WELLSTAR_CHNA_REPORT_2016

Your HEALTH. Our MISSION.
Community Health Needs Assessment (CHNA)
WellStar Cobb Hospital
Austell, GA
WellStar Douglas Hospital
Douglasville, GA
WellStar Kennestone Hospital
Marietta, GA
WellStar Paulding Hospital
Hiram, GA
WellStar Windy Hill Hospital
Marietta, GA
Cobb Hospital, Inc.
EIN#: 58-0968382
3950 Austell Road SW
Austell, GA 30106
Douglas Hospital, Inc.
EIN#: 58-2026750
8954 Hospital Drive
Douglasville, GA 30134
Kennestone Hospital, Inc.
EIN#: 58-2032904
677 Church Street
Marietta, GA 30060
Paulding Medical Center, Inc.
EIN#: 58-2095884
2518 Jimmy Lee Smith Pkwy.
Hiram, GA 30141
Kennestone Hospital, Inc.
EIN#: 58-2032904
677 Church Street
Marietta, GA 30060

This report serves to identify and assess the health needs of the community served by WellStar
Health System and its five not-for-profit hospitals. Submitted in fiscal year ended June 30, 2016 to
comply with federal tax law requirements set forth in Internal Revenue Code section 501(r) and to
satisfy the requirements set forth in IRS Notice 2011-52 and the Affordable Care Act for hospital
facilities owned and operated by an organization described in Code section 501(c)(3).
Website CHNA report is publicly available: www.wellstar.org/chna2016
Date CHNA adopted by WellStar Board of Trustees: June 2, 2016
Date CHNA report made publicly available: June 30, 2016
Date CHNA report required to be made publicly available
(per Notice 2011-52): June 30, 2016
Community input is encouraged.
Please address CHNA feedback to chna@wellstar.org.

CHNA Executive Leadership:
Kim Menefee
Senior Vice President, Strategic Community Development
Chair, WellStar Community Health Collaborative Task Force and Oversight Committee
WellStar Community Health
Collaborative Task Force:
Vickie Beckler BSN, RN
Program Coordinator, Lung Cancer Screening
Brenda Brown BSN, RN
Director, WellStar Diabetes Services
Ryan E. Breshears, Ph.D., LP
Chief Behavioral Health Officer, Clinical Psychologist
Kristin Caudell
Director, WellStar Community Education & Outreach
Darold Etheridge
Vice President, Finance and Chief Financial Officer,
WellStar Cobb Hospital, Hospital Community Benefit Liaison
Steven Fraime, BSN, M.B.A., M.H.A.
Director, WellStar Center for Health Transformation
Christopher “Shane” Greene
Chief Financial Officer, WellStar Douglas Hospital
Hospital Community Benefit Liaison
Kristyn Greifer, M.D.
Vice President, Population Health Management
Cindy Holcomb, BSN, RN
Heart Failure Program Manager
Meridith Kelly
Consultant, HighLand Productions, Inc.
Janet Memark M.D., M.P.H., F.A.C.P.
Medical Director, WellStar Kennestone Clinic
Associate Program Director, WellStar Kennestone Hospital
Internal Medicine Residency Program
Kim Menefee
Senior Vice President, Strategic Community
Development
Elaine Morgan
Director, Brand Development and Marketing
Carol O’Connell
Assistant Vice President, Long Term Care and
Support Services, WellStar Paulding Hospital
Renee Owen, M.Div.
Director of Pastoral Care, WellStar Kennestone Hospital
Hospital Community Benefit Liaison
Chirag Patel, M.D.
Medical Director, Population Health
Cecelia Patellis
Assistant Vice President, Community Education & Outreach
Tyler Pearson
Director of Public Relations
Lindsay Rehn, M.B.A.
Executive Director of Finance and Operations,
WellStar Paulding Hospital and Nursing Facility
Hospital Community Benefit Liaison
Kathy Sitten, RN
Manager, Care Coordination, WellStar Kennestone Hospital
Kamela Sooknanan
Assistant Vice President, Population Health Management
Julie Stebbins, M.S.
Director, WellStar Cardiac Wellness & Rehabilitation
Jeffrey L. Tharp, M.D., M.P.H.
Chairman, Board Safety & Quality Committee Chief, Medicine
Service Line, WellStar East Paulding Primary Care Center
Mary Weatherby, LMSW
Supervisor, Care Coordination, WellStar Kennestone Hospital
D. Leigh Webb, M.P.H., CTR
Manager, WellStar Cancer Data Center
Community Partner
Representatives:
Belisa Urbina
Executive Director, Ser Familia
Kacie McDonnell, M.P.A.
Director of Stewardship, Good Samaritan Health
Center of Cobb
Chris Fields
Senior Vice President, Programs and Administration,
MUST Ministries
Frank Smith
Director, The CarePlace
Sandy Ingram, RN
Practice Manager, Bethesda Community Clinic

WellStar Community Benefit
Oversight Committee
Candice Saunders, President & CEO
David Anderson, Executive Vice President, Human Resources, Organizational Learning and Chief Compliance Officer
Stephen Badger, Chief Administrative Officer, WellStar Medical Group
John Brennan, M.D., Executive Vice President, Chief Clinical Integration Officer
Jim Budzinski, Executive Vice President and Chief Financial Officer
Val Akopov, M.D., Senior Vice President, Hospital Division and Co-President of WellStar Medical Group
Joe Brywczynski, Senior Vice President, Health Parks Development and Administration
Amy Carrier, Senior Vice President and WellStar Cobb and Windy Hill Hospital President
Jill Case-Wirth, Senior Vice President, Nursing Services, Chief Nursing Executive
Barbara Corey, Senior Vice President, Managed Care
Kristyn Greifer, M.D., Vice President, Population Health Management
Mark Haney, Senior Vice President and WellStar Paulding Hospital President
Kim Menefee, Senior Vice President, Strategic Community Development
Kem Mullins, Executive Vice President, Ambulatory and Business Development
Jon Morris, M.D., Senior Vice President, Chief Information Officer
Alan Muster, M.D., Senior Vice President, Specialty Division and Co-President of WellStar Medical Group
Craig Owens, Senior Vice President and WellStar Douglas Hospital President
Carrie Plietz, Executive Vice President and Chief Operating Officer, Hospital Division
Leo Reichert, Executive Vice President and General Counsel
Dan Woods, Senior Vice President and WellStar Kennestone Hospital President

Executive Summary | Community is CARE 6
Community Benefit Defined
Triple Aim Framework
Research Methods and Process
Key Findings and Themes
Priority Health Needs
Community Health Needs Research
Implementation and Outcome Goals
Tracking WellStar Progress
WellStar and the Community Served | Community is COMMITMENT 16
The Enterprise
The Entity
Expansion for Innovation and Access
Community Profile
WellStar Hospitals’ Community At A Glance
Socioeconomic Gradient in Health
County Level Data Links
Table of Contents
Needs Assessment Overview | Community is CONTRIBUTION 32
Process
Research Methods and Timeline
CHNA Collaboration
Data Collection and Analysis
Data Sources
Community Input | Community is CONNECTION 38
Community Collaborators
Community Health Needs | Community is COMPASSION 42
Major Health Challenges and Drivers
Significant Needs
Prioritization Process
Priority Needs
Needs Not Addressed
Community Health Assets | Community is COLLABORATION 50
Strategic Community Partnerships
Potentially Available Community Resources
Evaluation of Impact: Tracking WellStar’s Progress | Community is CHANGE 60
2013 Implementation Update
Tracking System-Wide Progress
Tracking Hospital-Specific Progress
Report References 72
Significant Health Needs Data Summaries 79

COMMUNITY IS
BUILDING A BIGGER TABLE

IT TAKES A GREAT WORK TO MEET GREAT NEEDS.
A snapshot of community health needs.
WellStar’s culture of health is as strong as our ability to instill a shared value of health
in the community. Resilience is a skill when your aim is to impact community health.
As a community-based not-for-profit health system, WellStar Health System’s
(“WellStar”) vision to provide world-class healthcare extends beyond the patients we
treat to the community we serve.
COMMUNITY
BENEFIT DEFINED
Delivered by the WellStar Community Health Collaborative 1 and WellStar’s
five hospitals, community benefit is an organized and measured approach
WellStar takes to respond to identified community health needs. 2 The
term implies collaboration with a “community” to “benefit” its residents.
We provide community benefit by creating better access to healthcare
and services, advancing medical and health knowledge through research,
education and outreach and forging collaborative partnerships that reduce
the burden on government and other tax-exempt organizations.
EXECUTIVE SUMMARY
In compliance with federal tax laws under the Affordable Care Act 3 , WellStar
tracks and reports community benefit in the following categories:
1: Financial Assistance (Charity Care)
2: Government-Sponsored Means-Tested Health Programs
(Provided in hospitals and hospitals’ outpatient facilities)
3: Community Benefit Services (As an integrated health system, most
services are delivered at a System-level in our hospital communities via
the WellStar Community Health Collaborative and its partners; not by
individual hospitals.)
The provision of community benefit 4 is essential to the mission of WellStar to
deliver the most advanced level of care to the community we serve. It also is
a requirement to sustain WellStar’s status as Georgia’s largest not-for-profit
healthcare system. In fiscal year 2015, WellStar invested 11 percent of total
operating expenses in community benefit financial assistance, unreimbursed
care and services totaling more than $220 million.

TRIPLE AIM
FRAMEWORK
WellStar is the community’s lead investor in facilities, services and programs to achieve
the Institute of Healthcare Improvement’s (IHI) “Triple Aim” framework 5 to:
(1) Improve the patient care experience 6
(2) Improve the health of a population 7
(3) Reduce healthcare costs
This framework provides the criteria for actionable community benefit services to
address priority health needs and for collaboration with vital community partners
whose assets enhance and broaden the scope of WellStar and its hospitals’ capacity
and expertise.
COMMUNITY
HEALTH NEEDS
RESEARCH
WellStar deployed a systematic approach 8 to collecting, analyzing and using data and
community input to identify significant health needs and determine where current
assets of WellStar and community partners enable action to help improve the health
of the community, especially among the most vulnerable:
Assessment Planning
Driven by Community Input /
Internal Audit
Data Collection and
Analysis and Prioritization
of Health Needs
Action /
Implementation Planning
From September to December 2015, Community Health Needs Assessment (CHNA)
research was conducted by a third-party consultant and the Georgia Health Policy
Center 9 on behalf of WellStar’s five not-for-profit hospitals - WellStar Cobb, Douglas,
Kennestone, Paulding, and Windy Hill hospitals. 10
To capture the health status of more than 1.4 million residents in WellStar’s five-county
primary service area 11 (Bartow, Cobb, Cherokee, Douglas, and Paulding counties), the
following questions guided the process:
1. What is the current health status of the community WellStar serves?
2. What are the major risk factors and causes of poor health in our community?
3. What actions by WellStar and its partners are needed to address the risk
factors and causes?
4. What are the existing WellStar and community assets, programs and services that
can help address the needs?
5. Who are the partners or potential partners with the expertise and resources to
help expedite a connection to healthcare, education and resources?
8 2016 Community Health Needs Assessment (CHNA)

RESEARCH
METHODS
AND PROCESS
A broad spectrum of primary (qualitative) and secondary (quantitative) research methods
were used including:
• Surveys and interviews with multi-sector key stakeholders
• Web-based health status survey of the community-at-large
• Community focus groups in high need areas
• Photo testimonies
• Health status and resource assessment survey of the WellStar Medical Group
• Extensive community health and utilization data across multiple sites and databases
• Listening sessions with safety net clinic patients and uninsured/underserved
members of faith-based organizations
The full body of research was aggregated by the predominance of key findings and
themes. Significant health needs were reviewed by leaders in WellStar Population Health
Management and Strategic Community Development, the Georgia Health Policy Center, and
Kennesaw State University’s (KSU) A.L. Burruss Institute of Public Service and Research. 12
This was done in preparation for the WellStar Community Health Collaborative’s Health
Needs Summit held on Feb. 25, 2016 – the platform for prioritizing significant health needs.
KEY FINDINGS
AND THEMES
Although the five counties in the WellStar primary service area rank in Georgia’s top
quartile for health, 13 there are pockets of poor health in every county. Many of affected
communities are those we call “vulnerable populations” which include and may have
the following attributes: the underinsured/uninsured, low income, 14 lower education
attainment, limited English proficiency, poor health literacy, minorities, the elderly, and
those who are transient and/or live in an unsafe physical environment and/or food desert. 15
Many of the health challenges identified in the 2013 CHNA remain relevant for each hospital.
These include the disease burden from chronic disorders 16 (including cardiovascular
disease, diabetes, chronic obstructive pulmonary disease, and cancer) and chronic disease
primary drivers - obesity, tobacco use, poor nutrition, and physical inactivity.
Economic security is either the greatest door or barrier to access healthcare and preventive
services to keep people healthy. Income is a key driver of health status and where you live
can largely determine how healthy you are.
9

Underemployment and unemployment, due to low education attainment or other
factors, challenge the mind, body and spirit of indigent and low-income residents.
Community safety net clinic patients testify to the fiscal barriers which cause frustration
and hopelessness which often leads to unhealthy behaviors and mental health issues, a
health concern growing in prevalence.
With unaffordable healthcare costs, the most vulnerable in our community feel disqualified
from the preventive side of health, including tests and screenings. They seek care as a
last resort. “Why spend money if nothing is wrong?” This is not just a sentiment among
the 20 percent uninsured adult population in the five-county region 17 , but also for those
who have rising Affordable Care Act premiums and other high deductible plans.
Many “last resort” residents present in WellStar Emergency Departments (ED) with
ambulatory care sensitive conditions and preventable hospital readmissions. According to
internal data, approximately 22 percent of WellStar’s total ED visits in FY2015 were for
non-emergent conditions that potentially could have been treated in an outpatient setting.
There is a growing concern among key stakeholders representing vulnerable populations
about the underuse of primary care (due to both access and cost barriers), unaffordable
medication and specialist care, mental health issues, and substance abuse (specifically
the rise of opioids/heroin). In addition to health disparities, transportation and physical
environment factors like a lack of parks/sidewalks and neighborhood safety also were
commonly cited among residents living in vulnerable areas. These factors also contribute
to physical inactivity which increases the risk for obesity and chronic disease.
Health disparities are compounded by the low provider-resident ratio in Bartow, Douglas
and Paulding counties, although it’s still a level of concern community-wide. Underuse
of primary care remains a barrier to navigating healthcare including accessing affordable
medications and insurance / financial assistance programs.
Health fairs, education and free screenings in the community are deemed beneficial, but
with the lack of or awareness of low or no cost resources for follow-up care to manage
a revealed or unmanaged condition, the services may be a point of stress among the
vulnerable population. “Then what?” was a common question amplifying the need for
a more seamless prescription of resources and self-management education. These
needs were echoed by key stakeholders who serve this population.
Many cite more collaborative efforts among the public health system 18 as the biggest
catalyst for change and improvement in community health. Stakeholders noted the
need to leverage the expertise of organizations that already address significant health
needs and strategically pool funding and resources to maximize outcomes.
10 2016 Community Health Needs Assessment (CHNA)

After a thematic analysis of health needs data, priorities were identified by the WellStar Community Health
Collaborative Task Force at a February 2016 Health Needs Summit. The task force, made up of a broad spectrum
of WellStar team members and community stakeholders representing vulnerable populations, used the Triple
Aim framework and current assets / capacity measures 19 to prioritize significant health needs.
The overriding question:
Which health needs, when collaboratively addressed, will make the greatest difference in care access,
care quality and costs to improve the health of the community, especially the most vulnerable?
The task force identified the following as priority health needs
for the WellStar community’s five hospitals:
11

PRIORITY HEALTH NEEDS
Access to Care
• Underuse of primary care
- Lack of care capacity in community
safety net clinics
- Overuse of Emergency Department for
non-emergent needs
Healthy Lifestyles 20
• Cancer
• Cardiovascular Disease
• Chronic Obstructive Pulmonary Disease /
Asthma
• Type 2 Diabetes
• Obesity

IMPLEMENTATION
AND OUTCOME
GOALS
Recognizing health and social factors are closely intertwined, the priority health needs
require collaborative public health and primary care interventions (see the figure below)
to help prevent disease and injury, promote health and well-being, assure conditions in
which people can be healthy, and provide timely, effective and coordinated healthcare. 21
Social, economic & environmental
conditions that act as the primary
determinants of individual and
population health
Health services and education
+ +
Clinical care interventions
Public health activities that
target populations and
address individual health
behaviors
= IMPROVED
COMMUNITY
HEALTH
PRIMARY AREAS OF WELLSTAR INFLUENCE
TO PROVIDE THE RIGHT CARE
AT THE RIGHT PLACE
Galvanizing efforts and resources to achieve optimal community health outcomes is vital to:
• Improve access to care.
Help break access barriers (includes cost of care) and bridge service gaps,
especially for the most vulnerable.
• Improve community health status.
Support a healthier community by providing health needs-specific preventive
health services and education focused on reducing the incidence and prevalence
of chronic disease.
• Strengthen and build strategic community partnerships 22 .
Collaborate to leverage and maximize assets/capacity and prescribe resources
to address priority health needs, drivers and disparities.
14 2016 Community Health Needs Assessment (CHNA)

TRACKING
WELLSTAR’S
PROGRESS
Since the inaugural 2013 CHNA, WellStar has made a seismic shift from a volume-based
care delivery system to an integrated, value-based care delivery system 23 . With a focus on
prevention and wellness, we’re transforming care delivery and recalibrating System-wide
community benefit strategy to more effectively and efficiently align with the health priorities
of our residents, Public Health (public and private-sector partners) and key stakeholders.
Progress made on WellStar’s two-phased community benefit implementation strategy 24
has created a more sustainable framework for actionable community benefit services, yet
was too broad in scope. More work is needed in the structure, delivery and evaluation of
these activities and to replicate the community benefit model across multiple hospitals in an
expanding Georgia footprint.
A more detailed
progress report
based on
community
benefit
categories is
on page 60.
In other areas, WellStar’s taken a non-linear approach to addressing health needs by initiating
evidence-based care models, such as developing an integrated behavioral health network to
address growing mental health issues and the expansion of prevention-based education and
clinical care services. This includes clinical training for smoking cessation and a Comprehensive
Care Clinic focused on chronic disease management and treatment of high-risk patients.
Partnerships with community safety net clinics are being redefined and expanded laying the
groundwork for more collaborative and affordable community benefit services and education.
This includes leveraging the compassion, expertise and health knowledge of team members and
care providers via the new WellStar 4-1 Care Network 25 . The network is a conduit for reducing
Emergency Department utilization through hospital-based care coordination, navigation to
the right care at the right place and WellStar Medical Group (WMG) physicians and advanced
practice professionals volunteerism in community safety net clinics to help build needed care
capacity to serve more medically underserved and uninsured residents.
We established two more hospital outpatient community clinics in areas of high need to provide
access to OB/GYN and internal medicine. Care will be delivered by attending physicians and
residents participating in the new Graduate Medical Education program.
Through the WellStar Center for Health Transformation, we innovated ways to improve care
delivery in alliance with multi-sector partners, leading research institutes and technology to
energize and enable cutting-edge solutions that improve care and reduce healthcare costs 26 .
We brought quality community-based outpatient care and services to more neighborhoods
via our convenient and cost-efficient Health Park model – a lauded concept for improving care
access modeled nationwide – with two operational parks and one currently under construction
in Vinings.
We instituted WellStar Clinical Partners, a physician-led, clinically integrated organization, to
help optimize the wellbeing of the community. Its collaborative health management focus is
foundational to maximize value for patients and improve the delivery of and access to worldclass
care. To date, the organization is comprised of 1,167 affiliated physicians, including nearly
600 WMG physicians in more than 220 practice locations.
We established disease-specific clinics for leading causes of death (e.g. heart disease and
COPD) to provide more comprehensive care management and behavior/lifestyle modification
tools and education to improve community health.
15

COMMUNITY IS

STRENGTHENING SCALE
BROADENING CAPABILITIES
ENHANCING EFFICIENCY
IMPROVING QUALITY
WellStar and the Community Served
WellStar is Georgia’s largest not-for-profit health system, a national leader in the
transformation of healthcare delivery 27 and recognized as the fifth most integrated
healthcare delivery system 28 in the nation.
THE
ENTERPRISE
The WellStar Mission for our community:
To create and deliver high quality hospital, physician and other healthcare-related
services that improve the health and well-being of the individuals and community
we serve.
The WellStar Vision for our community:
To deliver world-class healthcare to our community. Our vision manifests itself
through a wide variety of supportive endeavors by which we provide excellent,
compassionate and holistic care. That means making preventive health screenings,
educational support and the highest quality of medical care available to everyone.
17

153,000 community members had access to
health fairs and community education.

