At Wellstar, we have moved beyond IRS requirements – from compliance to strategic alignment – which allows the system to improve community health and demonstrate return on investment for Community Benefit activities. This report shares how Wellstar Health System has continued building and aligning for health equity.
More than healthcare. PEOPLECARE THREE YEARS LATER — WELLSTAR HEALTH SYSTEM’S RESPONSE TO THE 2022 CHNA
Wellstar North Fulton Hospital More than healthcare. PEOPLECARE
At Wellstar, we have moved beyond IRS requirements – from compliance to strategic alignment – which allows the system to improve community health and demonstrate return on investment for Community Benefit activities. Maintaining efforts beyond the three-year Community Health Needs Assessment (CHNA) cycle ensures Wellstar remains responsive to persistent community health issues and maintains continuity from one Implementation Plan to the next. This report shares how Wellstar Health System has continued building and aligning for health equity.
1 | RESPONSE TO 2022 CHNA - THREE YEARS LATER
PEOPLE-CENTRICCARE DRIVING LASTING CHANGE
2 | WELLSTAR HEALTH SYSTEM
SUPPORTINGHEALTHEQUITY
In 2019, Wellstar Health System expanded its understanding and use of the Community Health Needs Assessment (CHNA) by launching the Wellstar Center for Health Equity (WCHE). The WCHE – an extension of Wellstar’s long history of community engagement and allyship to provide people-centric care – was formed to drive lasting change at a grassroots level. During the 2022 CHNA process, the following six strategic domains were identified as priorities: Access to Care, Behavioral Health, Food Access and Healthy Living, Housing, Pediatrics, and Women’s Health.
Wellstar’s Center for Health Equity activates system-wide strategies, initiatives and programs that are addressing health disparities. Driven by a cross-functional team; the Center leverages Wellstar’s diverse leadership and expertise so we can show up for our community when and where they need us most.
WELLSTAR STRATEGIES Strategic Alignment Six strategic domains guide the Center’s programs, policies and systems in addressing health disparities for our communities.
HEALTH FACTORS Social Determinants of Health
WELLSTAR TACTICS PeopleCare in Action Wellstar is committed to a multidisciplinary approach to address deeply entrenched inequities that inform health disparities.
WELLSTAR GOAL Health Equity
Health equity is the attainment of the highest level of health for all people.
Wellstar’s Community Health Needs Assessment highlights factors that impact our com- munity’s health and well-being.
Data-Driven Community Health Strategies
Access to Care
Access to Care
Strategic Partnerships Through internal and external strategic partnerships, the Center is better positioned to implement multi-disciplinary
Healthcare Systems
Education
Behavioral Health
Payor/ For-prot organizations
Clinical Integration
Public Health Agencies
Food Insecurity
Food Access and Healthy Living
Strategic Partnerships
approaches to address factors that drive deeply entrenched health inequities.
Income
Community Health Strategic Partnerships
Public Health Leaders and Advocates
Housing
Academia
Social Support
Thought Leadership
Pediatrics
Systemic Injustice
Community and Faith-Based Organizations
Philanthropic Community
Public Policy & Advocacy
Women’s Health
Transportation
Learn more about the Wellstar Center for Health Equity by going to wellstar.org/centerforhealthequity Want to join our listserv to receive up-to-date information? Email us at CenterforHealthEquity@Wellstar.org
Each of these strategic domains connects to Wellstar medical service lines to utilize the deep expertise and broad bench of resources needed to identify pertinent needs, relevant partnerships and viable evidence-based programs. Wellstar remains the only health system in Georgia with an established Center for Health Equity.
3 | RESPONSE TO 2022 CHNA - THREE YEARS LATER
Wellstar Community Health Department The Wellstar Community Health department coordinates connections between people who experience poor health outcomes and resources to improve their health. Community Health programs are designed as place-based investments, particularly in high-need zip codes (Figure 1) , to activate new ways for community residents to engage with their health or the health care system. The department ensures that after programs end, community residents and partner organizations are linked to more sustainable resources that they may
continue to engage in health and well-being (Figure 2) . Figure 1 | Community Needs Index Score by ZIP Code (2020)
Hall
Floyd
Bartow
Forsyth
Cherokee
Polk
Barrow
Gwinnett
Paulding
Cobb
Haralson
Walton
DeKalb
Douglas
Fulton
Rockdale
Clayton
Carroll
Newton
Henry
Fayette
Coweta
Jasper
Heard
Butts
Spalding
Meriwether
Pike
Lamar
Troup
Monroe
Upson
Harris
Alabama
Talbot
Crawford
1.0–1.7
1.8–2.5
2.6–3.3
3.4–4.1
4.2–5.0
Figure 1 shows the Community Needs Index for the zip codes served by Wellstar Health System. The index ranks each zip code in the United States against all other zip codes on five socioeconomic factors that are barriers to accessing healthcare: income, culture, education, insurance, and housing. Each factor is rated on a scale of 1 to 5 (1 indicates the lowest barrier to accessing healthcare and 5 indicates the most significant) .
4 | WELLSTAR HEALTH SYSTEM
Figure 2 | Wellstar Community Health Department Program Design
Deliver new information about a health topic or driver of health Empower individuals with new information about their personal health status Direct positive changes in health status for individuals and their families
Improved community capacity
Funding
Access to health care
Health Engagement Activation
Sustainable Resource Linkage
Place-Based Investment
Knowledge
Access to resources to support drivers of health (i.e.: food, technology, transportation, etc.)
