Schedule H, Part IV, Line 1(a) - Name of Entity
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Bloomington Endoscopy Center, LLC
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Schedule H, Part IV, Line 2(a) - Name of Entity
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SIRA Imaging Center, LLC
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Schedule H, Part IV, Line 3(a) - Name of Entity
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Southern Indiana Surgery Center, LLC
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Schedule H, Part I, Line 3c - Other Factors Used in Determining Elig.
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IU Health Bloomington uses several factors other than Federal Poverty Guidelines ("FPGs") in determining eligibility for free or discounted care under its FAP. These factors include the following: 1. Indiana Residency Requirement IU Health Bloomington only makes Financial Assistance available to residents of the State of Indiana. IU Health Bloomington employs the same residency test as set forth in Indiana Code 6-3-1-12 to define as resident any individual who was domiciled in Indiana during the taxable year, or any individual who maintains a permanent place of residence in this state and spends more than one hundred eighty-three (183) days of the taxable year in Indiana. 2. Alternate Sources of Assistance When technically feasible, patients must exhaust all other state and federal assistance programs prior to receiving an award from IU Health Bloomington's Financial Assistance Program. Patients who may be eligible for coverage under an applicable insurance policy, including, but not limited to, health, automobile, and homeowner's, must exhaust all insurance benefits prior to receiving an award form IU Health Bloomington's Financial Assistance Program. This includes patients covered under their own policy and those who may be entitled to benefits from a third-party policy. Patients may be asked to show proof that such a claim was properly submitted to their insurance provider at the request of IU Health Bloomington. Eligible patients who receive medical care from IU Health Bloomington as a result of an injury proximately caused by a third party, and later receive a monetary settlement or award from said third party, may receive Financial Assistance for any outstanding balance not covered by the settlement or award to which IU Health Bloomington is entitled. Said patients may be asked to complete a financial assistance application. 3. Presumptive Financial Assistance Eligibility Patients who are deemed to be presumptively eligible for Financial Assistance will receive a Financial Adjustment to their final statement balance based on the patient's individual scoring criteria. Patients are considered to be presumptively eligible if the financial need has been determined by the following third parties: Eskenazi Health, formerly Wishard Memorial Hospital, Project Health, Indiana Children's Special Health Care Services, Medicaid, Out-of-State Medicaid, Healthy Indiana Plan, or Volunteers in Medicine. Patients may also be considered presumptively eligible if they are pending Medicaid approval or have a hospital bill with a maximum balance to be determined by the Financial Assistance Committee and who meet certain risk segmentation scoring criteria. 4. Additional Considerations Financial Assistance may be granted to a deceased patient's account if said patient is found to have no estate. IU Health Bloomington will deny or revoke Financial Assistance for any patient or guarantor who falsifies any portion of a Financial Assistance Application. A patient's income and/or ability to pay may be taken into consideration in the calculation of a financial assistance award. 5. Patient Assets IU Health Bloomington will consider patient Assets in the calculation of a patient's true financial burden. A patient's primary residence and one (1) motor vehicle will be exempted from consideration in most cases. IU Health Bloomington will apply the definitions set for in Indiana Administrative Code 405 IAC 2-3-15 to define a patient's primary residence and motor vehicle. A patient's primary residence is defined as the patient's principal place of residence. The patient's primary residence will be excluded from a patient's extraordinary asset calculation so long as the patient's equity is less than five-hundred thousand dollars ($500,000) and the home is not occupied by the patient's spouse or child under twenty-one (21) years of age. One (1) motor vehicle, regardless of its fair market value, may be excluded in limited circumstances defined in Indiana Administrative Code 405 IAC 2-3-15(d)(6). IU Health Bloomington reserves the right to adjust a patient's Federal Poverty Level ("FPL") if the patient demonstrates a claim or clear title to any extraordinary Asset not excluded from consideration under the above guidance. IU Health Bloomington will not seek the title to discovered Assets without the express authorization of the Financial Assistance Committee.
