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Fiscal Year 2023 Year in Review

C O V E R P H O T O : Legacy Senior Primary Care Clinic in Missouri City

Letter from the Chief Executive Officer

Legacy by the Numbers

New in Fiscal Year 2023

Feature: Improving Health Outcomes Through Value-Based Care

Legislative Update

Legacy in the News

The Challenge: Conditions Affecting Our Communities and Nation

The Solution: Our Community Impact

Feature: Legacy Pharmacy

Development: Securing Tomorrow

Development: A Legacy of Trust

Development: Legacy and H-E-B

2023 YEAR IN REVIEW

Table of Contents

2023 YEAR IN REVIEW

Mission

D R I V I N G H E A LT H Y C H A N G E I N OUR COMMUNITIES.

Vision

CONNECTING OUR COMMUNITIES TO H E A LT H E V E R Y D AY, I N E V E R Y WAY.

Values

H E A LT H C A R E I S A R I G H T, NOT A PRIVILEGE We believe that comprehensive health care is a human right. Legacy’s services and programs are open to all who need us, regardless of the ability to pay, without judgment or exception. DEVOTION TO OUR COMMUNITIES We continue to build our legacy on a solid foundation by learning from our communities, embracing the people in them, and serving their unique needs. Especially when no one else will. LEADING THE CHANGE We address issues others shy away from. Not because it’s easy or popular, but because it’s the right thing to do. The Legacy team possesses unwavering courage and serves as a visionary catalyst for sustainable healthy communities. A C T I V E S T E WA R D S H I P OF RESOURCES We carefully manage our available resources in order to deliver on our promise of driving healthy change. We remain grounded in responsible decision-making for sustainable operations, putting every asset where it can do the most good for the community.

L E G A C Y C O M M U N I T Y H E A LT H SERVICES, INC.

Board of Directors

Naveen Pinglay Chairperson Ryan Martin Vice-Chairperson Allison Floyd Wells, M.D. Treasurer Ronnie Kurtin Secretary Mariana Chavez Mac Gregor, M.D. At-Large/Executive Committee Cathy Easter Taryn Hargrove Gore Gary Hammett George Hawkins Bryan Hlavinka Rebekah Le Johnson Olatunji Neftali Partida Cindy Scharringhausen L E G A C Y C O M M U N I T Y H E A LT H E N D O W M E N T, I N C .

Board of Directors Mike Holloman Chairperson George Hawkins Vice-Chairperson Ray Purser Treasurer Bryan Hlavinka Secretary Linda Cantu Tripp Carter Cyndy Garza Roberts Sharon Land Ryan Martin Mark McMasters, M.D. Board Members Emeritus Melanie Gray Melissa Mithoff James A. Reeder, Jr. Monsour Taghdisi Claire Cormier Thielke

As of June 2023

Robert Hilliard, Jr., M.D., MBA I am continuously impressed by and thankful for all that our agency accomplishes year over year – and Fiscal Year 2023 was another exceptional one as we worked to transform the way we drive healthy change and keep patients at the forefront of everything we do. In October, we announced our partnership with Health Choice Network for the implementation of Epic, a state-of-theart electronic health records system. Epic promises vast benefits across Legacy, including improved patient experience and outcomes, streamlined workflows, enhanced data access, improved security and reduced costs. With our Digital Solutions team spearheading the Epic journey, I have full confidence in a successful implementation in October 2023. In November, we opened Central Fill Pharmacy, a “closed door” pharmacy filling prescriptions for our three current pharmacies, all Legacy clinics and patients. This model allows clinic-based pharmacists to spend more time with patients building relationships and improving access to health care between visits. As a result, patient outcomes improve both inside and outside of our clinic walls. Throughout the year, our commitment to value-based care (VBC) gained steady traction as we collaborated with several managed care and accountable care organizations to provide VBC to 25,000 patients. With laser focus on early intervention, transition of care management and chronic care management, we continually worked to improve the way we deliver care, paving the way for even greater impact in the coming years. The legislative session wrapped up with great success as a result of our focused strategy to improve health outcomes for the communities we serve. The state increased the budget for the Federally Qualified Health Center Incubator grant, Medicaid coverage was extended for new moms, and patients were given access to injectable, long-lasting HIV medications and remote patient monitoring, just to name a few. As the fiscal year came to a close, we began planning for our second annual Legacy Leadership Conference, where more than 150 leaders will gather under the theme of Lead. Inspire. Live., setting our intention for the new year through interactive breakout sessions and team-building activities. Legacy continues to raise the bar as the largest Federally Qualified Health Center in the state and a leader amongst others across the nation. The work we’ve accomplished this year reflects a team that adapts in the evolving health care landscape while continuing to provide the best care possible for our patients and each other—and for that, I am most grateful and proud.

