2014 Report to the Community - Memorial Hermann Community

20
2014
14
Memorial
Community
Benefit Corporation
Memorial
HermannHermann
Community
Benefit Corporation
ANNUAL REPORT
ANNUAL REPORT
Putting HEALTH First
During 2014, plans that had been in the making for
programs fill the gaps for patients experiencing a
a number of years came to fruition. Through the
mental health crisis who, too often, turn to emergency
Affordable Care Act and subsequent changes to the
centers for help.
1115 Waiver, Memorial Hermann responded to the
community need and expanded many of its premier
This Annual Report highlights the Community Benefit
programs to benefit those who needed them the most.
purpose, programs, accomplishments and partnerships
that demonstrate Memorial Hermann’s unwavering
Table of Contents
Memorial Hermann kept pace with Houston’s
commitment to serving the residents of Southeast Texas.
unprecedented population growth by providing our
We provide more than just access to health and care, but
communities with increased access to health resources
also the supportive services that many of us might take
Letter to the Community
through expansion of programs like Health Centers for
for granted in our own lives. This commitment extends
Community Benefit Corporation
Creating a Culture of Health...............................................5
Investing in Health..............................................................7
Responsive to the Community...........................................8
Awards................................................................................8
Health Centers for Schools
Medical .............................................................................15
Mental Health...................................................................19
Mobile Dental...................................................................22
Nutrition............................................................................24
Childhood Obesity Initiative.............................................27
Project Fit America Program.............................................28
Schools and ER Navigation, and added a new Nurse
the impact of these programs beyond the communities
Health Line. Located on school campuses, in our
we serve and into the lives of Houston families.
Community Resources
ER Navigation/COPE Program.........................................32
Nurse Health Line.............................................................35
Neighborhood Health Centers.........................................36
emergency centers and reaching into the community,
these programs represent the heart of Memorial
Our insistence on establishing outcomes-based programs
Hermann’s mission – to provide high-quality health
combined with purposeful collaboration is building the
services in order to improve the health of the people
foundation for systemic change in the health of our
in Southeast Texas.
community. Looking to the future, Memorial Hermann is
responding to the unique health challenges of Greater
We have grown to 10 school-based health centers,
Houston by developing programs and services that
serving 70 schools across five school districts –
build a pathway to advancing health – encouraging
accessible to more than 65,000 students. And we
each adult and child to be mindful of their health and
added a third mobile dental clinic to rotate among the
to enrich our community by putting health first.
clinics. On-site social workers, dietitians and navigators
ensure that students’ needs are met holistically
and their families receive the social services they
Mental Health
Psychiatric Response Team...............................................40
Mental Health Crisis Clinics..............................................42
Home Behavioral Health Services....................................42
Community Partners
Gateway to Care...............................................................48
Children at Risk.................................................................49
Interfaith Community Clinic..............................................50
Additional Partnerships.....................................................51
need to provide a safe, secure and healthy home
environment. Seventeen ER Navigators support seven
of our emergency centers that serve the patients
most in need of assistance in finding an appropriate
medical home, social services and follow-up care.
The Nurse Health Line is accessible to anyone in the
Greater Houston area who is sick or injured and needs
immediate guidance from a nurse, in their language,
Memorial Hermann Overview of Services
Services.............................................................................53
who can advise them on where to seek appropriate
care. Memorial Hermann’s expanded Mental Health
Dan Wolterman
Will Williams
President and CEO
Memorial Hermann Health System
Board Chair
Memorial Hermann Health System
1
Community Benefit
Corporation
2
3
Creating a Culture
of Health
As the largest not-for-profit health system in Southeast
Texas, Memorial Hermann Health System has proudly
worked for more than 108 years to improve the health
of individuals and families in the Greater Houston
community. With 13 hospitals and numerous specialty
programs and services, Memorial Hermann annually
contributes more than $438 million in uncompensated
care and community benefits.
Through its subsidiary, the Memorial
To address these needs, Memorial
Hermann Community Benefit
Hermann Health System provides
Corporation, Memorial Hermann
the following initiatives described in
implements programs in partnership
detail in this report:
What is Community
Benefit?
As a not-for-profit hospital
system, Memorial Hermann is
a steward of the community’s
health, not only for the health
of the adults and children
who seek medical care at a
Memorial Hermann facility,
but by providing programs
and support to programs
designed to improve
the overall health of the
community and increase
access to health care.
with other healthcare providers,
government agencies, business leaders
• Health Centers for Schools
and community stakeholders to increase
• Mobile Dental Program
access to health care and improve the
• Childhood Obesity Health Initiative
overall health of the community.
• ER Navigation/COPE Program
• Nurse Health Line
Memorial Hermann’s longstanding
• Neighborhood Health Centers
commitment includes serving the long-
• Mental Health
term needs of at-risk and underserved
• Community Partners
populations through innovative models
of care delivery that address the
most common barriers to healthcare
access, including low income, lack of
knowledge of services available, lack of
transportation and the inability to take
time from work.
4
These programs that serve
Houstonians in need meet
one or more of the following
community benefit criteria:
•Improve access to
healthcare services
•Enhance the health
of the community
•Advance medical or
healthcare knowledge
•Relieve or reduce the
burden of government or
other community efforts
5
Memorial Hermann
Community
Benefit Values
•We collaborate with
others to improve
the community’s
infrastructure for the
uninsured.
•We embrace innovative
approaches.
•We are advocates at
the local, state and
national levels to
achieve 100 percent
access to basic care.
•We support
educational efforts
focused on prevention
and appropriate use
of our community’s
healthcare resources.
•We measure the
outcomes of each
effort and only sustain
and expand those with
demonstrable outcomes.
•We are committed
to engaging our
employees, volunteers
and medical staffs in
our efforts.
Investing in Health
Memorial Hermann
Health System’s passion
and commitment to
improve residents’
health and quality of life
in the Greater Houston
community is evident
in its governance,
administration, service
delivery and employee
engagement.
The board of directors and executive
staff lend their resources and vision
to initiatives that are designed to
improve the health and quality of
life of each and every resident of the
community, ensuring that millions in
THE YEAR IN NUMBERS
In 2014, community contributions were distributed to the following areas:
FINANCIAL
ASSISTANCE
AND
GOVERNMENT
PROGRAMS
Programs and initiatives developed to improve access to care
HEALTH
PROFESSIONS
EDUCATION
$39,781,105
Education and training of medical and allied health
professionals, nurses, students, interns, residents
and fellows
SUBSIDIZED
HEALTH
SERVICES
Clinical services provided in response to community need
despite financial loss incurred, including the Air Ambulance
Program, End-Stage Renal Disease Program (ESRD) and
obstetrics and delivery program
RESEARCH
to advancing health for every
$5,141,721
Research dollars serving the community
$4,023,069
Community education and awareness initiatives
and sponsorship of other organizations
TOTAL
CONTRIBUTIONS
FOR 2014
66
COMMUNITY
HEALTH
IMPROVEMENT
SERVICES AND
COMMUNITY
BENEFIT
OPERATIONS
$27,310,395
benefits are just the beginning of
Houstonian.
Charity care at cost, the unreimbursed cost of Medicaid
and means-tested government programs
$143,420,512
uncompensated care and community
Memorial Hermann’s commitment
$218,549,209
CASH AND
IN-KIND
CONTRIBUTIONS
FOR COMMUNITY
BENEFIT
$438,226,011
Memorial Hermann’s annual contribution in uncompensated
care and community benefit activities
7
Awards
Memorial Hermann Community
Benefit Corporation and its
programs have been recognized
by many different groups and
associations for innovative
efforts that address the issue
of healthcare access for the
underserved and uninsured.
FOSTER G. MCGAW PRIZE
One of three finalists for the
prestigious Foster G. McGaw
Prize, Memorial Hermann was
recognized for its significant
accomplishments in community
service to advance the health of
the people in Southeast Texas
through trusted partnerships
with physicians, employees
and others to deliver the best
possible health solutions while
relentlessly pursuing quality
and value.
HOSPITAL CHARITABLE
SERVICES AWARD
Memorial Hermann Health
Centers for Schools was named
a Program of Excellence by
Jackson Healthcare through its
Hospital Charitable Services
Award program.
