Sanford Health Community Commitment 2024

Committed to Community

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A Letter from Sanford Health President and CEO Bill Gassen

At Sanford Health, we believe that everyone, everywhere should have access to world-class health care close to home. As the largest nonprofit provider of rural health care in the United States, Sanford Health is committed to supporting our patients, residents and communities in ways that extend beyond the walls of our clinics, hospitals and facilities. It is in this spirit that I am honored to share with you Sanford Health’s Community Commitment Report.

In the pages that follow, you will learn how Sanford Health is using innovative, collaborative approaches to deliver equitable, affordable and high-quality care to everyone who comes to us in their time of need. As caregivers, we believe that it is not only our duty but also our calling to partner with our communities to help find solutions to the social and economic barriers that hold people back from living their best, healthiest lives.

Nonprofit health care organizations like ours have strong roots in the communities we are privileged to serve. We are driven by a promise to provide world-class health care services to every patient, regardless of their ability to pay. I am proud to share that in 2022, Sanford Health provided free or reducedcost health care services to more than 50,000 patients in our footprint. We are committed to improving access to care for underserved populations by making health care affordable for the individuals and families in our communities who need it most.

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From our virtual care initiative and 3D mobile mammography clinics to our wellness pantries and integrated behavioral health programs, Sanford Health is leading change that directly addresses social determinants of health, bridges gaps in care and benefits our communities. These are just a few examples of how we are advancing access to care and improving health outcomes in our footprint and beyond. I encourage you to continue reading to learn more about how Sanford Health is helping to improve public health and strengthen our communities.

The work we are doing is possible thanks to our incredible Sanford family and our community partners. I am deeply grateful to work alongside such dedicated and caring individuals. Together, we remain committed to establishing healthy communities throughout the upper Midwest, for generations to come.

With gratitude,

Bill Gassen President and CEO Sanford Health

In 2022, Sanford Health invested over $650 million in our communities to provide essential services and programs to improve access to care and positively impact health and well-being. This included $85 million in free or reduced-cost health care services to over 50,000 patients and $356 million in subsidized health services and absorbed underpayments from Medicaid and Medicare.

Sanford Health is a nonprofit organization dedicated to the work of health and healing for the public good. Headquartered in Sioux Falls, South Dakota, our organization serves more than 1.4 million patients and over 200,000 health plan members across 250,000 square miles. As the nation’s largest nonprofit rural health care system, Sanford Health is committed to improving the health and well-being of those we serve. We are proud to provide comprehensive services, support and investments to respond to the current and future health needs of our communities. These programs improve access to affordable, high-quality care, enhance public health, reduce barriers to care and address health disparities – all while making our communities more resilient.

1.4 million patients and over 200,000 health plan members

RURAL CARE CHALLENGES

People living in rural America face unique challenges. They are more likely to have fewer resources to access care and experience higher rates of poverty, food and housing insecurity, and chronic disease, which often leads to poorer health outcomes. At Sanford Health, two-thirds of our patients live in rural areas. That’s why our care extends beyond our medical centers and clinics. We are active in the communities we serve and invest substantial resources to drive more opportunities and better health for all.

ABOUT

COMMUNITY HEALTH NEEDS ASSESSMENT

Every three years, Sanford Health conducts a Community Health Needs Assessment (CHNA) to learn more about the health and well-being of the populations we serve. The CHNA allows us to identify and address unmet health needs through local partnerships and initiatives. The responses from past surveys have led to the development of new community health initiatives, offerings and programs in areas such as children’s care, mental health, rural health care access and health equity.

CARING FOR OUR PATIENTS AND OUR COMMUNITIES

As the nation’s largest rural nonprofit health system, Sanford Health is committed to enhancing the health and well-being of those we serve. Non-profit health systems in the United States are required to file Form 990 with the Internal Revenue Service (IRS) each year because of federal tax laws that apply to tax-exempt organizations. The Form 990 provides detailed information on our finances, governance, operations and compliance with tax regulations. It is designed to ensure that nonprofit health systems use their tax-exempt status to maintain financial accountability to the communities it serves. In 2022, Sanford Health invested over $650 million in our communities to provide essential services and programs aimed at improving access to care and positively impacting health and well-being. The following is detailed information regarding Sanford Health’s 2022 Form 990 for the health services division.

investing over $650 million in our communities

MILLION

$230 MILLION

$159 MILLION

$230 million in subsidized health services not reimbursed by other sources. Sanford Health offers these clinical services, despite a financial loss to the organization to ensure access to essential care for our communities.

$159 million in uncompensated care in free or reduced-cost health care services provided through financial assistance or unpaid medical services due to a patient’s financial hardship or lack of insurance, impacting over 179,000 patients.

$126 million in absorption of underpayments from Medicaid for acute care services. Medicaid is a government program that provides health coverage for eligible low-income individuals. Medicaid reimburses health systems for the services they deliver but at a rate that is often lower than the actual cost of providing care. Sanford Health is dedicated to serving the community and treating all patients, regardless of their ability to pay.

$46 million in community support including activities that protect or improve the community’s health or safety. Some examples of activities supported by Sanford Health include child care and mentoring programs for vulnerable populations, violence prevention programs, disaster readiness and public emergency activities.

$42 million in community health improvement services. Sanford Health is proud to support efforts and programs to safeguard or improve public health and expand access to health care services.

$36 million in health professions education. Sanford Health invests in educational programs that result in training necessary for health professionals to ensure our communities have the workforce needed to provide care now and into the future.

INVESTED

$16 million in medical research investments in studies or investigations to increase health or disease knowledge made available to the public.

