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CommunityClinicsHospitals PublicHealth CommunityPartners

COLUMBIAGORGEREGIONALCOMMUNITYHEALTHASSESSMENT:SUMMARY-2016CollaboratingforOptimumHealthandOptimizedHealthcare

A summary of the needs for improved health for the residents of the Columbia Gorge Region including Hood River, Wasco, Sherman, Gilliam, Wheeler counties in Oregon and Skamania and Klickitat counties in Washington – Fall 2016

NorthCentralPublicHealthDepartment

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The2ndColumbiaGorgeRegionalCommunityHealthAssessment ThisdocumentrepresentsthesecondversionofourregionalapproachtotheColumbiaGorge

CommunityHealthAssessment.Buildingonthepartnershipsstartedwiththefirstiterationin2013,thisregionalassessmentnowincludes7adjacentcountiesintheColumbiaGorgeRegion.Thecohortlistedonthecoverpagerepresentstheprimarysupportingorganizationsinthiseffort.

AcknowledgementtoKeyCommunityContributorsConductingathoroughhealthassessmentwaspossiblebythetirelesssupportofthesegroups.

Forgatheringhand-fieldedsurveys

DHS,Mid-ColumbiaHousingAuthority,HoodRiverCountyHealthDepartment,HoodRiverCountySeniorCenter,RevellCoyInsurance,OregonChildDevelopmentCoalition,MealsonWheels:TheDalles,Mid-ColumbiaCenterForLiving,NorthCentralPublicHealthDistrict,OneCommunityHealth,Wings,TheNextDoorInc,ProvidenceHoodRiverMemorialHospital,AgingintheGorgeAlliance,KlickitatValleyHealth,SkylineHospital,SkamaniaCountyHealthDepartment,KlickitatCountyHealthDepartment

Providingaugmenteddata

OregonPublicHealthDivision,WashingtonStateDepartmentofHealth,OregonHealthAuthority,Mid-ColumbiaEconomicDevelopmentDistrict-CoordinatedHumanServicesTransportationPlanData

CollectiveMedicalTechnologies(CMT):(CMT)usesreal-timedata,riskanalytics,notifications,andsharedcareguidelinestopromptandguideproviderdecisionmakinginawaythatdrivesdifferentialoutcomesintermsofreducedEDutilizationandinpatientreadmissions.CMTwasabletoprovideuswithaccurateuptodateinformationaboutEmergencyDepartmentUtilizationbasedonEmergencyDepartmentInformationExchange(EDIE).

Executionofthemail-basedsurveyanddataanalysis

ProvidenceCenterforOutcomeResearchandEducation(CORE)

AcknowledgmenttotheCommunityAdvisoryCouncil(CAC)TheCommunityAdvisoryCouncil,orCAC,iscomprisedofMedicaidconsumers,communitymembers,

andlocalorganizations.Theirmissionistogivethecommunityavoicesothattheconsumerandcommunityhealthneedsareheard.Theywereinstrumentalinreviewingandadjustingthesurveyitselftoensureourlocalneedsweremet.

AresultthatisrewardingInaruralcommunity,workingtogetherisparamountforsuccess.Theformationof

theColumbiaGorgeCoordinatedCareOrganizationwithPacificSourceCommunitySolutionsaidedustoturnanordinaryrequirementfromOregonlawmakersintoanextraordinaryopportunitytoimprovethehealthandwellnessofallresidents.WeareproudofouraccomplishmentsanddelightedthattheRobertWoodJohnsonFoundationrecognizedourwork.

Weinvitethecommunitytousethismaterialinthepursuitofbetterhealthforall.

***ForthefulldocumentlookontheColumbiaGorgeHealthCouncilwebsiteatcghealthcouncil.org

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20162013

QUESTIONS

COUNTY

COHORT

SOCIAL

DETERMINANTS

HEALTHCARE

CONNECTED

VS

6Counties:4Oregon+

2Washington

7Counties:5Oregon+

2Washington

65QuestionsincludingFood,

HousingandTransportation

72QuestionsincludingTrauma

andSupportforCaregivers

4hospitals;4HealthDeparts;

OneCommunityHealth;

CountyMentalHealth

ColumbiaGorgeCCO

2013cohort+UnitedWay;Four

RiversEarlyLearningHub

Housing&Food;

