Student Health Services 2015 Program/Service Unit Portfolio Management Criteria Analysis March 5, 2015
Demand Criteria: Student Health Services Program/Service Unit Portfolio Management Criteria Analysis: 1. Program Essentiality and Potential (250 words) 1.1. What are the functions and/or services that your unit provides and to which constituencies/clients and the costs of providing these programs and services? Complete table using functional categories supplied or include additional categories if needed: 1.2. Program uniqueness to SCSU, state and region, such as: Legislative, regulatory or other requirements Unique impact on the university, our students and region Impact on the diversity of our campus and community Other benefits to SCSU by offering this program/service 1.3. Reliance or interdependency of program/service with other programs/services. For example, What are the relationships/interdependencies of your program with other programs and/or other university services? Are there opportunities for interdisciplinary programming, shared programming or resources or collaboration with other programs in the future Student Health Services (SHS) is a nationally accredited provider of high quality, accessible, cost effective health care for SCSU students. The clinic is staffed by board certified medical doctors, nurse practitioners, and other health professionals. Having an accredited laboratory and pharmacy make it possible for assessment, diagnosis and treatment of most health concerns without barriers related to transportation, insurance or ability to pay. We directly bill the major health insurance payers and allow students to receive care and pick up medications and defer payment for services. Health Promotions is co-located with UChoose and collaboratively they provide experiential learning opportunities for students including involvement as peer educators, participation in the Student Health Action & Advisory Committee (SHAAC), internships, and graduate assistantships. Students use SCSU data obtained through the U of M College Student Health Survey then develop and present educational program modules based on evidence based best practices. Last year Health Promotions participated in over 150 different campus events reaching approximately 6,500 students. All of the events were designed to increase students knowledge about health topics with focus on
sleep, stress management, sexual health, nutrition and alcohol. Campus data shows in the past year positive changes in student behavior related to stress management, sexual health, nutrition, alcohol and tobacco use. MN Statute 136F.20 the board shall offer health services for students at each state university Accredited by Accreditation Association for Ambulatory Health Care (AAAHC), Commission on Office Laboratory Accreditation (COLA), and certification by Center for Medicare and Medicaid Services Clinical Laboratory Amendments (CLIA). Provide campus expertise on issues related to Health Insurance Portability and Accessibility Act (HIPAA). Licensed and inspected by MN State Board of Pharmacy. Responsible for MN Immunization Law student data collection and compliance. Provide campus expertise, leadership and student advocacy regarding MnSCU sponsored student insurance plan (required for international students). Provide campus leadership on public health issues such as Ebola. Assist local and state public health officials with communicable disease surveillance and treatment. Coordinate Tuberculosis screening for all new international students. We are the primary health care provider for many international students (approximately 26% of SHS visits are by international students). Our student insurance advocate works with MnSCU, the student insurance company, and campus departments to coordinate insurance coverage for international scholars and exchange students as well as assisting with international student benefits questions and concerns. We are working on a policy to require pre-travel medical consultation for study abroad programs. With the goal to double study abroad participation in the next few years, this policy will be important to assure students are prepared before leaving, reducing risk for students and liability for the University. We currently provide study abroad physicals on an as-requested basis. Students of color are a growing demographic, 16% of students in fall, 2014. MN Department of Health data indicates students of color are less likely to have health insurance. Therefore, our provision of accessible, affordable, high quality health care will be important for this group. Last year we referred 119 students to Project Care for assistance in obtaining insurance coverage. We provide consultation to academics, administration, athletics and residential life on health related issues, policies, and best practices. SHS staff participates on the following committees: Health and Wellness Committee, Behavioral Intervention Team, Critical Incident Readiness Team, Safety Committee, International Student Services Committee, Alcohol & Other Drug Advisory Committee, Tobacco Use Policy Implementation & Sustainability Committee; Institutional Review Board consultation. We have an agreement with Nursing that we will do their new student physicals, required tuberculosis testing annually; provide and track immunizations for their program. A similar agreement has been made with Communication Sciences Disorders and we have had discussions with other departments in the School of Health and Human Services. Opportunities for interdisciplinary programming will evolve as we plan for Eastman. Regular meetings with the SHHS are identifying new partnerships with Medical Lab Science, Community Health, Radiologic Technology, Counseling, Nursing, Kinesiology, and Social Work. Health Promotions, UChoose and the Campus Recovery Community are co-located, sharing resources and planning together.
