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Advancing an Action Plan for
Community Health Centres in
Rural Communities
• 35 mins of presentation, 25 mins discussion
• Goals:
• Evolution of CHC organizations
• Common challenges & opportunities in rural communities
• Specific value proposition for rural communities
• Initiate discussion/planning for national strategy and
working group on rural CHCs across Canada
Lorraine Burch
General Manager
Our Health Centre (Chester, NS)
Lyn Linton
Executive Director
Gateway Community Health Centre (Tweed, ON)
Raymond Babowicz
Director of Communications, Government Relations, and Marketing
Community Health Center of the North Country (Canton, NY)
OHC: A Community Invests in
Health and Wellness
Lorraine Burch
General Manager
Advancing an Action Plan for Community Health Centres in Rural Communities
• 2005-2012: a vision to achieve “healthy people, healthy
communities
• Assessment of health and medical needs highlighted:
• limited services available in the region
• a collaborative health care delivery model was the way of the
future
• 2012-2016: Capital Campaign; doors opened in Dec 2016
Our Health Centre (OHC):
much more than a building
Advancing an Action Plan for Community Health Centres in Rural Communities
The Vision
As a collaborative health centre, OHC promised to:
• Provide health and wellness programs for residents of
the Municipality of Chester and surrounding areas
• Attract and provide space for primary care practitioners,
wellness professionals, and visiting specialists
• Become a base for the provincial Health Authority’s
programs and services, with room for expansion
• Offer health-related information and care
Advancing an Action Plan for Community Health Centres in Rural Communities
• Problems:
• Provincial government transitioning from 7 health districts to 1
• Mixed messages
• Competing priorities
• Lack of communication
• Unhappy communities: wait list for doctors, failure to deliver on Capital
Campaign promises
• Forced to focus on primary care
• ‘Partnership’ language not reflected in actions
• Made decision to take control where we can
The First 18 months
• NSHA Primary Care Clinic:
• 5 salaried physicians
• 1 Nurse Practitioner
• 1 Family Practice Nurse
• Other community based physicians
• Other NSHA services: MH&A, Public Health, Continuing Care
• OHC programs & services- 50+ within first 2 years
• OHC Walk in Clinic
Where are we now?
• The brand “ Community Health Centre” is used by governments
but their definition is much different from true community model;
also different meanings for the word “collaborative”.
• Partnership model difficult to realize.
• Ensuring we deliver the programs & services the community will
respond to and which will have an impact on health outcomes.
• Paying for quality programs and services.
Ongoing Concerns
• A truly collaborative model/partnership with ALL parties with vested
interest.
• Continue to advocate for all citizens across their lifespan.
• Continue to insist we are part of the solution and need to be at the
table with the provincial government.
• Broaden our program/service offerings; collect strong data that
demonstrates positives outcomes.
• Community outreach: Hub & Spoke model
Thank you !
