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Created: 01/23/2018 • Last updated: 01/26/2018 General information Organization Sun Health Foundation Contact First name Claudia Contact Last name Vazquez Contact e-mail claudia.vazquez@sunhealth.org Contact phone number 6238324323 Address Street 14719 W. Grand Avenue City Surprise State AZ ZIP Code 85374 From what tribe is the Gila River Indian Community organization requesting the grant? Total grant amount request 39,500 1 / 2 The Gila River Indian Community offers multi-year awards. If your organization is requesting a multi-year grant for this project or program from the Gila River Indian Community, enter the amount to be requested each year. Amount Year 1 (Gila River Indian 39500 Community Grants Only) Year 2 (Gila River Indian Community Grants Only) Year 3 (Gila River Indian Community Grants Only) Year 4 (Gila River Indian Community Grants Only) Year 5 (Gila River Indian Community Grants Only) 2 / 2 Gila River Indian Community Grant Application Grant Cycle 2018 Cover Sheet Municipality Information 1. Date of Application: 2/27/2018 (NOTE: Click or use up/down arrow keys to move among fields) 2. Name of City, Town or County: Maricopa County 3. Mayor (City or Town) or Board of Supervisor’s Chairman (County): Steve Chucri 4. Mailing Address: 301 W. Jefferson, 9th Floor 5. City: Phoenix State: Arizona Zip Code: 85003 6. Acknowledgement of Submission by Authorized Municipality Representative: Typed Name/Title: Zachary Wolfe, Finance Department Signature: Applicant Information 7. Department/Organization Name: Sun Health Foundation 8. Is this a 501c non-profit Organization? No Yes If yes, attach IRS Determination Letter 9. Application Contact Person: Claudia Vazquez Title: Development Director 10. Phone Number: 623-832-4323 11. Mailing Address: 14719 W. Grand Avenue 12. City: Surprise State: Arizona Zip Code: 85374 13. Email Address: claudia.vazquez@sunhealth.org Website Address: www.sunhealthfoundation.org Project Information 14. Project Name: Sun Health Care Transitions 15. Purpose of Grant: Helping West Valley seniors recuperate after hospitalization 16. Priority Funding Area Healthcare 17. Annual amount requested $39,500 18. Number of years that funding is requested 1 19. Total amount requested (annual amount x $39,500 number of years) 20. Has your organization received past No funding from GRIC? If yes, list each year and amount 21. Geographic area served All West Valley cities from Avondale to Youngtown For Office Use Only: Data Entry Receipt Evaluation Outcome Approval Recommended/Amount $ Denial Gila River Indian Community Grant Application Grant Cycle 2018 Narrative Please structure your proposal to provide the following information in the order indicated. Provide the narrative in paragraph form in the text field provided. Please be thorough but strive for brevity. 1. Briefly describe the organization’s history, mission and goals. The mission of Sun Health is to champion healthy living, medical research and superior health care. Sun Health achieves its mission by focusing on three pillars: community wellness programs, community health education and senior life care communities. Through these pillars we served over 25,000 people last year. Sun Health also serves as the philanthropic link for Banner Boswell Medical Center, Banner Del E. Webb Medical Center, and Banner Sun Health Research Institute. The two hospitals had over 100,000 emergency department visits last year. Founded in 1966, Sun Health has made a significant impact on the health and wellbeing of seniors in the West Valley by strategically developing wellness programs, health education classes, medical care initiatives, and groundbreaking research to support successful aging. Today, we are the leading advocate for healthy living and go beyond the traditional care model to help seniors remain independent, active and healthy. Sun Health has developed a catalog of best practice programs with the specific intent to promote healthy aging such as Diabetes Prevention, Fall Prevention & Balance, Memory Care Navigator, Care Transitions, Brain Health education, and many more. Our programs are developed in direct response to community concerns regarding how best to sustain the well-being of a large and maturing Baby Boom population and address disease prevention, preventable medical complications, and quality of life issues in advanced years. While our programs target the senior population, we welcome people of all ages as they can be equally beneficial. Moreover, we do not refuse anyone in the community in need of our program services. 