The establishment of a formalized community benefit program by FirstHealth of the Carolinas defines and coordinates existing services and develops new services for the communities, which the institutions of FirstHealth serve.  In addition to the continuation of traditional benefits such as provision of essential hospital services at no cost to the indigent, a comprehensive community benefit program also responds to community needs, as well as represents good business practice.  This outline describes the comprehensive program at FirstHealth, as well as the specific programs established under such an initiative. 

DEFINITION OF COMMUNITY BENEFIT - Community Benefit represents those activities which FirstHealth of the Carolinas, as a not-for-profit corporation under federal and state law, provides in order to justify its tax-exempt status.  As a traditional eleemosynary organization, we provide services that enhance the health of the communities we serve because it is the right thing to do, not just because it is a profitable activity.

Under the provisions of the Federal Hill-Burton Act, hospitals are obligated to provide emergency care to any individual at time of need, regardless of the individual's ability to pay.  In addition, hospitals are expected to provide a certain amount of "charity care" for a period of time following the receipt of the Hill-Burton funds.  Since FirstHealth Moore Regional Hospital concluded its obligation for "charity care," this program continues on a voluntary basis, but in a streamlined, more user-friendly manner.  The program is established under the auspices of FirstHealth of the Carolinas, addressing needs in all of the communities in which the FirstHealth network provides services through Moore Regional Hospital, Montgomery Memorial Hospital, FirstHealth Hospice, Family Care Centers, Dental Care Centers and other service-delivery FirstHealth entities.

PURPOSE OF PROGRAM - There are many reasons for a comprehensive community benefit program.  The following objectives are indicative of both the importance and far-reaching nature of such a program:

·        Adhere to IRS Standards - At a minimum, any community benefit program should be compatible with applicable Internal Revenue Service guidelines for maintaining the organization's tax-exempt status.

·        Continue Hill-Burton Obligations- Since recipients and communities do not truly understand such arcane programs as the Hill-Burton Program, another purpose is to continue what Moore Regional Hospital and its other institutions have always done.  FHC will provide essential care and services to all in time of need, despite the individual's ability to pay.

·        Demonstrate Value to Community - As the largest not-for-profit organization in Moore County and as a significant entity in several neighboring counties, it is important that we understand the importance of continuously demonstrating the value we bring to our community.  We will not only be a successful enterprise, in a financial sense, but also show that we continue to deserve the communities' support in other ways.   The benefit is not only demonstrated in enhanced coordination and collaboration of services for our residents, but also in new business acquired by our entities, additional dollars raised through our foundations and strengthened recruitment and retention through increased employee and provider satisfaction.  An effective community benefit program enables us to better publicize our efforts and activities as well as respond to community interests and needs.

·        Help Those In Need - Fundamental to our establishment as a charitable organization is service to others.  In that regard we ensure that established programs help those who are in need and cannot otherwise provide for themselves.  As FirstHealth has the ability to respond to unmet needs, the community benefit program is a means by which we are able to provide that assistance.

·        Enhance Health Status - In our geographic service areas, community benefit programs have the ability to enhance health status.  Since programs to "improve health status" are not generally reimbursable to any extent by third parties or governmental agencies, there has been very little activity in this area.  With the efforts of our Community Health Services Department, Montgomery Community Resource Team and the MooreHealth Board of Directors, we address those needs as they are identified.  The establishment of a comprehensive community benefit program has enabled us to work toward identifying at-risk populations and enhancing their awareness and access to services to better manage their chronic disease, prevent acute illness and reduce injury.

·        Facilitate Access to Care - As we plan additional ways to benefit our community, we will build upon existing means by which care is accessed as well as develop new avenues to encourage and facilitate appropriate utilization of healthcare resources.   The provider and entity infrastructure created in the FirstHealth network is comprehensive, yet FirstHealth continues to identify and address barriers that include lack of information, language issues, transportation problems and inadequate financial healthcare resources of those in the region.  FirstHealth is also developing strategies to empower those not accessing care, often that population without "a voice," to ensure changes not only occur at the local delivery site, but affect state and national policy to impact a greater number. 

·        Ensure the Provision of Needed Services - As a regional healthcare network, it is important for our system to arrange for all the services needed by the population that we serve.  Since some clinical programs do not "pay for themselves," an organized community benefit program is an additional means by which needed services that are not inherently profitable are established and maintained.  The program inspires creativity in addressing solutions for gaps in services or testing new opportunities to evaluate effectiveness in meeting the need.

·        Support Other Charitable Organizations - In addition to targeting individuals for assistance, a comprehensive program also provides assistance to other charitable organizations in our region who may desire and could benefit from our capabilities.  There may even be opportunities where FirstHealth's assistance to others can help with issues we have identified, thereby leveraging funding from multiple sources for the same cause.

