Mercy Hospital Lebanon Community Health Improvement Plan (CHIP)

Created: Reviewed/Updated: Mercy Hospital Lebanon Community Health Improvement Plan (CHIP) PRIORITY AREA Improve Access to Health Care for Uninsured and/or Underserved Individuals GOAL #1 Improve Access through Affordable Care Act Insurance Education and Enrollment MERCY LEADER(S) Doug Hoban, Lee Ann Pendergraft, Rhonda Shoemaker PERFORMANCE MEASURES How we will know we are making a difference Short Term Indicators Source Frequency By July 2016, increase enrollment for the 2014 and 2016 open enrollment CoverMissouri & Quarterly sessions to a total of 375 lives. Internal reporting By July 2016, develop and implement Mercy s standardized coverage and enrollment TBD (Mercy Quarterly strategy for uninsured patients Department) Long Term Indicators Source Frequency By January 2019, decrease the amount of uninsured in Mercy Lebanon to 5% Internal Reporting Annually OBJECTIVE #1 Develop a process for screening for insurance eligibility, and provide alternatives to patients. BACKGROUND ON STRATEGY Source: CoverMissouri Evidence Base: YES Policy Change (Y/N): TBD Questionnaire is given at the time of service on eligibility of Medicaid and/or charity care with follow up on charity care. Insure patients are enrolled in Medicaid based on eligibility. January January None Finance leader Questionnaire given to all uninsured/self pay patient None Finance leader Medicaid enrollment increase Page 1

OBJECTIVE #2 Implement an Internal Mercy campaign to educate leaders and co workers on ACA, especially the coverage and enrollment aspects BACKGROUND ON STRATEGY Source: CoverMissouri goals Evidence Base: YES O Provide education to all Mercy leaders and co workers on enrollment opportunities. Partner with Human and Talent Development Optimization (TDO) to offer education to all new co workers and/or in appropriate educations/seminars/trainings. Educate front line employees in patient access on enrollment process. February July February MarCom outlets, HR/TDO outlets, hospital/clinic communication sponsorships HR/TDO outlets and MarCom sponsorships Brochures, My Education Finance leader TDO specialist Patient Access Director Heightened awareness and knowledge of enrollment process Heightened awareness and knowledge of enrollment process Providing assistance in the enrollment process OBJECTIVE #3 Identify long term funding strategy for continued coverage and enrollment initiatives, in collaboration with Mercy leadership. BACKGROUND ON STRATEGY Source: CoverMissouri goals (in alignment with ACA) Evidence Base: YES Policy Change (Y/N): TBD Evaluate costs identified with expanded coverage and enrollment activities. Develop funding proposal that fits the approved structure. July July ALIGNMENT WITH STATE/NATIONAL PRIORITIES Finance sponsorship Finance sponsorship Finance Leader/Senior Team Finance Leader/Senior Team Embedded and justifiable cost in budget. Embedded and justifiable cost in budget. Objective State Healthy People 2020 National Prevention Strategy 1 www.covermissouri.org/rules www.healthypeople.gov/2020/topicsobje http://wid.org/access to healthcare /basics/ ctives2020 2 www.covermissouri.org/rules www.healthypeople.gov/2020/topicsobje http://wid.org/access to health Page 2

/basics/ ctives2020 care 3 www.covermissouri.org/rules /basics/ www.healthypeople.gov/2020/topicsobje ctives2020 http://wid.org/access to healthcare DESCRIBE PLANS FOR SUSTAINING ACTION We will continue to evaluate processes and information that becomes available throughout the year from Local, State and Federal sources. PRIORITY AREA Improve Access to Health Care for Uninsured and/or Underserved Individuals GOAL #2 Improve Access to Care through Increased Access to Primary Care MERCY LEADER(S) President/Michele Schaefer; Regional President Clinic PERFORMANCE MEASURES How we will know we are making a difference Short Term Indicators Source Frequency By 2016 the number of primary care physicians on staff (or being recruited/funding available) meets the needs as identified by the Buxton data. Buxton data; internal manpower data Annually Long Term Indicators Source Frequency By 2019 telemedicine for primary care is available, contingent upon governmental funding. VCC Annual OBJECTIVE #1 Work with local system manpower planning process on an annual basis to recruit an adequate number of primary care providers to meet needs of community. BACKGROUND ON STRATEGY Desire to improve access to primary care providers to improve community health. Source: Buxton data; Manpower plan Evidence Base: Yes Utilize Buxton data to determine the preliminary primary care needs. October 29, 2014 Updated Buxton data from Mercy President Preliminary identification Participate in manpower planning October None President Identification of Page 3

