this individual do outreach to Walker, Park Rapids, Blackduck, and Cass Lake regional clinics to provide the same service to the other rural communities in our area. Pharma providers are now using Sanford Prescribing algorithms for opioid prescribing. This allows for a standard approach to opioid prescribing to patients - eliminating the patient trying different doctors to get different answers. Contracts are being used with patients as part of the opioid prescription process, having the patient and provider sign an agreement on how to safely utilize the prescribed medication. In the event we feel a provider is prescribing opioids outside of the guidelines we can audit each providers prescriptions.Crisis services are reporting in person for crisis visits. The crisis services team is a group out of Sanford Bemidji that can assist our providers in the event they have a patient in the middle of a mental health crisis. The crisis team can help determine the most appropriate next service. For example: a patient comes into the Emergency Department saying they are suicidal. Our provider can have the crisis team help determine next steps - inpatient vs. outpatient vs. other treatment. Priority 2: Children and YouthWe are making volunteer opportunities available to Bagley High School students and have participated in regional ""Career Fairs"" at high schools. SHNM has hired a teen/adolescence psychiatric nurse practitioner and a full-time licensed psychologist was hired and onboarded in September 2019. Sanford Bagley continues to be involved in community events, including health fairs. An RN health coach is available to the public for patient educationIdentified needs not directly addressed by this facility include:Economics - Availability of affordable housing, concern for homelessness, food insecurity, and a need for housing that accepts people with chemical dependency, mental health problems, criminal history or victims of domestic abuseAging - Cost of long term care, and availability of memory careSafety - Child abuse and neglect, crime, presence of street drugs, abuse of prescription drugs, presence of drug dealers, and domestic violenceHealth Care - Use of emergency services for primary care, and access to mental health/behavioral health providers"
    Group A-Facility 22 -- Sanford Bagley Medical Center Part V, Section B, line 13h:
    Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
    Group A-Facility 22 -- Sanford Bagley Medical Center Part V, Section B, line 16j:
    Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
    Group A-Facility 23 -- Sanford Canton-Inwood Medical Center Part V, Section B, line 5:
    "Sanford conducted a community health needs assessment (CHNA) during 2018 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2018 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County in North Dakota and Clay County in Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding economic well-being, transportation, children and youth, the aging population, safety, healthcare and wellness, mental health and substance abuse. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during 2019-2021. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and responses to the community health needs assessment and the implementations strategies are welcome on the Sanford website under ""About Sanford"" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA"
    Group A-Facility 23 -- Sanford Canton-Inwood Medical Center Part V, Section B, line 6a:
    Sanford USD Medical Center Sioux FallsSanford Medical Center FargoSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
    Group A-Facility 23 -- Sanford Canton-Inwood Medical Center Part V, Section B, line 7d:
    Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
    Group A-Facility 23 -- Sanford Canton-Inwood Medical Center Part V, Section B, line 11:
    The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: Economic Well-Being - Affordable HousingResources that enhance quality of life can have a significant influence on population health outcomes. Examples of these resources include safe and affordable housing, access to education, public safety, availability of healthy foods, local emergency/health services, and environments free of life-threatening toxins. Priority 2: Behavioral Health and Mental Health Access - Substance Abuse by YouthMental health is important at every stage of life and affects how people think, feel and act. According to the National Institute of Mental Health, depression is one of the most common mental disorders in the U.S. Current research suggests that depression is caused by a combination of genetic, biological, environmental and psychological factors. Depression is among the most treatable of mental disorders. Sanford has made mental health a significant priority and has developed strategies to reduce mortality and morbidity from mental health and behavioral health and substance abuse. It is Sanford's goal to reduce the number of individuals whose overall well-being is negatively impacted by addiction and mental illness.Addressing of Significant Needs during Current YearPriority 1: Economic Well-Being - Availability of Affordable HousingThe Canton area is in need of more affordable housing units to increase the well-being of community members. Sanford Canton-Inwood Medical Center (SCIMC) is collaborating with the Canton Economic Development Committee to expand options for local residents. The Senior Director of SCIMC is also the Board President of the Canton Economic Development Committee (CEDC), and this strategy is a priority for the committee. To date the CEDC has provided a grant to Canton Housing for $8,000. They are also applying with the State to develop a 15-unit building for low-income housing.CEDC has also updated their Housing