Implementation Strategy Report For Community Health Needs

Transcription

1 Implementation Strategy Report 2015 For Community Health Needs

2 Community Hospital Community Health Needs Assessment (CHNA) Implementation Strategy Report 2015 I. About Community Hospital Community Hospital in Grand Junction, Colorado, is a full service, acute care hospital licensed for 78 beds. As part of the Colorado West Healthcare System, we offer full outpatient diagnostic services and inpatient care for the Western Slope region of Colorado, and Eastern Utah. Community Hospital brings together expert staff and worldclass technology in a healing, family centered environment. We provide a full range of medical services, including inpatient and outpatient surgery, and emergency care. We have comprehensive diagnostic capabilities: state of the art ultrasound, 64 slice CT, digital mammography and cardiac testing. Community Hospital proudly partners with University of Utah Heath Care and Huntsman Cancer Institute to provide world class medical and radiation oncology right here at home. Community Hospital is both Joint Commission and American Osteopathic Association accredited the only hospital with this dual accreditation in the western United States. Our laboratory is College of American Pathologists accredited. For those lab tests that we don t conduct on site, the Mayo Clinic is our exclusive partner for reference laboratory services. We pride ourselves on delivering personalized care to our patients, and in working closely with our medical care providers in treating the whole person. This approach has resonated with our patients, and we are growing to meet our community s demand. On October 15th, 2014, Community Hospital broke ground on a new four story, 140,000 square foot, state of the art facility. Our new hospital is slated for completion in March of

3 II. Mission, Vision Statement and Values Mission Statement Community Hospital will improve the health and quality of life of the individuals and communities we serve. Our goal is to create a health care environment personalized to each patient that focuses on health and wellness, provides convenience and ease of access, and incorporates the latest technologies. Vision Statement Community Hospital will be the hospital of choice for the services we provide. Values Service: We will ensure a whatever it takes service attitude, guest centered processes, compassionate care, and respect for each person s individuality. Excellence: We provide dedicated, outstanding, professional, quality care through continual process improvement, education, and diligent patient guest safety practices. We strive to continuously improve all that we do. Partnerships: We recognize our employee, volunteer, physician, and student partners as our greatest and most valuable assets. We support them through education, recognition, and opportunities for personal growth. Integrity: We are honest, forthright, and we honor our commitments. We make the right decisions for the right reasons, and manage the hospital in a fiscally responsible manner. Attitude: We promote attitudes of excellence in every aspect of what we do. Attitude makes the difference. III. Community Benefit At Community Hospital, we work to inspire and support people to be healthier in all aspects of their lives, building happier, healthier and stronger communities. In pursuit of our mission, we have been an active participant in the Community Health Needs Assessment (CHNA) in collaboration with the Mesa County Health Department and a number of other local hospitals and organizations in Mesa County with a commitment 2

4 to improve the health of our residents. The CHNA is a fundamental tool of public practice which aims to describe the health of the community by presenting information on health status, community health needs, resources, and analysis of local health problems. The CNHA process helps us develop strategies aimed at making long term, sustainable change and it allows us to strengthen the relationships and partnerships we have with other organizations that are working together to improve community health. IV. Purpose of the Implementation Strategy This Implementation Strategy has been prepared in order to comply with federal tax law requirements set forth in Internal Revenue Code section 501(r) requiring hospital facilities owned and operated by an organization described in Code section 501(c)(3) to conduct a community health needs assessment at least once every three years and adopt an implementation strategy to meet the community health needs identified through the community health needs assessment. This Implementation Strategy is intended to satisfy each of the applicable requirements set forth in proposed regulations released April This implementation strategy described Community Hospital s planned response to the needs identified through the 2015 Community Health Needs Assessment (CHNA) process. For a copy of the report please visit V. Community Health Needs Identified in the CHNA Report The findings from the 2015 assessment demonstrate the need for continued work around the three winnable battles identified in the 2012 Community Health Needs Assessment listed below. Three Winnable Battles Suicide Obesity Unintended pregnancy Smoking, alcohol misuse and motor vehicle injuries are also highlighted as priorities in Mesa County. Key Determinants of Health Needs 3