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Schedule H, Part I, Line 6a - C.B. Report Prepared by a Related Org.
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IU Health Bloomington's community benefit and other investments, encompassing its total community investment, are included in the IU Health Community Benefit Report which is prepared on behalf of and includes IU Health and its related hospital entities in the State of Indiana. The IU Health Community Benefit Report is made available to the public on IU Health's website at http://iuhealth.org/communitybenefit/. The IU Health Community Benefit Report is also distributed to numerous key organizations throughout the State of Indiana in order to broadly share the IU Health Statewide System's community benefit efforts. It is also available by request through the Indiana State Department of Health or IU Health.
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Schedule H, Part I, Line 7, Column (c) - Total Community Benefit Expense
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Schedule H, Part I, Line 7, Column (f), Percent of Total Expense, is based on column (e) Net Community Benefit Expense. The percent of total expense based on column (c) Total Community Benefit Expense, which excludes direct offsetting revenue, is 25.62%.
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Schedule H, Part I, Line 7, Column (f) - Percent of Total Expense
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The amount of bad debt expense subtracted for purposes of calculating the percentage of total expense on Line 7, column (f) is $23,662,889.
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Schedule H, Part I, Line 7g - Subsidized Health Services
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IU Health Bloomington does not include any costs associated with physician clinics as subsidized health services.
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Schedule H, Part II - Promotion of Health in Communities Served
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IU Health Bloomington is part of the IU Health Statewide System. The IU Health Statewide System participates in a variety of community-building activities that address the social determinants of health in the communities it serves through investments in economic development efforts across the state, collaboration with like-minded organizations through coalitions that address key issues, and advocacy for improvements in the health status of vulnerable populations. This includes making contributions to community-building activities by providing investments and resources to local community initiatives that addressed economic development, community support and workforce development. Several examples include IU Health's support of the following organizations and initiatives that focus on some of the root causes of health issues, such as lack of education, employment and poverty: - Indianapolis Public Schools - Starfish Initiative - Early Learning Indiana - United Way Additionally, through the IU Health Statewide System's team member community benefit service program, "Strength That Cares", team members across the state make a difference in the lives of thousands of Hoosiers every year. For example, in 2014, almost 2,200 team members from IU Health worked together to create trails, install outdoor fitness equipment and beautify parks.
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Schedule H, Part III, Line 2 - Bad Debt Expense Methodology
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The amount reported on line 2 as bad debt is reported at cost, as calculated using the cost to charge ratio methodology.
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Schedule H, Part III, Line 4 - Bad Debt Expense
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IU Health Bloomington is a subsidiary in the consolidated financial statements of IU Health. IU Health's bad debt expense footnote is as follows: The provision for uncollected patient accounts, for all payors, is recognized when services are provided based upon management's assessment of historical and expected net collections, taking into consideration business and economic conditions, changes and trends in health care coverage and other collection indicators. Periodically, management assesses the adequacy of the allowance for uncollectible accounts based upon accounts receivable payor composition and aging, the significance of individual payors to outstanding accounts receivable balances, and historical write-off experience by payor category, as adjusted for collection indicators. The results of this review are then used to make any modifications to the provision for uncollected accounts and the allowance for uncollectible accounts. In addition, IU Health follows established guidelines for placing certain past due patient balances with collection agencies. Patient accounts that are uncollected, including those placed with collection agencies, are initially charged against the allowance for uncollectible accounts in accordance with collection policies of IU Health and, in certain cases, are reclassified to charity care if deemed to otherwise meet financial assistance policies of IU Health.