Study, which indicated the need for additional affordable housing. CEDC entered into an agreement with ISG out of Sioux Falls, SD who created a housing development project on two different land options. CEDC is currently exploring a TIF within the county to help develop the infrastructure that will attract contractors to assist in development of this housing project, including affordable housing units. Outcomes completed to date include a housing plan and completed housing development drawing to be utilized for presentations and requesting TIF funds for infrastructure.Priority 2: Behavioral Health and Mental Health Access - Youth Substance Abuse The Sanford Canton-Inwood Medical Center staff aims to raise awareness of drug use impact to help reduce substance abuse by area youth. Working in conjunction with local law enforcement, schools, and treatment facilities, SCIMC offers various educational and screening opportunities for the community and our staff. In 2019, we facilitated presentations by Sanford Health in Canton on Behavioral Health and Suicide to 16 of our staff, including providers.Additionally, Cari Folkens, CNP, participated in a Vaping Education Webinar on December 16, 2019 and will provide an update to our providers and staff. Cari was also a guest speaker along with the School Counselors regarding substance abuse, particularly as it relates to Vaping. SCIMC held a screening day at the hospital on October 1, 2019. We had a booth on the dangers of vaping as well as different vaping devices that are used and a description of how vaping affects the body. Approximately 30-50 people attended the event.Identified needs not directly addressed by this facility include:Economic - Employment options, a skilled labor force, household budgeting and money management, and maintaining livable and energy efficient homesTransportation - Availability of good walking or biking options, and driving habits related to speed and road rageAging - Cost of long term care and memory care, cost of in-home services, availability of memory care, availability of resources to help the elderly stay safe in their homes, and availability of resources for caregiversSafety - Abuse of prescription drugs in the community, presence of drug dealers in the communityHealth Care - Access to affordable health insurance, access to affordable vision insurance, availability of health care services for Native American people, access to affordable dental insurance, availability of non-traditional hours, availability of prevention programs, and availability of specialist physicians Children and Youth - Cost and availability of activities for children, cost and availability of quality childcare, cost and availability of services for at-risk youth, bullying, childhood obesity, teen tobacco use, teen suicide, and opportunities for youth mentoringMental Health and Substance Abuse - Depression, stress, dementia and Alzheimer's disease, drug use and abuse, smoking and tobacco use, alcohol use and abuse, and exposure to second hand smoke
    Group A-Facility 23 -- Sanford Canton-Inwood Medical Center Part V, Section B, line 13h:
    Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
    Group A-Facility 23 -- Sanford Canton-Inwood Medical Center Part V, Section B, line 16j:
    Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
    Group A-Facility 24 -- Sanford Clear Lake Medical Center Part V, Section B, line 5:
    "Sanford conducted a community health needs assessment (CHNA) during 2018 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2018 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County in North Dakota and Clay County in Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding economic well-being, transportation, children and youth, the aging population, safety, healthcare and wellness, mental health and substance abuse. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during 2019-2021. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and responses to the community health needs assessment and the implementations strategies are welcome on the Sanford website under ""About Sanford"" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA"
    Group A-Facility 24 -- Sanford Clear Lake Medical Center Part V, Section B, line 6a:
    Sanford USD Medical Center Sioux FallsSanford Medical Center FargoSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Westbrook Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
    Group A-Facility 24 -- Sanford Clear Lake Medical Center Part V, Section B, line 7d:
    Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
    Group A-Facility 24 -- Sanford Clear Lake Medical Center Part V, Section B, line 11:
    "The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: TransportationThe University of Minnesota's Rural Health Research Center reports that transportation is a concern for rural residents. A social determinant of health, affordable transportation is fundamental to mental, physical, and emotional well-being. Individuals with disabilities, those with low incomes, seniors, and others who may not have reliable access to transportation depend on public and private transportation to access health services, obtain food and other basic needs, and to engage with their communities.Sanford Health Clear Lake has made transportation a significant priority and has developed a strategy to work in collaboration with community organizations to explore options for the local community and county members. Priority 2: Physical HealthAccording the Center for Disease Control, Obesity is a complex health issue to address. Obesity can be caused from a combination of contributing factors such as behavior and genetics. Behaviors can include dietary patterns, physical activity, inactivity, medication use, and other exposures. Additional