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Health Care for All of Us

2018 ANNUAL REPORT

Mission

Leading the way to a healthier you and a healthier community through service, teaching, discovery and teamwork.

HOW

MetroHealth’s Population Health Innovation Institute created the Institute for Health, Opportunity, Partnership and Empowerment. It is a comprehensive, coordinated commitment to identify and act on social determinants of health as critical components of achieving optimal individual and community health, through effective programs, education, training and research.

WHY

A person’s overall health is affected four times as much by social, economic and environmental factors than by medical care and genetics. MetroHealth’s internal and community-wide efforts to address socioeconomic and lifestyle factors are leading to better physical and mental health
for our community.

Message from Leadership

Expanding our commitment to our community

Akram Boutros, MD
President and CEO
The MetroHealth System

Thomas McDonald
Immediate Past Chairman,
Board of Trustees
The MetroHealth System

Chief Executive Officer & President
McDonald Partners, LLC

Brian M. O’Neill
Chair, Board of Directors
The MetroHealth Foundation

Partner
Tucker Ellis, LLP

Another year of responding to the needs of others.

That’s what 2018 was for MetroHealth.

We opened our Medina Health Center and expanded our extraordinary trauma care to Lorain and Huron counties.

We partnered with Recovery Resources — to better serve those battling substance use disorder — and with Urban Community School (UCS) — to open a health center to care for UCS students, their families and the community.

We established a clinic that provides free, healthy food to the chronically ill, launched our community trauma services, hired hundreds more employees and continued to improve the health of hundreds of thousands of patients.

And we did all that while advancing our $1 billion campus transformation and the revitalization of the neighborhood around it.

We’re proud of those accomplishments.

But what we’re excited about is this:

We’re just getting started.

We have bold plans for 2019, plans that will do even more to lift our community.

And those new projects, every one of them, are driven by our calling to provide more than medicine.

Improving the health of our community is what is driving us to invest in social and environmental issues — education, healthy food, transportation, affordable housing and much more — issues that prevent social and physical ills and the suffering that follows.

We’ll be announcing those projects in the coming months.

When you see what we have in store for 2019, we think you’ll agree.

We’re just getting started.

And we hope you’ll hear the call, too.

That you will join us in lifting every member of this community until, together, we are healthier than ever before.

Understanding
health is
more than
medical care

As you will see on the following pages, our multi-faceted programs in these three targeted areas
improve physical and mental health and reduce health care costs.

Institute
for Health,
Opportunity,
Partnership and
Empowerment
(H.O.P.E.)

Developing innovative programs for those we serve

Physical Environment

BUILD Health Grant

Camp Phoenix

EcoDistricts

Family Medicine Home Visit Program

La Villa Hispana

Library-Based Primary Care

Northern Ohio Trauma System (NOTS)

Open Streets Cleveland

School Health Program

STANCE (Standing Together Against Neighborhood Crime Everyday)

Violence Interrupters, a program of the Northern Ohio Trauma System (NOTS)

Health Behavior

Aamoth Family Pediatric Wellness Center

Accountable Health Communities/United Way

Adult Burn Survivor Recovery Group

Arts in Medicine

Ascent ED

Asia-International Community Health Center

Breastfeeding Clinic

Buckeye HEAL (Healthy Eating & Active Living)

Care Alliance

Childbirth Preparation Classes

Community Trauma Institute

Compass Services

Correctional Health Program

Cuyahoga County Women, Infants, and Children (WIC) Program

Diabetes Self-Management Education Program

Doctors on the Streets (DOTS)

Doula Volunteer Program

Elisabeth’s House: The Prentiss Pediatric Crisis Nursery

Enrollment Van

EXAM (Expanded Access to Medication Assisted Treatment)

Falls Prevention Project

First Responder Project

First Year Cleveland

Friends of Mothers and Infants

Gun Safety Education Task Force

Healing Hearts

Injury Prevention Initiatives

Kidz Pride Clinic

Know the Rx

Language Access Services

Library-Based Primary Care

Medical Home for Children in Foster Care

Medication Assistance

MetroHealth Care Partners Medicare Shared Savings Program Accountable Care Organization (ACO)

MetroHealth Institute of Burn Ethics

Mi MetroHealth at La Placita

Mother and Child Dependency Program

Mother Nurture Project

Nurse-Family Partnership

Overdose Outreach Project

Pediatric Hispanic Clinic

PrEP Navigation Program

Pride Clinic

Project DAWN

REaL (Race, Ethnicity and Language)

SAFE (Students Are Free to Express)

Safe Sleep Initiative

Salud Popular

SANE

School Health Program

Shower Clinic

Sibling Classes

Simulation Center

Smoking Cessation

Stop the Bleed

STRIDES (Steps to Reach Individual Diet and Exercise Solutions)

Thrive Project

Tobacco Intervention & Psychosocial Support for Cancer Care

VIDA!