5 Since 2012, a collaborative initiative called Healthy Mesa County has been working to change the culture of health in Mesa County by addressing the determinants of health contributing to poor health outcomes. Key determinants (e.g. social, economic and environmental factors) strongly influence individual and community health. In fact, they have a reciprocal relationship; the lower the determinants, the more likely unhealthy behaviors are present and the more difficult it is to practice healthy ones. The Healthy Mesa County areas of emphasis: child health & safety (parenting), social and emotional wellbeing, the built environment (building community), and access to health services are based on determinants identified to have a direct impact on obesity, suicide, and unintended pregnancy. Those determinants are well prepared parents, adequate support systems, meaningfully designed communities, and access to health services. Changing determinants of health, as well as health outcomes, is a formidable task in need of continued involvement and participation from all players who comprise the Healthy Mesa County collaborative. The following table outlines the relationship between poor health indicators, winnable battle and key determinants of health. Identified Areas for Improvement Mesa County Winnable Battle Predisposing, Reinforcing, and Enabling Factors Heart Disease Chronic lower respiratory disease Cerebrovascular Disease Adults with arthritis Limited access to healthy foods for low income Teen birth rates Latina teen birth rates Women who smoke during pregnancy Firearm deaths Drug induced deaths Alcohol induced deaths Suicide Obesity Unintended Pregnancy Suicide Parenting Social and Emotional Wellbeing Access to Health Care Built Environment Building a Sense of Community Parenting Access to Health Care Building a Sense of Community Parenting Social and Emotional Wellbeing Access to Health Care Building a Sense of Community 4

6 VI. Health Needs Community Hospital Plans to Address Building on the criteria used in the CHNA process, Community Hospital evaluated the knowledge, skills and expertise of our current assets, the knowledge of existing community efforts and entities that may be addressing the identified needs, and the existing or promising initiatives that could be leveraged, perhaps in a collaborative effort, to impact the identified needs. Based on that evaluation, Community Hospital selected a number of needs from the broader list identified as significant during the CHNA process in order to maximize the hospital s ability to focus resources and have a meaningful impact on these significant and complex health needs. Community Hospital s Improvement Strategy addresses the five priority areas identified in the Community Health Needs Assessment. For each priority area, the plan outlines the following: the goals and objectives designed to guide improvement efforts, strategies for implementation, indicators for measuring and evaluating change, Community Hospital s role or action in addressing the priority areas, and the health needs in which Community Hospital did not address. 1. Access to Health Care (Lack of Primary Care Providers) Data gathered by the Mesa County Health Department, The Commonwealth Fund, and Colorado Health Institute establishes that lack of access to primary health care services among low income, uninsured, and underinsured residents of Mesa County is likely to result in fewer opportunities for preventive and necessary medical treatment and over utilization of emergency departments for non emergency issues. Understanding how people in Mesa County access healthcare provides valuable insight to form policies and promote appropriate use of local healthcare resources. People with a usual source of care are more likely to have better health outcomes and experience less disparities. They can develop a relationship with their providers thereby improving communication, trust, and appropriate care. The majority of Mesa County residents have a usual source of care (83.8%) though only 62.8% reported a preventive care visit in the past 12 months. Mesa County saw an increase in the percent of residents who reported using the emergency department one time (17.1%) and multiple times (7.7%) in the past 12 months. Over 40 percent of visits to the emergency department could have been treated by a routine provider and over 60 percent of visits were for an actual emergency. Barriers that are increasing for Mesa County residents include the inability to obtain timely appointments when needed and doctor s offices not accepting new patients. 2. Building a Sense of Community (Obesity and Diabetes) The CDC (2015) defines overweight and obesity as, weight that is higher than what is considered as a healthy weight for a given height (CDC, Defining Adult 5

