MAJOR IMPACTS OF DONOR AND FUNDER INVESTMENTS Mobile Dental program more than doubles capacity to serve rural areas and school based health centers with grants from Duke Endowment/Blue Cross Blue Shield and The Leon Levine Foundation Opened a new on-site Pharmacy in our BRH – Haywood location to ensure patients can get their medications quickly and as affordable as possible 12 School Based Health Centers and 13 additional counseling sites across 7 counties providing services to school children and their families NEW Street Outreach Program now providing unsheltered patients with access to healthcare and a safe place to isolate or quarantine if exposed to COVID-19 [See story page 8] Partnering with Highlands Cashiers Health Foundation to open a new clinical site in 2021 to serve the HighlandsCashiers Plateau. Provided over 16,000 COVID-19 tests Medication Assisted Treatment for Opiate Use Disorder available at eight BRH sites 88,474 prescriptions filled. 66% of these prescriptions were for uninsured patients 2020 HRSA Health Center Quality Leader Award

MESSAGE FROM OUR CEO When faced with challenges, the most important thing we can do is stay grounded. Stability conquers adversity. This steady approach has been present at Blue Ridge Health for over 57 years and is ever-present still today. Our focus on things that matter most are reflected in our mission statement: “to provide healthcare that is accessible and affordable for ALL.” In a year like 2020, remaining grounded and focused on what matters most, the health of our patients, was a Defining Moment. We all have moments in our lives that can be considered defining moments – times when a certain thing happened that changed our life trajectory. Nonprofit organizations are the same. Taking time to reflect and focus on these moments is what helps keep us grounded. Our Impact Report for 2020 will be a reflection on a few of our Defining Moments: patients and staff embracing new technologies in Telehealth; taking our dental services on the road; creating a street outreach program to serve our homeless and other vulnerable populations; managing the effects of diabetes with innovative tools; and preparing to open a new clinic in Macon County. All this and more while pivoting 57 years of well-oiled procedures and converting them to COVID-19 response. Blue Ridge Health remains grounded and as a result we remain strong. The strength of our organization and the commitment of our passionate staff who work tirelessly every day to deliver the highest quality care makes Blue Ridge Health the healthcare partner you deserve. Richard Hudspeth, MD Chief Executive Officer

BRH COVID RESPONSE For 57 years, BRH has remained a steadfast safety-net resource for individuals across Western North Carolina. Over the years, we responded swiftly to the various healthcare challenges that have arisen to ensure the communities we serve continue to receive the medical care they need, when and where they need it. The COVID-19 public health crisis is no different. In a time span of 3 days, we redesigned our 57 years of operational strategies so we could continue to provide safe, quality healthcare to our patients. All of this was done while maintaining our staffing team and ensuring a safe work environment for the heroes within our organization. While we were beginning to explore the notion of telehealth virtual visits within our School Based Health Center programs, COVID-19 turned that exploration into a full-tilt transformation. The processes and procedures within our medical and behavioral health departments were transformed to telehealth. Dental services were restricted to emergency procedures only, as elective and preventative care visits were suspended. The pandemic has affected every person and organization, and BRH is no different. We experienced a roughly 40% reduction in patient visits overnight. Though that number continues to fluctuate, we realize that a complete recovery will not be attainable until a proven vaccine is readily available. The administration of COVID-19 tests has become a daily norm for our medical and outreach staff, as tests are offered at all of our medical sites and during other testing events throughout the communities we serve. Since the onset of the pandemic, BRH has conducted over 16,000 tests and conveyed the results of the tests to each patient personally. We also established a COVID Hotline, so patients can speak with a nurse to triage their symptoms or simply ask questions. This resource has served to help alleviate patient concerns during a time that is fraught with uncertainty. For an organization of our size, we have impressed ourselves with our ability to remain agile and flexible as we face new challenges every day. It is through this agility and the commitment and perseverance of our staff that BRH will continue fulfilling our mission “To provide quality healthcare that is accessible and affordable for ALL.”