CARE FOR ALL

Sanford Health is proud to provide care to anyone who comes to us in need, regardless of their ability to pay. As a nonprofit organization, we provide a robust community care program to help our patients who are uninsured or experiencing financial hardship access care in hospitals and clinics across our health system. Sanford Health never denies medically necessary care to patients with medical debt.

FINANCIAL ASSISTANCE POLICY

Sanford Health offers financial assistance for patients experiencing emergencies and other medically necessary services. This assistance, which can range from a reduction in the balance to complete forgiveness, is provided to patients demonstrating financial need.

Patients can download an application online, contact a patient account representative at the phone number on their billing statement, or visit a registration representative at a Sanford Health clinic or hospital. To reduce language and literacy barriers, our financial assistance application has been simplified to a two-page document and translated into the top languages spoken by the populations we serve, including Chinese, German, Hindi, Korean, Laotian, Spanish and Vietnamese. Translated financial assistance applications are available from our website or by calling the Patient Financial Services office.

We have also implemented a presumptive community care policy. Instead of waiting for a patient to come to us after a bill has been sent to collections, we proactively evaluate some of the patient’s demographic information and other factors to determine if they might need financial assistance.

CARE

Sanford Health’s financial assistance program provides discounted and free services to patients who qualify. Over 90% of patients who request financial assistance receive it.

CONNECTING PATIENTS WITH COMMUNITY RESOURCES

Sanford Health offers a database to assist patients with finding and accessing community resources . The website sanford.findhelp.com compiles information to help address basic needs such as housing, food, transportation and child care. After entering their zip code, a patient can see free or reduced-cost programs nearby. While the resource is available to anyone in need, Sanford Health patients receive a link to access it from their after-visit summary, their My Sanford Chart account or via sanfordhealth.org.

In 2023, users to the Sanford Find Help platform increased by 10% with top search topics related to food, housing, health and financial needs.

Clinicians and nurses can also navigate the site on behalf of a patient. Based on an individual patient’s needs, caregivers can refer them directly to an organization for assistance. To ensure equitable access to resources, the site is translated into multiple languages and allows staff to print, text or email assistance information to a patient.

helping patients

PROVIDING NEEDED AID TO PATIENTS LOCALLY

Sanford Health helps patients in need through the Providing Needed Aid to Patients Locally (PNAPL) Foundation Fund. The fund aims to help patients experiencing financial hardships meet their basic needs when no other funding or charitable options are available. Funding is used to help establish patient self-management and access to necessary items to streamline a plan of care. Examples of items purchased through the fund include blood pressure cuffs, scales, pulse oximeters, pill boxes, medication copays, wheelchairs, canes, shower chairs, dressing supplies and transportation to and from appointments.

In 2023, Sanford Health provided over $950,000 in prescription assistance to patients with financial need.

PRESCRIPTION ASSISTANCE PROGRAM

A medical diagnosis can often cause a financial burden, and an inability to afford medication can prevent someone from fully recovering both physically and financially. Sanford Health’s prescription assistance program offers tiered assistance based on income level to help patients afford their medication. If a patient indicates that they can’t afford their medication, clinicians can presumptively qualify them for assistance. Patients who meet program guidelines are eligible for six months of prescription assistance.

ASSISTANCE

ASSISTANCE

EXPANDED ACCESS

Rural populations are more likely to have to travel long distances to access health care, particularly subspecialty services. This can be a significant burden. Many patients may face barriers paying for fuel and/or hotels, taking time off from work and/or finding child care. Sanford Health is committed to ensuring our patients have access to high-quality care no matter where they live or the health challenges they face. As an integrated health system, we are uniquely positioned to improve the overall health of the populations we serve through new, innovative care delivery models. Open 24/7, 365 days a year, we are available whenever and wherever our patients need us, and we are committed to bringing care closer to home.

AIR AMBULANCE SERVICES

In rural, sparsely populated areas, air ambulance services are crucial for patients who need immediate access to specialty care. Sanford Health operates a fleet of four AirMed helicopters and four airplanes from bases in Bismarck, Dickinson and Fargo, North Dakota; Sioux Falls, South Dakota; and Bemidji, Minnesota. With medical personnel on board, AirMed aircraft take patients to hospitals for lifesaving care and transport patients from the scene of an emergency to the nearest hospital. Sanford AirMed can provide stabilizing treatment to patients suffering from cardiac disease, trauma, burns, stroke, sepsis and more and specializes in providing adult, pediatric, neonatal and maternal care.

VACCINATION POP-UP CLINICS

In 2023, Sanford Health and The Evangelical Lutheran Good Samaritan Society were awarded a grant from USAging to improve immunization rates for adults ages 18 and older through over 400 vaccination pop-up clinics in South Dakota, North Dakota and western Minnesota. To help make vaccines accessible, the team brought vaccination pop-up clinics to over 50 community partner locations. Among them are the Eat Well Mobile Market, a mobile food system , and the Bishop Dudley Hospitality House in Sioux Falls, South Dakota, public libraries in Fargo, North Dakota, Beltrami Community Health in Bemidji, Minnesota, and Our Lady of Guadalupe Free Clinic in Worthington, Minnesota. As a result of the clinics, over 16,000 COVID-19 and influenza vaccinations and over 3,500 doses of other vaccines including RSV, Tdap, shingles, hepatitis B and pneumococcal disease were given.

HEALTH

More than 100,000 patients have safely flown with Sanford AirMed over the last four decades. Sanford Health’s fleet of helicopters and aircraft travels more than 1.5 million miles a year to ensure patients have efficient and safe access to specialty care.

