Overall Goal and Approach to Implementation Strategy

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2 Overall Goal and Approach to Implementation Strategy Aultman Orrville Hospital seeks to provide leadership in health care through fulfilling the mission of Aultman Health Foundation, which is to Lead Our Community to Improved Health. In addition, Aultman Orrville Hospital is committed to improving the health of the community by supporting organizations that improve the quality of life for area residents. 1 Aultman Orrville Hospital s approach to providing community benefit is to target the intersection of documented, unmet community health needs, as well as the hospital s key strengths and commitment to its mission. Community Partners Aultman Orrville Hospital understands that it is important to work with other diverse organizations and institutions to improve the quality of life in the community. By working together and effectively and efficiently using limited resources, Aultman Orrville Hospital can more successfully address the identified community health needs. Aultman Orrville Hospital believes that it cannot effectively address all of the community s health needs without community partners. Aultman Orrville Hospital has been collaborating with other community organizations throughout the entire Community Health Needs Assessment (CHNA) process and will continue collaboration throughout the implementation phase. The following organizations participated in the CHNA process: City of Orrville, Wayne County Job & Family Services, University of Akron Wayne College, Orrville Area Chamber of Commerce, Orrville Ministerial Association, Orrville Public Library, Growing Healthy Habits, Heartland Education Community, Salvation Army, Community Birth Circle, STEPS at Liberty Center, Viola Startzman Free Clinic, Wayne-Holmes Mental Health & Recovery Board, Counseling Center of Wayne & Holmes Counties, Your Human Resource Center, Wayne County Children Services, Wayne County Emergency Management and a member of the community representing the Amish. Aultman Orrville Hospital s Service Area Aultman Orrville Hospital s primary service area is in Eastern Wayne County, Ohio, with the remainder of Wayne being the hospital s secondary market.

3 Results of the CHNA The 2013 CHNA identified a number of unmet or partially met health needs through the hospital s service area. Analysis included survey data in conjunction with health and demographic data. Using all data available, priorities for the hospital s service area were identified Patient Protection and Affordable Care Act is Passed 2013 Community Leader Focus Group Secondary Data Analysis of Market CHNA Conducted & Board Approved Health needs were ranked on the following factors: 1. The number of people in the service area that are affected by the issue or size of the problem. 2. The consequences of not addressing the issue or problem. 3. The ability of Aultman Orrville Hospital to evaluate and measure outcomes. Focus Areas: As a result of the CHNA and subsequent analysis, the following were identified as the priority areas in which the hospital will focus: 1. ACCESS TO HEALTH INSURANCE COVERAGE AND HEALTH CARE. A. In the community health leaders focus group, access to health care was identified as the number one health-related need in the county. Transportation limitations due to the area s large rural base, high rate of poverty, and the lack of doctors available during the weekends and late evening/early morning hours were also named as community needs. In addition, there is no urgent care center located in the Orrville community. 2. OBESITY AND LACK OF HEALTHY LIFESTYLE CHOICES. a. In the community health leaders focus group, the mentality of area residents (in terms of their attitudes towards healthy behaviors) was identified as the second most important health-related need in the county. The need for programs to combat diseases/problems such as obesity and diabetes, the rising cost of food and the fact that junk food is less expensive than healthy food, were also identified as problems. More than a third (37 percent) of county adults are overweight, 25 percent are obese, and 22 percent have a lack of physical activity (Ohio Department of Health).