contributing factors in our society include the food and physical activity environment, education and skills, and food marketing and promotion.Obesity is a serious concern because it is associated with poorer mental health outcomes, reduced quality of life, and is associated with morbidity and illnesses including diabetes, heart disease, stroke, and some types of cancer.Sanford Health Clear Lake has made physical health specific to obesity a significant priority and has developed strategy to improve physical health and reduce the negative health effects of obesity.Addressing of Significant Needs during Current YearPriority 1: TransportationThrough enhanced availability of transportation options for community members, Sanford Clear Lake Medical Center (SCLMC) aims to address an existing access gap. Some patients are unable to keep appointments due to lack of personal transportation. While working to build a list of volunteer drivers in our community, we learned of a transit service that was looking to expand services to Deuel County. We received an invitation to complete a stakeholder survey and participated in a stakeholder meeting on July 11, 2019. Stakeholders at this meeting included community members, local business owners, and two of our Sanford Clear Lake staff. Stakeholders proposed that a community survey be conducted in our county to determine viability of a transit service. A survey was developed and circulated in the fall of 2019 via social media and newsprint. Surveys were available at area businesses as well. SCLMC also served as a collection site for the surveys. Paper surveys collected at our facility were entered into the online survey site by Sanford Clear Lake staff. The transit company has analyzed all survey data, and the next step will be a public meeting in the spring of 2020. The agenda will include a proposed plan, hours of operation, days of operation, the public survey and breaking down the wants and needs, developing a rough draft of a budget and more. A rough draft budget was created based on a project of similar size and operating details. In February 2014, Sanford Clear Lake staff and community stakeholders were introduced to a program sponsored by Wellmark. ""Healthy Hometown"" is a program that assists communities in implementing changes that promote healthy living by focusing on three areas - move more, eat well, and feel better. A component of this program analyzes walkability in the community and assists in facilitating people and resources in order to improve walkability. Healthy Hometown committee members meet routinely and report progress on individual projects/goals. A walking audit is scheduled for spring 2020.Priority 2: Physical Health Sanford Clear Lake Medical Center is committed to improving the physical health of the Clear Lake community with a particular focus on reducing negative health effects from obesity. Our wellness center sponsored a weight loss challenge in spring 2019. Teams reported initial weights and reported weight loss progress on a weekly basis. At the close of the challenge, teams reported final weights and were able to win prizes based on ranking of percentage of weight lost. Seven two-person teams participated in the weight loss challenge. Approximately 166lbs were lost, with the winning team losing 23.5% of their initial weight. In summer 2019, the wellness center underwent a significant facelift that aided in modernizing the facility. The facility also enrolled in the Silver Sneakers program allowing Medicare-aged seniors in our community access to the facility at no cost to them. In 2019, 13 members enrolled in Silver Sneakers.SCLMC staff and community stakeholders were introduced to a program sponsored by Wellmark. ""Healthy Hometown"" is a program that assists communities in implementing changes that promote healthy living by focusing on three areas - move more, eat well, and feel better. A component of this program provides tools and resources necessary to implement healthy options at concession stands in the community and improve access to drinking water in the community. Sanford Clear Lake staff continue to attend routinely scheduled meetings working towards improving the health of the community. Sanford Clear Lake provides meeting space for this project. In Fall/Winter 2019, our staff met with Deuel School administration to propose the addition of healthy items to concession stand offerings at Deuel athletic sporting events. Fresh fruit, string cheese, veggie straws, and trail mix were healthier options added to concessions at Deuel School. The CHNA planning team meets monthly and reviews sponsorship requests for community events. 1n 2019, approximately $2,300 was donated to events and organizations including a Good Samaritan Society Fun Run/Walk, Clear Lake Baseball Association, New Hope Walk for Cancer to name a few. Identified needs not directly addressed by this facility include:Economic Well-Being - Employment options, skilled labor force, availability of affordable housing and the need for budgeting and money management.Children and Youth - Childhood obesity and bullying Aging - Cost of long term care, availability of resources and cost of services to help the elderly stay in the homes, availability of activities for seniors, and availability and cost of memory careSafety - Abuse of prescription drugsHealth Care - Access to affordable health insurance, access to affordable health care, and availability of behavioral and mental health providersMental Health and Substance Abuse - Depression, stress and tobacco use"
    Group A-Facility 24 -- Sanford Clear Lake Medical Center Part V, Section B, line 13h:
    Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
    Group A-Facility 24 -- Sanford Clear Lake Medical Center Part V, Section B, line 16j:
    Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
    Group A-Facility 25 -- Sanford Westbrook Medical Center Part V, Section B, line 5:
    "Sanford conducted a community health needs assessment (CHNA) during 2018 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2018 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County in North Dakota and Clay County in Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding economic well-being, transportation, children and youth, the aging population, safety, healthcare and wellness, mental health and substance abuse. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during 2019-2021. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and responses to the community health needs assessment and the implementations strategies are welcome on the Sanford website under ""About Sanford"" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA"
    Group A-Facility 25 -- Sanford Westbrook Medical Center Part V, Section B, line 6a:
    Sanford USD Medical Center Sioux FallsSanford Medical Center FargoSanford Broadway Medical Center FargoSanford South University Medical CenterSanford Bismarck Medical CenterSanford Bemidji Medical CenterSanford Aberdeen Medical CenterSanford Bagley Medical CenterSanford Canby Medical CenterSanford Canton-Inwood Medical CenterSanford Chamberlain Medical CenterSanford Clear Lake Medical CenterSanford Hillsboro Medical CenterSanford Jackson Medical CenterSanford Luverne Medical CenterSanford Mayville Medical CenterSanford Rock Rapids Medical CenterSanford Sheldon Medical CenterSanford Thief River Falls Medical CenterSanford Tracy Medical CenterSanford Vermillion Medical CenterSanford Webster Medical CenterSanford Wheaton Medical CenterSanford Worthington Medical Center
    Group A-Facility 25 -- Sanford Westbrook Medical Center Part V, Section B, line 7d:
    Sanford invited community partners to attend presentations and discussions of the results. Community stakeholders and community councils were included.
    Group A-Facility 25 -- Sanford Westbrook Medical Center Part V, Section B, line 11:
    The following information is a compilation of the identified priority needs for each community and what Sanford is doing to address the priority needs. In cases where identified needs have not been directly addressed it is because those needs fall outside of Sanford's expertise, or because Sanford is working with community partners to address the needs. The needs not addressed directly by Sanford are listed for each facility. Additional information about what Sanford is doing to address other assessed needs of the community can be found for each hospital facility at:http://www.sanfordhealth.org/about/community-health-needs-assessmentPriority 1: WellnessAccording the Center for Disease Control, Obesity is a complex health issue to address. Obesity can be caused from a combination of contributing factors such as behavior and genetics. Behaviors can include dietary patterns, physical activity, inactivity, medication use, and other exposures. Additional contributing factors in our society include the food and physical activity environment, education and skills, and food marketing and promotion.Obesity is a serious concern because it is associated with poorer mental health outcomes, reduced quality of life, and is associated with morbidity and illnesses including diabetes, heart disease, stroke, and some types of cancer.Sanford Health Westbrook has made physical health specific to obesity a significant priority and has developed strategy to improve physical health and reduce the negative health effects of obesity.Priority 2: Mental Health and Substance AbuseMental health is important at every stage of life and affects how people think, feel, and act. According to the National Institute of Mental Health, depression is one of the most common mental disorders in the U.S. Current research suggests that depression is caused by a combination of genetic, biological, environmental, and psychological factors. Depression is among the most treatable of mental disorders. Sanford has made mental health a significant priority and has developed strategies to reduce mortality and morbidity from mental health and behavioral health and substance abuse. It is Sanford's goal to reduce the number of individuals whose overall well-being is negatively impacted by addiction and mental illness. Addressing of Significant Needs during Current YearPriority 1: WellnessSanford Westbrook aims to help our community improve physical and chronic health as well as general wellness. To do so, we are leveraging dietician and RN Health Coach services, the Sanford fit program, and community education opportunities. Dietician and health coach services - these continued to be offered/referred as needed. Dietician services are now available via telemedicine, making access quicker and easier. Dietician use five on-site visits (up from two in 2018) and no telemed visits in 2019. Our RN Health Coach had 125 visits in 2019.Community education - staff attended local HS basketball games in February 2019 to share heart health information with the community. A free diabetes lunch-and-learn event was held for community members in June 2019. We also work with A.C.E. to provide a Bone Builders class two times a week and a Matter of Balance class periodically for area seniors at Peterson Estates (senior living facility attached to Sanford Westbrook).-Heart Health event - shared heart healthy information with over 30 people at booth.