THE AMERICAN HOSPITAL
ASSOCIATION (AHA)
NOVA AWARD
The second-highest hospital
award given by the AHA, the
NOVA Award recognized Memorial
Herman Health Centers for
Schools for working collaboratively
and effectively to improve
community health status.
8
Responsive to
the Community
Memorial Hermann serves “Greater Houston,” a multicounty area along the Gulf Coast in Southeast Texas where
several counties are without hospital district services.
The fifth largest metropolitan area in
0.7%
the United States, the Greater Houston
area is one of the fastest growing in the
6.2%
nation, with a population of more than
6 million. A source of strength in a
global economy, Houston prizes its
racial and ethnic diversity.
23.7%
43.8%
• More than 90 languages are spoken
in the Houston community.
25.6%
• Nearly half of individuals ages 5
and up live in homes where English
is not the primary language.
African-American
According to the County Health Rankings
Asian/Pacific Islander
& Roadmaps 2014, social, economic
Hispanic
and environmental factors contribute
Native American
to 50 percent of health outcomes.
White
• Economic status is strongly correlated
• Education is one of the social factors
with health outcomes where individuals
that contribute to health. Only
with lower incomes have higher rates
29.2 percent of the Houston area
of poor health behaviors and higher
population, age 25 or older, has a
rates of most diseases. In 2013, more
college degree as compared to
than 22 percent of Houston residents
other large metropolitan areas
lived in poverty as compared to
such as New York City at 34.5,
17.6 and 15.4 percent of all Texas
Chicago at 34.2 and Los Angeles
and U.S. residents, respectively.
at 31.1 percent.
These significant societal factors impact
the major health needs and priorities
of the Houston region and drive
much of the community work in which
Memorial Hermann is engaged.
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Awards
MONROE E. TROUT
PREMIER CARES AWARD
The Premier Cares Award
spotlights innovative
programs that help the
medically underserved
and focuses attention on
the need to support and
replicate such efforts.
Memorial Hermann Health
Centers for Schools was
recognized as an award
finalist.
HISD HALL OF FAME AWARD
Memorial Hermann was
inducted into the Houston
Independent School District
(HISD) Hall of Fame for its
partnership with HISD to
develop the Memorial
Hermann Health Centers
for Schools.
THE TEXAS ASSOCIATION
OF PARTNERS IN EDUCATION
GOLD AWARD
The Texas Association of
Partners in Education (TAPE)
honored Memorial Hermann
with its prestigious Gold
Award for Texas Community
Partnership for Memorial
Hermann Health Centers
for Schools. TAPE works
to strengthen students’
performance through
volunteer, community and
business/school partnerships
that enhance the success
of young people in school.
10
• Uninsured rates are higher in Texas
• Health behaviors, including diet
than the U.S. and are even higher
and exercise, factor into the Greater
in the Houston region. Compared
Houston community’s health
to 15 percent of U.S. residents, 22.1
outcomes – more than 64 percent
percent of Texans and 28.4 percent
of adults are overweight or obese
of Houstonians are uninsured.
and more than a third of children
are overweight.
To prioritize the needs of the community, Memorial
Hermann conducts Community Health Needs
Assessments (CHNAs) for each of its hospitals
every three years.
The studies include demographic data for Harris, Fort Bend, Montgomery and
Brazoria counties, which comprise the majority of Memorial Hermann discharges.
The qualitative and quantitative data collected includes a careful review of
the most current health data available and input from numerous community
representatives with special knowledge of public health on prioritizing
community health needs and healthcare initiatives:
1) Education and prevention for diseases and chronic conditions
2) Address issues with service integration, such as coordination among
Other Awards
BEACON OF HOPE RECIPIENT
Mental Health America of
Fort Bend County (awarded
to the Lamar Clinic)
VHA (VOLUNTARY
HOSPITALS OF AMERICA)
LEADERSHIP AWARD FOR
COMMUNITY BENEFITS
EXCELLENCE
RECIPIENT OF THE
EXCELLENCE IN
COMMUNITY SERVICE
AWARD FROM TEXAS
HOSPITAL ASSOCIATION
Memorial Hermann Health
Centers for Schools
RECIPIENT OF TEXAS
DENTAL ASSOCIATION
CERTIFICATE OF MERIT
Memorial Hermann Mobile
Dental Program
providers and the fragmented continuum of care
3) Address barriers to primary care, such as affordability and shortage of
providers
4) Address unhealthy lifestyles and behaviors
5) Address barriers to mental health care, such as access to services and
shortage of providers
6) Decrease health disparities by targeting specific populations
Following the CHNA, each Memorial Hermann hospital developed an
Implementation Plan to address the identified needs. The process was
reported to the board in March 2014.
A new Community Health Needs Assessment will be available in June 2016.
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Health Centers
for Schools
12
13
Medical
“Working in school-based health care provides the
opportunity to serve in many capacities: healthcare
provider, mentor, role model, teacher, cheerleader,
advocate, listener, and sometimes just a person who
shows care and concern. Our goal in school-based
health care is to improve each child’s overall health,
and healthy children make better learners. The reward
I get is seeing kids thrive, and that is priceless.”
– Kelly Poindexter, Nurse Practitioner, Memorial Hermann Health Centers for Schools
Children in poor health, who are hungry, fearful, sad and living in poverty, face
often insurmountable barriers to learning. Students who then do not graduate are
less likely to be employed and insured, and they earn less – all of which continues
the cycle of poverty and disparities, including lifelong health risks, high medical
costs and increased engagement in risky health behaviors. Research shows that
school-based health centers increase educational success by providing medical
and mental health care that allows students to stay in school and learn.
In addition to addressing health needs including acute and chronic illness,
school-based health centers also address broader social factors that influence
health, wellbeing and preparedness to learn, such as hunger, lack of basic
needs, home environment and even homelessness.
“Memorial Hermann is committed to addressing the healthcare
access issues experienced by the medically disadvantaged.
We see school-based health care as an avenue to address
these issues; health care is provided where children are located –
at school – and children who feel better perform better.
Their future is brighter.”
Of the students served:
93%
are on the free/reduced
lunch program, a nationally
accepted indicator of poverty
34%
have limited English proficiency
44%
are without any kind of health
insurance coverage
27%
have some form of Medicaid
29%
are children who will not
otherwise obtain health care
due to access issues
Memorial Hermann Health Centers for Schools provides a stable medical home
for uninsured and underinsured children from pre-kindergarten through 12th
grade. Primary medical care, nutrition counseling, mental health services and
dental care are provided free of charge for children who may or may not have
insurance, and may experience other barriers including low income, lack of
knowledge about available health care, lack of transportation and parents’
inability to take time away from work.
Insurance does not equate
to healthcare access.
Parents are often unable
to take off work, may lack
transportation or may be
facing other challenges that
push health care down on
the list of priorities.
— Deborah Ganelin, Director, Community Benefit Corporation for Memorial Hermann
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15
OUTCOME
7
2
Health Centers for Schools
28,000
4
annual visits
9,000
10
school-based clinics
3
5
8 3
10
a defined population served and improved access
amount of healthcare services. One solution is
to health care. School-based health centers are
to provide children with the knowledge and skills
immediately accessible to children, do not require
to manage their disease. Children who take part
transportation, do not require parents to miss
in school-based asthma education programs have
work and do not present a financial obstacle to
decreased asthma exacerbations and reduced
families. The results are documented improvements,
ER visits and hospitalizations.
Asthma Patients
Pre and Post Clinic Management
2014 (n=51)
Access
Uninsured or underinsured children often use the
150
120
accessible medical home. Documenting that this
9
1 Alief Health Center
increased access results in more appropriate use of
6 Lamar Health Center
(West of Crossroads, Alief ISD)
70
(Lamar High School, Lamar Consolidated ISD/Fort Bend)
7 Nimitz Health Center
(Burbank Middle School, Houston ISD)
(Dunn Elementary School, Aldine ISD)
8 Sharpstown Health Center
(Sharpstown High School, Houston ISD)
(Elrod Elementary School, Houston ISD)
4 Hogg Health Center
9 Terry Health Center
(Hogg Middle School, Houston ISD)
5 Kruse Health Center
114
100
healthcare access through the provision of an
6
3 Elrod Health Center
(Terry High School, Lamar Consolidated ISD/Fort Bend)
hospital emergency rooms is important as ER visits
continue at inappropriately high utilization rates.