Similar work is happening with CAPS. We have trained their staff on our electronic health record and HIPAA. Their front desk staff is being cross trained to work at our appointment desk. Our clinical staff are working with the case manager to pilot a new intake model which is evidence based and is expected to improve early identification of a number of health related concerns so students can be referred for help. Being co-located in Eastman will make it easier to increase collaborations and better serve our students. Health Promotions collaborations included LGBT Resource Center, Residential Life, Women s Center, Student Health Action & Advisory Committee, Counseling & Psychological Services, PACC, Athletics, Campus Recreation, Kinesiology, Health and Physical Education, Admissions, Graduate Studies, Center for International Studies, Nursing, Active Minds, TXT4Life, Crave the Change, Smoke Free Communities, Tobacco Use Policy Implementation & Sustainability Committee, American Cancer Society and UChoose. 2. Demand Current and Future (250 words) 2.1. What demand trends do you expect for your services in the next five years? 2.2. What opportunities exist for your program/service to adapt to meet future student and university needs and demands? 2.3. What opportunities are you pursuing/could you pursue to alter program/service delivery to meet new needs? With our move to Eastman we expect increased utilization of services due to co-location with CAPS, UChoose, and other academic and community partners in the building. Our proximity to Halenbeck is expected to increase referrals from athletic trainers and campus recreation. If imaging and physical therapy are available in Eastman, we would anticipate keeping those types of injuries on campus for diagnosis, treatment and rehab. National trends continue to show an acute need for mental health and psychiatry services in the college student population. Access to this specialty care in the St. Cloud community is problematic. We may look to partner with local providers, other campuses and/or utilize technology such as telemedicine in the future. The Affordable Care Act has improved the number of students with health coverage, however, 7% of SCSU students remain uninsured. The percentage is higher for students age 25 and older (now 21% of SCSU s population) and their families. MN Department of Health Economists indicate students of color (now 16% or 2,403 students) are also more likely to be uninsured. We will refer uninsured students to Project Care for help with accessing the MnSure Program to determine insurance eligibility. Students who are insured are more likely to seek preventive services as well as access the health care system when they are ill. It is important that SHS continue to provide low cost, high quality, accessible care for our students as many students, even with insurance, are experiencing higher out of pocket costs. We bill the major insurance companies directly and offer for students to pay for out of pocket costs later in the semester. This is important in keeping students healthy and in class.
National trends on college campuses and in our local community are focused on health and wellness initiatives that address multiple dimensions of health - not just physical. Recognition of the links between health and academic success and retention are important in linking the classroom and health related services and programs. Strength Criteria: 3. Strategic Alignment (500 words) 3.1. How does your unit align with the SCSU s mission and strategic plan? How does your program engage in the issues and opportunities that face the communities we serve? Describe your efforts to embed sustainability in your programs, services and practices? How does your program participate in the world community through internationalized activities? How does your program support active learning strategies for students? 3.2. How does your program align with your major unit s strategic plan/outcomes/action plans? 3.3. What opportunities are there for better alignment in the future? Global and cultural understanding and support of diversity Provide international students with orientation to our clinic services, help with insurance questions, and a health screening upon their arrival to campus. We continue to serve the health care needs of many international students during their time at SCSU. Coordinate health screenings and insurance requirements for international scholars and exchange students to meet program requirements before arrival on campus for Nursing and other programs in SHHS. SHS is currently working with CIS and other campus departments and University administration to develop a more comprehensive pre-travel orientation program which includes a health screening process. An improved practice of required medical evaluation prior to travel would enable SCSU to meet best practice standards, reduce risk of liability, and most importantly help ensure a positive and healthy experience for the student traveler. Community Engagement SHS is involved in the recent partnership of SCSU, CentraCare and Greater St. Cloud Development Corporation to begin a community Workplace Well-being initiative. A grant from CentraCare Foundation will start the momentum of work that will have significant impact on the health status of the region in the future. There will be opportunities for SCSU students, faculty and staff to become engaged in activities that focus around living a balanced and purposeful life. SHS staff and students lead campus co-sponsorship of the annual Making Strides Against Breast Cancer Walk on campus. This event draws over 1,000 participants and engages approximately 300 volunteers many of them SCSU students. A Community Health class and its