-Diabetes Lunch & Learn - 20 community members in attendance.Sanford fit program - staff continued the Sanford fit program, which focuses on healthy lifestyle choices to prevent childhood obesity, from January 2019 - May 2019. They also shared Sanford fit online resources with local school administration and teachers. Local 4th grade students took a pre-test on the first day of fitClub and a post-test on the final day. Students increased their test scores by more than 25% from the pre-test to the post-test.Priority 2: Mental Health and Substance AbuseThis initiative focuses on enhanced access and awareness of community resources for mental health and substance abuse. This includes working with community partners to create new and promote current recovery program options, promoting telemedicine options for behavioral health, and providing community education. Awareness of mental health telemedicine services and local behavioral health providers began with development of marketing and social media campaigns in 2019. Referrals for behavioral health providers continued in 2019. Primary care providers were reminded of services available on site at their regular provider meetings. A total of 619 patients were seen by our behavioral health providers in calendar year 2019. Identified needs not directly addressed by this facility include:Economic Well-Being - Need for employment options, household budgeting, money management and the availability of a skilled labor force Transportation - Availability of public transportationChildren and Youth - Availability and cost of quality childcare, childhood obesity, and teen tobacco useAging - Cost of long term care, and cost of memory careSafety - Abuse of prescription drugs Health Care - Access to affordable health insurance and access to affordable health care
    Group A-Facility 25 -- Sanford Westbrook Medical Center Part V, Section B, line 13h:
    Other factors for calculating amounts charged to patients include balance owed, family size, debt to income ratio, savings and investments, other debt (both medical and non-medical), previous bankruptcies and liens, patient/guarantor involvement in other state and Federal assistance programs, individual circumstances, current employment status, total monthly expenses and third party analytic score.
    Group A-Facility 25 -- Sanford Westbrook Medical Center Part V, Section B, line 16j:
    Other measures to publicize the policy within the community served by the hospital facility include publishing with local public health agencies, collection agencies and submission to law firms that serve the underprivileged population.The financial assistance program summary, complete policy and the Sanford Financial Assistance Application are all available at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policy
    Supplemental Information
    Schedule H (Form 990) Part VI
    Part I, Line 3c:
    Sanford Health does not deny care to anyone based on the ability to pay. Sanford's Financial Assistance (charity care) policy provides discounted and free services to patients who lack the resources to be fully responsible for the healthcare they receive. The Financial Assistance Policy is designed to ensure the entire community served by Sanford has access to needed healthcare services. Eligibility for discounted or free services under the Financial Assistance Policy is based on income levels and family size. Generally, individuals earning income of up to 375% of the Federal Poverty Income Guidelines are eligible for varying levels of discounts, including full discounts for certain income levels. Applications for coverage under the program may be obtained at any Sanford patient registration area.The primary scope of Sanford's financial assistance matrix considers family income and family size to objectively determine financial need. The family income range varies from 0-225% up to 375% of the Federal Poverty Level (FPL). An applicant over 375% may be eligible for some level of financial assistance based on a review of additional factors such as: the size of the account balance, debt-to-income ratio, current assets, current liabilities, IRS food expense allowances, monthly cash flow, etc.Additionally, it is possible for a family to qualify in one segment (based on income and family size alone) but be moved to a more generous (for the patient) segment based on the other financial variables mentioned above. An applicant may be denied if they have substantial assets and applicants are considered on a case by case basis.The Amount Generally Billed (AGB) discount percentage is the least amount Sanford can discount for any patient qualifying under the Sanford Financial Assistance Policy. It is the percentage used for the lowest level of assistance granted for those qualifying under the Sanford Financial Assistance Policy as listed on Appendix 1 - Sliding Discount Schedule for Assistance. Anyone else qualifying for assistance at greater levels will receive discount amounts greater than the Sanford AGB discount amount. Part I, Line 5b: Sanford as a whole did not exceed its financial assistance budget for CY 2019, however, if they would have exceeded their budget it would not impact their ability to serve any patients and no patients would be disallowed services. The organization provided free or discounted services to patients who were eligible for free or discounted care.Part I, Line 6: Sanford Health's Community Benefit Annual Report is posted annually on the Sanford website at:http://www.sanfordhealth.org/about/community-benefit
    Part I, Line 7:
    Cost to Charge Ratios are used to calculate the amounts on Line 7a - 7c (Financial Assistance, Medicaid Shortfall, and Other Means-Tested Government Programs) and also Line 7g (Subsidized Health Services) for each of the subsidiaries included in the return. All other amounts for Lines 7e, 7f, 7h and 7i would come from the books and records of specific segments of the organization and would not be based on a Cost to Charge Ratio, or similar cost accounting methodology. These costs still represent the costs to provide benefits.