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Schedule H, Part III, Line 8 - Medicare Shortfall
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The amount reported on Schedule H, Part III, Line 6 is calculated, in accordance with the Form 990 instructions, using "allowable costs" from the IU Health Bloomington Medicare Cost Report. "Allowable costs" for Medicare Cost Report purposes, however, are not reflective of all costs associated with IU Health Bloomington's participation in Medicare programs. For example, the Medicare Cost Report excludes certain costs such as billed physician services, the costs of Medicare Parts C and D, fee schedule reimbursed services, and durable medical equipment services. Inclusion of all costs associated with IU Health Bloomington's participation in Medicare programs would significantly increase the Medicare shortfall reported on Schedule H, Part III, Line 7. IU Health Bloomington's Medicare shortfall is attributable to reimbursements that are less than the cost of providing patient care and services to Medicare beneficiaries and does not include any amounts that result from inefficiencies or poor management. IU Health Bloomington accepts all Medicare patients knowing that there may be shortfalls; therefore it has taken the position that any shortfall should be counted as part of its community benefit. Additionally, it is implied in Internal Revenue Service Revenue Ruling 69-545 that treating Medicare patients is a community benefit. Revenue Ruling 69-545, which established the community benefit standard for nonprofit hospitals, states that if a hospital serves patients with governmental health benefits, including Medicare, then this is an indication that the hospital operates to promote the health of the community.
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Schedule H, Part III, Line 9b - Written Debt Collection Policy
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IU Health Bloomington's FAP and Bad Debt Referral Policy describe the collection practices applicable to patients, including those who may qualify for financial assistance. 1. Financial Assistance Application Patients or their guarantors wishing to apply for Financial Assistance must submit a Financial Assistance Application within twenty-one (21) days of receiving their first billing statement from IU Health Bloomington. Individuals other than the patient, such as the patient's physician, family members, community or religious groups, social services or hospital personnel may request a Financial Assistance Application to be mailed to a patient's primary mailing address free of charge. IU Health Bloomington keeps all applications and supporting documentation confidential. 2. Eligibility Determination IU Health Bloomington informs patients or guarantors of the results of their application by providing the patient or guarantor with a Financial Assistance Determination within ninety (90) days of receiving a completed Application and all requested documentation. If a patient or guarantor is granted less than full assistance and the patient or guarantor provides additional information for reconsideration, Revenue Cycle Services may amend a prior Financial Assistance Determination. If a patient or guarantor seeks to appeal the Financial Assistance Determination further, a written request may be submitted, along with the supporting documentation, to the Financial Assistance Committee for additional review/reconsideration. All decisions of the Financial Assistance Committee are final. A patient's Financial Assistance Application and eligibility determination will remain in effect for three-hundred-sixty-five (365) days from the date of receipt of a completed application. 3. Extraordinary Collection Actions IU Health Bloomington only implements its "Bad Debt Referral Policy" or other Extraordinary Collection Action after it has made reasonable efforts to determine whether the patient account is eligible for assistance under its FAP. When it is necessary to engage in such action, IU Health Bloomington, and its contracted third parties, will engage in fair, respectful and transparent collections activities. Patients or guarantors who have not applied for Financial Assistance and whose accounts have been engaged in Extraordinary Collection Actions may request Financial Assistance, complete an Application with requested documentation, and be considered for a reduction in their bill if it is within the two-hundred-forty (240) days of receiving their first billing statement. IU Health Bloomington may also suspend collection activity on an account while an Application is being processed and considered. IU Health Bloomington and its collection agencies will not provide assistance after an account has entered into legal proceedings without first obtaining written consent from its Financial Assistance Committee. The award of Financial Assistance may be subject to successful completion of a payment plan. In the event a patient or guarantor who is receiving Financial Assistance fails to complete the terms of their payment plan, IU Health Bloomington reserves the right to submit the unadjusted account balance, less any amount previously paid by the patient, to an Extraordinary Collection Action.