HEALTH CARE

SERVICE

VIRTUAL CARE

In 2021, Sanford Health launched a landmark $350 million virtual care initiative to fundamentally transform how we deliver care by expanding access, improving the patient experience, advancing innovation through new research, and attracting and training a new generation of clinicians. Virtual care is one of the most powerful tools we have to bridge the gap when it comes to addressing the shortage of primary care doctors and specialists in rural America. By providing the most advanced technology close to home, patients can immediately access care, monitor their health, and connect with a trusted provider from home or a nearby satellite clinic.

Over the last decade, Sanford Health has provided more than 760,000 virtual consults, amounting to over 29 million miles saved by patients who didn’t have to travel long distances on country roads or through harsh winter weather to access high-quality care in time to make a difference.

In 2023, Sanford Health opened our first Virtual Care Satellite Clinic in Lidgerwood, North Dakota, with on-site staff supported through virtual technology and expanded clinic hours and services. The model provides greater flexibility and convenience in a small community of 600. Patients are able to connect with a provider virtually for primary care services, follow-up care appointments, urgent care visits and specialty consults, improving overall outcomes. As part of our commitment to meeting the needs of rural communities, four additional satellite clinics will be opened throughout our footprint, in addition to a Virtual Care Center, slated to open at the end of 2024 in Sioux Falls, South Dakota. The center will serve as a premier training ground to attract, retain and prepare medical students, residents and nurses for this next generation of care delivery.

SERVICE

Each year, Sanford Health conducts 9,700 mobile mammogram visits to reach the underserved in North Dakota and South Dakota.

BRINGING CARE TO OUR PATIENTS’ DOORSTEP

Mammograms are the best screening technology to detect breast cancer early. Sanford Health’s 3D mobile mammography clinics ensure all patients can access advanced diagnostic services, regardless of their zip code. The mobile clinics provide the same full service and experience as a clinic setting but can reach patients outside our clinic walls. In addition, Sanford Health provides 3D mammograms to underserved populations who would otherwise not have access to this advanced technology.

$3.67 million in federal grant funding for the RMOMS program

In 2021, Sanford Health of Bemidji received $3.67 million in federal grant funding for the Rural Maternity and Obstetric Management Strategies (RMOMS) program. As part of this work, we are investing in new, innovative care delivery models , including in the tribal communities of Red Lake and Cass Lake, Minnesota. Women in these communities face multiple barriers to health, including poverty, lack of access to transportation, broadband or smartphones, and increased prevalence of pre-existing conditions like hypertension and diabetes, which require more monitoring during pregnancy to prevent serious complications.

In 2020, we started offering OB video visits. However, we soon realized that even moderate to high-risk patients could benefit from OB video visits – especially if it meant the difference between care or no care. Virtual visits have been critically important for many patients who simply can’t afford to take time off from work and/or pay for fuel to travel for a prenatal visit and who may otherwise have “no show” appointments during their pregnancy and postpartum care. Virtual visits are also available for patients that may need additional monitoring due to conditions that put them at an elevated risk.

As part of an integrated system, we are uniquely positioned to provide innovative services to our Good Samaritan Society residents. For example, long-term care residents have access to a home hemodialysis den at Good Samaritan Society – Sioux Falls Village. We also operate several low-volume dialysis facilities located in very rural or isolated areas across our footprint. In Fort Yates, North Dakota, Sanford Health operates a dialysis facility on the Standing Rock Indian Reservation and transports three employees 67 miles from Bismarck, North Dakota, each day to provide critical dialysis care to our patients.

ensuring access to world class health care

OB

SUBSIDIZED HEALTH SERVICES

As a nonprofit health system, Sanford Health subsidizes a wide range of vital health services to meet the needs of the communities we serve. These high-cost medical services are provided despite operating at a significant financial loss to the organization.

Subsidized health services prioritize community health to ensure access to essential care in underserved areas. These services meet an identified community need and would not be available unless provided by Sanford Health. These services often include inpatient and outpatient care, specialized ICU services, mental health programs and other specialty care in rural or remote areas.

In 2022, Sanford Health invested over $232 million in subsidized health services.

Below are some examples of the types of subsidized care provided to the communities we serve.

• Maternity care deserts are counties without a hospital or birth center offering obstetric care and without any obstetric providers. Maternal care deserts are on the rise, particularly in rural areas. Sanford Health is committed to ensuring all women have access to maternity care. Through patient-centered care, clinician-led innovation and community collaborations, we are working to preserve and expand access to maternal health and improve disparate outcomes across our footprint.

• In 2019, Sanford Health and The Evangelical Lutheran Good Samaritan Society combined as one, nonprofit organization. The combination created an integrated care delivery system that provides care services across every stage of life and protects access to high-quality senior services close to home – despite record industry closures. Through the Society’s skilled nursing facilities, rehabilitation therapy services, senior living locations and home-based services, older adults across our footprint can receive high-quality senior services wherever they call home.

• Sanford Health offers pediatric care in 35 specialty areas. Our pediatric specialists are board-certified and fellowship-trained with extensive training and education in their area of expertise and are uniquely qualified to treat the sickest children with the most complex, chronic conditions.

PROVIDING

PROVIDING

BEHAVIORAL HEALTH

Increased access to behavioral health care is a vital part of Sanford Health’s effort to address community health needs. Sanford Health provides comprehensive behavioral health services across our footprint, ranging from psychological evaluations and substance use disorder programs to a nationally recognized eating disorder program. As a rural health system, we understand firsthand the unique barriers our communities face in accessing behavioral health care, and we are addressing these issues on multiple fronts to ensure every patient has access to the expert care and support they need, when they need it.

