Legacy Community Health Year in Review - Fiscal Year 2016

YEAR IN REVIEW Fiscal Year 2016

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Legacy Community Health - YEAR IN REVIEW 2016

TABLE OF CONTENTS

Forward by CEO

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By the numbers

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Our community impact

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We are the solution

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Physician profiles

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MISSION Driving healthy change in our communities.

VISION Connecting our communities to health every day, in every way.

VALUES Health Care As a Right, Not a Privilege. We believe that comprehensive health care is a human right. Legacy’s services and programs are open to all who need us, regardless of the ability to pay, without judgment or exception.

Devotion To Our Communities: We continue to build our legacy on a solid foundation by learning from our communities, embracing the people in them, and serving their unique needs. Especially when no one else will.

Leading The Charge: We address issues others shy away from. Not because it’s easy or popular, but because it’s the right thing to do. The Legacy team possesses unwavering courage and serves as a visionary catalyst for sustainably healthy communities.

Active Stewardship of Resources: We carefully manage our available resources, in order to deliver on our promise of driving healthy change. We remain grounded in responsible decision making for sustainable operations, putting every asset where it can do the most good for the community.

C ITY OF H OUSTON From its roots in the HIV/AIDS crisis of the 1980s, Legacy has become a powerhouse medical institution serving Houston’s low-income patients. One million Texans have little or no insurance, so Legacy fills a critical need in the region by providing adult primary care, pediatrics, OB/GYN, behavioral health and much more to 100,000 patients.

What’s so successful about the organization’s model is that each of its 20 clinics reflects the micro-communities it serves - no easy task since Houston is, quite literally, the most diverse city in the country.

We are home to the largest medical center in the world, brandishing a world-class reputation in medicine. Legacy’s work only makes that reputation stronger.

Sincerely,

Sylvester Turner Mayor

Forward by CEO

The growth of Legacy has exceeded my expectations, not to mention my wildest dreams.

We went from a tiny one-story yellow house on Westheimer Road back in the 1980s with a staff of 12 and budget of $3 million to now 22 clinics, anchored by our flagship building in the heart of Montrose, with a staff of 750 and a $100 million budget.

None of this would have been possible without the generosity of individual, corporate, and foundation donors.

They have continued to step up time and again to help us meet the explosive demand for health care in Southeast Texas.

Nor would we be where we are today without our physicians - like those profiled in this year’s annual report who on a daily basis strive to provide excellence in care. We’re lucky to have some of the brightest minds in the area go the non-profit route at Legacy.

There is much on our horizon over the next year: managing emerging infectious diseases, expanding a wildly successful early childhood literacy program called Little Readers, and revving up our public affairs practice for the next convening of the Texas legislature. On tap, too, is finalizing a citywide strategic plan to cut all new HIV infections in half over five years, thanks to a grant from the Ford Foundation and AIDS United.

And along the way we are always guided by our North Star: being a high-quality, judgement-free medical home for our patients, regardless of their ability to pay.

Katy Caldwell

CEO Legacy Community Health

LEGACY COMMUNITY HEALTH: BOARD OF DIRECTORS Beth Bruce Amanda Goodie Lauren Soliz Glenn Bauguss Glenna Pierpont Sehba Ali Beryl Basham Tony Bravo George Burch Dr. Abigail Caudle

Chairperson Vice-Chairperson Secretary Treasurer At-Large/Exec. Committee Victor Cordova, Jr. Bryan Hlavinka Alex Jessett Bethsheba Johnson Alton LaDay

Melanie Gray, Board Member Emeritus Melissa Mithoff, Board Member Emeritus Monsour Taghdisi, Board Member Emeritus

LEGACY COMMUNITY HEALTH ENDOWMENT: BOARD OF DIRECTORS FORWARD Claire Cormier Thielke Tripp Carter Mike Holloman James A. Reeder, Jr.

Chairperson Vice-Chairperson Secretary Treasurer

Michael S. Alexander, J.D. Joshua L. Espinedo Bryan Hlavinka Brent N. Whiteley

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BY THE NUMBERS

WHOM DO WE SERVE?