Bobby Hilliard CHIEF EXECUTIVE OFFICER

2023 YEAR IN REVIEW

LETTER FROM THE CHIEF EXECUTIVE OFFICER

2023 YEAR IN REVIEW

Legacy by the Numbers L O C AT I O N S

Whom We Serve

By Race/Ethnicity

(Across Baytown, Beaumont, Deer Park, Houston, Missouri City and Stafford)

H I S PA N I C

BLACK

WHITE

ASIAN

OTHER

64%

19%

11%

NUMBER OF EMPLOYEES

1,575 COMPLETED APPOINTMENTS

By Age

687,330

By Gender

COMMUNITY MEMBERS S E R V E D A N N U A L LY

215, 372

PAT I E N T S L I V I N G AT O R B E L O W THE FEDERAL POVERTY LEVEL

91%

59% 39%

0-12

13-19 20-44 45-64

65+

Financials 52% FEE FOR SERVICE BREAKDOWN

T O TA L R E V E N U E Medicaid Self-Pay / Sliding

30% Scale / Grants Private

14% Insurance 4%

$356,627,718 T O TA L E X P E N S E S

$364,174,579 TOTA L U N C O M P E N S AT E D C A R E

Medicare

$20,459,169

Behavioral Health Partnership with Baylor College of Medicine’s Child Psychiatry Access Network Legacy Pediatrics began partnering with Baylor College of Medicine’s Child Psychiatry Access Network, which provides patients with free phone consultations with child and adolescent psychiatrists and Behavioral Health specialists. This service helps our primary care clinicians treat and manage mild to moderate behavioral diagnoses and keep patients under their care while the patient is waiting for a Behavioral Health appointment.

Clinic Openings We added seven new sites to our network of clinics, closing the fiscal year with a total of 57 clinics. The new sites include Jordan Family Healthcare (July 2022, Family Medicine), Almatha Clark Taylor (August 2022, School-Based), KIPP Mosaic (August 2022, School-Based), Aurum Wellness (November 2022, Senior Primary Care), Taylor Pediatrics (December 2022, Pediatrics), Gulfton Dashwood, Suite 102 (December 2022, Infectious Disease), and Gulfton Dashwood, Suite 100 (February 2023, multiple service lines).

Project Walk-In Clinic at Legacy Montrose Legacy Montrose rolled out a new patient experience initiative in January, Project Walk-In Clinic. The project provides a designated line allowing patients without appointments to side-step the check-in process for scheduled appointments and register for a Walk-In Clinic slot. The initiative streamlined the check-in process for both patients with scheduled appointments and those walking in.

Quest Diagnostics Partnership Quest Diagnostics replaced LabCorp as Legacy’s laboratory testing provider. Quest is the world’s leading provider of diagnostic information services, and this change has provided our patients and staff many new and exciting benefits, including on-site check-in kiosks, enhanced customer service, and standardized processes and services across Legacy clinics.

WellMed for Senior Patients Following the successful WellMed pilot program at Legacy San Jacinto in June 2022, the program expanded to additional clinics, including Aurum Wellness, Legacy Montrose and Legacy Third Ward. As part of the WellMed network of doctors, specialists and professionals in Texas providing care for older adults, Legacy has improved access to care for our senior patients, scheduling them for annual wellness visits and providing gapclosing care, including chronic disease management, preventive screenings and medication management.

Legacy Montrose

2023 YEAR IN REVIEW

New in Fiscal Year 2023

2023 YEAR IN REVIEW

Value-Based Care I M P R O V I N G H E A LT H O U T C O M E S F O R L E G A C Y PAT I E N T S Legacy’s shift toward the value-based care (VBC) model over the past two years has dramatically enhanced our ability to provide comprehensive care both inside and outside of our clinic walls. “Through VBC, we take a holistic and comprehensive look at each patient and restructure how we deliver care to the diverse population that Legacy serves,” explained Chief of Population Health & Legacy Performance Services Vernicka Sales, D.O., FAAP. To support our VBC implementation, we entered into several new contract arrangements with managed care and accountable care organizations, which resulted in 25,000 Legacy patients managed under the VBC model this fiscal year. “We are proud and excited about our new contract arrangements,” said Sr. VP of Care Management Latonia Walker. “They provide an opportunity to closely collaborate with our VBC partners to improve the quality, health and cost outcomes for the patients we serve. Through these contracts, we have made significant gains in VBC.”

VBC vs. FFS

Dr. Vernicka Sales, Chief of Population Health & Legacy Performance Services

VA L U E - B A S E D C A R E : Clinicians paid/reimbursed based on the value provided to patients and overall health outcomes.

FEE-FOR-SERVICE: Clinicians paid/reimbursed on volume of patients with focus on treating symptoms only.

Legacy Fifth Ward

Early Intervention

Transition of Care Management

Developed a comprehensive, multi-disciplinary approach to help patients manage conditions like asthma, diabetes and hypertension—and ultimately keep them out of emergency rooms. The multi-disciplinary team includes physicians, clinical pharmacy specialists, registered dietitians, registered nurse care managers, patient educators and our Quality team.

Implemented the Transition of Care program to focus on outreach to patients recently discharged from inpatient or emergency department settings. Through Transition of Care, the Care Management Team assesses and addresses unmet needs, performs medication reconciliation and schedules follow-up appointments with primary care or Behavioral Health clinicians within seven days of discharge.