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Schedule H, Part VI, Line 2 - Needs Assessment
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Communities are multifaceted and so are their health needs. IU Health Bloomington understands that the health of individuals and communities are shaped by various social and environmental factors, along with health behaviors and additional influences. IU Health Bloomington assesses the health care needs of the communities it serves by conducting a CHNA. This assessment includes collaboration with other community organizations such as the Bloomington County Health Department, the Indiana State Department of Health, the Centers for Disease Control and Prevention and the United Way of Central Indiana. After completion of the CHNA, IU Health Bloomington reviewed the information gathered from community leader focus groups, community input surveys and statistical data. The needs identified were analyzed and ranked using the Hanlon method of prioritization to determine the prevalence and severity of community health needs and which ones were most critical. Additionally, the effectiveness of an intervention for each need and IU Health Bloomington's ability to impact positive change was evaluated.
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Schedule H, Part VI, Line 3 - Patient Education of Eligibility for Assist.
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IU Health Bloomington is committed to serving the healthcare needs of all of its patients regardless of their ability to pay for such services. To assist in meeting those needs, IU Health Bloomington has adopted a Financial Assistance Policy that provides Financial Assistance to eligible patients receiving Emergency or Medically-Necessary Services. This policy was developed and is utilized to determine a patient's financial ability to pay for services. IU Health Bloomington goes to great lengths to publicize its financial assistance policy and ensure that patients know they will be treated regardless of their ability to pay. IU Health Bloomington shares financial assistance information with patients throughout their entire episode of care and beyond including the admissions process, billing process, and online. 1. Admissions Process IU Health Bloomington educates all patient facing team members on its Financial Assistance Policy and the process for referring patients to the program. During the admissions process, opportunities for financial assistance are discussed with patients who are identified as self-pay (uninsured) or if they request assistance information. The patient is also provided with an Admissions Packet that outlines information regarding IU Health Bloomington's financial assistance program. Financial counselors are onsite to assist with financial concerns or questions during the patient's stay. Patient Financial Services Customer Service representatives are also available after the patient's stay to help patients apply for financial assistance, understand their bills, explain what they can expect during the billing process, accept payment (if needed), update their insurance or payor information, and update their address or other demographic information. 2. Billing Process IU Health Bloomington includes a plain language summary of its Financial Assistance Policy with all patient bills and statements of services. The plain language summary includes contact information allowing patients the ability to request financial assistance. Additionally, a Financial Assistance Application is mailed to all IU Health Bloomington patients with a patient balance due after insurance. IU Health Revenue Cycle Services representatives are available via telephone Monday through Friday, excluding major holidays, from 8 a.m. to 7 p.m. (Eastern Time) to address questions related to Financial Assistance. Customer Service team members will also mail paper applications to a patient at their request. 3. Online IU Health Bloomington's Financial Assistance Policy and Financial Assistance Application is available on its website at http://iuhealth.org/patients/my-iu-health/billing-services/financial-assis tance/. The website also includes contact information for customer service representatives to assist with the application process.
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Schedule H, Part VI, Line 4 - Community Information
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IU Health Bloomington is located in Monroe County, Indiana, a county located in south central Indiana. Monroe County includes ZIP codes within the towns of Bloomington, Ellettsville, and Unionville. Based on the most recent Census Bureau (2010) statistics, Monroe County's population is 137,974 persons with approximately 50% being female and 50% male. The county's population estimates by race are 85.8% White, 3.1% Hispanic or Latino, 3.4% Black, 5.6% Asian, 0.3% American Indian or Alaska Native, and 2.3% persons reporting two or more races. Monroe County has relatively high levels of educational attainment, as compared to other Indiana counties. Almost half of the population had an associate's, bachelor's or graduate/professional degree, a percentage that has increased slightly since 2000 (44.5% to 48%). An additional 18.8% had some college, but no degree. As of 2010, 24.3% of the population was a high school graduate or equivalent; however, this percentage has decreased by 1.9% since 2000. 35.8% of the IU Health Bloomington inpatient discharge population resides in Monroe County. 38% of community discharges were for patients with Medicare, 36% were for patients with commercial insurance, 18% were for patients with Medicaid, 7% were for self-pay (uninsured patients), and 1% was for other.
