Physicians Medical Center (Texas Health Center for Diagnostics & Surgery Plano) Community Health Needs Assessment

Physicians Medical Center (Texas Health Center for Diagnostics & Surgery Plano) Community Health Needs Assessment 2013

Table of Contents Executive Summary Why a Community Health Needs Assessment Community Health Improvement Vision and Goals Executive Summary of Health Needs Addressing the Health Needs of the Community Community Health Needs Assessment Secondary Data Assessment» Definition of the community» Demographic assessment of the community» Economic indicators» Health status and access indicators» Community supply of health care service providers and resources» Community demand / health services use» Review of other recent community health needs assessments Primary Data Assessment» Summary of community input» Identification of people representing the community s interests Notes to the Study» How the assessment was conducted including data sources» Process for consulting with people representing the community s interest» Process for identifying and prioritizing health needs and services» Gaps that limited ability to assess the community s health needs 2

Executive Summary

Why a Community Health Needs Assessment? Texas Health Resources, a leading faith-based nonprofit health care system in North Texas, is committed to improving the health and well-being of the people who live and work in the communities we serve. Texas Health provides hospital care, but also offers programs intended to educate people about health and provide them with resources to prevent illness, maintain health and improve their overall well-being. Texas Health has completed this community health needs assessment in order to better understand the health status and needs of the community and use the knowledge gained to implement programs that will benefit the community by: Identifying unmet needs in community health and developing strategies to address those unmet needs Informing the community about health services and available resources For more information regarding Texas Health Resources please visit http://www.texashealth.org 4

Texas Health Resources Locations that serve the North Texas community 5

Community Health Improvement: Statement and Goals Statement: Physicians Medical Center, a Texas Health Resources joint venture partner, is supportive of Texas Health s efforts to improve the health and well-being of the people who live and work in the communities we serve. Goals: Community Health supports the mission and core business of Texas Health by targeting preventive health/wellness activities and services to ensure the fulfillment of its charitable mission, to positively impact the health status of disproportionate unmet health needs populations, to facilitate the coordination of care (specifically prevention and disease management outreach activities) across the entire community, and provide community based activities that support and enhance hospital service lines and key performance indicators. 6 Source: Texas Health Resources

7 Executive Summary Community overview and population health indicators Community Highlights Physicians Medical Center s community is comprised of 1.27 million people, and is projected to grow to 1.54 million people by 2017; a growth rate of 21.5% exceeding that of Texas 7.3%. The community is young, having 27.9% of the population younger than 18, compared with 27.0% in Texas and 23.5% in the U.S. Median household income is $77,354, compared with $49,000 in Texas and $50,000 in the U.S. A small percent, 17.5%, of the population is reported below 200% Federal Poverty Level, much less than the Texas figure of 44.9% or U.S. figure of 39.0%. The percent of persons living in the community that are uninsured is 14.4%, which is lower than the Texas average of 24.0% and 16.0% in the U.S. Overall, the population has fewer avoidable inpatient admissions than Texas or the U.S. This population also uses the emergency room at a lower rate than the overall Texas or U.S. populations. While there is not an overall shortage of primary care physicians, there is likely a shortage when considering physicians who accept Medicare and Medicaid. Please see the following page for expanded legend criteria. COMMUNITY HIGHLIGHTS LESS FAVORABLE MORE FAVORABLE Population Growth Estimates <0% 0-7.3% >7.3% Population percentage of Age <18 <25% 25-27% >27% Median Household Income <$49,000 NA >$49,000 Population Below 200% Federal Poverty Level >50% 44.9-50% <44.9% Percent of Uninsured >25% 24-25% <24% Health Indicator Groups Avoidable Inpatient Admissions >1526.1 1272.6-1526.1 <1272.6 Emergency Room Usage >411.3 385.6-411.3 <385.6 Primary Care Supply <0 NA >0 Birth Indicators-such as percent of low birth weight babies or teen birth rates HEALTH INDICATOR GROUPS LESS FAVORABLE MORE FAVORABLE Birth, Death, General Health, Health Screenings, Clinical Prevention Services, Chronic Diseases and Conditions, Physical Environment, Substance Use and Reportable Conditions >35% 20-35% <20% Death indicators-such as all cause deaths or deaths from cancer General Health-such as self reported healthy days or no exercise Health Screenings-such as diabetes or cholesterol screening Clinical Prevention Servicessuch as an annual physical or vaccination Chronic Diseases and Conditions-such as diabetes or asthma County-level Physical Environment-such as crime rate or adult literacy County-level Substance Use and Reportable Conditionssuch as drinking and chicken pox vaccinations th

Executive Summary Criteria for community highlights and health indicator groups COMMUNITY HIGHLIGHTS LESS FAVORABLE MORE FAVORABLE TEXAS AVERAGES Population Growth Estimates <0% 0-7.3% >7.3% 7.3% Population percentage of Age <18 <25% 25-27% >27% 27.0% Median Household Income <$49,000 NA >$49,000 $49,000 Population Below 200% Federal Poverty Level >50% 44.9-50% <44.9% 44.9% Percent of Uninsured >25% 24-25% <24% 24.0% Avoidable Inpatient Admissions >1526.1 1272.6-1526.1 <1272.6 1,272.6 Emergency Room Usage >411.3 385.6-411.3 <385.6 385.6 Primary Care Supply <0 NA >0 Provider supply defined by population need HEALTH INDICATOR GROUPS LESS FAVORABLE MORE FAVORABLE Birth, Death, General Health, Health Screenings, Clinical Prevention Services, Chronic Diseases and Conditions, Physical Environment, Substance Use and Reportable Conditions >35% 20-35% <20% The percentage of total indicators, within each health indicator group, that are less favorable than the Texas average. 8

Executive Summary Addressing the health needs of the community Community Health Issues Access: Provider Supply Awareness, literacy, navigation Cancer Chronic Disease Injury and Violence Maternal, Infant, and Child Health Mental Health Nutrition, Physical Activity, and Obesity Oral Health Other Clinical/Preventive Preventive/Wellness Reproductive and Sexual Health Social Determinants Substance Abuse Tobacco Transportation Physicians Medical Center Vast amounts of quantitative and qualitative data were collected, refined and analyzed during this Community Health Needs Assessment process. Detailed data is presented in this document. The chart above summarizes the most significant health issues facing the community. X X X X X X X X X Physicians Medical Center s efforts to address the health needs of the community will focus on two areas: Awareness, Literacy and Navigation (ALN) and Chronic Disease. The following strategies will be implemented: Awareness, Literacy and Navigation Development of an Area Resource Guide Maintain Existing Programs with Awareness, Literacy and/or Navigation focus Educational Programs Sponsorship of Area Collaboratives Chronic Disease Maintain Existing Programs with Chronic Disease focus Educational Programs Sponsorship of Area Collaboratives 9

Community Health Needs Assessment

Secondary Data Assessment: Definition of the Community Demographic Assessment of the Community Economic Indicators

12 Physicians Medical Center Definition of the community served Data Source: Texas Health Resources Strategy and Business Planning Department Community Zip Codes: 75002 Allen Collin County 75006 Carrollton Dallas County 75007 Carrollton Denton County 75010 Carrollton Denton County 75011 Non-residential Dallas County 75013 Allen Collin County 75023 Plano Collin County 75024 Plano Collin County 75025 Plano Collin County 75028 Flower Mound Denton County 75034 Frisco Denton County 75035 Frisco Collin County 75056 The Colony Denton County 75057 Lewisville Denton County 75065 Lake Dallas Denton County 75067 Lewisville Denton County 75068 Little Elm Denton County 75069 McKinney Collin County 75070 McKinney Collin County 75071 McKinney Collin County 75074 Plano Collin County 75075 Plano Collin County 75077 Lewisville Denton County 75080 Richardson Dallas County 75086 Non-residential Collin County 75093 Plano Collin County 75094 Plano Collin County 75098 Wylie Collin County 75248 Dallas Dallas County 75252 Dallas Collin County 75287 Dallas Collin County