Next steps
GATEWAY COMMUNITY HEALTH CENTRE
TWEED, ONTARIO
JUNE 2019
Community Health in Rural Communities
Success  Opportunities  Risks
In a Funded Model
15
Rural Hastings
Rural Hastings
Past
Present
Future
Rural Hastings
Sub Region (2018)
Rural Hastings
Health Link (2013)
Gateway CHC
Rural Hastings
Ontario Health
Team (2019)
 2011: Oral Health
 2011: Pharmacist
 2013: Chiropody
 Complex Patients
 2014: Role of System Navigator
 Return on Investment
 Population Health
 Social Prescribing
 Collective Impact
 Determinants of Health
 Integrated
Systems of care
 Respiratory Model of Care
 Respiratory Therapist
1992
Rural Community Health Centre
Profile of Population
6,976
Square
Kilometers
POPULATION
66, 172
Highest Rates for
Material and Social Deprivation
 67% lowest Income Quintile
 66% highest Social Deprivation Quintile
 26.1% of the population aged 65+ as
compared to 16.9% for the province
 Diabetes at 8.6% (6.8% for the province)
 Heart Disease at 7.0% (5.0% for the province)
 COPD at 8.2% (3.9% for the province)
Gateway CHC Resource Investments
Primary Care
Investments
Community
Health
Investments
INTERPROFESSIONAL TEAM CARE
Lacking
Investment
in Health
Prevention &
Promotion
Present Future
Rural Hastings
Sub Region (2018)
Rural Hastings
Health Link (2013)
Rural Hastings
Ontario Health Team (2019)
 Complex Patients
 2014-Role of the System Navigator
 Return on Investment
 Population Health
 Social Prescribing
 Collective Impact
 Determinants of Health
 Integrated Systems
of care
 Respiratory Model of Care
 Respiratory Therapist
Rural Community Health Centre
EOL/ Palliative Care
System Planning
Care Coordination
System Planning
Data Quality &
Privacy
E-System Planning
Working Groups
Broader Sector Partners
Patient Engagement
Steering Committee
Participants
Primary Care
Steering Committee
Continuous
Communication
Mutually
Reinforcing
Activities
Governance, Vision
and Strategy
Common Agenda
Shared
Measurement
Backbone Support
Central Hastings
Family Health Team
Bancroft Family
Health Team
Gateway
Community Health
Centre
SE LHIN
Community Support
Services
Hospice
Long Term Care
Community Care
Access Centre
Hospital (Quinte
Health Care)
North Hastings
Family Health Team
Addictions & Mental
Health Services
Working Group
Participants
Patient Engagement Patient Feedback
Primary Care Broader Sector
Partners
Patient
Representative
Adaptive
Leadership
FinanceCommunications
Knowledge
Management
Admin
Support
E-Health
Patient
Representative
Collective Impact within a Regional System
A Registered Nurse System Navigator was embedded in primary care:
Social
Supports
Home &
Community
Care
Community
Support
Services
Primary
Care
Hospice
Addictions &
MH Specialists
Impacting Social and Medical Complexities
System
NavigatorPatient’s
Voice
Navigates transitions in Care
7 day follow - up
Medication reconciliation
Medical and Social Plan of Care
Shared-care planning
Ongoing monitoring &
evaluating
Conducts Home Visits
- 100% of complex patients
Primary Care
Provider
Primary
Care
Solo
Providers
Coordinated
Care
Plan
Monitors ED utilization,
hospital admissions and
discharges
Community
Assets
Influencing Models for Provision of Care
Hospital
Addressing Social Complexities
100% of complex patients we serve have social complexities
Leveraging Community Assets
Churches
The Legion
Service Clubs
Alzheimer’s Society
Library
Reducing Social Isolation
Home visits to assess home environment
Connecting to community social groups
Connecting to Social Services
Provincial and Federal Income Support Programs
Legal Services
Housing (maintenance)
Community Support Services
Housing applications
Ensure Food Security
Local food banks
Community diners
Meals on wheels
Meal planning on a limited budget
52%
report
Low Income
55%
report barriers to
accessing and
affording food64%
Transportation
Barriers
56%
Report Social
Isolation
Patient &
Provider
Experience
Return on Investment
Improved health outcomes
Seamless Transitions
System Integration
Return on Investment
Integrated
Plan
of Care
Population
Health
Reduction
of Costs
From October 1, 2013 to March 31,
2019 in Rural Hastings
 Net program benefit or a cost savings of
$5, 806, 590
 Return on investment of 352%, or for
every $1 invested we return $3.52 back
to the system.