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Schedule H, Part VI, Line 5 - Promotion of Community Health
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IU Health Bloomington's promotion of community health included the following highlight: IU Health Bloomington continued outreach through the Get Onboard Active Living (G.O.A.L.) program. This family-focused community initiative targets childhood obesity by helping children and families live healthier lives. In addition, IU Health Bloomington's after-school program, G.O.A.L. University, was offered in 14 elementary schools in 2014, reaching more than 425 children in the Bloomington area.
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Schedule H, Part VI, Line 6 - Affiliated Health Care System
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IU Health Bloomington is part of the IU Health Statewide System. The IU Health Statewide System is Indiana's most comprehensive healthcare system. A unique partnership with the IU School of Medicine, one of the nation's leading medical schools, gives patients access to innovative treatments and therapies. IU Health is comprised of hospitals, physicians and allied services dedicated to providing preeminent care throughout Indiana and beyond. National Recognition - Six hospitals designated as Magnet by the American Nurses Credentialing Center recognizing excellence in nursing care. - Named to the 2013-2014 U.S. News & World Report's Best Hospitals Honor Roll, their highest distinction. - Eleven adult clinical programs ranked among the top 50 national programs in U.S. News & World Report - Ten pediatric clinical programs ranked among the top 50 national programs in the U.S. News & World Report Education and Research As an academic health center, IU Health works in partnership with the IU School of Medicine to train physicians, blending breakthrough research and treatments with the highest quality of patient care. Research conducted by IU School of Medicine faculty gives IU Health physicians and patients access to the most leading-edge and comprehensive treatment options. Collaborative Strategic Research Initiative Conceived by IU Health and the IU School of Medicine in 2012, the Strategic Research Initiative aims to enhance the institutions' joint capabilities in fundamental scientific investigation, translational research and clinical trials targeting innovative treatments for disease. The two organizations committed to invest $150 million over five years to this new research collaboration. Established in 2013, the Center for Innovation and Implementation Science is partially supported by the Strategic Research Initiative. The new center, launched by the IU School of Medicine and the Indiana Clinical and Translational Sciences Institute, focuses on increasing efficacy and reducing costs at IU Health. With oversight of four specialized research and discovery units managed by IU School of Medicine researchers, the center will address problems with the potential to reduce costs or generate new revenue estimated at $5 million per year or more. IU Health Statewide System IU Health is a part of the IU Health Statewide System which continues to broaden its reach and positive impact throughout the state of Indiana. IU Health is Indiana's most comprehensive academic health center and consists of IU Health Methodist Hospital, IU Health University Hospital, Riley Hospital for Children at IU Health, and IU Health Saxony Hospital. Other hospitals in the IU Health Statewide System include the following: - IU Health Arnett Hospital - IU Health Ball Memorial Hospital - IU Health Bedford Hospital - IU Health Blackford Hospital - IU Health Bloomington Hospital - IU Health Goshen Hospital - IU Health La Porte Hospital - IU Health Morgan Hospital - IU Health North Hospital - IU Health Paoli Hospital - IU Health Starke Hospital - IU Health Tipton Hospital - IU Health West Hospital - IU Health White Memorial Hospital Although each hospital in the IU Health Statewide System prepares and submits its own community benefits plan relative to the local community, the IU Health Statewide System considers its community benefit plan as part of an overall vision for strengthening Indiana's overall health. A comprehensive community outreach strategy and community benefit plan is in place that encompasses the academic medical center downtown Indianapolis, suburban Indianapolis and statewide entities around priority areas that focus on health improvement efforts statewide. IU Health is keenly aware of the positive impact it can have on the communities of need in the state of Indiana by focusing on the most pressing needs in a systematic and strategic way. Some ways we address our community health priorities as a system include: IU Health Day of Service The annual IU Health Day of Service is a high-impact, one-day event aimed at engaging IU Health team members in activities