Partnerships with community safety net clinics allow
medically underserved and uninsured patients to receive
WellStar lab and radiology services at no or reduced cost.
have benefited from WellStar’s
eighth in the nation-ranked
Accountable Care Organization
(ACO) 29

DELIVERY OF COMMUNITY BENEFIT SERVICES
Categories:
Community Health Improvement Services
Subsidized Health Services
Health Professions Education
Research
Cash and In-Kind Contributions
Community Building Activities
$8,113,000
$14,380,000
$7,660,000
88%
INCREASE
ACCESS TO CARE SINCE 2013 30
IN THE INVESTMENT IN COMMUNITY
BENEFIT PROGRAMS AND SERVICES
DESIGNED TO IMPROVE HEALTH AND
FY2013
FY2014
FY2015
20 2016 Community Health Needs Assessment (CHNA)

THE
ENTERPRISE
(CONTINUED)
The majority of WellStar’s community benefit dollars provide indigent (below 125 percent
of the Federal Poverty Level (FPL) 31 and charity care (between 125 and 300 percent FPL) to
eligible patients 32 at all hospital and hospital-based facilities.
WellStar also provided an additional $47.5 million in unreimbursed care in FY2015 to those
who didn’t apply for charity care, but were unable to pay for services (the cost of delivering
care). The amount is a 27.3 percent decrease from 2014 after a significant increase (23.3
percent) in care provision from 2013 to 2014 33 .
“Hotspot” Maps: Population
Below 125% FLP – Indigent
Below 300% FPL - Charity
Population percentage
at or above 300 FPL
Do not qualify for WellStar
Community Financial Assistance
Percentage of that population
at or above 300 FPL that is
uninsured
21

THE ENTITY
Geographically enlarging the community’s access to care and clinically integrating the
way healthcare is provided improves patient satisfaction, health outcomes and overall
community health.
Delivering Care In Your Neighborhood
WellStar Congregational
Health Network
Hospitals
Urgent Care Center
Health Park
Community Clinic or Partner Safety Net Clinic 34
WellStar Medical Group locations
22 2016 Community Health Needs Assessment (CHNA)

EXPANSION FOR
INNOVATION
AND ACCESS
On April 1, 2016, WellStar Health System expanded its footprint beyond its historic
Northwest Georgia base. WellStar brought its vision of world-class healthcare to new
communities and patients, following due diligence, regulatory review and thorough
integration planning.
With the acquisition of Tenet Healthcare’s five Georgia-based hospitals (in Butts, Fulton,
Jackson and Spalding counties) and a new partnership with West Georgia Health in
LaGrange (Troup County), WellStar becomes the largest health system in Georgia and
one of the largest not-for-profit health systems in the country. With approximately
20,000 team members, the new 11 hospital system will expand upon its proven clinical
care models and patient safety programs that have resulted in increased quality and
improved access to healthcare in its new communities.
Joining WellStar’s existing five hospitals are: WellStar Atlanta Medical Center, WellStar
Atlanta Medical Center South, WellStar North Fulton Hospital, WellStar Spalding
Regional Hospital, WellStar Sylvan Grove Hospital and WellStar West Georgia Medical
Center. All facilities will now be operated as not-for-profits.
WellStar Medical Group, one of the largest employed physician groups in the Southeast,
will expand to more than 1,000 physicians and advanced practice professionals across
more than 220 medical office locations and numerous outpatient facilities.
With ever-changing government regulations and reimbursement pressures, health
systems across the country are looking for new efficiencies. To better serve its
patients, WellStar chose to be proactive to secure the future of high-quality care in its
communities. The geography of West Georgia Health and Tenet’s five Georgia hospitals
complements WellStar’s current footprint. With a larger integrated system, WellStar
will continue its strategic focus on the Triple Aim—higher quality, improved access and
affordable healthcare.
23

COMMUNITY PROFILE
Residents living in a five-county region (Bartow, Cobb, Cherokee, Douglas, and Paulding counties)
comprise the primary community served by WellStar Cobb, Douglas, Kennestone, Paulding, and
Windy Hill hospitals. Community is defined geographically, by WellStar hospitals’ intersecting 90
percent catchment areas irrespective of county lines, and statistically, by the demographics and
determinants of health reported in the CHNA.
Bartow
COUNTY POPULATION
101,736
35
Cherokee
COUNTY POPULATION
230,985
BELOW 18 ABOVE 65
26% 12%
BELOW 18 ABOVE 65
27% 11%
Paulding
COUNTY POPULATION
148,987
BELOW 18 ABOVE 65
28% 9%
WellStar Community is
51% FEMALE
24 2016 Community Health Needs Assessment (CHNA)

Cobb
COUNTY POPULATION
730,981
Douglas
COUNTY POPULATION
138,776
BELOW 18 ABOVE 65
25% 10%
BELOW 18 ABOVE 65
27% 10%
County Bartow Cherokee Cobb Douglas Paulding GA
Percentage of uninsured
adults 18-65 36 22% 19% 21% 21% 18% 21%
Median age of the
uninsured is 34
Total Number of uninsured 37 18,408 33,169 124,371 23,771 20,712
Percentage of
uninsured
Hispanic/Lation
16 28 31 18 10
Population on
Medicaid/means tested
13,506 15,895 58,383 16,161 13,382
public coverage 38
Georgia was among 39 states whose uninsured rate dropped by more than three
percentage points after the insurance changes debuted in 2014, yet the state’s percentage of people without
coverage is still among the highest in the nation. 39
25

40

SOCIOECONOMIC
GRADIENT IN
HEALTH
A mission-driven approach to profile a community’s health is to encapsulate it by
the “socioeconomic gradient in health.” This refers to the stepwise fashion health
outcomes improve as socioeconomic position improves. This gradient can be
measured by:
1. Income 41
2. Occupation
3. Level of education achieved 42
INCOME
Children Living in Poverty 43
Georgia – 26%
Bartow - 21%
Cherokee – 13%
Cobb – 18%
Douglas – 20%
Paulding – 16%
+
+
OCCUPATION
Unemployment 44
Georgia – 7 %
Bartow - 7%
Cherokee – 6%
Cobb – 6%
Douglas – 7%
Paulding – 6%
EDUCATION ATTAINMENT
2016 Estimated Population Age 25+ in 90% Hospital Catchment Area
Cobb
Some High School,
no diploma 7%
High School Graduate
(or GED) 26%
Some College, no degree 22%
Bachelor’s Degree 22%
Other 24%
Douglas
Some High School,
no diploma 8%
High School Graduate
(or GED) 31%
Some College, no degree 24%
Bachelor’s Degree 16%
Other 21%
Kennestone
Some High School,
no diploma 6%
High School Graduate
(or GED) 24%
Some College, no degree 22%
Bachelor’s Degree 24%
Other 24%
Paulding
Some High School,
no diploma 8%
High School Graduate
(or GED) 31%
Some College, no degree 24%
Bachelor’s Degree 17%
Other 21%
Windy Hill
Some High School,
no diploma 6%
High School Graduate
(or GED) 24%
Some College, no degree 21%
Bachelor’s Degree 24%
Other 24%
“You have families with a
lot of health issues, a lot of
problems, struggling…Why
finish high school when (you)
can get a job and help your
family?”
- Good Samaritan Health Center
of Cobb patient
28 2016 Community Health Needs Assessment (CHNA)

HEALTH OUTCOMES
=
Bartow
38
2013/61
Paulding
9
2013/25
Health
Cherokee
6
2013/6
Outcomes
2016 County Health
Outcomes 45
Bartow Ranking
(out of 159 counties)
Douglas
36
2013/27
Cobb
7
2013/6
In addition to socioeconomic factors, health outcomes also are based on
three other determinants of health factors:
Health Behaviors
Clinical Care
Physical Environment
Bartow
47
2013/50
Paulding
14
2013/16
Cherokee
6
2013/5
Douglas
45
2013/28
Cobb
7
2013/7
Health Factors
2016 County Health Factors Ranking
29

GEORGIA
16%
Health Behaviors 46
GEORGIA
25%
PAULDING
15%
DOUGLAS
17%
ADULT
SMOKING
COBB
14%
BARTOW
17%
CHEROKEE
14%
PAULDING
28%
DOUGLAS
34%
GEORGIA
29%
ADULT
OBESITY 47
COBB
22%
BARTOW
34%
CHEROKEE
26%
PAULDING BARTOW
26%
27%
PHYSICAL
INACTIVITY
DOUGLAS
CHEROKEE
26%
22%
COBB
18%
Primary Care Physicians 48
Residents to One Provider Ratio
Clinical Care
Mental Health Providers
Residents to One Provider Ratio
GEORGIA
BARTOW
CHEROKEE
COBB
DOUGLAS
PAULDING
1,540: 1
2,150: 1
2,920: 1
1,540: 1
2,310: 1
7,730: 1
GEORGIA
1,050:
850:
BARTOW
CHEROKEE
COBB 700:
DOUGLAS
PAULDING
GEORGIA COBB
15%
BARTOW
17%
CHEROKEE
Severe Housing Problems 49
1,150:
1,240:
Physical Environment
18%
15%
16%
18%
1
DOUGLAS
PAULDING
1
1
1
1
2,810:
1
30 2016 Community Health Needs Assessment (CHNA)

Top 5
Leading Causes of Death 50
County Level Data
DIG IN
For more in-depth county health
status profiles, 51 send a request to
chna@wellstar.org.
Bartow
Cherokee
Cobb
Douglas
Paulding
31

COMMUNITY IS

CHNA PROCESS
The broad spectrum of qualitative and quantitative data collected in this CHNA report
reflect the health needs of the WellStar community. For assessment planning and
gathering community input, the following steps were taken:
• Created a timeline for gathering and obtaining community input
• Located and obtained existing community health data
• Secured commitment from strategic community partners for data collection
(e.g. sites and patient recruitment for focus groups/listening sessions, partners
to distribute online survey and as key informants)
• Developed research tools based upon health indicators, input from other health
systems/organizations and the MAPP process used for the 2013 CHNA 52
• Identified populations from which to obtain data (e.g. low-income population, faith
community, care providers, minorities, medically underserved and uninsured)
• Considered language barriers for data collection (Spanish translation of community
survey provided and three Spanish-language focus groups conducted)
• Developed quantitative survey tools and a distribution plan
• Determined and developed qualitative methodology of focus groups/listening
sessions
• Secured approval of research tools/guides and participant consent forms
• Collected community input data via email, phone, web-based survey reports, group
meetings (focus groups/listening sessions), onsite interviews, WellStar hospital
president meetings, Facebook links, and surveys posted on community partner and
agency websites
• Solicited assistance to gather health indicator data mirroring Healthy People 2020 53
(including demographic data, social and economic factors, education attainment,
health behaviors, and access to clinical care) - assessed using databases of national
and state agencies, public health and non-profit health systems.
Community Health Needs Assessment Overview
33

RESEARCH
METHODS AND
TIMELINES
• Quantitative data mining (multiple sources): November – March 2016
• Focus groups in high need areas: November – December 2015
• Listening sessions with low-income residents (safety nets and congregations):
October 2015
• Key informant interviews and surveys: September – December 2015
• Photo testimonies: October 2015
• Online community health status survey: September – November 2015
• Online WellStar Medical Group survey: October 2015
CHNA
COLLABORATION
To support the development of the 2016 CHNA and to foster broad collaboration among
health systems and hospitals, WellStar engaged Georgia Health Policy Center (GHPC) 54
in the Andrew Young School of Policy Studies at Georgia State University to work with
its third-party CHNA consultant to leverage the research it does for Kaiser Permanente.
As a result, GPHC’s data collection and analysis contributed to the CHNAs of four
health systems (WellStar Health System, Grady Health System, Kaiser Permanente, and
Piedmont Healthcare), a health plan and an urban county health department.
Specific tasks of WellStar’s third-party consultant with assistance from the GHPC
included:
• Collecting, analyzing, and synthesizing state, county-specific and local level data
• Soliciting community input
• Coordinating WellStar team members for internal data and program information
• Assimilating stakeholder, community member and clinical team recommendations
• Leading the prioritization process with WellStar team members and community
partners
• Identifying community-based organizations and other institutional assets engaged in
health improvement
• Ensuring 501(r) regulations are met
WellStar also partnered with KSU’s Burruss Institute to help facilitate the health needs
prioritization summit of the WellStar Community Health Collaborative Task Force which
includes key community stakeholders.
34 2016 Community Health Needs Assessment (CHNA)

DATA COLLECTION
AND ANALYSIS
Insights from 99 WellStar Medical Group (WMG) representatives 55 regarding patient
health status and community resources were gleaned from an online survey tool sent
to WMG providers (MDs and nurse practitioners) and registered nurses.
A wide net was cast for community input using a similar online survey tool (English and
Spanish) capturing demographics and overall personal health status and behaviors
of 447 community members. 56 Community clinics, health e-newsletters, workplace
partners, a Public Health Department, a school system, a Hispanic non-profit, and
faith-based organizations disseminated the online link via email and social media. It’s
approximated the survey link was distributed to 5,000 people.
61 key informant surveys/interviews (all WellStar driven except eight by GHPC) were
conducted with multi-sector leaders representing diverse organizations including
Public Health Departments, governmental agencies, community safety net clinics,
business leaders, and regional health board representatives. Collecting information
from a wide range of experts with first-hand knowledge about the community provided
insight on health issues and care barriers along with recommended interventions.
To provide a broader base of input and use the CHNA process as a means to strengthen
community partnerships, seven listening sessions (three in Spanish) were conducted
with 58 medically underserved and uninsured community members. Sessions were
with partnering community safety net clinic patients (Bethesda Community Clinic in
Cherokee, Good Samaritan Health Center in Cobb, The CarePlace in Douglas), Latino
community members (WellStar Congregational Health Network members Iglesia de
Dios in South Cobb and McEachern UMC in Powder Springs), Ser Familia community
members 57 , and the Paulding County Health Department 58 . Two of the three sessions
conducted in Spanish were facilitated by the Hispanic Health Coalition of Georgia.
The Executive Director of Ser Familia co-conducted the third session with WellStar’s
third-party consultant. In each listening session, a few community members provided
a photo testimony to communicate their greatest health-related need.
To fortify the seven listening sessions and gain a broader base of input, GPHC also
conducted five focus groups with 41 participants in high need areas in each county in
WellStar’s primary service area. Locations of this primary research are mapped out on
the following page.
35

Approximated Locations of the CHNA Listening Sessions
and Focus Groups at Safety Nets and in High Need Areas
BARTOW
FG
FG
CHEROKEE
LS
LS
LS
PAULDING
COBB
LS
Paulding County
Health Department
FG
LS
McEachern
United Methodist Church
LS
FG
LS
LISTENING SESSION
LS
FG
FOCUS GROUP
The CarePlace
FG
DOUGLAS
36 2016 Community Health Needs Assessment (CHNA)

DATA SOURCES
Secondary Data (Quantitative county-level summaries of demographic and health
information for the hospitals’ service area)
Assigning statistics to core health indicators gave a broader, overarching view of the
community's health status.
WellStar:
• Georgia Student Health Survey (Behavioral Risk Survey)
• Centers for Disease Control and Prevention Community Health Improvement Navigator 59
• Cobb & Douglas Public Health data
• Community Commons
• County Health Ranking and Roadmaps - includes data from the CDC’s Behavioral
Risk Factor Surveillance System (BRFSS) 60
• Georgia Department of Public Health
• WellStar Enterprise Intelligence for Emergency Department utilization
• Catholic Health Association
• Vulnerable and At-Risk Populations Resource Guide 61
GHPC sources included publicly available datasets 62 :
• Community Commons CHNA Portal 63
• Georgia’s Online Analytical Statistical Information System (OASIS) 64
• U.S. Census Bureau, American Community Survey 5-Year Dataset 65
• Area Resource File
• County Health Rankings and Roadmaps which utilizes myriad of data sources
• Centers for Disease Control and Prevention, National Center for HIV/AIDS,
Viral Hepatitis, STD, and TB Prevention
Primary Data
In addition to the community safety net clinic patients and residents in high need areas,
an extensive list of leaders and community members representing Public Health and
multi-sector and non-profit organizations serving the broader community are listed in
the Community Input section that follows.
37

COMMUNITY IS
YOUR STORY IS OUR STORY

COMMUNITY
COLLABORATORS
Requests for input from individuals with a stake in community health representing the
broad interests of the community 66 began in August 2015 with feedback continuing
through December 2015. Some stakeholders solicited for input did not respond 67 .
The CHNA contributions of the following organizations were vital to gather a wide
array of insight, expertise and data to identify community health needs, assets and
barriers to care.
WellStar acknowledges and thanks the following for their participation. All were key
informants except where noted. Organizations in italics were contacted by the GHPC
as part of the collaborative CHNA research conducted by Grady, Kaiser Permanente,
Piedmont Healthcare, and WellStar.
A.L. Burruss Institute for Public Service & Research – CHNA health needs review/
feedback, facilitation of health needs prioritization
Allatoona Resource Center
American Cancer Society – Cobb2020 68 Steering Committee member
American Cancer Society – Marietta Health Department, Client Navigation Program
Atlanta Regional Commission
Austell Community Task Force – Cobb2020 Steering Committee member
Bartow Public Health Department
Bethesda Community Clinic (Cherokee County) - key informant, listening session
site and community representative on WellStar Community Health Collaborative
Task Force
The CarePlace (Douglas County) – key informant, listening session site and
community representative on WellStar Community Health Collaborative Task Force
Center for Pan Asian Community Services
Chattahoochee Technical College – Cobb2020 Steering Committee member
Cherokee County Department of Family & Children Services
Cherokee County Health Department
Cherokee County School District
Children’s Healthcare of Atlanta – Cobb2020 Steering Committee member
City of Marietta Police Department
Clarke County Commissioner
Clarkston Community Center
Cobb Chamber of Commerce – Cobb2020 Steering Committee member
Cobb County Board of Commissioners (District 4) – Cobb2020 Steering
Committee member
Cobb County Fire and Emergency Services
Cobb County Government – Cobb2020 Steering Committee member
Cobb County Public Services Agency
Cobb County Safety Village
Cobb County Sheriff’s Office – Cobb2020 Steering Committee member
Cobb 2020 Leadership (Cobb & Douglas Public Health) – distribution of key
informant survey
Cobb Douglas Public Health
Cobb Senior Services
Community Foundation of Greater Atlanta
Community Health Center in Austell
Community Input
39

Davis Direction Foundation
DeKalb County Commissioner
District Health Director, Assistant, District 1-2 North Georgia
District Health Director District 2
District Health Director District 3-4
District Health Director District 3-3
District Health Director District 4
District Health Director District 3-5
Douglas CORE – A Community Organizing Resources for Excellence, Inc.
Douglas County School System – key informant and online community survey
distribution
Fulton County Commissioner
Fulton County Policy Analyst, District 302
Georgia Department of Education
Georgia Health News – health news relating to community served
Georgia Health Policy Center at Georgia State University – CHNA collaboration and
research
Grady Health System – CHNA research collaboration
Good Samaritan Health Center of Cobb – key informant, site of listening session,
Cobb2020 Steering Committee member, and community representative on WellStar
Community Health Collaborative Task Force
Helping Hands of Paulding County
Hispanic Health Coalition of Georgia – key informant and facilitator of two Hispanic
listening sessions
Kaiser Permanente – CHNA research collaboration
Kennesaw State University – Cobb2020 Steering Committee member
Kennesaw State University, Center for Health Promotion and Wellness
Marietta City Schools – Cobb2020 Steering Committee member
Marietta Kiwanis Club – Cobb2020 Steering Committee member
MUST Ministries – key informant and community representative on WellStar
Community Health Collaborative Task Force
North Georgia Health District (1-2)
Northeast Health District Director, 10 Athens
NorthStar Psychological Services
Northwest Georgia Health District
Paulding Community Health & Resource Center Steering Committee members
Paulding County Health Department – key informant, site for listening session and
distribution of online community health survey
Paulding County Sheriff’s Office
Piedmont Healthcare – CHNA research collaboration
SafePath Children’s Advocacy Center, Inc.
Senior Citizens Council of Cobb County
Ser Familia – key informant, site for listening session, Cobb2020 Steering Community
Health Collaborative Task Force, and community representative on the WellStar
Community Health Collaborative Task Force
40 2016 Community Health Needs Assessment (CHNA)

