Rockbridge Area Implementation Strategy FY 2025-2027

Rockbridge Area Community Health Assessment HEALTH IMPROVEMENT IMPLEMENTATION STRATEGY FY 2025-2027 NOVEMBER 30, 2024

Carilion Rockbridge Community Hospital CarilionClinic.org/community-health-assessments

Contents

Carilion Rockbridge Community Hospital Health Improvement Implementation Strategy ........... 3 Overview ................................................................................................................................ 3 Community Served ................................................................................................................. 3 Target Population ................................................................................................................... 3 Priority Health Needs.............................................................................................................. 4 Drivers of Priority Health Needs.............................................................................................. 4 Board Adoption....................................................................................................................... 4 Disclaimer .............................................................................................................................. 4 CRBH Action Plan ...................................................................................................................... 5 Access to Care ....................................................................................................................... 5 Community Partnerships ........................................................................................................ 5 Community Grants.................................................................................................................. 5 Carilion’s Mission and Health Equity ....................................................................................... 6 Priority Areas to Be Addressed .................................................................................................. 7 Chronic Disease ..................................................................................................................... 7 Mental Health/Substance Use ................................................................................................ 8 Injury/Violence ........................................................................................................................ 9 Strategies Impacting Multiple Priority Areas ..........................................................................10 About Us ...................................................................................................................................11 Appendices ...............................................................................................................................12 Appendix 1: Community Health Assessment Team............................................................12 Appendix 2: Community Health Need Prioritization Activity Table .....................................14

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Carilion Rockbridge Community Hospital Health Improvement Implementation Strategy Overview

Carilion Clinic is committed to joining with our partners to pursue the essential work of improving and maintaining the health of the Rockbridge Area in accordance with our mission. Assessing the health concerns of each community periodically is a key component of addressing community needs. Every three years, the Rockbridge Area Community Health Assessment (RACHA) aims to uncover issues, indicate where improvement is needed, and track and promote progress in key areas so that there is demonstrated, ongoing change. The CHA process and the public availability of its findings enable and empower our community to effectively improve and maintain health.

Carilion, Live Healthy Rockbridge (LHR) and the Central Shenandoah Health District (CSHD) collaborated to conduct the 2024 RACHA alongside additional community partners, all of whom comprise the Community Health Assessment Team (CHAT). The 2024 RACHA led to the identification of seven priority health issues in the community, identified by the CHAT after review and discussion of the data collected.

As a component of our systemwide Community Health and Equity Improvement and Investment Plan, this Implementation Strategy (IS) gives an overview of key components of the localized response to community needs within Carilion Rockbridge Community Hospital’s (CRBH) service area. This plan applies to fiscal years 2025-2027 and will be updated as appropriate with the identification of new programs and strategy updates. Progress on initiatives described in this document will be reported to the CRBH Board of Directors twice yearly.

Please visit https://carilionclinic.org/community-health-assessments to review the full 2024 RACHA.

Community Served

Based on patient origin data, the service area for the 2024 RACHA included the cities of Lexington and Buena Vista and Rockbridge County.

Target Population

The target population for Carilion’s CHA projects consists of underserved/vulnerable populations disproportionately impacted by the social determinants of health (SDOH), including poverty, race/ethnicity, age, education, access and/or lack of insurance. Strategies are implemented to impact specific populations and life-stages, including parents of young children and adolescents, women of child-bearing age, adults and the elderly.

Other considerations include race, ethnicity and income levels. Distinct efforts were taken to ensure the CHA reflects those residing in Medically Underserved Areas and Health Professional Shortage Areas, and all patients were considered in the assessment regardless of insurance status or financial assistance eligibility.

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Priority Health Needs

In collaboration with the CHAT, we identified key health needs to align resources and other efforts for the following three years. The CHAT reviewed extensive data, asked questions and participated in a consensus-building prioritization process. The 2024 RACHA resulted in the following health priorities:

Chronic Disease

Overweight/Obesity Heart Disease Hypertension

Mental Health and Substance Use

Mental Health Challenges Substance Use Depression

Injury/Violence

Interpersonal Violence

Drivers of Priority Health Needs

The CHA process focused on prioritizing health conditions and outcomes, rather than a broader focus on their root causes. We recognize that access to healthcare and other services and the SDOH are key facilitators of good health and well-being. As such, we focused on those and other health factors as a strategic component of action planning. Some strategies included in this plan are intended to impact the root causes of health.

