MATAGORDA REGIONAL MEDICAL CENTER BAY CITY, TX

MATAGORDA REGIONAL MEDICAL CENTER BAY CITY, TX 2013 COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION PLAN ADOPTED BY BOARD RESOLUTION (DATE)

Dear Cmmunity Resident: Matagrda Reginal Medical Center (MRMC) welcmes yu t review this dcument as we strive t meet the health and medical needs in ur cmmunity. All nt-fr-prfit hspitals are required t develp this reprt in cmpliance with the Affrdable Care Act. The 2013 Cmmunity Health Needs Assessment identifies lcal health and medical needs and prvides a plan t indicate hw MRMC will respnd t such needs. This dcument suggests areas where ther lcal rganizatins and agencies might wrk with us t achieve desired imprvements and illustrates ne way we, MRMC, are meeting ur bligatins t efficiently deliver medical services. MRMC will cnduct this effrt at least nce every three years. As yu review this plan, please see if, in yur pinin, we have identified the primary needs and if ur intended respnse shuld make apprpriate needed imprvements. We d nt have adequate resurces t slve all the prblems identified. Sme issues are beynd the missin f the hspital and actin is best suited fr a respnse by thers. Sme imprvements will require persnal actins by individuals rather than the respnse f an rganizatin. We view this as a plan fr hw we, alng with ther rganizatins and agencies, can cllabrate t bring the best each has t ffer t address the mre pressing, identified needs. The reprt is a respnse t a federal requirement f nt-fr-prfit hspitals t identify the cmmunity benefit it prvides in respnding t dcumented cmmunity need. Of greater imprtance, hwever, is the ptential fr this reprt t guide ur actins and the effrts f thers t make needed health and medical imprvements. Please think abut hw t help us imprve the health and medical services ur area needs. I invite yur respnse t this reprt. We all live and wrk in this cmmunity tgether and ur cllective effrts can make living here mre enjyable and healthier. Thank Yu

Matagrda Reginal Medical Center Bay City, TX Cmmunity Health Need Assessment Page i Table f Cntents Executive Summary... 1 Prject Objectives... 2 Brief Overview f Cmmunity Health Needs Assessment... 2 Apprach... 4 Findings... 9 Definitin f Area Served by the Hspital Facility... 10 Demgraphic f the Cmmunity... 11 Leading Causes f Death... 14 Primary and Chrnic Disease Needs and Health Issues f Uninsured Persns, Lw-Incme Persns, and Minrity Grups... 15 Findings... 20 Cnclusins frm Public Input t Cmmunity Health Needs Assessment... 20 Summary f Observatins frm Matagrda Cunty Cmpared t All Other State Cunties, in Terms f Cmmunity Health Needs... 20 Summary f Observatins frm Matagrda Cunty Peer Cmparisns... 21 Cnclusins frm the Demgraphic Analysis Cmparing Matagrda Cunty t Natinal Averages... 22 Key Cnclusins frm Cnsideratin f the Other Statistical Data Examinatins... 24 Existing Health Care Facilities, Resurces and Implementatin Plan... 26 Significant Needs... 28 Other Needs Identified During the CHNA Prcess... 35 Overall Cmmunity Need Statement and Pririty Ranking Scre:... 37 Appendices... 39 Appendix A Lcal Expert Advisr Opinin Abut Significant Needs... 40 Appendix B Prcess t Identify and Priritize Cmmunity Need... 49 Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 1 EXECUTIVE SUMMARY Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 2 Executive Summary Matagrda Reginal Medical Center (MRMC) is rganized and gverned as an asset f the Matagrda Cunty Hspital District. A district hspital is a gvernment rganizatin, and as such, is nt required t prduce evidence f prviding an adequate amunt f cmmunity benefit t justify retentin f their nt-fr-prfit tax status. Hwever, MRMC has elected t vluntarily cmplete a Cmmunity Health Needs Assessment t assure it is respnding t the primary health needs f its residents. This study is designed t cmply with standards required f a nt-fr-prfit hspital. We assume MRMC acts as a nt-fr-prfit hspital slely fr purpses f prducing this reprt. Tax reprting citatins in this reprt d nt apply t MRMC. Prject Objectives MRMC partnered with Qurum Health Resurces (QHR) fr the fllwing: Cmplete a CHNA reprt, cmpliant with the Affrdable Care Act; and Prduce the infrmatin necessary fr the Hspital t issue an assessment f cmmunity health needs and dcument its intended respnse. Brief Overview f Cmmunity Health Needs Assessment Typically, nn-prfit hspitals qualify fr tax-exempt status as a Charitable Organizatin, described in Sectin 501(c) 3 f the Internal Revenue Cde; hwever, the term 'Charitable Organizatin' is undefined. Prir t the passage f Medicare, charity was generally recgnized as care prvided t the less frtunate withut means t pay. With the intrductin f Medicare, the gvernment met the burden f prviding cmpensatin fr such care. In respnse, IRS Revenue ruling 69-545 eliminated the Charitable Organizatin standard and established the Cmmunity Benefit Standard as the basis fr tax-exemptin. Cmmunity Benefit determines if hspitals prmte the health f a brad class f individuals in the cmmunity, based n factrs including: Emergency rm pen t all, regardless f ability t pay; Surplus funds used t imprve patient care, expand facilities, train, etc.; Cntrlled by independent civic leaders; and All available and qualified physicians are privileged. Fr hspitals wh file an IRS frm 990, specifically, the IRS requires: Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 3 Effective n tax years beginning after March 23, 2012, each 501(c) (3) hspital facility is required t cnduct a CHNA at least nce every three taxable years and adpt an implementatin strategy t meet the cmmunity needs identified thrugh such assessment; The assessment may be based n current infrmatin cllected by a public health agency r nn-prfit rganizatin and may be cnducted tgether with ne r mre ther rganizatins, including related rganizatins; The assessment prcess must take int accunt input frm persns wh represent the brad interests f the cmmunity served by the hspital facility, including thse with special knwledge r expertise f public health issues; The hspital must disclse in its annual infrmatin reprt t the IRS (Frm 990 and related schedules) hw it is addressing the needs identified in the assessment, and, if all identified needs are nt addressed, the reasns why (e.g., lack f financial r human resurces); Each hspital facility is required t make the assessment widely available and ideally dwnladable frm the hspital web site; Failure t cmplete a CHNA in any applicable three-year perid results in a penalty t the rganizatin f $50,000. Fr example, if a facility des nt cmplete a CHNA in taxable years ne, tw, r three, it is subject t the penalty in year three. If it then fails t cmplete a CHNA in year fur, it is subject t anther penalty in year fur (fr failing t satisfy the requirement during the three-year perid beginning with taxable year tw and ending with taxable year fur); and An rganizatin that fails t disclse hw it is meeting needs identified in the assessment is subject t existing incmplete return penalties 1. This reprt was develped under the guidance f IRS/Treasury 2011-52 as mdified by the Draft Federal Regulatins published in the April 5, 2013 Federal Register. 1 Sectin 6652 Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 4 APPROACH Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 5 T cmplete a CHNA, the hspital must: Apprach Describe the prcesses and methds used t cnduct the assessment; Surces f data and dates retrieved; Analytical methds applied; Infrmatin gaps impacting ability t assess the needs; and Identificatin f with whm the Hspital cllabrated. The prpsed regulatins prvide that a hspital facility s CHNA reprt will be cnsidered t describe hw the hspital facility tk int accunt input if the CHNA reprt: 1) Summarizes, in general terms, the input prvided and hw and ver what time perid such input was prvided; 2) Prvides the names f rganizatins prviding input and summarizes the nature and extent f the rganizatin s input; and 3) Describes the medically underserved, lw incme, r minrity ppulatins being represented by rganizatins r individuals prviding input. Describe the prcess and criteria used in priritizing health needs; Describe existing resurces available t meet the cmmunity health needs; and Identify the prgrams and resurces the hspital facility plans t cmmit t meeting each identified need, and the anticipated impact f thse prgrams and resurces n the health need. QHR takes a cmprehensive apprach t assess cmmunity health needs. We perfrm several independent data analyses based n secndary surce data, augment this with lcal survey data, and reslve any data incnsistency r discrepancies frm the cmbined pinins frmed frm lcal experts. We rely n secndary surce data, and mst secndary surces use the cunty as the smallest unit f analysis. We asked ur lcal expert area residents t nte if they perceived the prblems r needs identified by secndary surces t exist in their prtin f the cunty. Mst data used in the analysis is available frm public internet surces. Critical data needed t address specific regulatins r develped by the individuals cperating with us in this study is displayed in the reprt f the appendix. Data surces include: Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 6 Web Site r Data Surce Data Element Date Accessed Data Date www.cuntyhealthrankings.rg www.cmmunityhealth.hhs.gv Truven (frmerly knwn as Thmsn) Market Planner www.capc.rg and www.getpalliativecare.rg www.caringinf.rg and iweb.nhpc.rg Assessment f health needs f Matagrda Cunty cmpared t all TX cunties Assessment f health needs f Matagrda Cunty cmpared t its natinal set f peer cunties Assess characteristics f the hspital s primary service area, at a zip cde level, based n classifying the ppulatin int varius sci-ecnmic grups, determining the health and medical tendencies f each grup and creating an aggregate cmpsitin f the service area accrding t the cntributin each grup makes t the entire area; and, t access ppulatin size, trends, and sciecnmic characteristics T identify the availability f Palliative Care prgrams and services in the area T identify the availability f hspice prgrams in the cunty May 14, 2013 2002 t 2010 May 14, 2013 1996 t 2009 May 14, 2013 2012 May 14, 2013 2012 May 14, 2013 2012 www.healthmetricsandevaluatin.rg T examine