Physicians Medical Center 2012-2017 population growth projections The community is very similar to Texas among most age groups, but there is a lower percentage of persons aged 65+, 7.1 percent, than Texas, 10.8 percent, and than the U.S., 14.1 percent. The community is predicted to have strong growth over the next five years, especially among persons younger than age 18 and persons older than age 65. 2012 Total Population by Age 2012-2017 Absolute Growth by Age 2012-2017 Percent Growth by Age Zip Code Zip City Name 0-14 15-17 18-44 45-64 65+ Total 0-14 15-17 18-44 45-64 65+ Total 0-14 15-17 18-44 45-64 65+ Total 75002 Allen 17,441 3,389 26,166 17,252 4,879 69,127 7,530 892 1,730 4,527 2,543 17,222 43.2% 26.3% 6.6% 26.2% 52.1% 24.9% 75006 Carrollton 10,908 1,792 18,972 11,168 3,929 46,769 3,613-58 -1,149 693 742 3,841 33.1% -3.2% -6.1% 6.2% 18.9% 8.2% 75007 Carrollton 11,406 2,351 20,652 14,277 3,145 51,831 3,304 82-928 1,396 1,542 5,396 29.0% 3.5% -4.5% 9.8% 49.0% 10.4% 75010 Carrollton 5,714 910 10,069 4,738 969 22,400 2,501 329 456 1,767 683 5,736 43.8% 36.2% 4.5% 37.3% 70.5% 25.6% 75013 Allen 9,574 1,700 11,846 8,288 1,942 33,350 4,857 603 1,249 3,129 1,347 11,185 50.7% 35.5% 10.5% 37.8% 69.4% 33.5% 75023 Plano 9,211 1,794 17,148 13,251 4,058 45,462 2,307 247-557 962 1,279 4,238 25.0% 13.8% -3.2% 7.3% 31.5% 9.3% 75024 Plano 8,630 1,434 17,171 9,061 1,959 38,255 3,731 632 1,537 3,123 1,402 10,425 43.2% 44.1% 9.0% 34.5% 71.6% 27.3% 75025 Plano 14,639 2,505 21,925 12,436 2,503 54,008 5,302 608 544 3,186 1,397 11,037 36.2% 24.3% 2.5% 25.6% 55.8% 20.4% 75028 Flower Mound 11,560 2,202 16,170 10,816 1,811 42,559 3,671 223-381 1,835 1,291 6,639 31.8% 10.1% -2.4% 17.0% 71.3% 15.6% 75034 Frisco 21,603 3,892 33,665 18,882 5,184 83,226 12,581 1,503 5,584 7,462 3,135 30,265 58.2% 38.6% 16.6% 39.5% 60.5% 36.4% 75035 Frisco 14,197 2,353 22,668 11,199 2,680 53,097 6,748 992 1,936 4,683 1,573 15,932 47.5% 42.2% 8.5% 41.8% 58.7% 30.0% 75056 The Colony 13,050 2,519 22,582 12,646 2,642 53,439 6,335 592 2,175 4,204 1,888 15,194 48.5% 23.5% 9.6% 33.2% 71.5% 28.4% 75057 Lewisville 2,776 371 6,224 2,442 883 12,696 949 85-195 628 191 1,658 34.2% 22.9% -3.1% 25.7% 21.6% 13.1% 75065 Lake Dallas 2,375 419 4,258 2,748 859 10,659 910 87 138 525 358 2,018 38.3% 20.8% 3.2% 19.1% 41.7% 18.9% 75067 Lewisville 15,270 2,087 31,429 12,633 3,073 64,492 5,487 609-220 3,563 1,399 10,838 35.9% 29.2% -0.7% 28.2% 45.5% 16.8% 75068 Little Elm 9,652 1,463 14,928 7,871 2,261 36,175 5,556 624 2,177 3,069 1,330 12,756 57.6% 42.7% 14.6% 39.0% 58.8% 35.3% 75069 McKinney 8,467 1,446 14,867 7,315 3,312 35,407 3,323 357 442 1,953 839 6,914 39.2% 24.7% 3.0% 26.7% 25.3% 19.5% 75070 McKinney 23,910 4,408 31,291 18,451 5,400 83,460 12,494 1,546 3,712 7,894 2,643 28,289 52.3% 35.1% 11.9% 42.8% 48.9% 33.9% 75071 McKinney 9,380 1,687 14,649 8,793 3,695 38,204 4,982 548 1,802 3,190 1,489 12,011 53.1% 32.5% 12.3% 36.3% 40.3% 31.4% 75074 Plano 10,125 1,713 19,220 10,709 3,884 45,651 3,180 413 9 1,948 1,200 6,750 31.4% 24.1% 0.0% 18.2% 30.9% 14.8% 75075 Plano 6,610 1,276 12,957 10,217 4,127 35,187 1,753 261-347 727 1,081 3,475 26.5% 20.5% -2.7% 7.1% 26.2% 9.9% 75077 Lewisville 8,540 1,898 13,603 10,425 2,480 36,946 2,827 147 541 1,136 1,261 5,912 33.1% 7.7% 4.0% 10.9% 50.8% 16.0% 75080 Richardson 8,270 1,630 16,484 10,275 5,894 42,553 2,789-87 -471 462 663 3,356 33.7% -5.3% -2.9% 4.5% 11.2% 7.9% 75093 Plano 11,084 2,281 17,470 13,600 3,703 48,138 3,232 419-152 1,732 1,575 6,806 29.2% 18.4% -0.9% 12.7% 42.5% 14.1% 75094 Plano 5,644 1,023 8,032 5,805 1,950 22,454 2,948 444 1,342 2,100 1,067 7,901 52.2% 43.4% 16.7% 36.2% 54.7% 35.2% 75098 Wylie 12,765 2,546 20,472 12,734 4,344 52,861 6,345 795 2,908 4,551 1,968 16,567 49.7% 31.2% 14.2% 35.7% 45.3% 31.3% 75248 Dallas 5,057 996 11,996 10,762 4,457 33,268 1,885-62 -375-65 806 2,189 37.3% -6.2% -3.1% -0.6% 18.1% 6.6% 75252 Dallas 3,931 619 11,791 6,595 2,136 25,072 997 211-480 1,131 797 2,656 25.4% 34.1% -4.1% 17.1% 37.3% 10.6% 75287 Dallas 8,005 1,114 28,746 10,754 2,207 50,826 2,082 364-645 2,859 1,182 5,842 26.0% 32.7% -2.2% 26.6% 53.6% 11.5% Grand Total 299,794 53,818 517,451 306,143 90,366 1,267,572 124,219 13,406 22,382 74,370 38,671 273,048 41.4% 24.9% 4.3% 24.3% 42.8% 21.5% Total Community <18 = 27.9% 40.8% 24.2% 7.1% 100.0% <18 = 38.9% 4.3% 24.3% 42.8% 21.5% Texas <18 = 27.0% 38.1% 24.1% 10.8% 100.0% <18 = 4.6% 4.5% 4.8% 19.1% 7.3% U.S. <18 = 23.5% 35.6% 26.8% 14.1% 100.0% <18 = 0.2% 0.0% 0.4% 15.8% 2.2% The following community zip codes, not included in the table above, are non-residential: 75011 and 75086 13 Data Sources: U.S. projections from U.S. Census Bureau and Texas projections from the Texas State Data Center. Zip code population estimates and projections were retrieved by Texas Health Resources Strategy and Business Planning Department from Truven.

Physicians Medical Center 2012 total population density map 75070, McKinney, has the largest zip code population in the community, 83,000. 75065, Lake Dallas, has the smallest zip code population in the community, 11,000. 14

Physicians Medical Center 2012 population by age/gender and race/ethnicity The community is very similar to Texas among most age groups, but there is a lower percentage of persons aged 65+ than Texas and the U.S. The percentage of White Non-Hispanic people, 59.7 percent, and Asian Pacific Islander Non-Hispanic people, 11.1 percent, are greater than the Texas averages. 2012 Male Population 2012 Female Population 2012 Population The following community zip codes, not included in the table above, are non-residential: 75011 and 75086 American Indian Non- Hispanic Asian Pacific Islander Non- Hispanic Total White Non-Black Non- Other Non- Zip Code ZIP City Name 0-14 15-17 18-44 45-64 65+ Total Male 0-14 15-17 18-44 45-64 65+ Female Hispanic Hispanic Hispanic Hispanic 75002 Allen 12.9% 2.4% 19.1% 12.4% 3.3% 50.2% 12.3% 2.5% 18.7% 12.6% 3.7% 49.8% 64.8% 9.7% 13.2% 0.5% 11.6% 0.2% 75006 Carrollton 11.9% 1.9% 21.5% 11.6% 3.6% 50.7% 11.4% 1.9% 19.0% 12.3% 4.8% 49.3% 35.4% 7.5% 49.4% 0.3% 7.3% 0.1% 75007 Carrollton 11.2% 2.2% 19.8% 13.3% 2.8% 49.4% 10.8% 2.3% 20.0% 14.2% 3.2% 50.6% 51.2% 9.0% 24.7% 0.4% 14.4% 0.2% 75010 Carrollton 13.0% 2.0% 21.9% 10.5% 1.9% 49.4% 12.5% 2.1% 23.0% 10.6% 2.4% 50.6% 47.7% 10.3% 17.4% 0.3% 24.1% 0.2% 75013 Allen 14.8% 2.6% 17.2% 12.5% 2.9% 49.9% 14.0% 2.5% 18.4% 12.3% 2.9% 50.1% 64.6% 6.8% 9.1% 0.4% 19.0% 0.2% 75023 Plano 10.5% 2.1% 19.2% 13.9% 4.1% 49.7% 9.8% 1.9% 18.5% 15.2% 4.9% 50.3% 66.4% 8.4% 14.5% 0.3% 10.1% 0.2% 75024 Plano 11.5% 2.0% 22.1% 12.0% 2.5% 50.1% 11.0% 1.8% 22.8% 11.7% 2.7% 49.9% 52.3% 8.1% 8.2% 0.3% 30.9% 0.2% 75025 Plano 13.9% 2.4% 19.9% 11.7% 2.2% 50.1% 13.2% 2.2% 20.7% 11.4% 2.4% 49.9% 56.0% 7.0% 8.1% 0.3% 28.4% 0.2% 75028 Flower Mound 13.9% 2.7% 18.4% 12.5% 2.1% 49.5% 13.3% 2.5% 19.6% 12.9% 2.2% 50.5% 77.0% 3.8% 11.1% 0.6% 7.4% 0.2% 75034 Frisco 13.3% 2.4% 19.9% 11.5% 3.0% 50.0% 12.7% 2.3% 20.6% 11.2% 3.3% 50.0% 65.4% 9.2% 16.7% 0.4% 8.0% 0.2% 75035 Frisco 13.8% 2.3% 21.4% 10.5% 2.3% 50.4% 12.9% 2.1% 21.3% 10.6% 2.7% 49.6% 64.5% 9.5% 12.6% 0.4% 12.7% 0.3% 75056 The Colony 12.4% 2.3% 21.3% 11.7% 2.2% 49.9% 12.0% 2.4% 21.0% 12.0% 2.7% 50.1% 59.6% 8.0% 18.3% 0.4% 13.3% 0.3% 75057 Lewisville 11.0% 1.5% 26.7% 10.5% 2.9% 52.6% 10.8% 1.4% 22.3% 8.8% 4.0% 47.4% 40.5% 10.3% 45.2% 0.5% 3.2% 0.3% 75065 Lake Dallas 11.6% 2.1% 20.2% 12.7% 3.6% 50.2% 10.7% 1.9% 19.7% 13.1% 4.4% 49.8% 74.9% 3.6% 18.5% 0.7% 2.1% 0.1% 75067 Lewisville 12.1% 1.7% 24.6% 9.7% 2.0% 50.1% 11.6% 1.6% 24.1% 9.9% 2.8% 49.9% 46.4% 12.2% 31.5% 0.3% 9.3% 0.2% 75068 Little Elm 13.7% 2.3% 21.0% 11.1% 2.9% 51.0% 13.0% 1.7% 20.3% 10.7% 3.3% 49.0% 58.4% 13.9% 22.4% 0.5% 4.6% 0.2% 75069 McKinney 12.4% 2.1% 22.3% 10.6% 3.8% 51.2% 11.5% 2.0% 19.6% 10.1% 5.6% 48.8% 49.7% 9.8% 36.6% 0.4% 3.4% 0.1% 75070 McKinney 14.7% 2.7% 18.2% 11.2% 3.0% 49.8% 13.9% 2.6% 19.3% 11.0% 3.4% 50.2% 71.2% 9.9% 11.9% 0.5% 6.3% 0.2% 75071 McKinney 12.6% 2.2% 19.8% 11.5% 4.0% 50.1% 11.9% 2.2% 18.6% 11.5% 5.7% 49.9% 65.5% 11.9% 17.9% 0.5% 4.0% 0.1% 75074 Plano 11.3% 1.9% 22.8% 11.8% 3.8% 51.6% 10.9% 1.8% 19.3% 11.7% 4.8% 48.4% 41.4% 10.8% 38.0% 0.4% 9.2% 0.2% 75075 Plano 9.7% 1.8% 19.5% 14.0% 5.3% 50.3% 9.1% 1.8% 17.3% 15.0% 6.4% 49.7% 67.4% 5.7% 16.0% 0.4% 10.3% 0.2% 75077 Lewisville 11.7% 2.5% 18.1% 13.9% 3.2% 49.4% 11.4% 2.6% 18.8% 14.3% 3.5% 50.6% 77.9% 6.1% 10.8% 0.4% 4.6% 0.2% 75080 Richardson 10.2% 2.1% 21.0% 11.6% 5.7% 50.5% 9.3% 1.8% 17.8% 12.6% 8.1% 49.5% 63.3% 5.7% 23.9% 0.3% 6.6% 0.2% 75093 Plano 11.7% 2.4% 17.5% 13.9% 3.6% 49.2% 11.3% 2.3% 18.8% 14.3% 4.1% 50.8% 67.8% 6.1% 8.4% 0.3% 17.4% 0.2% 75094 Plano 13.0% 2.4% 17.2% 12.9% 4.2% 49.7% 12.2% 2.2% 18.5% 12.9% 4.5% 50.3% 54.2% 11.3% 9.8% 0.4% 24.1% 0.2% 75098 Wylie 12.3% 2.4% 19.6% 12.0% 3.8% 50.1% 11.9% 2.4% 19.1% 12.1% 4.5% 49.9% 62.6% 11.9% 17.5% 0.5% 7.4% 0.2% 75248 Dallas 7.9% 1.5% 19.1% 15.2% 6.1% 49.8% 7.3% 1.4% 17.0% 17.2% 7.3% 50.2% 70.9% 9.1% 15.0% 0.2% 4.5% 0.2% 75252 Dallas 7.9% 1.2% 24.5% 12.9% 3.9% 50.4% 7.8% 1.2% 22.5% 13.4% 4.6% 49.6% 58.5% 10.8% 16.2% 0.3% 14.1% 0.2% 75287 Dallas 8.1% 1.1% 28.6% 10.6% 1.9% 50.3% 7.6% 1.1% 28.0% 10.6% 2.4% 49.7% 43.8% 24.8% 23.1% 0.3% 7.4% 0.5% % Distribution of Tot Pop 12.1% 2.2% 20.6% 12.0% 3.2% 50.1% 11.5% 2.1% 20.2% 12.2% 3.9% 49.9% 59.7% 9.6% 19.0% 0.4% 11.1% 0.2% Grand Total 153,665 27,534 261,483 151,806 40,985 635,473 146,129 26,284 255,968 154,337 49,381 632,099 740,446 118,711 235,566 4,974 137,852 2,612 Total Community <18 = 14.3% 20.6% 12.0% 3.2% 50.1% <18 = 13.6% 20.2% 12.2% 3.9% 49.9% 59.7% 9.6% 19.0% 0.4% 11.1% 0.2% Texas <18 = 13.8% 19.2% 11.8% 4.8% 49.6% <18 = 13.2% 18.8% 12.3% 6.1% 50.4% 42.0% 12.0% 40.0% 1.0% 3.1% 2.0% U.S. <18 = 12.0% 18.1% 13.1% 6.1% 49.3% <18 = 11.5% 17.5% 13.7% 8.0% 50.7% 63.0% 12.0% 17.0% 1.0% 4.2% 3.0% 15 Data Sources: Population estimates and projections were retrieved by Texas Health Resources Strategy and Business Planning Department from Truven. U.S. and Texas percentages from Kaiser Family Foundation State Health Facts.