Staffing
From departmental inception in June 2020 through June 30, 2024, Wellstar Community Health achieved more than 89,000 contact points (Figure 3) . These intentional and meaningful engagements with community residents took place through a variety of community programs and across the entire Wellstar footprint. Figure 3 | Wellstar Community Health Contact Points (FY2020–FY2024) Program Name Number of Participants Cancer 2,398 Center for Global Health Innovation 1,390 Center for Health Equity 1,490 Community Transformation Program 13,218 Congregational Health Network 868 COVID-19 Pop-Up Testing 3,635 COVID-19 Vaccinations 10,411 Dignity Packs 550 Live to the Beat 36 Mobile Market 13,744 MSW Student Rotation 15 Nourish to Flourish 66 Passport to Health 1,591 Resource Room (Educational Material) 17,814 Soul Support 451 Virtual Health Initiative 5,266 Wholesome Wave 11,063 Women’s Health 5,055 Total 89,061
Access to Care
Food Access and Healthy Living
Behavioral Health
Women’s Health
5 | RESPONSE TO 2022 CHNA - THREE YEARS LATER
Wellstar Foundation Wellstar Foundation plays a crucial role in improving the health of our communities by actively pursuing community partnerships and philanthropic support that will transform the future of healthcare and improve access for every person within our service area. One hundred percent of all contributions are thoughtfully reinvested in programs, services, and equipment that meaningfully impact people’s lives and wellness. The strategic pillars of focus include: Health Equity, Behavioral Health, Innovation, Workforce Development, and Clinical Excellence.
Health Equity Improving access to high-quality healthcare and the preventative services that help Georgians stay healthy today and for generations to come.
Behavioral Health Providing integrated behavioral healthcare services that address the health of the whole person — mind and body.
Innovation Expanding access to world-class healthcare services and promoting best practices, like equipping patients and clinicians with state-of-the-art technology.
Workforce Development Supporting and training our team members and future healthcare professionals to provide superior, highly skilled care for patients at every age and stage.
Clinical Excellence Delivering world- class PeopleCare across all clinical services that is personalized to the unique and diverse needs of the people we serve across Georgia.
Examples of funded programs include: ■ Mobile market program serving 800 families across Georgia each month to address food insecurity. ■ Free mammograms and diagnostic services for high-risk communities, as well as lung cancer screenings provide peace of mind and life-saving treatment to individuals in need. ■ Resources and behavioral health services for individuals experiencing homelessness and those struggling with substance addiction. Catalyst by Wellstar
Click or scan the QR Code to learn more about the Wellstar Foundation, including its impact and ways to give.
Capital and expertise fuel innovation to disrupt the status quo and create a healthier future for all of us. Catalyst by Wellstar is the first-of-its-kind innovation company and venture firm. Catalyst builds better healthcare by harnessing problems, creating solutions, investing in promising startups, and partnering across industries to deploy a true ecosystem of care.
Care of Tomorrow Enabling well-being and sick care integration through health accessibility, such as inventive digital health methods, using wearables for early detection to increase wellness. Future of Work Empowering team members to feel support and belonging and be the best version of themselves whether providing care in-person or remotely.
Customer Experience Relieving “dread of the doctor” with patient-centric care tailored along your health journey that provides empathic connection across digital and physical environments. Sustainability Reducing negative environmental impacts to create a healthy Earth for future generations with investments in farming and nutrition, renewable energy and sustainable value chains.
Data and Security Equipping you with your own health data secured through leading edge technologies and providing breakthroughs with real world data reporting.
Supply Chain and Mobility Powering smart, orchestrated logistics and navigation with autonomous solutions and supply delivery to remote populations.
6 | WELLSTAR HEALTH SYSTEM
SUCCESS STORY: In 2024, Catalyst partnered with WCHE to bring
Enrichly – a fun, interactive digital program that teaches confidence, self-acceptance, and resilience to youth at Atlanta Berean Seventh-day Adventist Church. Wellstar Strategic Community Development
Click or scan the QR Code to learn more about Catalyst, including its impact and ways to fund innovation at wellstar.org/catalyst
Wellstar focuses on engagement, partnership and investment with organizations in the communities we serve across three primary domains, including Mission-Aligned & Other Non-Profits, Business & Civic, and Academic & Workforce Development. Wellstar also supports engagement opportunities that align with our current enterprise and strategic business goals and priorities. Mission-Aligned and Other Non-Profits: Includes organizations with a clear mission focused on health, well-being, and clinical outcomes. Wellstar will partner with these groups to address priority health needs as defined by Wellstar’s current Community Health Needs Assessments and to further enterprise strategic priorities and goals, including:
Housing
Pediatrics
Access to Care
Behavioral Health
Diversity, Equity, Inclusion and Belonging page 9
Food Access and Healthy Living
Women’s Health
page 26
page 36
page 38
page 12
page 22
page 42
Business & Civic Partnership: Includes organizations that exist to further the collective interests of the business and/or civic community such as Chambers of Commerce, Rotary and Kiwanis Clubs, and local city and government agencies. Academic & Workforce Development Partnership: Includes local school districts and organizations focused on youth and career development whose missions are aligned with creating talent pipelines to clinical and non-clinical careers in healthcare. Enterprise and Strategic Business Goals and Priorities : This includes community events or programs that serve to increase awareness of Wellstar’s presence and services. In the 2022 CHNA Implementation Plan, Wellstar Strategic Community Development committed to increase corporate social responsibility investments and provide positive social value through strategic partnerships and sponsorships.