Board Adoption

This document was approved by the CRBH Board of Directors on November 21, 2024, and formally adopted as the 2024 Rockbridge Area Community Health Assessment Health Improvement Implementation Strategy.

Disclaimer

Carilion began conducting CHAs prior to the IRS adoption of the 501(r)(3) standard which requires not-for-profit hospitals to conduct a Community Health Needs Assessment (CHNA) every three years. While meeting the CHNA requirement, Carilion maintains the longstanding formal name—Community Health Assessment—for our process and reports.

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CRBH Action Plan

While the focus of this plan is on new and innovative programs and initiatives, we will continue to respond to community health needs through ongoing efforts, including: • • • •

Ensuring access to state-of-the-art healthcare close to home, Working with other organizations on community-wide strategies to reduce barriers, coordinate resources and enhance community strengths, Providing community-based health and wellness programming, and Providing targeted grants for community health improvement.

Access to Care

We address access to care in numerous ways to ensure our patients can access the type of care they need, when and how they need it. We do this by expanding our services and updating our facilities, such as the recently complete operating room expansion project which included larger spaces that offer more flexibility and can accommodate more patients pre- and postop. We focus on giving patients more choices about how they receive care and communicate with their providers by utilizing digital health initiatives and other advancements. Through projects that look at internal efficiencies, we are making it easier for patients to get appointments and be proactive about their health.

Community Partnerships

Carilion believes in the power of collaboration and understands that area health issues must be addressed together, with the community. To ensure lasting impact from the health assessment and community health improvement process, Carilion provides support to health coalitions that address needs in the Rockbridge Area, such as LHR. LHR is an initiative that involves more than 50 organizations striving to enhance health equity and create a “culture of wellness” across our region. In addition, Carilion partners with multiple organizations and coalitions on initiatives to improve health, wellness and address SDOH.

Community Grants

Carilion’s community grants help build and sustain community health improvement programs through partner organizations. Each year, Carilion provides grants and community health sponsorships to help local charitable organizations fulfill their missions as they relate to the health and well-being of our communities. Community grant dollars are allocated across Carilion’s entire service area based on requests that align with CHA priorities, with particular focus on helping members of underserved communities with little access to services.

In addition to funding from Carilion, charitable organizations serving the Rockbridge Area also benefit from grants through the Rockbridge Community Health Foundation (RCHF), a supporting organization for CRBH. Funds held by the RCHF originated from Carilion’s purchase of the hospital. A joint grants committee consisting of members from CRBH Board of Directors and the RCHF Board of Directors provides grants to organizations based on alignment with needs identified in the most recent CHA.

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Carilion’s Mission and Health Equity

Our mission—improving the health of the communities we serve—calls for us to meaningfully address health inequities and disparities. Equity is a key lens for the CHA process, guiding our actions as we seek to understand community health needs. Community heath improvement strategies are focused on identifying and serving those who need it most, seeking to broaden the potential for everyone across our communities to thrive.

The Vital Conditions for Health and Well-Being is a widely adopted framework that asserts that there are two ways to safeguard the health and well-being of a community:

Image source: https://rippel.org/vital-conditions/

This framework provides an important lens for assessing opportunities to respond to health inequities. Its balanced approach helps people facing adversity today (urgent services) while also addressing conditions that reduce the number of people who need crisis services (vital conditions). As we seek to improve the health of the community, we are mindful of this balance to encourage thriving communities.

In addition to focusing on the community at-large, we also consider how we can support health equity for our employees. One mechanism by which we support our employees is through our employee benefits program with tiered premiums corresponding to employee salary ranges.