    Part I, Line 7g:
    Subsidized health services are clinical services provided to both inpatients and outpatients despite a financial loss to Sanford. Each loss has been calculated after removing losses associated with bad debts, financial assistance and Medicaid. Although these services generate overall losses to Sanford, they continue to meet the needs of the communities served. Various services that generate losses are provided by Sanford through physician practices. For CY 2019, subsidized health services provided through clinic physician practices generated losses of $86,596,523.
    Part II, Community Building Activities:
    Sanford Health is a not-for-profit organization dedicated to the work of health and healing for the public good. Sanford is committed to giving back to the communities in which its employees and patients live and work. Sanford invests resources in order to produce the best outcomes for patient care, education, research, and community enrichment, and partners with others to ensure that the community is a welcoming, healthy environment and one that attracts and sustains a diverse Sanford workforce to deliver the best patient care and much needed medical research. Sanford considers requests for funding and in kind support for new and ongoing programs with all areas supporting the above goals, such as basic human services, education and workforce development by recruiting physicians and other health professionals to medical shortage or underserved areas and collaborating with educational institutions to train and recruit health professionals, advocating community health improvement through efforts to support policies and programs that safeguard or improve public health and help to ensure access to health care services.
    Part III, Line 2:
    Bad debt expense at cost is determined using the same cost to charge ratios that are used to calculate Financial Assistance and Medicaid Shortfall. Discounts and allowances are accounted for separately from Bad Debt Expense.
    Part III, Line 3:
    It is Sanford's policy to make financial assistance available to patients who fit the financial assistance criteria. It is the organization's goal to make certain that Sanford is proactive in identification of the patients who need help with financial concerns. Financial counselors make every effort to ensure that financial assistance eligible patients do not progress to bad debt. For this reason, a dollar amount for bad debt is not included.
    Part III, Line 4:
    The audited financial statements of Sanford do not include a bad debt footnote. Sanford reports bad debt in accordance with generally accepted accounting principles (GAAP).
    Part VI, Line 5:
    Sanford maintains an open medical staff. Community Boards - The Sanford Board of Trustees was comprised of 12 members at the end of the calendar year, including 8 volunteer community members, 3 physicians and the CEO. Surplus Funds - Surplus funds are invested back into the community, as well as to resource development and facility development to better serve patients and communities.
    Part III, Line 8:
    "Per IRS instructions, Sanford has identified the cost associated with providing Medicare services from the Medicare cost report. The Medicare cost report calculations are total expense less expenses deemed ""unallowable"" per Medicare regulations. The net expense is then used to calculate the cost per day and cost to charge ratios which are multiplied by the Medicare days and ancillary charges to determine the cost of providing Medicare services. If all expenses that Sanford incurred were included on the Medicare cost report; this would show a shortfall of approximately $349,905,908. Sanford believes this shortfall should be considered community benefit because these services would need to be provided by either another charitable organization or the government if it was not provided by Sanford."
    Part III, Line 9b:
    Sanford will provide services at no cost or reduced cost to patients who qualify for the program. Patients with incomes at or below 225% of the United States Department of Health and Human Services poverty guideline will receive a 100% reduction of their payment responsibility. Patients with income between 225% - 375% of the poverty guideline will be given a discount based on a sliding scale and assets are considered in the calculation of the income of the patient, with the exception of the patient's principal residence. Patients above 375% of the FPG will be reviewed for additional factors such as size of medical debt before a final determination. Patients must make their financial need known to appropriate personnel and be engaged in filing appropriate and complete applications. The program is available to those patients without health care benefits from any source as well as to those who have coverage for health care costs through a government program, commercial insurance, or other health benefit plan but continue to have a remaining balance after benefits have been applied to the charges. Sanford will not deny financial assistance based on race, creed, sex, national origin, handicap or age.Every effort is made to identify patients with financial need as early as possible in the revenue cycle.Sanford has zero tolerance for abusive, harassing, oppressive, false, deceptive, or misleading language of collections conduct. This zero tolerance applies to internal Sanford staff and third party collection vendors and attorneys.Neither Sanford nor any of its third party collection vendors will take any extraordinary collection efforts until Sanford and the third party collection vendor have made reasonable efforts to determine if a patient is eligible for financial assistance under the Financial Assistance Policy.
