COMMUNITY HEALTH IMPLEMENTATION STRATEGY

COMMUNITY HEALTH IMPLEMENTATION STRATEGY

COMMUNITY HEALTH IMPLEMENTATION STRATEGY Overview IRS legislation requires that hospitals follow up on the Community Health Needs Assessment (CHNA) with a strategy for addressing the significant needs identified. Saint Francis Hospital and Medical Center completed a CHNA of the city of Hartford in collaboration with the Hartford City Health Department and the other three hospitals in the Hartford area (Connecticut Children s Medical Center, Hartford Hospital, University of Connecticut Health Center) in March of 2012. To augment the findings from this joint effort, data from interviews and focus groups with Saint Francis providers and patients, along with input from community members, were reviewed and incorporated. In addition, this effort was informed by discussions with Saint Francis clinical and administrative leaders about the approach being taken to engage community members and agencies to develop strategies that address the CHNA findings. Changes to be implemented as a part of the Affordable Care Act require new approaches to the delivery of healthcare. Saint Francis is taking a Community Outreach Alliance Approach which targets the needs highlighted by the CHNA and builds on the relationships and investments Saint Francis has in the community. Important issues considered: Healthcare costs are not evenly distributed. o Sickest 10% account for 64% of expenses. Social determinants of health are critical. o Poverty is a predictor of health status. Shifts in reimbursement encourage a focus on disease prevention. o Behavior change is a key vector for improving health outcomes. Community engagement is critical for success. o Patient perspectives are essential to the development of effective programs. Taken together, our findings reinforce the need to focus on four goals in the effort to address significant needs: Goal 1: Improve Communication Goal 2: Address Structural Barriers Goal 3: Focus on Specific Clinical Areas Goal 4: Target Social Determinants of Health 2 2/27/14

GOAL #1: IMPROVE COMMUNICATION Okay, in my opinion, you know someone is caring about you if they will have a conversation with you. * It is clear from talking with patients; providers; key informants; community members and staff who work in healthcare that communication is critical. As Hartford becomes more diverse this issue is highlighted in the need for language interpretation and translation services and the need for training of healthcare providers to understand and honor cultural differences. Trust and quality of care become issues when patients are not clear they are being understood. Most of all, people want to be heard. Saint Francis has prioritized communication both within the hospital system and with the community as evidenced by a number of initiatives that focus on this issue. Communication Initiatives at Saint Francis Relationship Based Care (RBC) This program focuses on communication and making certain that care is provided in a respectful manner to all patients who come to Saint Francis. RBC training is planned for every employee of the hospital; including all administration, all clinical providers and all other staff members. Center for Health Equity (CHE) The core principle of the CHE is community engagement. Staff at the CHE serves as a bridge between healthcare (providers and the system) and the community. Education, training, research and activities that engage the community are strategies used to develop more effective healthcare services in conjunction with clinical Service Line leaders. Language Services Currently staff are working to develop a language services program that will provide comprehensive language services throughout the hospital including: training of bilingual staff; hiring interpreters; making use of technology (video monitor interpretation and language line) and translation of critical documents for patient care. Diversity Collaborative A team is working to improve diversity in staffing and leadership; in the suppliers used throughout the institution; and to provide comprehensive diversity and inclusiveness training that improves staff understanding of our patient population and of each other. * (HRSA Grant - Focus Group Participant) 3 2/27/14