the prevalence f diabetic cnditins and change in life expectancy May 14, 2013 1989 thrugh 2009 www.dataplace.rg T determine availability f specific health resurces May 14, 2013 2005 www.cdc.gv www.chna.rg www.datawarehuse.hrsa.gv T examine area trends fr heart disease and strke T identify ptential needs amng a variety f resurce and health need metrics T identify applicable manpwer shrtage designatins May 14, 2013 2007 t 2009 May 14, 2013 2003 t 2010 May 14, 2013 2013 www.wrldlifeexpectancy.cm/usahealth-rankings T determine relative imprtance amng 15 tp causes f death May 14, 2013 2010 published 11/29/12 Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 7 In additin, we deplyed a CHNA Rund 1 survey t ur lcal expert advisrs t gain lcal input as t lcal health needs and the needs f pririty ppulatins. Lcal expert advisrs were lcal individuals selected t cnfrm t the input required by the Federal guidelines and regulatins. We received cmmunity input frm 27 lcal expert advisrs. Survey respnses started Wednesday, May 22, 2013 at 4:04 p.m. and ended with the last respnse n Friday, May 31, 2013 at 10:43 a.m.; Infrmatin analysis augmented by lcal pinins shwed hw Matagrda Cunty relates t its peers in terms f primary and chrnic needs and ther issues f uninsured persns, lwincme persns, and minrity grups. Respndents cmmented n if they believe certain ppulatin grups (r peple with certain situatins) need help t imprve their cnditin, and if s, wh needs t d what. When the analysis was cmplete, we put the infrmatin and summary cnclusins befre ur lcal grup f experts, wh were asked t agree r disagree with the summary cnclusins. They were free t augment ptential cnclusins with additinal statements f need, and a new need did emerge frm this exchange. Cnsultatin with 18 lcal experts ccurred again via an internet-based survey (explained belw) during the perid beginning Tuesday, June 11, 2013 at 2:51 p.m. and ended with the last respnse n Tuesday, June 25, 2013 at 11:21 a.m. With the prir steps identifying ptential cmmunity needs, the lcal experts participated in a structured cmmunicatin technique called a Delphi methd, riginally develped as a systematic, interactive frecasting methd that relies n a panel f experts. Experts answer questinnaires in a series f runds. We cntemplated and implemented ne rund as referenced during the abve dates. After each rund, we prvided an annymus summary f the experts frecasts frm the previus rund, as well as reasns prvided fr their judgments. The prcess encuraged experts t revise their earlier answers in light f the replies f ther members f their panel. Typically, this prcess decreases the range f answers and mves the expert pinins tward a cnsensus "crrect" answer. The prcess stps when we identify the mst pressing, highest pririty, cmmunity needs. In the MRMC prcess, each lcal expert allcated 100 pints amng all identified needs, having the pprtunity t intrduce needs previusly unidentified and challenge cnclusins develped frm the data analysis. A rank rder f pririties emerged, with sme needs receiving nne r virtually n supprt, and ther needs receiving identical pint allcatins. The prpsed regulatins clarify a CHNA need nly identify significant health needs, and need nly priritize, and therwise assess, thse significant identified health needs. A hspital facility may determine whether a health need is significant based n all f the facts and circumstances present in the cmmunity it serves. The determinatin f the break pint, Significant Need as ppsed t Other Need, was a qualitative interpretatin by QHR and the MRMC executive team where a reasnable break pint in the descending rank rder f vtes ccurred, indicated by the weight Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 8 amunt f pints each ptential need received and the number f lcal experts allcating any pints t the need. Our criteria included the Significant Needs had t represent a majrity f all cast vtes. The Significant Needs als needed a plurality f Lcal Expert participatin. When presented t the MRMC executive team, the dichtmized need rank rder (Significant vs. Other) identified which needs the hspital needed t fcus upn in determining where and hw it was t develp an implementatin respnse. Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 9 FINDINGS Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 10 Findings Definitin f Area Served by the Hspital Facility MRMC, in cnjunctin with QHR, defines its service area as Matagrda Cunty in TX, which includes the fllwing ZIP cdes: 77414 Bay City 77456 Markham 77465 Palacis 77419 Blessing 77457 Matagrda 77468 Pledger 77440 Elmatn 77458 Midfield 77482 Van Vleck In 2011, the Hspital received 78.1% f its patients frm this area. Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 11 Demgraphic f the Cmmunity The 2013 ppulatin fr Matagrda Cunty is estimated t be 36,577 and expected t increase at a rate f 2.8%. This is in cntrast t the 3.3% natinal rate f grwth and the TX grwth rate f 7.7%. Matagrda Cunty anticipates a ppulatin f 37,614 by 2018. Accrding t the ppulatin estimates utilized by Truven, prvided by The Nielsen Cmpany, the 2013 median age fr the cunty is 37.9 years, which is lder than the State median age (34.1 years), and the natinal median age (37.5 years). The 2013 Median Husehld Incme fr the area is $43,142, which is lwer than the State median incme f $48,509 and the natinal median incme f $49,233. Median Husehld Wealth value als is abve the Natinal and the State values. The Median Hme Values fr the area is $90,322 which is lwer than the Natinal and State values. Matagrda s unemplyment rate as f December, 2012 was 9.4%, which is wrse than the 7.8% statewide and the natinal civilian unemplyment rates. 2 The prtin f the ppulatin in the cunty ver 65 is 15.2%, abve the State average. The prtin f the ppulatin f wmen f childbearing age is 18.1%, slightly belw the State and natinal average f 20.1%. 10.6% f the ppulatin is Black nn-hispanic and 46.1% is White nn-hispanic. The Hispanic ppulatin cmprises 40.2% f the ttal. 2 http://www.cuntyhealthrankings.rg/app/#/texas/2013/matagrda/cunty/utcmes/verall/snapsht/by-rank Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 12 The ppulatin als was examined accrding t characteristics presented in the Claritas Prizm custmer segmentatin data. This system segments the ppulatin int 66 demgraphically and behavirally distinct grups. Each grup, based n annual survey data, is dcumented as exhibiting specific health behavirs. The makeup f the service area, accrding t the mix f Prizm segments and its characteristics, is cntrasted t the natinal ppulatin averages t discern the fllwing table f prbable lifestyle and medical cnditins present in the ppulatin. Items with red text are viewed as statistically imprtant, ptentially adverse findings. Items with blue text are viewed as statistically imprtant, ptential beneficial findings. Items with black text are viewed as either nt statistically different frm the natinal nrmal situatin, r nt cnsidered either favrable r unfavrable in ur use f the infrmatin. Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 13 Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 14 Leading Causes f Death Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 15 Primary and Chrnic Disease Needs and Health Issues f Uninsured Persns, Lw- Incme Persns, and Minrity Grups Sme infrmatin is available t describe the size and cmpsitin f varius uninsured persns, lw incme persns, minrity grups, and ther vulnerable ppulatin segments. Specific studies identifying needs f such grups, distinct frm the general ppulatin at a cunty unit f analysis, are nt readily available frm secndary surces. The Natinal Healthcare Disparities Reprt results frm a Cngressinal directive t the Agency fr Healthcare Research and Quality (AHRQ). This prductin is an annual reprt t track disparities related t "racial factrs and sciecnmic factrs in pririty ppulatins." The emphasis is n disparities related t race, ethnicity, and sciecnmic status. The directive includes a charge t examine disparities in "pririty ppulatins," which are grups with unique healthcare needs r issues that require special attentin. Natinally, this reprt bserves the fllwing trends: Measures fr which Blacks were wrse than Whites and are getting better: Diabetes Hspital admissins fr shrt-term cmplicatins f diabetes per 100,000 ppulatin; HIV and AIDS New AIDS cases per 100,000 ppulatin age 13 and ver; and Functinal Status Preservatin and Rehabilitatin - Female Medicare beneficiaries age 65 and ver, wh reprted ever being screened fr steprsis with a bne mass r bne density measurement. Measures fr which Blacks were wrse than Whites and staying the same: Cancer Breast cancer diagnsed at advanced stage per 100,000 wmen age 40 and ver ; breast cancer deaths per 100,000 female ppulatin per year; adults age 50 and ver wh ever received clrectal cancer screening; clrectal cancer diagnsed at advanced stage per 100,000 ppulatin age 50 and ver; clrectal cancer deaths per 100,000 ppulatin per year; Diabetes Hspital admissins fr lwer extremity amputatins per 1,000 ppulatin age 18 and ver with diabetes; Maternal and Child Health Children ages 2-17 wh had a dental visit in the calendar year; Children ages 19-35 mnths wh received all recmmended vaccines; Mental Health and Substance Abuse Adults with a majr depressive episde in the last 12 mnths wh received treatment fr depressin in the last 12 mnths; peple age 12 and ver treated fr substance abuse wh cmpleted treatment curse; Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 16 Respiratry Diseases Adults age 65 and ver wh ever received pneumcccal vaccinatin; hspital patients with pneumnia wh received recmmended hspital care; Supprtive and Palliative Care High-risk lng-stay nursing hme residents with pressure sres; shrt-stay nursing hme residents with pressure sres; adult hme health care patients wh were admitted t the hspital; hspice patients wh received the right amunt f medicine fr pain; Timeliness Adults wh needed immediate care fr an illness, injury, r cnditin in the last 12 mnths, wh received care as sn as they wanted; emergency department visits where patients left withut being seen; and Access Peple with a usual primary care prvider; peple with a specific surce f nging care. Measures fr which Asians were wrse than Whites and