In this section:

Charity Care and Community Benefit

As a nonprofit health system, Texas Health provides at least 5% of net patient revenue back to the community in the form of charity care and community benefit to:

• Care for and treat uninsured and underinsured patients.
• Absorb medical costs not reimbursed by Medicare or Medicaid.
• Invest in community health initiatives through community benefit grants and sponsorships.
• Finance community health programs.
• Volunteer employees' time and resources to support important health-related causes.

2022 Highlights

Texas Health provided $874.3 million, or nearly $2.4 million a day, in charity care and community benefit.

Charity Care	2018	2019	2020	2021	2022
Patient charity care1	$236,707,341	$211,327,936	$217,351,474	$235,315,852	$213,465,155
Cost of unreimbursed government-sponsored indigent healthcare2	$75,195,476	$45,322,544	$45,527,596	$25,122,786	$3,984,843
Charity care provided through others	$2,504,837	$2,230,154	$2,179,823	$751,203	N/A
Subtotal Charity Care	$314,407,654	$258,880,634	$265,058,893	$261,189,841	$217,449,998
Other Community Benefit Care
Unreimbursed Medicare2	$484,601,553	$558,172,380	$435,724,253	$599,540,675	$595,850,222
Community Benefit3
(Community Health Improvement program, cash and in-kind donations, and value of employee volunteer hours)	$44,038,957	$59,958,216	$56,086,387	$66,326,031	$61,046,234
GRAND TOTAL	$843,048,164	$877,011,230	$756,869,533	$927,056,547	$874,346,454

¹ The cost of care provided to those who are financially or medically indigent.
² The difference between the treatment costs for these patients and government reimbursement.
³ Programs or activities that provide treatment or promote health and healing in response to identified community needs.

Texas Health Community Impact

Texas Health Community Impact brings together agencies from different sectors – education, healthcare and government – plus grassroots organizations and others to make measurable change in communities where social determinants contribute to poor overall health.

Grants are awarded annually to facilitate interventions that improve the well-being of under-resourced populations. Projects are evidence-based, rooted in community expertise and tailored to the local context and regional priorities. Five regional leadership councils comprised of community leaders oversee programs and investments in Texas Health’s service area, which have totaled $18.2 million since 2018.

In the 2021-2022 grant cycle, Texas Health awarded $5 million and began soliciting additional funding sources to broaden its impact in high-need areas. We will invest $8 million in 2023-2024 thanks to a $1.5 million gift from Communities Foundation of Texas’s W. W. Caruth, Jr. Fund and a match of an additional $1.5 million from the Texas Health Resources Foundation.

2022 Highlights

Texas Health:

• Served more than 9,000 residents and connected 5,000 individuals to needed services and resources through 12 grant-funded projects. While all have made positive differences, eight projects have demonstrated significant improvements in the priority areas of depression, anxiety, resiliency, food security and self-efficacy.
• Identified additional high-need communities through the 2022 Community Health Needs Assessment. Community Impact grants will now support people living in 32 ZIP codes, up from 23.
• Received D CEO’s Excellence in Healthcare Award for “Achievement in Community Outreach” for the improvements underserved communities are experiencing through programs funded by Community Impact grants.

Snapshot: Transforming Lives and Generations WATCH NOW: Texas Health Community Impact -- Texas Health Resources Texas Health Community Impact grants have improved lives in less than five years through critical support, services and programs throughout North Texas. The grants are healing generations of families impacted by trauma through education, resiliency training, job skills, mental and behavioral health support and more. In this compelling video, watch how Community Impact has brought together community agencies to create sustainable solutions that break the cycle of poverty and abuse, address health disparities and bring hope and empower individuals to live a better life.

Snapshot: THRIVE Program Puts At-Risk Students on Their Feet With many Sanger Independent School District (ISD) students struggling, Texas Health awarded Community Impact grants to implement the Together Harnessing Resources to give Individuals Voice and Empowerment (THRIVE) program. THRIVE is a collaborative project among Sanger ISD, First Refuge Ministries of Sanger, First Baptist Church of Sanger, New Life Church of Sanger and the City of Sanger. The program aims to teach children resiliency skills to help them overcome trauma and improve their physical and mental health while also giving students and their families access to healthy foods. Students receive resiliency training, job skills and support services, such as counseling and low-cost or free medical and behavioral healthcare. They also are empowered to navigate healthcare and social assistance services, which improves their self-efficacy skills. More than 2,500 students at the district’s seven campuses were screened for behavior challenges, with 156 referred to wrap-around services, including counseling. On average, resiliency scores increased by 16.7% and self-efficacy scores by 10.6% for students who participated in the program. Additionally, the program addresses food insecurity by offering fresh, healthy food for students, their families and the surrounding community through school-based food pantries. Students run the stores themselves and purchase goods with points earned by performing good deeds or exhibiting kind or resilient behaviors. Through a community garden called Community Strong Farms, produce is grown to supply the school stores and other community food banks. THRIVE uses a food truck to deliver meals each month to impoverished neighborhoods and promotes its services and resources to reach more isolated populations. The First Refuge food pantries and Linda Tutt High School grocery store have served more than 500 families. Due to THRIVE’s success, the Texas Health Resources Foundation has been working to raise $2.6 million to expand the program to 10 new locations throughout North Texas by 2025. Other corporations, foundations and individuals have also provided funding, already raising more than $1.64 million to support the goal. “We’ve had several students that were on a trajectory to possibly end up homeless, addicted or with severe mental health, needing hospitalization,” said a THRIVE team member. “Through access to these services, some students have totally changed their lives.”

