Legacy Health led a collaboration of six health care organizations that invested $21.5 million to address housing, homelessness, and health care in their community by supporting 382 new housing units. The organizations did this because studies have shown that stable housing is important for good health, and achieving their mission of good health for the community requires adequate housing for those in need. The initiative provides housing for those challenged with addiction, behavioral health issues, or severe economic distress, and supports the community's health and economy by helping people improve their lives and become productive citizens.

1. Leading the Way to the Future: The ‘why’ behind Legacy, housing and health
Key points:
 Legacy Health led a collaboration of health care organizations that will invest $21.5
million to address housing, homelessness and health care in our community.
 One of the reasons we did so is because we have seen a direct connection between
housing and health.
 We feel that as part of our mission, we should help those most in need.
My initial impression about the housing crisis in our community was that this
was too big a problem for Legacy Health to do anything about.
Then, one day, I was walking on Northwest 19th
Avenue under the Fremont
Bridge where all these people were living on the edge of society in cardboard
boxes and tent-like structures, and it dawned on me: Legacy doesn’t have to do
this alone.
Why not reach out to other organizations to ask how can we come together to help?
A unique collaboration for community health
That was the beginning of the conversation that resulted in a collaboration between Legacy
Health and five other health care organizations to invest $21.5 million in a unique partnership
with Central City Concern to respond to Portland’s urgent challenges in affordable housing,
homelessness and health care. The investment will support 382 new housing units across three
locations.
For more details about the initiative, go here. What I want to talk to you about today is why we
are taking such an interest in housing.
Housing and health
First off, it has become clear that we have severe housing challenges in our community. We live
in an area where the cost of housing continues to escalate. These rising costs put particular
pressure on those who exist at lower incomes.
Plus, decades of reduced investments in subsidized housing and mental health services
nationwide have resulted in our cities becoming more and more challenged by homelessness.
It has also become evident that housing is an important component to health. Studies have
shown that individuals without safe, stable housing suffer from poorer health and cost society
more in emergency department use and hospital readmissions.
It’s just common sense: If you are worrying about basic survival, if you are making economic
choices between food, shelter and medicine, how could you possibly maintain good health?
Center on the mission
Then consider Legacy’s mission –– good health for our community. How can we really achieve
good health if there isn’t adequate housing for those most in need?

2. That’s when I decided that this was something we should pursue. I went to Ed Blackburn,
executive director of Central City Concern, which has expertise in housing and health, and we
invited the Portland-area health systems* to start a conversation.
After about four or five meetings, everybody decided that we can do this together, and that it will
have impact.
This isn’t the complete answer to the housing problem, but it will be an important part of at least
providing housing for those who are challenged with addiction, behavioral health issues or in
severe economic distress. It also goes hand-in-hand with the Unity Center for Behavioral
Health, which will provide immediate psychiatric care, as well as help in transitioning back to the
community, for those facing mental health issues.
No longer acceptable
My hope is that by the example of the health care organizations, the business community will
take a page from our playbook and find ways to help.
It is in the best interest for all of us to address this housing issue. If you give people a hand to
get them off the streets, they have a better chance of not only improving their lives but of
becoming productive citizens, which also helps our community’s economy and quality of life.
I think it is wonderful that the health care organizations have been able to come together on this
project as we have for Unity. It is also significant because it shows that we are all realizing we
live in a community with a mixture of people with different levels of challenge, and that we all
have a responsibility to do what we can. It is no longer acceptable to look the other way.
I’m glad my walk through the neighborhood helped me see that.
*The other health care organizations making contributions to the initiative:AdventistHealth Portland,CareOregon,
Kaiser Permanente Northwest, Oregon Health & Science University and Providence Health & Services–Oregon.
. . . George
__________________________________________________________________________________________________________________
George J. Brown, M.D. | President & CEO | Executive Office | Legacy Health
1919 N.W. Lovejoy Street | Portland, OR 97209 | (503) 415-5511 | (503) 415-5025 |*gjbrown@lhs.org

3. Leading the Way is a regular series of email communication from Legacy leadership addressing major
initiatives across our organization.
Leading the Way: Pride and progress inhealth literacy
If you have ever wondered about the importance of successful
communication with patients and families, what you know as “health
literacy,” consider this true story: A patient was recently discharged with
two prescriptions of blood thinner –– one medicine to be taken for 21
days; the other to be started after the initial 21 days.
The patient, however, didn’t understand the directions and took both
medicines at the same time. He ended up in the hospital with bleeding.
His ability to read and write was strong; his understanding of medical
directions was not.
Fortunately, in the five years since Legacy began emphasizing health literacy, we have been
able to prevent many of these cases by making progress in our communication with patients
and their families. Now, as we look to the future with an eye toward our care, our mission and
our strategies, how will health literacy evolve to help?
Not “Health Literacy101” anymore
Legacy has been on the forefront of health literacy nationwide for five years, making it a real
source of pride at Legacy. Our annual health literacy conference is one of only a handful in the
country and the largest. More than 2,300 professionals from Legacy and other organizations
have attended since the first year, 2012, and it fills up quickly every year.
In those five years, more than 4,300 of our doctors, nurses and others have undergone training
in “teach back,” a method in which providers confirm whether a patient understands what is
being explained to them. We have also offered dozens of classes to teach staff to write in “plain
language.” Legacy policy now states that patient education material be written at a sixth-grade
reading level. (Go here for more on health literacy at Legacy.)
While we have a long way to go in health literacy, the practices have taken hold. Health literacy
is integrated into the discussion at Legacy more naturally than it was five years ago. And not
just at the administrative level, but on the front line. Legacy is not a “Health Literacy 101” place
anymore.
A valuable tool
Health literacy has emerged as a valuable tool across many fronts: to help improve the
experience of our patients; to help reach our mission of improving the health of the community;
and to help advance our strategy of transforming care by managing the health of populations.
To keep evolving in health literacy, we have made the initiative part of our Patient Experience
Program, under the direction of Sara Sluder, program director of Patient Experience and Health
Literacy. “We have found that health literacy is a way to open dialogue so we can create more
authentic partnerships with our patients,” Sara says. “We are having discussions with our
patients, not just around them or about them.”