Smyrna Fire/Emergency Management
T. Lee Associates / City of Marietta
United Way of Metro Atlanta
WellStar Center for Health Transformation – internal data
WellStar Cobb Hospital President
WellStar Cobb and Kennestone Community Clinics – internal data
WellStar Community Education & Outreach – internal data
WellStar Congregational Health Network:
Hickory Flatt UMC – Canton, GA - online survey participants
Iglesia de Dios – Austell, GA - listening session site
McEachern United Methodist Church – listening session site
WellStar Douglas Hospital President
WellStar Enterprise Intelligence – internal data
WellStar Regional Health Board Trustees including:
Bethel Gardens Assisted & Memory Care (Cobb)
Caldwell Insulation, Inc. (Cobb)
Community Bank of the South (Cobb)
John L. Stone – (Douglas)
Keep Paulding Beautiful – (Paulding)
Paulding Quick Bail, Inc. (Paulding)
Puckett EMS – (Douglas)
Southeast Cooler – (Douglas)
WellStar Kennestone Hospital President
WellStar Medical Group, Director of Practice Operations
WellStar Paulding Hospital President
WellStar PR, Marketing and Internal Communications – production of survey tools
YMCA – Northwest Georgia - posting of online community health survey
41

COMMUNITY IS

MAJOR HEALTH
CHALLENGES
AND DRIVERS
Since the initial 2013 health assessment across the WellStar community, health needs
remained consistent and similar health challenges and drivers were cited:
• Chronic disease prevention and management
• Access and affordability of healthcare, health insurance or viable alternatives 69
(those that have insurance can’t afford rising premium costs and deductibles)
• Health equity and literacy; lack of resources that are linguistically and culturally
appropriate
• A concern about the prevalence of patient education and health fairs/ events with
health screenings without a connection to needed follow-up care
• Lack of knowledge of available health resources, services and navigation assistance
• A decrease in Public Health Department funding and staffing
• Low-income residents and those who are fearful of their illegal status (undocumented
Hispanics) are slow to seek medical attention
Community Health Needs
• Inequalities in determinants of health 70
• Medication access and affordability
• Targeted, prevention-based education to address health needs to combat the lack of
understanding of how lifestyle choices affect health
• Health education programs built on behavior change and physical activity are not
equal across all counties
• Transportation for care access
• Increase of heroin use by teenagers and young adults
• Lack of healthy food options in areas where vulnerable populations live
• Underuse of preventive care among men
• Lack of good health in early childhood / maternal and infant health
• Lack of affordable dental care
• Culture of violence and stress among vulnerable populations
43

SIGNIFICANT
HEALTH NEEDS
The following process was used to identify significant community health needs in
advance of the prioritization work by the WellStar Community Health Collaborative Task
Force:
Quantitative Data
(data platforms,
other numeric data)
Qualitative Data
(focus groups, key
informant interviews)
Poor performance
against benchmark
Themes
Health Issue
Health Issue
Issue comes up across
multiple data sources
= COMMUNITY HEALTH NEED
44 2016 Community Health Needs Assessment (CHNA)

The significant health needs related to access to care stem from
socioeconomic and clinical care barriers. These barriers create
health disparities in the communities WellStar serves especially
among the most vulnerable populations (low-income, uninsured,
low education attainment, elderly). Underuse denotes lack of
capacity /access and cost of the care.
Lack of Care Capacity
in Community Safety
Net Clinics
Lack of Care Capacity
in Community Safety
Net Clinics
The significant health needs related to healthy lifestyles primarily
stem from health behaviors causing chronic disease and/or
behavioral health issues. These needs require intervention
and management through clinical care, lifestyle modification
(primary prevention) and education and “prescribing resources”
(secondary prevention).
45

PRIORITY
HEALTH NEEDS
PROCESS
Focused on preventable health behaviors and access to care, priority health needs
were identified by the WellStar Community Health Collaborative task force using the
Triple Aim criteria.
Does the need:
Improve
population
health?
Enhance patient
experience/
outcomes?
Reduce
healthcare
costs?
PRIORITY HEALTH NEED
Health needs were plotted by A.L. Burruss Institute of Public Service and Research
during the Summit using a Qualtrics survey that measured the severity of need and
capacity to address the need assigned by each task force member. The health needs
with the highest need and highest capacity were identified as the priority needs.
Implementation-driven questions were considered as task force members
brainstormed actionable strategies for addressing the needs:
• How severe is the issue against benchmarks?
• Are there clear disparities/inequities?
• Are there existing assets, facilities and resources dedicated to the issue?
• Is there an opportunity to intervene at the prevention level?
• Do feasible and effective evidence-based interventions exist?
• Do we have a solution that has the potential to solve multiple problems leveraging
existing and/or potential collaborative community partners and assets?
46 2016 Community Health Needs Assessment (CHNA)

PRIORITY NEEDS
The following 2016 access to care and healthy lifestyles (for chronic disease prevention)
priority health needs, with the exception of underuse of primary care, track with the
trends and research findings in the inaugural 2013 CHNA report:
UNDERUSE OF PRIMARY CARE - ED UTILIZATION - CARE CAPACITY IN CLINICS
CANCER
CARDIOVASCULAR DISEASE
COPD & ASTHMA
OBESITY
TYPE 2 DIABETES
Community Health Needs Rated by Importance & Capacity
5
4.5
4
3.5
MEAN CAPACITY
3
2.5
2
1.5
1.5 2 2.5 3 3.5 4 4.5 5
MEAN IMPORTANCE
47

When implementing strategies to address priority health needs, many other significant
needs also will be addressed as a byproduct of meeting community benefit objectives.
Examples of intersecting needs include:
• The underuse of preventive screenings and tobacco use are actionable areas to help
reduce cancer’s prevalence (also COPD / asthma).
• Increased access to more affordable medications results from more low-income
community members receiving primary care in community clinics with
prescription assistance programs.
• Physical inactivity / poor nutrition are addressed with obesity-related, heart disease
and diabetes initiatives.
• Also, behavioral health is an integral part of all care WellStar provides – from mental
health assessments conducted in the EDs to the new oncology integrated behavioral
health services program designed to optimize management of the emotional,
behavioral, and cognitive challenges experienced by patients following cancer
diagnosis and treatment.
NEEDS NOT
ADDRESSED
Health needs not identified as priority fall into one of three categories:
1) Beyond the scope of WellStar services, e.g. dental care which is addressed by
safety nets clinics
2) Needs further intervention, but no plans for expanding current community benefit
services at this time, e.g. maternal/infant health
3) Relying on community partners with expertise to lead efforts in these areas
with WellStar in a supportive role, e.g. substance abuse, violence, suicide, STDs,
transportation
48 2016 Community Health Needs Assessment (CHNA)

If you have any additional feedback regarding the identified
and prioritized health needs, please email
chna@wellstar.org.

COMMUNITY IS

STRATEGIC
COMMUNITY
PARTNERSHIPS
Forging well-defined
collaborative
partnerships helps
build a comprehensive
low-cost health delivery
system.
Community assets are people, places, and relationships that may be used to achieve
the most equitable and optimal functioning of a community. WellStar is on a continuous
quest to transform the healthcare community’s culture of working independently
(mutual awareness) toward collaborative interdependence (partnership). It's the optimal
way to ensure WellStar, public health, governmental agencies, non-profits, community
safety net clinics, and other community stakeholders share the responsibility of care
and costs while offering access to a full continuum focused on prevention and wellness.
Access to Care
There are deficits and demands in our community for primary care, behavioral health
and specialty care/services to vulnerable populations. WellStar will help fill the gap
with the WellStar 4-1 Care Network, providing needed services and creating a conduit
for physicians and advanced practice professionals to serve community safety net
clinics to increase care capacity. Providing vulnerable community members with the
“right care at the right place” helps maximize and leverage partnerships outside of
WellStar facilities and optimize patient outcomes.
The diagram shows WellStar’s care partnerships serving the medically underserved
and uninsured populations. Through these partnerships, more community members
can be served. 71
Community Health Assets
COBB
Good Samaritan Health
Center of Cobb
Ser Famillia / SafePath
MUST Ministries
YWCA
Community Health Center
Kennestone
Community Clinic
Cobb
Community Clinic
PAULDING
Paulding Community
Health & Resource
Center
Coming Soon
WellStar
4-1 CARE
Network
CHEROKEE
Bethesda Community
Clinic
DOUGLAS
The CarePlace
51

Strengthening these partnerships creates a more comprehensive and sustainable lowcost
healthcare system. By coordinating medical services and community resources to
leverage assets and bridge care gaps, the WellStar Community Health Collaborative
can serve as an organizational launching pad for partners to meet growing and costly
healthcare needs.
To address mounting behavioral health needs in the community, the WellStar
Behavioral Health Network (WBHN) initiative was introduced in 2015. The network's
aim is to organize and coordinate a coalition of behavioral health service providers to
increase access to care for community members with mental health and substance
abuse conditions, including the most vulnerable. It also aims to reduce unnecessary
Emergency Department utilization and readmissions for those needing behavioral
health services.
Comprised of formal partnerships with the WellStar Behavioral Health Service Line 72 ,
mental health services are accessed through a centralized Behavioral Health Assessment
& Resource Center (ARC) to expedient care access and assure quality consistency in
care delivery standards. WBHN partnerships 73 will be forged to fill service gaps and
address key behavioral health needs in a manner that creates access across WellStar’s
expanding community.
Healthy Lifestyles
Community partnerships are vital to improving access to care and healthy lifestyle
interventions through public health policies, referral processes, community-based care
and services, health education programs, and other community benefit initiatives.
WellStar’s Community Education & Outreach Department is a conduit for outreach
and delivery of community benefit services to help meet priority health needs in
communities with health disparities.
Creating partnerships helps maximize collective resources to maximize community
health improvement efforts.
52 2016 Community Health Needs Assessment (CHNA)

Community Education & Outreach has forged local community partnerships for community health education,
programs and services (including screenings and immunizations): THIS MAY NOT BE AN ALL-INCLUSIVE LIST.
American Cancer Society
American Diabetes Association
American Heart Association
American Lung Association
Atlanta Blaze
Atlanta Community Food Bank
Atlanta Regional Commission
Bright Horizons Foundation
Camp Kudzu
Cherokee County School District
Cherokee Senior Services
Children’s Haven Inc.
City of Kennesaw
City of Marietta
Cobb 2020 Healthy Lifestyles Committee
Cobb County Department of Public Safety
Cobb County Safety Village
Cobb County School District
Cobb & Douglas Public Health
Cobb Master Gardeners
Cobb Senior Services
Congregations/Faith Based Organizations
Davis Direction Foundation
Douglas County School District
Douglas Senior Services
Family Life Resource Center
Family Promise of Cobb County
Georgia Faith Community Nurses Association
Georgia Healthcare Decisions
Goshen Valley Boy’s Ranch
Graduate Marietta Student Success Center
It’s the Journey
Kennesaw State University
LakePoint Sports Complex
Live Healthy Douglas
March of Dimes
Marietta City Schools
Medical Association of Georgia
MUST Ministries
Nobis Works
Osher Lifelong Learning Institute
Paulding County School District
Paulding Senior Services
Positive Athlete Georgia
Safe Kids Cobb County
Safe Kids Georgia
SafePath
Susan G. Komen Greater Atlanta
Town Center at Cobb
Wal-Mart
YWCA of Northwest Georgia
National/International Partnerships:
Safe Kids Worldwide
Spirit of Women
53

WellStar Congregational Health Network Partners
70+ congregations and faith-based organizations are conduits for community-based continuing care,
screenings and education:
Acworth United Methodist, Acworth
Allen Temple AME, Woodstock
Antioch Loving Spirit Missionary Baptist, Mableton
Bethel AME Church, Acworth
Beulah Baptist Douglasville
Bible Way Ministries International, Atlanta
Calvary Baptist Church, Austell
Calvary Christian Ministries, Powder Springs
Catholic Church of St. Ann, Marietta
Cedarcrest Church, Acworth
Christians Networking Training Center, Kennesaw
Clarkston International Bible Church, Clarkston
Cornerstone Baptist Church, Lithia Springs
Divine Order Church, Marietta
Douglasville SDA Church, Douglasville
East Cobb Church of Christ, Marietta
East Cobb United Methodist, Marietta
Ewing Road Baptist, Austell
Faith Christian Center, Smyrna
Galilee Missionary Baptist Church, Marietta
Golden Memorial United Methodist, Douglasville
Gospel Nation Christian Fellowship, Powder Springs
Grandview Seventh Day Adventist, Austell
Hickory Flat United Methodist, Canton
Highpoint Christian Tabernacle, Smyrna
Hiram Seventh Day Adventist, Hiram
Holy Family Catholic, Marietta
Holy Trinity Lutheran, Marietta
Iglesia de Dios Nueva Vida, Marietta
Judah Family Worship Center, Austell
Kennesaw United Methodist, Kennesaw
Kenyan American Community Church, Marietta
Larger Than Life Christian Ministries, Douglasville
Liberty Church , Marietta
Lithia Springs Assembly of God, Lithia Springs
Little River United Methodist , Woodstock
Mableton First Christian, Mableton
Marietta Adventist, Marietta
Marietta Christian, Marietta
Marietta First Christian (Disciples of Christ), Marietta
Mars Hill Presbyterian, Acworth
McEachern Memorial United Methodist,
Powder Springs
Mt. Zion AME, Kennesaw
New Mountain Top Baptist Church, Winston
Nurses Changing Communities, Inc., Sugar Hill
Oasis Family Life Church, Dallas
Philadelphia Seventh Day Adventist, Douglasville
Piedmont Baptist, Marietta
Pine St. Missionary Baptist Church, Marietta
Pleasant Grove Missionary Baptist, Marietta
Roswell Street Baptist, Marietta
Salem Seventh Day Adventist, Mableton
Shiloh Seventh Day Adventist, Smyrna
Smyrna First United Methodist, Smyrna
Smyrna Life Church Assembly of God, Smyrna
St. Andrew United Methodist, Marietta
St. Catherine’s Episcopal, Marietta
St. John Vianney Catholic, Lithia Springs
St. Joseph Catholic Church, Marietta
St. Mark AME, Atlanta
St. Phillip Benizi Catholic Church, Jonesboro
St. Teresa’s Episcopal, Acworth
St. Thomas the Apostle Catholic, Smyrna
StoneBridge Church, Marietta
Sweet Home Missionary Baptist, Hiram
The Pointe Church, Canton
Transfiguration Catholic, Marietta
Turner Chapel AME, Marietta
Unity North Atlanta, Marietta
Walker Tabernacle Baptist Church, Atlanta
Zion Baptist Church, Marietta
54 2016 Community Health Needs Assessment (CHNA)

OTHER
POTENTIALLY
AVAILABLE
COMMUNITY
RESOURCES
The WellStar region has a multitude of community and organizational assets
including local healthcare facilities, faith-based institutions and independent
community groups. 74 This section identifies resources that exist to provide low
or no cost care access points for the most vulnerable and provide prevention
education and health improvement services to the broader community. This list
provided by the GHPC is not all-inclusive of the myriad health assets in Georgia or
in the WellStar legacy hospitals' community nor does it capture the full scale of
ongoing and potential partnerships to meet community needs.
Documented health assets fall into three primary focus categories: healthcare,
community-focused, and education. The analysis of community assets 75 in the
WellStar service area was focused on those providing health and health-related
services. A priority is placed on representing organizations that provide services
to vulnerable populations, as well as organizations that provide free or sliding scale
services in order to better meet the identified health needs of the community.
Community assets and resources include existing health care facilities as access
is a major factor to achieving and sustaining good health. Each of the region’s
counties has within its boundaries or is proximate to the basic community assets
of schools, parks and healthcare facilities. Several areas of the region have a high
number of facilities to enhance access to care, while other areas are medically
underserved such as Bartow County.
HOSPITALS
Acute Care Hospitals in the WellStar Region
Cartersville Medical Center (HCA) Cartersville Bartow
Northside Hospital – Cherokee Canton Cherokee
WellStar Cobb Hospital Austell Cobb
WellStar Douglas Hospital Douglasville Douglas
WellStar Kennestone Hospital Marietta Cobb
WellStar Paulding Hospital Dallas Paulding
WellStar Windy Hill Hospital Marietta Cobb
Higgins General Hospital Bremen Haralson
(Tanner Health System)
Piedmont Mountainside Jasper Pickens
(Piedmont Healthcare)
55

STATE-WIDE
RESOURCES
Boys and Girls Club - Provides a structured and positive environment and
programs for young people. http://bgcncg.org/
SERVES: Bartow, Cherokee, Cobb, Douglas, Paulding
The Center for Family Resources - Works to stabilize and empower families so
they may become self-sufficient. http://thecfr.org/about-cfr/
SERVES: Cobb and Metro Atlanta
Communities in Schools - The nation’s largest dropout prevention organization
champions the connection of needed community resources with schools to help
young people successfully learn, stay in school and prepare for life.
http://www.communitiesinschools.org
SERVES: Cobb, Douglas
Georgia Family Connection - Collaborative organizations operating
independently in counties bringing community partners together to develop,
implement, and evaluate plans that address the serious challenges facing
Georgia’s children and families. http://www.gafcp.org
SERVES: All Counties
Georgia Head Start – Provides early childhood and family development services
to children from birth to five-years-old, pregnant women and families including
medical, dental, and mental health; nutrition; parent involvement and family
support. http://www.georgiaheadstart.org
SERVES: All Counties
United Way - Seeks to provide for the immediate needs of those in crisis
situations, meet long-term needs through the educational, emotional and
moral guidance of children and enable financially or physically disabled
people to become self-supporting.
Websites are regional, e.g. https://www.unitedwayatlanta.org
SERVES: Bartow
YMCA - Focuses on youth development, healthy living and social responsibility.
Website are regional, e.g. http://www.ymcaatlanta.org
SERVES: Bartow, Cherokee, Cobb
YWCA of NW Georgia - Delivers programs and services that increase the
awareness and reduce the occurrence of domestic violence and sexual assault to
victims over the age of 13. www.ywca.org
SERVES: Cobb, Cherokee, Paulding
56 2016 Community Health Needs Assessment (CHNA)

SAMPLING OF
COUNTY-
SPECIFIC
RESOURCES
BARTOW
Advocates for Children is dedicated to preventing and treating child abuse. A
national program, CASA trains volunteers to help abused and neglected children in the
juvenile court system. http://www.AdvoChild.org
Allatoona Community Action Partnership assists low income individuals and families
to acquire useful skills and knowledge, to gain new opportunities, and achieve selfsufficiency.
Programs include: adult basic education/GED assistance, job readiness
training, holistic case management, and emergency housing assistance.
http://www.tallatoonacap.org/
Allatoona Resource Center provides the residents of South Bartow with assistance
programs and educational and employment resources/opportunities. Features a gym
facility providing programs and recreation for youth.
http://www.bartowga.org/departments/social_services_indigent_care/allatoona_
resource_center/arc_links.php
Good Neighbor Homeless Shelter provides men, women, and families with temporary
shelter and physical, emotional, and spiritual support. They assist guests with
developing and prioritizing goals for their return to the community as productive
members. http://www.goodneighborshelter.org
CHEROKEE
Bethesda Community Clinic delivers healthcare to the underserved, uninsured and
underinsured populations of Cherokee County and the surrounding areas. They offer
physical exams, well-woman exams, limited dental care, acute care, chronic disease
management, diabetes education and nutrition classes, wellness coaching, prescription
assistance, and blood lab testing including STD/HIV testing.
http://www.bethesdacommunityclinic.org
Cherokee Day Training Center assists Cherokee County residents with developmental
disabilities by providing training services, recreational activities and community based
employment opportunities. http://cherokeetrainingcenter.com/
Cherokee Family Violence Center provides free services to meet the needs of victims of
domestic violence, educate stakeholders, and hold batterers accountable so victims and
the community are safe. http://cfvc.org/
Georgia Breast Cancer Coalition is a non-profit education and advocacy organization
founded by breast cancer survivors to focus the attention of Georgians on the epidemic
proportions of breast cancer. http://www.gabcc.org/
57