Medically
Complex
Socially
Complex
Present
Future
Rural Hastings
Sub Region (2018)
Rural Hastings Ontario
Health Team (2019)
 Integrated
Systems of care Respiratory Model of Care
 Respiratory Therapist
Rural Sub Regional System of Care
Rural Hastings
SUB REGION SYSTEM OF CARE
Integrating Social Complexities within Clinical Practice
Future
Ontario Health Team
(2019)
 Integrated
Systems of care
Ontario Health Teams
Simple
Making Soup
Right recipe
essential
Gives same results
every time
Complicated
Sending a
Rocket to the
Moon
Formulae & experts
needed, Experience
built over time and
can be repeated
with success
Complex
Raising a
Child
No right recipes or
protocols, Outside
factors influence,
Experience helps,
but doesn’t
guarantee success
KNOWN KNOWABLE UNKNOWABLE
Source: Brenda Zimmerman, late Director of Health Industry Management Program, Schulich School of Business
Success
RHHL / Sub-Region
 CHC Leadership
 Introduced Quadruple Aim
 Promoting System
Transformation
 Creating Spread SDH
 Established Trusted
Relationships
 Introduced new concepts
 System Navigation
 ROI / System Costs
 Created a platform for health
system evolution
 Experience in a Regional System
of Care
Opportunities
Ontario Health Teams
Risks
Ontario Health Teams
Influence Rural Focus
Innovation
Demonstrate CHC Value
within a system of care
Build on Trusted
Relationships & Success
RHHL / Sub-Region
 CHC Model of Care
 Health
Promotion
 Health Equity
 Addressing Social
Complexity
CHC Culture
Funding
Advancing an Action Plan for Community Health Centres in Rural Communities
Thank You
Contact Information
Lyn Linton: llinton@gatewaychc.org
Julia Swedak: jswedak@gatewaychc.org
Web Site
www.gatewaychc.org
U.S. Community Health Centers
National Data
Since 1965 Expanding Access, Improving
Outcomes, Lowering Costs
Advancing an Action Plan for Community Health Centres in Rural Communities
Advancing an Action Plan for Community Health Centres in Rural Communities
Advancing an Action Plan for Community Health Centres in Rural Communities
Advancing an Action Plan for Community Health Centres in Rural Communities
National Action on Rural CHCs
• Located in high-need areas identified by federal government as having
elevated poverty, higher than average infant mortality, and few physicians
• Offer services that help their patients access health care, such as
transportation, home visitation services, translation, case management,
and health education.
• Tailor their services to fit the special needs and priorities of their
communities.
• Funded under Section 330 of the Public Health Service Act
• $25,597,401,177 in 2017 or $941.97/per patient
National Action on Rural CHCs
• Federal Tort Claims Act (FTCA)
• HRSA-supported health centers may be granted medical malpractice
liability protection with the Federal government acting as their primary
insurer.
• National Health Service Corp (NHSC)
• Builds healthy communities by supporting qualified health care
providers dedicated to working in areas of the United States with
limited access to care. Loan repayment.
Collective Action
National Association of Community Health Centers (NACHC)
• 20 national committees focused on issues of strategic importance
NACHC Rural Health Committee
The Rural Health Committee considers issues relative to health care for individuals
and families in rural and frontier areas and makes recommendations to the
appropriate standing committees in their respective functional areas.
National Rural Health Association
• National nonprofit membership organization with more than 21,000
members. The association’s mission is to provide leadership on rural health
issues through advocacy, communications, education and research.
Rural CHCs in NY State
New York State defines a
county as being rural if it
has a population of less
than 200,000. More
than two thirds of all
New York counties are
classified as rural.