Physicians Medical Center 2012 population by economic indicators The median household income for the community, $77,354, is higher than the Texas or the U.S. average. On average, nearly 20 percent of the community lives below 200 percent of the Federal Poverty Level (FPL). The percent uninsured, 14 percent, is lower than Texas average of 24 percent. 2012 Population 2012 Population High School Median Income Income Income Income Population Age 18 + Age 18+ ZIP City Graduation Household Number Income $15,000- $25,000- $50,000- $75,000- Income below Uninsured Uninsured Managed Zip Code Name Percentage Income of HHs < $15,000 $24,999 $49,999 $74,999 $99,999 $100,000+ 200% FPL Count Percent Care Medicare Medicaid Self Pay Other 75002 Allen 96.6% $ 85,274 22,889 711 975 3,784 4,312 4,043 9,064 11.5% 4,576 11.4% 2,843 1,177 515 357 9 75006 Carrollton 85.8% $ 55,915 16,895 1,044 1,434 4,923 4,167 2,116 3,211 35.3% 7,773 22.6% 1,525 1,329 1,125 461 111 75007 Carrollton 92.8% $ 74,236 19,050 732 834 3,720 4,375 3,360 6,029 16.8% 5,379 13.9% 2,283 1,254 551 391 31 75010 Carrollton 94.1% $ 73,031 8,487 398 299 1,649 2,051 1,570 2,520 19.8% 1,919 12.6% 928 402 153 149 12 75013 Allen 98.2% $ 110,599 10,944 193 308 1,097 1,100 1,917 6,329 5.9% 2,272 6.9% 1,326 424 76 88 6 75023 Plano 96.2% $ 74,019 18,131 756 824 3,686 3,961 2,991 5,913 19.4% 3,935 11.8% 1,973 1,207 420 324 9 75024 Plano 98.6% $ 87,738 16,936 683 648 3,067 2,814 2,466 7,258 9.6% 2,946 11.3% 1,535 431 155 147 5 75025 Plano 97.6% $ 100,396 19,580 458 617 2,130 3,025 3,503 9,847 8.5% 4,036 10.6% 2,099 701 177 198 9 75028 Flower Mound 97.3% $ 102,499 14,485 275 315 1,357 2,326 2,717 7,495 5.4% 2,171 7.2% 2,050 597 120 149 24 75034 Frisco 95.7% $ 86,718 28,635 1,333 1,018 4,809 4,924 4,765 11,786 8.6% 9,835 14.8% 3,505 1,221 391 327 29 75035 Frisco 98.6% $ 92,005 17,890 340 462 1,714 3,463 4,358 7,553 8.6% 4,092 8.7% 2,581 739 177 214 10 75056 The Colony 96.5% $ 81,291 19,240 650 518 3,521 4,061 3,465 7,025 14.9% 4,348 11.6% 2,230 867 453 325 34 75057 Lewisville 85.7% $ 48,098 4,876 428 577 1,505 1,248 563 555 42.4% 2,393 24.0% 451 313 258 216 9 75065 Lake Dallas 94.8% $ 65,045 3,929 290 223 949 830 575 1,062 17.2% 1,119 22.5% 486 301 135 98 7 75067 Lewisville 92.5% $ 57,240 25,676 1,613 1,728 7,519 6,094 3,735 4,987 26.7% 10,228 22.2% 2,805 1,110 1,299 965 42 75068 Little Elm 92.9% $ 67,736 11,127 845 688 2,302 2,421 1,768 3,103 21.2% 2,710 13.8% 2,048 580 447 264 16 75069 McKinney 91.2% $ 46,994 12,270 1,585 1,287 3,556 2,219 1,216 2,407 40.8% 5,538 23.3% 1,342 1,352 848 443 17 75070 McKinney 98.2% $ 99,911 28,224 225 515 2,772 5,003 5,618 14,091 8.8% 3,611 6.3% 3,948 1,345 390 335 17 75071 McKinney 95.6% $ 78,107 12,133 650 827 2,028 2,321 1,943 4,364 19.4% 3,245 21.9% 1,735 633 304 217 8 75074 Plano 90.3% $ 56,530 15,776 1,163 1,416 4,405 3,308 2,234 3,250 30.8% 6,383 22.2% 1,691 905 934 513 19 75075 Plano 96.5% $ 73,248 14,559 843 649 3,085 2,915 2,436 4,631 21.3% 2,955 11.4% 1,531 1,348 301 289 11 75077 Lewisville 97.6% $ 96,095 13,386 218 361 1,487 2,397 2,644 6,279 10.1% 2,134 8.2% 1,677 849 140 153 15 75080 Richardson 94.3% $ 56,736 17,128 1,373 1,516 4,668 3,634 2,543 3,394 33.3% 6,282 18.6% 1,590 1,672 577 275 50 75093 Plano 98.1% $ 106,260 19,519 696 713 3,121 2,699 2,057 10,233 12.4% 3,560 10.5% 1,906 1,168 153 168 4 75094 Plano 97.4% $ 93,251 6,459 110 199 952 1,117 1,165 2,916 9.9% 564 5.2% 919 257 76 105 5 75098 Wylie 95.3% $ 69,348 16,981 841 914 3,594 4,014 3,168 4,450 14.9% 4,853 11.2% 2,479 872 513 312 26 75248 Dallas 96.9% $ 72,312 15,523 911 857 3,644 2,618 1,924 5,569 19.6% 3,448 12.2% 1,330 1,168 279 195 51 75252 Dallas 95.5% $ 59,094 12,701 954 905 3,622 2,163 1,355 3,702 25.3% 3,712 18.7% 977 635 339 179 18 75287 Dallas 96.5% $ 47,327 27,065 1,956 2,564 9,971 5,314 2,943 4,317 27.3% 8,704 20.7% 1,999 686 943 460 38 Grand Total 95.5% $ 77,354 470,494 22,274 24,191 94,637 90,894 75,158 163,340 17.5% 124,721 14.4% 53,792 25,543 12,249 8,317 642 % Distribution 4.7% 5.1% 20.1% 19.3% 16.0% 34.7% 53.5% 25.4% 12.2% 8.3% 0.6% Total Community 95.5% $ 77,354 17.5% 14% Texas 81.0% $ 49,195 44.9% 24% U.S. 85.7% $ 50,443 39.0% 16% 2010 Inpatient Payermix 16 The following community zip codes, not included in the table above, are non-residential: 75011 and 75086 Data Sources: Federal Poverty Level (FPL) estimates from U.S. Census Bureau. High school graduation, income, uninsured and Texas Health Care Information Council inpatient payer mix, retrieved by Texas Health Resources Strategy and Business Planning Department from Truven. U.S. and Texas percentages from Kaiser Family Foundation State Health Facts and National Information Center for Higher Education Policymaking and Analysis. Gray shading = Community statistic is less favorable than State of Texas.

Physicians Medical Center 2012 percent of 18+ population that is uninsured Community =14% Texas = 24% U.S. = 16% 75057, 24%, has the largest percentage of uninsured. 75094, 5%, has the lowest percentage of uninsured. 17

Demographics Needs Summary Population of focus Red shows areas of higher need. This map is based upon a grading system that includes population size and growth, lower income and the number of persons without health insurance. Data Sources: Population estimates and projections, income and uninsured, Texas Health Care Information Council inpatient payer mix, were retrieved by Texas Health Resources Strategy and Business Planning Department from Truven. Higher ranking = higher need based upon the indicator Demographics Needs Summary 2012 Total 2012-2017 Age 18+ Median HH Uninsured Zip Code ZIP City Name Population Growth Income Percent Total Score 75067 Lewisville 26 19 23 24 92 23.0 75034 Frisco 28 29 10 19 86 21.5 75069 McKinney 9 16 29 28 82 20.5 75287 Dallas 20 11 28 22 81 20.3 75074 Plano 17 14 25 24 80 20.0 75006 Carrollton 18 7 26 27 78 19.5 75002 Allen 27 27 11 11 76 19.0 75098 Wylie 22 26 19 9 76 19.0 75056 The Colony 24 24 12 13 73 18.3 75068 Little Elm 10 23 20 17 70 17.5 75071 McKinney 12 22 13 23 70 17.5 75070 McKinney 29 28 5 2 64 16.0 75080 Richardson 14 5 24 20 63 15.8 75007 Carrollton 21 9 14 18 62 15.5 75035 Frisco 23 25 8 6 62 15.5 75057 Lewisville 2 1 27 29 59 14.8 75025 Plano 25 20 4 8 57 14.3 75023 Plano 16 8 15 14 53 13.3 75252 Dallas 5 4 22 21 52 13.0 75024 Plano 13 18 9 10 50 12.5 75065 Lake Dallas 1 2 21 26 50 12.5 75010 Carrollton 3 10 17 16 46 11.5 75093 Plano 19 15 2 7 43 10.8 75248 Dallas 6 3 18 15 42 10.5 75075 Plano 8 6 16 11 41 10.3 75028 Flower Mound 15 13 3 4 35 8.8 75077 Lewisville 11 12 6 5 34 8.5 75013 Allen 7 21 1 3 32 8.0 75094 Plano 4 17 7 1 29 7.3 75011 non-residential 75086 non-residential 18

Secondary Data Assessment: Health Status and Access Indicators

2010-2011 Prevention Quality Indicators Prevention Quality Indicators (PQIs) are illnesses that lead to hospital stays that could have been prevented. PQI rates for adult and pediatric perforated appendices were higher than rates for Texas and/or the U.S. in 2010. LEGEND LESS FAVORABLE MORE FAVORABLE Data Sources: Zip code population estimates were retrieved by Texas Health Resources Strategy and Business Planning Department from Truven. Zip code level PQI data from Dallas Fort Worth Hospital Council. Notes: Rates are per 100,000 population except for Admissions with perforated appendix, which are per 1,000 admissions with appendicitis. Overall PQI based upon Acute + Chronic. Acute PQI based on the three AHRQ PQIs for bacterial pneumonia, dehydration, and urinary tract infection. Chronic PQI based on the nine AHRQ PQIs for angina, asthma, chronic obstructive pulmonary disease, congestive heart failure, diabetes, and hypertension. Gray shading = community rate is higher than Texas or U.S. rates 20

Community Defined Health Status Indicators Birth, death and general health status 21 Data Sources: PULSE Healthcare Survey retrieved by Texas Health Resources Strategy and Business Planning Department from Truven. Texas Behavioral Risk Factor Surveillance System (BRFSS) data provided by Texas Department of State Health Services - Center for Health Statistics. Texas Department of State Health Services - Center for Health Statistics and Vital Statistics Units. U.S. Centers for Disease Control and Prevention, Fast Stat reports. Note: Death rates for Texas and community are not age-adjusted but are crude death rates. US. Death rates are age-adjusted.