LEAD (Launch, Expose, Advise, Direct) provides at-risk, inner city, male youth with
access to higher education and civic engagement. Using the sport of baseball as the
motivating tool, LEAD provides young men with programming that shows them how to
be productive citizens. http://lead2legacy.org/
COBB
Anchor of Hope is a Christian organization providing financial and spiritual support,
encouragement, community resources and services to families with disabilities.
https://www.anchorofhopefoundation.com/
Adaptive Learning Center for Infants and Children, Inc. maximizes the potential of
young children with disabilities, and creates awareness and acceptance between nondisabled
people and people with disabilities. http://www.adaptivelearningcenter.org
The Adult Disability Medical Home (ADMH) is an innovative and comprehensive
program providing health and wellness to teens and adults with developmental
disabilities. http://www.adaptivelearningcenter.org
The Community Health Center (CHC) / Grassroots Dental is a nonprofit organization
whose mission is to provide quality, affordable medical and dental healthcare to the
communities in north-west metro Atlanta. http://www.chcaustell.org/
Good Samaritan Health Center of Cobb is a Federally Qualified Health Center (FQHC)
that provides a comprehensive range of medical, dental, prescription, and select social
services for patients without health insurance or the means to afford care.
http://www.goodsamcobb.org/
Cobb Community Collaborative is a membership of nonprofit organizations, local
government, businesses, faith- based organizations, educational institutions,
professional organizations, associations and citizens who share ideas, expertise and
resources to meet the needs of Cobb County. http://www.cobbcollaborative.org/
MUST Ministries cares for those in need in the Marietta, Smyrna and Canton/
Cherokee communities. http://www.mustministries.org/
58 2016 Community Health Needs Assessment (CHNA)

DOUGLAS
Good Samaritan Center of Douglas County assists needy families in the Douglasville area
with utility bills, prescriptions, food, and spiritual counsel. The Center is a food bank and
emergency assistance center for Douglas County residents.
http://www.goodsamaritancenter-douglasville.com
Douglas C.O.R.E. (Community Organizing Resources for Excellence) focuses on teen
pregnancy, physical and mental health disparities, childhood immunization, and truancy
rates. Douglas.gafcp.org/
The D.A.N.N.Y. (Developing and Nurturing Needy Youth) Center, Inc. serves as a centralized
resource for the community for both Douglas and Cobb counties to enrich the lives of
the youth in our community and serve as facilitators that provide education, career, and
recreational opportunities for all youth who can benefit from them.
http://www.dannycenter.org
PAULDING
The Paulding Community Health & Resource Center has received 501(c)(3) status and has
a working Board and Standing Committees comprised of multi-sector community leaders.
Its mission is to serve as a community wellness resource and safety net solution for those
who are underserved and most vulnerable at a centralized location. Board and committee
members represent county-specific organizations that are potential community partners.
Other potential partners were recommended by WellStar key informants and
are included in the supplemental appendices under Key Informant Input.
59

COMMUNITY IS
EMPATHY CONNECTS US.

IMPLEMENTATION
STRATEGY UPDATE
Community benefit
expansion takes
people, resources
and partners.
Areas Needing
Improvement
Phase 1 of the five-year 2013 CHNA Implementation Strategy to expand access
to care and improve healthy lifestyles through collaborative partnerships and via
existing and proposed WellStar facilities, providers, resources, and programs is still
underway with a more targeted approach to delivering community benefit services.
Since 2013, WellStar audited its delivery of essential prevention, education and
wellness programs and adapted to changes in regulations, laws and technology
to meet the demands of our growing population. With the addition of community
benefit liaisons appointed by the hospital presidents, each facility is able to measure
its specific community benefit services not captured at a System level.
Phase II’s stated goal has shifted. In lieu of creating an independent non-profit,
WellStar is developing defined, outcomes-driven partnerships with community
safety net clinics and other non-profit organizations to provide more affordable
and accessible care to the most vulnerable. These WellStar Community Health
Collaborative’s Partners in Health also will share responsibility for the health of the
community by promoting healthy lifestyles focused on the priority health needs.
No public comments were received after publication of the 2013 CHNA report
although feedback was received that the report was reviewed and data was utilized
by other health-related organizations. As soliciting public input was part of the
final CHNA requirements (December 2015), an email for feedback is now available:
chna@wellstar.org.
Continued process improvements are needed to better track, measure and report
community benefit services, exclusive of indigent, charity and unreimbursed care,
for evaluation purposes and to better tell our story 76 .
Evaluation of community benefit services is an area of improvement for WellStar as
much Phase 1 work was focused on auditing services and building an infrastructure
for accountability and realignment. Baseline data and outputs to assist in stating
the anticipated impact of implementation strategies is a necessity. Processes
are either in place or being developed for these evaluation methods in the 2016
Implementation Strategy.
A more precise shift and allocation of resources to better align services and
education with prioritized health needs and in areas with health disparities also is
needed. This will be done in strategic collaboration with WellStar's new community
benefit services programs and community assets already serving to bridge health
disparity gaps through initiatives and outreach.
Evaluation of Impact: Tracking WellStar’s Progress
61

TRACKING
COMMUNITY
BENEFIT
SERVICES
COMMUNITY
HEALTH IM-
PROVEMENT
SERVICES
COMMUNITY
HEALTH
IMPROVEMENT
SERVICES
The initiatives outlined in the 2013 Implementation Strategy were organized
using community benefit categories outlined by the Catholic Health Association 77
and tracked by the community benefit software, CBISA. The stated 2013 goals
were to improve access to care to vulnerable populations and promote healthy
lifestyles via preventive care, programs and activities. The categories now highlight
progress in the delivery of community benefit services and initiatives underway.
This is not an all-inclusive list of the community benefit services provided System-wide
or by the hospitals. Also, WellStar discloses that some of the stated 2013 initiatives were
not implemented or fully implemented due to either its ongoing, five-year approach to
the 2013 implementation plan, competing priorities, or limited staffing / resources.
COMMUNITY HEALTH EDUCATION:
WellStar’s aim to promote healthy lifestyles via preventive care, programs and activities
is primarily accomplished through the education and clinical services categories.
• Community Education & Outreach intersected with the lives of more than 153,000
people in FY2015 providing education, screenings and services.
• More than 15,000 free health screenings via Community Education & Outreach
health fairs and events in FY2015 at congregations, workplaces, civic organizations,
and community events provided opportunity for education and follow-up care
with those with identified health risks. Screenings/services provided:
• Blood pressure
• Glucose
• Total cholesterol
• Weight assessment
• Bone density
• Flu shots
2013 Implementation Strategy Goal: Improve prevention-focused education
resources and the referral process to free or reduced cost healthcare clinics for
continuity of care. Still in progress.
3
• 2,800 school-based health programs provided education to more than 62,000
students in Cherokee, Cobb, Douglas, and Paulding counties on nutrition, safety,
personal hygiene, and physical activity.
• Child injury programs reached more than 17,000 children and parents through
partnership with Safe Kids Cobb County in FY2015.
62 2016 Community Health Needs Assessment (CHNA)

• Health information and educational opportunities are communicated to more than
13,000 community subscribers of demographic and disease-specific e-newsletters.
• Women’s health education is prevalent in the WellStar community via Spirit of
Women 78 /Speaking about Wellness for Women outreach. 2016 marks the 10th
anniversary of the women-centered programming, including a robust speaker series,
free health screenings, national signature events, and a health and wellness eNewsletter.
• Healthy aging is promoted by The Good Life Club to more than 4,000 seniors in the
community including Speaking about Wellness for Healthy Aging and via community
partnerships.
• The Population Health Management team collaborates with Cobb Senior Services to
help enroll patients in Cobb Senior Center programs, volunteers in outreach projects
and provides education and screenings. Also, to bridge care access gaps in the senior
population, the outpatient case management team engages with patients in the
community and works with other community agencies to find resources to help
with mental health, medication assistance, transportation, meals at home and other
needs that are identified. The case managers work in a geographically aligned model
with physicians to support the senior patients in all aspects of their care.
• Worksite wellness program aligns with the Affordable Care Act's national public
health strategy to help address the prevalence of chronic disease in the workplace.
COMMUNITY-BASED CLINICAL SERVICES:
These are health services and screenings, provided on a one-time basis or as a special
event in the community, to meet identified health needs.
• Wellness and health promotion programs (self-help groups) abound for the community
creating a supportive network of preventive care. Support groups are available for heart
health, stroke, diabetes, COPD, weight management, nutrition, and cancer survivors
and caregivers.
• Clinical engagement in tobacco cessation and prevention education is underway.
Providers and case managers at multiple WellStar locations are undergoing smoking
cessation training in partnership with Pfizer utilizing its “Advise to Quit” curriculum. In
the community, WellStar participated in the American Lung Association’s state-wide
“Nobody Quits Like Georgia” campaign.
2013 Implementation Strategy Goal: Increase cancer prevention and education
community outreach (including smoking cessation program) utilizing the WellStar Cancer
Program team.
3
63

• To address mental health issues and substance abuse, WellStar is developing
the WellStar Behavioral Health Network, a coalition of behavioral health service
providers/partnerships to increase access to care for community members, including
the most vulnerable. The network will expand WellStar’s capacity with referrals to
partnering agency mental health providers, resources and education via the telesite
Behavioral Health Assessment & Resource Center (ARC).
2013 Implementation Strategy Goal: Develop a more collaborative delivery
system for behavioral health services/resources though partnerships.
3
• To expedite examinations and assessments of alleged child abuse, WellStar has
embedded a nurse practitioner at Cobb County’s SafePath Children’s Advocacy Center.
• Primary care delivered by WellStar Community Clinics on the Cobb and Kennestone
hospital campuses helps reduce hospital Emergency Department visits and hospital
admissions among low-income, uninsured patients needing non-emergent care.
• Endorsed by the Lung Cancer Alliance as a Screening Center of Excellence, 79 lung
cancer screenings are provided to low-income, high-risks patients in needs via the
WellStar Foundation at nine WellStar imaging centers.
• Grant-funded vouchers from community partners provide free mammogram
screenings to women in need. Partners include the Susan B. Komen Atlanta Chapter,
East/West Church in Austell, Biker’s Battling Breast Cancer, It’s the Journey, National
Breast Cancer Foundation, and generous gifts from WellStar team members through
the WellStar Foundation.
2013 Implementation Strategy Goal: Expand free health screenings to the
underinsured and uninsured through WellStar Community Education & Outreach.
3
• The impact of WellStar Community Clinics' (Cobb and Kennestone outpatient
service) referrals from the Emergency Departments (ED) is a more than 50 percent
reduction in ED visits and a 40 percent reduction in hospital admissions.
2013 Implementation Strategy Goal: Reduce preventable hospital admissions,
readmissions and Emergency Department visits by redirecting care to community
clinics and primary care via the hospital-based care management program.
3
64 2016 Community Health Needs Assessment (CHNA)

• Partnerships with community safety net clinics that provide free or low cost health care
to the medically underserved and uninsured 80 receive support via free or reduced costs
labs and radiology services and limited specialist care. Revised collaboration agreements
are in effect to better track and measure outcomes of patients served and referred by
WellStar to partnering clinics.
2013 Implementation Strategy Goal: Strengthen collaborative partnerships with
community stakeholders to increase access to preventative and primary care,
improve quality and reduce cost.
3
• The new 4-1 Care Network will leverage the expertise and skill of WMG providers as
care partners in community safety net clinics.
2013 Implementation Strategy Goal: Increase the number of hospital-affiliated / WMG
providers and specialists providing free or reduced cost healthcare.
3
HEALTHCARE SUPPORT SERVICES:
Provided to increase access and quality of care to individuals, especially those in vulnerable
populations.
• WellStar’s Accountable Care Organization (ACO) ranks in the nation’s Top 10 as a
pioneer in managing the care and improving the clinical outcomes of its aging Medicare
community of more than 65,000 people. A focus on prevention and chronic disease
management decreases costs and improves health and quality of life.
2013 Implementation Strategy Goal: Provide community benefit leadership/consultation
for the prevention and management of diabetes, cancer and cardiovascular disease.
3
• Established in 2016 to meet the multi-faceted needs of high-risk Medicare and other
community members with chronic disease, the Comprehensive Care Clinic provides
fully-integrated care featuring self-help programs and clinical management to help
reduce ED utilization and preventable hospital admissions.
• Hospital-based care coordinators have increased the number of referrals of frequent
Emergency Department visitors with chronic disease to outpatient community clinics
to receive needed primary care services and management. This is an area of needed
process improvement.
2013 Implementation Strategy Goal: Reduce preventable hospital admissions,
readmissions and Emergency Department visits by redirecting care to community clinics
and primary care via the hospital-based care management program.
3
65

• The “Green Belt Project” has boosted hospital, WMG referrals and community clinic
referrals for outpatient Diabetes Self-Management Education (DSME). DSME is
available at no cost to patients below 125 percent FPL, those considered indigent, and
at a reduced cost to patients qualifying for Community Financial Assistance.
2013 Implementation Strategy Goal: Expand the accessibility to hospital inpatient
and outpatient Diabetes Self-Management Education and services to the medically
underserved and uninsured.
3
• The WellStar Congregational Health Network’s upcoming pilot program at WellStar
Paulding Hospital will take patient care beyond routine discharge planning. Adaptation
of the MEMPHIS Model for better health navigation and care transitions from hospital
to home will assist patients to better manage chronic disease and, as a result, decrease
hospital readmissions. The model builds congregational health ministries and trains
liaisons to help with education, prevention and continuum of care post-discharge.
2013 Implementation Strategy Goal: Engage faith-based organizations in coordination
and provision of care (MEMPHIS Model).
• To help eliminate language barriers in the EDs, medical interpreters are onsite to help
the Latino population communicate with care providers.
• Expanding low-cost medication access through centralized reduced cost Pharmaceutical
Patient Access Programs (PAP) and the Federal 340B Drug discount Program 81 are under
evaluation. Currently, there are no structured PAPs at the hospitals, but Paulding is
looking into a discount card program in the ED to reduce costs to the patients and the
health system. Vouchers are used in the WellStar retail pharmacies to reduce drug cost
for certain brand medications.
2013 Implementation Strategy Goal: Improve medication access through centralized
reduced cost Pharmaceutical Patient Access Programs and the Federal 340B Drug Pricing
Program for the management of chronic disease and to reduce complications.
• 770-956-STAR provides referrals to community services and registration for free or
low-cost community health education programming.
• WellStar Cardiovascular Medicine (CVM) wellness coaches are available in the CVM
practices to offer mentoring, risk modification strategies and navigate patients to other
heart health services.
• The WellStar Cardiac Network’s outpatient diagnostic team at WellStar Kennestone
Hospital provides free heart screenings at the start of each semester for Kennesaw
State University athletes using the American Heart Association’s 14-element checklist to
determine if an athlete has a higher risk of sudden cardiac death. All incoming student
athletes receive an electrocardiogram or echocardiogram read by a cardiologist as part
of their physical. This provides an extra layer of safety for the student athletes.
3
3
66 2016 Community Health Needs Assessment (CHNA)

• Recognized as a Certified Advanced Comprehensive Stroke Center by The Joint
Commission in February 2015, WellStar Kennestone Hospital meets the highest
standards for treating the most complex stroke cases with advanced imaging,
staff capability and the presence of neuro-trained intensive care unit. WellStar’s
commitment to treating stroke is evident by the recent addition of WMG Neuroscience.
• WellStar Connect, the Epic electronic health record, is implemented across the
entire System and community clinics for integrated, seamless and safe patient
care. Its Open Notes functionality shares outpatient provider notes with patients
who have activated a MyChart account (patient portal). WMG’s participation in
this important and innovative step makes WellStar the first and only organization
in Georgia to bring patients the benefit of online access to provider notes.
HEALTH
PROFESSIONS
EDUCATION
• Groundwork is set for the accredited Graduate Medical Education (GME) Residency
Program to launch in 2017 82 . The GME program will provide evidence-based training
programs in internal medicine, emergency medicine, OB/GYN, family medicine, and
general surgery. The GME program undergirds WellStar’s commitment to improve
access to family-centered, prevention-focused care and protect the health status
of the community WellStar serves by helping ensure top medical talent stays in
the community. Medical residents will provide primary care support in outpatient
community clinics to expand low-cost care capacity.
2013 Implementation Strategy Goal: Increase the number of hospital-affiliated
/ WMG providers and specialists providing free or reduced cost healthcare
and clinics via a Graduate Medical Education program. Upcoming.
3
• Each year, WellStar’s number of academic partnerships continues to grow. Currently,
165 partnerships exist to help mentor, train and provide more than 1,850 clinical
rotations to medical students, undergraduate nursing students, allied health
students, graduate nursing students, physician assistants, anesthesia assistants,
graduate pharmacy students, and others including observers.
• Pediatric care is a top priority with WellStar hosting national and state American
Academy of Pediatrics leaders and pediatricians across Georgia in a quality
improvement initiative training to improve ADHD diagnosis and treatment
processes (January 2016).
SUBSIDIZED HEALTH
SERVICES
Evaluate hospital-based subsidized health services to more effectively and efficiently
allocate assets addressing prioritized health needs of the medically underserved and
uninsured.
• Since the last CHNA, subsidized health services investments have leaped $8.7
million totaling more than $10.6 million in uncompensated cost in FY 2015 primarily
attributed to assisting elderly community members living in skilled nursing facilities
and the expansion in hospice services.
67

• Women’s Health and Specialty Services at WellStar Kennestone Hospital provides
complimentary new mom coaching and education and helps navigate Medicaid
moms to needed resources.
• In 2016, all the hospitals and outpatient hospital facilities, including Cobb and
Kennestone hospitals’ community clinics for the medically underserved and/
or uninsured, expanded Community Financial Assistance (CFA) 83 eligibility
requirements to 300 percent FPL. This adjustment helps broaden access to primary
care to low-income community members.
RESEARCH
• With the largest research staff of any Georgia community cancer program and the
highest clinical trial participation rate in the state, the WellStar Cancer Network
offers advanced education to reduce cancer risk by promoting early detection.
Clinical trials for many cancer types are offered through the network’s partnering
practice, Northwest Georgia Oncology Centers. 84
2013 Implementation Strategy Goal: Increase cancer prevention and education
community outreach (including smoking cessation program) utilizing the WellStar
Cancer Network team.
3
• The WellStar Research Institute conducts research targeting community health
needs for patient care innovation and safety. Current studies focus on priority health
needs of cardiovascular conditions, COPD/asthma and stroke to promote optimal
clinical outcomes and ensure the highest standard of care for the community.
• Since 2013, investigators from the WellStar Center for Nursing Excellence have
completed more than 20 nursing research studies, many of which have been
published, to improve the practice environment and to deliver the highest
standards of nursing care to patients.
CASH & IN-KIND
CONTRIBUTIONS
• To better define a process for partnerships (community benefit) and sponsorships
(marketing), requests are formally vetted via an online application process with
prioritized community health needs objectives as the bellwether. Contributions
are given as part of existing relationships, but the majority of granted requests now
are a result of prioritized health needs. Current partnerships focus on a variety of
health issues aimed at improving the health of the community.
• Contributions to the WellStar Foundation are invested in vital community services
including health screenings, education, safety programs for children and adults in
addition to funding advancements in healthcare in the EDs and in cardiac, diabetes
and cancer research arenas. WellStar Kennestone Cancer Center’s Survivorship and
Support Services was newly renovated through a generous gift from the Foundation.
It features a wellness kitchen for nutrition education, a chapel and a Patient Resource
Center, the nation’s first IT collaboration with the American Cancer Society to provide
access to web-based cancer information resources for the community.
68 2016 Community Health Needs Assessment (CHNA)