GIFTS ANYONE CAN MAKE Annual Gifts are so very important to the care Blue Ridge Health is able to provide our patients. Yet, how many time has your heart said, “I wish I could do more?” In tumultuous times, we all may wish we had more to give, but have you thought about how you might be able to make a significant difference through a legacy gift? Leaving Blue Ridge Health a gift in your will or trust or making a gift of stock or other highly appreciated asset is an easy way you can do more. Kathryn McConnell, Director of Philanthropy, has 20+ years or experience in working with planned giving, either through estate planning, stock gifts or other real property assets, gifts from your retirement plan, or life income gifts that benefit you the donor as well as the patients of Blue Ridge Health. Kathryn will work with you, or if you wish, you and your professional advisors to help craft a gift that makes sense for you and helps fulfill your passion to help those less fortunate with their healthcare. WANT TO DO MORE? Contact Kathryn McConnell at 828-233-2209 or email at kmcconnell@brchs.com

PATIENT CENTERED MEDICAL HOME A patient-centered medical home is a healthcare delivery model that is designed to provide comprehensive and continuous medical care to help patients achieve the greatest possible health outcomes, and assures patients get the care when and where they need it. Mrs. Marjorie Livsey is no stranger to the importance of accessible healthcare as a critical aspect of maintaining personal health and wellness. Her husband was a substance abuse counselor and her daughter is a Ph.D. Nurse in the Western North Carolina area who works to improve access to medical care in our communities. As a patient at Blue Ridge Health – Givens Gerber Park, she has experienced first-hand how our patient-centered model and our commitment to providing healthcare that is accessible and affordable for all can have a positive effect on everyone. Mrs. Livsey lives in the same building as our Gerber Givens Park clinic and believes that "we should have a clinic like it in every community because access to healthcare is important." She also notes that, "what's good about having a clinic close to me is that my records are there and they can be kept in one place. It's great to have access to healthcare so closely without having to leave the community, and my provider is good about picking up on things." Mrs. Livsey utilizes our clinic for regular physical exams and other periodic visits, and she appreciates that her providers offer "great care and are willing to listen." Our Givens Gerber Park clinic is another example of how providing access to quality care close to home can help everyone in the communities we serve live healthier, more fulfilling lives. QUALITY CARE FOR YOU AND YOUR FAMILY At Blue Ridge Health we hold ourselves to the highest standard of care. Our commitment to quality means our patients receive the best level of care. Blue Ridge Health Exceeds National Quality Measures set by the Health Resources and services Administration (HRSA) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Child and Adolescent Weight Assessment and Counseling Adult Weight Screening and Follow-up Tobacco Use Screening and Cessation Ischemic Vascular Disease: Asprin or Other Antithrombotic Therapy BRH Average HRSA Average Colorectal Cancer Screening Hepatitis C Virus Testing Childhood Immunizations

TAKING IT TO THE STREETS BRH - STREET OUTREACH PROGRAM Blue Ridge Health – 7th Avenue was awarded two grants that will allow staff to further support the homeless population in the communities we serve. Funds from the NC Emergency Solutions Grant and the Community Foundation of Henderson County are being used to respond strategically to COVID-19 and has the potential to help countless individuals exit homelessness and stay safer and healthier during the pandemic. Trisha Ecklund, Vulnerable Population Program Coordinator, said, “The grant awards are crucial in allowing us to connect patients with a safe place to isolate or quarantine if they are unsheltered and are in need, and providing access to care to those that may not have the resources otherwise. “We plan to begin actual street outreach by going to local encampments and providing individuals with food, water and hygiene packs with hopes to engage with them and connect them to services they may otherwise not have sought out,” said Ecklund. As part of the new street outreach program, Dr. Joshua Christian plans to start visiting encampments providing street medicine to patients that are unable or unwilling to visit the clinic in person. These efforts will help our community gather a real-time accurate data list of who is experiencing homelessness. Ecklund is excited to see how the expansion of the services provided by the 7th Avenue clinic in Hendersonville will impact our community and create a model that may be duplicated in other communities across the BRH service area. QUALITY HEALTHCARE THAT IS ACCESSIBLE AND AFFORDABLE FOR ALL.