    Part VI, Line 3:
    Sanford employs a variety of strategies to make certain that the organization is transparent in the communication of financial assistance guidelines. The staff at Sanford makes every effort to identify patients needing financial assistance as early in the revenue cycle as possible. All Sanford entities display signage in registration areas advising patients of their ability to request financial assistance. The signage was made available in English and Spanish. Alternate languages were included on the signage that basically stated, if you need interpreter services, please inquire at the registration desk. Financial Assistance applications were available in English, Spanish, Chinese, German, Hindi, Korean, Laotian and Vietnamese upon request or on the Sanford website. All healthcare workers who identify patients with financial need are encouraged to provide patients or their designees a financial application. This may include, but not be limited to the following areas: Administration, Admissions, Patient Financial Services, Financial Counselors, Social Services, Physicians, Nursing, Clinic Director, Reception staff and Human Resources.Financial Counselors are trained to work individually with patients to determine the financial need and recommend appropriate assistance in application for charity care, government programs or discounted services.Sanford's Financial Assistance Program is available to anyone who qualifies for assistance. This program ensures that all people receive the care they need, regardless of their financial situation. Sanford makes Financial Assistance information available to community agencies and referral organizations. Financial Assistance information is also available on the Sanford website at:https://www.sanfordhealth.org/patients-and-visitors/billing-and-insurance/financial-assistance-policyfinancial-assistance-policy
    Part VI, Line 4:
    Sanford Health is an integrated health system headquartered in the Dakotas. It is one of the largest health systems in the nation with 25 hospitals and nearly 448 clinics in 158 locations in nine states and three countries. Sanford Health's approximately 34,000 employees, including 1,400 physicians, make it the largest employer in the Dakotas. Sanford USD Medical Center - Sioux Falls, South DakotaSioux Falls is the largest city in the state of South Dakota and is the County seat of Minnehaha County. Sioux Falls also extends into Lincoln County. The 2019 U.S. Census Bureau estimates a total population of 183,793 for Sioux Falls. According to the 2019 County Health Rankings, the population of Minnehaha County is 82.8% white, 5.6% African American, 2.8% American Indian, 2.2% Asian and 4.8% Hispanic. Sioux Falls is a significant regional health care center. Only 2% of the population is reported to be not proficient in English. The median household income in Sioux Falls is $61,200.Sanford Medical Center Fargo - Fargo, North DakotaFargo is the largest city in North Dakota, accounting for 15% of the state's population. Fargo is also the county seat of Cass County. The 2019 United States Census estimates the population of Fargo was 124,662. According to the 2019 County Health Rankings, the population of Cass County is 85.4% white, 5.6% African American, 1.4% American Indian, 3.3% Asian and 2.7% Hispanic. Only 1% of the population is reported to be not proficient in English. The median household income is $64,400. Sanford Bemidji Medical Center - Bemidji, MinnesotaBemidji is located in Beltrami County, Minnesota. Bemidji houses many Native American Services, including the Indian Health Service. The city is the central hub of the Red Lake Indian Reservation, White Earth Indian Reservation, and the Leech Lake Indian Reservation. According to the 2019 United States Census estimates, the population of Bemidji is 15,434. According to the 2019 County Health Rankings, the population of Beltrami County is 72.2% white, 0.7% African American, 21.9% American Indian, 0.7% Asian and 2.3% Hispanic. 0% of the population is reported to be not proficient in English. The median household Income is $47,300.Sanford Bismarck Medical Center - Bismarck, North DakotaBismarck is a city located in Burleigh County in central North Dakota. Bismarck is experiencing fast-paced growth as a direct result of oil development throughout the western part of the state. Bismarck is the state capital and is the second largest city in the state of North Dakota with an estimated population of 73,529. According to the 2018 County Health Rankings, the population of Burleigh County is 88.9% white, 2.2% African American, 4.1% American Indian, 0.8% Asian and 2.6% Hispanic. 0% of the population is reported to be not proficient in English. The median household income is $70,100.Sanford Network HospitalsSanford Health Network Hospitals is a network of rural hospitals located throughout South Dakota, North Dakota, Minnesota, and Iowa.Sanford ClinicsSanford Clinic is a multi-specialty clinic comprised of 1,400 physicians providing services in the US as well as internationally.