ACCESS TO BEHAVIORAL HEALTH SERVICES

As an extension of our virtual care initiative, Sanford Health recently launched an option for patients to self-schedule a virtual behavioral health appointment. The appointments do not require a referral from a primary care provider and are available to patients ages 10 years and older across our footprint. Offering patients the ability to directly schedule a virtual behavioral health appointment can reduce stigma and helps ensure they have timely and convenient access to the care they need.

Sanford Health’s emergency departments are staffed with virtual psychiatrists to ensure patients with emergent behavioral health concerns are triaged quickly. In an emergency, a psychiatrist sees their patient virtually, consults with the on-site provider and recommends appropriate next steps, including transfer to an inpatient behavioral health unit if necessary or discharge home with a safety plan in place.

OPTIONS

Over 60 integrated health therapists work side-by-side with primary care teams in over 65 clinics across our rural footprint either in person or through virtual care.

To further increase access to behavioral health care, integrated health therapists (IHTs) are embedded into primary care clinics and oncology departments across the Sanford Health footprint. If a patient expresses a need or a provider identifies a patient who would benefit from further assessment, the IHT is on site to have a conversation immediately, simplifying the process for patients and ensuring they leave their current appointment with a follow-up plan.

In Bemidji, Minnesota, the Sanford Bemidji Crisis Center opened an EmPATH unit, short for Emergency Psychiatric Assessment, Treatment and Healing. This new model provides urgent mental health care and treatment for people in crisis in a supportive, calming environment. The EmPATH unit is comprised of family, adult and children’s spaces to allow patients to decompress and receive individually tailored care for up to 23 hours. Staffed by mental health providers, the facility is the first in the state to feature separate EmPATH units for adults and children. There are also spaces that have been designed for cultural and spiritual healing, particularly for Indigenous patients. In addition, patients in crisis can call the mobile crisis team, available 24 hours a day, all year round, for evaluation of children, families and adults in northern Minnesota.

OPTIONS

During the peak of the COVID-19 pandemic, Sanford Health and the University of North Dakota partnered to launch the initial phase of the Behavioral Health Bridge, a website filled with mental health resources for those who may be struggling. The Bridge was developed to make it easy for consumers and health care providers to find information about behavioral health, common mental health concerns and ways to support or treat those needs, and resources for stress and coping. Now, years later, Sanford Health continues to leverage the information featured to help bring awareness to mental health and ways to support those who may be struggling.

PREVENTION AND SUBSTANCE USE DISORDER PROGRAMS

To help reinforce healthy behaviors in vulnerable populations, Sanford Health in Chamberlain, South Dakota, has implemented a points-based health hygiene program to provide diapers, bedding sets, nursing pillows, infant swings, bathtubs and other items to pregnant, low-income patients. The items are provided to incentivize and support pregnant patients to make healthy choices about nutrition, prenatal care, drinking and smoking.

Between January 2019 and December 2022, over 300 women participated in the health hygiene program.

Wellbriety is a program designed for and by Native Americans in recovery. It is available to Sanford Health patients in Bemidji, Minnesota. Through the program, licensed alcohol and drug counselors take a community approach to recovery, addressing Native Americans’ culturally specific holistic well-being. The program is one of less than two dozen Wellbriety Certified Treatment Centers in the nation.

SUPPORT

counselors take a community approach to recovery

PROGRAMS FOR YOUNG PEOPLE

Sanford Health Bismarck partners with more than 10 schools in Bismarck, Williston and Dickinson, North Dakota, to support students through the Multiple Tiered Systems of Support (MTSS) program. Through the program, students have access to three different tiers of behavioral health support, the first two provided by school staff. Students who need the highest level of care are moved to tier three and seen by a Sanford Health affiliated behavioral health clinician on site at the school.

MTSS measurable outcomes include a 70% decrease in referrals to office discipline, juvenile courts and arrests.

Additionally, Sanford Sports trainers attend a Behavioral Health Education Awareness and Response Development (BeHEARD) course to gain the tools needed to support youth struggling with a wide range of behavioral health concerns. BeHEARD is an interactive virtual course created by experts in behavioral health, educational design and evaluation to help participants increase their knowledge, skills and confidence in supporting people with behavioral health concerns.

Childhood obesity has become an epidemic in the United States, leading to the development of chronic health conditions earlier in life. The Sanford fit program is designed to get kids to think differently about their choices in a fun and engaging way. It focuses on four key elements of a healthy life: FOOD, MOVE, MOOD, RECHARGE. Through partnerships with state governments, WebMD, Discovery Channel and many more, fit provides free online resources to instill sustainable, health habits and empower children, families and communities to make healthy lifestyle choices.

SUPPORT

MEDICAL RESEARCH

Clinical trials are key to advancing the science of medicine and ensuring patients benefit from new discoveries as quickly as possible. However, clinical trial recruitment has historically been centered in larger urban areas. Sanford Health is committed to pursuing cures and improving treatments for diseases that affect our communities in rural America. We fund, test and use clinical trial research, data and best practices to generate better outcomes for our patients.

ACCESS TO CLINICAL TRIALS CLOSE TO HOME

Sanford Research, a multisite biomedical research institute headquartered in Sioux Falls, South Dakota, is involved in over 400 clinical trials that aim to improve the prevention, detection, treatment and survivorship of a wide range of diseases, from diabetes, cystic fibrosis and COVID-19 to eating disorders and cancers. Sanford Research offers cancer clinical trials in seven locations: Sioux Falls, South Dakota; Fargo and Bismarck, North Dakota; and Bemidji, Ortonville, Worthington and Thief River Falls, Minnesota. The sites collaborate to advance cancer research and care across the Midwest. Giving patients access to early-phase clinical trials close to home greatly improves their care and advances research to bring new treatments – and hope – to our patients.