·        Provide Community Funding - There are ongoing activities by different organizations and groups within our service area.  Our community benefit program are a source of funding where there are not sufficient, more appropriate sources.  Funding also includes the provision of resources other than money; the provision of staff expertise, manpower, in-kind services, and facilities are also greatly valued and well utilized by other entities in the region.

·        Enhance Staff Morale - Another goal of a community benefit program is to appeal to the inherent desire many of us in the health services field have to help others.  When a program provides the means and incentives for an individual to help others outside of our FirstHealthorganization, we find that feature an attractive tool for recruitment and retention of valued staff as well as a benefit to the community.

PRINCIPLES OF THE COMMUNITY BENEFIT PROGRAM -To address the purposes described above, there are several principles which need to be considered.  These principles are not meant to be a limiting factor, but serve as criteria by which programs are considered, established and evaluated over time.  It is also important to re-evaluate these very principles periodically to ensure their ongoing applicability and effectiveness.

·        Sustainable - Programs should have the ability to be sustained over time and not be subjected to significant fluctuation.  This is accomplished by either indexing in some manner or ensuring that the amount of financial obligation is realistically achievable over time.  This is why FirstHealth prefers to budget for community benefit initiatives based upon merit rather than "tithe" a portion of net profits.

·        Measurable - Programs should also lend themselves to being as measurable as possible.  This will include not just its costs, but the impact on recipients and effectiveness in carrying out the intended purpose through setting appropriate process, outcome and perception indicators.

·        Consistency with Twenty-Fifth Percentile - As with ongoing operations of the entities of FirstHealth, program support should also stress being in the top quarter of similar organizations with respect to performance, productivity, quality and recipient satisfaction.  Since the types of programs established under a community benefit initiative are not easily compared, this is a difficult principle to monitor, so it is important to establish a philosophy of high quality, cost effectiveness for all the enterprises in which we are to be involved.

·        Individual Respect & Dignity - Programs should always respect the individuals or organizations who may receive benefits.  To avoid the possibility of a stigma attached to program recipients, we should attempt to "mainstream" beneficiaries under our various programs and always ensure compassion and personal dignity to anyone served.

·        Health Services Emphasis - Programs should be primarily limited to the provision of health services, health status, or those enterprises that are reasonably related and linked to health.  Thus, efforts in the area of child care, education, economic development and other areas may be considered under this principle as all relate to an individual's quality of life.

·        Flexibility - The overall community benefit program, and its constituent parts, should be flexible over time to both meeting changing needs as well as adhere to the corporate value of continuous improvement.

·        Broad Focus - With respect to targeting individuals or organizations, who may benefit under such a FirstHealth initiative, we will not look to deal exclusively with helping a small number of people who are in tremendous need as opposed to helping a large number of people in a small way.  This principle would suggest that we consider both types of programs.

·        Cost Effectiveness - With any service or program provided, we should continue to be prudent in the deployment of resources and be as cost effective as possible.  Some programs may require "seed money" and require support for only a limited period, while others may never be solvent and require subsidies for the life of the service. 

·        Partnership with Other Agencies - As community benefit programs are established, we have the possibility of overlapping with activities currently being provided or planned by other human service agencies throughout the area.  As a principle, we should attempt to partner and coordinate with other agencies to meet the common goals and objectives.  This could also include governmental agencies, particularly as it pertains to health related services, as well as private foundations, as they look to entities such as FirstHealth to serve as demonstration sites to further their goals of improving access or reaching the underserved.

·        Consistency with Corporate Mission and Strategy - As a given, we should not engage in community benefit activities which are inconsistent with the strategic directions which the organization is following.  Community benefit is one of the five indicators by which the performance of the organization is evaluated annually. 

·        Avoid Entitlement Mentality - As we establish programs that provide services and benefits to individuals, we should avoid falling into the pit of encouraging an "entitlement mentality."  While we should provide assistance and support to those who are determined to be in need, we need to be careful to avoid the possibility of being seen as a quasi-governmental agency who is here to meet needs or provide services, regardless of the actions of individuals.  This principle should also enable us to reinforce the importance of personal accountability for all members of our society.

·        Avoid Cost-Shift Perception - In order to maintain a positive perception from the business community, we should ensure that all our actions reinforce the fact that our ability to operate our health care institutions cost effectively, and without a tax burden, are the means by which we can afford to provide community benefits.  Otherwise, we may be seen as providing community benefit services with business funded health benefits and, hence, run the risk of alienating those who have been supportive of us in the past.

