Strategies for a Healthy Future

1. Strategies for a Healthy Future Thurston County Community Health Task Force 1994 - 1998

2. Mission Identify health issues Assess current conditions and risk factors Prioritize action strategies

3. Principles Expressed Build on programs that work Start small and build success Maximize existing resources Strengthen existing relationships Expand local capacity

4. Priorities: May 1994 Access to Care Injury/Violence Drug Abuse Prenatal Care/Teen Pregnancy Mental Health

5. Priorities: July 1994 Substance Abuse Chronic Disease Violence Access Infectious Disease Prenatal Care Education Environment Mental Health Nutrition Dental

6. Priorities: September 1994 Substance Dependence Infectious Disease Chronic Disease Violence Mental Health Teen Pregnancy Prenatal Care Lack of Family Strengths Dental Nutrition Water Contamination Health Education Unintentional Injury Food Safety Air Quality

7. Final Priorities: June 1995 Dental decay in children Immunization of preschool children Over nutrition, Obesity in school age children Air quality Water quality: drinking and recreational Food safety Unintentional injury Child abuse and Domestic Violence Alcohol and Other Drug misuse and dependence

8. Implementation Strategies Action or objective to be met Convener: community leader Collaborators: others necessary to meet objective

9. Community Coalitions: 1998 Fitness & Nutrition Drinking Water Education & Monitoring Tobacco Free Thurston County Immunization Coalition Multi-Service Teen Center

10. Community Coalitions 1998 (cont.) Neighborhood Centers Home Food Safety Playground Safety Child Safety Dental Coalition

11. Thurston County Community Health Task Force continues: Access to Primary Medical and Dental Care 1999 - 2002

12. Four Subcommittees Children�s Dental Access Clinic Expansion Increase Insurance Access Advocacy

13. Recommendations Support establishment of Access to Baby and Child Dentistry (ABCD) program in Thurston County Actively pursue a Federally Qualified Health Clinic satellite (FQHC) with both medical and dental services Increase enrollment in publicly funded insurance products: Medicaid, Children�s Health Insurance Program, Basic Health Plan

14. Advocacy Subcommittee Part of each recommendation Children�s Dental Insurance Access Expand Clinic Capacity

15. Where are we now? Clinic Expansion: Sea Mar Community Health Centers took over operation of the Community Care Clinics (both medical & dental) January 1, 2001 The Clinic is currently at full capacity for medical and dental primary care Sea Mar is seeking to co-locate medical and dental services

16. Where are we now? Children�s Dental Access 30 dentists in Thurston & Mason Counties are accepting Medicaid children for screening and treatment Over 3,100 children have been enrolled in ABCD since October 1, 2000; over half of all eligible for this program

17. Where are we now? Insurance Access: Continuing to enroll in publicly funded insurance: Medicaid, Basic Health Plan through CHOICE Regional Access Program Advocacy: Some members of Task Force working to improve reimbursement, reform malpractice insurance, stable funding of public health, etc.

18. Next Steps Re-examine health priorities set in 1995 Examine �Menu of Critical Health Services� from Public Health Standards Continue work to improve access to care, as defined by the Thurston County community

19. SeaMar Community Health Center Susan Amberson Clinic Director

20. Who we are and what we do� Federally-funded community health center Serve low-income, uninsured, Medicaid, Medicare, Healthy Options, Basic Health Plan, and privately insured patients Bilingual/bicultural care in English and Spanish Reduced barriers to accessing healthcare through a �one-stop shopping� modality of care Provided over 25,000 service encounters in two years One of the first community health centers nationally to be accredited through the Joint Commission

21. Community Health Centers- Benefits Federally Qualified Health Center status- Receives 330 funding from Bureau of Primary Health Care Simple majority (51%) of the Board of Directors are users of services Required to provide care to all who seek it regardless of income or insurance status Benefits- Cost-based reimbursement similar to hospitals for Medicaid FFS Providers insured through Federal Tort Claims Act NHSC scholars and loan repayment charitable organization eligible for grants

22. Community Health Centers- Obligations Obligations- Must provide supplemental services (dental and mental health) Must meet productivity measures Must operate as non-profit Must provide at least as much uncompensated care as the amount of federal 330 funding

23. Thurston County Programs Medical Dental Mental Health Substance Abuse

24. Thurston County- Challenges Need among uninsured and publicly insured patients has grown beyond points of access Dependent upon increased funding for service expansion Multiple funding losses due to budgetary shortfalls No clear direction from consumers about healthcare needs Low-income populations have multiple needs beyond primary medical care Safety net providers� �referral circles�

25. Thurston County Opportunities Commitment among many different practitioners to addressing problems Possibilities for collaborative efforts among private providers and safety net providers through volunteer clinics, disease specific collaborations Ask consumers what they need for better health Continue to advocate for increased reimbursement rates for publicly insured patients

26. Sea Mar�s Future Plans in Thurston County New clinic site Increase in supplemental programs Advanced access; clinic redesign Implement chronic disease program

27. Capital Medical Center Primary Care Clinics Ann Neeld Chief Operating Officer

28. About Capital Medical Center Owned by HCA, the largest hospital company in the United States. Corporate mission of commitment to the care and improvement of human life by locally managed facilities in the communities served. Until late 1990�s operated a group of primary care clinics in southwest Washington. History of successful integration of nurse practitioner role in clinics.

29. Background 2000 bankruptcy of physician-hospital organization. 2001 break-up of 52 year-old clinic composed of primary care and specialists. Loss of 30 plus primary care physicians from Thurston County. Increasing reliance on Thurston County for medical care by people in all southwest Washington counties.

30. Why a new clinic?? Increased use of Emergency Department for non-urgent care. Loss of physicians in the community. New residents unable to find primary care physicians (or pediatricians). Physicians less accepting of covering patients from Emergency Rooms for follow-up care.

31. Why Nurse Practitioners? Educated and available supply of primary medical care providers. Well documented successes in providing medical care for population requiring primary and chronic care services. Washington State practice rules allow for wide scope of service. History of success with nurse practitioner role at Elma Clinic.

32. Nurse Practitioner Regulations in Washington State Examine patients and establish medical diagnoses. Admit patients to health care facilities and refer to other practitioners or facilities. Order, collect, perform and interpret laboratory tests and initiate requests for radiographic and other testing measures. Prescribe medications according to WAC�s Identify, develop, implement and evaluate a plan of care and treatment for patients to promote, maintain and restore health.

33. Clinic Demographics 25% of patients under 18 years of age 5% of patients are actually newborns 55-65% aged 21-55 5-15% aged 65 and older

34. West Olympia Payor Mix: For 600 plus patients a month Medicaid: 30% Healthy Options: 30% (Medicaid HMO) Medicare: 5% HMO/PPO: 25% Self-pay-Charity-Other: 10%

35. Elma Clinic Payor Mix: For 825 plus patients per month Medicaid: 15% Healthy Options: 30% (Medicaid HMO) Medicare: 15% HMO/PPO: 30% Self-pay-Charity-Other: 10%

36. Successful Outcomes More options for ER follow-up. Newborns have access to follow-up primary and preventative care. Medicaid/Healthy Options members have increased access to primary care in Olympia. Support from CMC medical staff.

37. The 100% Access Project CHOICE Regional Health Network� March 2003 Kristen West Executive Director

38. 100% Access � Where we are today Our vision is 100% access to services for people below 250% of federal poverty in our region We identified Six Principles based on �best practices� in communities across the nation We�re partnering with local, regional, and national leaders We�re involving communities at all levels We�ve launched an �action campaign� to make this real

41. Principles Mesh with State Board of Health Strategic Policy Directions State BOH Strategy - Maintain and improve access to critical health services 100% Access will: Fully fund primary care and prevention Stabilize the safety net Get small employers participating State BOH Strategy - Improve patient safety and increase value in government-purchased health services 100% Access will: Include moving financing closer to the community Provide administrative simplification and redirect savings to direct care Include disease case management through health teams

42. Principles Mesh with State Board of Health Strategic Policy Directions State BOH Strategy - Bolster the health system's capacity to respond to public health emergencies 100% Access will: Include a community-owned information system Assist in the identification of �illness clusters� in the region State BOH Strategy - Reduce disproportionate disease burdens among racial and ethnic minority populations 100% Access will: Increase language access and cultural competency Improve the health status of the low-income uninsured

43. Principles Mesh with Thurston County BOH Priorities Dental Services 100% Access definition of primary care includes primary dental care Success of Thurston County dental program through Olympia Union Gospel Mission Immunization of preschool children 100% Access includes action campaigns to get kids enrolled in health care Every month we�re finding 200 people a medical home

44. Financing Approach Use what�s already being spent State and federal visible assets and leverage with Hidden community assets Maximize Medicaid Community Health Centers and Rural Health Centers Get 6,000 uninsured kids enrolled Capture savings resulting from decreased fragmentation and delivering care better Solicit new revenue from employers and consumers This gets us pretty close to 100% Access

45. How it all comes together

46. What�s Happening in Thurston County Thurston County Dr. Albrecht is the champ for getting 70% of doctors participating in Project Access (#1) Bill Perkins, small business owner, is organizing small employers (#2,6) Susan Amberson, SeaMar, has organized a safety-net Council (#1) Joe Wall, St. Peter Family Practice Residency and Holly Paul, Capital Medical Center clinic, in action on clinical redesign(#5) Active consumer council Sherri Mc Donald, Public Health and Social Services, is hosting community roundtables

47. What�s Next Series of local and regional events to find and encourage champions Intensified community involvement Continued development of administration and financing options Encourage people who are interested to get involved Passage of legislation authorizing pilot projects

48. Dr. Stephen Albrecht

49. Project Access A system of health care for low income uninsured patients that better organizes physician volunteer services to leverage a closer alignment of existing healthcare and related resources in the community.