7 | RESPONSE TO 2022 CHNA - THREE YEARS LATER
Additional Strategic Collaborations WCHE drives change in alignment with Wellstar’s strategic destination as an ecosystem of care powered by a digital operating model. Wellstar’s bold approach ensures that digital transformation is not just about technology products, but also reflects transformation in Wellstar’s operations, spaces, and company culture. Priorities and initiatives centering improvements in access and enhanced health and well-being for patients, team members, and communities alike are demonstrated in each strategic theme.
Our Strategic Destination An ecosystem of care powered by a digital operating model.
Celebrate Our People & Culture Enable a workforce that is healthy (mind, body and spirit), inclusive, innovative, engaged, digitally competent, and operating at the top of scope.
Personalize Care Models Engage all we serve in an ecosystem of personalized care that delivers the highest value.
Engage Consumers Empower meaningful, curated experiences every step of the way to help consumers achieve their best health and well-being.
Elevate Communities Positively impact community well-being through engagement and partnership that honors all voices.
Build Connections Expand access to
world-class healthcare how, when, and where consumers want and need it.
8 | WELLSTAR HEALTH SYSTEM
To elevate communities, WCHE partners closely with internal departments for strategic thought leadership, institutional competency-building, partnership development, funding distribution, and project management support. WCHE follows a two-pronged approach:
Community-Driven Solutions Partnering with communities to drive locally determined solutions and policies that influence systems, services and practices to create equitable conditions that improve well-being.
Building Sustainable Infrastructure Building health equity capacity and competency within Wellstar Health System to streamline business practices and reporting.
Service Lines and Business Units
Wellstar Research Institute
Community Health
Community Development
Community- Driven Solutions
Sustainable Infrastructure
Government Relations
Wellstar Foundation
Data
Ethics
Inclusive Insights in Partnership with Diversity, Equity, Inclusion and Belonging (DEIB). April is annually recognized as National Minority Health Month. The recognition builds awareness of health disparities and encourages preventive action. In April 2023, Wellstar hosted a 3-part speaker series to amplify the voices of our internal subject matter experts. Members of Wellstar Community Health and Center for Health Equity and the Underrepresented Minority Physicians Business Resource Group (BRG) identified qualified and engaging speakers to share information
related to the historical inequities and disparities in healthcare. The series aimed to increase awareness of the root causes of health disparities among traditionally medically underserved communities, and promote best practices for reducing disparities and achieving equity. The series was attended by more than 800 team members; 98% of surveyed team members were likely to recommend the series to others.
Three virtual Lunch & Learn events were attended by more than 800 individuals.
9 | RESPONSE TO 2022 CHNA - THREE YEARS LATER
Advancing a Digital Ecosystem for Health Equity. In partnership with information technology teams, and with funding support from Wellstar Foundation, WCHE implemented Wellstar Find Help, a system-wide digital tool connecting patients to local resources for food, transportation, housing, and other resources. Wellstar Find Help enables Wellstar to address social determinants of health, the non-medical factors influencing the health and wellbeing of patients and community members. Additionally, WCHE team members began development and socialization of an “Equity Dashboard”. The dashboard is comprised of digital demographic information intended to guide system-wide decision-making for serving patients from traditionally medically underserved communities.
Wellstar Find Help search screen
With the Wellstar Find Help tool, people can search for free or reduced-cost resources to help care for every aspect of well- being, including: Food, Housing, Transit, Clothing, Personal care items, Financial assistance, and Legal aid. The site translates into multiple languages to best serve our communities.
Click or scan the QR Code to access Wellstar Find Help.
Wellstar System Equity Dashboard
The Wellstar System Equity Dashboard depicts patient demographic information intended to guide decision- making to transform population health outcomes.
10 | WELLSTAR HEALTH SYSTEM
11 | RESPONSE TO 2022 CHNA - THREE YEARS LATER
Access to Care
At Wellstar, people are at the center of everything we do. By listening actively to what people want, need, and expect from their healthcare, Wellstar is able to provide “More than Healthcare. PeopleCare.” — at every age and stage. Primary Care Access According to the 2022 CHNA, the communities served by Wellstar are largely classified as underserved by the Health Resources and Services Administration (HRSA). Douglas, Paulding, Spalding Regional and Sylvan Grove hospitals, and West Georgia Medical Center are all defined as Health Professional Shortage Areas, with lower provider rates (per 100,000 pop.) than is average for the state in primary care, dental, and mental health services. In response, the Primary Care service line embarked on a journey to offer non-traditional access hours that meet the needs of both patients and physicians who are seeking flexible hours. By the end of fiscal year 2024, Primary Care identified several practices across all regions to offer extended hours.
3 of 5 Wellstar health parks now offer extended primary care hours.
7 Wellstar primary care practices operate seven days a week.
9 others offer weekday extended hours.
These extended hours provide approximately six additional appointments per clinician during the week and between 10 to 16 more appointments on the weekends, per practice.