(Matthys Elementary School, Pasadena ISD)
Each Health Centers for Schools clinic
and sports physicals, immunizations,
is staffed by a nurse practitioner/
chronic care (asthma, obesity, cholesterol
physician assistant, licensed clinical
management), mental health therapy
social worker (LCSW), licensed vocational
and social service referrals, nutritional
nurse (LVN) and a receptionist, with
guidance and other specific care to
medical oversight provided by a
meet students’ needs. The school district
Memorial Hermann-affiliated physician.
provides transportation from the schools
Two dietitians and navigators rotate
to the campuses housing the clinics.
among the clinics. Services offered
Clinics are open Monday through Friday,
include sick and injury care, general
7:30 a.m. to 4 p.m., 12 months a year.
44
50
1
16
18
0
0
Exacerbations ER Visits
7
0
Hospitalizations
pre-management
Absences
post-management
% Non-Urgent ER Visits - 2014
Uninsured Community versus School-Based Health Centers
Education
15.00%
campuses and working closely with school nurses,
10.50%
School-based health centers, placed on school
minimize the amount of time that children are out
10.00%
of the classroom.
10 WAVE Health Center
(Kruse Elementary School, Pasadena ISD)
16
Children with asthma use a disproportionate
School-based health centers (SBHCs) improve
2 Burbank Health Center
The Health Centers
for Schools program
is funded by Memorial
Hermann in collaboration
with school districts,
local foundations and
state and federal grants.
outcomes are numerous and are a result of both
Emergency Room (ER) for primary care services.
mobile dental vans
schools with a total population
of approximately 65,000
Asthma
clinically as well as educationally.
1
students served
Memorial Hermann Health Centers for Schools
5.00%
2.03%
0.00%
Uninsured
Community
School-Based
Health Centers
Disposition Status of Medical Patients
During the School Day - 2014
2.0%
4.8%
Source for Uninsured Community: Community Tracking
Study, Medicaid/SCHIP Cuts and Hospital Emergency
Department Use, Peter J. Cunningham
0.2%
0.3%
ER
Home
Home Against Advice
Other
School
92.6%
17
Treating the Source, Not the Symptoms
Sarah is an elementary school student who lives
with her family in low-income apartments. She was
referred to the school-based health center by the
school nurse for a rash. It was found that Sarah did
not have a rash, but was actually getting bitten by
bed bugs while she slept at night. She was miserable
during this visit, consistently scratching her skin.
Her father was contacted and with much explanation
he was informed of the problem, educated about
Sarah’s prescription and how to rid his apartment of
these bugs. Mental Health
Sarah returned again one week later for a follow-up
visit. This time her father came along. Sarah was very
happy during this visit. Her skin was clear of all bug
bites. Her father stated that with the information
sent home, he exterminated her bedroom and home
of the bugs and bought Sarah a new mattress for
her bed. Unfortunately, during the skin exam, Sarah
Sarah returned a week later for another follow-up
was now diagnosed with scabies. Her father stated
visit. She was free of bug bites and scabies. She
that he had the same rash on his arm. Sarah was
stated her family is happy that there are no more
prescribed medication for the scabies, and her father
bugs, and they just welcomed a new baby brother
was given another handout and explanation on
into the home. Since the school-based clinic staff
how to rid the home of the bug that was causing
are located on school grounds, they periodically
it. The father was also advised about talking to the
see Sarah – smiling, happy and, most of all, not
landlord on the condition of the apartment and
scratching.
Mental illnesses can cause severe impairment in a child’s
ability to cope in school and in daily life, and the high rate
of uninsured children in the Greater Houston area results
in many untreated mental health illnesses. According to
the Mental Health and Mental Retardation Authority of
Harris County, in 2012, 74 percent of area children and
adolescents with a serious emotional disturbance could
not access services from the public mental health system.
how he can solve this problem.
Mental health services are offered through the Health Centers for Schools
clinics where licensed clinical social workers provide students with the tools
to improve their functioning at home, school and with peers, in collaboration
with parents and school staff.
School-based health centers give
students the chance to stay in school
where they can learn.
Social workers work hand-in-hand with teachers to help determine how to deal
with students with mental health issues so they don’t disrupt classes and are
able to get the most out of their school experience. Students who perform
well in school feel better about themselves and their accomplishments and are
encouraged to continue to perform well and remain in school.
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19
OUTCOME
Collaboration Leads to Academic Success
Each school year GPA rises; days absent and suspensions/detentions decline.
Ben was 7 years old when he was first referred to
the school-based health center for hyperactive,
Mental Health Therapy
Academic Outcomes of Students with 4+ Visits 2014 (n=444 patients)
3
to complete classwork and failing grades. His parents
3.7
4
3.5
defiant and disruptive behaviors as well as inability
reported daily incidents involving hitting peers and
arguing with parents and teachers. Ben disliked
2.8
school and had psychosomatic complaints at school
2.5
2
1.6
1.5
daily, requesting to go home. The parents and school
staff were very frustrated and overwhelmed by his
1.4
1.0
1
0.5
0.5
0
“There is nothing more
rewarding and beautiful
in life than to see a
child who was marked
for failure, strive and
succeed. I have never
met a child in whom
I could not see the
possibility for change
and success.”
behaviors and were at a loss as to how to address
grades
absenteeism
pre-therapy
susp/deten
the problems.
Collaboratively, the school and school-based clinic
social worker and medical director conducted a
post-therapy
psychosocial assessment and diagnostic evaluation
Mental Health Services provided within the Clinics are non-crisis in nature, but
which revealed a diagnosis of attention deficit
beyond the scope of service of school personnel. The services are diverse but
hyperactivity disorder (ADHD). Additionally, it
predominantly include therapy for situational adjustment, anxiety, depression
became apparent that the parents had extreme
and conduct.
deficits in their parenting skills.
Social Work Diagnoses Categories
FY 2014
Treatment began with education about ADHD;
Within six weeks, Ben’s disruptive behaviors at
physician visits for medication consultation and
home and school were abated. He was focused,
monitoring; social worker visits with parents
productive and his grades improved from Cs
on effective parenting; social worker consults with
and Ds to mostly As with a few Bs. He began to
Abuse
school staff for classroom accommodations and
like school and his psychosomatic complaints were
Academic Problem
behavioral management strategies; and social
no longer a problem. The parents reported feeling
Adjustment Disorder
worker visits with Ben to work on impulse control,
more empowered and less worried about their
Behavior Problem
focus, task completions and social skills. Ben also
son’s future.
Bereavement
began to participate in sports to help develop
3.2%
2.0%
Ecenthia Burnett
Memorial Hermann Health
Centers for Schools
Social Worker
1.3%
5.3%
4.3%
1.0%
5.8%
2.5%
53.0%
Depression
Other
21.1%
Phase of Life Problem
Relational Problem
Stress/Anxiety
social skills and cooperation with others.
Ben is currently 9 years old. He has been in the
program for two years. He is a model student.
Within two weeks Ben began to have more
He is an honor student and has not had one
focused, cooperative behaviors. The teachers
behavioral referral this school year. He is truly a
reported that he was able to complete more of
success story!
his assignments, was more easily redirected
back on task and showed a significant decrease
in defiant behaviors and peer conflict.
20
21
Mobile Dental
The Surgeon General reports that despite improvements
in oral health status, profound disparities remain among
population groups. Oral health is related to wellbeing and
quality of life. Diet, nutrition, sleep, psychological status,
social interaction, school and work are affected by impaired
oral and craniofacial health.
Unlike medical care, where treatment can be sought at emergency rooms, no such
safety net exists for dental services. Uninsured children are more than four times as
likely as insured children to have an unmet dental need.
OUTCOME
Recall Patients with Cavities versus
Healthy People 2020 Goals for Cavities
2014
The Mobile Dental Program compares the incidence of
cavities of its patients to the goals set forth by Healthy
People 2020, a national health promotion and disease
initiative. Staff strive to complete all diagnosed dental
work within the month in order to move students into
a six-month recall program. Patients are provided
with three- to six-month recall visits, which contribute
to the amazing cavities-at-recall statistics.
60.0%
49.0%
50.0%
48.3%
40.0%
30.0%
20.0%
10.0%
0.3%
3.0%
0.0%
These outcomes are significant, given that 59 percent
ages 4-11
of initial patients are diagnosed with cavities and
HP 2020
ages 12+
Student Population
20 percent are diagnosed with five or more cavities.
