slide1 n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
O n e i d a C om p r e h e n s i ve H e a l t h D i v i s i o n PowerPoint Presentation
Download Presentation
O n e i d a C om p r e h e n s i ve H e a l t h D i v i s i o n

Loading in 2 Seconds...

play fullscreen
1 / 8

O n e i d a C om p r e h e n s i ve H e a l t h D i v i s i o n - PowerPoint PPT Presentation


  • 112 Views
  • Uploaded on

Memorandum of agreement with health partners Oneida Tribe of Indians of Wisconsin. O n e i d a C om p r e h e n s i ve H e a l t h D i v i s i o n

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

O n e i d a C om p r e h e n s i ve H e a l t h D i v i s i o n


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide1

Memorandum of agreement with health partners

    • Oneida Tribe of Indians of Wisconsin

OneidaComprehensiveHealthDivision

OneidaCommunityHealthCenterBehavioralHealthServicesAnnaJohnNursingHomeEmployeeHealthNursing

POBox365

Oneida, WI54155

MEMORANDUMOFAGREEMENT BETWEENTHE

ONEIDACOMMUNITYHEALTHCENTERDIABETESTEAM

ANDTHE

ONEIDACOMMUNITYHEALTHCENTERHEALTHPROMOTION/DISEASEPREVENTIONDEPARTMENT

ANDTHE

ONEIDAFAMILYFITNESSCENTER

1.

Preamble

1.1.ThisMemorandumofAgreement (MOA)isenteredintobytheOneida CommunityHealthCenter(OCHC)DiabetesTeam(DT),Health Promotion/DiseasePrevention(HPDP),andtheOneidaFamily FitnessCenter (OFF).

2.

Purpose

2.1.ThepurposeofthisMOAisprovidetheframeworkwithinwhichtheOCHCDT, OCHCHPDP,andOFFwillworkcollaborativelytoprovidestructuredexercise programsforpatients referredbyanOCHCphysicianorotherOCHDmedical professionalneedingassistancewithpreventionand/orcontrolofmedically diagnosedconditions.Thesecollaborativeprogramsarecurrentlyreferredto as: TRIADProgram(TakingResponsibilityInAddressingDiabetes), TwatakalitatsProgram,andDPP orDiabetesPreventionProgram). TheyarejointeffortsbetweentheOCHCDT,OCHCHPDP,andOFF.Theseprograms arefundedbytheSpecialDiabetesProgramforIndians(SDPI)Grant,Health Promotion/DiseasePreventionCooperativeAgreement (HPDP),andDiabetesPreventionProgram(DPP)andaresubjecttofollowallgrantpoliciesaswellas applicabletribal,organizational,anddepartmentpolicies.

Themailingaddresstoall locationsis:P.O.Box365, Oneida,WI 54155

slide2

3.

  • Definitions
    • TRIAD: TakingResponsibilityInAddressingDiabetes
    • HPDP:HealthPromotion/DiseasePreventionGrantforTwatakalitatsProgram
    • DPP:DiabetesPreventionProgram
    • C2F:CommittoFitProgram
    • OCHD:OneidaComprehensiveHealthDivision
    • DT:DiabetesTeam
    • Graduates:Patients/Clientswhosuccessfullycompletethe12or16week programsincludingpreandpostassessments.

4.

ScopeandNatureofServices

4.1.DesignatedOCHCDT,HPDP,andOFFpersonnelwillworktogethertoprovide servicesto:

4.1.1.

4.1.2.

Followuponhealthscreeningsandreadinessassessments. Implementwellnesscoachingtoenhancephysicalactivitygoal achievement,retention,providemedicalrecorddocumentation,and provideadvocacyforeachpatient.

Provideweekly,biweeklyormonthlyeducationrelatedtoahealthylifestyle.

Designandimplementindividualizedfitnessplanstoinclude cardiovascularandstrengthtraining.

Maintainrecordsas requiredbyOCHC,OFF,andapplicable grants/cooperativeagreements.

DevelopprogramsinresponsetotheIHSStandardsofDiabetes Care,AmericanDiabetesAssociation,andAmericanCollegeof

SportsMedicineasapplicable.

4.1.3.

4.1.4.

4.1.5.

4.1.6.

5.

Implementation ProcessandResponsibilities

5.1.TheOCHC throughtheDTagrees toassurethefollowing:

5.1.1.

Patientsneedingorrequestingassistancewithlifestylemodifications topreventorcontrolmedicalconditionswillbereferredbytheirhealth careproviderorOCHDstafftoawellnessprogram.

ThehealthcareproviderorOCHDstaffwillcompleteandsubmitthe

MedicalClearance/Referral FormandHIPPAAuthorizationformtoa designatedbasketintheDToffice.