Congregational Health Network Wellstar’s Congregational Health Network (CHN) serves as a bridge between our healthcare system and faith communities. Coordinated by a full-time registered nurse who specializes in faith community nursing, Wellstar’s program is designed to assist congregations of all faiths to develop or support volunteer or paid health ministries. With more than 100 congregations and 1,500 spiritual care partners, CHN serves as a key to Wellstar’s successful implementation of equity-centered programs. Through this network, Wellstar can disseminate information, implement programs at trusted neighborhood-based sites, and strengthen the organizations to provide whole-person support. SUCCESS STORY: The Congregational Health Network – with support from the Wellstar Foundation – forged a relationship with Ser Familia to employ a “Promotora”. Promotoras serve as trusted community partners, advocating for and educating on the individual health needs of community residents. The Promotora – having completed Community Health Worker training – educates and connects Spanish- speaking community members to resources to address social determinants of health. Through this partnership, Wellstar helps traditionally medically underserved communities gain access to health and social care resources.
12 | WELLSTAR HEALTH SYSTEM
Community Clinic Network In 2016, Wellstar 4-1 Care was created to increase access to care and the capacity of partnering community clinics by providing reduced-cost outpatient medical services. Evolution of Wellstar 4-1 Care to the Community Clinic Network: The Community Clinic Network evolved to advance Wellstar’s ability to support community access to care and social support services. As Wellstar’s geographical footprint has expanded, Wellstar is also committed to forging new partnerships with community clinics (i.e., Community Safety-Net Clinics, Community Health Centers and Federally Qualified Health Centers) to more collectively achieve optimal outcomes for more medically underserved and uninsured residents. Wellstar’s reach into critical communities is continuing to grow (Figure 4) . PICKENS
HALL
BARTOW Figure 4 | Community Clinic Network Map FORSYTH
CHEROKEE
FLOYD
GWINNETT
Current: A Good Samaritan Health Center of Cobb B CareLink of Northwest Georgia C The Care Place of Douglasville D Rock Springs of Griffin E Someone Cares of Atlanta (new partner) Pending: F Troup Cares of West Georgia MCDUFFIE
B
E
A
COBB
PAULDING
C
DEKALB
FULTON
DOUGLAS
GREENE
COLUMBIA
AIKE
NEWTON
CLAYTON
CARROLL
RICHMOND L D
HENRY
FAYETTE
COWETA
HEARD
SPALDING
BUTTS
D
LAMAR
PIKE
MERIWETHER
F
TROUP
UPSON
HARRIS
$ 12 million + in relief from medical charges obtained for more than 6,000 Community Clinic Network patients between 2022 and 2023.
6,672 Community Clinic Network patients served from 2022 to 2023.
SUCCESS STORY: With support from Wellstar Foundation, CareLink of Northwest Georgia received a $150,000 donation to provide stipends to clinical providers to serve uninsured and underinsured residents in Paulding and surrounding counties.
Click or scan the QR Code to learn more about this funding.
13 | RESPONSE TO 2022 CHNA - THREE YEARS LATER
Community Transformation Program In 2020, WCHE launched a year-long initiative to enhance access to medical care via technology with leading community partners. The Community Transformation Program (CTP) provides a scalable solution for improving access to care in partnership with trusted community assets. Funded CTP partners leverage technology to produce long-term, sustainable changes in the communities we serve. Initiatives are expected to be tailored to a community need and align with each partner’s mission. At the end of 12 months, partners are expected to demonstrate improvements in: ■ Access to Health Care so that residents receive timely, high-quality and culturally appropriate medical care when they need it; or, ■ Access to Social Determinants of Health Support Services so that residents receive timely, high-quality food, employment, housing, transportation, education, and legal resources to improve daily living when they need it. To identify strongly suited partners, Wellstar recruits a cohort of internal subject matter experts to review candidate applications through a two-step web-based submission process. Candidate applications featured funding requests, project descriptions, budgets, descriptions of past community health improvement performance, and project sustainability plans. Figure 5 | Number of Participants Reached Through the Community Transformation Program Total Participants
8,000 6,000 4,000 2,000 0
7,729
3,261
2,228
FY22
FY23
FY24
SUCCESS STORY: Bethesda Community Clinic partnered with law enforcement agencies in three undercover human trafficking stings across Georgia, providing crucial on-site healthcare to 38 victims, primarily young women aged 18-25. Telehealth kits – funded by the Community Transformation Program – played a vital role, enabling multiple providers to offer care despite long hours and limited space. Beyond forensic exams, the clinic provided patient-centered primary care, addressing immediate health needs and offering emotional support. This collaborative effort with the Georgia Bureau of Investigation, Homeland Security, and local law enforcement significantly improved the care and support available to victims of human trafficking.
14 | WELLSTAR HEALTH SYSTEM
Throughout fiscal years 2022-2024, the following partners received funding:
72% of participants saw positive changes in biometrics following implementaion of a technology- based approach to give diabetic patients access to health and nutrition coaching by Bethesda Community Clinic in one funding period.
129 telehealth appointments were conducted by Must Ministries during the one-year funding period to provide remote access to behavioral health counseling for individuals in permanent supportive housing and emergency shelters.
200+ patients were served by Empowerment Resource Center with telehealth and mHealth technologies to improve outcomes for individuals with substance abuse disorders.
30% increase in resource utilization after Healthy Mothers, Healthy Babies Coalition of Georgia increased access to maternal mental health resources for birth givers using a digital platform.
1,300+ telehealth clients were served, and 582 family counseling sessions held over one year. The Summit Counseling Center used funding to increase access to telehealth for uninsured and underinsured residents and families.
334 new patients were served, avoiding 246 unnecessary emergency room visits through Giving Health, Inc.’s increased access to care for low-income, uninsured residents through telehealth and social service referrals.
