Community Health Needs Assessment Implementation Strategy Bronson Methodist Hospital

Transcription

1 Community Health Needs Assessment Implementation Strategy Bronson Methodist Hospital INTRODUCTION Bronson Methodist Hospital (BMH) in Kalamazoo, Michigan is a member of the Bronson Healthcare system. As a tertiary care facility, BMH serves patients and families throughout southwest and south central Michigan. Our mission, Together, We Advance the Health of Our Communities, demonstrates our unwavering commitment to improving the health of the men, women and children we have the privilege to serve. Every three years, BMH conducts a Community Health Needs Assessment (CHNA) to assess the health needs of residents in its region. Analysis of data from government sources, community surveys, focus groups, and key informant interviews in 2016, identified the following as significant community health needs: access to care addiction chronic disease management social health (connection to community) health education and literacy mental health treatment and support obesity poverty safety sexual health Based upon the findings of the 2016 CHNA, BMH has selected improving access to care as the priority focus of our Community Health Improvement Plan for the period from January 1, 2017 through December 31, This decision reflects a coming together of the health needs expressed by our community, scope of impact, the ability of BMH to directly remedy issues related to access, and availability of evidence-based interventions. Our focus on access is inclusive of access to insurance, access to appropriate treatment and support, quality and cost of insurance, access to education, and the supply of healthcare providers. BMH will serve as a catalyst and engage community partners in taking action to improve access for medical, mental, and social health. In particular, we will focus on removing barriers that influence health outcomes and work to make the healthcare system easier to navigate. Socio-economic drivers of health, such as poverty, are not addressed within the implementation plan. BMH staff determined that these needs were better aligned with the mission of other organizations within the community. IMPLENTATION PLAN OBJECTIVE 1. Improve access to insurance and affordability of services. Implementation Strategies 1

2 A. Lead a regional collaborative enrollment initiative to implement a coordinated community approach to enroll eligible residents in Medicaid and the insurance exchange. B. Employ a mobile community-based application counselor to provide outreach and assistance directly to community members. C. Deploy a certified application counselor to community agencies serving vulnerable populations to provide specialized year-round Medicaid enrollment assistance and insurance literacy education. D. Provide enrollment assistance to community members throughout the year for special enrollment periods. E. Develop a communication plan and distribute informational materials and resource guides related to Medicaid and insurance exchanges to improve insurance literacy. F. Assist community agencies, when needed, to explain insurance exchanges. G. Coordinate open enrollment events to provide education and assistance during open enrollment periods. H. Educate community partners about the Bronson Financial Assistance Policy to reach vulnerable or low income individuals. I. Collaborate with agencies focused on providing services to seniors to connect eligible individuals with appropriate Medicare enrollment and navigation assistance. Anticipated Impact This programming will help mitigate affordability barriers associated with receiving healthcare services, increase awareness and knowledge of Medicaid Expansion and the insurance exchange, improve insurance literacy, and reduce the number of uninsured in the region. Anticipated Measures 1. Number of individuals provided enrollment assistance 2. Number of enrollment events held each year 3. Other measures identified through establishment of programming throughout OBJECTIVE 2. Ensure residents obtain needed primary care services and reduce barriers associated with seeking and receiving healthcare. Implementation Strategies A. Increase the availability of healthcare providers in the community by enhancing recruitment efforts for primary care physicians and midlevel providers at Bronson practices. B. Participate in the State Innovation Model and continue to achieve Patient-Centered Medical Home designation for all Bronson practices. C. Strengthen care delivery transformation by participating in the national advanced primary care medical home model Comprehensive Primary Care Plus. 2

3 D. Promote establishment of medical homes within the recently insured population and promote use of medical homes throughout community. E. Mitigate barriers associated with inconvenient hours for primary care practices by adding an after-hours clinic for Bronson practices and continuation of Bronson Fast Care locations offering evening and weekend access.. F. Remove transportation barriers through the provision of a pediatric transport ambulance customized to transport sick and injured children to Bronson Children s Hospital from hospitals and doctor s offices across the region. G. Address the shortage of Family Medicine providers in southwest Michigan by pursuing the establishment of a Family Medicine Residency program at Bronson Battle Creek Hospital. Establishment of the program will assist with retention of providers in Southwest Michigan. H. Participate in the Michigan Pharmacists Transforming Care and Quality (MPTCQ) initiative to integrate clinical pharmacists into primary care settings I. Provide access to on-site behavioral health services by embedding mental health professionals in selected primary care settings and engaging medical social workers to provide behavioral health assessments and depression screenings. J. Participate in clinical integration network efforts through Affirmant Health Partners, the statewide clinically integrated network, and further develop the Bronson Network, our local clinically integrated care network. Anticipated Impact This programming will mitigate barriers associated with accessing primary care services, increase the number of residents with medical homes, improve after-hours access for non-emergency medical services, improve transport for critically ill or injured children, and improve access to mental health services in the primary care setting. Anticipated Measures OBJECTIVE Number of Bronson practices with open access for patients 2. Number of new primary care physicians and midlevel providers 3. Other measures identified through establishment of programming throughout Improve care coordination encompassing mental health, social services, and healthcare. Implementation Strategies A. Provide leadership and collaborative support for Cradle Kalamazoo and participate on the Fetal Infant Mortality Review board to improve birth outcomes for infants and reduce infant mortality. B. Participate in the Region 8 Perinatal Care System to improve coordination of care related to birth outcomes. C. Implement and provide leadership for the Frequent User System Enhancement 2.0 (FUSE) pilot in collaboration with Kalamazoo County Community Mental Health and Substance Abuse 3