Sanford Health is proud to be part of the National Cancer Institute’s (NCI) Community Oncology Research Program (NCORP). Sanford Health patients have access to state-of-the-art cancer treatment trials in or near their communities through our participation in this national coalition. There are only 46 NCORP sites throughout the country.

10% of Sanford Health oncology patients are enrolled in clinical trials at our two largest sites, which is higher than the national average.

Our NCORP typically has 80 to 100 clinical trials open across most cancer types. As an example, Sanford Worthington Cancer Center, located in Worthington, Minnesota, a town with a population of 13,000 residents, is a designated NCORP site. To date, Sanford Worthington Cancer Center has opened 27 clinical trials with over 200 enrollments. Sanford Pediatric Oncology Programs in Sioux Falls and Fargo are also Clinical Oncology Group sites. COG is a part of the NCI and is exclusively focused on pediatric clinical trials. COG sites provide the gold standard in pediatric cancer care.

In addition, Sanford Health is also a participant in the NCI’s Connect for Cancer Prevention Study. The nationwide study looks to identify how certain factors, like geographical location or occupation, may lead to a cancer diagnosis in healthy individuals later in life. Sanford Health is one of nine health care systems enrolled in a unique study focusing on individuals before they have any indication of cancer. Individuals in the Midwest are often exposed to potentially harmful carcinogens that are unique to rural populations. This study will help us better understand what the risk factors are to help future cancer patients.

The Boekelheide Neonatal Intensive Care Unit (NICU) at Sanford Children’s Hospital in Sioux Falls, South Dakota, is a participating hospital in the National Institutes of Health’s prestigious Neonatal Research Network . The network brings together the top neonatal facilities in the country to improve the short and long-term health of babies. Because Sanford Children’s Hospital is one of only 15 sites across the country, our critically ill newborn patients have exclusive access to leading-edge clinical trials.

PEDIATRICS AND RARE DISEASE RESOURCES

Sanford Health’s Population Level Estimate of type 1 Diabetes risk Genes in children (PLEDGE ) study works to screen and identify children at risk of developing type 1 diabetes or celiac disease. First launched in 2020, the program provides education, ongoing monitoring and appropriate early intervention to prevent serious illness at the time of diagnosis for children with risk markers.

The (PLEDGE) study is offered in over 126 clinics across Sanford Health’s footprint and has screened over 8,500 patients to date.

Sanford Research launched the Coordination of Rare Diseases at Sanford (CoRDS) platform to further connect rare disease patients and researchers. CoRDS provides a secure online space for patients to share their experiences and medical histories, facilitating collaboration among patients, caregivers and researchers. The platform also enables researchers to access a diverse pool of patient data, accelerating rare disease research and treatment development. Through CoRDS, individuals with rare diseases can find support, connect with others facing similar challenges and contribute to scientific advancements. This initiative underscores Sanford Health’s commitment to improving the lives of those affected by rare diseases through innovative research and community engagement.

CORDS

COMMUNITY OUTREACH

Social barriers, such as a lack of access to healthy foods, stable housing, transportation, education and employment, as well as poverty, are particularly acute in rural areas. At Sanford Health, we are active in the communities we serve and invest substantial resources to drive more opportunities and better health for all.

In 2022, Sanford Health provided significant financial support to over 500 nonprofit organizations serving communities across our footprint.

Sanford Health is proud to offer all employees paid volunteer time off. We understand the critical role our employees play in our communities, and we encourage our full-time team members to commit at least eight paid hours per year to nonprofit organizations. Good Samaritan Society employees and locations are also encouraged to participate in community outreach efforts. These can range from sponsorship for local programs like 4H and community fairs, meal preparation and delivery through the Meals on Wheels program, use of facility meeting space for local civic groups, free health fairs for seniors and other community events. In 2023, Society staff, locations and residents logged 252 community benefit activities.

being active in the communities we serve

ADDRESSING FOOD INSECURITY

Sanford Health’s hospitals and clinics operate wellness pantries, such as the Kid’s Kitchen at Sanford Children’s Hospital in Sioux Falls, South Dakota, providing food and essentials to patients in need. The Kid’s Kitchen distributes over 3,100 pounds of food weekly. A similar pantry operates at Sanford Children’s Southwest Clinic in Fargo, North Dakota, where 20% of screened patients showed signs of food insecurity in 2023. Sanford Health Moorhead, Minnesota, launched a food box program in late 2023, offering prepackaged meals for pediatric, family medicine and women’s health patients. Sanford Health Bemidji opened a food and essentials bank within their children’s clinic in May 2023, serving nearly 12,000 pounds of food to around 220 families in six months.

Since 2019, Sanford Health Bismarck has sponsored the Sanford Cares program, supplying food-filled backpacks to Title I schools. In 2023, 700 second graders received these backpacks just before the holidays.

Sanford Health

Bemidji food and essentials bank served nearly 12,000 pounds of food in six months.

SERVING

HOMELESSNESS RESOURCES

Unhoused and homeless individuals face barriers to care. Sanford Health recognizes the special health care needs of this population and has developed programs to help them obtain needed care. In 2023, Sanford USD Medical Center in Sioux Falls, South Dakota, sponsored a program through the Veterans Community Project of Sioux Falls to construct movein ready tiny homes for homeless veterans in the area. The family units can accommodate up to seven people, and the individual units include a fully functional kitchen and bathroom. The homes will surround a “base camp” that will provide medical, dental and veterinarian offices. The center will also have a fellowship hall and other support services.

