Exeter Hospital

Exeter Health Resources, Inc. is the parent company for:Exeter Hospital, Inc., a tax-exempt 100 bed acute care hospital; Rockingham Visiting Nurse Association and Hospice, Inc., a tax-exempt home health and hospice agency; Core Physicians LLC, a tax-exempt multi-specialty physician group practice; and Exeter Med Real, Inc., a tax-exempt real estate holding company.(Continued on Schedule O)In addition to Exeter Health Resources' program service accomplishments described above, and as noted further below, the Beth Israel Lahey Health (BILH) network engaged in significant activities focused on expanding access to care and services, including underserved patient populations in order to reduce health inequities.There was also a strong focus on continuing to provide high quality care at a lower cost, when appropriate. BILH continues to focus on the behavioral health care needs of its communities as well. BILH Network Accomplishments and Activities - Fiscal Year Ended September 30, 2023Throughout the period covered by this filing, Beth Israel Lahey Health ("BILH") and its affiliates focused on expanding access and services, including to underserved patient populations in order to reduce health inequities. In addition, there was a strong focus on continuing to provide high quality care at a lower cost, when appropriate, as demonstrated by BILH's efforts to leverage community settings, keep care within the BILH Performance Network ("BILHPN"), and allow patients to receive care in their homes. The following highlights specific efforts during the period covered by this filing:Access & Expansion to Pharmacy Services - BILH Pharmacy has continued to expand its contractual relationships, allowing more patients to utilize its pharmacy for their prescriptions. In FY 2023, BILH Pharmacy successfully negotiated access to the Point32Health specialty pharmacy network as well as the WellSense Medicaid Accountable Care Organization ("ACO") plan. Examples of BILH Pharmacy's other efforts to expand patient access to medications include: - Enhanced medication authorization and access services to help patients obtain necessary insurance authorizations and find co-pay assistance, - Expanded the medication refill center to assist patients and providers in expediting medication renewals and ensuring prescribed medication and dosage are still appropriate, - Extended patient co-pay assistance programs to the Joslin Adult Diabetes clinic and Northeast Hospital Corporation patients, and - Expanded clinical pharmacy services in ambulatory clinics to help manage and optimize patients' complex medication therapies. - BILH Pharmacy also expanded its clinical pharmacy presence in clinics to reduce the health equity gap in the use of highly impactful medications to treat patients with diabetes and atherosclerotic cardiovascular diseases by improving their blood pressure and hemoglobin A1C. Interventions centered around prescribing evidence-based medications, educating patients about their conditions, and ensuring access to medication. Initial results have demonstrated an increase in the use of GLP-1 agonists and SGLT-2 inhibitors by 32% in Black and Hispanic populations, an average reduction in hemoglobin A1c of 0.8, and a decrease of systolic and diastolic blood pressures of 7mmHg and 2mmHg respectively.Improvement in Lab Services - BILH optimized the transportation routes of collected laboratory specimens to testing laboratories, ensuring high standards for turnaround times and maximum efficiency. This is foundational to the system's ability to consolidate testing, expand access to in-network laboratory services which in turn generally reduces cost, and support the provision of high-quality care and the clinician and patient experience. - Focus remained strong in developing physician practice delivery models and re-opening patient service centers. These efforts enhance community providers' ability to use BILH labs and increase patient access to BILH labs.Leveraging In-Network Care - BILH operates a Transfer Center that facilitates patient access to the appropriate placement of patient transfers. With the creation of the Transfer Center, BILH has been able to retain patients who might otherwise have gone outside of the system. By expanding its focus to community hospitals, BILH has enhanced its ability to place patients, including at locations potentially closer to the patients' homes. - BILHPN operates a centralized referral management program that focuses on patients seeking out-of-network specialty care and redirecting them to in-network specialty care, when clinically appropriate. Throughout FY 2023, BILHPN redirected well over one thousand patient visits. In most cases, care retained within BILH resulted in enhanced care coordination at a lower cost of care.Enabling Patients to Receive Care at Home - BILH launched its Hospital at Home program in FY 2023, starting with Lahey Clinic Hospital d/b/a Lahey Hospital & Medical Center. This has allowed eligible patients to be offered care in the setting most comfortable for them - their homes - while also customizing care plans and improving patients' mobility even while they are acutely ill. - In FY 2023, BILHPN put programs in place to manage length of stay at skilled nursing facilities ("SNFs"), reduce readmissions, and discharge medically appropriate patients directly to their homes with homecare services instead of to a SNF, provided patients are medically stable to return home after an acute care stay and will likely have better outcomes and lower cost of care.Behavioral Health - In FY 2023, BILH Behavioral Services launched its Community Behavioral Health Center ("CBHC") in Lawrence, Massachusetts, consolidating outpatient, mobile crisis intervention, and adult community crisis stabilization services. The establishment of the CBHC is a part of the Commonwealth's Executive Office of Health and Human Services Roadmap for Behavioral Health Reform. - In addition, as part of the Roadmap for Behavioral Health Reform, BILH launched an Emergency Services Redesign that shifts emergency evaluations out of the Emergency Department ("ED"). BILH Behavioral Services also expanded its ED integration efforts to a total of six EDs, including Addison Gilbert Hospital, Anna Jaques Hospital, Beverly Hospital, Lahey Medical Center-Peabody, Beth Israel Deaconess Hospital-Milton, and Winchester Hospital.Health Equity - BILH and Lawyers for Civil Rights launched a medical-legal partnership to provide free legal support to low-income patients, beginning at Beth Israel Deaconess Medical Center. The collaboration will expand BILH's ability to address health equity and expand access to health care for patients living in under-resourced communities. - BILHPN focused on reducing health equity disparities in diabetes and hypertension management by stratifying health outcomes by race, ethnicity and language; sharing performance data with primary care groups; and implementing clinical initiatives such as off-hour clinics, home blood pressure monitor distribution, continuous glucose monitoring, and outreach to patients with higher needs.Ongoing Intiatives:Enhanced Access for MassHealth Patients - To mitigate barriers in access to care and increase the number of MassHealth patients that BILH serves, the system committed to universal network-wide provider participation in MassHealth. All BILH hospitals and providers employed by BILH or on whose behalf BILH jointly contracts participate in and/or have applied to participate in some form of MassHealth. In FY 2022, BILH signed a new MassHealth ACO contract with BMC HealthNet Plan / WellSense Health Plan that went into effect in April 2023. As part of this contract, BILHPN extended participation to all eligible primary care providers ("PCPs") who were not otherwise participating in a MassHealth ACO. Prior to that time, while all eligible BILHPN PCPs were participants in a form of MassHealth, some PCPs were not previously participating in a MassHealth ACO. - BILH has developed, refined and implemented a multicultural marketing, advertising, and outreach plan with the purpose of expanding access for underserved populations, including MassHealth patients, in targeted BILH service areas. (Continued later on this Schedule O)