Health Centers in NY NY Health Center Staff Provide a
# of Grantee Organizations 65 Comprehensive Range of Services
# of Delivery Sites 678 FTEs
% Grantees with PCMH Recognition 95% Physicians 1,275
% Grantees w/ Staff Authorized to Prescribe Medication-
Assisted Treatment (MAT) for Opioid Use Disorder
54% NPs/PAs/CNMs 849
Nurses 1,852
% of Grantees Utilizing Telehealth 38% Dentists 420
Dental Hygienists 169
NY Health Center Patients Behavioral Health Specialists 951
Children Served 656,134 Pharmacy 77
Homeless Patients Served 104,968 Enabling Services 1,878
Veterans Served 18,989 Vision 90
Growth in Patients since 2010 50% Other Staff 6,433
Total Patients 2,132,003 Total Staff 17,726
NY Health
Center Patients
NY
Residents
US
Residents
Patient Visits
Chronic Conditions 1,902,404
% at or Below 100% Poverty 68% 14% 13% Behavioral Health 2,342,054
% at or Below 200% Poverty 88% 30% 31% Preventive Services 2,666,264
% Racial/Ethnic Minority 71% 45% 39% Dental Services 1,280,201
Total Visits 9,854,101
% Uninsured 16% 5% 9%
% Medicare 10% 17% 17%
% Medicaid 53% 22% 17%
Every $1 in federal
investments generates
$9.28 in economic
activity across New York
State. In total, CHCs in
New York State deliver
$4.89 billion in
economic activity.
Ss
dd
Ss
dd
NYS Delivery System Reform Incentive Payment Program (DSRIP)
• Performing Provider Systems (PPS)
• Purpose is to fundamentally restructure the health care delivery system by
reinvesting in the Medicaid program, with the primary goal of reducing
avoidable hospital use by 25% over 5 years.
Community Heath Care Association of New York State (CHCANYs)
Fort Drum Regional Health Planning Organization (FDRHPO)
• Rural Health Network Development Programs (RHNDP)
• Population Health Improvement Programs (PHIPs)
• Linking Interventions For Total Population Health (LIFT)
Collective Action
North Country Health Compass Partners
• A collaborative of local hospitals, public health agencies, behavioral health providers,
prevention councils, insurance providers, community-based organizations and others.
Bridge To Wellness Coalition
• An active committee with twenty-six participating organizations including Public
Health, higher education, hospitals, Federally Qualified Health Centers and community
based organizations. Meetings are facilitated by the Local Public Health Department,
and the St. Lawrence County Health Initiative, Inc. Partners work collaboratively to
plan, implement and oversee the St. Lawrence County Community Health
Improvement Plan and Community Service Plan(s).
Primary Care Associations (PCAs)
• PCAs are designated to serve as the major link between community health centers
(CHCs), their satellite sites, the Bureau of Primary Health Care of the Department of
Health and Human Services and state and local governments. PCAs provide a
communication forum for providers of primary health care, relative to administrative,
managerial and clinical issues.
Collective Action
A Federally Qualified Health Center
WWW.CHCNORTHCOUNTRY.ORG
Ss
dd
Ss
dd
Approximately two-in-five adults in the region in 2018 report that they have
been diagnosed with at least one of these six chronic conditions (Diabetes,
High Blood Pressure, Mental Health, Heart Disease, COPD, Pre-Diabetes.
Barriers To Care:
• Geographic Isolation
• Lack of Transportation
• Food Insecurity
• Unsafe Housing
• Recruitment and Retention of Providers (1 dentist for every 3K
residents in St. Lawrence County)
Community Health Center
of the North Country
How Community Health Center of the North Country documents & expresses its value:
• Patient Centered Medical Home (PCMH) Accreditation Level 3
• A model of primary care developed by the National Committee for Quality Assurance. It
focuses on patient-centered care, communication among providers, elimination of duplicate
tests and procedures, and greater patient education and access.
• HRSA Quality Measures
• Delivery System Reform Incentive Payment Program
• FQHC Branding
What is the particular value proposition of CHCs for rural communities:
• Provide integrated, accessible health and human services; offering those services to people of all
income levels.
• A healthy community is more likely to be an economically vibrant community.