Veterans Community Project

In Bemidji, Minnesota, the Ridgeway neighborhood is a low-income housing area with a history of higher crime rates and drug use. Sanford Health Bemidji partnered with the Ridgeway Initiative as an opportunity to reach out to an underserved part of the community to help with housing, food insecurity and health care access. Through the initiative, Sanford Health employees have hosted vaccine clinics, offered on-site care to residents and provided food and other essential supplies. Sanford’s Stable Housing Program in Bemidji offers housing navigation services, case management and referrals to internal and external services and creates a housing-focused, person-centered plan.

BUILD

MINNESOTA NORTH DAKOTA SOUTH DAKOTA

BUILD

HOMELESSNESS

Homelessness is an increasing challenge in the Fargo-Moorhead metro area. Sanford Health Fargo has developed services to help support the medical needs of patients experiencing homelessness and dealing with medical issues. Sanford Health registered nurses (RNs) work in homeless shelters and are essential resources

Faith Community Nurses provide mentoring, documentation aid and grants for health programs.

for the Sanford Community Case Management team. The inpatient case management team, RNs and social workers collaborate with the nurses in the shelters when homeless patients are preparing to discharge from the hospital to the community. Sanford Health shelter nurses provide medical care to unhoused individuals at the YWCA women’s and children’s shelter and New Life Center for men in Fargo, North Dakota, and the Bright Sky transitional living apartments in Moorhead, Minnesota. Trained shelter nurse staff also provide counseling and medical respite for individuals recovering from surgery.

nurses assist with wound care, medication management, dietary needs and education on medical diagnoses

In addition to the shelter nurses, physician-level care is provided once a month to individuals in the region’s shelters through Sanford Health’s medical resident program. Fourth-year psychiatric residents meet individuals where they are through Micah’s Mission in Moorhead and the downtown engagement center in Fargo, North Dakota. In addition, community paramedics in Fargo go to patients to help with their medical needs, and community health workers assist with Medicaid and housing applications and with procuring other essential items.

The Faith Community Nursing Center (Center), part of Sanford Health in Sioux Falls, South Dakota, has been fostering community health for 25 years. The Center offers a Faith Community Nursing Course, training nurses in holistic care. Their efforts extend beyond churches to include community centers and shelters catering to diverse populations. Faith Community Nurses provide mentoring, documentation aid and grants for health programs in faith communities. Collaborating with various organizations, they address community health needs, such as foot care and health screenings for low-income individuals. Additionally, they combat falls, a significant cause of injury and death in South Dakota, through evidence-based prevention programs and a home-based intervention initiative.

faith community nurses helping support medical needs

SAFETY

CHILDREN’S RESOURCES

To prevent child abuse in our communities, Sanford Health offers assessments for children who may have experienced neglect or abuse as well as programs for adults who may be at risk of becoming abusive. At Safe Kids Fargo-Moorhead, Safe Kids Bismarck and CHILD Services in South Dakota, dedicated staff implement evidence-based programs to keep kids safe. Programs include car seat checkups, safety workshops and sports clinics that help parents and caregivers prevent childhood injuries.

For over 20 years, Sanford Health has been a proud sponsor of the Teddy Bear Den in Sioux Falls, South Dakota, a nonprofit organization that offers financial assistance

The Sanford Health Foundation leverages donor dollars to community benefit programs throughout our footprint including financial support for Child’s Voice of Sioux Falls.

to limited-income pregnant patients. Pregnant patients are enrolled in the program through a health care provider’s referral. Once enrolled, participants earn points for making positive choices like visiting the doctor, taking prenatal classes and leading healthy lifestyles. From there, they use those points to purchase necessary items for their child from the Teddy Bear Den.

Sanford Health Bemidji partners with the Family Advocacy Center of Northern Minnesota, an abuse assessment center that offers comprehensive medical care and treatment to victims of physical or sexual abuse. Through the partnership, Sanford Health provides leased space and a full-time advanced practice provider to provide 24/7 medical evaluations for children, adolescents and adults who have been sexually assaulted.

SAFETY

In Sioux Falls, South Dakota, Sanford Health fully funds and operates Child’s Voice, a nationally accredited Child Advocacy Center (CAC) that provides multidisciplinary medical evaluations for children in the community who may be victims of abuse and neglect. The services help reduce trauma for the child and non-offending family members and strives to improve long-term outcomes. Many of the victims and families Child’s Voice serves have very few resources. About 80% of the patients are on South Dakota Medicaid or without insurance. There are no copays for services at Child’s Voice, and the family is not billed the remaining balance that insurance does not cover.

SANFORD SPORTS

Sanford Sports , the athletics arm of Sanford Health, offers a diverse portfolio of sports-related services and programs. Sanford Sports gives back to the communities we serve through initiatives focused on promoting health, wellness and sports participation. Through a range of programs and events designed to engage community members of all ages, abilities and socioeconomic backgrounds, including youth sports leagues, fitness classes and sports camps, Sanford Sports helps to promote health and well-being throughout our footprint. Sanford Sports also partners with local schools, community organizations and nonprofits to provide resources and support for physical activity and healthy living initiatives.

promoting health, wellness and sports participation

WELLNESS

WELLNESS

Sanford Strong provides opportunities for athletes of all abilities to participate.

INCLUSIVE OFFERINGS

Sanford Strong, a program in Bismarck, North Dakota, provides an opportunity for high school and college athletes with complex medical backgrounds to participate in inclusive sports teams , including wiffle ball, football and bowling. Athletes of all abilities and ages are welcome to participate, including patients who have experienced a serious medical event such as a stroke, spinal cord injury or cancer diagnosis.