7 Overweight and Obesity). Obesity is a risk factor for many other chronic diseases, but it can be prevented and controlled with lifestyle changes. There are many factors that affect an individual s weight, but behaviors surrounding nutrition and exercise are major contributors. Between , Mesa County adults were more likely to be overweight and obese than adults in Colorado. Although children in Colorado were more likely to be overweight and obese between , Mesa County saw an increase in the percent of children who are obese. Between , the percent of Medicare beneficiaries with diabetes was on the rise in Mesa County, Colorado, and the U.S. Type 2 diabetes is the most common form of diabetes in the United States. The biggest risk factor for type 2 diabetes is obesity; however, lifestyle changes can help prevent, manage, and reverse type 2 diabetes. 3. Access to Healthcare (Underinsured, Screening and Early Detection of Chronic Disease) Health insurance coverage is potentially one of the most important factors related to access and use of healthcare. Lack of health insurance leaves people with either aggravated health issues or high medical bills. Service and coverage each have significant impact on utilization of high cost settings such as emergency rooms and urgent care. Nationwide, there is an urgency to increase the proportion of persons with health insurance, increase the number of practicing care providers, increase the number of people who have a source of ongoing care, and reduce the number of non urgent visits to the emergency room. In Mesa County, about 8.0% of residents do not have any health insurance coverage compared with 6.7% in Colorado. Additionally, 36.0% of Mesa County residents do not have any dental insurance compared with 29.0% in Colorado (CHAS, 2015). In Mesa County, 21.9% of residents are estimated to be underinsured, compared with 16.4% of Coloradoans (CHAS, 2015). Underinsurance can have a tremendous financial burden on families and communities. 4. Built Environment The way we design and build our communities can affect our physical and mental health. Healthy community design integrates evidence based health strategies into community planning, transportation, and land use decisions (CDC a, n.d., para. 1). Mesa County residents utilize the outdoors by walking, 6

8 biking, visiting parks, utilizing the trails, gardening, and many other outdoor activities. To improve the environment, respondents of the focus groups suggested increasing the number of bike lanes, parks, and trails. 5. Social and Emotional Wellbeing (Mental and Behavioral Health; Tobacco Use) According to the CDC, there is a strong connection between mental health and overall physical health and well being. Mental disorders can negatively affect behaviors such as tobacco and alcohol use, physical activity, and sleeping habits leading to an increase in chronic diseases such as cancer, diabetes, asthma, and obesity. The suicide rate in Mesa County (22.7 per 100,000) dropped back to levels similar to Colorado (19.4 per 100,000); however, the rate is nearly double the U.S. rate (12.4 per 100,000). The 2013 rate of attempted suicide or self inflicted injury hospitalization in Mesa County is alarming at (per 100,000) compared to 48.3 (per 100,000) in Colorado. Teenagers between years old attempt suicide at a much higher rate in Mesa County than in Colorado. Males between years old are the most likely to complete suicide in Mesa County when compared to Colorado. According to the Mesa County Coroner s report (2014), alcohol is one common denominator among suicides in Mesa County. Depression and poor health are two major potential stressors contributing to suicide. A couple of findings among high school students are worthy of attention: Three out of four students reported binge drinking (males 5+/ females 4+ drinks on an occasion) at least once in the past 30 days. One in four students reported being bullied on school property. VII. Community Hospital s Implementation Strategies Community Hospital is committed to enhancing its understanding about how best to develop and implement effective strategies to address community health needs and recognizes that good health outcomes cannot be achieved without joint planning and partnerships with community stakeholders and leaders. As such, Community will continue to work in partnership to refine its goals and strategies over time so that they most effectively address the needs identified. 7

9 1. Access to Health Care (Lack of Primary Care Providers) Goal: Increase access to and capacity of health care providers and services Objectives: To recruit two or three new primary care providers in this service area To improve utilization of health care services by encouraging a patient centered medical home To increase access points for those with Medicare, Medicaid, unisured and underinsured residents To increase access to primary care for employer groups Actions by Community Hospital to Address Health Need: Community Hospital continues to add more employed providers in the form of primary care, urgent care, obstetrics, gynecology and midwifery. For improved customer service, we ve launched a primary care call center to assist patients with healthcare needs and to streamline the communication process between patient and provider. Over the past year, we ve expanded our Community Health Partnership employer initiative to include a narrow facility network along with the primary care medical clinic direct arrangements. This enhancement increases access and lowers the cost of healthcare for employers with which we partner. In addition, we ve expanded the primary care access for our direct contract employer groups to include other private practices in the service area. To this end, we ve extended our current employer group partnerships for additional plan years and added a new employer partner who has also agreed to a multi year agreement. The CHP Partners Hotline, created to assist employer health plan members with questions and help them navigate the health care system, continues to grow with the volume of phone calls. The primary care practices are engaged in the process to become Patient Centered Medical Homes. More recently, the Centers for Medicare & Medicaid Services (CMS) announced 121 new participants representing 49 states and the District of Columbia in an innovative initiative Medicare Accountable Care Organizations (ACO s) designed to improve the care patients receive in the health care system and lowers costs. Community Hospital was selected as one of 100 new Medicare Shared Savings Program Accountable Care Organizations (ACOs), providing Medicare 8