instructor coordinate all of the volunteers and each student in the class is given a leadership role in the program planning. Other student groups, campus employees, families and friends participate. This, for many students, is a life-changing opportunity to experience civic engagement and making a difference in the lives of others. Other collaborations with the American Cancer Society include membership on the local Volunteer Leadership Board by SHS Director and LGBT Resource Center Director. A past SCSU administrator and the current SHS Graduate Assistant also recently joined the SHS director on the ACS State Leadership Board. ACS has partnered with our Employee Health and Wellness Committee to provide health related materials and did a lunch and learn for campus. Active and Applied Learning/Explore Leadership ACS has a new focus on global women s health issues. There have been discussions about the possibility of developing an experiential learning unit on global health issues and having students involved in education, advocacy and coordination of medical supplies to affected areas of the world. The Student Health Action & Advisory Committee is sponsoring a campus Relay for Life in April and plans are to organize a national Colleges Against Cancer Chapter at SCSU this summer. SHS has taken students to Day at the Capitol for the past three years to give them a chance to experience health advocacy at the legislative level. Feedback from students and legislators was that the visits were educational and very impactful. In Eastman, we plan to partner with several program area of the SHHS to provide out of the classroom experience, for example Medical Lab Science students coming to the clinic lab regularly to meet with our Lab Director and learn about what it s like to coordinate a clinic lab service. Students are provided an integrated learning experience by their involvement in Student Health Action & Advisory Committee, Peer Education, through graduate assistantships, internships, student employment, mentoring opportunities and in daily interactions with our clinic and health promotions staff. Health Promotions works with students doing internships, and graduate assistantships in a variety of areas including Community Health, Social Work, Counseling, Psychology Service to Community Student Health Services staff connects with the community by working, volunteering and serving on various boards and committees including: St Cloud Police Department, Civilian Review Board, Community Sexual Assault Committee, Attention Deficit Association of MN, Stearns-Benton Medical Society, American Cancer Society Environmental Sustainability SHS staff and students have worked for the past five years on tobacco free campus initiatives. We continue to have a Tobacco Use Policy
Implementation and Sustainability Committee that meets regularly to monitor compliance, campus data related to tobacco use, and reports to administration. This work is important for sustaining our environment, improving the health of our campus community and creating a healthy place to live, learn and work. We no longer have paper charts, billing statements or many paper forms in our office. We utilize the electronic health record capabilities to secure message patients with information which used to be printed and mailed. Program Sustainability SHS receives funding from student health fees and has the capacity to bring in revenue through fee for service, contracts with outside vendors and partners and grants. We monitor budgets and expenses closely and are consistently in the black with funds returned to the student fee reserve. Current work is being done to explore new fee models to improve our financial stability and also work on a MnSCU committee to review and make recommendations regarding the health fee ceiling. We currently rent space to St. Cloud Orthopedics to enable them to provide physical therapy services on campus. In the first year, we gained $15,092 in new revenue from rent and student utilization of physical therapy services doubled. Staff and student staff have been cross trained within our department, and across departments including SHS, Counseling and UChoose. This has allowed for more flexible staffing, reduced staff hours and decreased cost. It also is leading to a better understanding between departments and a more collaborative work environment. We are beginning to plan as a team instead of individual departments with individual budgets. This will continue to be key as we plan for Eastman and continue to face shrinking budgets. 4. Student Experience and Campus Community Success (250 words) 4.1. How does your program/service support student success and/or the campus community? 4.2. What steps have you taken to enhance service and support to underserved populations (as defined by your unit)? By providing high quality, low cost and accessible health care we keep students healthy and in class. On-site lab and pharmacy, insurance billing to most major companies and the ability to pay for services and medications later reduces barriers to good health. SCSU students ages 25-29 report the highest uninsured rate and 30-39 year old are the second highest uninsured group. This is important, since fall 2014 30th day numbers indicated 21% of SCSU students are 25 or older. In addition, nearly ¼ of SCSU students have a spouse and 16.3% of spouses are uninsured. 12.4% have dependent children and 3.4% lack health insurance. ( U of M College Student Health Survey, 2014, Pg 2) Collaborations to enhance service and support underserved populations include: We have provided numerous presentations on health related topics to the Student Parent Support Initiative Participants. Organized health insurance sign up events with LGBT Resource Center, American Indian Center, Multicultural Student Services, Counseling & Psychological Services and the Women s Center and Project Care. These campus events, along with presentations to