4 3. LARGE NEED FOR SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES, PARTICULARLY OPIATES. A. Increased substance abuse, particularly opiates was named as an emerging health need by the community health leaders focus group. In addition, between 2010 and 2013 there was a 105 percent increase in the number of people seeking treatment for opioid addiction (Mental Health and Recovery Board of Wayne and Holmes Counties). Documentation for the focus areas presented in this implementation plan is provided in the hospital s CHNA report posted on the hospital s website: 3 The goals and strategies for addressing each priority area are the same, but the current and planned programs for each priority will differ according to the need. Goals 1. Increase public awareness of current program offerings and create more awareness by reaching out to the community. The hospital will accomplish this through marketing and communicating with key community stakeholders. 2. Prevention and/or reduction of risk factors. 3. Collaborate to increase community capacity to offer health-related services. 4. Promote wellness and healthy lifestyle initiatives throughout the hospital s service area. 5. Promote patient and community education to increase community awareness of available services and programs. PRIORITY AREA #1: Access to Health Insurance Coverage and Health Care Summary: Large portions of county residents do not have health insurance and lack access to basic health care services. Availability of health insurance was identified as the biggest unmet health need in Wayne County by the community health leaders focus group. In Wayne County, 17 percent of residents are uninsured, according to data published by in the 2013 County Health Rankings report (as sighted in page 52 of the Aultman Orrville Hospital CHNA report). The Wayne County uninsured rate exceeds the state average of 14 percent uninsured. CURRENT AULTMAN ORRVILLE PROGRAMS AND SERVICES THAT ADDRESS THIS NEED Aultman Orrville offers the following services to address the lack of access to health insurance coverage and health care: Accept all payers and most insurance types, regardless of the patient s ability to pay. The hospital will remain part of the Independent Hospital Network (IHN), which includes five hospitals in a five-county service area that includes Stark (Aultman and Alliance Community Hospital), Wayne (Orrville Hospital), Carroll, Holmes (Pomerene Hospital), and Tuscarawas (Union Hospital) counties. The IHN has consistently provided health care services to patients at some of the lowest cost in the state. The IHN was established in 1996 with the mission of maintaining local, not-for-profit hospitals. Through this collaboration, member hospitals work

5 together to lower costs, improve patient care and increase patient satisfaction. The IHN provides support services to member hospitals including physician recruitment, medical practice management, continuing education, accreditation assistance, construction management and cost control. More information on the IHN is available at Aultman Orrville Hospital provides free transportation services for patients in need. Transportation is available to Aultman Orrville Hospital or any of its medical staff offices located in Orrville, Apple Creek, Dalton, Kidron or Mt. Eaton. Homes must be located within a 25-mile radius of the Aultman Orrville Hospital. If possible, requests should be made at least 24 hours in advance. Aultman Orrville Hospital provides free overnight accommodations for Amish patients in its Amish House. The hospital also provides a buggy barn located on the east side of the campus. The barn was provided by the Amish Community. Offer package pricing options & additional discounts for the Amish community and those who choose private pay due to lack of insurance coverage. The hospital will continue to offer prompt-pay discounts to patients who lack insurance or have patient co-pay or deductible responsibility of their bill. The hospital will continue to explore adding access to services through the use of package pricing discounts. Provide Hospital Care Assurance Program (HCAP) and financial assistance options through its Patient Financial Services Outreach Team. The hospital currently offers sliding scale discounts for patients up to 400 percent of the Federal Poverty Level (FPL). The Patient Financial Services Outreach Department offers charity care assistance to the uninsured or underinsured, along with providing patient rights notification to all Medicare beneficiaries in the hospital. Patients receive financial counseling and assistance in applying for Medicaid and the state-funded Hospital Care Assurance Program (HCAP), as well as guidance on the hospital s own Financial Assistance Program (FAP). The department processed more than 415 HCAP and charity care applications in 2012 and delivered nearly 4,535 patient rights documents to Medicare patients. Aultman Orrville provides high-quality health care programs and services to anyone in need, regardless of their ability to pay. Aultman Orrville is dedicated to your health, offering everything from educational programs to medical care discounts. Aultman Health Foundation, which includes Aultman Orrville Hospital, has a vertically integrated health care insurance plan through AultCare, and offers individual coverage through the product AultOne, employer group and self-funded plans and a Medicare advantage plan called PrimeTime Health Plan Medicare Advantage. Network providers span the spectrum of health care specialties to meet the needs of enrollees and keep care locally based. Founded in 1985, AultCare is the largest hospital/physician-based Preferred Provider Organization in Northeastern Ohio. AultCare administers payment benefits such as medical, dental, vision, short-term disability, workers compensation and flexible spending accounts. Benefit plans include: Preferred Provider Organization (PPO), traditional and Point of Service (POS) plans. Additionally, AultCare manages a subsidiary company as a licensed Health Maintenance Organization (HMO). To learn more visit the AultCare website at 4