GOAL #2: ADDRESS STRUCTURAL BARRIERS It s a business, because they feel that if they can medicate you and then them going to get paid. * The system and infrastructure for delivery of healthcare services impacts everyone: hours of operation; availability of parking; public transportation; wait times; provider skills and training; access to needed services; and insurance coverage all have an impact on patient s experiences and their perceptions of healthcare overall. Saint Francis has a number of initiatives in place that attend to the structural aspects of providing healthcare. Structural Initiatives at Saint Francis Connecticut Institute for Primary Care Innovation (CIPCI) CIPCI is a collaborative effort between Saint Francis Care and UCONN that serves as a resource for the region and the state with the following specific aims: (1) Serve as a trusted partner and resource; (2) Improve training of primary care providers; (3) Increase retention of primary care providers; (4) Conduct groundbreaking research on primary care delivery and practice transformation; (5) Help practicing providers manage change. Community and Population Health Model The new model of care developed by Saint Francis includes a community alliance approach that highlights the importance of wrap around services and programs that focus on behavior change that can prevent or control chronic disease. Navigation Services Saint Francis Care is expanding services to include healthcare navigators to provide critical services to patients with complex health needs and to assist with transitions of care to community settings. Saint Francis Healthcare Partners and the Center for Health Equity have both hired Community Health Navigators to facilitate adherence to follow up care; medication compliance; and problem solving for patients. Emergency Medicine Primary Care Coordination Leaders from the Saint Francis Emergency Medicine and Primary Care service lines have been working with our Chief Innovation Officer to connect with community groups, FQHCs, and other stakeholders in an effort to transform the current system of care. The group has focused on helping high utilizers of the Emergency Department and has piloted strategies to facilitate primary care access for patients who do not have a primary care physician. * (HRSA Grant - Focus Group Participant) 4 2/27/14

GOAL #3: FOCUS ON SPECIFIC CLINICAL AREAS Saint Francis clinical services include a number of programs designed to address diseases known to have a significant impact on the health of those living in our service area. Many of these illnesses can be impacted significantly by preventive services and support for behavior change. Saint Francis had developed programs focused on this set of illnesses and has partnered with other agencies to provide services that will impact health outcomes. These include (in alpha order): Clinical Initiatives at Saint Francis AREA OF NEED Asthma & COPD SAINT FRANCIS PROGRAM Easy Breathing Pediatric Asthma Treatment and Prevention Behavioral Health Heart Disease & Stroke Infant Mortality Prevention Screening Outpatient Pulmonary Rehabilitation Program Emergency Department Diversion to Behavioral Health Services Program Women s Heart Program at Saint Francis Cardiac Rehabilitation and Wellness Program Maternal Infant Outreach Program in Partnership with Hartford Health and Human Services Healthy Start Program Collaboration with CT Department of Public Health Diabetes - Center for Diabetes and Metabolic Care at Saint Francis Prostate - Curtis D. Robinson Men s Health Institute Lead Poisoning Lead Treatment Center Collaboration with CT Children s Medical Center Stroke The Stroke Center at Saint Francis Obesity Diabetes Oral Health Co-Morbidities Metabolic Syndrome Injury Violence and Injury Prevention Program Bariatric Surgery Program Center for Diabetes & Metabolic Care at Saint Francis Oral Health Outreach for Pregnant Women UCONN Fast Track Development of a program in partnership with behavioral health. 5 2/27/14

GOAL #4: TARGET SOCIAL DETERMINANTS OF HEALTH The issues on the margins of healthcare but in the center of people s lives have a huge impact on health outcomes. How much money someone makes, the neighborhood they live in, their level of education, the type of work they do, housing, food security, exposure to violence, experience of trauma all of these issues are referred to as the social determinants of health and must be addressed to have a significant impact on health. After reviewing the findings, four areas were identified as priorities: Housing, Food Security, and Transportation. These social determinants have the most significant impact on the delivery of health care and subsequent follow-up services provided to patients. Saint Francis will be working over the next year to identify resources in each of these areas to develop partnerships and alliances that enable patients to find needed resources and meaningful support for improved health outcomes. Prepared By: Mary Stuart, MPH Director, Saint Francis Center for Health Equity Email: mstuart@stfranciscare.org Phone: 860-714-4095 Reviewed By: Gregory Makoul, PhD Chief Academic Officer and Senior Vice President for Innovation Marcus M. McKinney, D.Min., LPC Vice President of Community Health Equity and Health Policy Adam Silverman, MD, FACP Medical Director Primary Care Service Line Rebecca Crowell, PhD Manager, Research Development Mark O Donnell, PhD Manager, State and Federal Grants Rebecca Santiago, RN Community Healthcare Navigator Mission Committee of the Saint Francis Board of Directors 6 2/27/14