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
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
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.
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
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
Info tables @ local business ; presentations at meetings all across the Municipality
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.