2. If the applying organization is non-municipal or a non-profit 501c, please describe your relationship with Arizona municipalities including past and present support, whether through partnerships, collaborations, in-kind contributions, grants, tax-based funding or other. Describe the supporting municipality’s role in this project. If the applying organization is a municipality governmental sub-division please enter the text “Not applicable.” During its 50 year history, Sun Health has enjoyed a number of partnerships, collaborations, and grants from various municipalities including Maricopa County, Surprise, Avondale, Peoria, and Litchfield Park. We currently have a Community Development Block Grant from the City of Surprise to support Care Transitions to benefit Surprise residents. For a number of years, Sun Health partnered with Maricopa County from 1995 through 2008 for support our former Olive Branch Senior Center, now operated by Banner Health. We are now pleased to partner with Maricopa County in applying for support from the Gila River Indian Community 12% grant program. 3. Describe the proposed project and planned goals and activities. Everything we do at Sun Health has a single purpose -- to improve the health and well-being of older adults in the West Valley. Sun Health developed Care Transitions as a pilot program in 2011 to address a substantial gap in care navigation following a hospitalization. This care gap is particularly harmful to seniors (65 and Gila River Indian Community Grant Application Grant Cycle 2018 older) who are considerably more fragile post hospitalization and are prone to dangerous medical complications. This program is offered a no charge to patients and it bridges the health care gap after hospitalization to support successful recovery, decrease medical complications and reduce hospital readmissions. Our Care Transition nurses help seniors navigate the healing process during the first 30 days after being released from the hospital and encourage independence and self-sufficiency through self-care education. Nurses provide bedside visits in the hospital, home visits and phone calls to help patients navigate the healing process, recognize red-flag symptoms and manage health conditions independently. Services include medication review, patient education regarding medical condition(s) and red flags symptoms, helping patients adhere to care plans, facilitating follow-up care and connecting patients to community resources, such as transportation or medical equipment lending closets. 4. Describe how the proposed project satisfies one or more of the priority funding areas identified by the Gila River Indian Community. Sun Health Care Transitions program satisfies the Gila River Indian Community’s priority funding in the area of Healthcare. Care Transitions directly benefits older adults in the West Valley with health promotion, nutrition, direct patient care, and health education. Sun Health was awarded Outstanding Leadership in Population Health by Care Continuum Alliance (CCA) for its leadership in establishing the program. In fiscal year 2016-17 a total of 3,050 patients were served, we reduced hospital readmissions by 64% saving millions in avoidable health care costs during the first four years of operation, and reduced complications through preventative health care measures and patient education. 5. Identify the needs/problems to be addressed, target population and number of people to be served by the project. Post-hospital care for seniors is often intimidating for both patients and family members who are frequently unsure about follow-up care, new medication schedules, and diet and lifestyle changes prescribed by multiple health care providers. Many leave the hospital confused and unable to follow-through with the care instructions provided at discharge, ultimately to be readmitted into the hospital. Studies show that almost 18% of Medicare patients discharged from U.S. hospitals are readmitted within 30 days. That's more than two million seniors annually who are re-hospitalized at a cost of over $26 billion every year. This is a significant concern for the community we serve. West Valley cities have a higher percentage of adults 65 or older than Maricopa County in general, with 26.4% of the population consisting of seniors compared to Maricopa County's 14.2%. With the combined support of our funders, individual donations and Gila River Gila River Indian Community Grant Application Grant Cycle 2018 Indian Community’s approval of our request, we anticipate serving nearly 3,000 patients total in the course of a year. Specifically, funding from the Gila River Indian Community will help us serve 100 seniors. 6. Define the project as a new or continuing program. Sun Health Care Transitions is a continuing program aiming to expand its geographic scope and service capacity to serve all West Valley seniors regardless of insurance coverage. A grant award from Gila River Indian Community will enable Sun Health to continue offering this proven program free of charge to seniors in need, as well as help us fulfill our mission to promote healthy living and superior health care. 7. Provide a brief timeline including start and finish dates. Indicate if the timeline is flexible. Sun Health Care Transitions services funded by Gila River Indian Community would start in November 1, 2018 through October 31, 2019, however this timeline is flexible 8. Identify other organizations, partners or funders participating in the project and their roles. Community partnerships and funders are critical to the success of Sun Health Care Transitions. We work very closely with our community hospitals, Banner Boswell and Banner Del E. Webb to identify the patients requiring Care Transitions services. We engage in active collaboration with other organizations offering complementary services in order to connect patients to community resources, such as transportation or medical equipment lending closets – partners include Benevilla, Northwest Valley Connect, Southwest Lending Closet, local food banks, to name a few. Current funders include the City of Surprise Human Services and Community Vitality, J.W. Kieckhefer Foundation, and RBC Foundation. 