BENEFICIARIES - While considering the comprehensive community benefit program, it is helpful to think of the various target groups which programs are intended to serve.  The following is a list of beneficiaries, which may be perceived as key recipients of programs and services under this initiative.

·        At-Risk Population - Populations who are at risk with respect to health care services are prime candidates to be served.  These would include not only children and the elderly, but also certain other at-risk populations such as the medically indigent, the Hispanic community, and other groups such as those with certain chronic diseases.

·        Community-At-Large - We will also look to serving all of our community with the programs we develop, not just those tailored to certain segments.  While some in our community obviously do not need any assistance or support from us, this is a way in which we can be seen as a good corporate citizen in the community.

·        Practitioners and Staff - Enabling our medical staff and employees to provide community benefit services to others should also be personally fulfilling and rewarding, hence, we should attempt to meet their needs as well.

·        Employers - Viewing employers in our region as a target population should not only be beneficial from a business perspective, but will enable us to maintain good relations with them and improve their ability to be a responsive employer to employee health needs which may be best provided in a work site setting.

·        Non-Profit Organizations - As the largest not-for-profit organization in our region, we are viewed as an informal resource and community asset.  If not-for-profit organizations or governmental agencies in our region were targeted, we have the possibility to provide resources and assistance, which would enable them to carry out their mission in a more effective manner.

programs and services - Consistent with the purposes and principles described above, as well as targeting the beneficiaries previously mentioned, the following ten-point plan encompasses the community benefit program.   FirstHealth identifies three distinct roles within the program: financial assistance, service delivery and support of others.

Financial Assistance Role

1.      Charity Care - In addition to continuing to provide hospital services for indigent at no cost, other than possibly a very small co-payment, no patient is turned away from our Family Care Centers, Dental Care Centers, Home Care and Hospice Services and FirstHealth Oasis based on inability to pay.

2.      Affordable Health Care Coverage  - This is a program that directs uninsured and underinsured to appropriate health coverage resources.  Many residents do not take advantage of the public assistance programs currently available through the state due to lack of awareness, complication of application process, financial barriers, misunderstanding of program qualifications and possibly program stigma.  FirstHealth is developing opportunities to impact this problem through education, plan promotion and enrollment fee assistance for Health Choice and Medicaid.   Other uninsured or "charity care" residents, ineligible for public assistance, will be converted into members of a virtual health plan.  Since individuals who are in need of services and do not have the ability to pay will present themselves for services at the least predictable and most expensive time, this program will provide them with a FirstHealth medical home and access to primary care.   It also provides a dignified way for individuals to receive care that should minimize or possibly avoid the need for more costly services which are now being rendered in the hospital setting.  FirstHealth is developing three pilot plans:  1) enrollment and care for "working poor" adults, 2) a mirror program of Health Choice to reach nonresident children, and 3) a product for small business.  In order to maximize the acceptance of this program, we will conduct focus groups to secure planning input from the target populations, incorporate simplified income determination and registration procedures in a more private setting than presently performed, and complete periodic re-enrollment to ensure that continued eligibility is maintained.  

Service Delivery Role

3.      Services for Selected Populations - Although FirstHealth provides services for all age groups, often special services or modification of care delivery must be made in order to reach at-risk groups such as children, teens, minorities, immigrants and the elderly.  Through program evaluation and unmet needs, culturally sensitive and age appropriate services would supplement, not replace, existing services provided.  Programs reaching infants, children and teens include neonatology services, car safety seat giveaways to new mothers, immunization reminder programs, school health services, behavioral health programs and dental care centers.   To better serve populations with English as their second language, FirstHealth subscribes to AT&T Language Line in the hospital and clinics, provides interpretation classes and incentive programs for those employees with foreign language skills to assist with patient care, offers classes on cultural sensitivity and language classes for health professionals and encourages employment of bilingual employees at critical access points to the healthcare system.  FirstHealth designs services to meet the needs of the elderly population through support of a Creative Senior Enrichment Center with the local community college, offering isolated, homebound elderly an emergency response program and providing an extensive influenza prevention program.  Programs under consideration include children dental sealant programs for migrant populations, human resource policy enhancement, pneumonia vaccine campaign, formalized child safety program and pharmaceutical assistance for the underserved.