Community Defined Health Status Indicators Screenings, clinical prevention and chronic diseases 22 Data Sources: PULSE Healthcare Survey retrieved by Texas Health Resources Strategy and Business Planning Department from Truven. Texas Behavioral Risk Factor Surveillance System (BRFSS) data provided by Texas Department of State Health Services - Center for Health Statistics. U.S. Centers for Disease Control and Prevention, Fast Stat reports.

County Defined Health Status Indicators Socio-economic, physical environment and other 23 Data Sources: County Health Rankings. Texas Center for the Advancement of Literacy & Learning. Texas Department of State Health Services - Center for Health Statistics and Mental Health and Substance Abuse Division. Texas Health and Human Services Commission. U.S. Bureau of Labor Statistics. U.S. Census Bureau. U.S. Centers for Disease Control and Prevention, Fast Stat reports. U.S. Department of Health and Human Services, Community Health Status Indicators.

Secondary Data Assessment: Community Supply of Health Care Service Providers and Resources Community Demand / Health Services Utilization

Health Services in the Community Many facilities and several charitable clinics are located within Physicians Medical Center s areas of higher need (shown in red). 25 Data Sources: Providers from American Academy of Urgent Care Medicine; National Association of Free and Charitable Clinics; Texas Department of State Health Services, Health Facility Program; Texas Department of State Health Services, Texas Primary Care Office; and Urgent Care Association of America. Zip code population estimates and projections were retrieved by Texas Health Resources Strategy and Business Planning Department from Truven.

Physicians Medical Center Community Inpatient utilization summary The community uses inpatient care at a lower rate than the state average. This may be because the people within the community are younger than the Texas average and because younger people use the hospital less 1. Rank Major Diagnostic Category (MDC) <18 18-44 45-64 65+ Total 1 Pregnancy, Childbirth And Puerperium 2.0% 97.8% 0.2% 0.0% 17,535 2 Circulatory System 2.0% 9.0% 33.8% 55.2% 9,154 3 Musculoskeletal System And Connective Tissue 3.6% 15.1% 36.2% 45.1% 8,319 4 Digestive System 9.1% 25.3% 32.1% 33.4% 8,237 5 Respiratory System 16.2% 10.1% 24.9% 48.7% 7,288 6 Newborn And Other Neonates (Perinatal Period) 100.0% 0.0% 0.0% 0.0% 4,867 7 Nervous System 11.0% 19.8% 28.3% 40.9% 4,495 8 Mental Diseases and Disorders 25.2% 42.9% 22.6% 9.3% 3,933 9 Kidney And Urinary Tract 5.6% 18.6% 26.4% 49.4% 3,739 10 Factors Influencing Health Status 1.2% 7.0% 24.6% 67.2% 3,414 11 Endocrine, Nutritional And Metabolic System 13.0% 27.7% 30.7% 28.7% 2,860 12 Female Reproductive System 1.2% 48.3% 40.9% 9.6% 2,670 13 Infectious and Parasitic DDs 7.8% 13.8% 29.1% 49.3% 2,507 14 Hepatobiliary System And Pancreas 2.6% 34.8% 35.3% 27.3% 2,479 15 Skin, Subcutaneous Tissue And Breast 11.5% 25.3% 35.1% 28.1% 2,296 16 Blood and Blood Forming Organs and Immunological Disorders 15.9% 24.4% 24.2% 35.5% 1,169 17 Injuries, Poison And Toxic Effect of Drugs 10.5% 34.7% 33.9% 20.9% 1,157 18 Myeloproliferative DDs (Poorly Differentiated Neoplasms) 21.0% 17.3% 37.7% 24.0% 1,050 19 Ear, Nose, Mouth And Throat 38.1% 23.0% 19.0% 19.9% 925 20 Male Reproductive System 1.8% 8.7% 43.0% 46.6% 393 21 Multiple Significant Trauma 12.1% 35.0% 30.0% 22.9% 140 22 Eye 31.6% 28.4% 21.1% 18.9% 95 23 Ungroupable 10.5% 33.3% 28.1% 28.1% 57 24 Burns 12.2% 61.0% 9.8% 17.1% 41 Grand Total 12.6% 34.5% 23.1% 29.8% 88,820 Community Discharge Rate per 1,000 population 70.1 Texas Hospital Admissions per 1,000 population 102.2 U.S. Hospital Admissions per 1,000 population 113.6 Data Sources: Texas Health Care Information Council Inpatient Public Use Data File Jan-Dec 2010, were retrieved by Texas Health Resources Strategy and Business Planning Department from Truven. U.S. and Texas percentages from Kaiser Family Foundation State Health Facts. 1 Number, rate, and average length of stay for discharges from short-stay hospitals, by age, region, and sex: United States, 2010. National Hospital Discharge Survey. Center for Disease Control and Prevention. Available http://www.cdc.gov/nchs/data/nhds/1general/2010gen1_agesexalos.pdf Last accessed March 22, 2013. Note: Acute care hospital discharges only excludes normal newborns. - Facilities not reporting due to small volume: Texas Health Specialty Hospital, Texas Institute for Surgery - Facilities opened during 2010: Flower Mound Hospital Partners, Baylor Orthopedic and Spine - Facilities opened post-2010: AMH Cath Labs, Texas Rehabilitation Hospital of Fort Worth, Texas Health Harris Methodist Hospital Alliance 26

Physicians Medical Center Community Emergency department acuity summary Physicians Medical Center Treat/ Release Critical Acuity Treat/ Release High Acuity Treat/ Release Low Acuity Treat/ Release No Acuity Treat/ Release Total Emergency Room Total Year Admitted 2011 44,450 1,574 190,681 45,263 17,198 254,716 299,166 2012* 47,153 1,165 188,039 50,444 29,217 268,865 316,019 Annual Chg 2,703 (409) (2,642) 5,181 12,019 14,149 16,853 2011 14.9% 0.6% 74.9% 17.8% 6.8% 100.0% 100.0% 2012* 14.9% 0.4% 69.9% 18.8% 10.9% 100.0% 100.0% Annual Chg 6.1% -26.0% -1.4% 11.4% 69.9% 5.6% 5.6% Total 2012 Community, Reported Emergency Room Visits per 1,000 Population 249.3 Texas, Emergency Room Visits per 1,000 Population 385.6 U.S., Emergency Room Visits per 1,000 Population 411.3 Reason for Emergency Visit 2012* Community % Distribution U.S. % Distribution Community/ U.S. Variance 1 Injury and poisoning 64,929 24.1% 22.0% 2.1% 2 Symptoms, signs & factors influencing health 37,229 13.8% 19.9% -6.1% 3 Diseases of the lung and respiratory system 34,329 12.8% 12.3% 0.5% 4 Diseases of the nervous system 25,911 9.6% 4.8% 4.8% 5 Diseases of the heart and circulatory system 18,899 7.0% 3.5% 3.5% 6 Diseases of the genitourinary system 17,295 6.4% 5.0% 1.4% 7 Diseases of the stomach and digestive system 15,567 5.8% 5.9% -0.1% 8 Diseases of muscles, bone & connective tissue 14,464 5.4% 6.0% -0.6% 9 All Other 14,232 5.3% 8.6% -3.3% 10 Mental Illness 9,141 3.4% 3.5% -0.1% 11 Diseases of the skin 8,451 3.1% 3.6% -0.5% 12 Infectious and parasitic diseases 4,485 1.7% 3.4% -1.7% 13 Nutritional, metabolic/immunity disorders 3,933 1.5% 1.6% -0.1% Treat/Release Total 268,865 100% 100% 0.0% 2012 Emergency Room Acuity T/R No Acuity, 10.9% T/R Low Acuity, 18.8% Admitted, 14.9% The community visit rate per 1,000 people is lower than the state average. T/R Critical Acuity, 0.4% T/R High Acuity, 69.9% Note that a reported emergency room visit rate higher than the state is a concern however, if the rate is lower it could be attributable to a few smaller facilities not reporting its emergency room visits. 27 Data Sources: Emergency department acuity data, for Jan-Dec 2011 and Jan-Sep 2012, from Dallas Fort Worth Hospital Council. U.S. distributions from National Hospital Ambulatory Medical Care Survey: 2009 ED Summary Tables. Zip code population estimates and projections retrieved by Texas Health Resources Strategy and Business Planning Department from Truven. Note: Emergency Department (ED) acuity is meant to show the mix of persons that visit the ED for serious illness, such as heart attack, as opposed to those that visit the emergency for reasons that could be treated outside the ED, such as an ear ache. *Note: 2012 was annualized from Jan-Sep 2012 visits.

28 Provider Supply/Demand Dentists, primary care doctors and psychiatrists The community shows a surplus in dentistry and primary care and a shortage in psychiatry. When considering the limited number of providers accepting Medicaid and/or Medicare the doctor shortage increases. Data Sources: Physician counts from American Medical Association, Texas State Board of Medical Examiners and Texas State Board of Dental Examiners. Physician need population ratios from Solucient and DGA, and dentist population ratios from Kaiser Family Foundation State Health Facts. Population estimates and projections were retrieved by Texas Health Resources Strategy and Business Planning Department from Truven. 1 Decker, Sandra L. In 2011 Nearly One- Third of Physicians Said They Would Not Accept New Medicaid Patients, But Rising Fees May Help. Health Affairs. 2012; 31 (8): 1673-1679. 2 TMA March 2012 Survey of Texas Physicians: Preliminary Findings Availability. 2012. Texas Medical Association. Available http://www.texmed.org/workarea/linkit.aspx?linkidentifier=id&itemid=24760&libid=22 396 Last accessed March, 22, 2013. Family Practice Internal Medicine Total Primary Care Doctors Zip Population Dentist Pediatrics 75002 69,127 24 4 1 0 5 3 75006 46,769 33 9 3 0 12 1 75007 51,831 22 3 8 8 19 1 75010 22,400 41 23 7 13 43 0 75011-0 0 0 0 0 0 75013 33,350 77 18 11 12 41 0 75023 45,462 46 17 6 1 24 4 75024 38,255 63 25 13 6 44 2 75025 54,008 39 4 3 3 10 0 75028 42,559 28 13 4 7 24 0 75034 83,226 82 29 15 18 62 3 75035 53,097 39 6 13 5 24 0 75056 53,439 33 5 2 2 9 0 75057 12,696 7 10 8 4 22 2 75065 10,659 1 0 0 0 0 0 75067 64,492 15 16 9 5 30 1 75068 36,175 11 2 2 0 4 0 75069 35,407 17 13 13 6 32 0 75070 83,460 51 12 4 17 33 3 75071 38,204 25 7 2 3 12 0 75074 45,651 29 8 0 5 13 2 75075 35,187 33 19 28 19 66 4 75077 36,946 20 8 4 4 16 0 75080 42,553 78 24 27 15 66 13 75086-0 0 0 0 0 0 75093 48,138 89 36 65 46 147 16 75094 22,454 21 0 2 2 4 0 75098 52,861 12 6 2 3 11 0 75248 33,268 32 7 1 0 8 12 75252 25,072 20 7 4 2 13 2 75287 50,826 25 7 3 1 11 1 Total 1,267,572 1,013 338 260 207 805 70 Psychiatrist Provider need per 100,000 population 60.0 22.5 19.0 13.9 55.4 5.7 Providers required for community 760.5 285.2 240.8 176.2 702.23 72.3 Surplus (Shortage) 252.5 52.8 19.2 30.8 102.8 (2.3) The shortage could be greater considering: 31% of Texas doctors are not accepting new Medicaid patients 1 Not applicable (48.9) (59.1) (31.5) (139.5) (23.3) 69% of Texas doctors do not accept Medicaid at all 2 Not applicable (48.9) (59.1) (31.5) (139.5) (23.3) 17% of US physicians are not accepting new Medicare patients 1 Not applicable (4.7) (25.0) (4.4) (34.1) (14.2)

Providers Supply Facilities dedicated to serving the population in need Twenty-six (26) facilities throughout the community serve the population in need: 8 community clinics 16 general hospitals (community hospitals with emergency departments) 1 county health immunization clinic 1 state funded primary health care clinic 29 Data Sources: National Association of Free and Charitable Clinics. Texas Department of State Health Services, Health Facility Program. Texas Department of State Health Services, Texas Primary Care Office.