9. Would you be able to implement the proposed plan if your organization received partial funding for this project? Our request for $39,500 from the Gila River Indian Community will enable Sun Health to offer services to 100 seniors in the West Valley. If the amount of funding received is less, the project can still be implemented and we will adjust the project deliverables proportionate to the amount of funding. The average cost to deliver this program is $395 per person. 10. Describe your plan for project financial sustainability beyond the grant period. If this is a program/project previously funded by the Gila River Indian Community describe efforts made towards the previously described sustainability plan. Gila River Indian Community Grant Application Grant Cycle 2018 While the value of care transition programs has been well-documented, the funding for demonstration projects that enabled Sun Health to pilot the program ended in January 2017. However, Sun Health is fully committed to ensuring that this project successfully transitions from the pilot stage and has committed $625,000 over a three-year period, starting with current fiscal year 2017-2018, to securely establish this critical program designed to boost long-term health among seniors. Furthermore, to ensure continuity of this free of charge program, we continuously seek to grow and diversify fundraising sources to include individual support and special events. Sun Health is also proactively pursuing contracts with healthcare organizations, payers and accountable care organizations. 11. Describe your plan to document progress and results. We measure success by documenting the number of West Valley families enrolled in the Sun Health’s Care Transitions program and by monitoring the results of the health services provided including medication review, medical condition care and symptom education, care plan adherence guidance, follow-up medical care, progress observation and community resource connection, such as transportation or medical equipment lending closets. Additionally, we are pleased to share the results of a recent study by the Health Services Advisory Group that has provided validation of Sun Health’s Care Transitions program including: A 30-day readmission rate of 8.8%, which is a 43.6% lower readmission rate than a control group without CT intervention at same hospitals. A one-year mortality rate of 10.7%, which is a 45.4% lower mortality rate than a control group without CT intervention at same hospitals. A 103% return on investment for the CT intervention, meaning that for every dollar spent to provide the CT intervention, $2.03 is saved in Medicare costs. 12. Indicate any application to and/or awards made by a tribe other than the Gila River Indian Community for state shared revenues for this and any other project for the past five (5) years. If this information is included in a separate attachment, please indicate that here. Sun Health has not received awards by a tribe in the past five years. In addition to applying for a grant from Gila River Indian Community, Sun Health Foundation plans to apply for funding from the Salt River Pima- Maricopa Indian Community as well as from the Tohono O'odham Nation. Gila River Indian Community Grant Application Grant Cycle 2018 Project Budget Budget Period: July 1, 2018 – June 30, 2019 For each budget item listed here please provide a narrative description on the following Project Budget Detail page. Proposed Budget Expense Amount Amount In Kind Total Budget (list each budget item) requested from requested or contributions GRIC secured from other funders 1. Program staff salary and wages $34,000 $1,016,724 $0 $1,050,724 2. Employee Benefits $4,800 $142,973 $0 $147,773 3. Supplies $200 $5,957 $0 $6,157 4. Mileage $500 $14,750 $0 $15,250 5. Click here to enter text. $0 $0 $0 $0 6. Click here to enter text. $0 $0 $0 $0 7. Click here to enter text. $0 $0 $0 $0 8. Click here to enter text. $0 $0 $0 $0 9. Click here to enter text. $0 $0 $0 $0 10. Click here to enter text. $0 $0 $0 $0 11. Click here to enter text. $0 $0 $0 $0 12. Click here to enter text. $0 $0 $0 $0 13. Click here to enter text. $0 $0 $0 $0 14. Click here to enter text. $0 $0 $0 $0 15. Click here to enter text. $0 $0 $0 $0 16. Click here to enter text. $0 $0 $0 $0 17. Click here to enter text. $0 $0 $0 $0 Total Budget $39,500 $1,174,447 $0 $1,219,904 Gila River Indian Community Grant Application Grant Cycle 2018 Project Budget Detail Please provide a narrative description for each of the project budget items listed on the previous page. Include the dollar figure and how it was derived. 