6 Employer groups, through AultCare insurance, may choose to add on wellness programs designed specifically to the needs of the group with onsite health coaching and education provided by licensed professional staff. Transitional Care Program provides members who are confined in an acute care setting ease in moving from the acute phase of their care to the next level, within the health care continuum, with the goal of reducing readmission. Collaborate with the Pink Ribbon Screenings for mammograms throughout the year. Support Primary Care investment. Since 2013, the hospital employs Dunlap Family Physicians through the Aultman Health Foundation Aultman Medical Group. Dunlap Family Physicians employs six physicians and two physician extenders over three locations in Eastern Wayne County: Orrville, Dalton and Apple Creek. Dunlap Family Physicians has expanded service hours to cover weekends, evenings, and early morning walk-ins. The Orrville location is open M-TH until 7:30p and Saturday 8:00-11:30a. The practice is committed to accepting new patients, treating walk-ins through specified times, and offering some weekend availability. Provide labs and X-rays services at no charge to the Viola Startzman Free Clinic (VSFC). VSFC is the only free clinic in Wayne County that provides comprehensive health and dental care, wellness education, medications, and related health services at no charge to qualifying patients. Offer free breast-feeding classes, once per month to the community. Taught by a certified lactation counselor, classes provide information that helps mothers develop realistic expectations for breastfeeding. Mothers also receive simple and helpful tools for solving common breastfeeding concerns. Aultman Orrville provides Safe Sitter Classes to the community. The class prepares young adolescents ages 11 and older to be safe, nurturing babysitters. The one-day course provides an up-to-date curriculum with hands-on practice in lifesaving techniques. Provide support and offer current Aultman Health Foundation programs that are operating in the hospital s service area (Eastern Wayne County), including: o Working on Wellness (WOW) program - The Aultman WOW van provides free health screenings and education throughout the community. The WOW van visits area schools, community/outreach centers, churches, senior centers, block parties, etc. Free, noninvasive health screenings including blood pressure checks, height, weight and Body Mass Index/percentage of body fat are provided. The WOW van is staffed by clinical personnel who are able to provide health education and referrals, if necessary. Health information is available on a variety of medical topics. o Health Talks at Aultman Orrville Hospital and other Aultman locations. The Aultman Health Talk Speaker Series was established in response to a rising community need of trusted, accurate health information. Through this free program, physicians and health care professionals take a personal approach in educating the community on a wide array of important medical topics ranging from managing diabetes to heart attack signs to cancer prevention. The educational courses are held on-site at Aultman Orrville Hospital s Community Room. 5