Wellness for Life Mobile Health Program

Texas Health's Wellness for Life mobile health units have delivered essential healthcare services at places of worship, schools, grocery stores, community centers and public parks to reach medically underserved communities for nearly 30 years.

Our family nurse practitioners, registered nurses and mammography technologists provide cancer prevention and early detection services, teach evidence-based practices and deliver vaccinations. Since the program’s inception, Wellness for Life has completed 111,317 mammograms and 18,334 wellness exams, helping to detect 143 breast cancers and 1,238 people with pre-diabetes. Clinicians also conducted 5,491 cardiovascular risk assessments and directed 82 individuals to HELP, our chronic disease management program that started in 2019.

To expand our impact in high-need communities, we collaborate with other organizations and provide mobile units at events hosted by BarbaraCares, which provides free mammogram screenings; Cancer Care Services, which provides free cancer support; and the City of Fort Worth, which hosts wellness fairs. These are funded through grants and sponsorships.

Our long-term presence in these neighborhoods has given staff insight into cultural barriers that commonly impede care delivery. We have learned that culturally and ethnically diverse program staff are essential to creating a welcoming environment and making long-term lifestyle changes possible. By fostering trusting relationships, they put individuals at ease and provide services where they are needed most.

One mobile health patient said it best: "Thanks to you, I can have day-to-day tranquility in my life so that I can focus on offering the best of me to my family."

2022 Highlights

Texas Health:

• Improved access to care by delivering healthcare services to 2,242 community members. Of those served, 80.8% reported a high satisfaction score.
• Conducted 2,099 screening mammograms, reaching 98% of eligible females. Of those with an abnormal result, 80.6% visited a Texas Health facility for a diagnostic procedure. We also completed 478 cervical exams, reaching 93.4% of females eligible for them.
• Administered 1,217 COVID-19 vaccine doses.
• Distributed 171 colon cancer screening kits, reaching 31.9% of eligible adults.
• Received a $75,000 sponsorship from North Texas Ford Dealers, allowing Wellness for Life to hold 24 community health events across nine counties in 2022 and 2023.

Health to Home

Texas Health Presbyterian Hospital Dallas and Austin Street Center (one of the largest homeless shelters in Dallas) have been operating a medical respite program that supports unhoused individuals with acute medical and behavioral health needs since 2020. The Health to Home initiative provides medical, behavioral health and wrap-around social services. Once individuals regain their health, they receive food, shelter, clothing, transportation, job assistance and career training to help them get back on their feet.

The two organizations recently joined forces to offer other homeless individuals employment opportunities at the hospital. New hires receive transportation assistance from Austin Street to get to and from work. Both the shelter and Texas Health help supply new employees with uniforms needed for work. This removes yet another barrier for those seeking a better, healthier life.

Due to the high number of people facing housing insecurity in Dallas, Texas Health and Austin Street leaders invited other North Texas health systems to participate in the program to broaden the impact and ensure long-term sustainability. The Texas Health Resources Foundation, American Rescue Plan Act and other community sponsors currently fund the program. Securing additional donors will lift up even more unhoused individuals, preserving their independence and dignity while saving significant money on reactive healthcare and social services.

2022 Highlights

Texas Health:

• Enrolled 70 people and housed 21, meeting 93.3% of the program target for the year. Of these, 68 received case management services, 43 were navigated to transportation services, 21 were connected to a primary care provider/patient-centered medical home and 17 received behavioral health services.
• Expanded capacity at Austin Street Center from nine to 27 beds and began taking in women.
• Delivered job training to 12 participants and hired 10 to work for Texas Health Presbyterian Hospital Dallas.
• Saved approximately $2.35 in healthcare dollars for every $1 spent to implement the program. Giving homeless patients a safe place to recover reduces their chances of infection or other poor outcomes that would most likely lead to readmission to the hospital or frequent emergency department visits.