10 beneficiaries with access to high quality, coordinated care across the United States, the Centers for Medicare & Medicaid Services (CMS) announced today. That brings the total to 434 Shared Savings Program ACOs serving over 7.7 million beneficiaries. Community Hospital was also selected to participate in the ACO Investment Model (AIM) which was designed to encourage ACO formation in low penetration and rural locations. This model provides ACOs access to the capital to invest in the infrastructure necessary to successfully implement population care management. All AIM ACOs also participate in the Shared Savings Program. Participating in both programs provides ACOs with additional resources to achieve lower costs and higher quality of care for beneficiaries. Expected Outcomes: Increased access to primary care services by employing more primary care providers Increased number of access points for Medicare, Medicaid and uninsured, underinsured patients Increased and more efficient utilization of primary care services through enhancement of CHP Employer direct contracts Evaluation and/or Impact Measures: Number of Mesa County residents without a primary care provider; Number of new providers in the market area; Fewer routine medical care visits to the Emergency Rooms 1. Building a Sense of Community (Obesity, Diabetes, Tobacco Use) Goal: Decrease the number of individuals who suffer from negative health conditions, including obesity, diabetes, and cardiovascular disease, related to poor eating habits, lack of physical activity and tobacco use Objectives: To implement programs to increase awareness of negative health effects caused by obesity, diabetes and tobacco use To increase utilization of the health coaching service To increase self management in pre diabetes and diabetics To create and implement lifestyle medicine program 9

11 To remove barriers to diabetes education and increase utilization of the outpatient nutrition and diabetes services To implement population health management in our practices Actions by Community Hospital to Address Health Need: Community Hospital is progressing toward a Diabetes Center of Excellence and a Bariatric Center of Excellence. The two departments are now co located with the health coaching team, which provides strength in promotion of department specific programs to target audiences, prevention of duplication of programs and opportunities to collaborate on more effective program development. Community provides outreach to employer groups for wellness and lifestyle programs, performs and hosts community wide cooking classes, selfmanagement programs, health education programs as well as diabetes specific support groups and education, skill building sessions. Wellness challenges are also provided through employer group wellness committees and include a variety of wellness topics and incentives for participants throughout the year. This past year, we continued to work with our CHP Employer group partners to remove the financial barriers for utilizing outpatient nutrition and diabetes services. These resources are now covered through the member s health plan at either a zero copay or low copay, allowing increased access for nutrition and diabetes education. Community has also partnered with other agencies on a grant funded Diabetes Prevention Program aimed to provide education to community members identified as pre diabetic. We refer members to this nocost program and provide space for program classes to take place. Our new Lifestyle Medicine program was introduced as a pilot for two large CHP employer partners. Offered at a reduced cost and paid for by the employer, the program attracted over one hundred interested members. However, due to staffing and facility size challenges, we decided to limit the number of participants for this initial pilot. Based on needs identified by the population, the program requires written commitments by the participants and mandatory participation in pre and post assessments, cooking classes and educational/skill building sessions. A group Facebook page was created and is used as a tool for sharing ideas, recipes and for reaching out to other participants for support. As an initiative through our practices, steps are being taken to perform population health management for patients and employer groups in our system. 10

12 Efforts to align reports from our medical record system and other data resources continue to evolve, but continue to present challenges for outcomes measurement. Expected Outcomes: Increased participation in programs that increase awareness of negative health behaviors Development of a comprehensive Lifestyle Medicine program Increased education and skills to improve lifestyle behaviors including healthy cooking, appropriate physical activity and tobacco use Increased outreach to high risk individuals through population health management Decrease number of pre diabetics advancing to diabetics Reduced hospital admissions and readmissions Decreased number of individuals identified as obese, diabetic and/or use tobacco Evaluation and/or Impact Measures Number of participants in lifestyle or behavior change programs; Number of prediabetics advancing to diabetics; Number of hospital admissions and readmissions; progress on diabetes, obesity and tobacco indicators; Number of high risk members for population management 2. Access to Healthcare (Underinsured, Screening and Early Detection of Chronic Disease) Goal: Increase the number of screening opportunities Objectives: To promote and conduct onsite health screenings for employer group populations To participate in community wide screening events To offer comprehensive worksite wellness programs Actions by Community Hospital to Address Health Need: Through the CHP Employer group s suite of services, Community Hospital offers and conducts low cost comprehensive onsite health screenings and worksite wellness services to assist employers in reducing their healthcare costs, promote 11