RESULTS: Surpassed the American Heart Association benchmarks for both hemoglobin A1C control and controlled blood pressure. Our team-based approach also led to recognition by the AHA for our focus on type 2 diabetes, cholesterol, and high blood pressure management and care. HEMOGLOBIN A1C CONTROL

CONTROLLED BLOOD PRESSURE

70 60

Legacy Community Health, 69.7%

Medicaid National Avg., 58.6%

Legacy Community Health, 63.9%

Medicaid National Avg., 48.3%

0 Higher averages indicate better control of A1C and blood pressure.

Chronic Care Management Piloted our Chronic Care Management program for patients with certain conditions and/or who are at increased risk of adverse events.

RESULTS: Successfully engaged over 3,000 discharged patients. Without the Transition of Care initiative, many patients would not have received post-discharge contact, which would have resulted in fewer follow-up health care visits and reduced health outcomes.

Patient-Centered Medical Home Recognition Applied for Patient-Centered Medical Home recognition from the National Committee for Quality Assurance. Seven Legacy sites participated in the reporting process and submitted the required information demonstrating that they met 65 criteria across six concept areas: Team-based care and practice organization; knowing and managing your patients; patient-centered access and continuity; care management and support; care coordination and care transitions; and performance measurement and quality improvement. RESULTS: Seven Legacy clinics received Patient-Centered Medical Home Recognition: BakerRipley, Bissonnet, Gulfton Dashwood, Fifth Ward, Montrose, San Jacinto and Southwest. This achievement signifies how effectively these clinics align their operations and care delivery, putting patients at the forefront of care.

RESULTS: Assisted and supported 150 program enrollees through outreach to some of our most vulnerable and chronically ill patients at Jordan Family Healthcare, a Legacy Clinic.

Looking Ahead In the coming year and beyond, we will focus on several areas, from optimizing Epic for comprehensive patient care and engagement to increasing VBC contracts, expanding Chronic Care Management enrollment and expanding Patient-Centered Medical Home accreditation. With much to celebrate over the past year, the future of VBC at Legacy is promising as we continue to put the patient first in all that we do.

2023 YEAR IN REVIEW

Fiscal Year 2023 Value-Based Care Highlights

2023 YEAR IN REVIEW

Pa t ien t Sto r y

Latonya Russell

L E G A C Y A D U LT M E D I C I N E A N D P H A R M A C Y PAT I E N T

In January 2023, extreme dizziness and frequent urination prompted 44-year-old food server Latonya Russell to go to the hospital for an evaluation. After being admitted, testing showed a high glucose level, and doctors diagnosed her with diabetes. Once she had been discharged from the hospital, Russell knew she needed to find a health clinic for ongoing care. However, she had recently changed jobs, and her new health insurance plan offered limited options. After learning about Legacy from her mother, she decided to make an appointment at Legacy’s Fifth Ward clinic.

“The moment I walked in the door, I was impressed,” said the Louisiana native. “It was so clean, and everyone was so nice.” Russell was seen by Dr. Danielle Wininger, who prescribed medications to help reduce Russell’s cholesterol, blood pressure and weight. Following her visit with Dr. Wininger, through Legacy Pharmacy, Russell was able to access vital diabetes medications at a reduced cost. She then met with Clinical Pharmacy Specialists Neha Agrawal, PharmD, and Kenicia Curry, PharmD, for one-on-one medication counseling. “We pride ourselves on reducing barriers for our patients,” Curry said. “If there’s a lack of transportation, that’s okay—we offer shipment. If cost is an issue, we have financial assistance.” The Clinical Pharmacy Specialist team is a unique offering at Legacy. “We collaborate with multiple disciplines across Legacy and prescribe medication, order labs, help coordinate care and provide education for our patients,” explained Agrawal. “Neha guided me every step of the way and explained things [about medication and nutrition] in a way that was easy to understand,” said Russell. “I’ve lost 70 pounds since I started my treatment,” she added, sharing that she weighed 315 pounds when she was admitted to the hospital. After nine months of forward progress with her care at Legacy, not only is Russell nearing her goal weight of 200 pounds, but she also no longer depends on metformin or insulin to control her diabetes. Thanks to Legacy, she feels healthier than she has in a long time and is optimistic about the path of continued good health ahead.

“The moment I walked in the door, I was impressed.”

In Mexico, however, his health grew worse. After weeks in the hospital with no answers, Gutierrez’s family brought him to a nearby hospital in Brownsville, Texas, where he finally received his diagnosis: Gutierrez had HIV. “I felt destroyed,” Gutierrez said of receiving his diagnosis. “I was afraid I would never be the same person I was before.” But soon after returning to Houston, he discovered Legacy’s Montrose clinic—and a glimmer of hope.

with Integrated Behavioral Health Director Sarah Bledsoe to provide additional support. Through the Rapid Start Program, Gutierrez has received all health care services and specialty medications at no cost. His health has improved significantly, and he is hopeful that soon his HIV status will be undetectable—meaning that the medicines will have reduced the amount of HIV in his blood to a level so low that it cannot be detected by standard viral load tests. “Many people at Legacy comforted me, educated me and genuinely cared for me,” Gutierrez shared. “Their guidance has made a positive and long-lasting difference in my life.” *Name changed for privacy.