Facilities Dedicated to Serving the Population In Need Many of the facilities are in areas identified to be of the most need (shown in red). Data Sources: National Association of Free and Charitable Clinics. Texas Department of State Health Services, Health Facility Program. Texas Department of State Health Services, Texas Primary Care Office. Zip code population estimates and projections were retrieved by Texas Health Resources Strategy and Business Planning Department from Truven. 30 PROPRIETARY & CONFIDENTIAL 2013 PREMIER INC.

Physicians Medical Center Area Selection of community assets for the underserved Health Care Related: Texas Health Presbyterian Hospital Plano Texas Health Presbyterian Hospital Allen Flower Mound Hospital Partners (Texas Health Flower Mound) Baylor Hospital of Plano, Carrollton, and Frisco Collin County Community Health Center Collin County Adult Clinic (formerly East Clinic) West Side Clinic Frisco Cares Clinic PediPlace Plano Children s Medical Clinic Christian Community Action - Adult Health Center Collin County Health Care Services - Immunizations Other Resources: Assistance League of Greater Collin County Assistance Center of Collin County Plano Community Charity Frisco Family Services Crossroads Family Services 7 Loaves Food Pantry The Samaritan Inn Hope s Door (domestic violence help) The Turning Point Rape Crisis Center of Collin County Children s Advocacy CASA of Collin County Collin County Project Access 31 Source: Texas Health Resources Community Health Improvement Department.

Secondary Data Assessment: Review of other recent Community Health Needs Assessments

Summary of Key Issues Identified in Other Recent Area Community Health Needs Assessments The health issues below are those which were ranked highest for recommended action or noted as key community needs. This is not intended to be a comprehensive list. Regional Health Partnership 9 Key Health Issues Identified and/or Prioritized CHNA Report Regional Health Partnership 10 CHNA Report Regional Health Partnership 18 CHNA Report 2012 Dallas County CHNA 2011 ABC: Dallas County 2012 ABC: North Texas 2011 Denton County, United Way Access: Provider Supply x x x x x x x x Mental Health x x x x x x x Substance Abuse x x x x x x Awareness, literacy, navigation x x x x x Preventive/Wellness x x x x x Social Determinants x x x x x Nutrition, Physical Activity and Obesity x x x x Chronic Disease x x x x Injury and Violence x x x x Other Clinical/Preventive x x x Oral health x x Maternal, Infant, and Child Health x x Cancer x Environmental Quality x 2012 Cook Children's CCHAPS 33 Notes: Key health issues sorted by count of inclusion within other Community Health Needs Assessments. Regional Health Partnership 9 CHNA Report includes Dallas, Denton and Kaufman counties. Regional Health Partnership 10 CHNA Report includes Ellis, Erath, Hood, Johnson, Parker, Tarrant and Wise counties. Regional Health Partnership 18 CHNA Report includes Collin and Rockwall counties. 2012 Dallas County CHNA includes Dallas County. 2011 ABC: Dallas County includes Dallas County. 2012 ABC: North Texas includes Collin and Denton counties. 2011 Denton County, United Way includes Denton County. 2012 Cook Children's CCHAPS includes Denton, Hood, Johnson, Parker, Tarrant and Wise counties.

Reference List for Recent Area Community Health Needs Assessments Children s Medical Center. Beyond ABC: Assessing Children s Health in Dallas County. Available http://www.childrens.com/assets/documents/aboutus/beyond-abc-2011.pdf. (2011). Last accessed February 15, 2013. Children s Medical Center. Beyond ABC: Assessing Children s Health in the North Texas Corridor. Available http://www.childrens.com/assets/documents/aboutus/babc-2012-%20fa.pdf. (2012). Last accessed February 15, 2013. Collins, Summer. Regional Health Partnership 9: Community Needs Assessment Report. Available http://www.parklandhospital.com/whoweare/sectionz115/pdf/final_1115_needs_assessment_report_5.22.12.pdf. (2012). Last accessed February 15, 2013. Cook Children s Center for Children s Health. The Decade of the Healthy Child : Healthy Children 2020. Available https://www.centerforchildrenshealth.org/en-us/pages/default.aspx. (2012). Last accessed February 15, 2013. Edwards, J., Pickens, S., Schultz, L., Erickson, N., Dykstra, D. Horizons: The Dallas County Community Health Needs Assessment. Dallas, TX: Dallas County Health and Human Services and Parkland Health and Hospital System. Available http://www.dallascounty.org/department/hhs/documents/dcchna- PublicCommentDraft.pdf. (2012). Last accessed February 15, 2013. Regional Healthcare Partnership 18. Community Needs Assessment. Available http://www.co.collin.tx.us/healthcare_services/rhp18_community_needs.pdf. (2012). Last accessed February 15, 2013. Salsberry, David. RHP Lead Contact. Regional Healthcare Partnership Plan: Region 10. Available http://www.jpshealthnet.org/uploadedfiles/region%2010%20rhp%20plan%20final.pdf. (2012). Last accessed February 15, 2013. United Way of Denton County. 2011 Community Assets and Needs Assessment. Available http://www.unitedwaydenton.org/activities/community-assets-needs-assessment. (2011). Last accessed February 15, 2013. 34

Primary Data Assessment: Summary of Community Input

Community Input Summary Survey responses Physicians Medical Center averages Twenty-nine (29) persons from the community completed the survey summarized below, with responses ranging 1-5, where 1 is strongly disagree and 5 is strongly agree. The top three issues of most concern: Lack of adequate resources for indigent (low-income people) in the community Cost of care as a barrier to access (tied for 2 nd ) Transportation as a barrier to access (tied for 2 nd ) Indicator Most favorable Score Physicians Medical Center Average Community members are informed and educated about health issues. 5 3.0 Community members know where to go for needed health services. 5 2.7 There are adequate health resources for children in the community. 5 2.8 There are adequate health resources for the elderly in the community. 5 2.3 There are adequate health resources for the indigent in the community. 5 2.0 There are adequate health resources for other vulnerable populations. 5 2.1 Supply (number, type of providers) is a barrier to access in this community. 1 3.3 Cost of care is a barrier to access in this community. 1 4.0 Transportation is a barrier to access in this community. 1 4.0 Language and culture are a barrier to access in this community. 1 3.6 Previous negative experiences are a barrier to access in this community. 1 3.2 36

Community Input Summary Physicians Medical Center stakeholder/community meeting STRENGTHS Faith community nursing programs Other, similar community partnerships» Clinics» Churches, faith based organizations» Plano Independent School District» Texas Health Presbyterian Hospital Plano» United Way Assertive Community Treatment (ACT) - psychiatric case management Project Access Collin County GAPS IN SERVICES/CARE Access for uninsured and under-insured No Parkland or JPS Health Network Some clinics, but not nearly enough capacity Transportation Mental health Emergency room is main provider of mental health No ongoing care only in crises situation Care for the elderly Biggest need for respite care, sitters for elderly Dementia care Dental for adults SUGGESTIONS AND OPPORTUNITIES Reach out to service groups with tangible action items for them to do transportation, whatever and they will respond Need more collaboration information sharing will allow for support rather than duplication Must develop new approaches to care for the elderly faith based options? Expand specialties available through Project Access Collin County not all specialties COMMUNITY CONCERNS Obesity and nutrition Coping skills, daily life skills Health literacy and awareness Cultural barriers to access Language issues; privacy issues Financial questions raise concerns Homelessness Bankruptcy following major illness 37

Community Input Summary Physicians Medical Center community representatives 38 Danelle Parker, Manager of Community Health Improvement Department - Texas Health Presbyterian Hospital Plano Leslie Baker - Texas Health Center for Diagnostics & Surgery Mary Jo Dean, Director of Community Relations - Texas Health Presbyterian Hospital Plano Susan Shuler, Executive Director - Plano Children s Medical Clinic Terrie Monroe, Community Development Coordinator - City of Plano Patrick McCoy, Trustee - Texas Health Resources James Thomas, Administration - Plano ISD Carolyn Rice - Wellness Center for Older Adults Patti Dickson - Wellness Center for Older Adults Stephanie Zabel, Nursing Supervisor - DART Fleet Pool Seena Thomas - Texas Health Presbyterian Hospital Plano Finance Dr. Giep, Internal Medicine Physician Carol Macrorie - Texas Heath Plano Amy Wilson, Nurse - Plano Independent School District Jill Vargas, Teacher - Plano Independent School District Tonia Cunningham - Frisco Police Department Tammy Mahan - Life Path Systems John Ernst - Collin County Adult Clinic Tanya Stastoque - Assistance Center of Collin County Shannon Fitzgerald - St. Elizabeth Ann Seton Cassandra Graham RN BSN, Program Coordinator, Faith Community Nursing - Texas Health Presbyterian Hospital Plano Joan Conway, Faith Community Nurse and Maternal Child Specialist Anne Nejdl, Parish Nurse - Prince of Peace Catholic Church Angela Gwinn, Pastoral Care Minister Lynda Shirley, Care Van Debbie Gonzales, Hispanic Counselor - St. Mark s Catholic Church Garnetta Ashmore, Faith Community Nurse - Keller Springs Baptist Church Dr. Saima Sulta - American Muslin Women Physician Association Representative Leader - Madinah Mosque Gloria Thomas RN, Lead Nurse - Shiloh Missionary Baptist Church Sandra Miller, Faith Community Nurse - Shiloh Missionary Baptist Church Karen Green, Director - Haven of Love Ministries Dallas Nancy Brill, Faith Community Nurse - St. Peter s Episcopal Church, McKinney

Notes to the Study: How the assessment was conducted including data sources Process for consulting with people representing the community s interest Process for identifying and prioritizing health needs and services Gaps that limited ability to assess the community s health needs