Sexual Assault Nurse Examiner (SANE) Program

Texas Health’s SANE program offers private forensic examination suites and trained, compassionate nurses who collect forensic evidence to aid in prosecuting sexual assault perpetrators. Program staff also:

• Deliver in-person and virtual education, training and professional development services related to sexual assault and abuse to medical services and fire departments, law enforcement agencies, child advocacy organizations, educational institutions and others.
• Guide county leaders in building sexual assault response teams and developing interagency efforts to provide wrap-around support services for sexual assault victims.
• Monitor pediatric SANE certification standards and train nurse examiners to examine children compassionately and effectively.
• Build awareness of recognizing, treating and preventing sexual assault and domestic violence using publicity, radio and social media.

2022 Highlights

Texas Health:

• Cared for and treated 881 sexual assault victims.
• Delivered 26 sexual violence prevention training programs to 923 community stakeholders.
• Helped establish sexual assault response teams to serve people in Dallas, Denton, Johnson and Kaufman counties. This was in response to a new law designed to create statewide resources, awareness, connection and coordination to address sex crimes locally.
• Certified nine new pediatric SANE examiners, enabling us to expand services to Kaufman and Erath counties and treat 89 children during the year.
• Continued exploring ways to increase retention of SANE staff, who suffer indirect trauma and emotional stress from serving victims and their families when needed.

YES Dallas Initiative

The Youth Engagement in Sports (YES) Dallas Initiative was designed to help underprivileged and ethnic minority youth living in one of the highest-need communities in North Texas adopt and sustain healthy lifestyle behaviors and reduce chronic disease. The U.S. Department of Health and Human Services’ Office of Women’s Health funded the $800,000 program in late 2019 as part of its federal YES Initiative, designed to increase youth participation in sports and reduce barriers to play in high-need communities across the nation.

The program’s objectives were to:

• Reduce barriers to play and increase participation in sports for 6th to 8th-grade students, particularly girls.
• Encourage healthier eating by delivering evidence-based nutrition education to participants and their families.
• Promote long-term health by establishing a community-based intervention model that introduces high-school students to careers in sports medicine.

Since the program launched, 407 students have participated in in-person, virtual and outdoor activities or served in the control group. Additionally, 16 high school students participated in a year-long internship to learn how to assist neighbors with minor health issues and boost their employment potential in such careers as athletic training, physical therapy, nutrition and kinesiotherapy.

Program Highlights

By the program’s completion in September 2022, the participants:

• Increased self-efficacy by 13% and self-confidence by 2%.
• Increased the number of days youth were physically active for at least 60 minutes by 6.3%.
• Increased girls’ participation in sports programs by 4.4%.
• Reduced consumption of sugar-sweetened beverages by 3.8%.

Additionally, it helped encourage nine high school graduates to enroll in college health sciences programs. Many of these students are the first in their families to pursue higher education.

Reduce Social Isolation and Lift Outcomes for Seniors (Reduce SILOS)

Research studies over the past decade have shown that social isolation and loneliness can be just as much of a threat to longevity as obesity or smoking 15 cigarettes a day. Through funding awarded to Texas Health by AARP Foundation in 2020, the system offers a free connection program for low-income, socially isolated hospital patients ages 50 and older.

Participants are paired with a community health worker, who connects them to resources, programs and events based on their interests. These activities are designed to reduce isolation and address other social determinants of health concerns over 12 months. Along with initial baseline screening, participants are re-screened at three, six and 12 months to determine their risk for social isolation.

Early in 2022, the program expanded from eight Tarrant County ZIP codes to 13 and one ZIP code within Parker County, reaching 14 ZIP codes. Baseline measures found that 51% of participants reported high social disconnectedness and 41% reported severe depression.

We plan to offer the program in 2023 to Texas Health Physicians Group patients who live in one of the 14 ZIP codes and meet age and financial criteria. They will be screened during clinic visits and those who qualify will receive Reduce SILOS information in their after-visit summary materials. A community health worker will also contact them to encourage participation in the program.

2022 Highlights

Texas Health:

• Identified and screened 1,760 adults ages 50 and over, exceeding our goal of engaging 1,000 individuals. Of those screened, 22.6% asked Texas Health to contact them about social engagement services that can improve their emotional well-being.
• Increased the program’s reach from an average of two older adults per month to more than 150.
• Improved participant outcomes, with 75% reducing social disconnectedness, 45% reducing depression and 67.5% improving social support.

Continuum of Care

Staying healthy can be limited by the lack of resources where people work, live, learn, pray and play. Because social determinants of health (SDoH) factors can significantly impact a person’s ability to live a healthy life, Texas Health implemented a Continuum of Care program. Funded partially through grants, the program is offered free of charge to uninsured and underinsured patients at risk for hospital readmission or who have chronic diseases.