Serving the Greater Houston community since 2000, three 40-foot mobile dental
vans, staffed with a dentist and one to two dental assistants, provide access to
“We are not only
changing their
appearances,
we are changing
their attitudes and
their lives.”
Mahasti Chalajour, DDS,
Mobile Dental Program
preventive and restorative dental services at nine Health Centers for Schools sites
A Reason to Smile
and are available as a dental home for uninsured and underinsured students.
With only one visit to a dentist in his entire young
The primary goal of the program is to provide children in need with regular dental care.
life, 17-year-old Alex arrived at the mobile dental van
Exams, X-rays, cleanings, sealants, fillings, extractions and some cosmetic procedures
with excessive cavities. His chief complaint was his
are provided at no cost to the student. A secondary goal is to educate children and
front tooth which was badly decayed. It was a black
families on proper dental care at home, including making healthy food choices.
and brown stub. The dentist explained to him that
the tooth would eventually need root canal therapy;
“Some of the children I see have never been to a dentist,” says Mahasti Chalajour,
however, in the meantime, she would make it look like
D.D.S. “They have, at a minimum, five cavities on the first visit. Poor oral hygiene,
a tooth. Alex wanted the work performed that very
excessive fluoride in drinking water and lack of education creates teeth defects
day, but the dentist explained that his teeth needed a
that cause children to hide their teeth.”
good cleaning first. She was concerned that if the front
tooth was taken care of first, he might not come back
The dental vans rotate among the Health Centers for Schools clinics at three-month
for the fillings. The dentist cleaned Alex’s teeth at the
The dentist told him that she needed the mirror,
intervals. The mobile environment requires a close working relationship between
first appointment and filled nine huge cavities.
but that she understood that he could not wait
to see himself in the mirror again. Alex interrupted
the stationary school-based clinic and the dental clinic. Serving as an anchor,
the school-based clinic staff schedules patients and contacts the clinic when
Alex made a follow-up appointment for the next
her and told her he could wait, but he did not think
emergencies arise while the van is off-site.
week to fix the front tooth. After the work was done,
his mom could wait for him to show her his smile at
the dentist handed him a mirror. Alex gasped.
home. Alex had no cavities at his follow-up visit.
Dental clinic staff diagnose dental problems, provide cleanings, treat cavities, perform
He held the mirror in his hands looking at himself
A graduating senior, he has been given referral
other restorative work and provide oral health education for each patient. Professionals
and started to leave the van with the mirror!
options for affordable dental care.
and educators, the staff also serves as the van drivers, cleaners and clerks. They have
received the Texas Dental Association’s Certificate of Merit Award for their efforts.
22
23
To combat this alarming epidemic,
to HELP. After meeting with the student
nutrition counseling and education is
and his or her parents and reviewing the
offered by registered dietitians through
medical information, the dietitian will
the Health Centers for Schools clinics at
suggest healthy food choices, create meal
no cost to students.
plans, set weight loss goals and discuss
how to read food labels and other topics
The Healthy Eating and Lifestyles
related to nutrition. The goal is to provide
Program (HELP) is designed to educate
children and their parents with a better
children and their families on the
understanding of how proper nutrition
importance of proper nutrition and
can improve the child’s health and school
exercise. Any child diagnosed as
performance. Quarterly dietitian visits
overweight/obese – in body mass index
continue for as long as the family remains
(BMI) percentile 85 or higher – is referred
engaged.
OUTCOME
Nutrition
“I may not see
substantial weight loss
results or perfectly
balanced diets but our
families truly amaze me
with whatever little effort
they are able to make
to better their diets and
physical fitness, despite
the numerous financial,
emotional, social and
environmental barriers
they face. These families
inspire me to continue to
help future families that
need my services.”
Mehreen Ansari
Dietitian, Health Centers
for Schools
In 2014, 126 students actively participated in HELP. Sixteen students realized
statistically significant improvements in BMI, moving out of the obese percentile,
into the overweight percentile range and, for eleven students, into a normal
For families living in poverty, food insecurity is an
underlying cause of obesity. When food is available, the
least expensive food is often not the healthiest food.
And Houston area “food deserts,” where healthy fruits
and vegetables are scarce, exacerbate the problem.
Poor nutrition, when combined with physical inactivity,
is associated with many chronic conditions such as high
blood pressure, diabetes and asthma.
According to the 2013 Youth Risk Behavior Survey, 34 percent of Houston-area high
school students are overweight or obese. More than one-fifth of these students had
not exercised for 60 minutes a minimum of one day during the week prior to the
survey. Studies show that overweight students are absent more often and grow up
to have less educational attainment, lower wages and higher unemployment.
24
BMI level.
Healthy People 2020
Objectives for Physical
Activitiy and Nutrition:
BMI Percentile
BMI Percentile (n, %)*
Pre
Post
Difference
Normal (<85th percentile)
0
11
+11
Overweight (85th to 94.9th percentile)
30
35
+5
Obese (>=95th percentile)
96
80
-16
Note: In the pediatric population the BMI percentiles as opposed to the BMI is more
meaningful because children are still growing. BMI alone may misrepresent weight
management progress.
*Differences are statistically significant
65%
met physical activity minutes
62%
met goal for fruits and vegetables
77%
met goals for % of calories
from FMNV (Foods of Minimal
Nutritional Value)
25
Childhood
Obesity Initiative
Memorial Hermann’s Health Centers for Schools program focuses on encouraging
children to eat healthy diets and participate in plenty of physical activity, and is an
active part of many recent community efforts to address childhood obesity, including:
• Healthy Living Matters
• Healthy Living Matters – Pasadena
•ECHOS (Epiphany Community Health Outreach Services)
Healthy Living Adventure
•REACH (Racial and Ethnic Approaches to Community Health)
Through a grant from Marathon Oil, studies were conducted at Sharpstown
High and Elrod Elementary Schools to identify and prioritize environmental
and policy barriers impacting healthy eating and active living for students.
Based on study results, community outreach was conducted to bring healthy
Putting a Plan in Play
resources to both schools from local organizations. Sharpstown students
planted a community garden and the Sharpstown Health Corp Coordinator
Fifteen-year-old Jacob was referred to the
His poor diet, lacking in most fresh foods, is due in
started a group called the Health Ambassadors to raise awareness on campus
school-based clinic’s dietitian for weight
part to financial barriers. His single mother works
about the importance of eating healthier foods and staying active.
management counseling. He was obese and
two jobs, is only able to use public transportation
had a history of attention deficit hyperactivity
due to her own mental health disorders, lacks time to
The Sharpstown High School Health Ambassador students’ enthusiasm spilled
disorder (ADHD). He is on the school football team
prepare meals at home and has limited resources
over to Elrod as they held five booths at Elrod’s Fall Festival and helped the
and motivated to lose weight for better sports
to buy fresh foods. Since improvement in diet quality
school nurse develop topics for monthly health assemblies. Other activities
performance as well as for reducing health risks.
is challenging due to these barriers, nutritional goals
at Elrod included planting a community garden, applying for and receiving a
His diet history is poor with excessive intake
include limiting excessive caloric intake and limiting
cylinder garden grant and implementing the Project Fit America program.
of highly processed, convenient foods such
foods of minimal nutritive value. Within a month
as frozen meals, instant soups, unhealthy snacks,
of the first nutrition visit Jacob lost 4 pounds. With
sugar-sweetened beverages and consumption
ongoing nutritional guidance, he hopes to continue
of fast-food restaurant meals at least three times
to lose weight and improve his sports performance as
a week.
well as his overall health.
The 2013 National Youth Risk
Behavior Survey indicates that
among U.S. high school students:
11%
drank a soda three or more
times per day
14%
did not eat breakfast
15%
did not participate in at least
60 minutes of physical activity
52%
did not attend P.E. classes
33%
watched television 3 or
more hours per day
41%
used computers 3 or more
hours per day
26
27
Project Fit America
Memorial Hermann
Health System is the
exclusive sponsor of
Project Fit America (PFA)
in the Houston area.
With the addition of
Elrod Elementary School
through the grant from
Marathon Oil, Houston
now has two PFA schools.