COMMUNITY
BUILDING
ACTIVITIES
• Participation in multiple coalitions in task-specific projects 85 addressing health needs
is an important part of WellStar’s People-Citizenship initiative. It encourages and
recognizes team leaders’ community service and support to organizations focusing on
skyrocketing needs such as:
• Opioids / heroin use (Davis Direction Foundation)
• Economic development (Cobb Chamber of Commerce)
• Live Well, Marietta partnership between WellStar Kennestone Hospital and the City
of Marietta strengthens the health and wellness of residents via health resources and
information focused on women’s and men’s health, diabetes, nutrition, cancer, and heart
health at the monthly Marietta Square Farmer’s Market
• Environmental improvements (Green Prints Trail at Woodstock Elementary and Bright
Space build out with CASA 86 )
• YWCA – provision of clinical care for victims of sexual assault/domestic violence
• Community support for Goshen Valley Boys Ranch in Cherokee
• SafePath - helps children who are victims of sexual assault
• Kennesaw State University’s Project IDEAL helps train WellStar Promotores to educate
the Hispanic population with diabetes prevention, management and support
• Advocacy for community health improvement and safety (i.e. Cobb & Douglas Public
Health’s Cobb2020 Partnership, 87 Live Healthy Douglas, Fit City Kennesaw, Cobb County
Senior Services’ Health and Wellness Advisory Committee, Safe Kids Cobb County, and
Cobb County Safety Village)
2013 Implementation Strategy Goal: Collaborate with Cobb2020 Healthy Lifestyles
initiatives.
3
• WellStar team members participate in health-related community fundraising and
awareness events during work hours tallying hundreds of coordination hours for events
such as The Heart Association’s Heart Walk, the Atlanta Cancer Society’s Relay for Life
and the March of Dimes’ March for Babies.
COMMUNITY
BENEFIT
OPERATIONS
Community benefit operations include costs associated with assigned staff and
community health needs and/or assets assessment, as well as other costs associated
with community benefit strategy and operations.
• The WellStar Community Health Collaborative was established to lead community
and clinical engagement in community benefit strategy and operations to address
prioritized health needs. Overseen by the executive leadership of Strategic Community
Development and Population Health Management.
69

Tracking Hospital-Specific Progress
via a Graduate
Medical Educaon
(GME) program
In progress, part
of new 4-1 Care
Network.
Referrals made to
current capacity
for WellStar
clinics at Cobb and
Kennestone.
Developing a
WellStar
Behavioral
Health
Network
Process and
partnerships for
more same day
referrals in
progress with
community clinics.
Improvements
underway for
resources and
referrals
to community
safety net clinics
for connuity
of care.
Program (2017)
will expand
low-cost
primary care
and OB/GYN
access

on 2013 Implementation Strategy
Led by Community Educaon
& Outreach and WellStar
Paulding Hospital.
Realigning health-needs specific
education to high-need areas via
Live Well, a new community benefit
services program.
In progress ulizing WellStar Cancer
Network and hospital-based outpaent
imaging centers and via Live Well
(cancer prevenon and screening).

REPORT
REFERENCES

COMMUNITY IS CARE 6
1 The WellStar Community Health Collaborative is the name of WellStar’s Community Benefit Department (co-led by executive
leadership of Strategic Community Development and Population Health Management) and its official Partners in Health who
have agreed to collaborate and share responsibility to address community health needs. Its mission is to create innovative,
low-cost ways to address health needs of vulnerable populations and to improve overall community health through communitybased
outreach, education and preventive health services.
2 More specifically, community benefit is a clinical or non-clinical program, service or activity with a low or negative margin
that would likely be discontinued if the decision were made on a purely financial basis that is: (1) Responsive to identified
health needs (access to care / healthy lifestyles). (2) Focused on people who are impoverished, elderly, disenfranchised and/
or located in an area with disproportionate unmet health-related needs. (3) Integrated into WellStar’s strategic planning and
budgeting process to increase access to care while lowering costs through preventative programming and services. (4) Planned
and implemented with program objectives and measurable outcomes that are beneficial to community stakeholders and the
community as a whole.
3 Conducting a Community Health Needs Assessment (CHNA) is a federal tax law requirement in section 501(r) of the Internal
Revenue Code for non-profit hospitals to maintain tax-exempt 501 (c)(3) status. The requirement was added by the Patient
Protection and Affordable Care Art (ACA) enacted on March 23, 2010 in Section 9007. Community benefit reporting for
WellStar’s not-for-profit hospitals is required via Form 990, Schedule H. Under the ACA, hospitals are required to conduct
community health needs assessments every three years and implement strategies to address those needs.
4 ACA “…legislation contains numerous provisions aimed at improving community health through direct investments in
wellness and prevention at the individual and community levels and by making population health improvement an integral
part of efforts to improve the quality and efficiency of healthcare.” From “Principles to Consider for the Implementation of
the Community Health Needs Assessment Process, June 2013, Sara Rosenblum, Department of Health Policy, The George
Washington University School of Public Health Services.
5 The IHI Triple Aim framework was developed by the Institute for Healthcare Improvement (www.ihi.org) and often functions
as a statement of purpose for healthcare system transformation that will better meet the needs of people and patients. Its
successful implementation results in fundamentally new systems contributing to the overall population health while reducing
the cost to society.
6 Patient experience encompasses the following Institute of Medicine dimensions: safe, effective, patient-centered, timely,
efficient, and equitable.
7 “True Triple Aim improvement cannot be realized by healthcare systems acting alone, or by solely delivering high-quality
care at lower costs. Improving health is a challenge that requires the engagement of partners across the community to address
the broader determinants of health.” IHI Leadership Blog, “A Primer for Defining the Triple Aim,” Sept. 23, 2015.
8 Process informed by the Catholic Health Association, the Georgia Department of Public Health (Chronic Disease University
PowerPoint, August 13, 2015, presented by Melissa Kinkoph, MPH, CHES, Program Manager, Healthy Communities) and valued
input by the Cobb & Douglas Public Health’s Department of Epidemiology.
9 WellStar joined forces with Kaiser Permanente, Grady Health System and Piedmont Healthcare to leverage the Georgia
Health Policy Center’s CHNA research conducted for Kaiser’s 32-county service area footprint. Targeted data reports were
provided for the shared counties served.
10 Hospital facility census as of December 2015 at the close of CHNA research.
11 As an integrated health system, the majority of WellStar’s community benefit services is managed and delivered System-wide
by WellStar Community Health Collaborative’s community engagement arm, Community Education & Outreach. WellStar’s
service area is deemed one community for this joint CHNA as hospital catchment areas overlap within the five-county primary
service area and identified health needs are the same or similar.
12 http://burruss.kennesaw.edu/about-institute.php
13 www.countyhealthrankings.org – Health Outcomes based on length and quality of life out of 159 Georgia counties.
14 Income inequality gaps are growing in the United States. Despite advances in medicine and education, the difference in
life span after age 50 between richest and poorest has more than doubled since the 1970s with smoking, the single biggest
cause of preventable death, helping to drive the disparity. Obesity is more ambiguous with the gap narrowing according to the
National Academy of Sciences from 1990 to 2010 from 37 percent among the poorest to 31 percent among those on the higher
end of the income ladder. Excerpts from The New York Times, “Disparity in Life Spans of the Rich and the Poor Is Growing,”
Sabrina Tavernise, Feb. 12, 2016.
15 Signifies limited access to healthy foods.
16 Chronic diseases—such as asthma, cancer, diabetes and heart disease—cost Georgia approximately $40 billion dollars each
year, keep kids out of school, cost Georgia employers, and results in more than 200,000 thousands of years of life lost. https://
dph.georgia.gov/chronic-disease-prevention
REPORT REFERENCES
73

COMMUNITY IS CARE
17 www.countyhealthrankings.org averaged data, 2016
18 The public health system includes government and public health agencies, public sector agencies (schools, Medicaid) and
private sector organizations whose actions have significant consequences for the health of the population.
19 Other considerations: (1) The burden, scope, severity, and urgency of the need. (2) The estimated feasibility and effectiveness
of possible interventions. (3) Health disparities associated with the need or the importance the community places on addressing
the need.
20 Healthy lifestyle needs primarily stem from unhealthy behaviors, which can lead to chronic disease. “High-cost patients are
twice as likely as the rest of the population to have a chronic condition and four times as likely to have two or more chronic
illnesses. In 2012, the top five most costly medical conditions in terms of healthcare expenditures were heart disease, traumarelated
disorders, cancer, mental disorders, and COPD/asthma.” Excerpts from the Huffington Post blog post, “Healing the Sickest
Patients: How ‘Hot Spotters,’ ‘Frequent Fliers,’ and ‘Super-Utilizers’ Impact Health Care in America” - August 18, 2015.
21 Taken from the Institute of Medicine’s “Primary Care and Public Health” (Washington, D.C., 2012) p. S-1.
22 “While the primary goal of the health system is improving health, another important goal is ensuring responsiveness to the
legitimate expectations of the population.” (World Health Organization) This can be achieved with the help and expertise of the
Public Health System as a whole and through formalized strategic community partners.
23 “Government and private insurers are increasingly emphasizing quality of care in reimbursements, instead of just paying for
the quantity of services delivered.” Excerpt from “Broader strategy: From local hospitals to regional players,” Georgia Health
News, Dec. 10, 2015.
24 From the 2013 Implementation Strategy Report: “To implement a five-year, two-phased Community Benefit program that
is sustainable and strategically aligned with the WellStar Health System mission and vision to address the prioritized health
needs of the uninsured and low-income populations. This is accomplished through expanding provider participation, education,
outreach and prevention activities/programs to promote healthy lifestyles and access to care (Phase 1: 2013-2015) and creating
a collaborative safety net organization for shared accountability to leverage and maximize complementary skills and capacity
building (Phase 2: 2015-2018).”
25 Expected rollout of the WellStar 4-1 Care Network is the fall of 2016. The network relies on WMG physicians and advanced
practitioners to help build care capacity in partnering community clinics. The name reflects the goal to treat and prescribe
resources one person at a time to improve primary care access to the most vulnerable.
26 WellStar’s Center of Health Transformation is the catalyst for developing pathways for improving patient safety, care efficiency
and technology by bringing together not-for-profit health systems, universities and technology organizations to develop real-world
health solutions through collaboration, research and innovation. It also serves as an incubator for promising new solutions to
medical challenges in Northwest Georgia and beyond.
COMMUNITY IS COMMITMENT 16
27 An example is WellStar’s Center for Health Transformation builds a collaborative network of start-up tech, higher education and
research institutes to develop new, innovative solutions to improve care delivery and lower costs.
28 An integrated healthcare delivery system is not just comprised of acute care hospitals. WellStar provides access to comprehensive
rehabilitation, education, outpatient services, and post-acute services to its patients.
29 Since the inception of WellStar’s ACO in July 2012, providing better care at a lower cost has saved more than $37 million.
30 These IRS defined community benefit categories are exclusive of uncompensated indigent care, charity care and bad debt.
31 Federal poverty level is a measure of income level issued annually by the Department of Health and Human Services. FPLs are
used to determine eligibility for certain programs and benefits.https://dch.georgia.gov/sites/dch.georgia.gov/files/related_files/
document/2015_Federal_Poverty_Guidelines.pdf
32 Guided by government policy, indigent care is care provided to those who do not have insurance and are not eligible for other
healthcare coverage such as Medicare or Medicaid. Charity care is guided by hospital policy and is care provided for free or
reduced prices to low-income patients. Community Financial Assistance (CFA) is available for qualifying community members.
33 The reduction reflects the full implementation of the propensity to pay system which automatically identifies indigent patients
and classifies them as charity without waiting for the completion of the CFA process.
34 Memorandums of Understanding (MOUs) are in effect with community safety net clinics to help serve the uninsured,
underserved and most vulnerable populations to improve community health. The MOUs are being reviewed and revised as part of
the WellStar Community Health Collaborative.
35 U.S. Census Bureau, 2014. Note population totals don’t align with the county profile data generated by the Georgia Health
Policy Center who used 2010-2013 data.
74 2016 Community Health Needs Assessment (CHNA)

36 County Health Rankings, 2016
37 U.S. Census Bureau, American Fact Finder. 2010-2014 American Community Survey 5-year estimates. www.factfinder.census.gov.
38 U.S. Census Bureau American Fact Finder, 2010-2014 American Community Survey- 5-year estimates. www.factfinder.census.gov
39 Excerpt from “Georgia’s Low Health Ranking Sinks Even Lower,“ Georgia Health News, Dec. 9, 2015, Andy Miller
40 Hospital community demographic data based on 90 percent hospital catchment areas and 2016 estimates from The Nielsen
Company, Pop-Facts Demographics, generated on 2/5/16 by WellStar Strategic Planning.
41 In addition to providing means for purchasing healthcare, higher incomes can provide better nutrition, housing, schooling, and
recreation. Independent of actual income levels, the distribution of income within countries and states has been linked to rates
of mortality.
42 “To the extent that education is key to health inequality, policies encouraging more years of schooling and supporting early
childhood education may have health benefits. When policymakers debate the merits of increasing access to education, they
rarely consider improvements in the health of the population. Other virtues—increasing human capital, boosting productivity,
augmenting lifetime earnings, and improving the socialization of the next generation—follow from improvements in educational
attainment as in others, collateral benefits such as decreasing health care costs also might emerge from increased investment
in education.” Socioeconomic Disparities In Health: Pathways and Policies, Health Affairs blog. http://content.healthaffairs.org/
content/21/2/60.full
43 County Health Rankings, 2016
44 County Health Rankings, 2016
45 The county’s health outcomes ranking is where it ranks overall among Georgia’s 159 counties as measured by how long people
live and how healthy people feel while alive. www.countyhealthrankings.org NOTE: Because ranks are relative, they aren’t as
helpful in isolation – a county’s rank depends not only on what is happening in the county, but also on what happens in all the
other counties in Georgia. In fact, if every county improved its health equally, the ranks would all stay the same. These ranks inform
the county’s progress measurement, not drive it.
46 All health factor statistics from County Health Rankings, 2016.
47 Percentage of adults that report a Body Mass Index (BMI) of 30 or more signifying obesity.
48 Primary Care Physicians and Mental Health Providers is the ratio of the population to total primary care physicians. For primary
care, the top US performers are 1,045:1 (90th percentile) and mental health is 385:1 (90th percentile).
49 Severe Housing Problems is the percentage of households with at least one or more of the following housing problems:
(1) housing unit lacks complete kitchen facilities, (2) housing unit lacks complete plumbing facilities, (3) household is severely
overcrowded; and (4) household is severely cost burdened. County Health Rankings and Roadmaps used the U.S. Department of
Housing Development (HUD) which periodically receives “custom tabulations” of data from the U.S. Census Bureau that are largely
not available through standard Census products. This data, known as the “CHAS” data (Comprehensive Housing Affordability
Strategy), demonstrates the extent of housing problems and housing needs, particularly for low income households.
50 Georgia Department of Public Health, OASIS – Age-Adjusted Death Rate, Last 5-Year Aggregate, 2010-2014 CHNA Dashboard.
A remarkable finding since the 2013 CHNA is the upward move of mental and behavioral disorders in the top five leading causes
of death reflecting the disparity in all counties served.
51 County health status summary sources: Community Commons CHNA Portal, County Health Rankings and Roadmaps, U.S.
Census Bureau - American Community Survey 5-Year Dataset, Georgia Department of Public Health Online Analytical Statistical
Information System (OASIS), and Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD,
and TB Prevention (NCHHSTP): www.cdc.gov/NCHHSTP/Atlas/
COMMUNITY IS CONTRIBUTION 32
52 For this report, the Cobb & Douglas Public Health’s Community Health Assessment did not align with WellStar’s CHNA timeline,
so the resources and funding previously procured for the 2013 CHNA were not available for this health needs assessment cycle.
An initial meeting in July 2015 with Cobb Douglas Public Health’s Epidemiology helped to define data sources and methodology
53 https://www.healthypeople.gov/
54 GHPC provides evidence-based research, program development and policy guidance locally, statewide, and nationally to
improve communities’ health status.
55 A total of 172 WellStar Medical Group representatives engaged with the survey – 73 of which partially completed the tool and
are not represented in the results in the supplemental appendices.
56 A total of 559 community members engaged with the survey - 112 of which partially completed the tool and are not represented
in the results in the supplemental appendices.
57 Ser Familia is a social services community organization that gives Latino youth, couples, parents and families the tools they
need for successful daily living through better relationships, leadership and life/communication skills to become emotionally
strong and healthy.
75

58 A listening session was conducted at the Paulding Health Department as there currently is no operating safety net clinic in
Paulding County.
59 http://www.cdc.gov/chinav/tools/index.html and Database of Interventions: http://wwwn.cdc.gov/chidatabase
60 Some data from the 2013 CHNA cannot be compared to the 2015 data as the BRFSS telephone survey has been traditionally
done with people using land lines. An increasing number of people are only using cell/mobile phones. CDC recognized the need
to include cell phone users in the survey in order to obtain data that better represents the diverse populations. Since the way
information is gathered and processed, new data cannot be accurately compared to previous findings.
http://www.cdc.gov/surveillancepractice/reports/brfss/brfss.html
61 http://www.varpguide.com/
62 Over a two-month period in the fall of 2015, the GHPC compiled service-area data including demographics, socioeconomic
factors, health behaviors, health outcomes, workforce adequacy and assets. The latest U.S. Census data (2010-2014) was not yet
released.
63 www.chna.org
64 www.oasis.state.ga.us
65 www.census.gov
COMMUNITY IS CONNECTION 38
66 Federal regulations emphasize involvement by people who represent the “broad interests” of the communities served by
nonprofit hospitals, including people with “special knowledge of or expertise in public health.” 78 Fed Reg at 20541 (to be codified
at 26 CFR 1:501(r)-3(b)(5)).
67 WellStar solicited more county-specific sources than noted for input. Representatives either didn’t respond to the inquiry,
failed to fulfill to provide the requested information or declined due to competing priorities.
68 The Cobb2020 Partnership is a partnership of community organizations and individuals dedicated to promoting healthy
lifestyles and the delivery of essential health services in Cobb County.
COMMUNITY IS COMPASSION 42
69 An August 2015 report by the National Association of Insurance Commissioners found that Georgia had the highest percentage
of “narrow” insurance networks (limited choice of doctors) in the 2014 health exchanges. “State senator expects legislation on
insurance reform,” Georgia Health News, 12/15/15.
70 Determinants of Health: (1) Biology and genetics. (2) Individual behavior. Examples: alcohol use, injection drug use (needles),
unprotected sex, and smoking (3) Social environment. Examples: discrimination, income, and gender (4) Physical environment.
Examples: where a person lives and crowding conditions (5) Health services. Examples: Access to quality health care and having
or not having health insurance
COMMUNITY IS COLLABORATION 50
71 Revised Memorandums of Understandings were implemented in 2016 to provide more definitive processes to help refer
patients, build capacity and measure/track outcomes. These partnerships help WellStar meet the primary care needs of the
medically underserved and uninsured who qualify for WellStar’s Community Financial Assistance (indigent care