• Triple Aim: More Access, Better Health, Provided at Lower Costs
Community Health Center
of the North Country
• Partnerships and collective action through National Association of Community
Health Centers (NACHC), Community Health Care Association of New York State
(CHCANYS), Fort Drum Regional Health Planning Organization (FDRHPO), and
North Country Initiative (NCI)
• Collaboration with other FQHCs/sharing of resources
• Hudson Headwaters helps manage our 340B Program
• North Country Family Health Center
• Participating in advocacy
• Collaboration with other Community Based Organizations
• i.e. Volunteer Transportation Grant(s) for non reimbursable trips “Rides To Healthier Options”.
• Documenting our impact and value
Collective Action

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Advancing an Action Plan for Community Health Centres in Rural Communities

  • 1. Advancing an Action Plan for Community Health Centres in Rural Communities
  • 2. • 35 mins of presentation, 25 mins discussion • Goals: • Evolution of CHC organizations • Common challenges & opportunities in rural communities • Specific value proposition for rural communities • Initiate discussion/planning for national strategy and working group on rural CHCs across Canada
  • 3. Lorraine Burch General Manager Our Health Centre (Chester, NS) Lyn Linton Executive Director Gateway Community Health Centre (Tweed, ON) Raymond Babowicz Director of Communications, Government Relations, and Marketing Community Health Center of the North Country (Canton, NY)
  • 4. OHC: A Community Invests in Health and Wellness Lorraine Burch General Manager
  • 6. • 2005-2012: a vision to achieve “healthy people, healthy communities • Assessment of health and medical needs highlighted: • limited services available in the region • a collaborative health care delivery model was the way of the future • 2012-2016: Capital Campaign; doors opened in Dec 2016 Our Health Centre (OHC): much more than a building
  • 8. The Vision As a collaborative health centre, OHC promised to: • Provide health and wellness programs for residents of the Municipality of Chester and surrounding areas • Attract and provide space for primary care practitioners, wellness professionals, and visiting specialists • Become a base for the provincial Health Authority’s programs and services, with room for expansion • Offer health-related information and care
  • 10. • Problems: • Provincial government transitioning from 7 health districts to 1 • Mixed messages • Competing priorities • Lack of communication • Unhappy communities: wait list for doctors, failure to deliver on Capital Campaign promises • Forced to focus on primary care • ‘Partnership’ language not reflected in actions • Made decision to take control where we can The First 18 months
  • 11. • NSHA Primary Care Clinic: • 5 salaried physicians • 1 Nurse Practitioner • 1 Family Practice Nurse • Other community based physicians • Other NSHA services: MH&A, Public Health, Continuing Care • OHC programs & services- 50+ within first 2 years • OHC Walk in Clinic Where are we now?
  • 12. • The brand “ Community Health Centre” is used by governments but their definition is much different from true community model; also different meanings for the word “collaborative”. • Partnership model difficult to realize. • Ensuring we deliver the programs & services the community will respond to and which will have an impact on health outcomes. • Paying for quality programs and services. Ongoing Concerns
  • 13. • A truly collaborative model/partnership with ALL parties with vested interest. • Continue to advocate for all citizens across their lifespan. • Continue to insist we are part of the solution and need to be at the table with the provincial government. • Broaden our program/service offerings; collect strong data that demonstrates positives outcomes. • Community outreach: Hub & Spoke model Thank you ! Next steps
  • 14. GATEWAY COMMUNITY HEALTH CENTRE TWEED, ONTARIO JUNE 2019 Community Health in Rural Communities Success  Opportunities  Risks In a Funded Model
  • 17. Past Present Future Rural Hastings Sub Region (2018) Rural Hastings Health Link (2013) Gateway CHC Rural Hastings Ontario Health Team (2019)  2011: Oral Health  2011: Pharmacist  2013: Chiropody  Complex Patients  2014: Role of System Navigator  Return on Investment  Population Health  Social Prescribing  Collective Impact  Determinants of Health  Integrated Systems of care  Respiratory Model of Care  Respiratory Therapist 1992 Rural Community Health Centre