that address an identified community need. Tackling the issue of obesity in the communities IU Health serves, the sixth annual Day of Service in 2014 focused on leaving behind key physical assets to help meet a statewide need for more venues for physical activity and recreation. During the 2014 Day of Service: - More than 6,700 volunteer hours were dedicated by IU Health team members - IU Health team members gave their time to improve walking trails and park assets, which serve more than 63,000 residents across the state. - Over a dozen community parks were enhanced. - A new community-envisioned pocket park was created. - A community garden was improved with educational information. - Third grade classes at three schools were provided with free bikes, helmets, and locks. Additionally, the students were led through a bicycle safety course. - 125,000 pounds of debris were removed from 107 abandoned properties; 98 tons of mulch, 7 trees, and 3,424 flowers were planted to boost aesthetic appeal. Kindergarten Countdown As one of IU Health's signature programs and collaboration with United Way, Kindergarten Countdown helps hundreds of soon-to-be kindergartners improve their readiness for school. In addition to providing health screenings and vaccinations to students, the program offers assistance to parents in registering their kindergartners for school. Kindergarten Countdown summer camps are designed to provide at-risk youngsters the basic skills they need to succeed in their first year of school. From "Get Ready to Read" pre- and post-tests, campers in the IU Health camps achieved a 21 percent average increase in scores from the beginning of the four-week camp to the end. The program also creates positive impact by increasing awareness of kindergarten readiness, improving parent engagement and strengthening relationships between volunteers and team members at hospitals, schools and community organizations. IU Health recognizes that in some cases we don't have all the expertise or resources to address the needs of the community and other organizations are better suited to tackle some of the specific needs of the community. IU Health, therefore, provided financial support to like-minded non-profit organizations that are working to improve the health of the community in our identified priorities of need. Clinical Research Clinical trials are conducted at the following IU Health locations: Academic Health Center (IU Health Methodist Hospital, IU Health University Hospital, and Riley Hospital for Children at IU Health), IU Health Arnett Hospital, IU Health Bloomington Hospital, IU Health La Porte Hospital, IU Health North Hospital, IU Health Saxony Hospital and IU Health West Hospital. Methodist Research Institute ("MRI") The Biorepository at MRI, under IRB approval, collects human biological materials (blood, bone, tissue, urine) vital for medical research to provide the best way to study a variety of diseases and their potential treatments. Basic science researchers at MRI publish the results of their innovative grant-supported research in prestigious peer-reviewed journals. Their work has been recognized both nationally and internationally as they participate in system-wide collaborative efforts within IU Health as well as with the IU School of Medicine. Community Health Initiatives With investments in high-quality and impactful initiatives to address community health needs statewide; IU Health is helping Indiana residents improve their health and their quality of life. In 2014, IU Health impacted many people statewide through presentations, health risk screenings, health education programs, and additional health educational opportunities made available to the community, especially to our community members in the greatest need of such services. Examples of the types of programming and investment we make in community outreach areas include: Access to Healthcare One of the first steps to improved health outcomes is having access to healthcare resources. To show its commitment to providing affordable healthcare access, IU Health treats all patients regardless of their ability to pay. IU Health is also working to raise awareness and works to identify individuals within our communities that have barriers to care and connect these individuals with better access and consistency of healthcare resources to meet their needs. Some ways that these IU Health hospitals address Access to Healthcare include: - Public Assistance Enrollment - Veggies and Vaccines - Indiana University Student Outreach Clinic - Indianapolis Public Schools Student Athlete Physicals - Fishers Fire Department QR Code Magnet Program for Immediate Access to Patient Medical Records - Partnership for a Healthy Hamilton County Obesity Prevention To improve the lifestyle of Indiana residents, IU Health has utilized innovative and best practice me
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