Number of employees

2%

750

Asian

3%

Other

Caucasian

61% of our patients live

15%

at or below 100% of the federal poverty level

125,000 50 40 30

2%

20

17%

395,000

AGE

35%

Number of annual appointments booked Over

African American

21%

More than

58%

22%

25%

Number of patients served annually

Hispanic

10

We have 22 locations

Houston, Baytown, and Beaumont

0

Under 5 5-19

20-44

45-64 Over 65

GENDER

43%

57%

<1%

OUR FINANCIALS (FY16)

Total revenue: $108,479,905 Total expenses: $106,351,921 Total uncompensated care: $8,541,465 6

Legacy Community Health - YEAR IN REVIEW 2016

Connecting our communities to health every day, in every way.

PATIENT PROFILE

“On a scale of one to 10, I give the employees here a 10.”

Charles Jackson, patient and Fifth Ward resident

Now in his late 70s, Charles Jackson was born in Houston’s Fifth Ward during segregation and lived through the turbulent integration process. He served in the Korean War and worked hard to make a life for his family. But health care for his family became an issue later in life.

“Our regular doctor stopped accepting Medicaid, and my wife and I needed a clinic that could manage our various conditions, like her diabetes, that wasn’t all the way across town,” Charles says. “We chose the Legacy Lyons Clinic, and immediately felt the welcoming spirit the employees give off. On a scale of one to 10, I give the employees here a 10.”

Patients like Charles, who have given so much to this country and city, deserve a medical home to call their own. Legacy’s new Fifth Ward clinic will be just that, providing a historic neighborhood with the high-quality compassionate health care.

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OUR COMMUNITY IMPACT

Major Depression Should Be Treated Like Any Other Serious Medical Condition

Healthcare Advocates in Houston Herald Clinton’s Strategy to End HIV/AIDS

APPOINTMENT AND AWARDS In addition to Katy Caldwell and Chree Boydstun serving on the transition team of Houston Mayor Sylvester Turner, Legacy staff members – Renita Cooksey, Januari Leo, Tim Martinez, and Kevin Nix have been appointed to the mayor’s LGBT advisory board, with James Lee appointed to the mayor’s Hispanic advisory council. Dr. Ann Barnes won the YMCA’s “Outstanding Woman in Healthcare” award. Venita Ray was named one of the year’s “most amazing HIV-positive people of 2016” by HIV-Plus Magazine.

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Legacy Community Health - YEAR IN REVIEW 2016

OUR COMMUNITY IMPACT

Both in and out of the exam room, Legacy had an impact on our patients and communities we served in the last year.

HIGH-QUALITY, AFFORDABLE HEALTH CARE

EDUCATION

Legacy graduated 149 people in our GED programs and, with sponsors like ExxonMobil, Kroger, United Healthcare, Visible Changes, and the Children’s Museum, provided 1,300 students with back-toschool supplies and haircuts.

In a state without Medicaid expansion, Legacy helped fill the demand for care among those who are uninsured or underinsured in Southeast Texas, serving 125,000 patients in the last year. The agency expanded its physical presence in underserved parts of the region.

MENTAL HEALTH

With a new grant from Houston Methodist, Legacy is now able to serve young people diagnosed with mental health disorders who have recently been released from Harris County Juvenile Detention.

HIGH-RISK PREGNANCIES

ZIKA VIRUS

The agency has been a statewide leader in responding to the Zika virus in Houston.

We distributed 2,000 free Zika Prevention Packs to pregnant moms. Through our robust advocacy efforts, political leaders and the public took on a greater sense of urgency around preparedness.

Legacy’s maternal fetal medicine program was awarded a multi-year grant from Noble Energy, Inc. to help expand staff and ensure the program will remain a resource for women with highrisk pregnancies for many years to come.

LITERACY

OBESITY

Our 3-month pilot program to reduce obesity among our young patients yielded impressive results: families made beneficial changes in the way they shopped for and prepared food, and kids took a greater interest in their own nutrition.