TheDT entersthepatientintoTRIADdatabaseandanHPDPReferral (electronic)database,verifyingallformshavebeencompleted.

TheDT andhealthcareprovidercompletesthemedicalscreeningto verifythepatientissafetoexercisewithanacceptableA1Clevel.

5.1.2.

5.1.3.

5.1.4.

5.1.4.1.

If thepatientisnotsafetoexercise,theDTwillfollowup every3monthswiththepatient.

TheDTwillassistthepatientbyschedulingappointmentsas neededwiththeappropriatehealthcareprovider.

Oncethepatientisdeemedsafetoexercisebytheirhealth careprovider,theDT refersthepatienttoHPDP.

5.1.4.2.

5.1.4.3.

slide3

5.1.5.

TheDTwillprovideHPDPwiththeMedicalClearance/ReferralForm. TheHIPPA authorizationformwillbefiledinthepatient’smedical record.

TheDTwillupdateHPDP andOFFstaffasnecessarywithany patientinformationand/orchangesthatmayoccur.

Submitquarterlyreport,whichincludes:PreandPostHemoglobinA1Ctests.

Providecopyofreportsummarytoallpartiesinvolvedinthis agreement.

5.1.6.

5.1.7.

5.1.8.

5.2.TheOCHC throughHPDP agrees toassurethefollowing:

5.2.1.

HPDPwillreceiveallphysicianreferralsviaemailwithascanned copyoftheMedicalClearance/Referral Form.HIPPA authorization formwillbekeptinthepatient’smedicalrecord.

HPDPwillassignacoachbasedonavailabilityandtomeettheneed ofthepatient.

HPDP staffwillcontactthepatientandcompletethereadiness

assessment.

5.2.2.

5.2.3.

5.2.3.1.

Pre-contemplationstage:TheHPDP staffwillfollowupmonthlywithpatienttoeducate,support,andmotivate patientuntilhe/shemovesfrom“Pre-contemplation”to “Contemplation”or“Preparation”stage.

Contemplationstage: TheHPDP staffwillworkwithpatient

onabiweeklybasisusingMotivationalInterviewingandAppreciativeInquiryuntilpatientmovesfrom“Contemplation”to“Preparation”stage.

Preparationstage: TheHPDP staffwillreferthepatientto

theappropriateprogram: TRIAD,C2ForDPP. Action/MaintenanceStage:Atthisstagethepatientis alreadymeetingtheoutcomesoftheprograms.HPDPStaff willdocumentthisstageintheHPDPReferralDatabase.

ThepatientwillnotenterTRIAD,C2F,orDPP butmaybe offeredaPersonalTrainingsessionand/ormonthlyfollowup visitsforgoalsetting.

5.2.3.2.

5.2.3.3.

5.2.3.4.

5.2.4.

HPDPwill:

5.2.4.1.

5.2.4.2.

5.2.4.3.

Introducepatienttoappropriateprogram. SetupWellnessVisionappointment.

SendorprovideWellnessAssessmenttopatient.

5.2.5.

  • UponcompletionoftheWellnessvision,HPDP staffwill:
        • Setupweekly,biweeklyormonthlyfollowupcoaching appointmentsforgoalsettingandtrackingfitnessprogress.ForTRIAD,seeattached“HPDPWeeklyProgramming.”
        • Providereferraltoappropriateprogramwhichincludesa copyofMedicalClearance/Referral Form,WellnessVision andWellnessAssessment results.
slide4

5.2.6.

Uponcompletionofanyprogram:

5.2.6.1.

5.2.6.2.

5.2.6.3.

CompletepostWellnessAssessment.

AssistpatientinschedulingpostFitnessAssessment. Assessinitialprogramgoalsandsetnewgoalsfor3,6or9months.

Offerand/orschedulemonthlyfollowupcoachingvisits,at patient’sdiscretion.

ForTRIAD,providepatientaconfidentialspacetocomplete

TRIADevaluationformandsealinanenvelope.HPDP staff willforwardtoDiabetesProgramSupervisor.

ForTRIAD,provideNikeshoevoucherandwalkpatientto OFFtoorderappropriateshoesize.

5.2.6.4.

5.2.6.5.

5.2.6.6.

Monthlycoachingvisitswillcontinuefor6-9monthsatwhichtime anotherWellnessAssessmentwillbecompleted.

UsingProchaska’sStagesofChangeModel,determinewhether patientshouldcontinuemonthly,quarterly,orsemi-annualfollowup

coachingvisits.

SubmitmonthlyreportforTRIADtoDiabetesProgramSupervisor, whichincludes:

5.2.7.

5.2.8.

5.2.8.1.

5.2.8.2.

5.2.8.3.

5.2.8.4.