At his first appointment, he met Health Prevention Specialist Steve Stellenwerf who confirmed Gutierrez’s HIV-positive status and recommended Legacy’s Rapid Start Program for newly diagnosed HIV patients. Gutierrez, who faced stigma due to his diagnosis, was surprised to learn that, with consistent treatment, HIV is a manageable disease, and he was relieved Legacy could provide that treatment. “In my heart, I knew I was at the best place to get back on my feet, to continue living and continue winning,” he said. Stellenwerf connected Gutierrez to Infectious Disease Specialist Dr. Meena Sunil who immediately began to manage his HIV. An urgent Behavioral Health appointment was scheduled

Health Prevention Specialist Steve Stellenwerf supported Gutierrez throughout his care.

Pa t ien t Sto ry

H I V R A P I D S TA R T P R O G R A M PAT I E N T

Working nights at an industrial lab and caring for his elderly parents during the day, 54-year-old Carlos Gutierrez did not have much time to focus on his health. But when a prolonged period of body aches, vomiting and weakness caused him to lose 25% of his body weight, he knew he needed to see a doctor. Not yet eligible for health insurance through his new employer, Gutierrez traveled to Mexico in hopes of affordable treatment.

2023 YEAR IN REVIEW

Carlos Gutierrez*

“In my heart, I knew I was at the best place to get back on my feet.”

2023 YEAR IN REVIEW

L E G I S L AT I V E U P D AT E F R O M T H E V I C E P R E S I D E N T O F G O V E R N M E N T R E L AT I O N S & P U B L I C A F FA I R S

Lindsay Lanagan

With a legislative strategy in place to improve health outcomes for the communities we serve, our 2022/2023 agenda focused on access to care through remote patient monitoring, extending Medicaid coverage for new moms, and increasing the state’s budget for the FQHC Incubator Grant and for access to injectable, long-lasting HIV Medications. On all of those fronts, our team met with successes that will have a lasting impact on our patients and physicians.

At the federal level, we celebrated two major wins: • Protection of the 340B program, resulting in no program cuts or changes for FQHCs and/or Ryan White clinics. The program allows health centers serving low-income and uninsured patients to purchase outpatient drugs at significantly lower costs. • Two earmarks in the Congressional Budget: Congressman Al Green directed $1,000,000 to help Legacy transition to a new electronic health records system, and Congresswoman Sylvia Garcia allotted $300,000 to renovate our Galena Park clinic.

Our state legislative efforts yielded multiple victories: • Protected FQHC reimbursement rates, resulting in no cuts or changes to the FQHC formulary for reimbursement under the state’s Medicaid program. • Advocated for an increase in Women’s Health programs, which received increased funding by 22%. • Secured $14 million in federal grants for the state budget for HIV injectables to be added to the Texas HIV Medication Program formulary. • Advocated for and achieved 12-month coverage for postpartum Medicaid, an increase of 10 months. • Advocated for and achieved 12 months’ supply of birth control in one pharmacy visit. • Achieved reimbursement for remote patient monitoring, thereby creating a new reimbursable code for FQHCs. Advocating for our patients and physicians is an important aspect of Legacy’s investment in the community, and our team is honored to be of service.

Lindsay Lanagan VICE PRESIDENT – G O V E R N M E N T R E L AT I O N S & P U B L I C A F FA I R S

T O TA L N E W S M E N T I O N S

1,200+ Articles SOCIAL MEDIA ENGAGEMENT

88,000

(Reactions, shares, comments across Facebook, Instagram, LinkedIn and Twitter)

A D E Q U I VA L E N C Y

$6 Million

(The value of earned media coverage)

Congressman Al Green presented a $1,000,000 check to Legacy in February 2023 for the upgrade of system-wide electronic health records software. U.S. Health and Human Services Secretary Xavier Becerra visited Legacy’s Northside Irvington clinic where he led a roundtable with Congresswoman Sylvia Garcia about the importance of Open Enrollment season for health insurance.

AWARDS: ouston Methodist: $900,000 Community H Benefits Grant & $100,000 Mental Health Initiative Grant

OutSmart Magazine: 2022 Gayest & Greatest Readers’ Choice Winner for Best Community Health Services Provider and Best Pharmacy

In a June 2023 interview with CW39, Wellness Manager Felicia White provided tips for healthy aging through nutrition and fitness.

Port Arthur LNG: $2,500 Safe Communities Initiative Grant for Behavioral Health & Season of Giving Award

The Immunization Partnership: Courage in Action Award

United Way of Beaumont & North Jefferson County: Allocations Award

Louis Canales, a 16-year-old student at YES Prep Gulfton, lost more than 60 pounds thanks to the help of the schoolbased clinic team. KPRC 2 interviewed him at Bayland Park.

2023 YEAR IN REVIEW

Legacy in the News

2023 YEAR IN REVIEW

Pa t ien t Sto r y

Jaxson Yarbrough P E D I AT R I C B E H AV I O R A L H E A LT H PAT I E N T

The first six years of Jaxson Yarbrough’s life were marked by emotional struggles and medical uncertainties, according to his mother, Amanda Yarbrough. But then, nearly seven years ago, Jaxson found a steadfast advocate in Psychiatrist Dr. George Groves. Soon, Jaxson was diagnosed with ADHD, anxiety and depression, and a treatment plan was developed. “Dr. Groves embarked on a journey with us to determine the medication best suited for Jaxson, given that standard medications caused severe side effects,” Yarbrough explained.