COMMUNITY IS CHANGE 60
76 Better storytelling focuses not only on the patient experience but also on compelling stories of the heroes of health in our
community.
77 WellStar uses the Catholic Health Association’s categories of community benefit which tracks with the reporting software CBISA.
https://www.chausa.org/docs/default-source/community-benefit-guide-2015/2015-cb-guide-categories-definitions.pdf?sfvrsn=4
78 WellStar is a member of Spirit of Women, an elite coalition of hospitals and healthcare providers across the United States that
ascribe to the highest standards of excellence in women’s health education and community outreach.
79 WellStar is endorsed by the Lung Cancer Alliance as a Screening Center of Excellence because it’s committed to the principles
identified in the National Framework. The Framework was modeled after the WellStar lung cancer screening program and is now
used as the standard for screening centers across the country. http://www.lungcanceralliance.org/am-i-at-risk/national-frameworkfor-lung-screening-excellence.html.
East Cobb Health Park and Douglas Imaging Center have received Lung Cancer Screening Center
accreditation from the American College of Radiology.
80 This also addresses the 2013 Implementation Strategy to Participate as a Cobb Access Health integrator/partner to build a
low-income healthcare delivery system in Cobb County. The proposed non-profit organization, Cobb Access Health, is not being
pursued. Instead, WellStar has formalized its community benefit services by creating a department, the WellStar Community Health
Collaborative, and is improving access to care via partnerships with community safety net clinics and other non-profit organizations.
81 The federal government’s 340B Drug Discount Card enables eligible healthcare organizations/covered entities to provide
medications at significantly reduced prices through participating retail locations.
82 http://gme.wellstar.org/
83 Also known as a Financial Assistance Policy or FAP.
84 www.ngoc.com
85 This is not an all-inclusive list.
86 In collaboration with Bright Horizons Foundation for Children, the Bright Space was created for children with open abuse and
neglect cases through CASA - Court Appointed Special Advocates for Children In Canton (Cherokee County).
87 Cobb2020 is a partnership of community organizations and individuals dedicated to providing healthy lifestyles and the delivery
of essential health services in Cobb County. www.cobb2020.com
77

2016 Community Health Needs Assessment (CHNA)
78 2016 Community Health Needs Assessment (CHNA)

SIGNIFICANT
HEALTH NEEDS
DATA SUMMARIES
79

The significant health needs related to access to care stem from
socioeconomic and clinical care barriers. These barriers create
health disparities in the communities WellStar serves especially
among the most vulnerable populations (low-income, uninsured,
low education attainment, elderly). Underuse denotes lack of
capacity /access and cost of the care.
Lack of Care Capacity
in Community Safety
Net Clinics
Lack of Care Capacity
in Community Safety
Net Clinics
The significant health needs related to healthy lifestyles primarily
stem from health behaviors causing chronic disease and/or
behavioral health issues. These needs require intervention
and management through clinical care, lifestyle modification
(primary prevention) and education and “prescribing resources”
(secondary prevention).
80 2016 Community Health Needs Assessment (CHNA)

[Healthcare Costs - Background]
Economic security is either the greatest door or barrier to access care and preventive services. From all the
2016 primary research, income is a key driver of health status. Low income typically equals poor health. Most
of the nation’s medical costs come from a small fraction of very sick patients. Knowing who they are is an
efficient way to lower healthcare spending. In 2012, the top 5 percent of patients accounted for half of all
healthcare spending and less than three percent of costs came from the bottom 50 percent, who remained
relatively healthy. 1
Although WellStar does not accept the Affordable Care Act exchanges, a theme among community clinic
patients is that it does not help them gain access to care and is not affordable as rates are going up. “(The cost
of) Obamacare puts you in a no-win situation.” Backing their claim are excerpts from the Georgia Health News
article, “Exchange enrollment shows strong Atlanta area numbers,” published on Jan. 22, 2016:
Consumers face a higher penalty this year for not enrolling in ACA exchange coverage. The penalty is
$695 per adult and $347 per child up to a family cap of $2,500 or 2.5 percent of household income,
whichever is greater. (Last year’s penalty was $325 for adults, with a $975 maximum or 2 percent of household
income.) Bill Custer, a health insurance expert at Georgia State University, said Georgia would have had
stronger growth this year if health plan premiums had held steady. But as in other states, there were
rate increases, which averaged six percent statewide.
Also, in Georgia, 305,000 of poor, uninsured non-elderly adults fall into a “coverage gap” (

60.7 percent of the community surveyed could not see a doctor when needed because they could not afford it
and 70.5 percent of those who were not able to get prescribed medication in the last 12 months cited cost/high
co-pay.
Underinsured / uninsured community members feel they are disqualified from participating in the prevention
part of health due to high healthcare costs/co-pays.
- They want better access to affordable medical care “Not everyone can get Medicaid. I was turned
down for services. (It) makes you want to give up… You get kicked to the curb. You gonna kick your
family to the curb? No. You’re gonna do everything in your power to do what you gotta do.”
- They desire transparency and flat, up-front fees. “I believe there’s money (to help us)…but they don’t
want you to know how to get it.” “You don’t know the actual cost of services (under after they are
performed).”
- They are willing to pay according to their income.
- Among Hispanics, WellStar is viewed by the community as a hospital, but not as a health system, and is
mostly related to expensive services.
Nielson Pop Facts Demographics Bartow Cherokee Cobb Douglas Paulding GA U.S.
% below 100% FPL 17.14% 9.83% 12.82% 16.11% 11.41% 18.20% 15.37%
% below 200% FPL 38.25% 24.66% 28.98% 35.27% 27.69% 38.73% 34.23%
% of population receiving
Medicaid
20.23% 10.42% 12.48% 18.99% 13.31% 20.18% 20.21%

[Primary Care Access]
Access to regular primary care is important to preventing major health issues and emergency department visits.
While high rates of specialist physicians have been shown to be associated with higher, and perhaps
unnecessary utilization, a sufficient number of primary care physicians is essential for preventive and primary
care, and when needed, referrals to appropriate specialty care.
Primary Care Physicians
(CHR 2016)
Access to Primary Care (rate of
physician per 100,000 population)
Preventable hospital stays 4
(CHR 2016)
*Designated as a Health Professional Shortage Area
Bartow Cherokee Cobb Douglas Paulding GA US
2,150:1 2,930:1 1,430:1 2,310:1 7,730:1 1,540:1
HPSA*
43.7 32.1 68.6 41.8 12.4 63.6 74.5
73 51 51 63 72 61 55
Referrals from WellStar Emergency Departments (ED) to WellStar Community Clinics for patients with nonemergent,
primary care needs have remained stagnate due to limited providers, 5 but partnering community
safety net clinics help shoulder the load, but also struggle with inadequate staffing.
FY 2015 (July 2014 –
June 2015)
Level 0-2 Outpatient
Visits*
% of Total ED
Level 0-2
Outpatients
Visits
ED Referrals to WellStar Community Clinics 2014 2015
Cobb ED to Cobb Community Clinic 601 644 26,580 30.30%
Kennestone ED to Kennestone Community Clinic 661 670 17,012 15.48%
Douglas ED 18,906 31.29%
Paulding ED 16,567 27.74%
*Care levels 0-2 are non-emergent visits –visits that potentially could be treated in a primary care setting.
According to the community’s vulnerable populations, “hours of primary care not aligned to accommodate the
work schedule is a hindrance.” ED use has become a matter of convenience outside of work hours. Tension
comes from their jobs that don’t pay a decent and livable wage to pay for the high cost of care. “Walk-in clinics
are needed. We can’t play with peoples’ lives like this.”
4 This indicator reports the patient discharge rate (per 1,000 Medicare enrollees) for conditions that are ambulatory care sensitive (ACS).
ACS conditions include pneumonia, dehydration, asthma, diabetes, and other conditions which could have been prevented if adequate
primary care resources were available and accessed by those patients. This indicator is relevant because analysis of ACS discharges
allows demonstrating a possible “return on investment” from interventions that reduce admissions (for example, for uninsured or
Medicaid patients) through better access to primary care resources. Hospitalization for diagnoses treatable in outpatient services
suggests that the quality of care provided in the outpatient setting was less than ideal. The measure may also represent a tendency to
overuse hospitals as a main source of care. County Health Rankings, 2012 data.
5 In 2017, the WellStar’s Graduate Medical Education (GME) program will commence boosting the community clinics’ current active
roster of 400 patients to more than 1,500 patients at the end of the first year of the residency program, 2,500 at year two and nearly
4,000 at the end of year three.

A desire to shift from a sick system to a well system is hindered by patients’ lack of resources to cover
preventative care (annual check-ups, screenings). “Why pay a co-pay if you’re fine? Why do I need them to tell
me I’m OK?”
Hispanic community members note “the insurance we can afford, doctors don’t accept.” Overall, the tendency
is to, as one resident said, “…wait until we can’t wait anymore.” In the Acworth / Kennesaw area, everyone
knows about Kennesaw Urgent Care which charges a $45 flat fee. They also go to CVS Minute Clinic and ED if
there’s no other option.

[Children]
Affordability of pediatric and adolescent health services impedes access to care, especially among those
community members living in poverty.
CHR 2016 Bartow Cherokee Cobb Douglas Paulding GA
% of children living in
21% 13% 20% 20% 16% 26%
poverty
(CHR 2016)
% of children eligible for 52% 26% 41% 52% 34% 53%
free lunch
Number of children in a
single-parent household 6 32% 25% 31% 36% 27% 37%
Hispanic community members in Acworth (Cobb/Cherokee/Paulding) have babies at Kennestone, but they can’t
find a pediatrician. “Discharge won’t help. You must look before baby is born.” Dr. Rodriguez doesn’t accept
new patients unless it’s a sibling of a current patient. They also remarked on the need for positive parenting
skills. “If I knew how to cope, my stress would diminish.”
Paulding residents noted the lack of birthing center at the new hospital.
6 Children in single-parent households are at greater risk of severe morbidity and all-cause mortality then their peers in two-parent
households. Both adults and children in single-parent households are at risk for adverse health outcomes such as mental health
problems (including substance abuse, depression, and suicide) and unhealthy behaviors such as smoking and excessive alcohol use.
County Health Rankings 2016.

[Care Capacity of Community Safety Net
Clinics]
The uninsured patient average across the WellStar five-county area is 20 percent. 7 Access to primary care
providers in every county except Cobb far exceeds the state ratio of 1,540:1 primary care physician. As a result
of being uninsured, Obamacare’s rising premiums costs, high deductible insurance plans, and the changing
healthcare landscape in Georgia (including the current debate regarding expanding Medicaid), community safety
net clinic demand exceeds the supply in the communities WellStar serves.
Community safety net clinic patients are keenly aware of the need and see WellStar provider engagement as an
answer to expanding community clinic hours, eliminating appointment wait time and onboarding new patients:
- We need a free clinic in Paulding County or a better use of the Health Department for adults, not just children and
pregnant women.” “If you have more providers available to serve the community that would be great.” “You
have enough resources and enough doctors – top specialists – …you can’t give two hours out of a week to show
somebody compassion…?” “…We are lucky to be in Good Samaritan, but there’s a waiting list to get in here.
Unfortunately, a lot of people cannot get in because they don’t have the space, the doctors and what they need to
serve us. I wish they had more doctors to help us.”
The majority of WellStar Medical Group (WMG) respondents noted involvement in and support of free or lowcost
community clinics as the best way we can help serve the healthcare needs of the medically
underserved/uninsured and to decrease the burden on Emergency Department and primary care offices.
- “We need to expand free clinics where patients can have follow-up as an outpatient.”
- “We need to partner with community clinics that can see a larger number of patients…in each county that we
serve. Utilize WMG physicians who want to volunteer.”
- A majority would put skin in the game: Would you be interested in investing four hours a month of your time to
help meet the growing patient demands of our partner community health clinics? (More clinician volunteers will
help our partners caring for low-income and under/uninsured patients extend hours to provide much needed
primary care and chronic disease management. As a byproduct, it will help reduce WellStar ED utilization to give
patients a medical home.)
No 41.1%
Yes 58.9%
(Represents 240 hours a
care per month)
7 County Health Rankings, 2016

[Emergency Department Utilization]
Frequent Emergency Department utilization for non-emergent healthcare needs is prevalent among the lowincome
and uninsured populations.
From June 2014
– July 2015
Total # of
ED
patients
# of visits # of
patient
with 4+
visits
% of
patients
with 4+
visits
Total of 4+
visits
4+ visits as
a % of
total ED
patients
Cobb Hospital 62,616 99,430 3,618 5.78% 21,672 21.80%
Douglas Hospital 38,768 66,662 3,042 7.85% 18,294 27.44%
Kennestone Hospital 89,773 132,509 4,145 4.62% 23,939 18.07%
Paulding Hospital 38,922 64,128 2,744 7.05% 15,247 23.93%
System-Wide:
Total # of ED patients: 215,285
Total # of visits: 362,729
Total patients 4+ visits: 15,683
Total 4+ visits: 94,828
The 4+ category represents 7.28 percent of all ED
patients and 26.14 percent of total visits to the WellStar
EDs. Self-pay (uninsured or OOP) represent nearly 25
percent of all 4+ visitors.
Payer Summary Group (PSG) for 4+ Visits
% of PSG Patients % of PSG Visits % of PSG Total Charges
Managed Care 2.84% 11.81% 12.57%
Self-Pay 6.41% 24.48% 23.61%
Medicaid 8.56% 28.28% 34.11%
Medicare 10.27% 32.99% 30.84%
Other 1.53% 7.00% 8.61%
HIE 3.56% 14.13% 13.41%
WHS Emp Plan 2.97% 11.22% 10.68%
WellStar ED Service Levels 0-II represent lower acuity cases – those non-emergent conditions that potentially
could be treated in a primary care setting.
TOTAL OUTPATIENT ED VISITS
SERVICE LEVEL 0-II
July 2013 -
June 2014
July 2014 –
June 2015
Cobb Hospital Outpatient 29.18% 30.30%
Douglas Hospital Outpatient 35.09% 31.29%
Kennestone Hospital Outpatient 13.91% 15.48%
Paulding Hospital Outpatient 26.80% 27.74%

A Good Sam community clinic patient explained the lack of options leading to an ED visit:
“There’s a waiting list to get in Good Sam. My father-in-law can’t get in so he goes nowhere. If he got
very sick we would get him to the emergency room. When you go, they do a great job and do whatever
they have to do, but after that there’s no other place to go. They refer you to a specialist, but you
cannot afford the specialist and there are no other clinics like this. We need more places (to go).”

[Medication Access & Affordability]
Community clinic patients cite the residual expenses associated with managing their chronic disease and other
medical conditions:
- “I cherish my life and don’t want to die of something that could be fixed.” (The patient’s medications are
over $100/month.)
- “My biggest health challenge is figuring out what prescriptions I should take for my money.”
- “You don’t do the medicine at $700/month.”
- At Good Sam in Cobb medication is affordable via a prescription assistance program (PAP). “You get
what you need here. It’s $100 on the outside and five or six dollars here.”
- “You decide whether you’re gonna eat or get the medicine.”
- “The ER will give you a 30-day supply of medicine then you go back to the ER. Thank God the
pharmaceutical companies have programs where they give free or low cost medications. A vial of
Lantus costs $200.”
- A Bethesda Community Clinic nurse finds many patients in Cherokee County are put on expensive
medications at an ER visit. “They can’t afford them so they just quit taking their meds and finally find us
after two or three months… Their blood pressure or blood sugar is through the roof because they
couldn’t afford to go back to the ER to get their refills. So they fall through the cracks.”
WellStar Medical Group respondents say the biggest reason their patients have issues filling their medication is
the cost factor (68 percent) followed by non-compliance (11 percent). This aligns with their cited reasons
mental health patients have issues; along with the lack of education about maintenance medications.
Of the 13.7 percent of the 447 online community health survey respondents who said “Yes, there was a time
during the past 12 months when they could not get prescribed medication,” 70.5 percent said it was due to

cost/high co- pay. Other reasons cited included an issue with the pharmacy, not available in the pharmacy,
insurance would not cover, needed to see a doctor to get the Rx refilled and did not have time to make an
appointment – delayed six months in getting the meds.
A blog article in The Huffington Post 8 (updated in August 2015) said “The Patient Protection and Affordable Care
Act of 2010 (ACA) includes an important provision that prohibits insurers from denying coverage to patients with
pre-existing conditions. This prohibition, however, may lead some insurers, hospitals, and providers to engage in
unethical practices regarding the "sickest patients." For example, it has been reported that some insurers are
placing high-cost medications for chronic conditions into the highest-priced tiers of drugs they cover, forcing
patients to potentially pay thousands more dollars in co-payments out-of-pocket for essential medications to
treat their illnesses. For example, a recent study published in the New England Journal of Medicine in 2015
found that some plans offered through the health insurance marketplaces may be pricing HIV drugs out of reach
for some patients in an effort to get around the health law's mandate prohibiting discrimination based on a
person's pre-existing condition.
8 “Healing the Sickest Patients: How 'Hot Spotters,' 'Frequent Fliers,' and 'Super-Utilizers' Impact Health Care in America,” Susan
Blumenthal, M.D., Public Health Editor, The Huffington Post; Former U.S. Assistant Surgeon General

[Mental Health]
A remarkable, yet not surprising, finding since the 2013 CHNA is the upward trend of mental and behavioral
disorders in the top five leading causes of death.
Bartow Cherokee Cobb Douglas Paulding
1
Heart disease Heart disease Heart disease Lung cancer Lung cancer
Lung cancer Lung cancer Mental & behavioral
2
disorders
All COPD (except Mental & behavioral Lung cancer
3
asthma)
disorders
4
Stoke All COPD (except
asthma)
Heart disease
Heart disease
Mental & behavioral
disorders
All COPD (except
asthma)
Stroke Stroke Hypertension &
hypertensive renal
and heart disease
Mental & behavioral
Stroke
COPD (except
COPD (except
5
disorders
asthma)
asthma)
Rankings from the Georgia Department of Public Health, OASIS, Age-Related Death Rate, Last 5-Year Aggregate, 2010-2014, CHNA Dashboard.
Mental & behavioral
disorders
48.8 percent of community members surveyed would go to their doctor first to address a mental health issue
followed by a private counselor/therapist (24.4 percent).
-“Now thinking about your mental health, which includes stress, depression and problems with
emotions, how many days during the past 30 days was your mental health not good?”
Don’t know 5.9%
More than 10
days 23.5%
1 to 5 days 41.2%
6-10 days 29.4%
WellStar Medical Group (WMG) providers rank mental health concern level as high (46.7 percent), medium (41
percent) with 78.2 percent see gaps finding behavioral health services for Medicaid and/or uninsured patients.
- 66.7 percent believe there is not reasonable access to care and/or education regarding mental health
and for patients with insurance (67.3 percent).
Bartow Cherokee Cobb Douglas Paulding GA
Ratio of mental health providers 9 1,050:1 1,150:1 700:1 1,240:1 2,810:1 850:1
% of depression among Medicare
beneficiaries (GHPC data)
19% 13% 14% 14% 16% 15%
9 The ratio of the county population to the number of mental health providers including psychiatrists, psychologists, licensed clinical
social workers, counselors, marriage and family therapists and advanced practice nurses specializing in mental health care: (2016
communityhealthrankings.org)

***As the mental health parity aspects of the Affordable Care Act create increased coverage for mental health
services, many anticipate increased workforce shortages.
The Hispanic community is “in denial about (mental health issues)…it will go away.” The need is big, but services
are available in Spanish and/or they are too expensive.
A Bethesda care provider and clinic patients confirm the high prevalence of depression due to job loss, diabetes,
hypertension, and socioeconomic factors leading to family problems.
- “Depression comes when all these thing happen. It’s a merry-go-round of stinking thinking. As much as
you try to keep your head above water, they’re riding the whirlpool down the drain.”