Volunteer Services

Weight Loss Surgery and Weight Management Center

Window of Health

Zubizarreta House

Socio-Economic Factors

Adults with Developmental Disabilities Intern Program

Annual Pastoral Care Conference

Baldwin Wallace University MPH Program

Better Health Partnership

Boot Camp for New Dads

BREAST (Bringing Education, Advocacy and Support Together)/Amigas Program

Center for Reducing Health Disparities

Child Life and Education Hospital School Program

Community Advisory Councils

Community Advocacy Program (CAP)

Cuyahoga County Health Care Council

Cuyahoga County Public Library at MetroHealth Medical Center

Cuyahoga Health Access Partnership (CHAP)

Diversity Recruitment

Engage Quarrytown

Farm Stand

Food as Medicine

Food Service Training

Healthcare Anchor Network

Hearts Against Hunger

HIP-Cuyahoga

Holiday Grants

Library Cards for Newborns

Lincoln-West School of Science and Health

MetroHealth Research Institute

Navigating Your Care Patient Education Sessions

Northeast Ohio Transgender Job Fair

Open Table

Patient and Family Advisor Program

Reach Out and Read

Renee Jones Empowerment Center

St. Martin De Porres College Work Study Program

Survivor Recovery Resources

The Center for Health Affairs, Community Health Needs Assessment (CHNA) Roundtable

The MetroHealth Foundation

Voter Registration

WRAP (Wellness Reentry Assistance Program)

Lisa Ramirez, PhD

Psychologist

Founder, MetroHealth’s SAFE Project that helps kids cope with trauma

Trauma has become a regular part of life for many of our city’s children and the prevalence of anxiety and depression in local teens is on the rise. Dr. Lisa Ramirez, a psychologist for our School Health Program (SHP) in the Cleveland Metropolitan School District (CMSD), is tackling the effects of trauma head-on.

Acting out is common and toxic stress contributes to kids turning to smoking, drugs and alcohol. Lisa says, “We know that children who have ongoing adversity in the first 18 years of their lives are more likely to be adults with obesity, cancer, heart disease and strokes.”

Working with our Arts and Medicine program, Lisa began the SAFE (Students Are Free to Express) Project with high school students already involved in our SHP. This fall, she added SAFE for the pre-K level, knowing that earlier intervention is needed. Visual art, music, dancing, drum circles — they’re all ways to connect, destress and express.

”We provide an empathetic environment that is supportive, safe and fun,” explains Lisa. “We’re looking to help validate and normalize stressful experiences while talking about healthy ways to cope. We know that an antidote for adversity is meaningful relationships, and we promote that among the artists we bring in, teachers and our staff.”

Lisa looks hopeful as she says, “We’re trying to change the future health of these children by giving them an opportunity to just be children, and by hitting the pause button on the toxic stress process. We just might be able to help reduce some of the negative outcomes our children typically face.”

“We know that children who have ongoing adversity in the first 18 years of their lives are more likely to be adults with obesity, cancer, heart disease and strokes.”

Social Determinants of Health Addressed:
• Health Behavior
• Socio-Economic Factors

Justine H.

Graduate Student in Psychology and Criminal Law

Graduate of MetroHealth Trauma Recovery Center’s trauma-focused therapy

When you see Justine interacting with her 2½-year-old daughter, Jhani, you sense that Justine has a strong emotional foundation. She’s nurturing and enjoys hearing her daughter precociously sing her ABCs perfectly.

It’s not obvious that Justine is recovering from anxiety and PTSD, the remnants of an abusive relationship. Justine describes her former boyfriend as manipulative, controlling and sexually abusive. He stalked her and during one episode of anger he smashed some of the contents of her home, tore down curtains and dumped out dresser drawers. She called the police, ended the relationship and says, “I was terrified, my judgment was clouded and I had lost confidence. I knew I needed assistance with coping.” She contacted MetroHealth’s Trauma Recovery Center. A year of one-on-one therapy and the Trauma Recovery Center’s sessions on cognitive processing therapy for PTSD helped Justine acknowledge and interpret her feelings and become more resilient.

She also was invited to be at the center of a MetroHealth Open Table. Six volunteers meet once a week with Justine to provide a network of support and advice. They have helped her access resources and are always available by phone call or text to answer a question or even read her 16-page paper for her Law and Society course.