getting better: Cancer Adults age 50 and ver wh ever received clrectal cancer screening; and Patient Safety Adult surgery patients wh received apprpriate timing f antibitics. Measures fr which Asians were wrse than Whites and staying the same: Respiratry Diseases Adults age 65 and ver wh ever received pneumcccal vaccinatin; hspital patients with pneumnia wh received recmmended hspital care; and Access Peple with a usual primary care prvider. Measures fr which American Indians and Alaska Natives were wrse than Whites fr the mst recent year and staying the same: Heart Disease Hspital patients with heart failure wh received recmmended hspital care; HIV and AIDS New AIDS cases per 100,000 ppulatin age 13 and ver; Respiratry Diseases Hspital patients with pneumnia wh received recmmended hspital care; Functinal Status Preservatin and Rehabilitatin Female Medicare beneficiaries age 65 and ver wh reprted ever being screened fr steprsis with a bne mass r bne density measurement; Supprtive and Palliative Care Hspice patients wh received the right amunt f medicine fr pain; high-risk, lng-stay nursing hme residents with pressure sres; adult hme healthcare patients wh were admitted t the hspital; and Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 17 Access Peple under age 65 with health insurance. Measures fr which American Indians and Alaska Natives were wrse than Whites fr the mst recent year and getting wrse: Cancer Adults age 50 and ver wh ever received clrectal cancer screening; and Patient safety Adult surgery patients wh received apprpriate timing f antibitics. Measures fr which Hispanics were wrse than nn-hispanic Whites fr the mst recent year and getting better: Maternal and Child Health Children ages 2-17 wh had a dental visit in the calendar year; Lifestyle Mdificatin Adult current smkers with a checkup in the last 12 mnths wh received advice t quit smking; adults with besity wh ever received advice frm a health prvider abut healthy eating; and Functinal Status Preservatin and Rehabilitatin Female Medicare beneficiaries age 65 and ver wh reprted ever being screened fr steprsis with a bne mass r bne density measurement. Measures fr which Hispanics were wrse than nn-hispanic Whites fr mst recent year and staying the same: Cancer Wmen age 40 and ver wh received a mammgram in the last 2 years; adults age 50 and ver wh ever received clrectal cancer screening; Diabetes Adults age 40 and ver with diagnsed diabetes wh received all three recmmended services fr diabetes in the calendar year; Heart Disease Hspital patients with heart attack and left ventricular systlic dysfunctin wh were prescribed angitensin-cnverting enzyme inhibitr r angitensin receptr blcker at discharge; hspital patients with heart failure wh received recmmended hspital care; HIV and AIDS New AIDS cases per 100,000 ppulatin age 13 and ver; Mental Health and Substance Abuse Adults with a majr depressive episde in the last 12 mnths wh received treatment fr depressin in the last 12 mnths; Respiratry Disease Adults age 65 and ver wh ever received pneumcccal vaccinatin; hspital patients with pneumnia wh received recmmended hspital care; Lifestyle Mdificatin Adults with besity wh ever received advice frm a health prvider t exercise mre; Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 18 Supprtive and Palliative Care Lng-stay nursing hme residents with physical restraints; high-risk, lng-stay nursing hme residents with pressure sres; shrt-stay nursing hme residents with pressure sres; adult hme health care patients wh were admitted t the hspital; hspice patients wh received the right amunt f medicine fr pain; Patient Safety Adult surgery patients wh received apprpriate timing f antibitics; Timeliness Adults wh needed care right away fr an illness, injury, r cnditin in the last 12 mnths and gt care as sn as wanted; Patient Centeredness Adults with ambulatry visits wh reprted pr cmmunicatin with health prviders; children with ambulatry visits wh reprted pr cmmunicatin with health prviders; and Access Peple under age 65 with health insurance; peple under age 65 wh were uninsured all year; peple with a specific surce f nging care; peple with a usual primary care prvider; peple unable t get r delayed in getting needed care due t financial r insurance reasns Measures fr which Hispanics were wrse than nn-hispanic Whites fr the mst recent year and getting wrse: Maternal and Child Health Children ages 3-6 wh ever had their visin checked by a health prvider. We asked a specific questin t ur lcal expert advisrs abut unique needs f pririty ppulatins. We reviewed their respnses t identify if any f the abve trends were bvius in the service area. Accrdingly, we place great reliance n the cmmentary received t identify unique ppulatin needs t which we shuld respnd. Specific pinins frm the lcal expert advisrs are summarized as fllws: Access t specialist regarding diabetes management and cardi vascular disease. Obesity and related chrnic diseases are pressing health issues amng Matagrda Cunty citizens. I believe the Cunty needs t fcus n preventive care, wellness prgrams and facilities that are affrdable t the majrity f ur citizens. Nt nly clinicians, but nn-traditinal partners that interface with cmmunity residents regularly are critical players such as lcal gvernment, schls, churches, lcal businesses, independent health prviders, and public health practitiners. Affrdable health insurance and preventative services fr the lw incme, uninsured, r minrity grups. Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 19 Statistical infrmatin abut special ppulatins fllws: Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 20 Findings Upn cmpletin f the CHNA, QHR identified several issues within the Matagrda cmmunity: Cnclusins frm Public Input t Cmmunity Health Needs Assessment 27 area residents participated in a survey asking pinins abut their perceptin f lcal healthcare needs. In descending rder f pinin, seven tpics were identified as being f "Majr Cncern" r "Mst Imprtant Issue t Reslve": 1. The need fr affrdable health care, and preventin f chrnic medical cnditins fr all ppulatins. 2. Cncerns abut elderly issues, chrnic diseases and the affrdability (insurance) f care. 3. Specific service needs f diabetes and cancer preventin. 4. Mre lcal health services, access t emergency services, disease preventin, and educatinal health needs. 5. Need mre educatin n healthy eating, smking cessatin, besity and dental health fr lw incme cmmunity members (uninsured). 6. Diabetes and cancer preventin educatin are needed in the cmmunity. 7. Accessible care, preventative services and affrdable insurance is needed in keeping ur cmmunity healthy. Summary f Observatins frm Matagrda Cunty Cmpared t All Other State Cunties, in Terms f Cmmunity Health Needs In general, Matagrda Cunty residents are at abut average health fr State; In a health status classificatin termed "Health Outcmes," Cunty ranks number 145 amng the 232 ranked cunties (best being #1). On the beneficial side f the ledger, lw birth weight births amng Cunty mthers is 8.2%, a value appraching the natinal gal but abve the state averages. Premature Death rate (death prir t age 75) in Matagrda Cunty is statistically abve the state average and the natinal gal. Self-reprted health status measures shw Cunty residents abve the state average natinal gal; and In anther health status classificatin "Health Factrs," Matagrda Cunty des nt fare as well, ranking 201 st amng the 232 cunties. Clinical care measures are belw the state average. Cnditins where imprvement remains t achieving state average rates and then natinal gals include: Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 21 Adult smking; Adult besity; Physical inactivity; Excessive drinking; Mtr vehicle crash death rate; Sexually transmitted disease; Teen birth rate; Uninsured; Primary care physicians; Preventable hspital stays; Diabetic screening; Mammgraphy screening; Unemplyment; Children in pverty; Children in single parent husehlds; Vilent crime rate; Drinking water safety; and Limited access t healthy fd Summary f Observatins frm Matagrda Cunty Peer Cmparisns The federal gvernment administers a prcess t allcate all cunties int "peer" grups. Cunty "peer" grups have similar scial, ecnmic, and demgraphic characteristics. Health and wellness bservatins when Matagrda Cunty is cmpared t its natinal set f peer cunties and cmpared t natinal rates make the fllwing bservatins: UNFAVORABLE - bservatins ccurring at rates wrse than natinal AND wrse than amng peers: Very lw birth weight <1500 g); Births t wmen under 18; White nn-hispanic infant mrtality; Pst-nenatal infant mrtality; Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 22 Female breast cancer; Cln cancer; Crnary heart disease; Hmicide; Lung cancer; and Strke. SOMEWHAT A CONCERN - bservatins because ccurrence is EITHER abve natinal average r abve peer grup average: Premature births (<37 weeks); Births t unmarried wmen; Infant mrtality; and Mtr vehicle injuries. BETTER PERFORMANCE better than peers and natinal rates: Lw birth weight (<2500 g); Births t wmen ages 40 t 54; Hispanic infant mrtality; Nenatal infant mrtality; Suicide; and Unintentinal Injury. Cnclusins frm the Demgraphic Analysis Cmparing Matagrda Cunty t Natinal Averages Matagrda Cunty in 2013 cmprises 36,577 residents. During the next five years, it is expected t see a ppulatin increase f 2.8% t achieve 37,614 residents. This grwth is slwer than anticipated state (7.7%) and natinal (3.3%) grwth. The ppulatin is lder and has a lwer median incme than the state r natinal cmparisns. 15.2% f the ppulatin is age 65 r lder, a higher percentage than TX. 1.8% are nn-hispanic White, Asian, and Pacific Island rigin; Hispanics cnstitute 40.2% f the ppulatin; Blacks cmprise 10.6% f the ppulatin; Whites 46.1%. Females ages 14 t 44 cmprise 18.1% f the ppulatin, slightly less than the percentage in TX (20.8%) r the natin (19.8%). Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 23 The fllwing areas were identified cmparing the cunty t natinal averages. Metrics impacting mre than 30% f the ppulatin and that are statistically significantly different frm the natinal average: Pap/Cervix Screening was 8% belw average, impacting 56% - an adverse finding; Respnsible fr health was 5% belw average, impacting 54% - an adverse finding; Vigrus exercise was 7% belw average, impacting 47% - an adverse finding; Emplyer Health Savings Accunts was 7% belw average, impacting 47% - neither a beneficial r adverse finding; Chlesterl Screening was 8% belw average, impacting 47% - an adverse finding; OB/GYN Visit was 12% belw average, impacting 41% - an adverse finding; Cmpliant With Treatment Recmmendatins was 9% belw average, impacting 36% - an adverse finding; Emergency rm use was 6% abve average, impacting 36% - and adverse finding; Making Charitable Cntributins t Nn-Health Organizatins was 10% belw average, impacting 35% - neither a beneficial r adverse finding; and Smking was 21% abve average, impacting 31% - an adverse finding. Situatins and cnditins statistically significantly different frm the natinal average, but impacting less than 30% f the ppulatin include: Chrnic High Bld Pressure was 13% abve average, impacting 29% - an adverse finding; Mrbid Obese was 11% abve average, impacting 28% - an adverse finding; Healthy Eating Habits was 10% belw average, impacting 27% - an adverse finding Chrnic Allergies was 8% abve average, impacting 26% - an adverse finding; Cardiac Stress Screening was 8% belw average, impacting 15% Chrnic Diabetes was 20% abve average, impacting 12% - an adverse finding; Chrnic Osteprsis was 14% abve average, impacting 11% - an adverse finding; Chrnic Heart Disease was 28% abve average, impacting 11% - an adverse finding; Chrnic COPD 23% was abve average, impacting 5% - an adverse finding; and Very Unhealthy Eating Habits was 9% abve average, impacting 3% - an adverse finding. Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 24 Key Cnclusins frm Cnsideratin f the Other Statistical Data Examinatins Additinal bservatins f Matagrda Cunty fund: Palliative Care prgrams (prgrams fcused nt n curative actins but designed t relieve disease symptms pain and stress arising frm serius illness) d nt exist in the cunty; and Hspice 8 prgrams exist in the cunty. Ranking the causes f death in Cunty finds the leading causes t be the fllwing (in descending rder f ccurrence): Heart Disease #1 cause f death statewide and in Cunty 238/100,000 ranking #94 amng 253 TX Cunties; Cancer #2 cause f death statewide and in Cunty 210/100,000 ranking #44 TX Cunty - significantly higher than expected; Strke #3 cause f death statewide and in Cunty 52/100,000 ranking #123 TX Cunty; Accidents #4 cause f death in Cunty, statewide #11 41.6/100,000 ranking #192 TX Cunty significantly higher than expected; Lung Disease #5 cause f death in Cunty, statewide #4-40.8/100,000 ranking #161TX Cunty significantly higher than expected; Diabetes #6 cause f death in Cunty, statewide #7 26.4/100,000 ranking #149 TX Cunty significantly higher than expected; Flu-Pneumnia #7 cause f death in Cunty, statewide #13 24.1/100,000 ranking #67 TX Cunty - significantly lwer than expected; Alzheimer s #8 cause f death in Cunty, statewide #6 20.8/100,000 ranking #155 TX Cunty; Kidney Disease #9 cause f death in Cunty and statewide 18.7/100,000 ranking #54 TX Cunty; Bld Pisning #10 cause f death in Cunty, statewide #12 17.7/100,000 ranking #36 TX Cunty - significantly higher than expected; Amng ther leading causes f death, Liver, Hypertensin, Suicide, and Parkinsn s are significantly higher than expected; Hmicide is significantly lwer than expected; The incident f Heart Disease is abve state and natinal average. The incident f Strke deaths is abve state and natinal average. Diabetes is well abve state average; Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 25 Life expectancy fr Matagrda males in 1989 was 70.5 years, 3.1 years behind the tp cunties, imprving in 2009 t 73.7 years, nly 6.8 years behind the tp cunties; and Life expectancy fr Matagrda females in 1989 was 78.3 years, 2.4 years behind the tp cunties, imprving in 2009 t 79 years, nly 4.7 years behind the tp cunties. Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 26 EXISTING HEALTH CARE FACILITIES, RESOURCES AND IMPLEMENTATION PLAN Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 27 Significant Health Needs We used the pririty ranking f area health needs by the lcal expert advisrs t rganize the search fr lcally available resurces as well as the respnse t the needs by Matagrda Reginal Medical Center. The fllwing list includes: Identifies the rank rder f each identified Significant Need; Presents the factrs cnsidered in develping the ranking; Establishes a Prblem Statement t specify the prblem indicated by use f the Significant Need term; Identifies Matagrda Reginal Medical Center current effrts respnding t the need; Establishes the Implementatin Plan prgrams and resurces Matagrda Reginal Medical Center will devte t attempt t achieve imprvements; Dcuments the Leading Indicatrs Matagrda Reginal Medical Center will use t measure prgress; Presents the Lagging Indicatrs Matagrda Reginal Medical Center believes the Leading Indicatrs will influence in a psitive fashin; and Presents the lcally available resurces nted during the develpment f this reprt as believed t be currently available t respnd t this need. In general, Matagrda Reginal Medical Center is the majr hspital in the service area. Matagrda Reginal Medical Center is a 58 bed, acute care medical facility lcated in Bay City, TX. The next clsest facilities are utside the service area and include: Sweeny Cmmunity Hspital 14 bed critical access hspital in Sweeny, TX; 21.7 miles frm Bay City (27 minutes) El Camp Memrial Hspital 26 bed acute care medical facility in El Camp, TX; 31.3 miles frm Bay City (42 minutes) Gulf Cast Medical Center 35 bed acute care medical facility in Whartn, TX; 33.1 miles frm Bay City (29 minutes) Palacis Cmmunity Medical Center 17 bed critical access hspital in Palacis, TX; 26.7 miles away frm Bay City (27 minutes) All data items analyzed t determine significant needs are Lagging Indicatrs, measures presenting results after a perid f time, characterizing histrical perfrmance. Lagging Indicatrs tell yu nthing abut hw the utcmes were achieved. In cntrast the Matagrda Reginal Medical Center Implementatin Plan utilizes Leading Indicatrs. Leading Indicatrs anticipate change in the Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 28 Lagging Indicatr. Leading Indicatrs fcus n shrt-term perfrmance, and if accurately selected, anticipate the brader achievement f desired change in the Lagging Indicatr. In the QHR applicatin Leading Indicatrs als must be within the ability f the hspital t influence and measure. Significant Needs 1. MENTAL HEALTH/SUICIDE/SUBSTANCE ABUSE Suicide is the 14th leading cause f death in TX and cunty; wrse than expected; Lcal Experts cite mental health access issues. Prblem Statement: There is a lack f mental health services in the cunty. MRMC SERVICES AVAILABLE TO RESPOND TO THIS NEED INCLUDE: MRMC Geriatric Psych Prgram MRMC IMPLEMENTATION PLAN PROGRAMMATIC INITIATIVES: MRMC effrts can help prvide mre access t the mental health services MRMC will establish an integrated apprach t mental health by crdinating its effrts with ther lcal resurces n mental health initiatives. MRMC will cllabrate in evaluating the need and resurces t address mental health issues f the cunty. LEADING INDICATOR MRMC WILL USE TO MEASURE PROGRESS: Vlume f patients wh cmplete a mental health screening in the ED: 2012 suicide attempt patient encunters = 16 LAGGING INDICATOR MRMC WILL USE TO IDENTIFY IMPROVEMENT Suicide death rate 7.0 per 100,000 in Matagrda cunty Other Lcal Resurces identified during the CHNA prcess which are believed available t respnd t this need include the fllwing: MEHOP (services) TEXANA (services) 101 Ave. F Nrth Bay City TX 77414 400 Avenue F Bay City, TX 77414 979-245-2008 979-245-9231 Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 29 2. OBESITY/OVERWEIGHT Lcal experts listed nutritinal educatinal needs; Engage in Vigrus Exercise belw avg. impacts 47.4% f pp.; Mrbid bese abve average impacts 28% f pp.; Very Unhealthy Eating Habits impacts 3% f pp.; Healthy eating habits belw avg. impacts 26.6% f pp.; Obesity impacts 28% f adults and increasing faster than TX r US trend. Prblem Statement: Obesity impacts 28% f the adult ppulatin in the cunty. MRMC SERVICES AVAILABLE TO RESPOND TO THIS NEED INCLUDE: MRMC wrksite wellness educatinal prgram MRMC IMPLEMENTATION PLAN PROGRAMMATIC INITIATIVES: MRMC will establish an integrated apprach t besity by crdinating its effrts with ther lcal resurces n besity preventin initiatives. MRMC will lead by example by fstering emplyee and cmmunity invlvement in preventin initiatives. MRMC will expand its prgram n wellness t ther cunty businesses and industries. MRMC will implement a wrksite wellness prgram fr its emplyees. MRMC will prvide cmmunity wide educatin in cllabratin with Castal Health Cnnectin ANTICIPATED RESULTS FROM MRMC IMPLEMENTATION PLAN MRMC anticipates a greater participatin in cmmunity awareness prgrams. LEADING INDICATOR MRMC WILL USE TO MEASURE PROGRESS: Annual enrllment in MRMC wrksite besity preventin prgram, 2013 = 195 LAGGING INDICATOR MRMC WILL USE TO IDENTIFY IMPROVEMENT Reductin in the percent f Matagrda residents having an besity value f 28% Other Lcal Resurces identified during the CHNA prcess which are believed available t respnd t this need include the fllwing: Palacis Cmmunity Medical Center (PCMC) 311 Green Ave. Palacis, TX 77465 (361) 972-2511 MEHOP 101 Ave. F Nrth, Bay City, TX 77414 (979) 245-2008 Cheryl Sacc, MD (Weight Management) 1120 Avenue G, Bay City, TX 77414 (979) 245-5721 Mike Neret, MD (Weight Management) 1809 Merlin St, Bay City, TX 77414 (979) 244-2007 Fit fr Life 2200 Avenue F, Bay City, TX (979) 245-5535 Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 30 3. AFFORDABILITY Lcal Experts cite lack f access and affrdability cncerns. Uninsured rate fr cunty is 29 %. Prblem Statement: Lcal residents are underinsured and nt aware f available resurces. MRMC SERVICES AVAILABLE TO RESPOND TO THIS NEED INCLUDE: MRMC Medical Assistance Prgram (MAP) MRMC IMPLEMENTATION PLAN PROGRAMMATIC INITIATIVES: MRMC will cllabrate with Castal Health Cnnectin and ther lcal resurces t educate the cmmunity abut available resurces MRMC in cllabratin with CHC and the cmmunity will evaluate ways t imprve access t affrdable health care. ANTICIPATED RESULTS FROM MRMC IMPLEMENTATION PLAN MRMC effrts can help address the symptms f and results frm prblems f affrdability and access. LEADING INDICATOR MRMC WILL USE TO MEASURE PROGRESS Vlume f patient financial assistance effrts shuld increase frm 2012 vlumes. 