summit to identify recruitment based on needs. Work with the Clinic on funding for recruitment and compensation for primary care. Seek and maintain Certified Rural Health Clinic designation where appropriate Enhanced role of APs in rural practices 29, 2014 needs April Budgeted dollars for recruitment and retention President Funding approved Ongoing None Clinic VP Designations approved Ongoing Manpower funding Clinic VP More APs OBJECTIVE #2 Implement Mercy ACO model. BACKGROUND ON STRATEGY: Mercy has chosen to participate in the ACO Source: Physician schedules; Virtual Care Center; CMS Evidence Base: Yes Policy Change (Y/N): Y Evaluate use of telemedicine. May Partnership with Virtual Care Center Enhance primary care access via December Availability of streamlined appointment process 1, 2014 physician time Evaluate need for earlier and April Availability of later clinic hours. physician time Define case management function for ACO and embed in facility. November 2014 Regional Clinic President/Section Chair Increase use of telemedicine Regional Clinic Additional access President/Section Chair Regional Clinic Additional access President/Section Chair Case Manager Clinic ACO lead Additional access OBJECTIVE #3 Consider opportunities to assist the high utilizers of ED with primary care needs. BACKGROUND ON STRATEGY Source: ED logs; claims data; ED care management Evidence Base: yes Case managers assigned to work with patients with high ED utilization. Make Nurse On Call available to patients to cut down on overuse of ED ID other resources. January 1, November 1, 2014 ALIGNMENT WITH STATE/NATIONAL PRIORITIES Case management time Case management time Director of Case Management/CNO Director of Case Management/CNO Decrease ED utilization by select population Decrease ED utilization by select population Objective State Healthy People 2020 National Prevention Strategy 1 MHA; Univ of MO Medical School Healthy People 2020 ACA; CMS Page 4

2 N/A N/A ACA; CMS 3 MHA Quality Healthy People 2020 ACA; Robert Wood Johnson Foundation: IHI DESCRIBE PLANS FOR SUSTAINING ACTION Will evaluate at end of FY. PRIORITY AREA Improve Behavioral Health Education and Services GOAL #1 Improve Access to Behavioral Health Care and Services through Addiction Management MERCY LEADER(S) Hospital President, CNO (Judy O Connor Snyder), ED Medical Director (Dr. Angela Clay), ER Manager (Jodi Rhoads) PERFORMANCE MEASURES How we will know we are making a difference Short Term Indicators Source Frequency By July 2016, improve access to appropriate behavioral health care by increasing utilization of existing psychologist and facilities by 5%. Internal Data Annual Long Term Indicators Source Frequency By July 2019, develop an inpatient network for placement of psych patients within 7 hours of arrival. Internal Data Evaluate quarterly OBJECTIVE #1 Partnership with community support groups for addiction management. BACKGROUND ON STRATEGY Prolonged time all psychiatric patients wait for appropriate placement and reduces the number of ED treatment beds available to accommodate sudden surges and demands in the ED. Source: Internal Data Evidence Base: Y ID county and state resources for referral. Evaluate barriers to local psychiatric resources access to the ED. July 2016 Research time CNO/Case Management Referral database June Data analysis President/Clinic VP Improved access Page 5

OBJECTIVE #2 Coordinate and collaborate with Mercy Clinic and Mercy leadership on overall strategy. BACKGROUND ON STRATEGY Boarding of psychiatric patient consumes ED resources Source: Internal Data Evidence Base: Y SWAT analysis on tele psychiatry. June MarCom and Black Belt assistance Improve internal referral access to Mercy. September President/VCC Medical Director President/Springfield VP Operations Decision made on implementation of tele psychiatry Improve access ALIGNMENT WITH STATE/NATIONAL PRIORITIES Objective State Healthy People 2020 National Prevention Strategy 1 http://dmh.mo.gov/ http://www.nami.org/ms https://www.healthypeople.go v/2020/topics http://www.samhsa.gov/prevention/ http://www.hhs.gov/ash/oah/news/assets/ Template.cfm?MicrositeID objectives/topic/mental health and mental disorders sts_primary_prevention_behavioral_health =310.pdf 2 http://dmh.mo.gov/ http://www.nami.org/mste mplate.cfm?micrositeid=310 3 DESCRIBE PLANS FOR SUSTAINING ACTION Will evaluate end of Fiscal Year 2016. https://www.healthypeople.go v/2020/topicsobjectives/topic/mentalhealth and mental disorders http://www.samhsa.gov/prevention/ http://www.hhs.gov/ash/oah/news/assets/ sts_primary_prevention_behavioral_health.pdf Page 6