The first was implemented
in 2012, through a
grant from Memorial
Hermann, Senior Games
and General Electric, at
Eugene Field Elementary
School. Both Elrod and
Field are schools served
by the Health Centers
for Schools program.
Serving communities for 25 years,
Project Fit America (PFA) provides
elementary schools with indoor
and outdoor fitness equipment
and a curriculum designed
to enhance existing physical
education programs. PFA works
with schools to fully train the
teaching staff and integrate the
program into the school curriculum. At the end of the program, the school is able
to run PFA without any outside intervention. PFA is designed to be a permanent
program in each school, as the need to get children fit will never diminish.
PFA’s benefits include:
• To learn how to set and achieve goals
• To take charge of one’s own “Fitness Quest for Life”
• To give all kids, not just the already gifted athletes, the chance to discover,
explore, improve and be recognized for their physical, mental and fitness efforts
• To improve a students’ overall productivity and brain power, because exercise can
increase serotonin levels which can help improve focus and mental clarity
• To develop not only physically, but mentally and emotionally as well, through
leadership, communication, teamwork, cooperation and understanding
OUTCOME
All PFA schools participate in two years of testing and
evaluation for project measurement. Tests are administered
to the students at the beginning of the fall semester, prior
to implementing PFA and at the end of the spring semester
21.12% Upper Body Strength
after using the program. The data is analyzed by Sonoma
24.33% Abdominal Strength
State University, Department of Mathematics and Statistical
Consulting, and reports are compiled for each school as
well as national school averages.
28
Proven before and after outcomes for 850 Project Fit schools
in 2012-2013 indicate that participating students show an
average improvement in the following:
22.86% Lower Body Strength
10.07% Cardiovascular Endurance
29
Community
Resources
Since 2003, The
University of Texas
Health Science Center
at Houston School
of Public Health has
conducted an annual
survey of hospital
emergency room (ER)
visits in Houston area
hospitals, including
the Memorial Hermann
hospitals. The most
recent survey published
in 2013 revealed that
41 percent of all
ER visits are primary
care related. The
potential to decrease
this percentage is great
when patients are
provided with options
such as the following
Community Benefit
Corporation programs:
•ER Navigation/COPE
•Nurse Health Line
•Neighborhood
Health Centers
30
31
ER Navigation/
COPE Program
“The ER is the primary care
physician for a significant
percentage of our population. I
was hired to work in the ER to
assist patients along the care
continuum and to solve patient
“barrier to care” problems
that the clinical staff does not
have time to address. A major
loophole that we all experience
on a daily basis involves patients
who will see case managers and
social workers multiple times in
the ER, receive resources and
applications, and then after
discharge show right back up in
the ER with similar complaints
and problems, as if no one
had ever intervened or given
assistance. Before we label
this group as noncompliant,
I challenge everyone to think
about one story of a friend,
family member or even
yourself trying to “navigate” the
healthcare system. Imagine
trying to gain access WITHOUT
an insurance card. Now think of
what a relief it would be if you
were able to call someone who
has met you and knows your
problems and cares that you find
the right place to get answers
and relief. That is what the CHW
does for our ER every day.”
Dee Gunter, RN, CCM,
Nurse Case Manager,
Memorial Hermann-Texas Medical Center
32
In 2008, Memorial Hermann launched
CHWs offer a vital service, working with
the ER Navigation program as a natural
patients to identify clinics that are the
response to the community need of
best fit according to patient location,
educating patients on how to navigate
income, language, work hours and bus
through existing resources, increasing
routes, and they also work to address
access and using healthcare resources
issues that may lower the priority
appropriately to reduce healthcare costs.
of health care for many, such as the
Today ER Navigation is in place at seven
need for food stamps, rental support
Memorial Hermann emergency centers.
and assistance with utilities. Working
in tandem with ER Navigation is the
The ER Navigation program places
Community Outreach for Personal
a community health worker (CHW)
Empowerment (COPE) program for
or “navigator” on-site in emergency
patients at the highest risk of declining
rooms to educate patients on the
health and recidivism resulting from the
importance of identifying and using a
lack of appropriate self/community care.
consistent medical home rather than
COPE employs social workers to help
relying on emergency rooms for their
these patients navigate the healthcare
primary care. Patients eligible for the
system. The intervention focus is on key
program are ages 18 months to 65
elements of empowerment to maximize
years and are uninsured, on Medicaid
the potential for health and wellness:
or self-pay. Certified CHW training
knowledge, behavioral skills and self-
covers the navigator role, barriers to
responsibility.
care, communicating with patients,
supporting the emotional needs of
patients and privacy concerns.
While CHWs and social workers initially meet patients during
a hospital visit, much of their work is done in follow-up: ensuring
a clinic appointment was made, helping fill out the required
paperwork for qualification for Medicaid, CHIP or county indigent
programs, and assisting with navigating future heath concerns.
33
OUTCOME
OUTCOME
Nurse Health Line Callers:
pre/post navigation
9.0
experienced a 77%
8.0
reduction in ER visits
7.0
6.0
pre-ER activity after
navigation assistance
from community
health workers.
Mean Visits
intervention timeframe
as compared to
50%
Mean Visits to Memorial Hermann ERs
by Navigated Patients Decreased Significantly*
from Pre- to Post-Intervention Visits
Patients in a six month
6 Months Pre-, Post-Intervention
5.0
3.0
3.0
2.0
1.0
70%
4.5
4.0
4.0
of callers would have
called 9-1-1
7.8
2.0
1.4
0.4
1.0
1.3
0.6
0.3
of callers would have gone to
the nearest emergency room
1.7
99%
0.0
All*
1*
2*
Pre
Intervention Dates: 03/01/2013 to 08/31/2014
3*
4*
5 or more*
Post
*Mean differences significant at alpha<0.001.
Making Health a Priority
Nurse Health Line
of callers would use the
service again
713.338.7979
Nurse Health Line Growth in
Calls Since Inception:
While a large percentage of callers
Nurse Health Line in 2014. This free
are uninsured or on Medicaid, others
telephone service was created for
have insurance but are simply looking
Greater Houston residents who are
for guidance on what level of care is
experiencing a health concern and
needed, such as a physician’s office,
2,409
FEB-MAR 2014
Jessica is a 20-year-old college student, caring for an
documentation she would need to qualify for the
are unsure of what to do or where
an urgent care clinic or an emergency
APR-JUN 2014
ailing father, who is noncompliant in her own diabetes
program, and ensuring that the appointment was
to go. Experienced, bilingual nurses
room. If callers do not have a primary
management. She met the COPE social worker when
both scheduled and attended. Jessica reported back
use their training and expertise to
physician, operators can recommend
she was hospitalized for cellulitis. The social worker
that her future visits will indeed be free! She was very
conduct assessments by phone, and
clinics or after-hour facilities. They
3,091
connected her to Memorial Hermann’s diabetic
pleased and excited to have found a primary medical
are available to answer calls 24 hours a
also assist with community resource
disease management program and to a local clinic
home. She received insulin pens for free, was set up
day, seven days a week for any resident
referrals and transportation needs.
providing free services to females 21 years of age and
on the prescription assistance plan and scheduled to
living in Harris or surrounding counties.
Callers receive healthcare advice and
under. The social worker then worked with the clinic
be seen every three months. The social worker was
Experienced nurse operators help
education using nationally recognized
to consider extending the services beyond Jessica’s
equally excited, knowing that she was making an
callers decide when and where to go
standardized protocols.
21st birthday. She assisted Jessica in collecting the
impact, one patient at a time.
for medical care. The operators are not
charged with diagnosing or treating
patients but rather with helping callers
make decisions that will support a
positive outcome.
34
222
Memorial Hermann established the
JUL-SEPT 2014
5,392
OCT-DEC 2014
12,388
JAN-MAR 2015
23,502
TOTAL CALLS
35
Neighborhood
Health Centers
Northeast and Northwest
Interviewees for Memorial
Hermann’s 2013 Community
Health Needs Assessment
(CHNA) reported that lack of
availability of primary care
services, difficulty accessing
primary care and “lack of
coverage/financial hardship”
are the top barriers to
primary and preventive care
for low-income residents in
the community. According
to the most recent Houston
and Harris County State of
Health Survey, one-third of
Harris County residents rely
on safety net clinics.