Other examples include financial support for dependent care and a robust employee wellness program which provides regular programming to improve both physical and mental health and well-being. Additionally, employees can participate in programs such as evidence-based health education and work with community health workers to navigate SDOH needs. We also have an employee emergency fund to help fill gaps in times of need. Through other programs such as YES and Grow Our Own, we provide opportunities for entry-level employees to gain skills and education leading to higher pay careers at little-to-no-cost to the employee. We continue to seek innovative ways to support employee health, well-being and ability to thrive.

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Priority Areas to Be Addressed Chronic Disease

Overweight/obesity, hypertension and heart disease Goal: Improve health behaviors and outcomes for individuals with overweight/obesity, hypertension and heart disease who are also experiencing health-related social needs Strategy Metrics Resources Collaborators Timeline Explore • Number of • Designated staff Carilion Community FY25 – FY27 implementation a participants and department Health and fruit and vegetable Outreach, Carilion support • Value of prescription Family and prescriptions • Possible grant program Community redeemed funding Medicine, Blue • Participant food Ridge Food Bank, insecurity, body RARA, Live Healthy weight and blood Rockbridge pressure

Implement Healthy Heart Ambassadors program

• Number of participants • Participant blood pressure

• Designated staff and department support • CDC grant via VHHA Foundation

Carilion Community Health and Outreach, Carilion Family and Community Medicine, VDH, VHHA Foundation

FY25 – FY27

Implement evidence-based health and nutrition education programs

• Number of participants • Participant dietary behaviors and physical activity frequency

• Designated staff and department support

Carilion Community Health and Outreach, Carilion Family and Community Medicine, Live Healthy Rockbridge, Carilion Wellness

FY25 – FY27

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Mental Health/Substance Use

Mental health challenges and substance use Goal: Increase access to and capacity of mental health and substance use services for lowincome individuals Strategy Metrics Resources Collaborators Timeline Expand Carilion’s peer support specialist workforce

• Number of staff across service area • Number of referrals and consults

• Staff and department leadership

Carilion Community Health and Outreach, Carilion Mental Health, Carilion Women’s, other internal departments as applicable

FY25 – FY27

Implement evidencebased mental health education and wellbeing programs

• Number of participants • Participant stress management skills, anxiety and depression symptom frequency and resilience indicators

• Designated staff and department support

Carilion Community Health and Outreach, Carilion Mental Health, Carilion Women’s, Live Healthy Rockbridge, Carilion Wellness

FY25 – FY27

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Injury/Violence

Interpersonal violence Goal: Decrease the prevalence of interpersonal violence across the service area.

Strategy Support initiative to grow transitional housing for people experiencing homelessness due to domestic violence

Metrics • Number of transitional housing units available • Number of people utilizing transitional housing

Resources • Staff and department resources

Collaborators Project Horizon, Live Healthy Rockbridge, RARA, RAHC, Valley Community Services Board

Timeline FY 25 FY27

Work with forensic nursing program to identify opportunities and fill gaps in transitioning patients from acute care to the community

• Number of patients seen • Number of patients referred to community organizations • Number and types of resources provided

• Department support • Financial support to address SDOH needs

Project Horizon, law enforcement

FY25 – FY27

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Strategies Impacting Multiple Priority Areas Goal: Create a system of care that addresses health-related social needs within the community and clinical services Strategy Metrics Resources Collaborators Timeline Implement RATS FY25 • Number of health • Department health and FY27 education events held leadership, wellness (screenings, vaccinations, staff support, programming education sessions) through the Rockbridge CAN dinners Explore implementing pop-up clinic model for safety net partnerships Expand Carilion’s community health worker workforce

• Number of clinics held • Number of patients seen and types of services received

• Department leadership • Staff support • Clinical supplies

RARA, Rockbridge CAN, Live Healthy Rockbridge

FY25

• Number of staff across service area • Number of referrals and consults

• Staff and department leadership

FY25 – FY27

Develop employee volunteer program to support the capacity of local organizations working to address CHAidentified needs Coordinate communitywide strategic plan through Live Healthy Rockbridge to further address community health needs