Justine is juggling a lot. She’s a single mom with a full-time job, school studies and the drive to eventually work with people who have experienced trauma. “I’m still a work in progress, but I don’t think I would have been able to get this far without the help of MetroHealth.”

Justine with her Open Table

“I’m still a work in progress, but I don’t think I would have been able to get this far without the help of MetroHealth.”

Social Determinants of Health Addressed:
• Physical Environment
• Health Behavior
• Socio-Economic Factors

Oliver Schirokauer, PhD, MD

Assistant Professor, Bioethics, Case Western Reserve University School of Medicine

Medical Facilitator who assists seriously ill patients with their health care journeys and decisions

How — or why — would somebody leave a tenured job as a math professor at Oberlin College to become a medical student, at age 47?

Dr. Oliver Schirokauer had his reasons. Multiple family members had grappled with cancer diagnoses, unfamiliar medical information and difficult decisions about their care. Oliver recognized how useful it would have been to have someone with medical experience help make sense of everything that was happening, and he decided he could try to be that someone for other families.

As a medical facilitator, Oliver meets with our family medicine team to identify hospitalized patients with a new diagnosis of a major illness, who can benefit from extra support during their follow-up care and who are interested in that help.

For outpatient appointments, Oliver and the patient meet in the lobby, chat in the waiting room and go together to the appointment. Oliver explains, “I’m not there to prescribe something or to design a course of treatment. I’m really there to pay attention for them.” After the appointment, he goes over what the caregiver said, answers the patient’s questions and generally is a calming force. Oliver says, “I sort of see myself as a repository of information for the patient, to be accessed when it works for the patient.”

Employed in our Center for Biomedical Ethics, Oliver is also involved in research and our clinical ethics consultation service. His vision of being a medical facilitator brought him to medicine and as the husband of one patient said, “I’m glad you’re here. It helps us take the next step.” Reflecting on this comment, Oliver notes, “This is my goal, what I want to be doing.”

“I sort of see myself as a repository of information for the patient, to be accessed when it works for the patient.”

Social Determinants of Health Addressed:
• Health Behavior
• Socio-Economic Factors

Endia R.

Graduating Senior, Lincoln-West School of Science and Health

Fall 2019 scholarship student in nursing at Cleveland State University

Since 10th grade, Endia has never wavered; her goal is to be a flight nurse. Her eyes light up as she explains what for her was a transformative experience.

It was during her first year at Lincoln-West School of Science and Health, the school inside MetroHealth Medical Center, when her class visited our Metro Life Flight communications office. A family was in a terrible car crash and had to be airlifted to MetroHealth. Endia was immediately struck by how the teamwork of everyone involved — dispatchers, pilots and medical staff — was precise and made the most precarious situation look routine. She says, “You could see how much they wanted to help people in need, and I want to do that.” That’s why she plans to study nursing.

The youngest of eight children, Endia is the first in her family to go to college. Her father has been motivating her all along, suggesting opportunities that point toward college. She listened and says that her experience at Lincoln-West School of Science and Health clinched it. As she tells it, her teachers are encouraging and supportive, so much so that all 20 members of the 2019 class have been accepted to college.

And now that Cleveland is a “Say Yes to Education” city, Endia, as a Cleveland Metropolitan School District graduate, will go to college tuition-free. On top of that, her first two years of on-campus housing and student support services will be covered by the Parker Hannifin Foundation’s Parker Hannifin Living and Learning Community at CSU. Everything’s looking up for Endia.

“You could see how much they wanted to help people in need, and I want to do that.”

Social Determinants of Health Addressed:
• Health Behavior
• Socio-Economic Factors

Shannon K.

Newly Sober Member of the Community

Participant in MetroHealth’s WRAP (Wellness Reentry Assistance Program) that provides physical/mental health and addiction services for current and former Cuyahoga County inmates with mental illness

“The day I got arrested is the day that began the rest of my life,” says Shannon. Her childhood had been one of mental and verbal abuse, and pregnancy and marriage at 17. She was using cocaine and ecstasy at 19 and graduated to hard liquor along with drugs. Sometimes she was homeless. Years of being addicted to crystal meth led to sleepless nights and a suicide attempt.

Looking back through more than a year of sobriety, Shannon, age 38, says getting arrested for forgery and possession of drugs saved her life. After six days in jail, she was told about WRAP, our program to connect people with mental health services and the support needed to successfully reenter society.