13 education and knowledge on navigating the health care system and provide baseline health information so members have the resources to take appropriate steps to improve their health. The employers also pay for Community s health coach service which allows any employer partner s health plan member visits up to twelve times per year at no cost. Health coaches facilitate health improvement behaviors and act as a resource to help the member evaluate their progress in reaching their health improvement goals. Community also offers wellness coordinator services to assist with internal wellness committee activities to promote employee health. Our new Lifestyle Medicine program and many of our current health programs include pre and post assessments. Community participates in community wide events and activities to promote improvement in health and assist with health screenings. Expected Outcomes: Increase in the number of individuals who are screened for early detection of disease Evaluation and/or Impact Measures: Number of participants in our current health programs and/or Lifestyle Medicine program; Number of new and repeat participants of our employer group wellness program onsite health screenings; Number of community wide screening events we participate in 3. Built Environment Goal: To promote health through advocacy for a well constructed and inclusive built environment Objectives: To mobilize the community and support efforts aimed to enhance active transportation in Mesa County To support efforts to ensure safe routes to schools To incorporate a walking/exercise path around the new hospital campus Actions by Community Hospital to Address Health Need: 12

14 Community Hospital participates in community forums and committees to support the development of safe trails and walkways to increase and encourage physical activity of our residents. We provide financial support and in kind support to community wide events and often provide wellness points for volunteers and participants, acknowledging our commitment to advocacy in our community. Sidewalks have been created to provide contiguous, safe pathways for our students walking or biking to school, which also positively impacts neighborhood solutions to support safe transportation for adults to walk and bike. Finally, Community Hospital has invested in not only a walking path around the entire new hospital campus, but is providing exercise equipment for path walkers/joggers/employees along the way as well. As a hospital organization, it is as critical for us to demonstrate our commitment to our employee s health and wellbeing as it is for us to promote health in our community. We re doing our part to support a built environment. Expected Outcomes: Increased utilization of sidewalks to schools Increased built environment planning for new construction projects Increased utilization of trails and pathways for transportation Evaluation and/or Impact Measures: Number of students walking and/or biking to school; Number of residents walking/jogging/biking on trails, sideways and pathways; Number of community members and employees walking on Community s new path and utilizing exercise equipment 4. Social and Emotional Wellbeing (Mental and Behavioral Health) Goal: To decrease adverse effects caused by mental health problems Objectives: To increase awareness of mental health problems To understand the specific qualifications for identified mental health community resources To increase referrals to appropriate mental health community resources To refer appropriately to our own behavioral health service 13

15 Actions by Community Hospital to Address Health Need: Community Hospital actively engages in community task forces and committees for suicide prevention, crisis teams and other mental/behavioral health related initiatives. We have employed behavioral health specialists who provide services to patients in our Emergency Department in crisis situations; to patients of our primary care practices in crisis situations; to employees/families through EAP services offered by local employers; to patients through our Outpatient Behavioral Health service; to members of our CHP employer group medical clinic; and to participants in our Lifestyle Medicine program. Expected Outcomes: Increased awareness of mental health Increased knowledge of available community mental health/suicide resources and the requirements for utilization/referrals Increased number of patients referred to appropriate community resources Increased referrals to our own Behavioral Health Service Evaluation and/or Impact Measures: Development of available community mental health/suicide resources including the requirements for referral; Number of patients referred to appropriate community resources; Number of patients referred to our own Behavioral Health Service; VIII. Health Needs Community Hospital Does Not Intend to Address While Community Hospital actively supports many of the health needs that have been identified by the CHNA, we made the decision not to address parenting at this time. We know that parenting is a crucial and complex determinant of health; it impacts the physical and mental status, ongoing development, and prevalence of risk behaviors among children. Beginning at conception, parents directly impact their children s physical and mental health. Prenatal care, maternal health, breastfeeding and an environment free from dangerous objects and substances in which to play and explore are all important factors for a child s health. As children grow older, parents continue to influence their health outcomes, as primary role models. During early childhood, the behavioral health of the child s family is strongly correlated to the child s successful 14

16 development. With the addition of our Labor and Delivery Service scheduled to open in March 2016, we will have more capacity and resources to address parenting as a community health need. We are excited to bring more resources and services to the residents of the community and continue to grow and expand to meet those needs. 15