Student Government, and individual referrals when uninsured students present at SHS have resulted in many uninsured students now having insurance. Insured students are more likely to utilize health care services. We are highly involved with Center for International Studies in preparing students, faculty and staff for education abroad experiences as well as serving our international student population as their primary health care provider. Many of our programs and educational presentations provided through Health Promotions contain messages about skills for developing selfconfidence, managing personal emotion, promoting communication and healthy relationships. Our department offers career building and experiential learning opportunities. Over the past two years, all of our student worker graduates have found jobs in their fields of study. Our peer educators deliver high quality, evidence based programming on topics of relevance to student success. These teaching modules are using best practices and have had some positive impacts on student rates of tobacco and alcohol use, improved nutrition and reductions related to stress. Medical care is provided in accordance with medical best practices for positive patient outcomes. Mental health issues can have a profound impact on students ability to engage fully in college and affect their physical, emotional, and cognitive well-being and can lead to poor academic performance, lower graduation rates and poor interpersonal relationships. According to the 2014 U of M College Student Health Survey, 34.8% of SCSU students report being diagnosed with at least one mental health condition in their lifetime and 17.2% in the past 12 months. Students 25 and older have higher rates of depression than traditional aged students. GPAs reported by students with a mental health diagnosis are significantly lower (3.23) than students without this condition (3.33). Days of poor physical health also impact GPA. Students with two days of poor physical health had GPAs of 3.35 compared to those with over 11 days having GPAs of 3.2. Students experiencing seven days of adequate sleep per week had GPAs of 3.41 compared to those with three days of adequate sleep at 3.29. Our student educational modules focus on these important health topics. SHS has had a positive impact on my academic performance 91.5% agree or strongly agree and 96.2% would recommend to fellow students. (SHS Patient Student Satisfaction Survey, Fall 2014) 5. Quality and Continuous Improvement as Evidenced through Assessment and Evaluation (250 words) 5.1. Describe the status of the assessment or evaluation efforts of your program/service. How do you measure success and performance? 5.2. What changes have you made to your program/service in the last two years based on evaluation results? AAAHC - Nationally accredited by Accreditation Association for Ambulatory Health Care (AAAHC). The process assesses all areas of our services including clinical, pharmacy, laboratory, health promotion, facilities, administration and governance. The surveyors conduct on-site visits every three years with our most recent site visit June, 2013.
COLA - Lab is nationally accredited by the Commission on Office Laboratory Accreditation (COLA). This involves an on-site inspection and review of policies, procedures and practices. CLIA - Lab is certified by the Center for Medicare and Medicaid Services Clinical Laboratory Improvements Amendments (CLIA) review process, which occurs every two years. Pharmacy Regular inspections by the MN Board of Pharmacy. Student Health Action & Advisory Committee We have an active student organization who meets twice a month. The group provides information about student needs as well as feedback on programs and services. Student Patient Satisfaction Surveys We conduct satisfaction surveys of 200 patients twice a year. Feedback and results are reviewed by the management team, shared with staff, SHAAC, and the Vice President of SLD. These surveys include both qualitative and quantitative information. Quality Improvement Committee QI studies on both clinical and administrative issues are conducted by a multidisciplinary group of SHS staff who meet monthly during the academic year. College Student Health Survey In collaboration with UChoose, SHS Health Promotions conducts an annual survey of a randomly selected group of SCSU students. The data is important to determine program priorities, monitor program effectiveness and benchmark against national standards. Unit Assessment Annually we do an anonymous voluntary survey of our SHS staff to assess how our department is working as a unit as well as to identify areas of success and of concern. The results are shared with the management team and presented to staff. Areas of concern are addressed as we are able and incorporated into our work plan. National Benchmarking, Staffing and other Studies - We participate in benchmarking and studies related to college health issues and staffing. These include comparisons to the National College Health Assessment and Healthy Campus 2020 through the American College Health Association. Health Promotion programming effectiveness is measured by gathering student information surrounding the topic after the presentation including demographics, health behavior information and if the programming had or will have an influence on their health behaviors. They also use longitudinal data regarding health behaviors obtained by the U of M College Student Health Survey. Cost, Productivity and Resources 6. Cost and Productivity (250 words) 6.1. What could you do differently to improve the effectiveness of your program/service but have not had the opportunity, time or resources to do?