7 6 o The Aultman Orrville website, located at is a community resource for health and wellness information, hospital services, calendar of events, online physician directory and more. Aultman also has a relationship with a health information content provider known as Krames Staywell. Krames Staywell is an interactive web solutions health library including comprehensive health and wellness content, conditions and diseases, interactive tools, healthy recipes and assessments. These programs provide current, relevant and unbiased health content to patients, families and the community. Krames Staywell is designed to educate the consumer and build a knowledge base to become an informed consumer of health care services. Invest in primary care providers and physician recruitment strategies. o Increase capacity for Primary Care. Dunlap Family Physicians, part of the Aultman Medical Group, recruited Brett Buller, D.O. to their practice in Family Practice Center, Inc., of Orrville, recently recruited Robert J. Norman, D.O. to their practice. o Improve specialty provider access through use of Aultman Health Foundation physician groups. List offerings added during Additional access to specialties now includes endocrinology, nephrology, vascular and neurosurgery. NEW OBJECTIVE 1: PROMOTE AND INCREASE THE USAGE OF A PRIMARY CARE PHYSICIAN AMONG WAYNE COUNTY RESIDENTS REGARDING PREVENTIVE HEALTH CARE AND EARLY INTERVENTIONS TO IDENTIFY CHRONIC DISEASES. 1. Increase awareness of health care resources available within the community. a. Promote, educate and encourage health care providers within Wayne County to use the Orrville Community Guide for medical information and patient referrals. b. Increase awareness of health screenings in the community through media networks and agency referrals and promote the usage of these screenings to high-risk populations. c. Perform additional analysis of urgent care needs on campus or with employed primary care group (Dunlap Family Physicians). 2. Promote, educate and encourage residents in the community to use a primary care physician when seeking health care. a. Promote and educate residents on the importance of practicing prevention techniques through a multimedia campaign. b. Increase awareness to the community on the importance of meeting their basic health care needs, particularly the lower income and underserved populations through educational messages and/or workshops. NEW OBJECTIVE 2: PROMOTE GROWTH OF PRIMETIME MEDICARE ADVANTAGE PROGRAM IN WAYNE COUNTY.

8 1. Increase awareness of PrimeTime Medicare Advantage Program availability through open enrollment and on-site meetings. a. Collaborate with PrimeTime Medicare Advantage Program to market plan to the community. b. Schedule on-site informational sessions. 7 NEW OBJECTIVE 3: HEALTH CARE INSURANCE EXCHANGE PARTICIPATION IN 2014 WITH COMMERCIAL CARRIERS. THE HOSPITAL WILL ALSO EXPLORE OPTIONS WITH OTHER CARRIERS AND TYPES TO EXPAND ACCESS IN THE FUTURE. 1. Study and explore potential relationships with insurance exchange providers to increase health care access in the new era of health care reform. a. It is anticipated through health care reform that patients without insurance or insufficient insurance coverage, will be able to obtain health insurance through marketplace exchanges. Aultman Orrville Hospital wishes to position itself to serve these patients in order to meet the access needs of our community. i. Current commercial contracts demonstrate participation of marketplace exchanges with Medical Mutual of Ohio and SummaCare. ii. Work with AultCare to determine if a health care insurance exchange product should be offered in Wayne County beginning in iii. Explore a relationship with an insurance exchange HMO product. HMO exchanges will primarily serve the current uninsured population. NEW OBJECTIVE 4: EXPLORE OPPORTUNITIES TO IMPROVE AND EXPAND 340B DRUG PROGRAM 1. Explore opportunities to expand use of 340B drug program to include retail pharmacies a. Reduce pharmaceutical inventory. b. Explore development of 340B relationship with local pharmacies. AULTMAN ORRVILLE S ROLE Aultman Orrville will be involved in these strategies as the main hospital and health care provider in Eastern Wayne County. Aultman Orrville will collaborate with other tertiary care facilities in Stark and Summit County. This will be primarily Aultman Hospital, which will provide access to services that may not otherwise be available locally.