4. In addition, we know that there are health disparities in our community: inequalities in receiving
and accessing health care across racial, ethnic and socioeconomic groups. One of the best
ways to bridge these gaps is to improve our culture competency and our communication with
these groups. Good tools for those goals can be found in the health literacy toolbox.
Same thing for population health. Because populations consist of all kinds of diverse people of
different backgrounds and languages, if we really want to make sure we improve health status,
we have to make sure we break down the health care jargon and communicate in a way that
promotes better health.
What’s next?
On a broader level, we have opportunities to use health literacy in a range of communication:
Every place where patients and families have to make a decision, we should make sure we are
communicating in a way that they understand us –– think billing, insurance, directions. We also
could improve our communication to each other for patient safety and for our own job
satisfaction.
And, again, health literacy gives us the tools. I know that is a big undertaking –– there are
11,000 of us. But, hey, we have come a long way in five years, and I am excited to see where
we can go in the future.
Thank you for all you do for our patients,
Sonja Steves
Senior Vice President
Human Resources

5. Leading the Way to the Future is a regular series of email communication from Legacy leadership
addressing major initiatives across our organization.
Leading the Way to the Future: Legacy–GoHealthexceeds expectations
Key points
 Legacy–GoHealth Urgent Care has so far met or exceeded our expectations in growth,
volumes and patient satisfaction, as well as electronic connection and referrals to the
rest of the system.
 The centers offer more options for care to the community and give our employees a new
place for urgent care.
 The centers also fit into our strategy of being in touch with patients outside of the
hospital.
We’ve been pleased with the progress of Legacy–GoHealth Urgent Care. We
launched the new line of urgent care centers with our partner GoHealth in 2015
as a way to give people more options and meet the needs of those seeking
convenient care.
In less than two years, we are hitting or exceeding our targets.
First, we are growing faster than we had initially planned. Our original goal was
to have 20 locations by the end of 2017. By early 2017, we expect to have about 20 clinics in
place, putting us almost a year ahead of schedule.
In addition, we are very happy with the locations. Legacy–GoHealth has helped us extend into
parts of the metro area where we haven’t had many services. A good example is Legacy–Go
Health Johnson Creek, which takes us into Southeast Portland.
Satisfaction, connection, efficiency and referrals
We have several other measures of success:
 Referrals from Legacy–Go Health to our other services have been strong, especially as
we open more locations. In April and May, Legacy–GoHealth Urgent Care locations sent
1,390 referrals to Legacy providers; in June alone, more than 1,350 referrals were made
to Legacy providers.
 Adopting a measure of consumer satisfaction used mostly in the retail industry, our
satisfaction score is 84 out of 100, exceeding such companies as Costco (79),
Southwest Airlines (62), Apple (47) and Amazon (38).
 We are happy with the ability to integrate GoHealth with Legacy’s Epic electronic health
record. Our electronic connection to our providers has been a differentiator between
Legacy–Go Health and other urgent care clinics.
 The centers are running efficiently. Our goal is to have “door-to-door” time –– from when
a patient enters the center to when they leave –– average 45 minutes. We are currently
averaging between 47 and 48 minutes, very close to meeting our goal. Plus, online
scheduling is a hit with patients.
Other interesting developments
We have found other benefits of this network of urgent care centers:

6.  In interviews with patients, some said they chose Legacy–Go Health because of the
Legacy name and Legacy providers. “I had a good experience with Legacy while in the
hospital, so I decided to trust Legacy–GoHealth,” one patient told us.
 Of the Legacy employees and dependents who use urgent care, some 70 to 80 percent
now choose Legacy–Go Health.
 We did a comparison and found that a large majority of our employees live within a five-
to 10-minute drive of a Legacy–Go Health location, meaning our employees and their
dependents have easy access to Legacy–Go Health centers.
Connected to our strategies
As for the future, once we hit our goal of 20 sites, we will likely take a pause from opening new
centers. In the big picture, we feel as if Legacy–GoHealth fits nicely into a vision of Legacy
being less reliant on “episodic” trips to the hospital, and more toward being in touch with
patients all along the continuum of their health care.
Our urgent care centers are in line with this vision because they allow us to connect with many
patients before they need hospital care. It allows us to keep in touch with patients, perhaps even
helping them manage chronic conditions. Our centers also are in line with our mission of good
health for the entire community in that they accept patients on Medicare or Medicaid; some
other urgent care clinics do not.
We realize that launching and expanding a new line of services has taken dedication and focus
by a number of people. We appreciate your commitment and applaud the success of Legacy–
GoHealth, now and in the future.
Trent S. Green
Senior Vice President & Chief Strategy Officer
President, Legacy Medical Group
1919 N.W. Lovejoy Street | Portland,OR 97209
503.415.5121 Office| 503.415.5025 Fax | tsgreen@lhs.org
Assistant:Sheryl Miller | Phone: 503.415.5373 | shemiller@lhs.org
www.legacyhealth.org