When Dr. Groves joined Legacy’s Beaumont team at the Central Stagg clinic, the Yarbrough family followed him there, where they have continued to receive care since August 2020. For Yarbrough, the steadiness offered by Dr. Groves and Legacy is invaluable. “Knowing that someone understands Jaxson’s history before making any medication or treatment decisions is a relief,” she explained. The Yarbrough family also receives support from Reyna Godinez, Behavioral Health supervisor. “She is accommodating and welcoming,” Yarbrough said, noting that the Legacy team and the clinic atmosphere add comfort to their patient experience. Yarbrough also appreciates the flexibility in scheduling appointments, especially for a child with a busy schedule like Jaxson’s. “We can meet with Dr. Groves digitally through Zoom or come in face to face for check-ins,” she said, emphasizing the importance of this convenience for managing Jaxson’s health. “The past five years have been stable and comfortable, a significant milestone we attribute to Dr. Groves’ expertise and commitment,” said Yarbrough. She has noticed discernible improvements in her son’s behavior and academics. “Jaxson now evaluates information before reacting,” she shared. “He’s more balanced in his interactions with others.” In addition to clinician expertise, Yarbrough recognizes the impact of Legacy’s full-service health care system that accommodates and understands the complex needs of a young patient and his family. With a robust health care team in their corner, the Yarbrough family looks toward the future with newfound hope.

“The past five years have been stable and comfortable.”

2023 YEAR IN REVIEW

“[The doctor] seemed genuinely concerned about me, and that meant a lot.”

| Pa t ien t Sto ry

Emma Reeder S E N I O R P R I M A R Y C A R E PAT I E N T

Life has been a little easier for Emma Reeder since finding a health clinic close to home that specializes in health care for seniors. A 73-year-old retired cook from Lake Charles, Louisiana, Reeder moved to Houston to live with her daughter after Hurricane Harvey in 2017. But as Reeder began to experience health ailments and require more care, they decided it would be best for her to move closer to her daughter’s job in the Texas Medical Center. In January 2023, she settled into her new apartment at Law Harrington Senior Living Center and began looking for a new health clinic. Convenience was important to her due to limited transportation, so when she realized a Legacy Senior Primary Care clinic was housed within Law Harrington, she immediately made an appointment. “That’s when I met Dr. Kim,” said Reeder, recalling her first visit. “I really liked him because he took the time to listen to me.” A few months later, Reeder began to experience symptoms that eventually led to a stroke. After her hospitalization, Geriatrician Dr. Jung-Hoon Kim checked on her. “He seemed genuinely concerned about me, and that meant a lot,” Reeder said.

Dr. Kim, who has been a geriatrician for 15 years, values long-term relationships with his patients. “Over the years, I not only provide medical care, but I also become a trusted friend and source of emotional support, making my work exceptionally fulfilling,” he shared. He said that most of Reeder’s acute problems are now stabilized, and that she understands her medical conditions better and how to manage them. “Lifestyle changes and health management strategies like following a healthy diet and regular exercise can significantly reduce the risk of another stroke,” he explained. Since recovering from her stroke, Reeder is socializing more with her neighbors and feels more confident managing her cardiovascular health. She is grateful for the specialized care available for seniors at Legacy’s Third Ward clinic, and her daughter has peace of mind while at work, knowing that Reeder has access to exceptional medical care right where she lives.

2023 YEAR IN REVIEW

The Challenge:

C O N D I T I O N S A F F E C T I N G O U R C O M M U N I T Y A N D T H E N AT I O N

Behavioral Health Texas ranks 46th in the U.S. for mental health, measured by the prevalence of mental illness versus access to care. Twenty-one percent of adults (50 million Americans) are experiencing mental illness, 28 million of whom receive no treatment, with cost of service identified as a major barrier. Sixteen percent of youth (nearly 3 million) are experiencing severe major depression, and more than half do not receive Behavioral Health care. In the U.S., there are 350 individuals for every one mental health provider. (Houston State of Health, National Alliance on Mental Illness, Mental Health America)

Chronic Conditions Chronic diseases are the leading cause of death and disability in the U.S., with one in six adults having a chronic condition like heart disease or diabetes. High blood pressure, the leading cause of heart disease and stroke, affects 116 million U.S. adults (nearly 50%). Additionally, 96 million adults have prediabetes, a precursor to diabetes which leads to an increased risk in heart disease, stroke and other severe complications. (Centers for Disease Control and Prevention)

HIV Pandemic Beaumont and Greater Houston have been disproportionately impacted by HIV, with Black and Latinx communities especially affected. Black and Latinx people account for 50% and 29% of Houston HIV cases, respectively, and 56% and 27% of Beaumont HIV cases, respectively. People living with HIV are more likely to experience poverty, homelessness, food insecurity and

serious health conditions such as tuberculosis, hepatitis C, and mental health disorders. HIV can also lead to stigma and discrimination, which can limit access to care and support for people living with HIV. (Centers for Disease Control and Prevention, Houston Health Department)