9 8 PRIORITY AREA #2: Obesity and Lack of Healthy Lifestyle Choices Summary: An Ohio Department of Health study revealed that 37 percent of Wayne County residents are overweight, 25 percent are obese and almost one quarter (22 percent) of Wayne County residents have a lack of physical activity. County health rankings indicate that the prevalence of diabetes in Wayne County is 10 percent. The mortality rate for diabetes-related illness is much higher in Wayne County compared to Ohio as a whole, particularly for residents ages 65 and older. CURRENT AULTMAN ORRVILLE PROGRAMS AND SERVICES THAT ADDRESS THIS NEED Aultman Orrville Hospital services and initiatives to target obesity and unhealthy lifestyle choices currently include: The MyPlate program, which is a USDA initiative based on 2010 Dietary Guidelines for Americans to help consumers make better food choices. Aultman Orrville supports and offers current Aultman Health Foundation programs that are operating in the hospital s service area, including the Health Talk Series. Health Talk topics relevant to this priority includes women s health, managing diabetes, hypertension and heart health. The PrimeTime Seniors Program is offered to people ages 50 and older. The program features educational seminars, discounts and travel opportunities to members. Benefits include Medicare/Insurance claims assistance, prescription assistance and notary services. The Bee Healthy Program is offered to employees as a Wellness Program that requires participants to (1) Attend a Wellness Fair (includes cholesterol and glucose screenings, blood pressure, PSA for men 50 and older, body fat, BMI and cancer education), (2) Complete an Annual Health Assessment, (3) Have an annual physical examination, (4) Have at least one age- or gender-appropriate screening, and (5) Be tobacco free. The Spring into Wellness Event at Aultman Orrville is an annual family-friendly event that includes activities, health education, door-prize raffles, health education material and free health screenings for people of all ages. In 2013, the event was part of a community-wide collaboration known as Healthy Orrville Day. The event features activities for people of all ages. Adults have the opportunity to learn about services Aultman Orrville provides, including the PrimeTime Program, the WOW mobile unit, AultCare and more. Aultman Orrville continues to collaborate with the Growing Healthy Habits Coalition to provide health screenings including glucose, cholesterol, triglycerides, blood pressure, pulse, height, weight and body mass index measures. The SilverSneakers program was approved in 2013 (fitness center memberships to seniors with prescriptive exercise plans) and allows for growth. Aetna and Humana Medicare Advantage Plans offer this benefit. The Diabetes Self-Management Training Program is a comprehensive program that provides participants with the knowledge to manage diabetes and empowers individuals to make appropriate lifestyle changes.

10 The Diabetes Information and Support Group is a free community program that is conducted as a support group for those who have diabetes or are affected by the disease. Led by a certified diabetes educator, the support group meets the first Wednesday of every month, and group sessions last one hour. Aultman Orrville Sports and Wellness is a facility that combines athletic training and exercise science to create a total wellness center. There are more than 300 active members. The staff develops and implements specific exercise plans and wellness programs for each individual. The program also provides athletic training services to four area local schools Orrville, Dalton, Rittman and Norwayne. Exercise as Medicine offers a physician-prescribed exercise program which is directed toward specific disease processes and entities. The Celiac Support Group Program helps community members to adjust to a gluten-free lifestyle. The WOW van provides free health screenings and education throughout the community. The WOW van visits area schools, community outreach centers, churches, senior centers, block parties, etc. to provide age-appropriate health information. In 2012, the WOW program promoted healthy eating to local school children by providing colorful MyPlate placemats to teach kids about food groups and creating smart plates of food. The WOW van also provides noninvasive health screenings including blood pressure checks, height, weight and Body Mass Index/body fat percentage are provided. Give It Up! Smoking Cessation Program is directed by a certified counselor and provides participants education and support to quit smoking. 9 NEW OBJECTIVE 1: DEVELOP AND IMPLEMENT A MEDICALLY SUPERVISED WEIGHT MANAGEMENT PROGRAM. 1. Open an Aultman Weight Management program in Orrville by January a. Model program based on vendor recommendations. b. Collaborate with participants primary care physicians to ensure safety and continuity of care. NEW OBJECTIVE 2: ENHANCE THE AVAILABILITY OF DIABETIC CARE TO RESIDENTS OF WAYNE COUNTY. 1. Increase availability of care and services for diabetic residents. a. Recruitment of additional endocrinology specialist. b. Increase diabetic education resources. c. Collaborate with primary care physicians to facilitate the diabetic disease management process.