• Development of employee volunteer program • Number of employees engaged in volunteerism • Financial value of employee time supporting organizations addressing community health needs

• Department leadership • Staff support

Carilion Community Health and Outreach, other internal departments as applicable Internal collaboration

• Annual reports from LHR committees accounting for reach and impact of programs hosted by LHR members

• Staff support

Live Healthy Rockbridge

FY25 FY27

FY25

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About Us

Carilion Clinic is a not-for-profit, integrated healthcare system located among the Blue Ridge Mountains. Carilion provides quality care for nearly one million individuals through a comprehensive network of hospitals, primary and specialty physician practices, wellness centers and other complementary services. Our roots go back more than a century when a group of dedicated citizens came together and built a hospital to meet the community’s healthcare needs. Today, Carilion is a vital anchor institution focused on healthcare and dedicated to our mission of improving the health of the communities we serve.

With an enduring commitment to our region’s health, we advance advanced through clinical services, medical education, research and community health investments. Carilion believes in service, collaboration and caring for all. We invest in discovering and responding to local and regional health needs, understanding that we must involve additional stakeholders to address community health issues and create change effectively.

Carilion recognizes the impact the environment has on the health of our communities. Efforts continue to make our hospitals and other facilities more energy-efficient, increase recycling and use of recyclable or bio-degradable materials, reduce waste materials and serve local, sustainable foods to patients and in our cafeterias. Carilion has an office of sustainability which leads these efforts and empowers employees to be involved in environmental health related projects.

CRBH is a critical access hospital dedicated to quality care and patient comfort. Offering both inpatient and outpatient services, CRBH also impacts the health of the community through its Swing Bed program—extended recovery for patients with skilled care needs before transitioning home.

CRBH serves all patients regardless of their ability to pay. The hospital’s governing board members are elected annually and reside in the region. The majority of members are neither hospital employees nor contractors. Medical staff privileges are extended to qualified providers.

Surplus funds are reinvested in new technology, clinical initiatives, education, staff development and charitable efforts. Reinvestments include providing free, discounted and subsidized care and critical medical services not otherwise offered in our region. 1

1 https://www.carilionclinic.org/locations/carilion-rockbridge-community-hospital

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Appendices Appendix 1: Community Health Assessment Team

First Name Last Name

Organization Type

Organization

Marylin

Alexander

Lori

Ashbridge

Leslie

Ayers

Local Government Representative Federally Qualified Health Center (FQHC) Local Government Representative

Beth Nick

Bland Blibro

Senior Services Healthcare

Sade

Bowers

Health District

Malcolm Jenna Patti Elisabeth

Brownlee Cline Cook Copp

United Way Mental Health FQHC Youth Services

Anna Jenny

Crockett Davidson Del Conte Dickovick Dent Douglas Dunn Fitzgerald

Faith Community Higher Education

Rockbridge Area Health Center Rockbridge County Board of Supervisors, FOR Swimming Valley Program for Aging Services (VPAS), Maury River Senior Center Carilion Clinic Virginia Department of Health - Health Educator United Way and Rockbridge Baths Community Organization Rockbridge Area Community Services Rockbridge Area Health Center Girl Scouts - Skyline Council Rockbridge Community Health Foundation and Grace Episcopal Church Washington and Lee University Washington and Lee University United Way of Rockbridge TAP Head Start Lexington City Office on Youth Project Horizon Rockbridge County, Director of Economic Development

Melissa Shirley Jutta Julie Jim

Flint GladwellSayre Holland Hopkins Jenkins Jones

Higher Education United Way SDOH-Focused Organization Youth Services Domestic Violence Local Government Representative Senior Services Healthcare Healthcare - Hospice Chamber of Commerce State Park

Jan Greg

Kaufman Madsen

Higher Education Healthcare

Dorina

Mattioli

Mental Health

VPAS, Maury River Senior Center Carilion Clinic ConnectionsPlus Healthcare Chamber of Commerce Natural Bridge State Park Washington and Lee University – Health Promotion Carilion Rockbridge Community Hospital Rockbridge Area Community Services Trauma Informed Care Network