  • 18. Profile of Population 6,976 Square Kilometers POPULATION 66, 172 Highest Rates for Material and Social Deprivation  67% lowest Income Quintile  66% highest Social Deprivation Quintile  26.1% of the population aged 65+ as compared to 16.9% for the province  Diabetes at 8.6% (6.8% for the province)  Heart Disease at 7.0% (5.0% for the province)  COPD at 8.2% (3.9% for the province)
  • 19. Gateway CHC Resource Investments Primary Care Investments Community Health Investments INTERPROFESSIONAL TEAM CARE Lacking Investment in Health Prevention & Promotion
  • 20. Present Future Rural Hastings Sub Region (2018) Rural Hastings Health Link (2013) Rural Hastings Ontario Health Team (2019)  Complex Patients  2014-Role of the System Navigator  Return on Investment  Population Health  Social Prescribing  Collective Impact  Determinants of Health  Integrated Systems of care  Respiratory Model of Care  Respiratory Therapist Rural Community Health Centre
  • 21. EOL/ Palliative Care System Planning Care Coordination System Planning Data Quality & Privacy E-System Planning Working Groups Broader Sector Partners Patient Engagement Steering Committee Participants Primary Care Steering Committee Continuous Communication Mutually Reinforcing Activities Governance, Vision and Strategy Common Agenda Shared Measurement Backbone Support Central Hastings Family Health Team Bancroft Family Health Team Gateway Community Health Centre SE LHIN Community Support Services Hospice Long Term Care Community Care Access Centre Hospital (Quinte Health Care) North Hastings Family Health Team Addictions & Mental Health Services Working Group Participants Patient Engagement Patient Feedback Primary Care Broader Sector Partners Patient Representative Adaptive Leadership FinanceCommunications Knowledge Management Admin Support E-Health Patient Representative Collective Impact within a Regional System
  • 22. A Registered Nurse System Navigator was embedded in primary care: Social Supports Home & Community Care Community Support Services Primary Care Hospice Addictions & MH Specialists Impacting Social and Medical Complexities System NavigatorPatient’s Voice Navigates transitions in Care 7 day follow - up Medication reconciliation Medical and Social Plan of Care Shared-care planning Ongoing monitoring & evaluating Conducts Home Visits - 100% of complex patients Primary Care Provider Primary Care Solo Providers Coordinated Care Plan Monitors ED utilization, hospital admissions and discharges Community Assets Influencing Models for Provision of Care Hospital
  • 23. Addressing Social Complexities 100% of complex patients we serve have social complexities Leveraging Community Assets Churches The Legion Service Clubs Alzheimer’s Society Library Reducing Social Isolation Home visits to assess home environment Connecting to community social groups Connecting to Social Services Provincial and Federal Income Support Programs Legal Services Housing (maintenance) Community Support Services Housing applications Ensure Food Security Local food banks Community diners Meals on wheels Meal planning on a limited budget 52% report Low Income 55% report barriers to accessing and affording food64% Transportation Barriers 56% Report Social Isolation
  • 24. Patient & Provider Experience Return on Investment Improved health outcomes Seamless Transitions System Integration Return on Investment Integrated Plan of Care Population Health Reduction of Costs From October 1, 2013 to March 31, 2019 in Rural Hastings  Net program benefit or a cost savings of $5, 806, 590  Return on investment of 352%, or for every $1 invested we return $3.52 back to the system. Medically Complex Socially Complex
  • 25. Present Future Rural Hastings Sub Region (2018) Rural Hastings Ontario Health Team (2019)  Integrated Systems of care Respiratory Model of Care  Respiratory Therapist Rural Sub Regional System of Care
  • 26. Rural Hastings SUB REGION SYSTEM OF CARE
  • 27. Integrating Social Complexities within Clinical Practice