ORLANDO TERRORIST ATTACK

Legacy built a coalition of Houstonbased businesses and non-profits, #HoustonStandsWithOrlando, to stand with the victims’ families and to calm security concerns around the city’s LGBT Pride parade.

ENDING HIV

Our “Little Readers” early childhood literacy program, in partnership with H-E-B and the Barbara Bush Literacy Foundation, has given away 20,000 books to pediatric patients in one year and established reading nooks in our clinics.

With a grant from the Ford Foundation and AIDS United, Legacy is spearheading a citywide strategic plan to cut the number of people living with HIV in half over five years. Our bilingual “Down it” marketing campaign educated thousands about pre-exposure prophylaxis (PrEP).

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PATIENT PROFILE

“The staff made me feel warm right off the bat.”

Oralia Cordero, patient-turned-employee

Oralia Cordero kept her pregnancy a secret for five months. “I was 19, pregnant, scared to confront reality.

I was worried about what people would say.”

Like many young people in her situation, Oralia was uninsured and didn’t know how to find a good, affordable doctor. Luckily, her future mother-in-law knew about Legacy. “The staff welcomed me warmly and made me comfortable right off the bat,” says Oralia.

Her first visit to the Legacy Southwest Campus included a free pregnancy test and an appointment with eligibility staff. Oralia and her unborn child were soon getting the prenatal care that nearly 30% of women in Harris County go without.

Oralia now works as an Obstetrics Care Coordinator at Legacy’s Southwest clinic.

Driving healthy change in our communities.

THE PROBLEM

Health conditions that affect our communities and the nation.

WOMEN’S HEALTH

DENTAL

ELIGIBILITY

About

An estimated

children aged 5 to 11 years have at least one untreated decayed tooth.

new cases of HPVassociated cervical cancer are diagnosed in the U.S. each year.

5.0 million

(Centers for Disease Control and Prevention)

(Texas Medical Association)

1 of 5

11,995

(Centers for Disease Control and Prevention)

Texans are uninsured, including 784,000 children.

BEHAVIORAL HEALTH

ADULT CARE Heart disease is the leading cause of death for men of most racial/ethnic groups in the U.S. (Centers for Disease Control and Prevention)

The number of adults in the U.S. aged 18–79 with newly diagnosed diabetes has more than tripled from 493,000 in 1980 to more than 1.4 million in 2014.

(Centers for Disease Control and Prevention)

25%

of all U.S. adults have a mental illness.

(Centers for Disease Control and Prevention)

HEALTH EDUCATION

12.7

Approximately million U.S children and adolescents aged 2–19 years are obese.

(Centers for Disease Control and Prevention)

66%

Approximately of Houston-area adults were overweight or obese in 2009, compared to 61% in 2002. Since 1990, Texas adult obesity rate has tripled.

(Texas Department of State Health Services; stateofobesity.org)

HIV CARE

LGBTQ SERVICES

1.2 million 22,551 Americans are living with HIV/AIDS. (Centers for Disease Control and Prevention)

people are living with HIV/AIDS in the Houston/ Harris County area.

(HIV Infection in Houston – An Epidemiological Profile 2010 - 2014)

4x

Trans youth are more likely to attempt suicide than their heterosexual peers.

(National Alliance on Mental Illness)

21.5%

do not know their status.

of lesbian, gay, and bisexual youth were likely to attempt suicide in the previous 12 months vs. 4.2% of heterosexual youth.

(Centers for Disease Control and Prevention)

(American Academy of Pediatrics)

16% of those people

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THE SOLUTION

With Legacyâ&#x20AC;&#x2122;s vision of health care to all, weâ&#x20AC;&#x2122;re committed to providing a range of clinical services: Adult Primary Care

Health Promotion & Education

Pediatrics

Behavioral Health

HIV Specialty Care

Pharmacy

Dental

LGBT Services

Social Services

Eligibility & Enrollment

OB/GYN & Maternity

Vision

Family Medicine

Patient Navigation & Linkage to Care

Gender Health & Wellness

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Legacy Community Health - YEAR IN REVIEW 2016

DR. ANN BARNES

PHYSICIAN PROFILES

Chief Medical Officer

Harvard Medical School, M.D. University of Texas School of Public Health, M.P.H. Ann Barnes found her calling to serve Legacy’s primary patient population - the underserved - growing up and going to church in Houston’s Fifth Ward. Her upbringing is also the basis for her governing philosophy, what she coins the Medical Golden Rule: care for others as you wish to be cared for.