1. Direct program service staff salary & wages ($1,050,724) includes Patient Care Coordinator – 1.0 FTE, Registered Nurses – 2 FTE and 5 PTE, Licensed Practical Nurse – 4 FTE, PRN – 1 FTE, and Master of Social Work – 1 0.6 FTE 2. Employee Benefits for FTE’s ($147,773) 3. Supplies ($6,157) includes information binders with guides and resources for each patient 4. Mileage (15,250) for gas reimbursement of program staff going to visit patients at hospitals and their homes 5. Click here to enter text. 6. Click here to enter text. 7. Click here to enter text. 8. Click here to enter text. 9. Click here to enter text. 10. Click here to enter text. 11. Click here to enter text. 12. Click here to enter text. 13. Click here to enter text. 14. Click here to enter text. 15. Click here to enter text. 16. Click here to enter text. 17. Click here to enter text. Other explanation: Donations received to support Care Transitions are applied directly to the program. Overhead expenses are covered by Sun Health Foundation. City of Peoria Fire-Medical Department 8401 West Monroe Street, Peoria, Arizona 85345 Phone: 623-773-7279 Fax: 623-773-7295 February 20, 2018 Ms. Cheryl Pablo Program Director Gila River Indian Community Office of Special Funding P.O. Box 97 Sacaton, AZ 85147 Dear Ms. Pablo: I am writing in support of the Sun Health Foundation and their Care Transition Services. I have had the opportunity to work with the Sun Health Foundation over many years, most recently with Sun Health Foundation’s Support of a Regional Fire Service based Community Paramedicine Pilot Program in the west valley. The Community Paramedicine Program represents a consortium partnership between Goodyear, Peoria, Surprise, Avondale and Sun City Fire Department’s. The Sun Health Foundation has been an integral part of the development of our program, providing support and guidance in training, resource development and patient interaction. They are recognized as a leader in the Northwest Valley in their ability to provide Care Transition services and in their support of community health. The Sun Health Care Transitions Program has served as a resource for our emergency service providers as well as a resource of the residents we serve. Their programs for health promotion, disease prevention and wellness have been beneficial to many residents in our community. I have found that the personnel of Sun Health Foundation to be leaders in their field and the programs that they provide to be exemplary and a model for community health service delivery. We feel very fortunate to have the ability to partner with the Sun Health Foundation and to have them a resource and a contributor to our community and to have the resource of their Care Transition services. I wholly support and recommend the quality and service that the Sun Health Foundation provides. Please feel free to contact me if you require any additional information. Sincerely, Jim Bratcher, Deputy Chief – Medical Services Peoria Fire-Medical Department SERVING WITH: STRENGTH – HONOR - COMPASSION 1 HSAG HEALTH SERVICES ADVISORY GROUP February 27, 2018 Ms. Cheryl Pablo Program Administrator Gila River Indian Community Office of Special Funding P.O. Box 97 Sacaton, AZ 85147 Dear Ms. Pablo, Health Services Advisory Group, Inc., contracted as the Arizona Quality Improvement Organization (QIO) by the Centers for Medicare and Medicaid Services (CMS), has enjoyed a very productive and collaborative relationship with the Sun Health Care Transitions program for the last five years. It is on their behalf that I write this letter of support as they apply for the Gila River Indian Community Grant. The Sun Health Care Transitions program has proven to be an effective resource for the members of the community they service. Through their program, Sun Health Care Transitions assists many frail elderly so they have a successful care transition during that vulnerable period from hospital discharge through the first 30 days at home. This allows patients to recuperate in their own home, where they have the comfort of their surroundings, and ultimately avoid a hospital readmission. Their program has been so successful that the Sun Health Care Transitions program staff were asked to present at a national CMS conference in December 2016 so many other states could learn of their successful, patient centered program. Not only are their staff knowledgeable about the medical needs of the patients and the community resources and programs that can be accessed, but their empathy and genuine concern for the patients they serve is evident. They are truly patient centered so the follow-up care they provide is customized to every patient's needs and not a cookie-cutter format. We are proud to have been a supporter of their work from the onset and we would highly recommend them as a recipient of any grant program so they can continue this great work. Respectfully, It 7 Ma Vn áalton, PhD, MBA, RN Presis e and Chief Executive Officer Health Services Advisory Group 3133 East Camelback Road, Suite 100, Phoenix, AZ 85016 4545 1 Phone: 602.801 .6600 1 Fax: 602.801.6051 1 www.hsag.com