Dr. Ewald Horwath, Chair of MetroHealth’s Department of Psychiatry and founder of our WRAP program explains, “If you treat the problem as an illness rather than a moral failing, I think that’s what helps people.” With Intensive Outpatient Treatment, Shannon says she learned a lot about herself and how to handle her depression, anxiety, PTSD and ADHD.

Shannon notes that the program coordinators, therapists and physicians treated her with respect. And the love that her registered nurse care coordinator showered on her went a long way. Shannon gets teary when she says, “They were there to love me until I was able to love myself.”

Because of her compliance with the WRAP program, Shannon’s arrest record is sealed and due to be expunged. She loves her full-time job and is taking college classes so she can enter management. This is the rest of her life.

Rashell Tallent, left, Shannon’s nurse care coordinator

“They were there to love me until I was able to love myself.”

Social Determinants of Health Addressed:
• Physical Environment
• Health Behavior
• Socio-Economic Factors

Forming

alliances

to meet our

aspirations

POWERFUL PARTNERSHIPS

Case Western Reserve University School of Medicine

As a teaching hospital, we have been associated with CWRU School of Medicine since 1914.

During this 104-year affiliation, we have trained thousands of physicians, many of them renowned in their fields throughout Cleveland and the world.

All of our active staff physicians hold faculty appointments at CWRU School of Medicine.

Our researchers work with CWRU in key areas of scientific discovery and biomedical technology.

In the last year, we trained:

  • 1,200 medical students and nurse practitioner, physician assistant, anesthesia assistant, bioethic, podiatry and informatics students
  • 600 residents/fellows rotating from other institutions
  • 395 MetroHealth residents/fellows

Recovery Resources

Late in 2018, we partnered with Recovery Resources to coordinate care for people affected by mental illness, alcoholism, trauma, drug addiction and other addictions.

MetroHealth Recovery Services offers an intensive, individualized outpatient program teaching the behavior and relationship skills needed to develop a positive, healthy lifestyle. Services include:

  • addiction management
  • stress and mood management
  • relationship issue management
  • coping with trauma and triggers

Urban Community School

In the summer of 2018, we signed a memorandum of understanding with Urban Community School (UCS) for a health center to be built by UCS on its Lorain Avenue campus. We will provide health care for UCS students and their families, UCS faculty, staff and their families, and the surrounding community.

Services will include:

  • pediatrics
  • primary care
  • behavioral health
  • Hispanic Culture Health Clinic
  • MetroExpressCare
  • other health and family support including for children affected by trauma

TRANSFORMATION update

Building on a foundation of trust, for all of us

How do you build a new 11-floor hospital, parking garages, upgraded buildings and lush green space while all else on a 52-acre campus hums with business as usual? With a methodical, integrated plan. Begun in 2014, progress through 2018 includes:

Demolition of Northcoast Behavioral Health

Addition of 85 intensive care rooms to the existing
Critical Care Pavilion

Construction of new
parking garage

Demolition of old parking garage

And, in April 2019 — Groundbreaking for the new hospital

Our Center for Campus Transformation, a large physical space in the lower level of the current hospital, provides a collaboration area for the multiple contractors and MetroHealth staff dedicated to the transformation. The team includes 26 local firms, with 10 being minority- or women-owned businesses.

The master plan, which is proceeding on schedule and on budget, efficiently choreographs the multi-faceted construction and staff relocation. Our new hospital is designed for patients and those directly involved in their care. Many of our employees who indirectly support hospital operations have already moved from our main hospital to other MetroHealth sites such as an office complex in Brooklyn Heights. This is ahead of the real need, but is all part of the long-term planning that promises a smooth transition.

See a video of the groundbreaking ceremony

“There will never be a day without available hospital care. The new hospital, situated south of the current hospital, will open in 2023, and patients will be transferred to many of the 270 airy, high-tech, private rooms.”

Following the opening of the new hospital, demolition of the old hospital will make way for parklike green space, a scarcity in the Clark-Fulton neighborhood.

Through the entire process, our Office of Sustainability will ensure that we are environmentally responsible. For example, they require our vendors to submit reports on where materials from construction and demolition go. Steel is recycled, and concrete is crushed and reused. Sustainable practices increase efficiency and promote the protection of all.

We are financing the new hospital with the $946 million in revenue bonds we issued in 2017. The MetroHealth Foundation’s $100 million fundraising campaign will support expanded green space and community programs. Our funding, along with our educational, social and economic investment in the West 25th Street Corridor, demonstrate a commitment to the entire neighborhood’s revitalization.