Additional Partners:
15 | RESPONSE TO 2022 CHNA - THREE YEARS LATER
Breast Cancer Breast cancer is the second leading cause of cancer deaths for women in Georgia (Georgia Department of Public Health) and the leading cause of cancer death for Black women in Georgia (American Cancer Society). According to The Komen Atlanta 2015 Community Profile, Black women in the greater Atlanta area are 30% more likely than white women to have breast cancer diagnosed at a later stage and are 45% more likely to die of breast cancer. We also know that Latina women and women in rural communities are less likely to be screened for breast cancer, increasing the risk for late-stage diagnosis. As one of the largest providers of care in Georgia serving diverse urban, suburban, and rural communities, Wellstar is committed to addressing the damaging health disparities that impact our communities. For more than a decade, Wellstar has provided breast screening and
diagnostic services to individuals who lack access to or are unable to afford these life-saving services within Wellstar’s service areas. By providing these services at no cost to those in need, we seek to eliminate existing breast cancer disparities and decrease the number of late-stage breast cancer diagnoses by providing access to healthcare within the communities we serve. This program increases the number of regular mammogram screenings and diagnostic services provided, particularly within high-risk communities, enabling Wellstar healthcare providers to detect breast cancer at an earlier stage and resulting in better treatment options and improved outcomes for our community members.
1,600+ free mammograms provided
To identify patients who need access to these services most, we partner with local health departments, community clinics, and a robust list of other trusted community organizations. The Wellstar physician liaison team and Wellstar Clinical Partners team also works with 2,500+ Wellstar Medical Group physicians and partner physicians throughout our service area to generate referrals to the program. Many of our community members rely on this program for their annual mammogram, and we continue to reach new patients through new methods of outreach and community and physician partnerships. This program is fully funded by community partners and individual donors, including Georgia Alliance for Breast Cancer, National Breast Cancer Foundation, Susan G. Komen and Wellstar Team Member Giving donors. SUCCESS STORY: A breast cancer survivor was “lost to follow-up” due to losing Medicaid coverage. When she presented to the ER with concerning symptoms the oncology nurse navigator intervened. Despite the patient’s inability to afford a doctor’s visit, the navigator secured an order for a diagnostic mammogram. This swift action, facilitated by a voucher program, led to a timely diagnosis and the patient is now back on treatment. Colorectal Cancer Screening
Colorectal cancer, also called colon or rectal cancer, is the third most common cancer in the United States and the second most common cancer- related death. WCHE partners with BLKHLTH to improve colorectal cancer
screening rates among traditionally medically underserved communities. The national #GoodDownThere campaign with Colorectal Cancer Alliance is designed to reduce stigma surrounding colorectal care by providing equity-centric access for colorectal cancer.
16 | WELLSTAR HEALTH SYSTEM
Wellstar Congregational Health Network
Individuals complete FIT test screening
Colorectal Cancer Alliance
Wellstar Health System
■ Establishes partnership with BLKHLTH ■ Activates Wellstar Center for Health Equity
■ Kits distributed to at- risk communities ■ Individuals complete demographic profile and pre-assessment
■ Mail or E-Survey results to Wellstar ■ Positive recipients are referred to the Colorectal Cancer Alliance
■ Connects individuals with funding to receive follow-up care
Colorectal Cancer Screening Kits: Wellstar activates the Congregational Health Network to host screening kit distribution events. Community participants complete screenings in the privacy of their homes and notify Wellstar if they receive a positive result and need assistance with follow-up care. Wellstar connects participants with the Colorectal Cancer Alliance, which provides support through the continuum of care.
Previously screened for CRC? * Figure 6 | Colorectal Cancer (CRC) Screening Kit Distribution Program
Patient Race/Ethnicity *
n Yes, using a FIT test n Yes, by colonoscopy
5%
n Asian 1% n Black/African American 74% n Hispanic/Latino 11% n White/Caucasian 34% n Other 2%
39% 53%
n No
n No Response
3%
CRC Screening Kits Distributed
Reason you have not been previously screened? *
n Do not have access to a FIT or colonoscopy n Do not have health insurance
1,000 800 600 400 200 0
19%
1,005
822
8% n Afraid of being screened 6% n Not interested in being screened 13% n No Response 54%
409
FY22
FY23
FY24
* from 1,474 responses
2,200+ screening kits distributed; 242 participants referred for colonoscopy after receiving a positive result
21% of colorectal cancer screening participants indicate not having a personal doctor or personal health care provider, and 21% of participants indicate not having any kind of health care coverage.
9.57% of kits returned a positive result
17 | RESPONSE TO 2022 CHNA - THREE YEARS LATER
64% of participants identify as Black or African American
22% of prostate cancer screening participants indicate not having a personal doctor or personal health care provider, and 16% of participants indicate not having any kind of health care coverage.
162 tests conducted throughout the Wellstar service areas.
Prostate Cancer Screening In partnership with Wellstar Urology & Lab Outreach Services, Community Health provides prostate cancer screening education and free prostate- specific antigen (PSA) testing to members of our Congregational Health Network and other community-based organizations serving high-risk communities. SUCCESS STORY: Two men previously in remission for prostate cancer participated in this screening and received abnormal results. The results led to further testing and a resumption of treatment.
Click or scan the QR Code to learn more about Wellstar cancer screenings initiative.
SUCCESS STORY: One participant received a new prostate cancer diagnosis. Despite a family history of prostate cancer, he was reluctant to be screened. Community Health team members at the event encouraged him to get screened on the spot.