6.2. What strategies do you suggest for reducing costs in your unit or make your unit more efficient? 6.3. What are the opportunities for new revenue from your services and programs? National accreditation surveys show the need to improve in three areas facility, access to mental health services, staffing in health promotions. Eastman The opportunity to design a new space that is appropriate to provide health care in a professional, accessible and integrated model will make it possible to improve patient privacy, improve work flow and will likely increase utilization. Mental health services could be improved by adding psychiatric services on campus. A new model of care that includes a common intake and screening process for all patients seen at Health Services and Counseling and Psychological Services would provide a better safety net for early identification of concerns such as domestic violence, alcohol, or mental health issues. A care coordinator position would be necessary to help with triage of patients and follow up after screening and referral. The addition of a position in the area of health promotion/marketing. Currently the position is less than full time and does both health promotion and marketing. For a campus our size, we are below the staffing benchmarks. Adding a position in this area would enable us to increase marketing, which could lead to additional revenue. It would also give us the capacity to expand the peer education program, giving more students valuable experiences to develop additional educational modules on other important health topics. The addition of a business manager would enable us to bill more insurance companies and leverage reimbursements as a revenue source. We could consider reducing hours during breaks and in the summer to cut personnel costs. We could also change our hours to 8:30-5 to have more appointments available in the afternoons. New revenue could be gained by increasing partnerships to provide physicals for additional campus programs. Additional targeted outreach and collaborations with LGBT Resource Center and Student Veterans could result in additional student visits. 7. Adequacy of Current Resources (250 words) 7.1. Are current resources (FY15 levels) adequate to support the program (finances, faculty and staff, program administration, physical facilities, equipment, etc.)? Our current facility, funding model and staffing are not adequate to support the program at levels that are important for meeting accreditation and best practices standards for our population. We are funded by student health fees, which are currently over the MnSCU fee ceiling and assessed at a per credit rate. We have requested to increase the health fee ceiling; however that may not be possible in the near future. Options have been explored and discussed to move to a flat
fee, which would be a more stable and predictable model using head count instead of FYE. This model also recognizes that each student has access to the same level of services regardless of the number of credits. Over 60% of students would actually pay less under a flat fee model per semester. Increasing the fee would enable us to begin adding back positions that have been cut in the past few years, add a health promotions position and billing coordinator as well as mental health care coordination and psychiatry. Our AAAHC surveyors consistently comment on the need to increase staffing. Staffing ratio for psychiatry and the health educator position does not meet the needs of a student population of 18,000. Recommendations included, Consider increasing psychiatric services to better meet the needs of the students with a goal of having psychiatry as a fixed service within the health center budget rather than by a grant. The surveyor went on to note, Having the health center providers manage mental health patients may prove to be a liability. (AAAHC Survey Report, June 2010.) In the 2008 Keeling and Associates Campus Mental Health Study done for SCSU the recommendation was to utilize resources to support a limited number of dedicated on-campus psychiatric consultation hours (e.g. 4-6 hour per week). This was identified as the single most serious deficiency identified in their review. An additional health promotions position would enable us to expand the peer education program, increase internships and GA positions. More students would gain valuable workplace experience in program development, assessment, communications, and leadership skills. We would also be able to reach more students with expanded health care information and education ultimately impacting their retention and academic success. We currently do not have a repair and replacement budget for computers and equipment which is problematic.