How the Assessment was Conducted Texas Health Resources Community Health Needs Assessment was a six-month collaborative process, led by Texas Health s Community Health Improvement Department and entity community advocates with significant input from Texas Health s Community Health Advisory Council. Vast amounts of quantitative and qualitative data were collected, refined and analyzed. Approximately 200 community members provided invaluable information, data, and feedback. Texas Health utilized the following approach to complete a community health needs assessment: Create the Vision for the Community Health Needs Assessment Define the Scope, Including the Zip-Code Level Service Area Identify Key Demographics of Service Area Identify Services Provided by Area Health Resources (Supply) Identify Key Health Needs by Service Area (Demand) Identify Gaps in Services Provided Develop Community Needs Model, Including Criteria for Prioritizing Needs Prioritize Community Needs, Based on Data and Model Criteria Develop Strategies to Address Needs Outline Actionable Objectives, Timelines and Implementation Process Secondary data used throughout this analysis was obtained from more than 30 sources, and is outlined in detail on the following slides. 40

Secondary Data Sources 41 Demographic Assessment Education Levels of the Population: ACS Educational Attainment by Degree-Level and Age-Group ( U.S. Census Bureau, 2011 American Community Survey). National Information Center for Higher Education Policymaking and Analysis. (2011). Available http://www.higheredinfo.org/dbrowser/index.php?submeasure=344&year=2011&level =nation&mode=data&state=0. Last accessed March 21, 2013. Texas 2012 population projections from 2010 census. Texas State Data Center. (2013). Available http://txsdc.utsa.edu. Last accessed February 15, 2013. Texas Health Resources. (2012). Language Access Service Data 2012. Texas Health Resources Diversity and Inclusion Department. Retrieved on January, 28 2013. Texas Hospital Inpatient Discharge Public Use Data File, Q1-Q4 2010. Texas Health Care Information Council, Austin, Texas. (2012). Texas population distributions by age and gender. Texas State Data Center. (2013). Available http://txsdc.utsa.edu. Last accessed January 28, 2013. Texas and U.S. population distributions by race and ethnicity. Kaiser Family Foundation s State Health Facts. (2012). Available http://www.statehealthfacts.org. Last accessed January 28, 2013. The Nielsen Company, Truven. Average and median income. (2012). Retrieved by Texas Health Resources Strategy and Business Planning Department. The Nielsen Company, Truven. High school graduation percentages. (2012). Retrieved by Texas Health Resources Strategy and Business Planning Department. The Nielsen Company, Truven. Inpatient payer mix percentages. (2012). Retrieved by Texas Health Resources Strategy and Business Planning Department. The Nielsen Company, Truven. Population 2012 estimates and 2017 projections. (2012). Retrieved by Texas Health Resources Strategy and Business Planning Department. The Nielsen Company, Truven. Uninsured estimates. (2012). Retrieved by Texas Health Resources Strategy and Business Planning Department. U.S. Census Bureau. Poverty and uninsured estimates. Available http://www.census.gov. Last accessed January 28, 2013. U.S. Census Bureau. U.S. population distributions by age, gender, and race. Available http://www.census.gov. Last accessed January 28, 2013.

Secondary Data Sources Community Access and Health Status Indicators Behavioral Risk Factor Surveillance System. (2012). Texas Department of State Health Services. Available http://www.dshs.state.tx.us/chs/brfss/query/brfss_form.shtm. Last accessed February 12, 2012. Community health status indicators. CHSI 2009. U.S. Department of Health and Human Services. Available http://wwwn.cdc.gov/communityhealth. Last accessed November 17, 2012. County Health Rankings and Roadmaps. County Health Rankings Project. (2012). Available http://www.countyhealthrankings.org. Last accessed November 20, 2012. Dallas Fort Worth Hospital Council. Prevention Quality Indicator data, for 2010 and 2011, by zip code. Retrieved by Dallas Fort Worth Hospital Council from internal databases. Health facts profiles for individual counties. (2012). Texas Department of State Health Services. Available https://www.dshs.state.tx.us/chs/cfs/texas-health-facts-profiles.doc. Last accessed November 29, 2012. Percentage by county of illiterate adult Texans. (2009). Texas Center for the Advancement of Literacy & Learning. Available http://www-tcall.tamu.edu/docs/09illitmap.html. Last accessed November 20, 2012. Texas Department of State Health Services. Texas health status indicators 2007-2010. Retrieved by Texas Department of State Health Services from Behavioral Risk Factor Surveillance System (BRFSS) database. Texas Department of State Health Services. Texas mortality and natality data 2010. Retrieved by Texas Department of State Health Services Center for Health Statistics and Vital Statistics Units from Texas vital statistics database. Texas Department of State Health Services. Texas substance abuse treatment statistics 2009. Retrieved by Texas Department of State Health Services Mental Health and Substance Abuse Division from mental health and substance abuse databases. Texas Medicaid enrollment statistics. Texas Health and Human Services Commission. Available http://www.hhsc.state.tx.us/research. Last accessed November 27, 2012. The Nielsen Company, Truven. 2010-2012 PULSE Healthcare Survey health status indicators. (2012). Retrieved by Texas Health Resources Strategy and Business Planning Department. Unemployment statistics. U.S. Department of Labor Bureau of Labor Statistics. Available http://www.bls.gov. Last accessed February 18, 2013. 42

Secondary Data Sources U.S. Federal Poverty Level guidelines. U.S. Census Bureau. Available http://factfinder2.census.gov/faces/nav/jsf/pages/index.xhtml. Last accessed February 19, 2013. U.S. statistics. Centers for Disease Control and Prevention, Fast Stat reports. (2013). Available http://www.cdc.gov/datastatistics. Last accessed February 14, 2013. Supply and Demand Utilization Dallas Fort Worth Hospital Council. Emergency Department acuity data, for Jan-Dec 2011 and Jan-Sep 2012. Retrieved by Dallas Fort Worth Hospital Council from internal databases. Directory of Community Clinics. National Association of Free and Charitable Clinics. Available http://nafcclinics.org. Last accessed November 21, 2012. Directory of Physician Specialties. American Medical Association. Available http://www.redimeddata.com. Last accessed November 14, 2012. Directory of Primary Care Clinics. (2012). Texas Department of State Health Services State of Texas Primary Care Office. Available http://www.dshs.state.tx.us/phc/locator/locator.shtm. Last accessed November 14, 2012. Directory of Texas Dentists. Texas State Board of Dental Examiners. Available http://www.tsbde.state.tx.us. Last accessed November 20, 2012. Directory of Texas Health Facilities. (2013). Texas Department of State Health Services. Available http://www.dshs.state.tx.us/hfp/apps.shtm. Last accessed February 1, 2013. Directory of Texas Physicians. Texas State Board of Medical Examiners. Available http://www.tmb.state.tx.us. Last accessed November 21, 2012. Directory of Urgent Care Centers. American Academy of Urgent Care Medicine. Available http://aaucm.org/patients/findurgentcarecenter. Last accessed November 21, 2012. Directory of Urgent Care Centers. (2012). Urgent Care Association of America. Available http://www.ucaoa.org/ucaoa_orgs.php. Last accessed November 21, 2012. Directory of Federally Qualified Health Centers. (2012). Texas Department of State Health Services, Texas Primary Care Office. Available http://www.dshs.state.tx.us/chpr/fqhcmain.shtm. Last accessed November 14, 2012. 43

Secondary Data Sources Health Professional Shortage Areas. (2013). U.S. Department of Health and Human Services Health Resources Administration. Available http://hpsafind.hrsa.gov. Last accessed January 22, 2013. JPS Health Clinic locations. JPS Health System website. Available http://www.jpshealthnet.org. Last accessed January 7, 2013. Parkland Health System Clinic locations. Parkland Health and Hospital System website. Available http://www.parklandhospital.com. Last accessed January 7, 2013. Ten leading principal reasons for emergency department visits, by patient age and sex: United States. National Centers for Health Statistics: National Hospital Ambulatory Medical Care Survey: 2009 Emergency Department Summary Table 10. Center for Disease Control and Prevention. Available http://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2009_ed_web_tables.pdf. Last accessed February 19, 2013. Other References Decker, Sandra L. In 2011 Nearly One-Third of Physicians Said They Would Not Accept New Medicaid Patients, But Rising Fees May Help. Health Affairs. 2012; 31 (8): 1673-1679. Number, rate, and average length of stay for discharges from short-stay hospitals, by age, region, and sex: United States, 2010. National Centers for Health Statistics: National Hospital Discharge Survey. Center for Disease Control and Prevention. Available http://www.cdc.gov/nchs/data/nhds/1general/2010gen1_agesexalos.pdf. Last accessed March, 22, 2013. Physician Community Requirements in the 21 st Century: The 2003 Physician to Population Ratios. Solucient. Simmons, H.J., Harris, John M. Community-Based Physician Need Planning Methodologies Evolve. Health Care Strategic Management. 2004; 22(12). DGA Article Physician Need Methodologies. TMA March 2012 Survey of Texas Physicians: Preliminary Findings Availability. 2012. Texas Medical Association. Available http://www.texmed.org/workarea/linkit.aspx?linkidentifier=id&itemid=24760&libid=22396. January 23, 2013. 44

Process for Consulting with People Representing the Community s Interest During December 2012 and January 2013, interviews were conducted with approximately 200 persons representing the community s interests. Information and data were gathered using two different methods: Open-ended discussions, led by Premier, Inc., aimed at soliciting input from the interview participants as to community health resources, as well as the health needs of the community. Likert surveys, containing 11 statements regarding community health for which participants ranked their agreement or disagreement. 45

Process for Identifying and Prioritizing Health Needs Drawing from the data elements analyzed and presented in each entity community health needs assessment, Texas Health Resources has developed a model to identify and prioritize health needs. At its most basic level, the model outlines all identified health issues in rows, and marks in columns each entity impacted by that specific issue. The specific issues were also grouped into health categories adapted from the Healthy People 2020 categories. Any issue not meeting threshold levels (e.g., a minimum number of indicators showing a problem and/or a minimum number entities having raised that issue) were removed from subsequent analysis. Remaining issues were assessed using criteria designed to rank, or prioritize the issues. Texas Health used the resulting rankings to select which health needs will be addressed over the next three years. Once selected, the organization developed strategies and initiatives aimed at impacting those gaps. 46

Gaps that Limited the Ability to Assess Needs The vast majority of secondary data required to assess community need was available for Texas Health Resources analysis. In certain instances, however, data was not available at Texas Health s preferred level of detail. Specific examples of this include: Zip Code Level Data Some health indicators and behavioral factors are published at the county level, not the zip code level, which prohibited Texas Health from analyzing these data for an entity s defined service area. Examples include sexually transmitted disease rates, obesity rates, literacy rates, and many others. These data elements have been included in the community health needs assessment data as reference points but county-level indicators were not used in the prioritization of health needs. Data for Uninsured and Underinsured A significant finding of this study is that access to health services is limited for the uninsured and underinsured. This issue was mentioned numerous times by a wide range of participants. However, quantifying this issue is difficult, if not impossible. There is no publicly available source of data to identify providers who accept uninsured patients or providers who accept patients with Medicare or Medicaid. Estimates have been included in the physician supply and demand section of this study, but these are estimates only and do not provide the ideal level of specificity. Lack of Efficacy Texas Health prefers to utilize evidence based programs to improve the health of the community it serves. However, there are few existing studies that measure, evaluate and/or report the effectiveness of preventative wellness programs and initiatives. Texas Health will proceed with information currently available and supplement with internal expertise as needed. 47 Note: Texas Health does not believe the limitations outlined above impacted Texas Health s ability to reach reasonable conclusions regarding the health needs of the community.