Previously screened for prostate cancer? * Figure 7 | Prostate Screening Program
Reason you have not been previously screened? *
n Do not have access to a PSA level test or DRE n Do not have health insurance
n Yes, by digital rectal exam 7% n Yes, by PSA level test 40% n No 51% n No Response 2%
44%
5% n Afraid of being screened 7% n Not interested in being screened 44%
* from 123 responses
18 | WELLSTAR HEALTH SYSTEM
Wellstar Strategic Community Development In the 2022 CHNA Implementation Plan, Wellstar Strategic Community Development committed to increasing corporate social responsibility investments (Figure 8) and providing positive social value through strategic partnerships and sponsorships focused on access to care.
Figure 8 | Community Development Investments - Access to Care Sum of Investments
$ 70,155 in investments across 12 community partner organizations to support access to health care and social support services.
$50K $40K $30K $20K $10K $0
$48,655
$21,500
0
FY22
FY23
FY24
Community partner organizations included: ■ CareLink of Northwest Georgia, Inc.: In the fall of 2014, a team of concerned community members embarked on a journey to form what we now know as CareLink: a community-based clinic delivering healthcare to those in need in Paulding County and surrounding areas. ■ Clark Atlanta University: Building on its social justice history and heritage, Clark Atlanta University is a culturally diverse, research-intensive, liberal arts institution that prepares and transforms the lives of students. Ignited by its history, Clark Atlanta University is committed to delivering education that is accessible, relevant, and transformative. ■ Cobb Public Safety/Safe Kids Cobb County: Safe Kids Cobb County is one of more than 400 U.S. Coalitions and 30 Member Countries that bring together health and safety experts, educators, corporations, foundations, governments, and volunteers to educate and protect families. ■ Covenant House Georgia: For more than 20 years, Covenant House Georgia has been the only agency in Metro Atlanta to provide a comprehensive suite of programs, services, and access to resources for youth and young adults ages 16-24 experiencing homelessness and escaping trafficking. ■ Good Samaritan Health Center of Cobb: Good Samaritan Health Center of Cobb is committed to its founding purpose, to spread the love of Christ and provide a primary medical and dental healthcare to the uninsured and underinsured, working poor and indigent in our community. ■ Harmony House: Harmony House provides around-the-clock residential shelter and safety to domestic violence victims and their children. ■ Illuminate Justice: The Illuminate Justice mission is to prevent child trafficking and pursue justice for the vulnerable. We strategically focus on prevention efforts within the child welfare system as youth in foster care and involved in juvenile justice are disproportionately impacted by these types of harms. ■ LiveSafe Resources: LiveSafe provides safety and support services to victims of domestic violence and sexual assault.
19 | RESPONSE TO 2022 CHNA - THREE YEARS LATER
■ The Family Health Centers of Georgia: The Family Health Centers of Georgia, Inc. is a non-profit, 501(c)(3), Federally Qualified Health Center, whose mission is to provide comprehensive, high quality, patient-centered healthcare to the communities we serve, with a commitment to excellence.
■ Visiting Nurse Health System: Visiting Nurse Health System is Georgia’s solution for healthcare and aging at home, caring for over 15,000 patients each year throughout 57 counties. Celebrating 75 years as the first and largest nonprofit provider of healthcare, hospice and aging services in the home, Visiting Nurse continues to live its mission, today, by delivering a full care continuum of health care in the home. Wellstar Foundation In the 2022 CHNA Implementation Plan, Wellstar Foundation committed to increasing investments from the philanthropic community that support equitable access to care.
SUCCESS STORY: Wellstar Foundation supported the implementation of Wellstar Find Help – a system-wide digital tool connecting patients to local resources for food, transportation, housing, and other resources. Wellstar Find Help enables Wellstar to address social determinants of health, the non-medical factors influencing the health and wellbeing of patients and community members.
Click or scan the QR Code to learn more about Find Help.
$ 1 million + in Wellstar Foundation investments to support the partnership with Ser Familia for a Promotora, funding for providers to serve at CareLink of Northwest Georgia, implementation of Wellstar Find Help, and to support LiveSafe Resources.
$200,000
$184,500
$150,000
$478,200
20 | WELLSTAR HEALTH SYSTEM
21 | RESPONSE TO 2022 CHNA - THREE YEARS LATER
Behavioral Health
At Wellstar, we understand that health is more than just the absence of physical illness. True well-being encompasses the health of the mind and spirit, which is why behavioral health care is an absolutely essential component of our commitment to serving our communities. Soul Support Soul Support is a collection of programs offered to the community centered around behavioral health, particularly access to care and education. Over the past 3 years, Soul Support has evolved based on feedback from community partners and participants and remains focused on bringing awareness to mental health challenges as well as available resources. The major components include: ■ Suicide Prevention – education and awareness, resources for crisis assistance ■ Support – caregivers and telehealth counseling (equipment provided as needed); local resources ■ Community Advocates – instructor training/credentialing suicide prevention
Soul Support Programs
PTC
QPR
MHFA
Powerful Tools for Caregivers A 6-week virtual
Question, Persuade, Refer Training session focused on suicide prevention through awareness and education. Participants learn how to recognize suicide warning signs, how to intervene, and how to access resources (both crisis and non-crisis related).
Mental Health First Aid Intensive training focused on mental health challenges and how best to respond. Resources are provided (both crisis and non-crisis related).
program focused on giving support and resources to those caring for others.