CONNECTION opportunity programs

Sanford Wellness Center in Sioux Falls, South Dakota, offers Adaptive Aquatics for children with special needs. The individualized approach to swimming lessons allows children of all abilities to learn how to be comfortable and safe in the water. In addition to Adaptive Aquatics, the facility also offers Adaptive Personal Fitness, which pairs a student with a personal trainer for cardio and strength training, allowing individuals with special needs to live their happiest, healthiest lives.

individualized approach to swimming lessons

In South Dakota, the Good Samaritan Society offers the Senior Companions program to provide valuable care and support to clients in rural communities. These services can help prevent or delay long-term care placement, increase the client’s ability to live alone, reduce loneliness and isolation, and reduce stress levels. Through the program, the Good Samaritan Society connects volunteers with older adults and anyone 21 and older who needs assistance to live independently.

CONNECTION

HEALTH EQUITY

Sanford Health is focused on making care more equitable by addressing the social determinants of health and working upstream to improve health. This work includes removing barriers to access such as lack of transportation, addressing provider shortages, and addressing health disparities such as food and housing insecurity, poverty and health literacy.

ADDRESSING BIAS IN HEALTH CARE

Sanford Health has identified closing minority health care disparities as a priority. Bias in health care can lead to disparities in treatment and outcomes. Closing these disparities is a priority for Sanford Health, and we are actively addressing this issue by educating providers on ways to support every patient, particularly those with marginalized identities. Through multiple education opportunities and ongoing professional development, caregivers are learning to recognize and mitigate biases, ultimately improving the quality of care and ensuring equitable health outcomes for all patients.

At the Concordia Language Villages in Moorhead, Minnesota, Sanford Health employees whose first language is not English can take English classes to build confidence and career mobility. Through the classes, students learn the basics of communicating in the workplace, Sanford Health’s safety policies and training materials. By expanding their knowledge of the English language, employees develop a greater sense of belonging in the workplace. This is a testament to our commitment to supporting employees in their careers and in their personal lives.

In 2022, Sanford Medical Center Fargo was named a top performer on the Healthcare Equality Index for creating equitable and inclusive access to care to LGBTQ+ patients.

RESOURCES FOR A DIVERSE PATIENT POPULATION

To advance health equity in our communities, Sanford Health offers to serve as patient advocates. Health guides assist patients in navigating the health care system, particularly those facing socioeconomic barriers or disparities in accessing health services. For example, they can help patients access community resources, apply for financial and/or prescription assistance and facilitate

Across our health system, health guide interventions have led to a 66% reduction in emergency department visits, 57% reduction in inpatient admissions, 36% improvement in blood pressure readings, 50% improvement in depression screening and a 76% improvement in A1C levels.

communication with their care team. In 2021, Sanford Health started working with a group of individuals identified as “rising risk” –those with one or two well-managed chronic conditions and co-occurring psychosocial risk factors. By offering personalized support and guidance, health guides help individuals overcome obstacles to care, ensuring they receive timely and appropriate medical attention.

Sanford Health serves 26 Tribal Nations, several of which are located within the poorest counties in the U.S. Native American Community Advocates in Bemidji, Minnesota, focus on providing comfort and building trust for our Native American patients. With a deep understanding of the cultural nuances and historical context, health advocates serve as a bridge between patients and health care providers, ensuring patients’ unique needs are met.

working to address disparities in health care access

By offering culturally sensitive care and support, we are working to address disparities in health care access and outcomes faced by our Indigenous populations. For example, at Sanford Chamberlain Medical Center, members of the Crow Creek Reservation host smudging ceremonies on campus. At Sanford Health Bemidji, traditional Native American healing practices like pipe ceremonies and sweat lodges are incorporated into the Wellbriety program.

Sanford Health’s Equity in Education scholarship program serves underrepresented and traditionally underserved populations seeking higher education. The scholarship is available to first-generation Americans, first-generation college students and non-traditional students of at least 25 years of age. Award recipients demonstrate exceptional character and leadership in furthering their own progress and in enriching the lives of others, especially in service, academics, and community involvement and impact. The scholarship opportunity is important to Sanford Health and its mission of fostering a culture where diversity in skill, background and lived experiences are not only accepted but also recognized as a key strength and celebrated.

scholarship program serves underrepresented and traditionally underserved populations

PROVIDES

PROVIDING COMMUNITY CARE

In Worthington, Minnesota, Our Lady of Guadalupe Free Clinic operates out of a Sanford-owned facility and provides free health care for the uninsured . Sanford Health’s Health Care Cooperative registered nurses travel to the free clinic once per week to serve underserved patients with chronic and acute conditions who would otherwise be unable to receive much-needed medical care.

Sanford Health hosted an event to provide free hand surgeries to uninsured patients.

Sanford Children’s, in collaboration with Fresh Start Surgical Gifts , provides reconstructive surgery to qualifying children at no cost to families. Eligible patients are under 18 years old, have a condition caused by birth defects, an accident, abuse or disease that requires plastic or reconstructive surgery, and must be uninsured, underinsured or face significant financial hardship in paying for treatment, regardless of citizenship status.

In 2023, in partnership with the American Society for Surgery of the Hand, Sanford Health hosted an event to provide free hand surgeries to uninsured patients. The event offered surgical procedures, consultations and followup care at no cost to individuals who lack health insurance. By removing financial barriers, Sanford Health aims to ensure that all patients, regardless of their insurance status, have access to essential health care services.