    Part VI, Line 2:
    "Sanford conducted a community health needs assessment (CHNA) during 2018 in 24 communities throughout the enterprise. Sanford Health worked in partnership with Public Health Units across the organization's footprint to develop the methodology for the 2018 CHNA. Sanford requested input from community and county leaders, public health administration, physicians, nurses, representatives from the community and representatives of diverse populations through a series of community stakeholder meetings. Sanford extended a good faith effort to engage all of the aforementioned community representatives in the CHNA process. The names of community stakeholders who participated in the CHNA process are listed in the acknowledgement section for each medical center's CHNA report.A generalizable survey was conducted of residents in the Fargo area (Cass County in North Dakota and Clay County in Minnesota), the Bemidji area (Beltrami County in MN), the Bismarck area (Burleigh and Morton counties in ND), and the Sioux Falls area (Minnehaha, Lincoln, Turner and McCook counties in SD). A stratified random sample was obtained through a qualified vendor to ensure that appropriate proportions from each of the counties were included.A non-generalizable on-line survey was conducted for all of the Sanford Medical Centers through a partnership between Sanford and the Center for Social Research (CSR) at North Dakota State University. The purpose of this non-generalizable survey of community leaders was to learn about the perceptions of area community leaders regarding economic well-being, transportation, children and youth, the aging population, safety, healthcare and wellness, mental health and substance abuse. This group included community leaders, legislators, and agency leaders representing chronic disease and disparity.A Likert scale was developed to determine the respondent's highest concerns. Needs ranking 3.5 and above were included in the needs to be addressed and prioritized. Many of the identified needs that ranked below 3.5 are being addressed by Sanford. However, 3.5 and above was used as a focus for the purpose of the required prioritization. Asset mapping was conducted by reviewing the data and identifying the unmet needs from the various surveys and data sets. The process implemented in this work was based on the McKnight Foundation model - Mapping Community Capacity. Each identified need was researched to determine what resources are available in the community to address the needs. An informal gap analysis was conducted to determine what needs remained after resources were researched through asset mapping. Each Sanford Health Medical Center invited community stakeholders to meet, review the findings of the research, develop the asset/resources map, and determine the key priorities to address by implementation strategies during 2019-2021. Individuals who were invited to attend included county commissions, city council members, school board members, and agencies representing the chronic disease groups and disparity. Community stakeholders helped to determine key priorities for their respective communities.A listing of the community stakeholders can be found in each published CHNA at: http://www.sanfordhealth.org/about/community-health-needs-assessment Public comments and responses to the community health needs assessment and the implementations strategies are welcome on the Sanford website under ""About Sanford"" in the Community Health Needs Assessment section. The only comment received since the publications on the Sanford website was a question asking if a CHNA was conducted in a rural area where Sanford does not have a medical center. The following community leadership members contributed their expertise with the planning, development and analysis of the community health needs assessment. Each member met multiple times during the CHNA process to guide and advise the team.-Sioux Falls Public Health-Pennington County Public Health-Beltrami Public Health-Traill County Public Health-Steele County Public Health-City of Halstad-South Dakota Department of Health-Clay County Public Health-South Dakota State University-Center for Social Research, North Dakota State University-Center for Rural Health -Burleigh County Public Health-Fargo Cass Public Health-South Dakota Department of Health-North Dakota Department of Health-North Dakota Public Health Association, in partnership with the American Indian CHNA"
    Part VI, Line 6:
    Sanford Health is an integrated health system headquartered in the Dakotas. It is one of the largest health systems in the nation with 25 hospitals and nearly 450 clinics in nine states and three countries. Sanford Health's 34,000 employees, including 1,400 physicians, make it the largest employer in the Dakotas.Sanford Health provides services at every level from critical access hospitals to tertiary and quaternary care. The Sanford footprint includes over 220,000 square miles with a nine state service area and a network of children's primary care clinic locations across the country and world. Sanford Health operates full-time emergency centers and provides emergency care to everyone regardless of their ability to pay. Sanford facilities and clinics provide services to remote and medically underserved areas that would otherwise not have access to even primary care services. Sanford Health financially supports health and wellness, education and community development activities to improve the quality of life and strenghten communities throughout the region. Each facility promotes health and healing that responds to the unique needs of the patients in the community, ensuring access to comprehensive and specialized services. Part VI, Line 7: Community benefit reporting is not required and therefore not filed in North Dakota, South Dakota, Nebraska or Iowa. Filing in Minnesota is voluntary.