100% of QPR participant evaluations indicated “I would recommend this training to others”
Participating Soul Support partner organizations include:
Clayton County: New Morning Light Baptist Church Cobb County: Acworth UMC Atlanta GLOW Bethel AME Catholic Church of St. Ann Cobb Collaborative First Christian of Mableton Rivers of Hope St. Thomas the Apostle Catholic Church
Paulding County: Bethany Christian Spalding County: Tabernacle of Praise Church Troup County: First Baptist First Presbyterian of LaGrange LaGrange Housing Authority St. Mark’s Episcopal Church of LaGrange
Turner Chapel AME Zion Baptist Church Douglas County: Douglasville First United Methodist Church Douglasville Seventh-day Adventist New Mountain Top
Baptist Church Fulton County: First Congregational UCC Atlanta Henry County: Tabernacle of Praise Church International
500+ participants across all Soul Support programs
22 | WELLSTAR HEALTH SYSTEM
Figure 9 | Soul Support Participation
Number of Soul Support Program Participants
140 120 100
128
112
98
80 60 40 20 0
49
42
10
5
24
19
18
0
0
FY22
FY23
FY24
n PTC
n QPR
n MHFA
n QPR Instructor Training
“Just this year alone I’ve heard about more young people considering suicide than ever before. I believe [the QPR instructor] training will equip me with the skills to recognize warning signs, offer support, and potentially save lives. I am certain early intervention will make a crucial difference in preventing tragedies.”
What people are saying
“I feel so much better on how to engage with someone I’m concerned about their struggles; especially if it could lead to suicide.”
“Very informative and helpful, helps put things in context and how to position conversation to gain trust and to be their advocate and support.”
“The training was really helpful. Grateful to have these resources to help someone/anyone.”
SUCCESS STORY: With support from Wellstar Foundation, Soul Support received a $25,000 grant award from the MolinaCares Accord to expand its support for virtual health counseling and instructor training. Social Work Student Rotation
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The Social Work Student Rotation program is supported through collaboration with Clark Atlanta University’s Whitney M. Young Jr. School of Social Work. Master’s level social work students spend an academic year interning with Wellstar Community Health, supporting initiatives of the department as well as patients of Wellstar Graduate Medical Education Internal Medicine.
The rotation ensures student understanding of the influence of social determinants of health with health outcomes. Patients and community members benefit from improved access to social support services to improve their health.
SUCCESS STORY: Quiara Sharp, a 2023 social work student, successfully completed QPR instructor training, building her capacity to provide community suicide prevention workshops after graduation. She completed 509 hours and served 15 patients. Quiara showed evidence of stress reduction levels in the patients she served at Wellstar Graduate Medical Education. With her support, patients were connected to resources for financial assistance, transportation, housing and food insecurity. When screened pre- and post for stress due to social determinant of health challenges, 71% of her patient group indicated reduced stress after being connected to supportive resources.
23 | RESPONSE TO 2022 CHNA - THREE YEARS LATER
Opioid Steering Committee Wellstar Behavioral Health offers a variety of services to assist the unique health needs of our community members. As part of our ongoing efforts, the Wellstar Opioid Steering Committee is focused on planning and implementing a comprehensive response to growing opioid misuse. A collaborative team of Wellstar providers, patients and communities have come together to help reduce opioid misuse, abuse, and addiction. Three physician-led workgroups lead the charge using provider and patient education, clinical initiatives, and community awareness and engagement. In the 2022 CHNA Implementation Plan, Wellstar Behavioral Health committed to the reduction of opioid scripts, reduction of co-prescribed medications (opioids and benzodiazepines) (Figure 10) , and the implementation of fentanyl testing across the system. Achievements: ■ With ongoing emphasis on opioid stewardship, opioid prescribing results have improved each fiscal year. ■ In recognition of the dangers of combining opioids and Figure 10 | Opioid Prescribing Rate Opioid Scripts Per 100
3.5 3.0 2.5 2.0 1.5 1.0 .5 0
benzodiazepines, providers may discover that either class may have been prescribed and filled elsewhere. In each fiscal year, providers utilized prescription drug monitoring program data through individual provider alerts and reviewable reports at the time of prescribing to reduce duplication. ■ By the end of fiscal year 2024, fentanyl testing was available in all Wellstar emergency departments. Zero Suicide Initiative
FY22
FY23
FY24
Wellstar’s Suicide Prevention initiative was derived from the national Zero Suicide (ZS) framework, offering a cohesive care model and continuous process improvement to prevent deaths by suicide for patients under active care. Through implementation of the ZS core elements (Lead, Engage, Identify, Treat, Transition, Train, & Improve), Wellstar’s approach includes the routinizing of screening for suicidal thoughts, proactive education about risk factors and warning signs to healthcare clinicians, evidence-based safety planning, suicide-specific care, and stepped-care case management to augment behavioral healthcare and keep our most vulnerable patients safe. In the 2022 CHNA
Figure 11 | Zero Suicide Initiative Risk Screening % Risk Screenings Completed
Figure 12 | Zero Suicide Initiative Safety Plan % Safety Plans Evaluated
Implementation Plan, Wellstar Behavioral Health committed to the utilization of standardized risk screening in emergency departments (Figure 11) , the completion of safety plans for all patients evaluated in the emergency department by a behavioral health team member who discharged to the community (Figure 12) , and the application of the stepped-care model for high-risk patients.