The exam-room experiences of the 170 medical providers Barnes oversees as chief confirm the startling statistics that obesity - and related conditions like diabetes and depression is the number one health problem today. The solution, Barnes says, is for medical institutions to expand their singular focus beyond the exam room to environmental factors, like access to affordable, healthy food and exercise facilities.

“Your daily grind, my daily grind, has a direct impact on our health,” says Barnes. “My hope is more providers get into the business of influencing social determinants of health like Legacy is. That’s the only way we will see a truly healthier Houston.”

DR. CHAD LEMAIRE

Medical Director, Behavioral Health Baylor College of Medicine, M.D.

Through Chad Lemaire’s six years at Legacy, he has seen the behavioral health department grow from five providers to more than 60. That’s due to the agency’s overall growth in recent years and to the skyrocketing demand for behavioral health services. Some would see that as a troubling sign. Lemaire doesn’t.

He believes the stigma around seeking treatment for mental health conditions is declining, albeit slowly. More patients are actively treating, instead of ignoring, behavioral conditions. He is the first to admit, however, that meeting the increased needs of patients seeking treatment for mental disorders remains a monumental task.

Lemaire values working at an organization where every patient is given the same high-quality care regardless of socioeconomic status. Patients and their families express gratitude for their care. He recalls fondly the daughter of one of his formerly suicidal patients telling him, “Thank you for giving me my mom back. You saved her life.”

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PHYSICIAN PROFILES

DR. JENNIFER FELDMANN

Adolescent Medicine/Gender Care Indiana University, M.D. University of Texas School of Public Health, M.P.H.

Jennifer Feldmann left her academic teaching career behind to come work for high-risk populations that didn’t have access to health care. That Legacy was willing to take on an innovative topic – transgender care - helped, too.

Feldmann sees transgender youth, who are eight times as depressed and much more likely to attempt suicide as the rest of the population. More than 40% of transgender Americans try to kill themselves at some point in their lives, compared with 4.6% of the general public, according to the American Foundation for Suicide Prevention and the Williams Institute.

Feldmann sees patients who drive 12 hours - from as far away as El Paso and Brownsville - to get the highest-quality trans care at Legacy’s flagship Montrose clinic. The agency sees 1,000 transgender patients a year.

DR. NATALI MUEHE

Pediatrics

Texas Tech Health Sciences Center, M.D. Natali Muehe was raised by a family of educators, which explains why she was drawn to a profession that educates parents about their child’s health, be it treatment for current ailments or prevention.

Obesity is just one example. Muehe notes that for the first time in history, pediatricians are seeing very young children with elevated cholesterol and hemoglobin A1c as a result of a more sedentary society. Her goal is to inform parents from the beginning how to start healthy habits for their children.

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Legacy Community Health - YEAR IN REVIEW 2016

PHYSICIAN PROFILES

DR. JUAN FRANCO

OB/GYN SPECIALIST

University of Texas Health Science Center at Houston, M.D. Juan Franco is the lead OB/GYN doctor. At Legacy’s Southwest Houston clinic, he and his team see 300 pregnant moms a day for prenatal care, many of whom come from, or have roots in, Latin America.

“Working at Legacy allows me to work with a patient population that I feel I have a connection with,” says Franco.

“For that reason, there is a level of trust in the exam room that helps provide superior care.”

With the emerging Zika virus, Franco has been assuaging anxiety among his pregnant patients. “I can’t imagine a better doctor to have while being pregnant,” Victoria, a patient, says of Dr. Franco. “I do what the doctor orders to protect myself from Zika. And he just makes me feel better.”