2012 MAP applicatins = 764 LAGGING INDICATOR MRMC WILL USE TO IDENTIFY IMPROVEMENT Number f Cunty residents uninsured minus the MAP = (8650 117 = 8533) Other Lcal Resurces identified during the CHNA prcess which are believed available t respnd t this need include the fllwing: PCMC 311 Green Ave, Palacis, TX 77465 361-972-2511 MEHOP 101 Ave. F Nrth, Bay City TX 77414 979-245-2008 TEXANA 400 Avenue F, Bay City, TX 77414 979-245-9231 4. PRIORITY POPULATIONS 30% f children live in pverty; 14% f lw incmes have lw fd access; lcal experts nte lw incme and children need better educatin n healthy fd chices and cncerns abut the number f uninsured in their cmmunity. Prblem Statement: High pverty levels and fd scarcity exist in the cunty especially amng children. MRMC SERVICES AVAILABLE TO RESPOND TO THIS NEED INCLUDE: MRMC Wmen Infant and Children (WIC) prgram Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 31 MRMC IMPLEMENTATION PLAN PROGRAMMATIC INITIATIVES: Crdinating effrts with the rganizatins listed belw which ffer resurces respnding t this need by identifying hw MRMC services can benefit frm their initiatives. MRMC will initiate effrts by cntacting each rganizatin t establish a frum fr effrt cllabratin. ANTICIPATED RESULTS FROM MRMC IMPLEMENTATION PLAN MRMC effrts can help address the symptms f and results frm prblems related t fd access. LEADING INDICATOR MRMC WILL USE TO MEASURE PROGRESS: Vlume f patients applying fr WIC: 2012 applicatins = 4581 LAGGING INDICATOR MRMC WILL USE TO IDENTIFY IMPROVEMENT Crude mrtality rate fr deaths f under age 18 pp.; reductin in deaths frm 17 Other Lcal Resurces identified during the CHNA prcess which are believed available t respnd t this need include the fllwing: State f Texas Medicaid P.O. Bx 14200, Midland, TX 79711 1-800-252-8263 Palacis ISD 1209 Twelfth Street, Palacis, TX 77465 361-972-5491 Bay City ISD 520 7 th Street, Bay City, TX 77414 979-245-5766 Tidehaven ISD P.O. Bx 129, El Matn, TX 77440 361-588-6321 Matagrda ISD P.O. Bx 657, Matagrda, TX 77457 979-559-0628 Van Vleck ISD 142 S. Furth St., Van Vleck, TX 77482 979-245-8518 Cmmunity fd pantries and feeding prgrams Bay City, TX 5. COMPLIANCE BEHAVIOR/PREDISPOSING CONDITIONS Lcal experts cite educatin and preventin as needs; I am respnsible fr my health belw average and impacts 53.9% f ppulatin; Fllws treatments is belw nrmal and impacts 36.4% f ppulatin; High Schl Graduatin rate is 91% while Sme Cllege is at 45% fr Matagrda cunty. Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 32 Prblem Statement: Nt enugh residents engage in immunizatin cmpliance accrding t the CDC guidelines. 3 MRMC SERVICES AVAILABLE TO RESPOND TO THIS NEED INCLUDE: MRMC prvides flu shts fr its emplyees MRMC prvides pprtunity t receive pneumnia vaccine n admissin fr apprpriate ppulatin MRMC IMPLEMENTATION PLAN PROGRAMMATIC INITIATIVES: MRMC will implement an Educatinal prgram fr Pririty Ppulatin members. MRMC will cllabrate with the CHC fr public awareness f immunizatin resurces ANTICIPATED RESULTS FROM MRMC IMPLEMENTATION PLAN Increased immunizatin cmpliance fr Matagrda cunty residents. LEADING INDICATOR MRMC WILL USE TO MEASURE PROGRESS: CMS cre measure f the percent f patients assessed and given pneumnia vaccine. Pneumnia vaccines in 2012 = 213 LAGGING INDICATOR MRMC WILL USE TO IDENTIFY IMPROVEMENT Cluster prfile f I am respnsible fr my health belw average and impacts 53.9% f ppulatin Other Lcal Resurces identified during the CHNA prcess which are believed available t respnd t this need include the fllwing: PCMC 311 Green Ave, Palacis, TX 77465 361-972-2511 Physician practices Bay City, TX MEHOP 101 Ave. F Nrth, Bay City TX 77414 979-245-2008 Lcal Pharmacies Bay City, TX Suth Texas Medical 2100 Reginal Medical Dr, Whartn, TX 979-532-1700 6. PHYSICIANS 90.3% f pp have used a Primary care physician at least nce; Primary Care Physician t Ppulatin Rati significantly higher (adverse) than TX average and US gal Prblem Statement: There is nt a current evaluatin f the number f prviders in the cunty. 3 http://www.cdc.gv/features/adultvaccines/ Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 33 MRMC SERVICES AVAILABLE TO RESPOND TO THIS NEED INCLUDE: MRMC physician and midlevel recruitment effrts MRMC IMPLEMENTATION PLAN PROGRAMMATIC INITIATIVES: MRMC in cllabratin with CHC will evaluate the number f prviders in the cunty. MRMC will review the success f its prvider recruitment prcess and enter discussins abut hw t cnstruct the mst desirable practice envirnment. MRMC will recruit and emply prviders as needed thrugh an affiliated medical grup. ANTICIPATED RESULTS FROM MRMC IMPLEMENTATION PLAN Increase in the number f prviders at MRMC. LEADING INDICATOR MRMC WILL USE TO MEASURE PROGRESS: MRMC will develp a tracking methd t measure prgress: Number f primary care practitiners interviewed/recruited fr a psitin at MRMC = 1 LAGGING INDICATOR MRMC WILL USE TO IDENTIFY IMPROVEMENT Primary care physician t ppulatin rati, Matagrda is 67 primary care physicians per 100,000. Other Lcal Resurces identified during the CHNA prcess which are believed available t respnd t this need include the fllwing: PCMC 311 Green Ave, Palacis, TX 77465 361-972-2511 MEHOP 101 Ave. F Nrth, Bay City TX 77414 979-245-2008 7. MATERNAL AND INFANT MEASURES - Lcal experts nted that a fcus f attentin in Matagrda Cunty is the rate f teen births and the health f these infants. One asked whse respnsibility is the health educatin that fcuses n hw t prevent pregnancy in thse wmen (children!) 18 and yunger? OB/GYN visit belw average impacts 40.5% f pp.; Better than Peers and US rates- Lw Birth Weight, Births t Wmen Age 40 t 54, White nn Hispanic Infant Mrtality and Nenatal Infant Mrtality. Wrse than US r Unfavrable rates wrse than US - Births t Unmarried Wmen, Peers fr Births t Wmen Under 18, Infant Mrtality, Pst Nenatal Infant Mrtality and Very lw birth weight. Prblem Statement: Need t reduce the number sexually active teens in the cunty. MRMC SERVICES AVAILABLE TO RESPOND TO THIS NEED INCLUDE: MRMC prvides childbirth classes fr cmmunity Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 34 MRMC IMPLEMENTATION PLAN PROGRAMMATIC INITIATIVES: Crdinating effrts with CHC and ffer resurces respnding t this need by identifying hw MRMC services can benefit their initiatives. Increase awareness f the MRMC childbirth classes available ANTICIPATED RESULTS FROM MRMC IMPLEMENTATION PLAN A reductin in the number f STD cases and teen pregnancies in the cunty. LEADING INDICATOR MRMC WILL USE TO MEASURE PROGRESS: Vlume f patients enrlled in the MRMC childbirth classes: 2012 patients = 6 LAGGING INDICATOR MRMC WILL USE TO IDENTIFY IMPROVEMENT Lwer the percent f pregnant wmen in Matagrda Cunty nt seeking prenatal care late r during their first trimester frm 37% 4, 8.1% f births t wmen under age 18 in cunty. Other Lcal Resurces identified during the CHNA prcess which are believed available t respnd t this need include the fllwing: PCMC 311 Green Ave, Palacis, TX 77465 (361) 972-2511 MEHOP 101 Ave. F Nrth, Bay City TX 77414 (979) 245-2008 Pregnancy Center 1418 Avenue H, Bay City, TX 77414 (979) 245-9900 8. Cancer #2 cause f death statewide and in Matagrda Cunty; Lcal experts nted highest resident cncern. Lung Cancer and Cln Cancer rates are abve natinal average; Breast Cancer rate is abve natinal but belw peer average. Prblem Statement: Cancer detectin and screening services need greater participatin by cmmunity members. MRMC SERVICES AVAILABLE TO RESPOND TO THIS NEED INCLUDE: MRMC prvides Clnscpy and mammgraphy screenings MRMC IMPLEMENTATION PLAN PROGRAMMATIC INITIATIVES: Crdinating effrts with the Castal Health Cnnectins which ffer resurces respnding t this need by identifying hw MRMC services can benefit their initiatives. MRMC will initiate effrts by cntacting each rganizatin t establish a frum fr effrt cllabratin. 4 (http://datacenter.aecf.rg/data/tables/3200-births-t-wmen-receiving-late-r-n-prenatalcare?lc=45&lct=5#detailed/5/6515-6768/false/35,18,17,16/any/8248,8249 Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 35 Allcating resurces t acquire educatinal material t distribute t patients receiving a cancer diagnsis r interested in the disease. ANTICIPATED RESULTS FROM MRMC IMPLEMENTATION PLAN An increase in the use f screening and cancer detectin services leading t earlier interventin and increased survival. LEADING INDICATOR MRMC WILL USE TO MEASURE PROGRESS: Vlume f clnscpy and mammgraphy exams shuld increase frm 2012 vlumes. 2012 clnscpy exams = 489 2012 mammgraphy exams = 1050 LAGGING INDICATOR MRMC WILL USE TO IDENTIFY IMPROVEMENT Cancer death rate 164 per 100,000 in cunty Other Lcal Resurces identified during the CHNA prcess which are believed available t respnd t this need include the fllwing: American Cancer Sciety 4401 Lilac Ln, Victria, TX 77901 (361) 578-2849 PCMC 311 Green Ave, Palacis, TX 77465 (361) 972-2511 MEHOP 101 Ave. F Nrth, Bay City, TX 77414 (979) 245-2008 Lcal physician practices Bay City, TX Other Needs Identified During the CHNA Prcess 9. DIABETES - #7 cause f death statewide; 26.4 per 100,000 ranking #149 TX Cunties significantly higher than expected fr Matagrda C.; Chrnic Diabetes abve avg. impacts 12.4% f pp.; screening rate is higher than TX avg. and US gal 10. DENTAL - 21% f residents have pr dental health, exceeds 13% TX avg.; Dentists t Ppulatin Rati significantly higher (adverse) than TX avg. and US gal 11. BLOOD PRESSURE (High) - Hypertensin 13th cause f deaths in Matagrda Cunty, death rate higher than expectatins; 13% abve average, impacting 29% f the ppulatin. 12. CORONARY HEART DISEASE - #1 cause f death statewide; death rate per 100,000, 238, ranking #94 amng 253 TX Cunties - higher than expected. Chrnic Heart Disease abve avg. impacts 10.6% f pp.; Rutine cardiac stress testing belw avg. impacts 14.7% f pp. Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 36 13. ACCIDENTS - #11 cause f death statewide; 41.6 per 100,000 ranking #192 TX Cunties significantly higher than expected; death rates wrse than US AND Peers fr Mtr Vehicle Injuries; Apprximately better than Peers and US rates fr Unintentinal Injury; Mtr Vehicle Crash Death Rate higher than TX r US avg. 14. EMERGENCY SERVICES - Emergency Rm use abve avg. impacts 36% f pp. 15. CHOLESTEROL (HIGH) - Chrnic high chlesterl affects 22.8% f the pp.; Rutine chlesterl screening belw avg. impacts 46.6% f pp. 16. SMOKING/TOBACCO USE - 24% f the ppulatin use Tbacc; abve natinal average use fr Cunty and TX. 17. CHRONIC COPD/LUNG DISEASE/PULMONARY - Lung Disease affects 40.8 ut f 100,000, and is 5th leading cause f death in Matagrda Cunty; Chrnic COPD impacts 23% and is abve average, impacting 5% f the pp.; Chrnic allergies abve avg. impacts 16.5% f pp. 18. POLLUTION - Air particulate matter better than TX avg. but wrse than US gal; Water, drinking water safety wrse than TX and US gal. 19. PREVENTABLE HOSPITALIZATION - Preventable Hspital Stays slightly higher than TX avg. and US gals. 20. LIFE EXPECTANCY/PREMATURE DEATH - Life expectancy increased but females imprved better than males; Premature Death rate (death prir t age 75) in Matagrda Cunty is statistically abve the state average and the natinal gal. 21. PALLIATIVE CARE & HOSPICE - Palliative care prgrams d nt exist in Matagrda Cunty, 8 facilities prvide Hspice services in the cunty. 22. KIDNEY DISEASE - #9 cause f death in Cunty and statewide 18.7 per 100,000 ranking #54 in TX Cunties which is as expected. 23. STROKE - #3 cause f death statewide and in Cunty 52 per 100,000 ranking #123 TX Cunties - as expected fr C, and TX. ; Unfavrable rates wrse than US and Peers fr Strke. 24. WELLNESS CENTER - Lcal experts cited as a need fr Matagrda Cunty. 25. ALZHEIMER S - #6 cause f death statewide; 20.8 per 100,000 ranking #155 TX Cunties; as expected. 26. CHRONIC OSTEOPOROSIS (bne disease) - Lcal experts cited as a need fr Matagrda cunty. Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 37 27. FLU-PNEUMONIA - #13 cause f death statewide; 24.1 per 100,000 ranking #67 in TX Cunties - significantly lwer than expected. 28. LOW BACK PAIN (Chrnic) - Chrnic lw back pain abve avg. impacts 23.6% f pp. Overall Cmmunity Need Statement and Pririty Ranking Scre: Significant Needs Where Hspital Has Implementatin Respnsibility 1. AFFORDABILITY 2. MENTAL HEALTH/SUICIDE/SUBSTANCE ABUSE 3. OBESITY/OVERWEIGHT/ACCESS TO HEALTH FOOD 4. CORONARY HEART DISEASE 5. MATERNAL AND INFANT MEASURES 6. DIABETES 7. SMOKING/TOBACCO USE 8. COMPLIANCE BEHAVIOR/PREDESPOSING CONDITIONS 9. ACCIDENTS Significant Needs Where Hspital Did Nt Develp Implementatin Plan Nne Other Needs Where Hspital Develped Implementatin Plan Nne Other Identified Needs Where Hspital Did Nt Develp Implementatin Plan 10.CANCER 11. EMERGENCY SERVICES 12. PRIORITY POPULATIONS 13. CHOLESTEROL (HIGH) 14. DENTAL 15. STROKE 16. BLOOD PRESSURE (High) 17. CHRONIC COPD/LUNG DISEASE/PULMONARY Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 38 18. PREVENTABLE HOSPITALIZATION 19. PALLIATIVE CARE & HOSPICE 20. PHYSICIANS 21. LIFE EXPECTANCY/PREMATURE DEATH 22. POLLUTION 23. CHRONIC OSTEOPOROSIS 24. ALZHEIMER'S 25. LOW BACK PAIN (Chrnic) 26. FLU-PNEUMONIA 27. KIDNEY DISEASE Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 39 APPENDICES Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 40 Appendix A Lcal Expert Advisr Opinin Abut Significant Needs A ttal f 27 lcal expert advisrs participated in an nline survey ffering pinins regarding their perceptins f cmmunity health needs. The fllwing is an analysis f their respnses: The first questin was pen-ended. What d yu believe t be the mst imprtant health r medical issue cnfrnting the residents f yur Cunty? Answers were placed in a Wrd Clud frmat fr analysis and generated the fllwing image: Wrd Cluds are analytical tls, which give greater visual prminence t wrds appearing mre frequently in the surce text. This infrmatin visualizatin establishes a prtrait f the aggregate respnses, presenting the mre frequently used terms with greater text size and distinctin in the visual depictin. Cmmn article wrd (i.e., a, the, etc.), nn-cntextual verbs (i.e., is, are, etc.) and similar wrds used when writing sentences are suppressed by this applicatin. Specific verbatim cmments received were as fllws: Life cnditins-medical specifically Lack f specialty care specially mental Uninsured and under insured I believe that the mst imprtant health issues affecting Matagrda Cunty residents are besity and related chrnic diseases. Apprximately 29% f Matagrda Cunty adults were bese in 2009, cmpared with the state average f apprximately 28%. The rate f diabetes in Matagrda Cunty was als higher than the state average in 2009, with 11% f Matagrda Cunty residents diagnsed with the disease, as cmpared t 9.7% acrss the state. The direct causes f besity and besity-related chrnic diseases are well-established inadequate levels f physical activity and cnsumptin f calrie-dense, lw nutritinal value fds are Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 41 the main cntributrs t energy imbalances and health cmplicatins. Hwever, if we are t lk beynd these direct causes, it becmes clear that besity and ther chrnic diseases stem frm a cmbinatin f systematic and build envirnment factrs. Fr instance, if healthy fds r safe areas fr physical activity are inaccessible t residents, it becmes very difficult t engage in these types f healthy behavirs that wuld cntribute t gd health and prevent chrnic cnditins. In rder t encurage the types f envirnments that prmte health, plicies and prgrams need t be put in place. The plicy and prgrammatic areas f cmmunity design, transprtatin systems, agricultural activities, and access t gds and services all play an imprtant part in determining the health f a cmmunity. In Matagrda Cunty in 2009, almst 40% f the ppulatin had lw access t a grcery stre, and there were nly tw recreatin/fitness facilities in the entire cunty. Strategies t address health issues cnfrnting the Matagrda Cunty ppulatin shuld take int accunt these multi-factrial and multi-level influences n health. Effrts shuld be made t engage stakehlders n multiple levels in rder t stimulate change that will have lasting impact n the health f Matagrda Cunty residents. The cst f emergency medical care prvided t citizens by ur hspitals has utgrwn the revenue available t cver such csts, particularly in the case f Palacis Cmmunity Medical Center whse budgeted revenue des nt include any revenue frm taxes cllected by the Matagrda Cunty Hspital District. Either we need t make sure the Center is subsidized by the taxatin f the Hspital District r the Center needs t cllabrate with Matagrda Cunty General Hspital fr additinal help in prviding care t ur citizens. I believe we have a shrtage in primary health dctrs, mental health dctrs and the inability t attract and keep gd specialty dctrs in the unmet needs categries we have such as rthpedic surgens and urlgists, etc. Preventive Health Care- Peple are (1) nt willing t seek medical attentin early n due t financial r lack f cncern, and (2) nt willing t take steps t address their wn health needs in rder t stay healthy. Chrnic diseases appear t be amng the mst imprtant health issue facing Matagrda Cunty. It is well-dcumented that chrnic disease is the leading cause f death and disability in the U.S. and Matagrda Cunty is n exceptin. Mre imprtant than the health issue f chrnic disease is understanding hw ppulatins get t the phase f chrnic illness where they have t rely n treatment which ften results in preventable and cstly in-patient hspitalizatin and daily management the disease. The disease is nly the physical manifestatin f illness; hwever, there are many pathways that can be addressed t prevent r reduce the risk f disease. Clinicians and direct-care prviders must begin t think upstream and address distal and intermediate causes that directly cntribute t chrnic disease which can be prevented t decrease these negative, lng term diseases. Careful evaluatin f upstream causes f chrnic disease is very useful fr the develpment f Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 42 preventin strategies at the level f the ttal target ppulatin. Instead f fcusing n the disease cnditins that plague Matagrda Cunty, it is mre beneficial t the cmmunity residents and has a higher return n investment t fcus effrts n preventin strategies. Upstream factrs fr chrnic diseases can be attributed t distal and intermediate causes. Distal causes include backgrund factrs that may predispse and individual r ppulatin t mre r less health risk such as scial class, educatinal attainment, r emplyment status. Intermediate causes ccur between distal and prximate causes and cntribute t the impact f distal causes. Intermediate causes include behavirs such as tbacc smking, sedentary lifestyle, stress r high sugar cnsumptin. Mre imprtant fr an entire ppulatin than an individual, the physical and built envirnment and the assets and capacity f a cmmunity can facilitate a healthy cmmunity and healthy ppulatin. The residents f a cmmunity are ne f its greatest assets and if they cannt r are nt thriving, the cmmunity usually suffers as well. Accrding t Cunty Health Rankings published by the Rbert Wd Jhnsn Fundatin, Matagrda Cunty ranks 145th in health ut f 232 cunties ranked in Texas, with 1 being better health and 232 being prer health. Health behavirs such as tbacc smking, lack f physical activity and pr nutritin and seem t cntribute t the lack f ptimal health f residents in the Cunty. Even thugh these may preliminarily appear t be individual-level health behavirs, there are envirnmental and plicy changes that culd assist with lwering these prevalence rates which wuld result in a decreased burden f chrnic disease burden fr the Cunty. Fr example, cnsidering smke-free rdinances in public establishments is ne plicy change that culd reduce tbacc smking and secndhand tbacc smke expsure fr thse wh chse nt t smke. In additin, implementing safe sidewalk structures that imprve cnnectivity t ppular destinatins, ample street lighting that make peple feel safer when walking, bike lanes that facilitated safe places fr cyclists t ride frm ne pint t anther, crsswalks and traffic calming islands that facilitated safe crssing fr pedestrians are all changes t the physical envirnment that wuld supprt increased physical activity and reduced besity fr all, and nt nly the few that are frtunate t live in neighbrhds equipped with these features. In additin, the rate f uninsured appears t