  • 28. Future Ontario Health Team (2019)  Integrated Systems of care Ontario Health Teams Simple Making Soup Right recipe essential Gives same results every time Complicated Sending a Rocket to the Moon Formulae & experts needed, Experience built over time and can be repeated with success Complex Raising a Child No right recipes or protocols, Outside factors influence, Experience helps, but doesn’t guarantee success KNOWN KNOWABLE UNKNOWABLE Source: Brenda Zimmerman, late Director of Health Industry Management Program, Schulich School of Business
  • 29. Success RHHL / Sub-Region  CHC Leadership  Introduced Quadruple Aim  Promoting System Transformation  Creating Spread SDH  Established Trusted Relationships  Introduced new concepts  System Navigation  ROI / System Costs  Created a platform for health system evolution  Experience in a Regional System of Care Opportunities Ontario Health Teams Risks Ontario Health Teams Influence Rural Focus Innovation Demonstrate CHC Value within a system of care Build on Trusted Relationships & Success RHHL / Sub-Region  CHC Model of Care  Health Promotion  Health Equity  Addressing Social Complexity CHC Culture Funding
  • 31. Thank You Contact Information Lyn Linton: llinton@gatewaychc.org Julia Swedak: jswedak@gatewaychc.org Web Site www.gatewaychc.org
  • 32. U.S. Community Health Centers National Data Since 1965 Expanding Access, Improving Outcomes, Lowering Costs
  • 37. National Action on Rural CHCs • Located in high-need areas identified by federal government as having elevated poverty, higher than average infant mortality, and few physicians • Offer services that help their patients access health care, such as transportation, home visitation services, translation, case management, and health education. • Tailor their services to fit the special needs and priorities of their communities. • Funded under Section 330 of the Public Health Service Act • $25,597,401,177 in 2017 or $941.97/per patient
  • 38. National Action on Rural CHCs • Federal Tort Claims Act (FTCA) • HRSA-supported health centers may be granted medical malpractice liability protection with the Federal government acting as their primary insurer. • National Health Service Corp (NHSC) • Builds healthy communities by supporting qualified health care providers dedicated to working in areas of the United States with limited access to care. Loan repayment.
  • 39. Collective Action National Association of Community Health Centers (NACHC) • 20 national committees focused on issues of strategic importance NACHC Rural Health Committee The Rural Health Committee considers issues relative to health care for individuals and families in rural and frontier areas and makes recommendations to the appropriate standing committees in their respective functional areas. National Rural Health Association • National nonprofit membership organization with more than 21,000 members. The association’s mission is to provide leadership on rural health issues through advocacy, communications, education and research.
  • 40. Rural CHCs in NY State
  • 41. New York State defines a county as being rural if it has a population of less than 200,000. More than two thirds of all New York counties are classified as rural. Health Centers in NY NY Health Center Staff Provide a # of Grantee Organizations 65 Comprehensive Range of Services # of Delivery Sites 678 FTEs % Grantees with PCMH Recognition 95% Physicians 1,275 % Grantees w/ Staff Authorized to Prescribe Medication- Assisted Treatment (MAT) for Opioid Use Disorder 54% NPs/PAs/CNMs 849 Nurses 1,852 % of Grantees Utilizing Telehealth 38% Dentists 420 Dental Hygienists 169 NY Health Center Patients Behavioral Health Specialists 951 Children Served 656,134 Pharmacy 77 Homeless Patients Served 104,968 Enabling Services 1,878 Veterans Served 18,989 Vision 90 Growth in Patients since 2010 50% Other Staff 6,433 Total Patients 2,132,003 Total Staff 17,726 NY Health Center Patients NY Residents US Residents Patient Visits Chronic Conditions 1,902,404 % at or Below 100% Poverty 68% 14% 13% Behavioral Health 2,342,054 % at or Below 200% Poverty 88% 30% 31% Preventive Services 2,666,264 % Racial/Ethnic Minority 71% 45% 39% Dental Services 1,280,201 Total Visits 9,854,101 % Uninsured 16% 5% 9% % Medicare 10% 17% 17% % Medicaid 53% 22% 17% Every $1 in federal investments generates $9.28 in economic activity across New York State. In total, CHCs in New York State deliver $4.89 billion in economic activity.