Recognizing the need to help bridge
Patients with chronic conditions
the gap for individuals and families
represent the most neglected area of
who may have some disposable
care among underinsured populations.
income, but not enough to afford
At Neighborhood Health Centers these
private health insurance, Memorial
patients are monitored for hypertension,
Hermann Neighborhood Health Centers
diabetes and other conditions to prevent
offer an appropriate alternative to
frequent ER visits and exacerbated and
emergency room care for non-urgent
debilitating conditions.
conditions. Originally designed to
serve as a medical home for uninsured
“Neighborhood Health Centers
working families, today the Northeast
are designed for cost-conscious
and Northwest Neighborhood Health
patients who are seeking quality care
Centers provide uninsured, Medicaid
at affordable prices,” said Chips Adams,
and Medicare populations with
associate vice president of Outpatient
preventive, acute and chronic care,
Clinic Services. “Our proven model of
seven days a week with extended
care delivery used at the Centers ensures
weekday hours.
patients receive personalized treatment
for short- and long-term healthcare
Patients use the services of
needs. Our staff and affiliated physicians
Neighborhood Health Centers for a
work to find financially obtainable
variety of reasons, such as lower costs
solutions so that patients are capable
than emergency room visits, urgent care
of the recommended follow-up that is
centers and not-for-profit community
so important for them to get well.”
clinics; location and hours; and quality
of care provided. Of the patients
seen each year, 70 percent consider
Neighborhood Health Centers as their
1,000+
patient visits per month
36
home for medical treatment, preventive
care and medical education. Patients
also rely on the Centers for annual
health physicals, sports physicals,
wellness exams and immunizations.
Each Neighborhood Health Center provides a wide range of services,
including wound treatment, STD screenings, preventive care, sports
physicals, immunizations, urgent care and treatment for illnesses such
as influenza or strep throat. The clinics also provide much-needed
management of chronic illnesses such as asthma, diabetes and high
blood pressure.
37
Mental Health
38
39
Mental Health
Volume
In Harris County, 36.8 percent of all patients given a primary
diagnosis of a mental health disorder in the ER were
uninsured in 2013. According to the Mental Health and
Mental Retardation Authority of Harris County (MHMRA),
the high rate of uninsured residents in Harris County has
resulted in many untreated mental health illnesses.
Psychiatric Response Team Volumes
Volume - Comparison of FY 13, FY 14 and FY 15
800
700
600
500
400
300
200
100
0
Jul
Aug
2015
Sep
2014
Oct
Nov
Dec
2013
Jan
Feb
Mar
April
May
June
Month
mental health community’s resourced
engage patients in the development
patients to obtain care for non-resourced
of their own mental healthcare plan
With a shortage of psychiatric
care and ongoing support for mental
patients; patients are seen regardless
and long-term recovery goals, with
facilities, coupled with a lack of
health patients, both inside acute
of ability to pay. No longer is it one
the ultimate objective of improved
financial resources, patients both
care facilities and in the community.
ER/nurse/physician competing with the
patient wellness. Behind the scenes,
rest of the ERs for a limited amount of
case managers work to identify
psychiatric resources.
individuals whose chronic mental illness
insured and uninsured seek treatment
from emergency room physicians and
clinical staff untrained in psychiatry.
PSYCHIATRIC
RESPONSE TEAM
These patients often experience long
predicts the likelihood of repeat visits
Supporting the Psychiatric Response
to emergency room facilities, and to
wait times while emergency personnel
Since 2000, on call 24 hours a day,
Team are the Psychiatric Response
educate them about mental health
attend to others with more pressing
the Psychiatric Response Team has
Case Managers, who work with patients
outpatient treatment centers and
physical needs. Additionally, patients
worked across the Memorial Hermann
to improve outpatient treatment
support networks. The case manager
visiting Houston emergency rooms
Health System to provide mental health
compliance. Also available 24 hours a
also connects these individuals with
with a primary diagnosis of mental
expertise to all acute care campuses,
day, case managers not only refer to
a community-based social worker who
health conditions are 3.4 times more
delivering care to the emergency
the Mental Health Crisis Clinics and
will help them navigate the barriers
likely to be hospitalized following
rooms and inpatient units. The team
other community agencies, but actively
to outpatient treatment.
the emergency room visit compared
is comprised of master’s-level licensed
to persons with a primary diagnosis
clinicians and responds to all patients
unrelated to behavioral health.
with behavioral health needs, ranging
OUTCOME
The Psychiatric
Response Team has
seen, on average, a
68.29 percent volume
reduction in emergency
room utilization. Once
the patient has been
successfully discharged
from the program, on
average, there has
been a 77.56 percent
reduction in emergency
room visits in the
six months following
program discharge.
from depression and psychosis to
40
In response to the community need,
chemical dependency. The clinicians
Memorial Hermann’s dynamic mental
evaluate, stabilize, arrange for transfer
health services include the Psychiatric
and develop aftercare plans for patients.
Response Team and Case Managers,
A coordinated effort, the team refers
Mental Health Crisis Clinics and Home
patients to more than 200 mental health
Behavioral Health Services Program.
community treatment providers within
These innovative programs are staffed
Harris, Fort Bend and Montgomery
with professionals with the expertise
counties. This large referral network
needed to provide the necessary
allows the program to leverage the
41
MENTAL HEALTH
CRISIS CLINICS
room visits. Clinicians work with
patients needing immediate access
to psychiatric services, and refer them
After identifying Humble and Spring
to the Psychiatric Response Team
Branch as having the highest clusters
case managers and other community
of chronic mental health issues, in
agencies as appropriate. To assist
2014 Memorial Hermann opened two
outpatient follow-up, the clinic staff
Mental Health Crisis Clinics to respond
helps patients establish an appointment
to each community’s significant gap in
with an outpatient provider or directs
mental and behavioral health services.
them to resources and referrals.
These clinics operate as “urgent care”
The graphic below depicts how
the Psychiatric Response Team,
Psychiatric Response Case
Managers, Mental Health Crisis
Clinics and Psychiatric Home
Health Services work collaboratively
to create a continuum of services
for the community’s mentally
ill population.
mental health service providers for
These clinics promote better health
individuals in crisis situations.
outcomes for patients with mental
health treatment needs, decrease
These clinics are not designed to
unnecessary emergency room visits,
provide continuous outpatient
and decrease inpatient hospitalizations
follow-up for mental health needs;
and incarcerations due to noncompliance
rather, they serve as a part of the
with mental health treatment plans.
mental health safety net as an
alternative to expensive emergency
“The emergency center is not
the place for these patients,” said
Memorial Hermann and Community Partners Collaboration - Patient Movement Overview
Theresa Fawvor, associate vice
president, Behavioral Health Services.
“The Mental Health Crisis Clinics allow
Community
Agency
us to provide the appropriate care
Mental
Health Crisis
Clinic
The Psych
Response Team
and put these patients in front of the
provider they need outside of the
acute care hospital setting.”
Community
Agency
Community
Agency
HOME BEHAVIORAL
HEALTH SERVICES
Patients with behavioral health issues
Psych Response
Case
Management
MH
Psych Home
Health
Community
Agency
Patient movement within Memorial Hermann services
Patient movement between Memorial Hermann and community agencies
42
in addition to medical conditions have
few options for treatment. Facilities
that treat mental or behavioral issues
will not accept patients with existing
medical conditions such as feeding
tubes, pregnancy, cardiac disorders and
other conditions. Alternatively, hospitals
43
OUTCOME
Getting Back on Her Feet
This past year, the
Home Behavioral
Health Services
Program documented
an increase in visits,
medication compliance
and discharge planning.
For years, Connie, 60, struggled with major depressive
to be angry. But she just kept coming back. She and
disorder. When she presented at Memorial Hermann
Kimberly were godsends. They were my angels.”