PROVIDES

specialized gifts

WORKFORCE DEVELOPMENT

The future health of our communities rests on our ability to attract and develop highly trained clinicians and employees. Sanford Health has prioritized breakthrough initiatives to support the caregivers we need today and cultivate the workforce we know we will need tomorrow.

PARTNERSHIP WITH SECONDARY SCHOOLS

Sanford Health facilities serve as clinical and non-clinical training sites for thousands of students every year. We work locally with high school students in career exploration and partner with secondary academic institutions to provide students with learning experiences that are second to none. By introducing young people to STEM (Science, Technology, Engineering and Mathematics) programs and activities, we can inspire future generations of health care professionals and cultivate a pipeline to meet the needs of our communities well into the future.

Through Aspire by Sanford, students kindergarten through 12th grade have opportunities to explore careers in health care and develop the skills necessary for success in the workforce. With hands-on learning experiences, mentorship opportunities and exposure to careers in the medical field, the program seeks to inspire the next generation of health care professionals to enter the workforce.

In addition, Sanford PROMISE, the outreach arm of Sanford Research, inspires learners to become critical thinkers, problem solvers and the innovators of tomorrow. The program connects the communities in our region with cutting-edge biomedical, behavioral and clinical research.

STEM

Through Aspire by Sanford and Sanford PROMISE, the programs inspire future generations to be innovators of tomorrow.

Through community engagement and rural outreach, Sanford PROMISE promotes science literacy and contributes to STEM workforce development.

students pursuing careers in health care

Sanford Health supports students pursuing careers in high-growth professions like medical assistants, dialysis technicians, licensed alcohol and drug counselors and medical laboratory technicians. Through partnerships with various schools, financial assistance is provided to help students achieve their career goals. In some high-demand professions, participating schools offer financial aid in exchange for a student’s work commitment to Sanford Health.

Through the Classrooms to Careers program, Sanford Health career development consultants work with high school students to explore careers and reduce barriers for students looking to continue their education after high school. The purpose of the program is to empower students to envision their future and make postsecondary education a reality for many who would become first-generation college learners. The program includes college coursework paid for by Sanford Health, individual career advising and tutoring, career exploratory time and leadership development. The program is a partnership with the Sioux Falls School District and Southeast Technical College.

PARTNERSHIP WITH COLLEGES AND UNIVERSITIES

Across Sanford Health communities, we partner with accredited secondary educational institutions to provide students with clinical and research training sites. Students at the University of South Dakota Sanford School

In total, Sanford Health has sponsored 218 students through the Build Dakota scholarship program.

of Medicine and University of North Dakota School of Medicine & Health Sciences train at Sanford Health’s two flagship medical centers.

In Bemidji, Minnesota, Sanford Health provided $1 million in partnership with Bemidji High School, Bemidji State University and Northwest Technical College to provide professional development opportunities, scholarships and programs for local students interested in health care careers.

clinical and research training sites

WORKFORCE TRAINING

The Build Dakota scholarship covers tuition programs, fees and necessary supplies for students pursuing technical education in many high-demand fields, including health care. Scholarship recipients must be full-time students, complete their program on time, maintain a 2.5 GPA and work three years in their field after graduation. In total, Sanford Health has sponsored 218 students.

Each year, Sanford Health also offers opportunities for 11 volunteers to receive scholarships to pursue careers in the medical field. Volunteering exposes recipients to what it is like to work in the health care setting and prepares them for a career in health care.

As part of the Minnesota Dual-Training Pipeline, Sanford Health partners with the state of Minnesota to provide tuition grants for students pursuing education and careers such as respiratory therapy, nursing, surgical technology, exercise science and drug and alcohol counseling.

In Fargo and Bismarck, North Dakota, and Thief River Falls and Luverne, Minnesota, individuals interested in a career as an emergency medical technician can receive hands-on training from Sanford Health emergency medical responders, advanced emergency medical technicians, and paramedic and community paramedic professionals. Through this training, students gain college credit from the North Dakota State College of Science and Minnesota State Community and Technical College. Aspiring technicians learn on-the-job skills such as airway management, how to use oxygen, taking vital signs and using monitors, giving basic medications, putting on tourniquets, splinting limbs and operating an ambulance.

Sanford Health has made an unprecedented expansion in our graduate medical education programs by fully funding 15 additional residency and fellowship programs.

GRADUATE MEDICAL EDUCATION

Rural America is facing historic provider shortages. The U.S. faces a projected physician shortage of up to 124,000 physicians by 2034, with the biggest gaps in primary care, behavioral health and rural communities. There are 30 specialists per 100,000 people in rural communities compared to 263 specialists per 100,000 people in urban areas. The shortage of health care providers in rural areas exacerbates rural health disparities.

Sanford Health has made an unprecedented expansion in our graduate medical education programs to bring clinical expertise, resources and subspecialties to the upper rural Midwest. In partnership with universities across our region, Sanford Health will fully fund 15 additional residency and fellowship programs, training more than 300 residents and fellows a year. Expanding the number of medical residency training programs in rural areas is key to filling gaps in care because many doctors – including more than half of family medicine physicians – stay within 100 miles of where they train. Today, on average, one-third of the physicians who are trained here stay with Sanford Health.

EDUCATE

LEARN MORE

Making our communities stronger and healthier is at the core of everything we do at Sanford Health. As the nation’s premier rural health system, we’re committed to reducing barriers to accessing care for all, improving public health and strengthening community resilience. To learn more about our involvement in our communities, please visit sanfordhealth.org/about/ community-commitment.

As caregivers, we believe that it is not only our duty but also our calling to partner with our communities to help find solutions to the social and economic barriers that hold people back from living their best, healthiest lives.