Over a period of up to six months, community health workers (CHWs) meet with participants to identify their needs and connect them to healthcare, social services and resources that remove their barriers to better health. Hired from local communities, the certified health workers understand these patients' cultural and socioeconomic challenges, strengthening trust and support.

The program had a soft launch early in 2022 at Texas Health Arlington Memorial Hospital and a broader rollout to three other Texas Health hospitals mid-year. Since it began, the CHWs have been helping individuals address their key barriers to care, identified as primary care, patient-centered medical homes, housing stability, food, navigating healthcare, prescription assistance and health insurance. We plan to expand the program to other Texas Health hospitals and patients participating in the Texas Health Care at Home program in 2023.

2022 Highlights

Texas Health:

• Launched and expanded the Continuum of Care program to four hospitals, supporting 115 individuals. Of those, 87% were uninsured or self-pay, 86.1% had no primary care provider or medical home and 60% resided in high-need ZIP codes. More than 52% of patients served were Latino, 23% were White and 23% were Black. Most patients were 40-59 years of age and 53.2% were female.

Faith Community Nursing and Health Promotion

Texas Health's Faith Community Nursing and Health Promotion program provides education, resources and tools to equip faith community nurses (FCNs) and health promoters (HPs) to lead health ministries and care for the community through faith settings.

FCNs assist members with maintaining or regaining wholeness in body, mind and spirit by bringing together the clinical and spiritual aspects of healing. They partner with faith communities to provide health-related programs tailored to meet the needs of members and the surrounding neighborhood. Nurses who serve in the role have an active nursing license and at least two years of experience.

HPs are nonclinical professionals who help develop and implement health-related programs that meet a congregation's unique needs. Together, they bring essential care and support to high-risk communities, from conducting health screenings, delivering flu and COVID-19 vaccinations, and hosting educational events on mental health, diabetes, Alzheimer's and more.

2022 Highlights

Texas Health:

• Engaged and supported members of 116 North Texas faith communities, reaching 103,118 people. Of those served, individuals gained access to services to prevent chronic disease, manage behavioral health, and advance health literacy and navigation that address health disparities. This effort improved health outcomes and avoided healthcare costs of nearly $2.6 million.
• Shared education and resources at 2,416 events, providing people with information and support for behavioral health, health literacy and navigation; health screenings; vaccinations; chronic disease management; social determinants of health and more.
• Administered 4,217 flu vaccines at 94 community, faith-based and school clinics with the help of students from seven nursing schools.

Community Health Ministry

Texas Health’s Community Health Ministry strategy is designed to align the system’s resources and tools with communities of faith and other community health and social service organizations to advance health equity in underserved communities. Its priorities are to:

• Equip faith communities with tools and resources that support holistic care for the priorities identified by their members and communities.
• Connect faith communities to programs and resources that eliminate silos and drive a coordinated approach to health improvement.
• Advance innovative programming and research around faith-based interventions that improve individual and community well-being.
• Leverage Texas Health’s advocacy and community engagement activities to support the needs of faith communities.

2022 Highlights

Texas Health:

• Conducted surveys and consulted with faith communities across our 16-county service area. We learned that additional resources and support were needed for mental health, suicide awareness, chronic disease management and cancer care. In 2023, we will focus on capacity building, addressing key faith community needs, deploying community health workers to congregations and offering additional resources through Texas Health’s Community Health Ministry website.

Recognitions

National and state authorities have recognized Texas Health for community health improvement grants and programs, Blue Zones Project Fort Worth initiatives and charitable giving.

2022 Highlights

Texas Health received:

• The American Hospital Association’s Foster G. McGaw Prize for Excellence in Community Service. 
• The Texas Hospital Association’s Excellence in Community Service Award.
• The 2030 Healthy People Champion designation by the Office of Disease Prevention and Health Promotion within the U.S. Department of Health and Human Services.
• Inclusion in PEOPLE magazine’s and Great Place to Work® 2022 Companies That Care®.

Snapshot: System Selected as Healthy People 2030 Champion Texas Health was selected as a Healthy People 2030 Champion by the Office of Disease Prevention and Health Promotion within the U.S. Department of Health and Human Services. As a Healthy People 2030 Champion, Texas Health has demonstrated a commitment to helping achieve Healthy People 2030’s vision of a society where all people can reach their full potential for health and well-being across their lifespans. “One of the greatest threats to an individual’s health and well-being is having inequitable access to quality healthcare,” said Catherine Oliveros, DrPH, Texas Health's vice president of Community Health Improvement. “We work towards improving poor health outcomes by seeking to meet people where they live, work, play and pray.”