Maternal Mortality Rates vary by age and ethnicity, but maternal mortality continues to affect the Black community and those age 40 and over at disproportionate rates, with mortality at two times and six times, respectively, above the overall mortality rate (last measured at 32.9 deaths per 100,000 live births in 2021). Access to quality health care before, during and after pregnancy greatly affects health outcomes, and it is estimated over 14% of those expecting do not start receiving care until the fifth month of pregnancy or later. (Centers for Disease Control and Prevention – National Vital Statistics System, Texas Maternal Mortality and Morbidity Review Committee)

Social Services Access to social programs and services that improve the well-being of individuals, families and communities can affect health outcomes, and that access varies significantly by determinants including education, income and geography, among others. Across Greater Houston, 14% of households live below the federal poverty line, and another 31% of households, though employed, cannot afford basic necessities. Also adding to the problem is a shortage of resources in some instances, including a continuing shortage of therapists and social workers across the state and country. (United Way, Houston State of Health)

O U R C O M M U N I T Y I M PA C T

Access to Behavioral Health Care Legacy increased its hybrid in-clinic and work-from-home schedules for Behavioral Health clinicians, extended clinician hours and significantly expanded the clinic-based Behavioral Health team, adding four psychiatrists and 24 therapists for a total of 36 psychiatrists and 82 therapists. The agency realized a 22% increase in completed appointments compared to Fiscal Year 2022, and we increased our focus on transition of care after hospitalization and access to care for juvenile detention patients.

Care Management Programs Our Care Management team launched an outreach initiative to engage patients with uncontrolled hypertension and/ or uncontrolled diabetes. Patient education specialists and registered dietitians engaged with patients through connections to Legacy resources and education on self-monitoring blood pressure and glucose levels. As a result, 63.9% of Legacy patients with diabetes achieved hemoglobin A1C control versus the American Heart Association benchmark of 48.3%, and Legacy patients with uncontrolled hypertension achieved 69.7% controlled blood pressure versus the AHA benchmark of 58.6%.

Fighting to End HIV Our first Infectious Disease clinic opened in Southwest Houston in December 2022: Legacy Gulfton Dashwood, Suite 102. Additionally, Clinical, Marketing and Operations teams collaborated to launch the ID Care Now program across the Gulfton Dashwood, Montrose and Wellness Bar clinics. A concierge-like service for patients living with HIV or other infectious diseases (or who are on prevention medication), ID Care Now connects patients directly to Legacy’s team of 18 Infectious Disease clinicians and their care teams. In total this year, Legacy had 3,993 patients on PrEP for HIV prevention,

Maternal Mortality The Patient Education team completed nearly 28,000 patient interactions, including testing, and scheduled over 91% of positive walk-in pregnancy test patients for an initial maternity appointment. To increase patient access in 2023, the OB/GYN team modified schedules to improve clinician availability for initial maternity appointments, increasing OB ratios by 5% at sites, and began offering some Saturday clinics for gynecological services. Legacy’s OB/GYN team also collaborated with Social Services to increase Children and Pregnant Women Case Management (CPW) enrollment, a program that provides health-related case management services for high-risk pregnant women.

Social Services The Social Services team continued to engage the whole patient with educational and wraparound services, including bi-weekly addiction recovery support groups, free or discounted rides to Legacy appointments, education and resources for families with autism, and immigration education and consultation with BakerRipley. Through these initiatives, Legacy Social Services helped over 400 families in 2023, and outreach efforts continue to expand.

2023 YEAR IN REVIEW

The Solution:

including 691 on the bimonthly injectable prevention medication Apretude. We also had 7,268 HIV patients in care, 280 of whom were on the monthly injectable HIV treatment Cabenuva.

2023 YEAR IN REVIEW

18 P R E S C R I P T I O N S F I L L E D P E R D AY

1,300 + PRESCRIPTIONS FILLED PER YEAR

395,000+ FREE

M E D I C AT I O N DELIVERY

RANKED #1 IN THE WORLD FOR THE NUMBER OF H I V/ P R E P I N J E C TA B L E A D M I N I S T R AT I O N S

Legacy Pharmacy E X PA N D I N G R E A C H, INCREASING ACCESS

Since its inception six years ago, Legacy Pharmacy has continuously expanded to meet the needs of our patients and the communities in which we serve, removing barriers that prevent patients from achieving optimal health. In its first year, Legacy Pharmacy saw 9,000 patients and filled 95,000 prescriptions. This year, 38,729 patients filled more than 395,000 prescriptions through our pharmacies with the addition of our closed-door Central Fill Pharmacy in November 2022. At 4,459 square feet and outfitted with two robots, Central Fill Pharmacy is staffed by 15 team members and shares building space with our newest standalone Senior Primary Care clinic in Missouri City. The new pharmacy fills prescriptions for shipment on behalf of Legacy clinic pharmacies, freeing the pharmacists in those clinics to focus on the immediate needs of patients, whether they

“Our innovative, full-service pharmacies are leaders in the field of ambulatory care,” said Sr. VP of Pharmacy & Financial Support Trina La, PharmD. “Data shows that patient outcomes improve when Legacy Pharmacy is part of their health care team.” For example, we were one of the first pharmacies to launch injectable medications for patients living with HIV and PrEP for HIV prevention. As a result, while HIV viral load suppression in Houston is estimated at 59%, Legacy Pharmacy users have an average viral load suppression of 86%. And Legacy Pharmacy continues to innovate. Along with Central Fill Pharmacy, Legacy implemented the ScriptCenter locker system at our San Jacinto clinic, allowing patients to pick up and pay for prescriptions from a secure storage locker. A Patient Assistance Program representative is also available at all times to help connect patients to medications and provide technical support.