Appendix

Demographics Needs Summary Population of focus Grading System Demographic information was collected from Truven Health Analytics for the four below data elements listed below: 2012 total population 5 year population growth 2012-2017 Median household income Age 18+ percent uninsured Each of the four elements were ordered either ascending or descending depending upon whether a higher need was suggested: There is more need in densely populated areas There is more need in areas of high population growth There is more need in areas of low income There is more need in areas with high percentages of uninsured These rankings are summed in total and then averaged to obtain a score which is itself then ranked. Considering these four key factors, the associated maps show the areas of highest need in darker red to areas of minimal need in dark blue. Data Sources: Population estimates and projections, income and uninsured, Texas Health Care Information Council inpatient payer mix, were retrieved by Texas Health Resources Strategy and Business Planning Department from Truven. Higher ranking = higher need based upon the indicator 49

List of Health Services in the Community PROVIDER TYPE FACILITY NAME STREET ADDRESS CITY STATE ZIP ASC BAYLOR AMBULATORY ENDOSCOPY CENTER 4708 ALLIANCE BLVD SUITE 210 PLANO TX 75093 ASC BAYLOR SURGICARE AT CARROLLTON 4780 JOSEY LANE NORTH CARROLLTON TX 75010 ASC BAYLOR SURGICARE AT PLANO 1701 OHIO DRIVE PLANO TX 75093 ASC BAYLOR SURGICARE AT PLANO PARKWAY LLC 4031 WEST PLANO PARKWAY PLANO TX 75093 ASC CENTENNIAL SURGERY CENTER 4401 COIT ROAD SUITE 100 FRISCO TX 75035 ASC COOK CHILDRENS PEDIATRIC SURGERY CENTER 7000 WEST PLANO PARKWAY SUITE 100 PLANO TX 75093 ASC DALLAS IVF SURGERY CENTER LLC 2840 LEGACY DRIVE SUITE 110 FRISCO TX 75034 ASC FAITH SURGICAL CENTER, LLC 3716 STANDRIDGE DRIVE, STE 100 THE COLONY TX 75056 ASC FRISCO REPRODUCTIVE SURGERY CENTER 8380 WARREN PARKWAY SUITE 201 FRISCO TX 75034 ASC GASTROINTESTINAL ENDOSCOPY CENTER 1600 COIT ROAD SUITE 401A PLANO TX 75075 ASC HERITAGE SURGERY CENTER 1501 B REDBUD BOULEVARD MCKINNEY TX 75069 ASC INSTITUTE FOR MINIMALLY INVASIVE SURGERY 17980 DALLAS PARKWAY DALLAS TX 75287 ASC LEGACY SURGERY CENTER OF FRISCO 5616 WARREN PARKWAY FRISCO TX 75034 ASC LEWISVILLE SURGERY CENTER 591 WEST MAIN STREET LEWISVILLE TX 75057 ASC MCKINNEY SURGERY CENTER 4510 MEDICAL CENTER DRIVE SUITE 150 MCKINNEY TX 75069 ASC NORTH DALLAS SURGICARE 375 MUNICIPAL DRIVE SUITE 214 RICHARDSON TX 75080 ASC OUTPATIENT SURGERY CENTER 1505 HARROUN STREET SUITE 1 MCKINNEY TX 75069 ASC PAIN CARE OF NORTH TEXAS LLC 1111 RAINTREE CIRCLE SUITE 190 ALLEN TX 75013 ASC PARK VENTURA ENDOSCOPY CENTER 5055 PARK BOULEVARD SUITE 800 PLANO TX 75093 ASC PLASTIC AND COSMETIC SURGERY CENTER OF TEXAS 5316 WEST PLANO PARKWAY PLANO TX 75093 ASC PRESTON PLAZA SURGERY CENTER 17950 PRESTON ROAD SUITE 75 DALLAS TX 75252 ASC STONEBRIDGE SURGERY CENTER 8855 SYNERGY DRIVE MCKINNEY TX 75070 ASC SURGERY CENTER OF LEWISVILLE 1854 LAKEPOINTE DRIVE LEWISVILLE TX 75057 ASC SURGERY CENTER OF PLANO 1620 COIT ROAD PLANO TX 75075 ASC SURGERY CENTER OF RICHARDSON 610 NORTH COIT ROAD SUITE 2120 RICHARDSON TX 75080 ASC SURGERY CENTER OF TEXAS 6020 WEST PLANO PARKWAY PLANO TX 75093 ASC TEXAS ENDOSCOPY 6405 WEST PARKER ROAD SUITE 370 PLANO TX 75093 ASC TEXAS ENDOSCOPY LLC 2023 WEST MCDERMOTT DRIVE SUITE 370 ALLEN TX 75013 ASC THE SURGERY CENTRE AT CRAIG RANCH 8080 STATE HIGHWAY 121 SUITE 100 MCKINNEY TX 75070 ASC WINDHAVEN SURGERY CENTER LLC 6160 WINDHAVEN PARKWAY SUITE 220 PLANO TX 75093 BIRTHING CENTER ALLEN BIRTHING CENTER 406 WEST MAIN STREET ALLEN TX 75013 BIRTHING CENTER BELLA BIRTHS, CENTER FOR BIRTH & WOMENS HEALTH 2411 W. VIRGINIA PARKWAY MCKINNEY TX 75071 BIRTHING CENTER LOVERS LANE BIRTH CENTER INC 304 SOUTH COTTONWOOD SUITE A RICHARDSON TX 75080 Continued on next slide 50 Data Sources: National Association of Free and Charitable Clinics. Texas Department of State Health Services, Health Facility Program. Texas Department of State Health Services, Texas Primary Care Office.

List of Health Services in the Community 51 Continued from previous slide PROVIDER TYPE FACILITY NAME STREET ADDRESS CITY STATE ZIP COMMUNITY CLINIC ALLEN COMMUNITY OUTREACH(ACO): MOBILE CLINIC 301 W BOYD DR. ALLEN TX 75013 COMMUNITY CLINIC CHRISTIAN COMM. ACTION ADULT HEALTH CENTER 200 S. MILL STREET LEWISVILLE TX 75057 COMMUNITY CLINIC COLLIN COUNTY ADULT CLINIC DBA COLLIN COUNTY COMMUNITY HEALTH CENTER 2520 AVENUE K, SUITE 100 PLANO TX 75074 COMMUNITY CLINIC COLLIN COUNTY ADULT CLINIC WEST SIDE 4100 W. 15TH STREET, SUITE 112 PLANO TX 75093 COMMUNITY CLINIC FRISCO CARES CLINIC 6811 OAK STREET FRISCO TX 75034 COMMUNITY CLINIC HIV CLINIC - PLANO 2540 AVENUE K SUITE 500 PLANO TX 75074 COMMUNITY CLINIC PEDIPLACE 502 SOUTH OLD ORCHARD 126 LEWISVILLE TX 75067 COMMUNITY CLINIC PLANO CHILDREN'S MEDICAL CLINIC 1407 14TH ST. PLANO TX 75074 DIALYSIS CARROLLTON DIALYSIS 1544 VALWOOD PARKWAY SUITE 114 CARROLLTON TX 75006 DIALYSIS COLLIN COUNTY DIALYSIS CENTER 3420 AVENUE K SUITE 150 PLANO TX 75074 DIALYSIS FMC ALLEN DIALYSIS #5446 925 WEST EXCHANGE PARKWAY ALLEN TX 75013 DIALYSIS FMC DIALYSIS SERVICES MCKINNEY 1831 HARROUN MCKINNEY TX 75069 DIALYSIS FRESENIUS MEDICAL CARE OF WEST PLANO 4405 TRADITION TRAIL PLANO TX 75093 DIALYSIS MCKINNEY DIALYSIS 4717 MEDICAL CENTER DRIVE MCKINNEY TX 75069 DIALYSIS PLANO DIALYSIS CENTER 481 SHILOH ROAD SUITE 100 PLANO TX 75074 DIALYSIS RENAL CENTER OF CARROLLTON LP LLLP 4240 INTERNATIONAL PARKWAY CARROLLTON TX 75007 DIALYSIS RENAL CENTER OF FRISCO LLLP 10850 FRISCO STREET SUITE 300 FRISCO TX 75034 DIALYSIS RENAL CENTER OF LEWISVILLE LLLP 1600 WATER RIDGE LEWISVILLE TX 75057 DIALYSIS RENAL CENTER OF PLANO 4112 W. SPRING CREEK PARKWAY PLANO TX 75024 DIALYSIS WEST PLANO DIALYSIS 5036 TENNYSON PKWY PLANO TX 75024 FREE STANDING ER E-CARE EMERGENCY CENTER 2810 HARDIN BOULEVARD MCKINNEY TX 75070 FREE STANDING ER EMERUS 6045 ALMA ROAD, SUITE 110 MCKINNEY TX 75070 FREE STANDING ER ER CENTERS OF AMERICA INC 6501 PRESTON ROAD PLANO TX 75024 FREE STANDING ER FIRST CHOICE EMERGENCY ROOM 211 EAST FM 544, SUITE 401 MURPHY TX 75094 FREE STANDING ER FIRST CHOICE EMERGENCY ROOM 2401 PRESTON ROAD, SUITE D PLANO TX 75093 FREE STANDING ER LEGACY ER 9205 LEGACY DRIVE FRISCO TX 75034 HOSPITAL BAYLOR INSTITUTE FOR REHABILITATION AT FRISCO 2990 LEGACY DRIVE FRISCO TX 75034 HOSPITAL BAYLOR MEDICAL CENTER AT CARROLLTON 4343 NORTH JOSEY LANE CARROLLTON TX 75010 HOSPITAL BAYLOR MEDICAL CENTER AT FRISCO 5601 WARREN PARKWAY FRISCO TX 75034 HOSPITAL BAYLOR MEDICAL CENTER AT MCKINNEY 5252 WEST UNIVERSITY DRIVE MCKINNEY TX 75071 HOSPITAL BAYLOR REGIONAL MEDICAL CENTER AT PLANO 4700 ALLIANCE BOULEVARD PLANO TX 75093 HOSPITAL CENTENNIAL MEDICAL CENTER 12505 LEBANON ROAD FRISCO TX 75035 HOSPITAL CHILDRENS MEDICAL CENTER LEGACY 7601 PRESTON ROAD PLANO TX 75024 HOSPITAL COLUMBIA MEDICAL CENTER OF MCKINNEY SUBSIDIARY, L.P. 4500 MEDICAL CENTER DRIVE MCKINNEY TX 75069 HOSPITAL FOREST PARK MEDICAL FRISCO 5500 FRISCO SQUARE BLVD FRISCO TX 75034 HOSPITAL HEALTHSOUTH PLANO REHABILITATION HOSPITAL 2800 WEST 15TH STREET PLANO TX 75075 HOSPITAL LIFECARE HOSPITALS OF PLANO 6800 PRESTON ROAD PLANO TX 75024 HOSPITAL MEDICAL CENTER OF LEWISVILLE 500 WEST MAIN STREET LEWISVILLE TX 75057 HOSPITAL MEDICAL CENTER OF MCKINNEY-WYSONG CAMPUS 130 SOUTH CENTRAL EXPRESSWAY MCKINNEY TX 75070 HOSPITAL MEDICAL CENTER OF PLANO 3901 WEST 15TH STREET PLANO TX 75075 HOSPITAL METHODIST MCKINNEY HOSPITAL LLC 8000 WEST ELDORADO PARKWAY MCKINNEY TX 75070 HOSPITAL METHODIST RICHARDSON MEDICAL CENTER 401 WEST CAMPBELL ROAD RICHARDSON TX 75080 HOSPITAL PLANO SPECIALTY HOSPITAL 1621 COIT ROAD PLANO TX 75075 HOSPITAL RELIANT REHABILITATION HOSPITAL NORTH TEXAS 3351 WATERVIEW PARKWAY RICHARDSON TX 75080 HOSPITAL SELECT SPECIALTY HOSPITAL - DALLAS 2329 PARKER RD CARROLLTON TX 75010 Continued on next slide Data Sources: National Association of Free and Charitable Clinics. Texas Department of State Health Services, Health Facility Program. Texas Department of State Health Services, Texas Primary Care Office.