Unlike gentrification, which often squeezes out longtime residents, we are focused on lifting everyone. To this end, we established the first hospital-driven EcoDistrict in the world. By addressing social determinants of health — physical environment, health behaviors and socio-economic factors — EcoDistricts create secure, healthy and sustainable communities that are vibrant and fun. Partnering with public, private and community organizations, we are developing a resilient community where everyone has the opportunity to succeed.

FINANCES

Growing our means to meet our mission

EARNINGS*

$107.3 M

OPERATING INCOME**

$49.4 M

*Earnings before interest, depreciation and amortization, which excludes the non-cash actuarial pension and OPEB adjustment (GASB 68 & 75)
** Operating income, which excludes the non-cash actuarial pension and OPEB adjustment (GASB 68 & 75)

COMMUNITY BENEFIT

Maintaining our commitment

We’re investing in Cuyahoga County by addressing social determinants of health, increasing access to health care services and improving overall community health.

Our investment includes uncompensated care, financial assistance, 100+ community programs, education and research.

*MetroHealth community benefit calculation for the year ended 2018
**From American Hospital Association Tax-Exempt Hospitals’ Schedule H Community Benefit Reports (May 2019)

STATISTICAL HIGHLIGHTS

Serving in many ways

1,403,044

Patient Visits

25,943

Inpatient

1,231,740

Outpatient

145,361

Emergency Department*

2,979

Babies Delivered

3,967

Metro Life Flight Transports

1,152

Helicopter

2,815

Ground

4,641

Major Trauma Cases

* at our West 25th Street verified Level I Trauma and Burn Center, and our emergency departments in Brecksville, Cleveland Heights and Parma

EMPLOYEE GROWTH

Attracting expertise and providing opportunities

632

Physicians*

2,075

Nurses

395

Residents

4,629

All other employees

INCLUSION AND DIVERSITY

As an organization, we are committed to reflecting the diverse patient population and community we serve.

In 2018, of the 92.8% of hires who self-identified, 48.8% were racially/ethnically diverse.

*All MetroHealth active staff physicians are faculty of Case Western Reserve University School of Medicine.

Locations

Expanding to meet the needs

Beachwood Health Center

Bedford Medical Offices

Brecksville Health and Surgery Center

Broadview Heights Sports Medicine and Physical Therapy

Broadway Health Center

Brooklyn Health Center

Brunswick Health Center

Buckeye Health Center

MetroHealth Medical Center, Cleveland Heights

J. Glen Smith Health Center*

Lyndhurst Health Center

Medina Health Center, Reagan Parkway

MetroHealth Medical Center, Main Campus

Middleburg Heights November Family Health Center

MetroHealth Medical Center, Old Brooklyn

Parma Health Center

MetroHealth Medical Center, Parma

Rocky River Medical Offices

State Road Family Practice

Thomas F. McCafferty Health Center*

West 150th Health and Surgery Center

West Park Health Center

Westlake Health Center (at Crocker Park)

Emergency Dept.
Pharmacy

*Operating in partnership with city of Cleveland

Clinics at Discount Drug Mart

Independence
North Royalton
Olmsted Falls
Parma Heights

Other locations

Elisabeth Severance Prentiss Center (skilled nursing/rehabilitation)
West Shore YMCA (physical therapy)
Zubizarreta House (temporary housing for spinal-cord injury patients)

MetroHealth Recovery Resources

Midtown (3950 Chester Avenue)
Old Brooklyn (4269 Pearl Road)
Lakewood (14805 Detroit Avenue, Suite 200)

MetroExpressCare

Beachwood
Broadway
Middleburg Heights
West Park

Schools served by MetroHealth’s School Health Program

Anton Grdina School
Buhrer Dual Language Academy
Fullerton School of Academics
Garrett Morgan High School
Harvey Rice School
John Adams High School
Lincoln-West High School
Luis Munoz Marin School
Miles Park School
Mound-STEM School
Scranton School
Walton School
Willow School

For a listing of health centers and physicians nearest you, please visit metrohealth.org/locations

FOR ALL OF US.

MetroHealth is revolutionizing health care in Northeast Ohio in a way that no one else can, by serving as a catalyst for change.

We’re treating more than symptoms. We’re tackling root causes. We know that how and where people live have a direct impact not only on their physical health, but also on their emotional, social and financial well-being.

Our plan supports education, creates jobs, revitalizes neighborhoods and builds the regional economy.

The MetroHealth Foundation

Raised $43.4 million of $100 minimum goal, as of 12/31/18
When you donate to MetroHealth’s campaign (metrohealth.org/foundation/donate), you too will be a catalyst for change. You will help patients, neighbors, businesses and communities across our region thrive.

To see a list of donors, visit metrohealth.org/donor-honor-roll.