ACCREDITED B Y T H E U T I L I Z AT I O N R E V I E W A C C R E D I TAT I O N COMMISSION

RECOGNIZED

A S A PAT I E N T - C E N T E R E D M E D I C A L H O M E B Y T H E N AT I O N A L COMMIT TEE FOR QUALITY ASSURANCE

AVAILABLE TO BOTH LEGACY AND N O N - L E G A C Y PAT I E N T S

“We are proud of our pharmacies and the care we provide,” La said. “We look forward to continued growth in the coming years and increasing access to pharmacy services in our communities.”

The Legacy Pharmacy Team difference Beyond filling prescriptions, Legacy’s Clinical Pharmacy Specialists provide direct care for patients with certain chronic diseases under Collaborative Practice Agreements with providers. Through both in-person and telemedicine appointments, Clinical Pharmacy Specialists make assessments, provide education/counseling, and change therapies as needed to ensure that patients achieve their clinical goals. When a patient is seen by a Legacy Clinical Pharmacy Specialist three times or more, over 85% of patients either achieve their clinical goals or improve their clinical outcomes.

2023 YEAR IN REVIEW

are picking up medications or require a vaccination or one-on-one medication counseling.

2023 YEAR IN REVIEW

Pa t ien t Sto r y

Louis Canales

S C H O O L - B A S E D H E A LT H C A R E PAT I E N T

Louis Canales was 13 years old and weighed over 300 pounds when he first became a patient at Legacy’s SchoolBased Health Care clinic at YES Prep Secondary Gulfton. Concerned about his overall health after his first clinic visit, Nurse Practitioner Susanna Reich began working closely with Canales to incorporate healthy lifestyle habits like exercise and nutritious eating. “Susanna helped me a lot,” Canales said. “She motivated me…to eat better and to do right, and I think I needed that motivation to keep going.”

With vital resources and support readily available at the on-campus clinic, Canales embarked on a journey to better health. He began working out at the gym at 5 a.m. every day before school, and after school he took up running, eventually working up to three miles per day. As he changed his lifestyle and developed healthier eating habits, his lab results steadily improved while his weight steadily reduced. Over the course of the next couple of years, Canales lost more than 60 pounds. “Louis was really a dream patient because he’s very motivated…and he had the support of his family,” Reich said, adding that the clinic’s convenience provides a way to connect families to quality health care they might not otherwise be able to access. “I think one thing that’s important is that the family supports and goes on the journey with the patient,” Reich said. “Legacy has...shown me how to lose weight, how to eat better, and how to be more confident,” Canales said. “My mom has diabetes, and when I’m an adult, I don’t want to be sick. I don’t want to be worried about my health.” Now, nearly three years after his first Legacy appointment, he continues his commitment to healthy living and hopes to one day become a Navy Seal.

“When I’m an adult…I don’t want to be worried about my health.”

2023 YEAR IN REVIEW

“Every day, I see the tangible impact of our work.”

| Devel o pmen t

Securing Tomorrow

KEVIN ALOYSIUS’ PLEDGE TO LEGACY

“When I joined Legacy, I didn’t just find a job; I found a cause,” said Director of Pharmacy Services Kevin Aloysius, PharmD. “I saw firsthand the difference we make in the lives of the people we serve.” And while many his age are only beginning to contemplate their legacies, Aloysius has already taken decisive steps to ensure his impact resonates into the future. Paying off his student loans and securing his retirement was just the start. Next, he made the decision to allocate a portion of his assets to Legacy in his will, ensuring that his commitment to health and community endures even in his absence. Many believe setting up a will is complicated and costly, but Aloysius found the process surprisingly straightforward, thanks to Legacy’s partnership with FreeWill.com. “The idea of making a will seemed daunting, but with precise guidelines, it became a seamless process. Plus, selecting Legacy as a beneficiary was an added benefit,” Aloysius said. He chose to direct his contributions to the Jackson Hicks Fund for the Education, Prevention, and Treatment of HIV/AIDS, a choice inspired by his daily encounters in the pharmacy. “Every day, I see the tangible impact of our work, the lives touched and transformed. While the enormity of the need can feel overwhelming, it’s a reminder of the

Kevin Aloysius, PharmD Director of Pharmacy Services

profound difference even a small contribution can make,” he said. “It’s not about the magnitude of the gift but the heart behind it.” He often shares such wisdom with the younger generation when, beyond his official Legacy Pharmacy role, he mentors and guides University of Houston Pharmacy interns both at work and during volunteer outreach. “Life’s twists are unforeseen,” Aloysius expressed. “It’s crucial that we anticipate and plan, not just for ourselves but for those we love and the causes we believe in. For young professionals like us, it’s about recognizing our values and investing in them. And I’ve found my value in Legacy.” Selecting Legacy as a beneficiary in his will signifies Aloysius’ dream for Legacy’s mission to touch even more lives. Through his planned giving, he’s making sure his dream edges closer to reality. For Aloysius, this isn’t just a donation; it is a partnership, an investment, and most of all, it is a legacy.