DR. NATALIE VANEK

Infectious Disease

University of Texas Health Science Center at Houston, M.D. For almost a decade, Natalie Vanek had helped build Legacy’s preeminent HIV practice, which remains anchored in the Montrose location but has expanded to multiple clinics in the region. She has made significant contributions to the agency’s reputation in HIV medicine across Texas and the nation. More than once has she treated an HIV- positive husband and his HIV-positive wife, then working with them both to give birth to an HIV-negative baby.

She also develops the protocols, both internally and for the public, around other infectious diseases like Hepatitis C, Ebola, and measles. It’s about treatment, prevention, and, importantly, managing the public’s anxiety around new diseases to the region.

Vanek has been honored to serve as national vice chair for the AIDS Drug Assistance Program, which determines how to spend federal money from the Ryan White HIV/AIDS Program for those who cannot afford medication.

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DONOR MESSAGE

“The people at Legacy constantly impress me with their patient-driven initiatives.”

Beth Bruce wants to make sure Legacy is part of the Texas landscape for decades to come. “I was introduced to Legacy in 2007, and immediately saw how much the people of Houston needed the services they provide,” she says. “Health care for all is such a noble goal, I knew I had to be a part of ensuring the organization survived.”

Bruce has stayed with the organization through thick and thin, going from Board member to employee and back to Board member. “I can remember a time when we were all worried about sustainability, when we relied on the same donors over and over just to keep the lights on,” she recalls. “We were also very small, with only a few locations in central Houston.” It’s those memories that drive her today as Legacy’s Board Chair.

“It’s a huge responsibility, making sure Legacy is part of the ever-changing health care environment. Those of us in leadership positions owe it to our patients and employees to make sure Legacy is in this for the long haul,” Bruce says.

“That’s what excites and energizes me as Board Chair, I want to make sure our doors never close so that people all over Southeast Texas know they can always rely on Legacy for their health care needs.”

Given her feelings, it’s no surprise Bruce wants to see Legacy’s footprint continue to expand. “Legacy is very good at finding the right areas and employing our model,” Bruce says. “I want us to keep doing what makes us successful: finding areas of need and becoming part of those communities. We’re no longer a local clinic, but a regional health center that can make a huge impact on people’s lives. Our adaptability is key, and it’s why we’re able to meet so many diverse needs.”

Bruce points to programs like Little Readers, which gives children six months to 12 years old an age-appropriate book at well-child visits, and the Zika virus education and prevention efforts as success stories. “We saw the need for improved literacy and started giving away books. We saw a life-threatening disease arrive in Texas, and were proactive in preparing prevention kits to stop it from spreading. Instances like these are a testament to Legacy’s leadership and staff, as well as the volunteers who put together thousands of Zika prevention packets.”

“The people at Legacy constantly impress me with their patient-driven initiatives,” Bruce concludes.

“From medicine to behavioral health, from back to school events to Becoming a Mom classes, if you have a need we’ll figure out how to help you.”

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Legacy Community Health - YEAR IN REVIEW 2016

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PATIENT PROFILE

“Legacy’s Autism Support Group has changed not only Robert’s life, but the lives of our entire family.”

Idalia Martinez, mother of a patient

Three years ago Robert Martinez didn’t like to talk to people, much less look them in the eye. “I couldn’t get him out of his room by himself,” says Idalia, his mother.

“He was uncomfortable around other people. I wasn’t sure what was wrong.”

Robert then enrolled in Legacy’s Autism Support Program, the first bilingual autism initiative in Houston.

Following weekly social skills meetings, he learned how to better interact with people by looking for social cues and recognizing facial emotions and body language. Now, at 17, he’s independent, smiles easier, can make his own food and get ready for school without help.

“He’s the best-dressed in the family,” says his mom. “I’m optimistic about his future.”

“My hope is more providers get into the business of influencing social determinants of health like Legacy is. That’s the only way we will see a truly healthier Houston.”

DR. ANN BARNES Chief Medical Officer

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