MANAGING THE EFFECTS OF DIABETES WITH INNOVATIVE TECHNOLOGY Diabetic Retinopathy is a complication of diabetes that affects the eyes. It's caused by damage to the blood vessels at the back of the eye (retina) that reflect light which creates vision. The condition can develop in anyone who has type 1 or type 2 diabetes. Approximately 40% of patients diagnosed with diabetes have some stage of Diabetic Retinopathy but less than half of them are aware of it. The longer a patient has diabetes and the less controlled blood sugar is, the more likely they are to develop this eye complication. Diabetic Retinopathy is the most common cause of vision loss in people with diabetes and a leading cause of visual impairment and blindness in working-age adults, yet early detection and treatment can reduce vision loss by 90%. The barriers to recommended eye examinations are numerous and include socioeconomic factors and poor geographical access to care. Recent advances in digital imaging have opened new avenues for assessing retinopathy, which will provide better access to diagnosis and management for this treatable, but often blinding, condition. Thanks to the support of the Community Foundation of Western North Carolina and the Dogwood Health Trust every BRH patient with a diabetes diagnosis will be able to receive retinal screening. By training our primary care providers and diabetes treatment professionals who have the greatest opportunity to educate patients with diabetes or those at risk, BRH will be able to provide regular eye examinations as part of these patients’ routine healthcare exams. “APPROXIMATELY 40% OF PATIENTS DIAGNOSED WITH DIABETES HAVE SOME STAGE OF DIABETIC RETINOPATHY, BUT LESS THAN HALF OF THEM ARE AWARE OF IT.”


ON THE HORIZON EMBRACING CHANGE In a matter of weeks, a new virus led to an unprecedented health emergency; moving from a localized epidemic to a global health crisis. As we prepare for the future, the scope of preparedness must broaden. Many operational changes instituted because of COVID-19 will become part of our new normal and will remain part of our daily operations. BRH will continue to fast forward our efforts to upgrade and advance our use of digital tools. From a new electronic health record platform, to continued expansion of telehealth services and video conferencing, BRH will utilize innovative technologies to assist our staff in providing our patients with the best care possible. COLLABORATION Collaboration is a pillar on which BRH was built. In the coming year BRH will be opening a new clinic in the Highlands-Cashiers area due to a collaborative effort between the Highlands Cashiers Health Foundation, Mountain Area Health Education Center (MAHEC), Community Care Clinic of Highlands-Cashiers and BRH. This collaboration will expand access to primary care on the Highlands-Cashiers Plateau by opening a new Community Health Center and bringing additional physicians and services to that area. Funding for this endeavor is provided by the Highlands Cashiers Health Foundation. EXPANSION We’ve all heard the quote, “If you’re not growing you’re dying.” At BRH, we believe, “If we’re not growing, we’re not doing our job.” If growth is not part of our operation that means our communities are going without care, children are going to school sick and neighbors are suffering with dental issues. In the coming year BRH will be focusing growth in several areas. You read earlier about our expansion into the Highlands Cashiers area. In 2021 you will see us expand our School Based Health Centers into communities where children may not have access to healthcare unless they can access it at school. The same will hold true for our Mobile Dental program as we have plans to expand this service 2 to 3 fold. THE FUTURE OF HEALTHCARE AND BLUE RIDGE HEALTH DEPENDS ON COMMITMENT TO OUR PATIENTS, PASSION FOR OUR MISSION AND CREATIVITY IN THINKING. ” - RICHARD HUDSPETH, MD CHIEF EXECUTIVE OFFICER ”

BOARD OF DIRECTORS Joshua Kennedy, Chair Director Polk County Consolidated Human Services Agency Bob Bednarek, Vice Chair Retired Hospital CEO Buncombe County Matthew Gruebmeyer, Treasurer Director Student Services Henderson County Public Schools Cheryl Harbin, Secretary Retired Educator Polk County Mary Ann Holloker Attorney Transylvania County Renèe Kumor Author and Community Volunteer Henderson County Aida Ortiz-Antonio Lifestyle Coach Henderson County Juan Ramirez Agriculture Crew Leader Henderson County Linda Weldon Retired Public Health Nurse Buncombe County STAFF LEADERSHIP TEAM Richard Hudspeth, MD Chief Executive Officer Tammy Greenwell Chief Operations Officer Brian Morton Chief Financial Officer MaryShell Zaffino, MD Chief Medical Officer Michelle Hogsed Director of Quality Management

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