11 AULTMAN S ORRVILLE S ROLE Aultman Orrville Hospital will be involved in these strategies as a primary hospital and health care provider in Eastern Wayne County. As a Critical Access Hospital that serves a very small demographic in our market, Aultman Orrville Hospital will collaborate with Aultman Hospital to meet this shared community need. 10 PRIORITY AREA #3: Substance Abuse/Mental Health SUMMARY: The community need for substance abuse and mental health treatment and intervention continues to increase. CURRENT AULTMAN ORRVILLE PROGRAMS AND SERVICES THAT ADDRESS THIS NEED Aultman Orrville offers a variety of services to help patients with mental health issues including: Collaborate with the Mental Health and Recovery Board of Wayne and Holmes Counties (MHRB), which has taken the lead at addressing this need in the community. Employee Care Fund money donated by employees to assist those in need. Contributor to the United Way of Wayne County In 2013, employee donations exceeded $12,000, which is considered a Pace-setter giving organization level in Wayne County. The United Way provides support for the area s non-profits that deal with mental health and substance abuse issues. Continue to offer Health Talk Series with topics such as depression and holiday eating. NEW OBJECTIVE 1: PROMOTE AND ENCOURAGE MENTAL HEALTH WELLNESS AND SUBSTANCE ABUSE PREVENTION THROUGHOUT WAYNE COUNTY. 1. Increase awareness of mental health wellness promotion and substance abuse prevention programs, activities, initiatives, events, resources, screenings and examinations available within Stark County to community partners and residents. a. Collaborate with county entities, worksites and community organizations to assess and identify wellness promotion and prevention programs. b. Identify programs available for model wellness promotion and prevention, resources, activities, initiatives, events, screenings and examinations available throughout Wayne County in order to update and share data regularly with community partners. 2. Provide awareness of mental health and substance abuse issues. a. Develop and promote a county-wide awareness media campaign educating residents on the importance of mental health wellness promotion and substance abuse prevention. b. Promote access to and encourage the usage of wellness promotion and prevention programs, screenings and examinations available within Wayne County to the community by encouraging county entities, worksites and community organizations to promote emotional health. This can aid in reducing the likelihood of mental illness and substance abuse. c. Develop a close relationship with mental health agencies within Wayne County.

12 AULTMAN ORRVILLE S ROLE Aultman Orrville will be involved in these strategies as the main hospital and health care provider in Eastern Wayne County. Other organizations that would be involved are Wayne County Jobs and Family Services, Counseling Center of Wayne and Holmes Counties, Every Woman s House, Wayne-Holmes Mental Health and Recovery Board, STEPS at Liberty Center and social and/or behavioral health organizations. 11 Meeting the Community s Needs Aultman Orrville Hospital is committed to improving the health of the community by supporting organizations that improve the quality of life for area residents. Aultman Orrville Hospital and its employees support health-related causes such as fundraising walks for the American Cancer Society, American Heart Association and Juvenile Diabetes Research Foundation. Aultman Orrville Hospital donates to community causes including the United Way of Wayne County. Aultman Health Foundation, along with Aultman Orrville Hospital, has a special homegrown outreach program. Through the Safety First program, hundreds of Aultman volunteers teach approximately 5,000 local first grade students about bicycle safety, including schools in the City of Orrville and surrounding Eastern Wayne County communities. The children receive a workbook that outlines the importance of wearing a bike helmet and other safety gear, along with obeying traffic signs and using hand signals. In addition to the in-class education, each student receives a free bike helmet to use at home. Additionally, in order to give children a healthy and safe start to life, Aultman Orrville Hospital offers birthing classes to expectant parents on a quarterly basis to assure a smooth transition to parenthood. A certified Car Seat Safety technician is also on staff to install or verify proper installation of car seats. The Aultman Health Foundation has made the commitment and begun the journey to become a High Reliability Organization. Our focus is on improving communication and processes and delivering high quality care and service every single time, including tools for safety and tones for teamwork.