Southwest Hospital in the spring of 2014, she had
fallen into such a deep depression that pulling herself
Working in partnership, Gilmore and Johnson literally
up again was not a possibility. She had no job, no
got Connie back on her feet – both mentally and
insurance, no resources and no hope.
physically. Now, she is looking to get a job, attending
an amputee support group and waiting to be fitted
Coupled with her depression, she was overweight and
with a prosthetic leg. In addition, she has also:
suffered with other chronic medical problems, including
800+
visits
• Obtained a Gold Card, now receiving Harris Health
with two lengthy hospitalizations. When told she was
Outpatient Services, including a primary care
going to lose her right leg due to an infection, she
physician, psychiatrist, vision care, and physical and
thought about ending it all, but didn’t have the courage.
occupational therapy
and outpatient clinics that provide
are made from case managers in
care for medical treatment do not offer
emergency rooms, hospital intake
services to treat mental health issues.
departments, physician offices,
When all glimmers of hope nearly faded for Connie,
With few to no resources available in
community clinics and home health
in stepped her “angels” – in the form of Kimberly
• Red Cross transportation
the community, coupled with the high
staff, who often determine patients
Gilmore, Case Manager, Memorial Hermann
• METROLift transportation
cost of treatment, most patients fall
currently receiving medical treatment
Psychiatric Reponse, and Jessica Johnson, RN,
• Services to obtain Social Security disability payments
through the cracks of the healthcare
are in need of behavioral or mental
Home Behavioral Health Services.
system and seek treatment only
health care as well. Patients with
through emergency rooms when
and without resources are accepted,
“When I first came home and thought about how
said Connie, adding that she is now determined to find
their behavioral issue is exacerbated.
and services are available 24 hours
difficult it was going to be without a leg, I thought rather
a job as an accountant. “Even though I pulled away
a day, seven days a week.
than deal with that, I would rather die,” Connie said.
from all my friends, they were not going to go away.
“I was mad. I was furious. But the Memorial Hermann
Now, I have been lifted up because of my family and
The Home Behavioral Health Services
• Supplemental Nutrition Assistance Program
(SNAP) benefits
“I would never have gotten through this without them,”
Program is a team of specialty
The project’s goal is to reduce
physical therapy team helped me. I vented at Nurse
Memorial Hermann. I can’t believe that you guys are
nurses and social workers who help
emergency room visits by patients
Jessica, but she allowed me to vent because I needed
still holding my hand. I’m amazed.”
patients with medical conditions
whose behavioral issues can be
and behavioral issues in their homes.
managed within the community
Treatment offerings include developing
setting. Emergency rooms will
coping skills, medication compliance,
still be the best choice for patients
disease management education, and
whose symptoms have become
help with accessing resources such
exacerbated or whose medical
as transportation and medications.
condition has deteriorated to
Team members also work collaboratively
the point where they may pose a
with other established mental health
danger to themselves or others.
programs such as the Memorial
Hermann Crisis Clinics and Case
Management programs. Referrals
44
diabetes. She was a frequent patient at Memorial Hermann
“Providing services for patients who are unable to leave their
homes due to a mental or medical condition benefits the entire
Houston community. Combining physical and mental services in
addition to offering therapies, education and support for patients
can be life-altering, and in some cases, life-saving.”
— Susan Markland, Administrative Director of Patient Care, Home-Based Programs
45
Community
Partners
46
47
Community Partners
Through the years,
Memorial Hermann
has taken a leadership
role in several Gateway
to Care initiatives,
including the Gateway
to Care Provider
Health Network (PHN)
launched in November
2005. It is based on a
national model called
Project Access that
connects people to
medical specialists
so they can receive
the right treatments
earlier in their illness.
Connecting people
to the appropriate
specialty care sooner
results in improved
clinical outcomes and
improved productivity
as patients are able
to return to their daily
lives sooner rather
than later.
“It really does ‘take a village.’ It is very rewarding to
know that by working together with our community
partners, we can harness the amazing collective energy,
talent and resources of several organizations to
improve the health of those who need it most.”
Carol Paret, Senior Vice President and Chief Community Health Officer
the quality of life for children through
organizations, each of which is a
for more than 100 years, Memorial
proven leader committed to resolving
healthcare resources and improving
strategic research, public policy
Hermann recognizes that there are
the most pressing social issues in
the health lives of more than
analysis, education, collaboration and
many organizations doing tremendous
the Houston community.
100,000 individuals and families
advocacy. The only organization in the
work for the underserved, often with
• 12 new federally qualified health
Houston area focused solely on the
particular populations and communities.
GATEWAY TO CARE
Funding to support the
Provider Health Network (PHN)
and Surgical Saturday
By actively partnering with these
Established in 2000, Gateway to Care
of community health workers (or
children by educating legislators on
organizations, Memorial Hermann
began with six member organizations,
navigators) in hospitals, clinics and
the importance of improving each of
furthers its vision of 100 percent
including Memorial Hermann, and
community organizations
the key indicators.
access to basic care and improving
today works with more than 170
the health and enriching the lives
leaders in health care, government
Network (PHN) to provide pro
Children at Risk makes children’s needs
of adults and children residing in
and the business sector toward the
bono specialty care
a priority and ensures ample resources
Southeast Texas.
shared vision of 100 percent access
• Implementation of Surgical Saturday,
are available for children and their
to health care for the uninsured and
an extension of the PHN, that covers
families to thrive. Children at Risk’s
To amplify their collective impact on
underinsured residing in the Harris
general surgical ambulatory cases
focus areas include:
a community, Community Benefit
County/Greater Houston area.
on selected Saturdays
limited resources. These organizations
provide a high level of expertise, fluidity
and depth of service in working with their
programs are collaborative in nature.
wellbeing of the whole child, Children
of 33 clinics serving the Harris
at Risk tracks key indicators through
County region
its publication Growing Up in Houston
• Establishment, training and use
Collaborative is responsible for:
Children at Risk’s mission is to serve
selected based on their shared
and affiliated organizations working
values and measurable impact on
together to coordinate resources and
the community.
streamline healthcare services in the
and proactively drives change for
• Creation of a Provider Health
local community, the Gateway to Care
Operating as a “collaborative” of member
support and in-kind support for these
centers (FQHCs) and a total
CHILDREN AT RISK
Memorial Hermann provided
funding to support a policy
coordinator for a Food in
Schools initiative
Prospective partners are carefully
Memorial Hermann provides program
48
• Bringing in more than $100 million in
As a leader in health and wellness
• Public education
• Human trafficking
• Health and nutrition
•Parenting
• Current legislative session
as a catalyst for change to improve
49
Opening Doors through Partnership
The Interfaith Community
Clinic provides:
50+
Betty was caught
between a rock and a
hard place – she couldn’t
weekly hours of
medical service
afford private insurance,
but she made too much
10
for public assistance. This quandary was preventing
75+
licensed professional
volunteer staff
patients per year
14,150
total social service,
medical and dental visits
health – from every corner of Montgomery County.
ICC opened in 1994 “with one patient the first night,
and two patients the second night,” Snyder said.
“After that, people started hearing about us.”
until she discovered Interfaith Community Clinic
“None of this would have been possible if not for
(ICC) in Montgomery County. “They’re available
collaborative relationships,” she added, “including the
for anything I need them for,” Betty said, “but
one with Memorial Hermann. Their funding has given
certainly the life-saving exams – the Pap smears,
us the freedom to provide staff and expanded hours of
the mammograms.”
operation. In addition to our professional volunteers,
we now contract with a medical doctor and a dentist.
INTERFAITH
COMMUNITY CLINIC
Memorial Hermann provided
funding to support general
operations
Up to 68 percent of patients at ICC are women, said
We are a safety net that provides care and a consistent
president and CEO Ann Snyder, adding that ICC
medical home to those who fall between the cracks.”
Among the many services provided are:
• Primary medical care management
of both acute and chronic health
problems
• Primary dental care, including
Established in 1996, Interfaith Community
extractions, restorations and
Clinic is a volunteer-based healthcare
oral hygiene care
center whose primary goal is to provide
• Individual, couple and
medical and dental care, mental health
counseling and social service support to
• Childhood immunizations
those individuals in the north Houston
• Health and lifestyle education
community of Conroe who have no
• Social service support and advocacy
form of health insurance.
50
treats the whole person – medical, dental and mental
her from undergoing regular well-woman checkups,
weekly hours of dental service
8,000+
“You just don’t know
what you would do if
Interfaith Community
Clinic wasn’t here.”
family counseling
ADDITIONAL PARTNERSHIPS
•Aldine Independent School District
•Alief Independent School District
•CanCare of Houston
•Covenant House
•Epiphany Community Health Outreach Services (ECHOS)
•The George Foundation
•The Gulf Coast Regional Blood Center
•Health Resources and Services Administration
•Healthy Living Matters
•Healthy Living Matters – Pasadena
•Houston Independent School District
•Lamar Consolidated Independent School District
•Medical Missions
•Newspring
•One Voice
•Pasadena Independent School District
•Project Fit America
•Racial and Ethnic Approaches to
Community Health (REACH)
•San Jose Clinic
•Spring Branch Community Health
•Department of State Health Services,
School Health Program
•Tomagwa Ministries, Inc.