Alessandra Jen LaTonya Tammy Carol Brandy

Lexington City Council

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First Name Last Name

Organization Type

Organization

Erynn Monique Hattie Alex Stephanie Holly

Miller Moore Myers Neal Noel-Branch Ostby

Healthcare SDOH-Focused Organization Local Foundation SDOH-Focused Organization Healthcare Healthcare

Rebecca Jennifer Malachi Lindsey Vicki

Owen Palmer Palmer Perez Pickle

Kristina Stephanie Molly BreAnne Suzanne Justin Tasha Michelle

Ramsey RiCharde Roberts Rogers Sheridan Skinner Walsh Watkins

Food Access Youth Services Prevention Services SDOH-Focused Organization Healthcare Local Government Representative Transportation Healthcare Community Services Board FQHC Insurance Provider Healthcare - Hospice Transportation

Carilion Clinic TAP Head Start Rockbridge Community Health Foundation TAP Head Start Carilion Clinic Internal Medicine Carilion Clinic Virginia Cooperative Extension FCS SNAP-Ed Agent Live Healthy Rockbridge Kids Rockbridge Area Prevention Council Rockbridge Area Resource Association Carilion Rockbridge Community Hospital

Laura Lee Alexa Christian

Wight Williams Worth

Health District Healthcare United Way

Buena Vista City - Economic Development Rockbridge Area Transportation System Carilion Clinic Rockbridge Area Community Services Rockbridge Area Health Center Anthem Medicaid Rockbridge Area Health Center VPAS, Maury River Senior Center Virginia Department of Health - Population Health Rockbridge Area Health Center United Way of Rockbridge

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Appendix 2: Community Health Need Prioritization Activity Table Activity Prioritization Survey Teams Poll Group Discussion Method Using their community Using the results of the The group was asked to knowledge, data collectively Prioritization Survey, the reflect on the results of the reviewed, and additional group was asked to dot voting exercise. The data shared, CHAT individually choose 5 topics following points were made to prioritize: during that discussion: members were asked to complete an electronic • The CHAT facilitators • Mental Health vs. survey to prioritize hung pages around the Substance Use vs. community health topics Depression meeting room, each with prior to CHAT meeting 3: one of the topics from the o Mental Health • The survey matched the Prioritization Survey should be results. structure utilized during considered the data walk at CHAT separately from • Utilizing a poll within the Meeting 2 Substance Use Teams meeting, each attendee was asked to • First prioritized broad o Depression can be choose the top 5 topics categories, then specific included with poor they felt were the most topics within those mental health categories important to address in the next three years. o Substance Use • CHAT facilitators ranked should include the following to develop • The voting results were tobacco use, vaping results: available immediately. and cover all ages o Broad categories • The CHAT was • High blood pressure (resulting top 3 presented with the top 5and heart disease indicated by bold type 7 topics. The number of can be combined. below) results presented depended on any ties o Topics within each of • Domestic Violence and how closely votes the 3 top broad had nearly as many categories were distributed. If topics votes as the other o Remaining topics were additional (i.e. not top needs and in the true top 5), CHAT should be included • Results include: facilitators noted this to the group and separated o Top 3 topics of each of them visually on the the top 3 broad screen. categories o Top 4 topics of the remaining categories

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Results* Mental Health/Substance Top 6: Use • Substance use • Substance use • Poor mental health • Poor mental health • Overweight/obesity • Overdoses • High blood pressure • Depression Chronic Disease • Heart Disease • Overweight/obesity • Diabetes • Heart disease

Injury/Violence • Firearm injuries/deaths • Domestic violence/intimate partner violence • Motor vehicle crashes

Additional: • Domestic

violence/intimate partner violence

Top 5: • Substance use • Poor mental

health/depression

• Overweight/obesity • Heart disease/high blood

pressure

• Interpersonal Violence o Domestic violence o Child abuse o Elder abuse

Maternal/Child Health & Infectious/Communicable Disease • Teen pregnancy • Infant mortality • STIs • Hepatitis C *Results are not presented in any ranked order.

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