be higher in Matagrda Cunty than that f Texas (29% vs. 26%, respectively). Similarly, the high rate f unemplyment further exacerbates this issue (11.6% in Matagrda Cunty vs. 7.9% in Texas). Lastly, limited access t healthy fd appears t be an issue fr the Cunty. Frm 2006-2010, age-adjusted mrtality rates fr cardivascular disease were calculated fr Matagrda Cunty and the fur adjacent cunties including Brazria, Jacksn, Frt Bend, and Whartn cunties and the state f Texas. Accrding t the Cardivascular Disease in Texas: A Surveillance Reprt 2012, Matagrda Cunty had the highest age-adjusted mrtality rate fr bth cnditins: 222.6 deaths per 100,000 fr heart disease and 52.9 deaths per 100,000 fr strke. Age-adjusted rates fr ther gegraphic regins were respectively as Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 43 fllws: Brazria Cunty (201.6/45.4), Jacksn Cunty (215.0/38.3), Frt Bend Cunty (164.2/41.0), Whartn Cunty (194.3/48.7), and Texas (195.2/48.4). Of curse, bth preventive care and clinical care are necessary fr a healthy cmmunity the tw wrks in cncert. Individuals will always need medical care, which they shuld be able t receive when they need it, where they need it, and it shuld be f high quality. At the same time, residents f a cmmunity shuld be able t live, wrk and play in a cmmunity that supprts the health f all residents and als makes the healthy chice the easy and safe chice. Surces: http://www.cuntyhealthrankings.rg/app/texas/2013/matagrda/cunty/utcmes/ver all/snapsht/by-rank Need fr affrdable health care. Obtaining affrdable health care. The ability t pay fr medical prcedures fr thse wh have n medical insurance. Access t lcal Primary/Specialty/Mental Health prviders. Nt enugh dctrs r specialists. S many f the physicians are nt taking new patients r nt taking sme insurance cmpanies. Mst appintments are nt available fr ne t tw weeks because they are s busy. This pstpnes the very treatments that individuals need. Peple can suffer while waiting, much less cmplicate the illness. Cancer affecting individuals at yunger ages. Individuals that are yunger receiving screenings t assist in early detectin f illnesses/diseases. Funding frm Texas and the State nt jining the natin is health care. We must nt place all f the funding f ur Hspital n just a few f us wh pay fr ur healthcare, insurance, and Taxes. Smene needs t step up and let us pay ur way and let the peple wh dn t care pay their wn way. We cannt affrd t prvide health care fr peple wh shuld be wrking but are just t lazy. The availability f specialists (Neurlgists, Onclgists, Endcrinlgists, Hematlgists, Plastic Surgens etc). Our Matagrda Cunty residents need t be able t access specialists within their wn cunties. Educatinal & Wellness prgrams t educate a healthy living lifestyle. Affrdable chices f medical transprtatin fr the elderly & disabled t their medical appintments. Increasing cst f medical care. Many citizens d nt have private health insurance. Grup plicies are expensive t the cmpanies ffering them and t the emplyees wh pay part f the csts. Hspitals and dctrs have t charge mre t thse wh have insurance r can pay. We have a large ppulatin f peple wh are prbably illegal residents. They are least Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 44 likely t have any kind f medical cverage r t be able t pay fr medical care they receive as a result f emergencies. I believe a huge prblem ur elderly residents face that are either t yung fr Medicare, r have Medicare and dn't have a supplemental insurance, they can't affrd their health care cverage fr their part, r all their medicatins due t being n a fixed incme. S, that makes the patients nt be cmpliant with their medicatins because they can't affrd them, then they end up hspitalized cntinuusly ver and ver fr the same diagnsis. This in turn frces the hspital t lse mney due t multiple hspitalizatins fr the same diagnsis. Lack f health insurance Drug abuse amng residents f Matagrda Cunty and especially students is rampant. It is exceedingly difficult if nt tantamunt t impssible t educate a mind that is under the influence f drugs and/r alchl. There needs t be greater educatin than the current levels t educate students cnstantly t the degenerative effects f drug use. Undetected r nn cmpliant chrnic health cnditins. Rising health insurance csts and affrdable health care. Public awareness f health issues and related health services available. Included is public perceptin f lcal services related t histrical views. The size f the cunty cntinues t be an issue related t access and transprtatin. Lack f infrastructure in sme specialty areas. Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 45 Our secnd questin t the lcal experts was, D yu perceive there are any primary and/r chrnic disease needs, as well as ptential health issues, f uninsured persns, lw-incme persns, minrity grups and/r ther ppulatin grups (i.e. peple with certain situatins), which need help r assistance in rder t imprve? If yu believe any situatin as described exists, please als indicate wh yu think needs t d what. The respnses generated the fllwing image: Specific verbatim cmments received were as fllws: Access t specialist regarding diabetes management and cardi vascular disease. Based n the wrk that I d, I wuld say that STDs in ur cmmunity is a valid cncern. As mentined in the previus questin, besity and related chrnic diseases are pressing health issues amng Matagrda Cunty citizens. Accesses t healthy fds and safe places fr physical activity are particularly pressing needs fr citizens in pverty, and the pverty rate in the cunty has been n the rise since 2000. Accrding t data frm the Suthern Rural Develpment Center, the pverty rate was 15.9% in 2000 and had risen t 20.9% in 2009. Pverty has a large impact n health, bth frm the preventin and treatment perspective. Peple in pverty are less likely t have access t healthy fds, mre likely t be fd insecure (nt sure where their next meal is cming frm) and safe places fr recreatin and physical activity. They are less likely t receive preventative screenings, are mre likely t delay visits t the dctr, and ultimately, are mre likely t be suffering frm later stages f disease when they d finally g t a dctr. As I mentined in my previus respnse, I believe that multiple grups in the cmmunity must be engaged in rder t prevent besity and related chrnic diseases. Plicy and ther decisin makers must be Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 46 aware f the impact f their plicies and prgrams n the health f the ppulatin, and shuld be held accuntable t make decisins that imprve the health and well-being f the citizens they serve. Grassrts calitins shuld be encuraged t frm and shuld be ffered funding and technical assistance. These types f calitins can help t empwer the general cmmunity t identify specific issues they want t fcus n and create the changes they identify that they need. Schls must be engaged in educating children n hw t stay fit and eat healthy. Hspitals and clinics shuld engage in the cmmunity t assess needs, and shuld prvide a mixture f strng health care fr thse wh are already ill and strng preventin effrts t help citizens avid illness in the first place. Finally, it will be imprtant that all grups engage with ne anther - it is much easier t maximize impact when all parties invlved in similar effrts are crdinating with ne anther. Diabetes and besity need t be addressed practively via affrdable preventin. Perhaps lcal prviders culd vlunteer time mnthly t prvide care t underserved areas. I believe the Cunty needs t fcus n preventive care, wellness prgrams and facilities that are affrdable t the majrity f ur citizens. It shuld start with the students - walking clubs and ther activities that d nt have t include cmpetitive athletics. I can't speak t chrnic disease needs, but d believe that we have a large segment f lw incme ppulatin that needs primary healthcare and advanced healthcare needs and believe that MCHD shuld take a leading rle in building the netwrk t care fr these citizens. I believe the cllabratin between MCHD, MEHOP and PCMC is a gd first step, but we still need mre dctrs in MC that can serve these needs. Obesity, Diabetes; this is smething I think every medical entity shuld be invlved with utreach awareness, screenings, health/exercise ptins. T the cmmunity's credit, this has started with the health and wellness prgram. Hwever, nly thse wh have "bught in" t this are participating. It is well dcumented that all ppulatins mentined abve (uninsured persns, lw-incme persns, and minrity grups) suffer frm prer health utcmes than their cunterparts. It will take a cncerted effrt invlving all players t reduce any health inequities r disparities that exist in Matagrda Cunty. Nt nly clinicians, but nn-traditinal partners that interface with cmmunity residents regularly are critical players such as lcal gvernment, schls, churches, lcal businesses, independent health prviders, and public health practitiners. Obesity and related diseases -- need fr educatin which culd be handled thrugh healthcare rganizatins, scial services and the schls. Cmmunity shuld be educated n nutritin and healthy lifestyle chices, but als n the cnsequences f besity like diabetes, heart disease, high risk pregnancies, etc. They need t be able t see a physician regularly, nt just when there is a majr prblem. Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 47 1) Increase number f Primary Care prviders-bth hspitals t recruit, 2) Prvide lcal access t Specialists r transprtatin t Physician practice - Enter int Telemedicine cntract with large teaching hspital, r when cntracting Specialists, state that 1 day per week will be in Palacis, Blessing, etc. 3) Prmte access t Mental Health - Medicatin mnitring, Individual therapy, grup therapy, shrt term lcked facility, and lng term lcked facility, etc. The families that live in Matagrda full time are basically lw incme families wh have n insurance. They can't pay and they have n way t reduce the cst unless they g t the emergency rm as indigent care. A lt f families als have limited transprtatin available. It wuld be wnderful t have a lcal surce fr medical care nce a week. I d nt feel that the need is greatest t the lw incme, uninsured, r minrity grups. I feel the greatest need is the individual that either has health insurance but a large deductible and large premiums r the individual that is nt ffered health insurance thrugh their emplyer and is trying t d the crrect thing by insuring his/her family. I feel the grup f individuals that yu all mentined have a lt mre ptins with in the cmmunity then smene wh falls in the categry that I mentined abve. As smene wh pays my health insurance premiums and wrks in the health care field, I see a lt f patients like myself that try very hard t d the right thing by paying fr insurance and avid seeking medical care unless it is abslutely necessary. Whereas thers wh are nt required t try t help themselves ver abuse the system by crwding the ERs and ver utilizing their benefits and run int the dctr s ffice fr minr things. I truly believe that because peple have larger premiums/deductibles this is keeping them frm preventative measures/test that culd detect certain types f cancer that are widely diagnsed. Hypertensin, Diabetes II, COPD, Cancer, CHF and Mental Health issues are areas that ur cmmunity needs thrugh educatin. We as a medical cmmunity need t wrk tgether t prvide a gd cntinuum f care. Discharge planners/scial wrkers/clinical Educatrs at the Clinic & Hspital Level shuld ensure thrugh the discharge planning phase that the fllwing are dne: Educatin f patient & family members f Disease Prcess & cmprehensin cnfirmed f the instructins. Prescriptins called int Pharmacy. Hme Health reinfrce and fllw thrugh with the cmpliance f the educatin/instructin received, as well as cnfirm that patient fllws up with PCP/Specialists and explre any ther sci-ecnmical factrs in the hme that may impact the patient's health. Health & Human Services ffices, Department f Assistive Rehabilitative ffices, Department f Aging & Disability Services and Adult Prtective Services need t take a mre active rle and be practive in assisting thse wh need resurces apply and becme eligible fr all services pssibly eligible fr. I again say we dn t mind helping thse that help themselves, but we are tired f paying fr peple wh can wrk but dn t. Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 48 Matagrda Cunty has a higher than state r natinal unemplyment rate. It has had higher than average unemplyment fr years. Large cmpnents f the unemplyed are Hispanic and African American. These grups are least likely t have medical cverage and t use expensive Emergency Rms fr their medical care. Qualified medical service persns have said we als have a large number f unhealthy prblems due t pr diet selectin and nt knwing hw t ck fresh vegetables r meats in healthy ways--ways ther than frying. Packaged and fast fds are substituted fr health fd chices. I d nt knw wh shuld be respnsible fr educating an adult ppulatin in health living and dietary chices. While it is a medical prblem, reaching this ppulatin is difficult. It is a scatter and diverse ppulatin where access t large grups f its individuals is nt readily available. Unhealthy indicatins are besity, high bld pressure, diabetes, etc. Pverty rbs peple f hpe. Hpelessness fsters an envirnment where peple will abuse substances in rder t escape reality. Pverty is very high in my schl district. MEHOP as an FQHC is the access pint fr uninsured and lw-incme individuals t receive care fr bth acute as well as chrnic cnditins. Patients are still being accepted by all 3 adult medical prviders as well as the pediatric prvider. Individuals will require assistance t navigate the changes with health refrm. Access during the evening and n weekends fr uninsured and lw-incme needs t be expanded. There is als a significant need fr diagnstic availability as well as specialty care fr this ppulatin grup. Ptential health issues are related t unhealthy lifestyles. Lw-incme and Hispanic ppulatins need cntinued educatin n healthy lifestyles fr themselves and mst f all fr their children. Schls repeatedly educate the children but smehw parents need t be educated as t what they are ding t themselves and t their children. The health indicatrs fr multiple factrs fr Matagrda Cunty are higher than bth state and natinal averages. The uninsured rate is higher than the state average and almst 3 times the natinal benchmark. It will take the cllabratin f multiple public and private entities t adequately address the identified issues. Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 49 Appendix B Prcess t Identify and Priritize Cmmunity Need Individuals Participating as Lcal Expert Advisrs Cmpany r Organizatin: Title r Psitin Area f Expertise: Cmpany r Organizatin: Title r Psitin Area f Expertise: Cmpany r Organizatin: Title r Psitin Area f Expertise: Cmpany r Organizatin: Title r Psitin Area f Expertise: Chaplain Chaplain Chaplain Auxiliary Van Vleck ISD District RN Public health Texas Department f State Health Services, Health Service Regin 6/5 S. Team Lead fr the Cmmunity and Family Health Prgram Public health practitiner Texas State Health Care & Hspice Care Senir Accunt Executive Sales, Business Develpment & Cmmunity Liaisn Health Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 50 Cmpany r Organizatin: Title r Psitin Area f Expertise: Cmpany r Organizatin: Title r Psitin Area f Expertise: Matagrda Cunty Cunty Judge Chief Elected Official Texas AHEC East Castal Regin Healthcare Public health Cmpany r Organizatin: Matagrda Cunty Navigatin District N. 1 Title r Psitin Prt Directr Area f Expertise: Gvernment Special District Cmpany r Organizatin: Title r Psitin Area f Expertise: Cmpany r Organizatin: Title r Psitin Area f Expertise: Cmpany r Organizatin: Title r Psitin Area f Expertise: Cmpany r Organizatin: Title r Psitin Area f Expertise: Cmpany r Organizatin: Title r Psitin Area f Expertise: Cmpany r Organizatin: Title r Psitin Area f Expertise: Cmpany r Organizatin: Title r Psitin Area f Expertise: Matagrda Independent Schl District Superintendent Representative f a special ppulatin Crisis Center Executive Directr Nn prfit victim services Matagrda Cunty Ecnmic Develpment Crpratin Executive Directr Ecnmic grwth fr cunty MEHOP CEO Directr f FQHC Palacis Cmmunity Medical Center CFO Healthcare SR Farms Owner lng term resident Palacis ISD Superintendent Educatin Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 51 Cmpany r Organizatin: Title r Psitin Area f Expertise: Cmpany r Organizatin: Title r Psitin Area f Expertise: Cmpany r Organizatin: Title r Psitin Area f Expertise: Texas Department f State Health Services Prgram Specialist besity preventin, fd security, fd systems, public health Bay City ISD Superintendent Educatin Bay City Chamber f Cmmerce and Agriculture President Business cmmunity Advice Received frm Lcal Experts Q. D yu agree with the bservatins frmed abut the cmparisn f Matagrda Cunty t all ther State cunties? Unemplyment nw in the lw 9's. I have nt had a reasn fr examining data related t the abve findings. Therefre, I assume the findings are backed by reasnable surveys, hspital recrds, crime statistics, etc. I am surprised by the cunty's high rankings in these categries, but I knw that we are a high unemplyment, lw educatin and lw husehld incme cunty. I find it difficult t tell whether these data pints are accurate r nt, mainly due t their presentatin. Fr instance, it is listed abve that adult besity affects 28% per 100,000 - this is nt an accurate way t reprt data. If listing as a rate, the numbers shuld have been Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 52 presented as 28 per 100,000. If that is the way it was meant t be reprted, I als find that number t be incredibly lw. My research has fund that mst cunties in Texas have an besity rate f abut 30% f the adult ppulatin (r 30,000 per 100,000). In terms f diabetic and mammgraphy screening, are these the number wh ARE getting screened, r the number wh ARE NOT getting screened? I am interested t give a better reprt n my bservatins, hwever, I wuld need t be given a mre detailed and clear prtrait f this data in rder t d s. We have a ppulatin that is under emplyed and a pay scale that is lwer than any cunty near us. The thing that will help ur cmmunity is educatin and higher pay scales. Q. D yu agree with the bservatins frmed abut the cmparisn f Matagrda Cunty t its peer cunties? D Yu Agree with the Cmparisn f Hancck t Its Peer Cunties? I disagree with sme r all f the abve bservatins. 5% I agree with the 1 abve bservatins. 95% I will agree because I have n statistics fr cmparisn n which t base a disagreement. Q. D yu agree with the bservatins frmed abut the ppulatin characteristics f Cunty t Cunty? Prprietary

Matagrda Reginal Medical Center Cmmunity Health Needs Assessment Bay City, TX Page 53 I wuld like t see the data used t determine the % f the ppulatin impacted. The impact appears lw fr chrnic allergies, DM, and heart disease I d nt review health recrds r data as part f my jb r interests. Therefre, these are mstly new findings t me. I can bserve a few that seem accurate, such as high smking rates, unhealthy eating habits reflected by besity, etc., but the thers I take are frm hspital and medical recrds t which I wuld nt have access. S, I cncur with the findings. I wuld expect the grwth rate f the cunty t be higher due t the Tanaris plant being built and bringing 600 well paid jbs t the cunty. I am nt familiar with mst f these health metrics, s d nt feel cmfrtable agreeing r disagreeing with these bservatins. Frm my knwledge f the cunty, I d believe that the besity, eating habits, and diabetes data lks accurate, therefre wuld agree with thse specific bservatins. Q. D yu agree with the bservatins frmed abut the pinins frm lcal residents? I disagree that insurance, health services, access t specialty prviders and specific service needs are the mst imprtant health r medical issues fr the residents f Matagrda Cunty. It is well-dcumented that medical care accunts fr 10% f ne's health while behavir and envirnment accunt fr 70% f ne's health. It's time t shift the fcus frm sick care (high cst persnal services) t preventive care (healthy lifestyles, healthy places). The best mdel f this paradigm shift is the framewrk frm health equity which fcuses n upstream factrs instead f dwnstream factrs. Fcusing n health services, access t specialty prviders and specific service needs are dwnstream factrs and while having insurance is imprtant (prvides access), it will nt shift the distributin f health fr a Prprietary