PRIORITY AREA Improve Access and Health/Wellness Education and Services for Women and Children GOAL #1 Improve Access to Health/Wellness Education and Services for Children through Dental Care MERCY LEADER(S) Judy O Connor Snyder, Karen Simpson Neasby PERFORMANCE MEASURES How we will know we are making a difference Short Term Indicators Source Frequency Monitor number of patients that present in ER with tooth pain and average age of Internal data Quarterly patient. Continue to network with school nursing leaders on overall dental needs of Lebanon Lebanon R 3 Schools Bi annually children to determine improvement. Long Term Indicators Source Frequency Additional access for children through community partnerships with dental based agencies like Ronald McDonald tooth truck. Lebanon R 3 School Transportation Annually OBJECTIVE #1 Partner with local dentists (Dr. Ross Stryker, Ozark Dental Studio, Dr. Alison Potter, and Dr. Jerry Cox) on dental hygiene education. BACKGROUND ON STRATEGY Lack of utilization of dental care: end up in ER. Source: Mercy ED, Division of Family Services, School System Evidence Base: Yes Meet with dentists on current education; determine additional needs. Visit schools promoting good dental hygiene. October 2014 January 2014 CNO/VP Foundation Needs identified Completed CNO/VP Foundation Visits made Completed/Education provided to parents OBJECTIVE #2 Mercy Smile Team conduct dental screenings and varnishings for Lebanon Public School System. BACKGROUND ON STRATEGY Identified through community needs assessment Source: School System Evidence Base: Yes Page 7

Dental varnish clinic at summer school, K 6. Community dental clinic for kids at Mercy Hospital. July 2014 September 2014 Dental kit and educational materials Dental kit and educational materials CNO/Nursing Leadership Clinics held Completed by June 30th CNO/Nursing Leadership Clinics held Completed by August 30th ALIGNMENT WITH STATE/NATIONAL PRIORITIES Objective State Healthy People 2020 National Prevention Strategy http://www:cdc.gov/oralhealth/ 2 http://www.modental.org/mx/hm.asp?id= home 1 http://www.ncsl.org/research/health/child rens orgal health policy issuesoverview.aspx http://www.healthypeople.gov/2020/topicsobjectives/topic/oral health http://www.ada.org/en/publicprograms/action for dentalhealth/prevention and education 3 DESCRIBE PLANS FOR SUSTAINING ACTION Will evaluate at end of FY 16. PRIORITY AREA Development of Community Collaborations/Partnerships GOAL #1 Development of Community Collaborations/Partnerships MERCY LEADER(S) Mercy Hospital Lebanon President, Lebanon HR Leader (S. Atteberry) & Vice President (R. Pickup) PERFORMANCE MEASURES How we will know we are making a difference Short Term Indicators Source Frequency By 2017, 25% of executives activelyserve on community boards. Community board Annually minutes By 2017, 10% of MAP eligible leaders are included in community benefit/community Mercy HR Annually health initiatives. Long Term Indicators Source Frequency By December 31,, community benefit oversight will achieve Tier IV status Mercy/s.e.b.e.s.a. Annually Page 8

OBJECTIVE #1 Hold annual discussions with community leaders in Lebanon on healthcare needs of the community include input in development of annual strategic/budget priorities. BACKGROUND ON STRATEGY The Sisters of Mercy heritage includes partnership with the communities in which it serves. Source: Community needs assessment Evidence Base: Y Seek out membership from schools, health department. January 2016 Leadership President Collaborate on CHIP development. OBJECTIVE #2 Work with Fort Leonard Wood on continued healthcare needs of St. Robert/Waynesville area. BACKGROUND ON STRATEGY Fort Leonard Wood is a substantial presence in our region. Pending changes in funding (such as sequestration) may change the ownership of some health needs of the community. Source: www.defence.gov & FLW leadership. Evidence Base: Y Participation on St. Robert/Waynesville Economic Committee. Ongoing September 30, 2014 Leadership participation Clinic VP Improved partnership with FLW. Clinic VP attending S.O.P. Annual meeting in September. ALIGNMENT WITH STATE/NATIONAL PRIORITIES Objective State Healthy People 2020 National Prevention Strategy 1 https://www.mffh.org/conte nt/818/statewide focus andcollaboration.aspx https://www.mffh.org/conte nt/811/healthycommunities.aspx http://www.mo pca.org/ http://ctb.ku.edu/en/table ofcontents/overview/models forcommunity health anddevelopment/map it/main http://www.healthypeople.gov/2020/ healthy people in action/consortium Members http://www.surgeongeneral.gov/initiatives/pre vention/strategy/report.pdf http://www.cdc.gov/features/annual statusreport/ 2 https://www.mffh.org/conte nt/818/statewide focus andcollaboration.aspx https://www.mffh.org/conte nt/811/healthycommunities.aspx http://www.mo pca.org/ 3 http://ctb.ku.edu/en/table ofcontents/overview/models forcommunity health anddevelopment/map it/main http://www.healthypeople.gov/2020/ healthy people in action/consortium Members http://www.surgeongeneral.gov/initiatives/pre vention/strategy/report.pdf http://www.cdc.gov/features/annual statusreport/ Page 9

DESCRIBE PLANS FOR SUSTAINING ACTION Will evaluate at fiscal year end. Page 10