[Dental Health]
Engaging in preventive behaviors decreases the likelihood of developing future health problems. Oral health
can highlight a lack of access to preventive care, a lack of health knowledge, insufficient provider outreach,
and/or social barriers preventing utilization of dental services, especially among low-income populations.
One community member remarked, “If you have a pain, you pull it (the tooth) out. Dental care means more
money and more language barriers (to overcome).”
Statewide, there is a dentist for every 2,060 residents. Only Cherokee and Cobb counties beat the state
benchmark. (CHR 2016)
Bartow: 3,080:1
Douglas: 2,080:1
Paulding: 7,450:1
GHPC data Bartow Cherokee Cobb Douglas Paulding GA US
Poor dental health 23.20% 12.30% 9.60% 12.10% 17.70% 16.70% 15.70%
(adults over 18 who’ve had
six or more teeth removed
due to decay, disease or
infection)
No recent dental
exam (adults over 18 who
have not received dental
care within the past year)
30% 27% 23.20% 31.60% 23.20% 29.10% 30.70%
Healthy People 2020 Target
for people to have annual
dental exams – 49%
Access to dentist per
100,000 population
28.6 49.3 63.9 44.7 14.3 47.6 63.2

[Language & Cultural Barriers]
Limited English Proficiency 10
(CHR 2016)
Linguistically isolated households 11
– Total population
Bartow Cherokee Cobb Douglas Paulding GA
2% 3% 4% 2% 1% 3%
2,380 6,670 29,486 3,917 1,937 325,741
The lack of health information in Spanish and providers that speak Spanish are barriers to the Hispanic
community adopting a healthy lifestyle. Health information is most prevalent coming from the schools to home,
but it’s in English only.
- “We’re not taken seriously. I’ve pretended not to know English to test the care. They take shortcuts…”
Community clinic and Hispanic congregation members also expressed the need for more culturally appropriate
education and materials to help them navigate the healthcare system and better participate in wellness.
A WellStar Medical Group provider remarked “many of my patients complain that many of the medical staff are
hard to understand due to their thick accents (English is their second language) and that causes a lot of
frustration and anxiety…They have much less confidence in the person caring for them and the facility if they
don’t know what’s going on.”
10 Population with limited English proficiency (LEP): This indicator reports the percentage of the population age 5 and older that speaks a
language other than English at home and speaks English less than "very well." This indicator is relevant because an inability to speak
English well creates barriers to healthcare access, provider communications, and health literacy/education.
11 This indicator reports the percentage of the population age five and older that lives in a home in which no person 14 years old and over
speaks only English, or in which no person 14 years old and over speaks a non-English language and speak English "very well."

[Maternal & Infant Health]
Women utilize more health care than men, in part because of their need for reproductive services. According to
the U.S. Department of Labor, females of all ages accounted for 57 percent of all expenses incurred at doctors'
offices in 2011.
Core Indicators of health
(Kaiser portal) Bartow Cherokee Cobb Douglas Paulding GA
Low birth weight 12 8.20% 7.50% 8.30% 9.60% 7.30% 9.5%
Infant mortality 13
Healthy People 2020 Target: 6.0
In Blacks
15.10%
In Blacks
13.40%
In Blacks
12.20%
In Blacks
12.20%
In Blacks
11.30%
6.9 4.6 6.7 7.3 7 7.6
In Blacks
12.6
In Blacks
10.7
Lack of prenatal care Suppressed 7.12% 9.38% Suppressed Suppressed 13.80%
Teen births (15-19) 54.3 27.1 28.9 37.8 25.3 45.3
In Blacks
36.1
In Non-
Hispanic
Whites
40.7
By 2019, the Georgia Department of Public Health (GDPH) aims to reduce the preventable infant mortality rate
from 6.3 (2013) to 5.3 per 1,000 births. (GDPH Strategic Plan, 8/5/15)
Perinatal period conditions rank number four in the leading causes of premature deaths (before age 75) in
Georgia according to the Georgia Department of Public Health. (OASIS Dashboard)
The Bartow Public Health Nurse Manager noted a high incidence of infant deaths from co-sleeping or bed
sharing. A recent Georgia Health News article (Jan. 31, 2016), “Report underscores alarming problem of baby
sleep deaths,” more than 30 percent were sleep-related and three in four of the deaths could have been
prevented including “overlay” incidents. Among the sleep-related deaths, 61 percent were Black babies, 66
percent were less than four months old and 60 percent occurred in an adult bed. .
12 This indicator reports the percentage of total births that are low birthweight (Under 2500g). This indicator is relevant because low
birthweight infants are at high risk for health problems. This indicator can also highlight the existence of health disparities.
13 This indicator reports the rate of deaths to infants less than one year of age per 1,000 births. This indicator is relevant because high
rates of infant mortality indicate the existence of broader issues pertaining to access to care and maternal and child health.

[Transportation]
Our current transportation system contributes to physical inactivity—each additional hour spent in a car per day
is associated with a six percent increase in the likelihood of obesity. 14 Also, the American Journal of Preventive
Medicine found that the farther people commute by vehicle, the higher their blood pressure and body mass
index. All WellStar countries have high percentages of people who commute over 60 minutes to work.
Among the vulnerable populations, the lack of vehicle and/or the residents’ dependence on public transit
(Cobb), taxi services, walkability factors, and a support system greatly diminishes quality of life and is a barrier to
access care.
Bartow Cherokee Cobb Douglas Paulding GA
Commute to work alone in car 15 84% 81% 80% 80% 82% 79%
Public transit stop within 0.5 mile 16 0 0 0.20% 0 0 3.78%
Road network density (roads per square mile – 3.22 4.42 10.68 5.27 4.13 2.6
relevant to air quality and tree canopy coverage)
51.5 percent of community members surveyed said access to public transportation in their community was poor
or very poor.
Transportation challenges hit the community clinic patients and residents in high-need areas the hardest:
- “I pay $12 to get to Kroger and back. That’s $12 I could use for my medicine.”
- “I have to depend on CCT (Cobb Community Transit) buses to get around. The VA provides a way for
their veterans to get to where they need to go. Why can’t they (Good Sam) provide a ride…What if our
churches filled the gaps? Milford Church picks up people and brings them to the doctor.”
- “They (government) are not doing anything about transportation issues.”
- Paulding and Douglas community members cited the need for public transport and housing as CCT and
Cherokee’s system don’t cross county lines.
- Bartow Transit requires a 24-hour notice.
A Cobb key informant remarked on the new Cobb Community Transit Flex program designed to provide
sustainable transit options to the southern portion of Cobb County. It’s an on-demand service requiring a two
14 Frank, Lawrence D., Martin A. Andresen, and Thomas L. Schmid. "Obesity relationships with community design, physical activity, and
time spent in cars.” American Journal of Preventive Medicine 27.2 (2004): 87-96.
15 CHR 2016. This indicator reports the percentage of the population that commutes to work on a daily basis using a motor vehicle, and
commutes as the only occupant of the vehicle. It’s relevant because it conveys information about the efficiency of the public
transportation network, potential impacts on the environment (e.g. air pollution), and can inform policy, system and improve public
transportation networks.
16 GHPC county level data. This indicator measures the proportion of the population living within 0.5 miles of a GTFS or fixed-guide way
transit stop. Access to public transportation can positively impact community safety and social capital, improve ability to access timely
healthcare and employment and reduce air pollution in communities vulnerable to the health impacts of climate change.

to 24-hour reservation notice.
http://www.cobbcounty.org/index.php?option=com_content&view=article&id=3600&Itemid=1647

[Type 2 Diabetes]
Diabetes increases the risk of death from heart disease or stroke and may indicate an unhealthy lifestyle /
obesity. Community members with diabetes have a higher utilization rate of the health system and are at higher
risk for other health issues. The chronic condition also has a high prevalence rate in our partnering community
safety net clinics and, and according to the CDC, is the leading cause of kidney failure, lower-limb amputations
other than those caused by injury, and new cases of blindness among adults.
Of note, is the upward growth of the prevalence of diabetes in the WellStar service area as compared to the
data in the 2013 Community Health Needs Assessment.
Diabetes Prevalence
% of adults aged 20 and above with
diagnosed diabetes – CHR 2016
Bartow Cherokee Cobb Douglas Paulding GA
10% 9% 9% 12% 9% 11%
Compared to CHR 2013 9% 7% 9% 10% 11%
% of diabetic Medicare enrollees ages 65-
75 that receive HbA1c monitoring (CHR 2016)
90% 87% 86% 86% 85% 85%
Diabetes is a health challenge of 13.9 percent of community members surveyed which tracks slightly above the
county-level estimates from the National Diabetes Surveillance System estimates using three years of data from
CDC's Behavioral Risk Factor Surveillance System (BRFSS) and data from the U.S. Census Bureau’s Population
Estimates Program.
-Only 26.2 percent said they receive adequate education and care assistance for chronic disease.
57 percent of WellStar Medical Group survey respondents have seen an increase in newly diagnosed patient
with diabetes in the last three years due to diet and lifestyle (obesity and physical inactivity).
- Do you think there are adequate community resources to refer Medicaid or unfunded patient to for
diabetes–related education and services? (WellStar Community Clinic indigent patients – below 125%
FPL – can receive free diabetes education)

No 53.1%
Yes 46.9%
The care and education received by community clinic patients make the difference in behavior modification that
leads to the best, sustainable change and management of their chronic disease: “I’ve been a diabetic for 15
years and when I was insured I went to some good endocrinologists but they didn’t do as good of a job as when I
came here (Bethesda Community Clinic) after I had no insurance and couldn’t afford to go anymore. They
treated me, not just give me a bunch of medicine.”

[Cancer]
Cancer is a health need related to health behaviors, clinical care, physical environment, and genetics. According
to the Georgia Department of Public Health research from the National Centers for Health Statistics, cancers are
the number one leading cause of premature death (before age 75) in Georgia. Related indicators to the
incidence of cancer are tobacco use/secondhand smoke, lack of preventive cancer screenings (promoting the
importance of early detection), poor nutrition, physical inactivity, air quality, and alcohol consumption.
(GHPC county data) Bartow Cherokee Cobb Douglas Paulding GA US
Cancer Mortality 190 157.1 151 174.3 173.1 171.3 168.9
Incidence rate per 100,000:
Breast Cancer
119.9 126.8 132.4 121.3 118.2 123.5 123
Cervical Cancer 7.7 8 6.6 7.7 6.5 8 7.7
Colon and Rectum Cancer 55.8 34.7 40.2 46.4 43.8 42.3 41.9
In 2013, 22 percent of Georgians died from cancer. Lung cancer is the most deadly type of cancer and is a
leading cause of death in all the counties WellStar serves.
(GHPC county data) Bartow Cherokee Cobb Douglas Paulding Georgia U.S.
Lung cancer incidence (1) 95.6 76 59.6 78 80.4 68.8 63.7
Adult Smoking (2) CHR 2016 17% 14% 14% 17% 15% 16% -
Air Quality – Particulate
Matter 2.5 (3)
3.30 2.48 3.48 3.70 2.86 2.31 1.19
(1) Reports the age adjusted incidence rate (cases per 100,000 population per year) of colon and rectum cancer.
(2) The percentage of adults age 18 and older who self-report currently smoking cigarettes some days or every day. This indicator is relevant
because tobacco use is linked to leading causes of death such as cancer and cardiovascular disease.
(3) Reports the percentage of days with particulate matter 2.5 levels above the National Ambient Air Quality Standard (35 micrograms per cubic
meter) per year. The indicator is relevant because poor air quality contributes to respiratory issues and overall poor health, and is associated
with the health impacts of climate change.
4.3 percent of the community survey respondents (447) said cancer was a health challenge they face.

WellStar Health System Cancer Cases

[Tobacco Use]
Each year approximately 443,000 premature deaths can be attributed to smoking. Cigarette smoking is
identified as a cause of various cancers, cardiovascular disease, and respiratory conditions, as well as low
birthweight and other adverse health outcomes. Measuring the prevalence of tobacco use in the population can
alert communities to potential adverse health outcomes and can be valuable for assessing the need for
cessation programs or the effectiveness of existing programs.
% of adult smokers
2016 CHR
Bartow Cherokee Cobb Douglas Paulding Georgia HP 2020
17% ↓ 14% ↓ 14% ↓ 17% ↑ 15% ↓ 16% ↓ 12%
CHR 2013 24% 18% 15% 13% 20% 19%
No viable statistics could be found measuring the growing rate of adolescents, teenagers and young adults using
e-cigarettes / vapor. 17
Even though number of smokers has slightly decreased in all counties except Douglas, residents in high-need
areas and community clinic patients noted tobacco use as a concern with a high awareness of tobacco’s overall
effects on health.
- “On the cigarette boxes it says if you smoke that causes cancer. I mean it’s written right there so
everyone knows, but they do it anyway.”
- “We always want the thing we’re not supposed to have. If they said cigarettes were good for us we
wouldn’t want them.”
Among Hispanics, smoking is perceived as part of the American culture, not theirs, and it is a perceived way for
younger people to assimilate.
The WellStar Medical Group survey respondents’ concern level of tobacco use is almost equally divided between
a high concern at 39.6 percent and medium (37.7 percent). (Securing a baseline for the number of WellStar
smokers is not a reportable field in WellStar Connect.)
Of the self-reported smokers of the community surveyed, 47.4 percent said they stopped smoking for a day or
longer because they were trying to quit, but 80 percent said they did not get help via prescribed medication or
nicotine patches. This supports the need for clinical intervention.
17 Electronic cigarettes and similar electronic nicotine delivery devices have not been approved by the U.S. Food and Drug Administration
as tobacco cessation devices. The only current safe and effective tools to quit nicotine and tobacco products are approved nicotine
replacement therapy products, which contain controlled doses of nicotine.

[COPD/Asthma]
Chronic obstructive pulmonary disease (COPD) is a top five leading cause of death in WellStar communities and
is commonly caused by tobacco use, physical environment (air pollution/climate change), genetics, and asthma.
Bartow Cherokee Cobb Douglas Paulding
#1 Heart disease Heart disease Heart disease Lung cancer Lung cancer
#2 Lung cancer Lung cancer Mental &
behavioral
Heart disease Heart disease
#3 All COPD (except
asthma)
Mental &
behavioral
disorders
#4 Stroke All COPD (except
asthma)
disorders
Lung cancer
Mental &
behavioral
disorders
All COPD (except
asthma)
Stroke Stroke Hypertension &
hypertensive renal
and heart disease
#5 Mental &
behavioral
disorders
Stroke
COPD (except
asthma)
COPD (except
asthma)
Mental &
behavioral
disorders
Georgia Department of Public Health, OASIS – Age-Adjusted Death Rate, Last 5-Year Aggregate, 2010-2014 CHNA Dashboard.
Asthma – Asthma is a chronic inflammatory disorder of the airways that is triggered by things including
allergens, air pollution, smoke from cigarettes, exercise, and viral upper respiratory infections. Untreated
asthma can permanently change the shape of the airways and reduce lung function possibly raising the risk of
COPD later in life.
Asthma Prevalence
(adults over 18 who report they
have asthma)
Bartow Cherokee Cobb Douglas Paulding GA
10% 15.40% 11.70% 12.80% 13.40% 13.50%
Related health indicator: 0% 0% 0.27% 0.55% 0.49% 0.20%
Air Quality Ozone 18
Tobacco Use (CHR 2016) 17% 14% 14% 17% 15% 16%
One of the Georgia Department of Public Health’s (GDPH) strategic goals is by 2019 to eliminate all pediatric
asthma deaths in Georgia. (GDPH Strategic Plan - 8/5/15)
The importance of preventive care, smoking cessation interventions and access to care was exemplified by a
community clinic patient: “I have COPD. I had an attack and they put me in the hospital for almost a week.
They sent me to a pulmonologist and she made it sound like it was a death sentence because it was going to be
so expensive for my treatment. I wished I would just go ahead and die.”
18 This indicator reports the percentage of days per year with Ozone (O3) levels above the National Ambient Air Quality Standard of 75
parts per billion (ppb). Figures are calculated using data collected by monitoring stations and modeled to include census tracts where no
monitoring stations exist. This indicator is relevant because poor air quality contributes to respiratory health issues, including asthma
prevalence and asthma hospitalizations, overall poor health, and community vulnerability to climate change.

[Cardiovascular Disease]
Cardiovascular disease (CVD) remains a top leading cause of death in all the communities WellStar serves. In
Georgia, the death rate is six percent higher than the national average. It is the second leading cause of
preventable death (before age 75) in Georgia and contributes to 29 percent of deaths each year due to:
Ischemic heart disease (46.2%)
Hypertensive heart disease (9%)
Other heart disease (44.7%)
Preventive measures can be taken through diet and exercise which are known to be lacking among most
residents, especially the most vulnerable. They have limited resources and/or healthcare access to self-manage
their chronic disease(s), lack good nutrition and exercise habits.
Clinical care also has an impact on heart health. A lack of management of diabetes, high cholesterol and
hypertension (high blood pressure) is a related health indictor for CVD. 19 Of note is the 32 percent of Paulding
County adults age 18 and older who self-report that they are not taking medication for their high blood
pressure. This indicator is relevant because engaging in preventive behaviors decreases the likelihood of
developing future health problems. When considered with other indicators of poor health, this indicator can
also highlight a lack of access to preventive care, a lack of health knowledge, insufficient provider outreach,
and/or social barriers preventing utilization of services.
Leading Causes of Death in WellStar Communities
Bartow Cherokee Cobb Douglas Paulding
#1 Heart disease Heart disease Heart disease Lung cancer Lung cancer
#2 Lung cancer Lung cancer Mental & behavioral
Heart disease
Heart disease
disorders
Georgia Department of Public Health, OASIS – Age-Adjusted Death Rate, Last 5-Year Aggregate, 2010-2014 CHNA Dashboard.
GHPC data Bartow Cherokee Cobb Douglas Paulding GA
% of adults over 18 who have ever 7.8% 7.5% 2.6% 5.7% 4.7% 4.4%
kind of heart disease 20
been told by a doctor they have any
Mortality rate for ischemic heart
disease 21 85.7 65.3 55.4 60 63.1 85.9
19 According to the CDC, about half of US adults (47 percent) in the United States have at least one of the following major risk factors for
heart disease or stroke: uncontrolled high blood pressure, uncontrolled high LDL cholesterol, or are current smokers. Ninety percent of
Americans consume too much sodium, increasing their risk of high blood pressure.
20 This indicator reports the percentage of adults who have ever been told by a doctor that they have any kind of heart disease. This
indicator is relevant because coronary heart disease is a leading cause of death in the US and is also related to high blood pressure, high
cholesterol, and heart attacks.
21 This indicator reports the rate of death due to coronary heart disease per 100,000 population, age-adjusted to year 2000 standard.
This indicator is relevant because heart disease is a leading cause of death in the U.S.

WellStar Medical Group survey respondents: Do you think there are adequate community resources to refer
your Medicaid or unfunded patients to for cardiovascular and/or respiratory services?
No 48.5%
Yes 51.5%
The mortality rate in Cobb County for ischemic heart disease for non-Hispanic whites is above the benchmark.
There are significant race/ethnic group disparities: Blacks, Hispanic, Native Hawaiian, Native American were
poor performers against the benchmark using health indicators 1) living in poverty (below 100 FPL), 2) education
attainment and 3) uninsured.
Percent of Discharges by Cause by Census Tract of WellStar Counties. High Blood
Pressure, Hypertensive Heart Disease, Obstructive Heart Disease (incl. Heart Attack).
2010-2014.
In Georgia, the one of every six healthcare dollar spent on CVD in the U.S. equates to $6.1 billion spent
statewide on total hospital charges with the average charge per CVD-related hospitalization in Georgia being
$45,744.