2023 YEAR IN REVIEW

Devel o p men t

A Legacy of Trust:

T H E C U L L E N T R U S T F O R H E A LT H C A R E ’ S U N WAV E R I N G S U P P O R T

In the realm of health care philanthropy, few partnerships have been as enduring and impactful as the one between Legacy and The Cullen Trust for Health Care. Since its first donation in 1999, when Legacy was known as the Montrose Clinic, The Cullen Trust has been a cornerstone of support, contributing nearly $5 million to date. The Cullen Trust was launched in 1978 with a gift from The Cullen Foundation, established in 1947 by Hugh Roy and Lillie Cranz Cullen—great-grandparents of Cullen Geiselman, board chair of The Cullen Trust. The family’s philanthropic legacy continues to deeply and positively impact Houston’s Cullen Geiselman, Chair of The Cullen Trust for Health Care (left); Beth Robertson, Chair of The Cullen Trust for Health Care (right)

health care landscape, and part of that impact stems from The Cullen Trust’s partnership with Legacy. “In the 1990s, a coalition of funders came together to push for more access to primary care for the underserved and uninsured,” said Geiselman. “Legacy stood out ahead of all the other clinics,” she said, explaining that The Trust’s vision for an integrated health care system aligned with Legacy’s mission of “connecting our communities to health every day, in every way.” “We would love a system where everyone can receive care, and Legacy [provides that] to the people we’re trying to help,” said Geiselman. In support of our aligned missions, The Cullen Trust awarded Legacy a $1.5 million grant in 2008 to construct the Legacy Montrose clinic and $2.5 million toward the capital campaign for Legacy’s Southwest clinic, among other initiatives. But the relationship between The Cullen Trust and Legacy extends beyond financial support. “Our partnership with Legacy is more than a transactional relationship,” Geiselman shared. “It’s nice to have that relationship of respect and friendship to help The Trust implement its mission through its grantees. Legacy is a fantastic example of how we can help people.” The bond between Legacy and The Cullen Trust is a testament to what can be achieved when shared visions come together for the greater good of community health. Our alliance not only enriches the lives of Houstonians today but also sets a promising course for the future of health care in the region.

“Legacy is a fantastic example of how we can help people.”

2023 YEAR IN REVIEW |

“[Legacy looks] at health care holistically...with a focus on both physical and mental health.”

Devel o pmen t

Legacy and H-E-B

Lisa Helfman, H-E-B Regional Director of Public Affairs

A PA R T N E R S H I P S H A P E D BY S H A R E D VA LU E S

From its humble beginnings in 1905 as a small family grocery store in Texas, built on a modest $60 investment, H-E-B is now one of the nation’s largest independently owned food retailers serving more than 300 communities. But its mission is not limited to filling grocery baskets; H-E-B is also committed to supporting causes that are close to its core, donating 5% of pre-tax annual earnings in support of environmental stability, health, hunger relief, military relief, and more. For years, H-E-B has generously backed our mission, identifying deeply with our commitment to integrated health care. “[Legacy looks] at health care holistically...with a focus on both physical and mental health,” noted Lisa Helfman, H-E-B’s regional director of public affairs. This overarching vision is mirrored in H-E-B’s approach to catering to community-specific needs through their tailored grocery offerings, emphasizing the sentiment that “people matter.”

Recognizing our aligned goals to care for every member of our communities, H-E-B provided significant contributions to our Montrose and Southwest clinic capital campaigns, as well as a $100,000 gift to our school-based Behavioral Health program. The retailer is also the presenting sponsor of Legacy’s Little Readers program, founded a few years ago when H-E-B realized the gap in literacy among potential young employees. This revelation ignited a passion for fostering employee growth and ensuring communities thrive educationally, emphasizing prevention over cure. H-E-B’s contributions to Legacy’s educational endeavors are a reflection of that commitment. With 154,000 employees across various communities, H-E-B is often more than just a grocer; it is the lifeline and backbone of many neighborhoods. Likewise, partnership with Legacy is not just about funds or facilities; it is a shared dream, a combined mission, a symbiotic relationship rooted in a desire to see communities flourish.

With Legacy’s vision of health care for all, we’re committed to providing a wide range of services: Adolescent Care Adult Gender Health & Wellness Adult Medicine Behavioral Health Dental Eligibility & Enrollment Endocrinology Family Medicine Health Promotion & Education HIV/STI Screening, Prevention & Treatment Infectious Disease LGBTQIA+ Services

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Obstetrics & Gynecology Patient Navigation & Linkage to Care Pediatrics Pharmacy School-Based Health Care Senior Primary Care Social Services Sports Medicine Vaccinations & Immunizations Vision