4 Services, InterAct of Michigan, and Kalamazoo County Housing Commission for frequent users of the emergency room who have unmanaged chronic pain and are also homeless. D. Provide information technology expertise and resources supporting EPIC as a community-wide electronic health record system utilized by providers at Bronson, Kalamazoo Family Health Center and the WMU Homer Stryker M.D. School of Medicine improve care coordination and communication between partnering healthcare agencies. E. Embed medical social workers and care managers in Bronson primary care practices. F. Embed clinical care coordinators in primary care settings to coordinate care for high risk patients. G. Mitigate barriers associated with health system navigation through the provision of nurse navigators for select complex care specialties including Neurology, Cardiovascular, Oncology, and Orthopedics. Nurse navigators support, guide, and navigate the patient and family through the entire process and are available to answer questions and remove barriers associated with complex conditions. H. Organize, coordinate, and improve access to community transportation resources and promote the use of community resources with community partners and hospital staff. I. Collaborate with Kalamazoo County Health & Community Services, Kalamazoo County Community Mental Health and Substance Abuse, Southwest Michigan Behavioral Health, and other key organizations and provide leadership support for a community-wide opioid abuse surveillance system. J. Collaborate with Western Michigan University, Senior Services of Southwest Michigan, Hospice Care of Southwest Michigan, Area Agency on Aging, Heritage Community, Family Health Center, WMU Homer Stryker M.D. School of Medicine, Ecumenical Senior Center, Kalamazoo Community Mental Health & Substance Abuse Services, and CentraCare Inc. in the Program for All-Inclusive Care for the Elderly (PACE), a community-based supplemental adult care service for Medicare and Medicaid "dual-eligible" seniors. This program provides physician, social worker and rehabilitation facilities, as well as dietitian and personal care services in a single location. Continue collaborative efforts with Healthy Babies, Healthy Start; Nurse Family Partnership; and Great Start Collaborative to improve birth and learning outcomes for Kalamazoo County children. Anticipated Impact This programming will enhance and improve coordination of care across the spectrum of care, reduce barriers associated with navigation of the healthcare system, and improve complex care coordination for vulnerable high risk populations. Anticipated Measures 1. Established measures for FUSE 2. Established measures for Cradle Kalamazoo 3. Other measures identified through establishment of programming throughout

5 NEEDS NOT ADDRESSED IN THIS IMPLEMENTATION PLAN The 2016 Community Health Needs Assessment included a prioritization of health needs encompassing: magnitude of needs, measurable outcomes, hospital capabilities, evidence for effective interventions, community commitment, and consistency with the Bronson Healthcare system s strategic plan. At the conclusion of this prioritization process, access to care was selected as the priority focus of our Community Health work in This effort will require substantial financial and staffing resources, as well as significant collaborations with community organizations. However, other significant health needs identified in the Community Health Needs Assessment, while not specifically outlined in this implementation, are being addressed through various efforts across our healthcare system. One of these efforts is the creation and further development of the Bronson Healthy Living Campus. Completed in 2016, the Bronson Healthy Living Campus is a catalyst for urban revitalization, community health, and workforce development through sustainable food education, training, production, distribution, and preparation. Bronson partnered with Kalamazoo Valley Community College and Kalamazoo Community Mental Health and Substance Abuse Services (KCMHSAS) to remediate a blighted, former superfund site and donated the land to create this 14 acre campus adjacent to the hospital. The synergies developed between the project organizers and others will meet increasing demand for holistic approaches to food education and health by preparing the next generation of professionals for existing and emerging careers. Community cooking and nutrition classes and outreach are also part of the programming. The campus includes the KVCC Culinary/Allied Health Building, the KVCC Food Innovation Center, and a building that houses KCMHSAS s integrated health services and pharmacy. Bronson also offers a variety of classes and educational programs each month for the community including, but not limited to: cancer support child safety chronic disease management & awareness heart health & stroke prevention injury prevention pregnancy & parenting smoking cessation weight management For a full listing of classes and events please visit our website at: BMH is also committed to improving the health of our community by providing representation and leadership to local organizations, and as a partner in collaborative community efforts. Bronson executives, leaders, and staff sit on boards and volunteer time across the region to provide leadership to nonprofits serving vulnerable populations such as homeless shelters, food banks, child health organizations, community centers, senior services, youth development, prisoner re-entry committees and many others. BMH acknowledges that in some circumstances the hospital is not the most appropriate leader to address identified needs and where possible supports and partners with relevant community organizations which are better suited to addressing those needs. In addition, Bronson recognizes the important role of non-profit organizations and their often limited staff resources. To 5

6 support these non-profit agencies, foster community connection, and advance the health of our community, all employees are provided paid time off to volunteer with partner agencies through our Bronson Volunteer Experience program. RESOURCES In keeping with Bronson s strategic commitment to be a community leader and serve as a catalyst to improve the overall health and wellbeing of individuals and families in our region, BMH commits substantial resources to community health improvement efforts. These resources include, but are not limited to: staffing for programs related to community health, continuation of financial and charity care provisions for those in need, direct financial support for community health strategic initiatives, funding for pilot programs, and sponsorships for community activities that impact significant community needs. The Bronson Healthcare system has a designated executive and support staff in its Community Health department responsible for overseeing the development and implementation of this Community Health Improvement Plan and to engage community organizations in collaborative efforts. For more information, contact: Amy Terry, System Director Community Health at terrya@bronsonhg.org or