•The University of Texas Health Science
Center at Houston School of Public Health
(ER Algorithm Study)
•The University of Texas Health Science Center
at Houston School of Nursing
51
Overview of Services
One of the largest not-for-profit health systems in
the nation, Memorial Hermann is an integrated
system with an exceptional medical staff and more than
22,000 employees. Memorial Hermann’s 13 hospitals
include four hospitals in the Texas Medical Center:
an acute care hospital which houses a Level I trauma
center, a hospital for children, a rehabilitation hospital
and an orthopedic and spine hospital; eight suburban
hospitals; and a second rehabilitation hospital in Katy.
Affiliated with UTHealth Medical School,
the system also operates three Heart &
Our specialty services include:
Hermann Mischer Neuroscience
HEART AND
VASCULAR CARE
Institute at the Texas Medical Center;
We are one of the world’s largest
the IRONMAN Sports Medicine Institute
providers of cardiovascular care,
at three locations; Women’s Memorial
annually performing more than
Hermann; Memorial Hermann Life
50,000 heart procedures. Patients
Flight , the largest and busiest air
at our three Memorial Hermann
ambulance service in the United States;
Heart & Vascular Institute locations
the Prevention and Recovery Center
and our Heart & Vascular centers
(PaRC) for chemical dependency
across the community have access
treatment; and a comprehensive array
to affiliated heart specialists with
of home health services, rehabilitation
extensive training and experience
centers, outpatient imaging and
in the complete range of cardiac
laboratory services.
treatments, from interventional
Vascular Institute locations; the Memorial
®
1
system serving Southeast
Texas and the Greater Houston
community
13
hospitals, include four hospitals
in the Texas Medical Center:
an acute care hospital which
houses a Level I trauma center,
a hospital for children, a
rehabilitation hospital and an
orthopedic and spine hospital;
eight suburban hospitals; and
a second rehabilitation hospital
in Katy
22,000+
employees across the system
cardiology to electrophysiology and
Memorial Hermann has been a trusted
the most complex heart transplants.
healthcare resource for more than a
century. As Houston’s only full service
health system, Memorial Hermann
continues to identify and meet our
region’s healthcare needs.
52
53
of patients with a variety of neurological
disorders, including those caused
by aneurysm, stroke, brain tumors,
disorders of the spine, peripheral nerve
problems, neurodegenerative disorders,
infections of the nervous system and
movement disorders.
CANCER CARE
Memorial Hermann has been accredited
by the American College of Surgeons
Commission on Cancer as the first
Integrated Network Cancer Program in
ORTHOPEDICS AND
SPORTS MEDICINE
trauma patients of all ages, throughout
services, including targeted anticancer
Memorial Hermann offers expert care
vision, Memorial Hermann Life Flight®
drugs, intensity-modulated radiation
in orthopedics and sports medicine,
has completed more than 140,000
therapy (IMRT), image-guided radiation
from injury prevention and evaluation
missions since its inception in 1976. It
Offering the largest and most
therapy (IGRT), the most advanced linear
to joint replacement and post-surgery
continues to be one of the busiest air
comprehensive neuroscience program
accelerators, prostate seed implantation
rehabilitation. Memorial Hermann
ambulance services in the nation and
in Texas, Memorial Hermann continues
and the innovative MammoSite and
operates an orthopedic and spine
the only area program accredited by
to push the boundaries in the diagnosis,
Contura™ radiation therapy systems
hospital, more than 30 Sports Medicine
the Commission on Accreditation of
evaluation, management and treatment
for breast cancer.
& Rehabilitation clinics, seven Memorial
Medical Transport Systems.
Houston. Memorial Hermann Cancer
Centers provide a full continuum of
NEUROSCIENCES
®
Hermann Joint Centers and three
Medicine Institute locations, led by
WOMEN’S AND
CHILDREN’S SERVICES
a group of affiliated sports medicine
With 240 pediatric beds and 68 beds
fellowship-trained physicians. The
dedicated to Women’s Services,
Institute uses scientific discovery to help
Children’s Memorial Hermann Hospital
athletes of all ages and abilities prevent
in the Texas Medical Center has been
injury and improve performance.
caring for women and children under
Memorial Hermann IRONMAN Sports
TEXAS TRAUMA
INSTITUTE AND
MEMORIAL HERMANN
LIFE FLIGHT®
54
the continuum of care. Supporting this
one roof longer than any other hospital
in Houston and is the Gulf Coast region’s
leading Level I pediatric trauma center.
The Fetal Center at Children’s Memorial
Hermann Hospital ensures that mothers
The collaborative, multidisciplinary team
with high-risk pregnancies and their
at the Memorial Hermann Texas Trauma
babies receive the latest treatments
Institute provides leading-edge care for
and comprehensive, quality care.
55
Hermann Rehabilitation Network,
rehabilitation hospitals in U.S.News
offering inpatient and outpatient
& World Report’s list of “America’s
rehabilitation for adults and children
Best Hospitals” for 25 consecutive
at select locations around Houston.
190
35
Keller Springs Rd.
114
in research and treatment for traumatic
amputations, multiple sclerosis and
other neurological diseases and
disorders. TIRR Memorial Hermann
is designated as a Model System by
clinical discovery and the development
Memorial
Hermann
Katy
1,300 studies are in progress or pending
Memorial Hermann
Memorial City
across the system – all intent on finding
290
Memorial
Hermann
Northwest
59
8
Beaumont
10
10
Memorial Hermann
Orthopedic & Spine
Memorial
Hermann
Southwest
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Memorial
Hermann
Hospital
69
90A
TIRR
Memorial
Hermann
288
Memorial
Hermann Texas
Medical
Center
365
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Southeast
Richmond
Rosenberg
FM 1
301
Southeast Texas
Regional Airport
HOBBY
AIRPORT
Pearland
59
347
Nederland
Spencer Hwy.
6
FM
10
2
96 287
225
8
71
Wall St.
.
wy
new ways to advance health.
Gr
NIDRR spinal cord injury program.
improvements in patient care through
Memorial
Hermann
Northeast
yH
provides follow-up data for the
GEORGE BUSH
INTERCONTINENTAL
AIRPORT
290
Cit
traumatic brain injury program and
1960
45
1960
in
Tw
and Rehabilitation Research for its
249
Memorial Hermann achieves
of new treatments for patients. Nearly
336
N.
the National Institute on Disability
635
Memorial Hermann
Cypress
RESEARCH AND
INNOVATION
45
105
ll Road
Hardy To
brain injury, stroke, spinal cord injury,
45
Love
Field
years, TIRR Memorial Hermann has
achieved world-renowned excellence
Teas Rd.
Conroe
ier St.
N. Fraz
Named among the top five
Memorial Hermann
The Woodlands
Dallas
Preston Rd.
It recently created the Memorial
Midway Rd.
REHABILITATION
St
.
St
.
36
FM
Manvel
6
36
Needville
0
Imaging Centers
Breast Care Centers
Sports Medicine & Rehabilitation
Diagnostic Laboratories
Surgery Centers
24 Hr Emergency Center
Home Health
Cancer Centers
Heart & Vascular Institutes
Physicians at Sugar Creek
School-Based Health Centers
Neighborhood Health Centers
Convenient Care Centers
3
2
1
5
60
2
1
9
1
1
2
2
1
IRONMAN Sports Medicine Institutes
Women’s Memorial Hermann Hospitals
Mischer Neuroscience Institute
Prevention & Recovery Centers (PaRC)
Memorial Hermann Medical Group
Executive Health Centers
Rehabilitation Katy
Acute-Care Hospitals
Children’s Memorial Hermann Hospital
TIRR Memorial Hermann
Acute-Care Hospitals Under Construction
Convenient Care Centers Under Construction
Orthopedic & Spine Hospital
227 Memorial Hermann Facilities
TIRR is a registered trademark of TIRR Foundation.
54 56
56
909 Frostwood, Suite 2.205
Houston, TX 77024
713.222.CARE
www.memorialhermann.org
4407466