87% 86% 85% 84% 83% 82% 81% 80%
80% 79% 78% 77% 76% 75% 74% 73%
FY23
FY24
FY23
FY24
24 | WELLSTAR HEALTH SYSTEM
730,000+ risk screenings completed across fiscal years 2023 and 2024
2,875 total patients engaged in stepped-care model across fiscal years 2023 and 2024
“I asked this Wellstar Medical Group patient at the sixth outreach about his thoughts on restarting pathway and he said, ‘sometimes I feel like I’m an island’ and support services calling biweekly was like someone paddling over every two weeks to check on him.”
What people are saying
“I like being committed to having to answer these calls.”
“I think it’s awesome that you guys call and check on people, I’ve never had that before.”
“When I get phone calls like these, it kind of lifts my day.”
Wellstar Strategic Community Development In the 2022 CHNA Implementation Plan, Wellstar Strategic Community Development committed to increasing corporate social responsibility investments (Figure 13) and providing positive social value through strategic partnerships and sponsorships focused on behavioral health.
Figure 13 | Community Development Investments – Behavioral Health Total Investments
$ 80,750 in investments across 14 community partner organizations to support behavioral health access
$60K $50K $40K $30K $20K $10K $0
$48,250
$21,500
$11,000
FY22
FY23
FY24
25 | RESPONSE TO 2022 CHNA - THREE YEARS LATER
Food Access and Healthy Living
In the 2022 CHNA, Wellstar identified food insecurity and hunger as a key social determinant of health that is impacting the health of communities served. Food insecurity is defined as a household’s inability to provide enough food for every person to live an active, healthy life. Some of the most common, yet complex, effects of food insecurity include health complications, especially when families are forced to choose between spending money on food and medicine or medical care, and damage to a child’s ability to learn and grow. Populations at greatest risk of experiencing food insecurity include: ■ Children ■ Rural communities ■ African-American communities ■ Hispanic/Latinx communities ■ Senior adults Figure 14 shows that the percentage of the low-income population with low food access is higher than state averages in the communities served by Paulding, North Fulton, Cobb, Kennestone, Windy Hill, and Douglas Medical Centers. Figure 14 | Percentage of Low-income Population with Low Food Access
60% 50% 40% 30% 20% 10% 0%
n Wellstar Douglas Medical Center n Wellstar Cobb Medical Center, Kennestone Regional Medical Center, and Windy Hill n Wellstar North Fulton Medical Center n Wellstar Paulding Medical Center n Wellstar Spalding and Sylvan Grove Medical Centers n Wellstar West Georgia Medical Center n Georgia
Low-Income Population with Low Food Access (2019)
Sources: U.S. Department of Agriculture, Economic Research Service, USDA – Food Access Research Atlas, 2019. Source geography: Tract; Feeding America. 2017.
Community Partnerships Working with a variety of community partners is essential to successfully address hunger in communities served:
Atlanta Community Food Bank
Feeding the Valley
Food Well Alliance
Goodr
Master Gardener Volunteers
Open Hand Atlanta
Second Helpings Atlanta
Wholesome Wave Georgia
26 | WELLSTAR HEALTH SYSTEM
Wellstar Food Access Strategy Framework The Wellstar Food Access Strategy Framework is based on the Feeding America Addressing Food Insecurity in Health Care Settings Framework and advisement with community leaders like the Atlanta Community Food Bank. This framework emphasizes a multi-pronged approach, which is reflective of the need for a diversified approach to address food insecurity and hunger in Georgia:
WELLSTAR HEALTH SYSTEM | WELLSTAR CENTER FOR HEALTH EQUITY
Healthy Food Access
Eliminate Food Waste
Food Resource Referrals
Food Ecosystem Support
Food Sovereignty Innovation
Focus Area
Tactical Programming Wellstar Community Health Wellstar Foundation Catalyst by Wellstar
Mobile Market Program
Composting Initiative
Snack Pack Distribution
Food Resource Connection Program Wellstar Find Help
WellFarm Live to the Beat Garden Initiative
Bee Downtown Day of Service Food Access Network
Food Rescue Partnership
Mobile Grocery Store South Cobb Wellness Garden Food is Medicine
Partners Wellstar Strategic Community Development
Mobile Market Program In 2020, Wellstar launched a Mobile Market program to feed metro Atlanta at-risk families across six Georgia counties. In collaboration with Goodr, the joint initiative addresses food access for vulnerable communities in Wellstar’s service areas. Through Wellstar Foundation and vital community funding, Goodr provided food and staffing support for this program, registered participants and provided impact reporting each month. Wellstar provided program logistical support, participant incentives and nutrition education. Community partners helped recruit volunteers and set up food distribution sites in key service areas, including Cobb, Troup, Fulton, Spalding, Paulding, and Douglas counties. The following community organizations have partnered with Wellstar since program inception: ■ Butts County Life Enrichment ■ C.H.O.I.C.E.S. ■ Calumet Park Neighborhood Association ■ CareLink of Northwest Georgia, Inc. ■ Cathedral of Faith Church of God in Christ ■ Cobb Senior Services ■ First Presbyterian Church of Douglasville ■ First Presbyterian Church of LaGrange ■ McEachern United Methodist Church ■ New Mercy Baptist Church ■ New Mercy Community Services, Inc. ■ Paulding County School System ■ Roswell Organization for Community Development
27 | RESPONSE TO 2022 CHNA - THREE YEARS LATER
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