List of Health Services in the Community Continued from previous slide PROVIDER TYPE FACILITY NAME STREET ADDRESS CITY STATE ZIP HOSPITAL TEXAS HEALTH CENTER FOR DIAGNOSTICS & SURGERY PLANO 6020 WEST PARKER ROAD PLANO TX 75093 HOSPITAL TEXAS HEALTH PRESBYTERIAN HOSPITAL ALLEN 1105 CENTRAL EXPRESSWAY NORTH ALLEN TX 75013 HOSPITAL TEXAS HEALTH PRESBYTERIAN HOSPITAL FLOWER MOUND 4400 LONG PRAIRIE ROAD FLOWER MOUND TX 75028 HOSPITAL TEXAS HEALTH PRESBYTERIAN HOSPITAL PLANO 6200 WEST PARKER ROAD PLANO TX 75093 HOSPITAL THE HEART HOSPITAL BAYLOR PLANO 1100 ALLIED DRIVE PLANO TX 75093 HOSPITAL TWIN CREEKS HOSPITAL 1001 RAINTREE CIRCLE ALLEN TX 75013 HOSPITAL VICTORY MEDICAL CENTER PLANO LP 2301 MARSH LANE PLANO TX 75093 IMMUNIZATIONS COLLIN COUNTY HEALTH CARE SERVICES 825 N. MCDONALD ST #130 MCKINNEY TX 75069 PRIMARY CARE CLINIC DENTON COUNTY HEALTH DEPARTMENT LEWISVILLE CLINIC 190 NORTH VALLEY PARKWAY LEWISVILLE TX 75067 PSYCH HOSPITAL CARROLLTON SPRINGS 2225 PARKER ROAD CARROLLTON TX 75010 PSYCH HOSPITAL TEXAS HEALTH SEAY BEHAVIORAL HEALTH CENTER PLANO 6110 WEST PARKER ROAD PLANO TX 75093 URGENT CARE ACUTE KIDS URGENT CARE 3350 DALLAS PARKWAY SUITE 345 PLANO TX 75093 URGENT CARE ACUTE KIDS URGENT CARE 3401 PRESTON ROAD SUITE 11 FRISCO TX 75034 URGENT CARE ACUTE KIDS URGENT CARE 8080 HIGHWAY 121 SUITE 110 MCKINNEY TX 75070 URGENT CARE CARENOW 1017 W HEBRON PKWY CARROLLTON TX 75010 URGENT CARE CARENOW 1218 W MCDERMOTT DR. ALLEN TX 75013 URGENT CARE CARENOW 301 W MAIN STREET FRISCO TX 75034 URGENT CARE CARENOW 3821 W SPRING CREEK PKWY. PLANO TX 75023 URGENT CARE CARENOW 5644 PRESTON ROAD FRISCO TX 75034 URGENT CARE CARENOW 809 NORTH CENTRAL EXPRESSWAY MCKINNEY TX 75070 URGENT CARE CONCENTRA - CARROLLTON 1345 VALWOOD PKWY CARROLLTON TX 75006 URGENT CARE CONCENTRA - FRISCO 8756 TEEL PARKWAY, SUITE FRISCO TX 75034 URGENT CARE CONCENTRA URGENT CARE 701 E PLANO PKY SUITE 103 PLANO TX 75074 URGENT CARE CONCENTRA URGENT CARE 701 E PLANO PKWY PLANO TX 75023 URGENT CARE FRISCO URGENT CARE 3550 PARKWOOD BLVD SUITE A205 FRISCO TX 75034 URGENT CARE LEGACY ER 9205 LEGACY DRIVE FRISCO TX 75034 URGENT CARE MAIN STREET URGENT CARE 571 WEST MAIN STREET LEWISVILLE TX 75057 URGENT CARE MINUTECLINIC (INSIDE CVS) 100 WEST CORPORATE DRIVE LEWISVILLE TX 75067 URGENT CARE MINUTECLINIC (INSIDE CVS) 1100 FLOWER MOUND ROAD FLOWER MOUND TX 75028 URGENT CARE MINUTECLINIC (INSIDE CVS) 1540 EAST MAIN STREET ALLEN TX 75002 URGENT CARE MINUTECLINIC (INSIDE CVS) 2100 ELDORADO PARKWAY MCKINNEY TX 75070 URGENT CARE MINUTECLINIC (INSIDE CVS) 2101 WEST SPRING CREEK PARKWAY PLANO TX 75023 URGENT CARE MINUTECLINIC (INSIDE CVS) 2591 FM-423 LITTLE ELM TX 75068 URGENT CARE MINUTECLINIC (INSIDE CVS) 4100 STATE HIGHWAY 121 CARROLTON TX 75010 URGENT CARE MINUTECLINIC (INSIDE CVS) 5401 LEBANON ROAD FRISCO TX 75034 URGENT CARE MINUTECLINIC (INSIDE CVS) 750 WEST FM 544 WYLIE TX 75098 URGENT CARE MINUTECLINIC (INSIDE CVS) 8995 STACY ROAD MCKINNEY TX 75070 URGENT CARE NOVA MEDICAL CENTER 1111 JUPITER RD., SUITE 100B PLANO TX 75074 URGENT CARE PRIMACARE MEDICAL CENTER - 1920 W EL DORADO MCKINNEY TX 75070 URGENT CARE PRIMACARE MEDICAL CENTER - 3304 ALMA DRIVE PLANO TX 75023 URGENT CARE PRIMACARE MEDICAL CENTER - 5076 W PLANO PARKWAY PLANO TX 75093 URGENT CARE PRIMACARE MEDICAL CENTER - 540 SURF STREET LEWISVILLE TX 75067 URGENT CARE PRIMACARE MEDICAL CENTER - 7227 PRESTON ROAD FRISCO TX 75034 URGENT CARE RAPID MED URGENT CARE 2940 FM 407, SUITE 302 HIGHLAND VILLAGE TX 75077 URGENT CARE US HEALTHWORKS MEDICAL GROUP URGENT CARE 1837 W FRANKFORD ROAD SUITE 116 CARROLLTON TX 75007 52 Data Sources: National Association of Free and Charitable Clinics. Texas Department of State Health Services, Health Facility Program. Texas Department of State Health Services, Texas Primary Care Office.

Health Professional Shortage Areas Primary medical care Health Professional Shortage Areas (HPSAs) are designated by the U.S. Department of Health and Human Services as having shortages of primary medical care providers and may be geographic (a county or service area), demographic (low income population) or institutional (federally qualified health center or other public facility). Shortages are defined by population-to-physician ratios, or by other indicators including - but not limited to - poverty rate, infant mortality rate, and physical distance from care. Geographic or demographic shortage areas are shown on map in red. Reported institutional HPSAs are listed. HPSA Name HPSA Type County Parkland Ambulatory Care Clinic Other Facility Dallas Parkland Internal Medical Clinic Other Facility Dallas Federal Correctional Institution - Seagoville Correctional Facility Dallas MLK Jr Family Center Comprehensive Health Center Dallas Parkland Hospital Ob/Gyn ICC Other Facility Dallas Agape Clinic Other Facility Dallas Los Barrios Unidos Communty Health Center Comprehensive Health Center Dallas Urban Inter-Tribal Center of Texas Native American Tribal Population Dallas Mission East Dallas (Medical) and Metroplex Project Comprehensive Health Center Dallas Dallas County Health Department Comprehensive Health Center Dallas Health Services of North Texas, Inc. Comprehensive Health Center Dallas Data Sources: U.S. Department of Health and Human Services Health Resources and Services Administration. 53

Health Professional Shortage Areas Dental care Health Professional Shortage Areas (HPSAs) are designated by the U.S. Department of Health and Human Services as having shortages of dental providers and may be geographic (a county or service area), demographic (low income population) or institutional (federally qualified health center or other public facility). Shortages are defined by population-to-physician ratios, or by other indicators including - but not limited to - poverty rate, infant mortality rate, and physical distance from care. Geographic or demographic shortage areas are shown on map in red. Reported institutional HPSAs are listed. HPSA Name HPSA Type County Federal Correctional Institution - Seagoville Correctional Facility Dallas Los Barrios Unidos Communty Health Center Comprehensive Health Center Dallas MLK Jr Family Center Comprehensive Health Center Dallas Dallas County Health Department Comprehensive Health Center Dallas Deharo Saldivar Dental Center Other Facility Dallas East Dallas Dental Center Other Facility Dallas Parkland Dental Center Other Facility Dallas Mission East Dallas (Medical) and Metroplex Project Comprehensive Health Center Dallas Urban Inter-Tribal Center of Texas Native American Tribal Population Dallas Health Services of North Texas, Inc. Comprehensive Health Center Denton Data Sources: U.S. Department of Health and Human Services Health Resources and Services Administration. 54

Health Professional Shortage Areas Mental health Health Professional Shortage Areas (HPSAs) are designated by the U.S. Department of Health and Human Services as having shortages of mental health providers and may be geographic (a county or service area), demographic (low income population) or institutional (federally qualified health center or other public facility). Shortages are defined by population-to-physician ratios, or by other indicators including - but not limited to - poverty rate, infant mortality rate, and physical distance from care. Geographic or demographic shortage areas are shown on map in red. Reported institutional HPSAs are listed. HPSA Name HPSA Type County Los Barrios Unidos Communty Health Center Comprehensive Health Center Dallas MLK Jr Family Center Comprehensive Health Center Dallas Dallas County Health Department Comprehensive Health Center Dallas Federal Correctional Institution - Seagoville Correctional Facility Dallas Mission East Dallas (Medical) and Metroplex Project Comprehensive Health Center Dallas Urban Inter-Tribal Center of Texas Native American Tribal PopulatiDallas Health Services of North Texas, Inc. Comprehensive Health Center Denton 55 Data Sources: U.S. Department of Health and Human Services Health Resources and Services Administration.

Community Health Needs Assessment: Strategic Implementation Plan Physicians Medical Center (Texas Health Center for Diagnostics and Surgery)

Needs Identification and Prioritization Identification of the community s significant health needs draws from more than 90 data elements presented in the CHNA. These include both quantitative data (health status indicators, use rates, etc..) and qualitative data gathered during meetings with community representatives. Vast amounts of quantitative and qualitative data were collected, refined and analyzed during this Community Health Needs Assessment process. Detailed data is presented in the CHNA. The chart below summarizes the most significant health issues facing the Texas Health Center for Diagnostics and Surgery Center community. The data points have been placed in a model. This model outlines all identified health issues and then groups the specific issues into health categories adapted from the Healthy People 2020 categories. Any issue not meeting threshold levels (e.g., a minimum number of indicators showing a problem and/or a minimum number entities having raised that issue) were removed from subsequent analysis. The findings from Texas Health Center for Diagnostics and Surgery are shown on the right. In addition, the model allows Texas Health Resources to assess all of its facilities and service areas at once.