[Stroke]
Stroke remains as a top five leading cause of death in the communities WellStar serves in those residents
primarily 55 years of age and older. According to the GDPH, strokes accounted for 17.4 percent of all
cardiovascular disease deaths in Georgia. Lifestyle risk factors include obesity, physical inactivity, heavy drinking
and illicit drug use. Diabetes, tobacco use, high blood pressure, and cardiovascular disease are medical risk
factors that could lead to stroke.
Bartow Cherokee Cobb Douglas Paulding
#1 Heart disease Heart disease Heart disease Lung cancer Lung cancer
Heart disease Heart disease
#2 Lung cancer Lung cancer Mental & behavioral
disorders
#3 All COPD (except Mental & behavioral Lung cancer
asthma)
disorders
#4 Stroke All COPD (except
asthma)
Mental & behavioral
disorders
All COPD (except
asthma)
Stroke Stroke Hypertension &
hypertensive renal
and heart disease
#5 Mental & behavioral
disorders
Stroke
COPD (except
asthma)
COPD (except
asthma)
Georgia Department of Public Health, OASIS – Age-Adjusted Death Rate, Last 5-Year Aggregate, 2010-2014 CHNA Dashboard.
Mental & behavioral
disorders
GHPC data Bartow Cherokee Cobb Douglas Paulding GA
Benchmark
Stroke Mortality Rate 54 35.3 36.5 49.5 37 43.7
This indicator reports the rate of death due to cerebrovascular disease (stroke) per 100,000 population, age-adjusted to year 2000
standard. This indicator is relevant because strokes are a leading cause of death in the U.S. Kaiser Portal

[Obesity]
The WellStar service area is below the benchmark in core indicators of a healthy weight including low
fruit/vegetable consumption and the presence of food deserts signifying a lack of access to grocery stores.
These are related health indicators to obesity.
Obesity (a Body Mass Index or BMI > 30) is often the result of an overall energy imbalance due to poor diet and
limited physical activity. It increases the risk for poor health status and many health conditions including
coronary heart disease, type 2 diabetes, cancer, hypertension, dyslipidemia, stroke, osteoarthritis, sleep apnea,
liver and gallbladder disease, and respiratory problems.
Adult Obesity:
Percentage of adults that report
a BMI of 30 or more (CHR 2016)
Overall in
Georgia
Healthy
People
2020 Target
Bartow Cherokee Cobb Douglas Paulding
34% 26% 22% 34% 28% 29% 30.5%
The concern level about the obesity epidemic in WellStar communities is high at 76 percent among WellStar
Medical Group (WMG) respondents as it relates to significant chronic disease issues including diabetes, heart
disease and stroke.
- 52.8 percent don’t think there are adequate and affordable community resources to refer patients to
for obesity-related / healthy lifestyle education.
- Have you seen an increase in patients who are overweight or obese in the last three years?
No 14.1%
Yes 85.9%
Obesity may present from adverse socioeconomic situations that may affect self-esteem, stress levels and the
ability to cope causing emotional eating. A CarePlace community clinic patient in Douglas County remarked, “All
I have to do is eat and sit there and feel sorry for myself.” Another patient at Bethesda “…got depressed and put
on 40 pounds.”
Being overweight/obese was a health challenge of 40.9 percent of the community surveyed (447), 66 percent of
all respondents were self-aware of their need to lose weight.

[Substance Abuse]
Alcohol and drug (illegal and prescription) abuse is commonly driven by mental health issues and socioeconomic
factors, although the recent boom of opioid/heroin use in WellStar communities is affecting middle and upper
class teenager and young adults.
ILLEGAL DRUGS:
The CDC reports death from heroin overdose in all age groups doubled in the United States from 2010-2012.
- The Georgia Bureau of Investigation Crime Lab has seen an increase of 300 percent of samples of seized
heroin between 2011 and 2014. WSB-TV, 1/14/16.
According to the New York Times, the drug overdose death rate for whites ages 25-34 in 2014 was five times the
level in 1999 and the rate for 35-44 whites tripled during that period. The numbers cover both illegal and
prescription drugs.
59.4 percent of WellStar Medical Group (WMG) survey respondents said they don’t think there is adequate
education available within our community concerning the risk of binge drinking, substance and tobacco use.
WMG provider concern levels for substance abuse (drugs/alcohol):
Low 16.2%
High 37.4%
Medium 46.5%
As it relates to low education attainment – a key determinant of health - a community safety net clinic patient
who dropped out of high school explains: “My family never had a lot of money so a lot of times people feel
stuck. (They think) I can work this fast food job all my life and do nothing or I can sell drugs and make a whole
lot more money.”
- Need for awareness education in the schools. “They showed us in school how to make skirts and cook,
but didn’t tell us anything about smoking and doing drugs and what it can do to you.” – Bartow resident
- Need for medication monitoring. “I got addicted to painkillers prescribed my doctors. They didn’t tell
me there was an alternative drug to take without narcotics in it.” - Bethesda patient in Cherokee
- Need for law enforcement. “Meth is a problem out here.” – CarePlace patient in Douglas
o A Cherokee resident in a high need area remarked kids are soaking gummy bears in alcohol and
selling them at school. At WSB radio report in 2011 confirmed the story’s validity.

o
A Good Sam patient noted the presence of drug dealers around her neighborhood school and
knows a young boy who got addicted from drugs obtained at a neighborhood park.
Drug overdose
deaths 22 (CHR
2016)
Bartow Cherokee Cobb Douglas Paulding GA
15 14 14 11 17 11
ALCOHOL:
GA Student Health Survey Data
(% 12 th ) (2015) Paulding Bartow Cherokee Georgia
Alcohol Use, past 30 days (≥1
day(s) of use) 21 24.40% 26.70% 29.00% 22.20%
From Cobb Douglas Public Health
16 percent of Cherokee and Cobb county adults report excessive alcohol consumption 23 slightly higher than the
state average of 14 percent. Binge drinking is a risk factor for a number of adverse health outcomes such as
alcohol poisoning, hypertension, heart attack, sexually transmitted infections, unintended pregnancy, fetal
alcohol syndrome, sudden infant death syndrome, suicide, interpersonal violence, and motor vehicle crashes.
- Also, the percentage of driving deaths with alcohol involvement is higher in Cobb (26 percent) and
Douglas (28 percent) counties than the state (24 percent).
22 Drug Overdose Deaths are the number of deaths due to drug poisoning per 100,000 population. ICD-10 codes used include X40-X44,
X60-X64, X85, and Y10-Y14. These codes used cover accidental, intentional, and of undetermined poisoning by and exposure to: 1) nonopioid
analgesics, antipyretics and antirheumatics, 2) antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not
elsewhere classified, 3) narcotics and psychodysleptics [hallucinogens], not elsewhere classified, 4) other drugs acting on the autonomic
nervous system, and 5) other and unspecified drugs, medicaments and biological substances.
23 Excessive Drinking is the percentage of adults that report either binge drinking, defined as consuming more than 4 (women) or 5 (men)
alcoholic beverages on a single occasion in the past 30 days, or heavy drinking, defined as drinking more than one (women) or 2 (men)
drinks per day on average.

[Preventive Cancer Screenings]
Preventive screenings allow for early detection and treatment and help decrease cancer mortality and chronic
disease. This indicator of health can also highlight a lack of access to preventive care, a lack of health
knowledge, insufficient provider outreach, and/or social barriers preventing utilization of services.
Cancer
Screenings Bartow Cherokee Cobb Douglas Paulding GA US HP 2020
Mammogram 24 63% 64% 64% 58% 63% 62% 63%
(CHR 2016)
Pap Test 78.30% 84.70% 85.30% 81.80% 80.70% 82.70% 78.50%
Colonoscopy 61.20% 68.20% 66.50% 60.90% 59.90% 62.40% 61.30% 70.5%
GHPC county level data
45 percent of WellStar Medical Group survey respondents said their concern level for clinical preventive cancer
screenings is high, medium (29.4 percent) and low (25.5 percent). 87.9 percent believe patients have
reasonable access to care and/or education regarding the screenings.
Hispanics in listening sessions and focus groups are aware of the preventive screenings. When it’s a good
service at an affordable cost, they are willing to pay. Paulding Health Department patients want more
affordable screening services in the count, as cost is a monumental barrier to getting preventive care.
Of the age-appropriate community survey respondents, 47.7 percent said they are diligent about getting
preventive screenings. In the past 12 months:
- 10.7 percent got a colonoscopy
- Two percent got a lung cancer screening
- 45.3 percent of men have not had a prostate cancer screening in past 12 months because it’s not
affordable or it’s not indicated.
- 70 percent of women got a breast cancer screening mammogram. The remaining 30 percent of women
who did not get a mammogram cited the following reasons:
24 Percentage of female Medicare enrollees ages 67-69 that receive mammography screening.

The main barrier to preventive cancer screenings for community clinic patients is money:
“I don’t have $300-400 for a colonoscopy.” “If I can’t afford (the screening), why pay the money? Nine times
out of ten you’re going to make the decision that’s going to benefit you right away, not long-term.”
“My challenge is with the need
for screenings to prevent future
medical issues.”

[Men’s Health – Prostate]
Women are the healthcare decision makers. They make approximately 80 percent of the healthcare decisions in
their families. 25 Women take the lead role in choosing health plans, scheduling doctor’s appointments and
making sure their loved ones are getting the care they need. Better health in men comes from equipping
women with the tools and information they need.
To most of WellStar’s vulnerable, high-risk residents, the attitude toward preventive healthcare is not negative.
The negativity comes from the lack of resources live well and stay healthy:
- “…They want men to get the prostate checked yearly and they’re wondering why they don’t. They are
providers of the home and they have to take care of everybody else before they get taken of. If you
have a $100 and five kids, then you’re out.”
- There’s a high prevalence of depression in men leading to areas where there race disparities of reckless
behavior (violence, STDs and suicide).
A nurse at Bethesda Community Clinic admits they do better with women than men. She suggested flagging
charts to get exams scheduled with male patients.
Age-appropriate male respondents to the online community survey question, “Have you had a prostate cancer
screening (PSA test) in the past 12 months?
25 U.S. Department of Labor. General Facts on Women and Job Based Health. Retrieved 10 July 2013, from
www.dol.gov/ebsa/newsroom/fshlth5.html

The reasons men did not get a prostate cancer screening include:

[Physical Inactivity]
Lack of time and motivation are the biggest reasons people don’t exercise. A barrier to physical activity in adults
is their long commute times in Metro Atlanta for WellStar community members.
Physical Inactivity (Percentage of adults aged
20 and over reporting no leisure-time physical
activity)
Factors:
Drive Alone, more than 30 minutes
Bartow Cherokee Cobb Douglas Paulding GA
27% 22% 18% 26% 26% 25%
38% 53% 48% 54% 64% 39%
Commute over 60 minutes 10.83% 14.60% 9.77% 13.62% 21.37% 8.97%
Park Access (% of population living within 0.5 1.41% 6.42% 23.96% 12.52% 3.32% 13.39%
mile from a park)
County Health Rankings 2016 and GHPC portal
Although 47 percent of community online survey respondents (447) said they exercise a minimum of three times
per week, 36 percent said they are too busy to exercise on a regular basis followed by “don’t like to exercise” (19
percent) and “my neighborhood” (15 percent) due to safety issues, lack of sidewalks, etc.
Lack of money for gym memberships, motivation, unsafe neighborhoods, recreation areas, sidewalks, and time
were themes of the listening sessions and focus groups in high-risk areas and community clinics:
- “Work and family responsibilities consume too much time.”
- A Paulding resident said “there’s no safe place to exercise.”
- Astutely noted: “People think their busyness is enough, but it isn’t. They aren’t focused on how
exercise affects diabetes, blood pressure – all those things play together.”
The Hispanic community is willing to learn healthy habits but lack of transportation, sidewalks and access to the
gym prevents their community from exercising.

[Poor Nutrition]
There is strong evidence that residing in a food desert is correlated with a high prevalence of overweight/
obesity, chronic disease and premature death.
The Food Environment Index ranges
from 0 (worst) to 10 (best) and
equally weights two indicators of the
food environment.
Food environment index 26
(CHR 2016)
Bartow Cherokee Cobb Douglas Paulding GA
6.6 8.1 7.1 6.3 7.7 6.5
Although related indicators include consumption of fruits and vegetables, diabetes incidence and mental health
issues (depression), the biggest barriers to healthy eating for vulnerable populations is cost and lack of
motivation.
- “I have to walk to the food pantry to get something to eat.”
- “It costs less to eat off the dollar menu than to buy a salad.”
- “…Depression and anxiety leads to you want to eat yourself to death.”
- “The most expensive aisle in Kroger is the healthy aisle.”
- “We (Blacks) were never taught to read labels.”
Hispanics are in need of education about the healthy ingredients they can find in in their new culture and how to
cook and adapt those foods to their needs/likes.
34 percent of the online community survey respondents (447) reported they eat at least five serving of fruits
and vegetables each day, yet 27 percent eat fast food more than once a week.
- The general community cites the following reasons they don’t eat well sometimes with time and
temptation as the biggest triggers:
26 1) Limited access to healthy foods estimates the percentage of the population who are low income and do not live close to a grocery
store (“food desert”). Living close to a grocery store is defined differently in rural and non-rural areas; in rural areas, it means living less
than 10 miles from a grocery store whereas in non-rural areas, it means less than 1 mile. Low income is defined as having an annual
family income of less than or equal to 200 percent of the federal poverty threshold for the family size.
2) Food insecurity estimates the percentage of the population who did not have access to a reliable source of food during the past year. A
2-stage fixed effect model was created using information from the Community Population Survey, Bureau of Labor Statistics, and
American Community Survey.

WellStar Medical Group survey respondents to the question: Do patients have reasonable access to care
and/or education? -Obesity/Nutrition/Physical Activity said:
No 42%
Yes 58%

[Sexually Transmitted Diseases]
HIV/AIDS, syphilis and other infectious, sexually-transmitted diseases (STDs) were noted as a significant health
need in Cobb and Paulding counties from public health and key informants due to unsafe sex practices. Notable
is Cobb and Douglas counties’ high prevalence of chlamydia, the most common STD in the United States, which
often doesn’t present with symptoms and is treatable with antibiotics.
GHPC data Bartow Cherokee Cobb Douglas Paulding GA
STD – Chlamydia Prevalence 27 282.8 197 402.8 518.2 204.1 534
HIV/STD/ Health Disparity: Higher
prevalence in this population
STD – HIV Prevalence
NO HIV Screening – related clinical
care health indicator
Non-Hispanic Black
189.5 142.6 301 150.5 36.8 428.8
57.45% 60.87% 55.14% 51.13% 57.97% 55.12%
27 This indicator reports incidence rate of chlamydia cases per 100,000 population. This indicator is relevant because it is a measure of
poor health status and indicates the prevalence of unsafe sex practices.

[Violence]
The quantitative data surrounding violent crime in WellStar communities tracks below the Georgia benchmark,
but it remains an area of concern from residents desiring safe communities, especially among low-income
residents and counties with a higher rate of crime - Bartow, Cobb and Douglas.
36.5 percent of the community surveyed believes in the next five years their community will become a worse
place to live. Many cite crime and demographic shifts for the lack of optimism.
Residents from high-risk areas and community clinic patients echo the sentiment. “I have lived in Douglas
County for 43 years and it has already changed for the worse with crime and violence.
- Douglas Care Place patients attribute the violence to anxiety. “You get turned down and pushed away.
What do they have to resort to? They don’t know what to do. They lose hope and start striking out.
Oh my God, it’s right where we live.”
- “People want to get out of their neighborhood. I, for one, do. They got to jail, get out and do the same
thing – it’s all they know. There needs to be more education than just locking them up.”
Not only can violent crime compromise physical safety and psychological well-being, it can deter residents from
pursuing healthy behaviors. Increased stress may exacerbate other health needs including hypertension and
other stress-related disorders and may contribute to an inactive lifestyle leading to obesity.
Rate of violent crime offenses
reported by law enforcement per
100,000 residents
(includes homicide, rape, robbery, and
aggravated assault) - CHR 2016
Bartow Cherokee Cobb Douglas Paulding GA US
360 100 264 289 144 385 395.5
The WellStar Medical Group survey respondents’ level of concern regarding injury and violence is low (45.2
percent), medium (41.4 percent) and high (13.5 percent). Although they treat injuries from violence, this could
be attributed to the inability of health providers to inform change and lead interventions in this area.
- 72.2 percent believe patients have reasonable access to care and/or education regarding injury and
violence.
DOMESTIC VIOLENCE:
The high rate of family violence in the Hispanic community was noted by a Bethesda care provider (“we have a
lot of family abuse patient from Cherokee County Violence Center). The data is backed up by research
independently conducted by Ser Familia as well as listening session participants.

[Suicide]
Suicide is related to poor mental health. It is a documented concern among the Hispanic/Latino population, yet
is most prevalent among non-Hispanic whites in all the communities WellStar serves and exceedingly high in
Cherokee County.
GHPC data Bartow Cherokee Cobb Douglas Paulding GA
Mortality – Suicide 28
16.7 12.5 10 11.9 15.9 11.8
Healthy People 2020 Target: 10.2
Suicide Race/Ethnic
Disparities
19.1
among
non-
Hispanic
whites
14.5
among non-Hispanic whites
13.8
among
non-
Hispanic
whites
Intentional Self Harm cases
significantly higher than
expected in Emergency Room
visits 29 #14 no
rank
17.7
among
non-
Hispanic
whites
no
rank
18.5
among non-
Hispanic
whites
#12
GA Student Health
Survey data (%12 th ) -
2015
Considered suicide
in the past year
Cobb Douglas
Public Health
Paulding
Northwest Health
District 1-1
Bartow
Northwest Health
District 1-1
Cherokee
North Georgia
Health District 1-2
Georgia
8.6% 7.9% 7% 11% 8.5%
28 This indicator reports the rate of death due to intentional self-harm (suicide) per 100,000 population, age-adjusted to the year 2000
standard. This indicator is relevant because suicide is an indicator of poor mental health.
29 OASIS, CHNA Dashboard, 2010-2014.

[Health & Wellness Education - Strategy]
Prevention-based health and wellness education as part of overall preventive care helps reduce the risk factors
for approximately half of morbidity and mortality. 30
1. Primary prevention– Avoids health issues by behavior and lifestyle modifications 31
2. Secondary prevention – Provides education and resources for disease management / control
3. Tertiary prevention– Manages complications to avoid unnecessary healthcare
WellStar’s Community Education & Outreach Department is a conduit for outreach and realignment of
community benefit services to help meet priority health needs in communities with health disparities.
Community online survey respondents (447) reported having the following procedures done in the past 12
months. Some of these could reflect the need for more education in the community. Some are age-appropriate and
have a lower response rate due to demographics.
Community clinic patients would like WellStar to better utilize faith-based congregations to educate on health
and wellness topics as “the spiritual aspect of things gives you a better or different perspective of things that can
lead to your physical well-being and it helps you make better choices, too.” – Bethesda patient
- Many clinic patients, who are looking for hope, support and relief from depression due to
socioeconomic factors, look to the church. This is especially true for the Hispanic/Latino community.
- Some would be willing to participate as volunteers at community events/education if the timing and
setting aligned with work and transportation needs.
- “We don’t know how to be healthy, so weekend classes would be welcome.”
- They understand their personal responsibility regarding their health, yet are motivated by empathy and
personal relationships with their caregivers and others. “If (my nurse) was going to care enough for me
30 Despite spending more than twice what most other industrialized nations spend on health care, the U.S. ranks 24th out of 30 such
nations in terms of life expectancy. A major reason for this startling fact is that only 3 percent of our healthcare dollars is spent on
preventing diseases (as opposed to treating them), when 75 percent of our healthcare costs are related to preventable conditions.
31 The World Health Organization estimates that 80 percent of all heart disease, stroke, and Type 2 diabetes, as well as more than 40
percent of cancer, would be prevented if Americans would stop using tobacco, eat healthy and exercise. From the Harvard School of
Public Health slide on the cost of non-communicable diseases.

to hold me accountable, I need to do what I can to educate myself and do what I need to do to be
educated and choose proper foods and exercise.
- No community members at the Paulding Health Department listening session knew about 770-956-
STAR. They suggested a resource list / calendar distributed at the schools so parents will receive.
[Health Need-Specific Community Health
Improvement Programs – Strategy]
Investments in community health improvement programs and services is one of the key community benefit
services sub-categories that can be fortified to target prioritized health needs to make measureable
improvements in community health, including the vulnerable populations along with realignment and vetting of
cash and in-kind contributions.
Many WellStar Medical Group survey respondents cite wellness-focused community outreach and education as
how WellStar can best meet health needs.
- Do you think there are adequate community resources to refer your patient for obesity-related /
healthy lifestyles education?
No, it’s lacking 55%
Yes 45%
Comments from WMG regarding areas of need: Education about how obesity affects chronic conditions, free
nutrition counseling, more affordable diet and exercise programs, resources for information, free physical
activity/nutrition programming, comprehensive/integrated programs

Lack of awareness of free prevention and wellness education and resources is prevalent among vulnerable
populations.
- “Be more present in the community. I’m not aware of any community outreach programs in my area.”
- “(My biggest health challenge is) knowing steps to prevent health problem or correct the health issues
without using medications for everything.”
- “Many people believe that chronic condition just happen to them. Please create program to heighten
awareness of the direct impact of lifestyle on health.”
# # #