5.2.8.5.

#ofactiveparticipants

#ofcoachingsessions

#ofselfreportedphysicalactivityminutes

#check-instoOFFWeightloss

5.2.9.

SubmitquarterlyreporttoDiabetesProgramSupervisor,whichincludes:

5.2.9.1.Total#ofparticipants 5.2.9.2.Total#ofcoachingsessions

5.2.9.3.Averageselfreportedphysicalactivityminutes 5.2.9.4.Total#ofcheck-instoOFF

5.2.9.5.Totalweightloss

ActivelyparticipateinSDPI/DPPGrant Teammeetings.

ProvidecopyofreportsummaryforDPP toallpartiesinvolvedinthis agreement.

5.2.10.

5.2.11.

5.3.TheOFFagreestoassurethefollowing:

5.3.1.

OFFwillreceivereferralsfromHP/DPviaMedicalClearance/Referral Form.

ThepatientwillpresenttheMedicalClearance/ReferralFormtoOFFFrontDeskwhowillassistpatientwithmembershipapplicationand

routepatienttoFitnessServiceDesktobeginappropriateprogram.

5.3.2.1.TRIAD:

5.3.2.

slide5

Personaltrainingwilloccurweeklyfor12weeks,in½hoursessions.Seeattached“WeeklyTrainer Responsibilities.”

          • Personaltrainingwillincludebriefpatient education,andcardiovascularandstrength training.
          • Additionalpersonaltrainingwillbeofferedto
  • “graduates”asdeemednecessaryandagreed uponbyDT,HP,andOFF.
          • DesignatedFitnessSpecialistswillcompletepre andpostfitnessassessmentstoincludethe
  • following:BMI,Height,Weight,Waist:Hip,BloodPressure,RestingHeartRate,appropriateAerobic
  • Fitnesstest, Strengthtest,andappropriate Flexibilitytest.
          • Atcompletionofpersonaltraining,FitnessSpecialistwillinformclientaboutfinalincentiveof
  • NikeNativeshoetobedistributedbyHPDP coach.GiveclientformwithHPDPspecialistname
  • andphonenumberforpatienttocontactthemand setupfinalappointment.
          • SubmitpostFitnessAssessment resultstoHPDP Coachuponcompletionoftheprogram.
          • Submitmonthly reporttoDiabetesProgramSupervisor,whichincludesthefollowingfor
  • patientsWITHOUTCOACHING: 5.3.2.1.6.1#ofactiveparticipants
  • 5.3.2.1.6.2#selfreportedphysicalactivityminutes 5.3.2.1.6.3#checkinstoOFF
  • 5.3.2.1.6.4Weightloss
          • SubmitquarterlyreportstoDiabetesProgramSupervisor,whichincludes:
            • Total#ofparticipants
            • AveragechangeinBMI
            • AveragechangeinWaisttoHipRatio 5.3.2.1.8.4.AveragechangeinAerobicFitness 5.3.2.1.8.5.AveragechangeinStrength 5.3.2.1.8.6.AveragechangeinFlexibility

5.3.2.2.

  • C2F:
          • IndividualsessionsfollowingC2FProgram protocolfor12weeks.
          • Submitpostfitnessassessment resultstoHPDP
  • Coachuponcompletionoftheprogram.

5.3.2.3.

DPP:

slide6

5.3.2.3.1.

  • FitnessSpecialistwillcompletepreandpost fitnessassessmentsforDPPParticipantsthatare OFFMembers,toinclude:BMI,Height,Weight, Waist:Hip,BloodPressure,RestingHeartRate, appropriateAerobicFitnesstest,Strengthtestand appropriateFlexibilitytest.
  • SubmitpostFitnessAssessmentresultstoHP
  • Specialist/DPPCoordinatoruponcompletionof theprogram.
  • ProvideavailabilityofspaceforAfter-Core activitiesinvolvingphysicalactivity.
  • ProvideavailabilityofOFFEducationRoomto teachDPPCurriculum.
  • SubmitquarterlyreportstoHPSpecialist/DPP Coordinator,whichincludes:
            • AveragechangeinBMI
            • AveragechangeinWaisttoHipRatio 5.3.2.3.5.3.AveragechangeinAerobicFitness 5.3.2.3.5.4.AveragechangeinStrength 5.3.2.3.5.5.AveragechangeinFlexibility

5.3.2.3.2.

5.3.2.3.3.

5.3.2.3.4.

5.3.2.3.5.

5.4.

