Beyond the Status Quo: Building Effective Coalitions

1. Beyond the Status Quo: Building Effective Coalitions Crystal Conner, MA Shannon Medical Center Mimi Baugh, MSN Angelo State CareGiver Research Institute

2. Tom Green County Population 110,224 • 13.9% population 65 years old or older • 57% White, non-Hispanic 36.3% Hispanic 6.7 % Other • 24.3% Uninsured • 75.7% Insured • 20.4% Medicaid • 13.6% Medicare Source: US Census, 2010, Small Area Health Insurance Estimates; Department of State Health Services, County Health Facts; Texas HHSC Medicaid Enrollment by County, November 2012.

3. Tom Green County Population 110,224 The Problem • From 2006-2011, adult residents (18+) of Tom Green County received $214,677,910in charges for hospitalizations that were potentially preventable. Source: US Census, 2010; Department of State Health Services

4. Preventable Hospitalizations Source: Center for Health Statistics, Texas Department of State Health Services Hospitalizations for the conditions selected are called “potentially preventable,” because if the individual had access to and cooperated with appropriate outpatient healthcare, the hospitalization would likely not have occurred.

5. Selected Conditions Source: Center for Health Statistics, Texas Department of State Health Services

6. Financial Impact 2005-2010 Source: Center for Health Statistics, Texas Department of State Health Services

7. Collaborating Organizations • Administrative agency for County Indigent Program, serving approx. 1,400 clients • Provides case management • Agreement with local providers for indigent health services • Fiscal agent for Preventable Hospitalizations project

8. Collaborating Organizations • Full Continuum of Care—Independent Living, Memory Care, Long Term Care, Skilled Nursing, Home Health, Hospice, Peace of Mind Program, Rotary House of Hope, and Outpatient Therapy • Unique concept of Continuum of Care found nowhere else in this area • 100 acres, 600 residents, 300+ employees • Has served the Concho Valley area since 1951 • A leader in innovation with many different options in various Senior Living areas

9. Collaborating Organizations • 171-bed acute care hospital • Designated Level III Trauma Center • Concho Valley's only accredited ChestPain Center • Concho Valley’s only accredited Congestive Heart Failure facility • Comprehensive Heart and Vascular program, including open heart surgery • Robotic-assisted surgery • Level III-A Neonatal Intensive Care Unit

10. Collaborating Organizations • The leader and advocate in facilitating supportive services and opportunities that enable older citizens to be able to live more independently and productive • One of 28 Area Agencies in Texas • The region covers over 16,000 miles and approximately 112,000 citizens • Locally sponsored by the Concho Valley Council of Governments

11. Collaborating Organizations • 409-bed safety net hospital • Over 225 providers • Locally owned non-for profit medical center and clinic • With more than 20 locations, Shannon provides a range of services for Tom Green and 18 surrounding counties • The lead Level III Trauma Center and Air Med 1 air ambulance serving a 200-mile radius • The primary stroke center for the region

12. Collaborating Organizations • Serves older adults, frail elders, caregivers, and all people providing care to others • The main focus is helping those providing care to others and education of nurses specifically taking care of the elderly or working in long-term care settings • The mission of CRI is to ensure that we have caregivers, both formal and informal, who are well-equipped to care for this distinctive group. CRI draws from many campus resources, and a variety of nursing specialties, to help caregivers and nurses provide exceptional care to older adults

13. Core Partners

15. Teach a man to fish. Assets Resilience Sustainability

16. Partnering Organizations • Intrepid Home Health • Odyssey Hospice • Meals for the Elderly • Myer’s Drug • Disability Connections • Relative Marketing & Design • Sam’s Club • San Angelo Standard Times • KIXY radio • KKCN radio • KLST/KSAN news

17. Collective Impact: Rules of Engagement Framework for Success

18. Common Agenda • Not a transfer of costs Savings to one organization is savings to all • Organizations serve similar populations Collaboration of efforts • Support from organizational leaders Relationships based on shared objectives • Commitment to improving health in Tom Green County

19. Shared Measurement • DSHS Data brought it to our attention • DSHS defined the data sets • Allowed for comparisons among the community • DSHS defined accountability (interventions are evidence-based efforts are targeted)

20. Mutually Reinforcing Activities • Differentiated interventions with coordinated efforts • Public events, provider conferences, immunization clinics • Print Ads • Billboards • Online Media (Website, Facebook, Patient Channel)

21. Interventions: Events April 2012 Public Event October 2012 Provider Event October 2012 Heloise Public Event Heart of Texas Conference on Aging Speakers Bureau Health Fairs/Events

22. Education Events

23. Interventions: Immunization Clinics Area Agency on Aging Station 618 Senior Center Diabetes Update Seminar Sunset Mall Health Fair Friday Immunization Clinics

24. Interventions: Education Materials Hand Sanitizer Hydration Cups Hydration card (urine) Rack Cards in Spanish & English Immunization Records (lifetime & adult) Walking booklet COPD Consult, Harvard Health Publications COPD Manuals, UT Tyler

25. Interventions: Media Television, radio, newspaper, classifieds coverage and print ads Stethoscoop & Heartbeat, hospital newsletters Health Beat Hospital Magazine Direct mail www.tgcpartnershipforbetterhealth.org Patient Channel, The Wellness Network Facebook Page

29. Billboards

30. Continuous Communication • DSHS Roadmap • Required monthly meetings; planning and status updates • Monthly Technical Assistance calls with DSHS and 16 participating counties • Two face-to-face meetings with 16 Counties in Austin and DSHS experts/staff • Sub-committee meetings • Intervention Ad Hoc group meetings as needed, PRN

31. Backbone Support

32. Backbone Support

33. Where are we now? • Provider/Public Education • Collateral materials • Website • Mobilized immunization resources • Center of educational expertise and resources

34. Bacterial Pneumonia Interventions 5,459 high risk adults vaccinated for Bacterial Pneumonia 17,228 high risk adults vaccinated for Influenza 564 high risk adults educated on Bacterial Pneumonia and ways to possibly avoid it 12 education opportunities provided 505 healthcare providers educated 1,895 smoking cessation services provided to high risk adults

35. Urinary Tract Infection (UTI) Interventions 305 high risk adults educated on UTI and ways to possibly avoid it 12 education opportunities provided to the general population 505 healthcare providers educated

36. Chronic Obstructive Pulmonary Disease (COPD) Interventions 1,594 adults diagnosed with COPD vaccinated for Bacterial Pneumonia 1,169 adults diagnosed with COPD vaccinated for Influenza 1,998 adults diagnosed with COPD educated on the condition and ways to manage it 2652 adults educated on COPD and ways to manage it 505 healthcare providers educated 2,260 diagnosed with or at risk for COPD provided with smoking cessation services

37. Success begets MOREsuccess Sustainability + Assets = Resilience Resilience = Effectual Change Effectual Change  Improved Community Health

38. Opportunities/Future Efforts “Train the Trainer” program for long-term care & assisted living facilities Collaborate with existing events and organizations Promote the website and Facebook page October 18, 2013: Provider Education Look for additional funding/support

39. The StatusisnotQuo.

40. Contact InformationMimi Baugh, MSN, RN-BC, RAC-CTDirector, Caregiver Research Institute, Angelo State University325.486.6607 mimi.baugh@angelo.eduCrystal Conner, MARegional Health Coordinator, Shannon Health & WellnessShannon Medical Center325.657.5677 crystalconner@shannonhealth.org