51. Where do the uninsured go when they need healthcare? ??????

56. BCMS Project Access: Outcomes Nearly doubled number of patients with regular source of care. Reduced per capita charity care costs by 45% from 1996 to 2000 ER utilization rate dropped from 28% in 1995 to 8% in 1998 80% report improved health $20 million free care 1996-2000

57. Next Steps . . . Getting the word out . . . One-on-one meetings with specialty providers Presentations to community groups, hospitals, and ???? Establishing a website & email Seeking more champions Pursuing funding Developing a planning and implementation team

58. We Need Your Help! Here�s how . . . Ask the tough questions Get involved Who else should we be talking to?

59. Contact information Dr. Stephen Albrecht Olympia Family Medicine Phone 360/459-7282 Email alberndts@attbi.com Dr. Kevin Haughton Providence St Peter Hospital Family Practice Phone 360/493-4126 Email khaugton@providence.org Holly Detzler CHOICE Regional Health Network Phone 360493-5762 Email: detzlerh@choicenet.org

60. Current Efforts to Increase Access to Dental Care

61. Community School Sealants History and Development Children�s Dental Health Coalition Grant award for portable dental equipment Smile Survey of 6-8 year olds

62. Partnership Thurston County Oral Health Coalition SeaMar Community Dental Clinic Thurston County Public Health Thurston County School Districts

63. Qualification for participation Public school with at least 30% children in Free and Reduced Lunch 2nd grade students with fully erupted 6-year molars

64. How the Program works in our community: Contact with schools and families Education Screening with volunteer dentists (20) Coordination with SeaMar for sealant Placement of sealant by hygienist Follow up with schools, families and dentist Compiling and reporting statistics Planning and recruitment for next year

65. At the end of the 6th year: 23 schools served in 7 school districts 7952 students educated 3128 students screened by dentists 2010 students received sealants 6829 sealants placed

66. Thurston County ABCD Program

67. ABCD is... Access to Baby and Child Dentistry Focused on Prevention and Education A Public/Private partnership between the Dental Society, Health Department, UW Pediatric Dentistry, Medicaid, and the Washington Dental Service Foundation

68. ABCD is... Collaborative approach to increasing access to dental services A Best Practice named by the American Academy of Pediatric Dentistry in 2000 A Model Program for Washington State A community supported solution for a preventable disease

69. ABCD Provides... Care for children ages 0-5 years Prevention techniques starting early Family oral health education Training for dentists in caring for young children Enhanced reimbursements for dentists

70. Program participation... 30 Participating dental practices 3172 children enrolled, of 6026 eligible (March, 2003) Outreach and enrollment continues Education and training continues

71. VISION HEALTHY MOUTHS FOR ALL OUR KIDS

72. Olympia Union Gospel Mission George Wehness Linda Barrett

73. Why dental care? Need is great Access, particularly for uninsured and unemployed adults, is overwhelming Our mission is to help We found willing partners

74. What have we done? Collaborated with: Northwest Medical Teams CHOICE Regional Health Network Thurston County Health Department Thurston County Oral Health Coalition Recruited volunteer dentists Provided staff and space Provided restorative and preventive dental care to about 1,000 people without any other access to care

75. Principles Expressed by Community Health Task Force in 1994: Build on programs that work Start small and build success Maximize existing resources Strengthen existing relationships Expand local capacity

76. Menu of Critical Health Services General access to health services Health risk behaviors Communicable and infectious diseases Pregnancy & maternal, infant, & child health & development Behavioral health & mental health services Cancer services Chronic conditions & disease management Oral health

77. Public Health Standards for �Helping people get the services they need� Information is collected and made available at both the state and local level to describe the local health system, including existing resources for public health protection, health care providers, facilities and support services. Available information is used to analyze trends which, over time, affect access to critical health services. Plans to reduce specific gaps in access to critical health services are developed and implemented through collaborative efforts. Quality measures that address the capacity, process for delivery and outcomes of critical health care services are established, monitored and reported.