  • 43. NYS Delivery System Reform Incentive Payment Program (DSRIP) • Performing Provider Systems (PPS) • Purpose is to fundamentally restructure the health care delivery system by reinvesting in the Medicaid program, with the primary goal of reducing avoidable hospital use by 25% over 5 years. Community Heath Care Association of New York State (CHCANYs) Fort Drum Regional Health Planning Organization (FDRHPO) • Rural Health Network Development Programs (RHNDP) • Population Health Improvement Programs (PHIPs) • Linking Interventions For Total Population Health (LIFT) Collective Action
  • 44. North Country Health Compass Partners • A collaborative of local hospitals, public health agencies, behavioral health providers, prevention councils, insurance providers, community-based organizations and others. Bridge To Wellness Coalition • An active committee with twenty-six participating organizations including Public Health, higher education, hospitals, Federally Qualified Health Centers and community based organizations. Meetings are facilitated by the Local Public Health Department, and the St. Lawrence County Health Initiative, Inc. Partners work collaboratively to plan, implement and oversee the St. Lawrence County Community Health Improvement Plan and Community Service Plan(s). Primary Care Associations (PCAs) • PCAs are designated to serve as the major link between community health centers (CHCs), their satellite sites, the Bureau of Primary Health Care of the Department of Health and Human Services and state and local governments. PCAs provide a communication forum for providers of primary health care, relative to administrative, managerial and clinical issues. Collective Action
  • 45. A Federally Qualified Health Center WWW.CHCNORTHCOUNTRY.ORG
  • 47. Approximately two-in-five adults in the region in 2018 report that they have been diagnosed with at least one of these six chronic conditions (Diabetes, High Blood Pressure, Mental Health, Heart Disease, COPD, Pre-Diabetes. Barriers To Care: • Geographic Isolation • Lack of Transportation • Food Insecurity • Unsafe Housing • Recruitment and Retention of Providers (1 dentist for every 3K residents in St. Lawrence County) Community Health Center of the North Country
  • 48. How Community Health Center of the North Country documents & expresses its value: • Patient Centered Medical Home (PCMH) Accreditation Level 3 • A model of primary care developed by the National Committee for Quality Assurance. It focuses on patient-centered care, communication among providers, elimination of duplicate tests and procedures, and greater patient education and access. • HRSA Quality Measures • Delivery System Reform Incentive Payment Program • FQHC Branding What is the particular value proposition of CHCs for rural communities: • Provide integrated, accessible health and human services; offering those services to people of all income levels. • A healthy community is more likely to be an economically vibrant community. • Triple Aim: More Access, Better Health, Provided at Lower Costs Community Health Center of the North Country
  • 49. • Partnerships and collective action through National Association of Community Health Centers (NACHC), Community Health Care Association of New York State (CHCANYS), Fort Drum Regional Health Planning Organization (FDRHPO), and North Country Initiative (NCI) • Collaboration with other FQHCs/sharing of resources • Hudson Headwaters helps manage our 340B Program • North Country Family Health Center • Participating in advocacy • Collaboration with other Community Based Organizations • i.e. Volunteer Transportation Grant(s) for non reimbursable trips “Rides To Healthier Options”. • Documenting our impact and value Collective Action

Notas do Editor

  1. Info tables @ local business ; presentations at meetings all across the Municipality
  2. Update on physician numbers, but make sure that you also talk about how a Hubbards doctors is closing his practice, thus may be partly at the root of the increase in physician numbers; lots of retirements etc Programs: Since January 2017 we have offered 50 different programs, info sessions & workshops 65% of them well attended Many great partnerships Next steps: Identifying the gaps and determining the evaluation process Services : Sleep clinic, Hearing Specialist, Plastic Surgeon; OMG; CaregiversNS; Auricular Acupuncture, etc.