4.      Nontraditional Delivery Sites - FirstHealth currently provides healthcare services at over 25 traditional delivery sites through FirstHealth hospitals, primary care centers, dental care centers and emergency medical services.  Even though many access care through these entities, barriers still exist.  FirstHealth recognized the importance of developing nontraditional methods and sites to encourage individuals to participate in preventive and screening activities, seek health education and access care.  With the sponsorship of mobile health services through the FirstHealth Moore Regional Hospital Auxiliary, FirstHealth provides screenings for cancer, heart disease and diabetes and health risk appraisals at worksites, community centers, schools and churches at no cost to the participant.   The six Centers for Health and Fitness provide opportunities for wellness activities, screenings, nutritional counseling and health education in four counties.  The Business Health Division impacts over 25,000 persons through business and industry on-site health contracts and mid-level provider services.  The FirstHealth school-based health services are tailored to the needs of each county school system and range from an assessment, referral and screening program with school nurses in Moore County, to part-time centers and a full-time comprehensive health center for prevention, fitness and nutritional services, and behavioral and acute care in Montgomery County.  Additional opportunities to develop in the future include health advocacy programs through the faith communities, assistance to the volunteer fire and emergency squads for home safety checks and programming for those in assisted living facilities.  

5.      Subsidized Specialty and Support Services - FirstHealth supports services that generate low or negative margins in order to meet the continuum of care for those in the region to include neonatal intensive care, hospice services, trauma and emergency facilities.   FirstHealth supplements direct patient care services most often without reimbursement for needs that include provision and sponsorship of infant car safety seats, influenza and pneumonia vaccination campaigns, personal emergency response units and athletic physicals for middle and senior high students.  

Supportive Role

6.      Employee Contributions - In several ways it is possible to provide our employees to outside agencies and organizations.  Rather than attempting to develop a list of eligible agencies or organizations, the Contributions Committee and the county-based Employee Action Teams are organized ways in which employees contribute FirstHealth-paid time to outside approved activities.  Provisions are made so that ongoing organizational services are not interrupted or compromised and opportunities are consistent and equitable for those in the region. FirstHealth employees participate in Habitat for Humanity, home fire and safety checks, elementary school mentorship programs and youth sports programs.

7.      Community Assistance - FirstHealth initiated Employee Action Teams, the Contribution Committee and policies to create opportunities for employees to identify needs of the human service agencies and communities in which they live and recommend allocation of FirstHealth in-kind and financial support.  The resources come from multiple areas of the organization such as rebates from benefit plans, non-vested funds from terminated employees and operational budgets of the Foundation, Community Health Services and Marketing and Communications departments.   Employee participation enhances morale and willingness to document community benefit activities for organizational and federal reporting.  Employees have recommended FirstHealth support in the areas of health education materials, park development and community health promotion activities.

8.      Non-Profit Support Services - This is the establishment of a more organized way for FirstHealth to assist other not-for-profit organizations.  Through the Speaker's Bureau, educational offerings and consultation, providers and FirstHealth management enhance the skills of local not-for-profit managers and staff in financial, marketing, human resource, information systems, volunteer and resource identification areas on a low or no-cost basis.  Since FirstHealth is seen not only as a large organization, but also one that has been successful, we are finding that organizations and their leaders are turning to us for assistance in greater numbers.   In addition to educational and leadership offerings, FirstHealth provides administrative support to county-based multi-agency groups with the goal for collaboration in addressing health issues. 

9.      Corporate Citizen Enhancement and Economic Development - As a tax-exempt organization, our hospitals do not pay taxes to county governments or municipalities.  Even though that is entirely within our rights, there may be benefit in establishing a mechanism by which our institutions can demonstrate being a "good corporate citizen" by financially supporting our government entities.  Nevertheless, some of FirstHealth service sites, such as practice sites, fitness centers and others, do make payments in lieu of taxes to support the local government entity.  By making the payment distinct from paying taxes, we are able to maintain our federal tax-exempt status and avoid any possible legal problems.  Employees currently serve on civic, economic development, chamber, school, parks and recreation committees to participate in the planning for our community's growth and advocating for policy changes.  In addition, volunteer time and funding has been given to support park development, home construction and septic tank repair programs.

10.  Advocacy for Policy Change - FirstHealth realizes that often the barriers that exist in accessing care require policy or practice changes in meeting cultural needs of the patients, redesigning healthcare delivery and enhancing systems of remuneration.  Primary focus will be on changes FirstHealth can make internally, with a growing campaign to impact policies at the county, regional and state level.  Through development of a multifaceted communications plan and participation with relevant state and local committees, FirstHealth will share best practices and serve as a demonstration site to inform and influence policymakers.  FirstHealth also serves as a resource to organizations such as the NC Office of Rural Health, NC Health and Human Services and state universities in assisting providers, training legislative staffers and educating others in enhancing systems of care.  FirstHealth is developing strategies to assist informal and community groups in facilitating grassroots advocacy to improve quality of life for target populations and communities.