  • Incentives:
      • TRIAD:
        • TheDTwillpurchaseandprovideHPDP and/orOFFwithpatient incentives:
        • Incentiveswillbeawardedtopatientswhomeetminimum
  • requirementsasdefinedbytheTRIADcommittee.
        • IncentiveswillbepurchasedfromtheSDPIgrant.
        • SDPIGrantpolicyallowsforincentivesthatdonotexceed$30.
        • IncentiveswillbestoredandinventoriedatOCHCandhanded outbyHP/DP and/orOFF.
        • TypesofincentivesaredeterminedbyOCHCDT,HP/DP,and
  • OFF.
        • Seeattached“TRIADIncentiveStructure.”

5.1.1.

TRIADandDPP fitnessparticipation(Note:HPDP fitness participationincentivewillbegin9/1/11):

5.1.1.1.Patientsverifyingfacilityusageofatleast2timesperweek

eachquarterwillreceiveanOneidaRetailCardinthe amountof$25.00.

5.3.2.3.1.

HPDPCoachwillprovidepatientincentive uponverification.

slide7

6.

  • Fiscalagreements
    • ForTRIAD:
      • FitnessSpecialistswillmaintainacombined40hoursforindividualized personaltrainingandTRIADadministrativeduties.
      • Atthecloseofeachmonth,OneidaFamilyFitness representativewill
  • emailtotalhoursforpersonaltrainingandTRIADadministrativedutiesto DiabetesProgramSupervisor.
      • DiabetesProgramSupervisorwillforwardtoAccountingrepresentativeto completejournalentrytransferforthereportedhours.
      • Atthecloseofeachmonth,AccountingwillreimburseOFFamaximumof 40hoursperweektoincludetheexactpersonnel,fringe,andindirect
  • coststhroughSpecialDiabetesProgramforIndiansGrant.
      • AnITPOwillbemadeintheamountof$1750for501-hourpersonal trainingsessionsat$35.00/sessiontobeusedforTRIADgraduates.
    • ForDPP:
      • FitnessSpecialistswillmaintainacombined20hoursforJustMoveIt– Oneidaeventplanning/facilitating,quarterlygroupexerciseinstruction(as needed),pre/postfitnessassessments,collection/reportdataasrequired byDPPGrant,andanyothergrantresponsibilitiesrelatedtophysical activityasdesignatedbyDPPProgramDirector(HPDPSupervisor).
      • HPDPSupervisor,throughDPPCooperativeAgreement,willworkwith
  • Accountingtoreimburseamaximumof20hoursperweektoinclude, personnel,fringeandindirectcosts.
      • Atthecloseofeachmonth,HPDPSupervisorwillrequesttotalhoursof participatinginDPP forthemonthviaemail.
      • HPDPSupervisorwillsendemail requesttoAccountingtocomplete journalentrytransferforthereportedhours.
    • MembershipcostswillnotincurtoHPDP orDT.OFFagreestothefollowingmembershippricesthatwillbepaidbyanypatient referredintothedesignated
  • programs,ifandonlyif,thepatientdoesnotqualifyforscholarshipeligibility. Thispriceincludeswaivingtheinitiationfee.

6.3.1.

6.3.2.

6.3.3.

6.3.4.

Youthmembership(under18yearsofage)-$25.00/year Adultmembership(18yearsofageandover)-$75.00/year Eldermembership(over55yearsofage)-$25.00/year Familymembership(includes2adults)-$150.00/year

7.

  • Disclaimers,Terms,and Termination ofAgreement
    • ContinuationoftheTRIADandDPP programiscontingentuponSDPI/DPP Grantfunding.
    • TheeffectivedateoftheMOAisOctober7, 2011andremainsineffect annuallyuntilamendedorterminatedbyeitherparty.
    • ThepartiesagreethatthisMOAmaybeterminatedatanytimeuponthirty(30) calendardaysnoticebyeitherparty.Thisnoticemustbeinwriting,and
  • addressedanddeliveredtotheotherparty’ssignatoryorsignatoriestothisMOA.
slide8

7.4.EachpartyagreesthatthisMOA doesnotabsolvethemof responsibilitiesand obligationsthathavebeenormaybeestablishedinConstitutions,By-Laws, andPoliciesofeachorganization.

8.

Amendments

8.1AmendmentstothisMOAshallbebymutualconsentandshallbecomea partofthisMOA byaddendum.Allamendmentsshallbesignedbythe signatoriesofthisMOA.

OnBehalfoftheOneidaTribeofIndiansofWisconsin: BysigningbelowIagreetoalltermsofthiscontract.

RyanWaterstreet

OneidaFamilyFitnessDirector

Date

ScottMurray

Fitness,Adventure&RecreationAreaManager

Date

RavinderVir,M.D.

ComprehensiveHealthDivisionMedicalDirector OneidaCommunityHealthCenter

Date

DebraJDanforth,RN,BSN

ComprehensiveHealthDivisionOperationsDirector OneidaCommunityHealthCenter

Date