Transportation;Jobs

AdultDentalAccess;Physical

andMentalhealthtogether;

MentalHealthaccessfor

Children&Youth

Coordinationwithhealthcare&social

services;Healthinsurancere-

enrollment;SupportingDevelopmental

andHealthyGrowthintheEarlyYears

Employmentratebetter;

otherareasremainaconcern

DentalAccessremains#1gap;

ProgressonMentalHealthAccess;

PCPAccessharder

Coordinationwithprimarycareand

mentalhealth=good;Morepeopleare

insured;Familieswithchildren0-5more

likelytogowithoutbasicneeds

ColumbiaGorgeRegional

CommunityHealthAssessment

Hospitals:ProvidenceHoodRiver,Mid-ColumbiaMedicalCenter,KlickitatValleyHealth,SkylinePublicHealth:HoodRiverCounty,KlickitatValley,NorthCentral,Skamania

OneCommunityHealth,Mid-ColumbiaCenterforLiving,PacificSourceCommunitySolutionsUnitedWayoftheColumbiaGorge,4RiversEarlyLearningHubInpartnershipwith:

SURVEYS

Mail=457

Hand-fielded=691

Mail=674*statisticalsignificance

Hand-fielded=694

DEMOGRAPHICS

Non-HispanicWhite=827

Hispanic/Latino/Other=290

LowIncome=668

Non-HispanicWhite=1043

Hispanic/Latino/Other=301

LowIncome=631

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ColumbiaGorgeRegionalHealthAssessment-2016

GeneralPopulation

BasicNeeds

IncomeSecurity

FoodSecurityandHealthyEating

TransportationAccess

HousingSecurity

HealthInsurance

SocialCohesion

SupportforCaregivers

1in3hadtroublepayingforbasicneeds

7%hadtogowithoutstablehousing

25%areworriedabouttheirhousingsituation

morethan1in10hadtogowithoutfood

1in4hadtogowithoutabasicneedAND1in4hadtogowithoutahealthcareneed

13%hadtogowithouttransportation

8%areuninsured

1in3areworriedaboutrunningoutoffood*

oftheuninsured,21%liveinWashingtonand69%liveinOregon

21%donothavesomeonetomakethemfeellovedorwanted

22%donohavesomeonetogivethemgoodadvice

29%donohavesomeonetorelaxwith

26%donothavesomeonetotalktoaboutproblems

29%donothavesomeonetohelpiftheywereconfinedtoabed

1in5arecaregivers

6outof10caregiversdon'tfeelthattheyhaveadequatesupport

13%thinkpeopleintheircommunityareunwillingtohelp

25%feeltheycannottrustpeopleintheircommunity

20%cannotcountonadultsintheircommunity

10%donotfeelsafeintheircommunity

SocialSupport

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BasicNee

dsCom

mun

ityand

Soc

ialE

nviro

nmen

t

*GorgeWideFoodSurvey

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ColumbiaGorgeRegionalHealthAssessment-2016

Populationswithdisparitiesbyrace/ethnicity,income,orinsurance

BasicNeeds

IncomeSecurity

FoodSecurityandHealthyEating

TransportationAccess

HousingSecurity

HealthInsurance

SocialCohesion

SupportforCaregivers

MorethanhalfoftheHispanic/Latino/Other,Lowincome,Uninsured,andMedicaidpopulationshadtroublepayingforbasicneeds

16%ofthesepopulationshadtogowithoutstablehousing

About40%inHispanic/Latino/Other,Uninsured,andMedicaidpopulationsareworriedabouttheirhousingsituation

1in4intheHispanic/Latino/Other,Uninsured,andMedicaidpopulationshadtogowithoutfood

4in10intheHispanic/Latino/Other,Lowincome,Uninsured,andMedicaidpopulationshadtogowithoutabasicneedandhealthcareneed

Hispanic/Latino/OtherandLowincomepopulationsareabouttwiceaslikelytobeuninsuredthanthegeneralpopulation

Lowincomewaslesslikelytofeelliketheyhadthesesocialsupportsthanhigherincomes

UninsuredandMedicaidpopulationswerelesslikelytofeelliketheyhadthesesocialsupportsthanthePrivateandMedicarepopulations.

6outof10caregiversdonotfeelliketheyhaveadequatesupport

25%oftheUninsuredthinkpeopleintheircommunityareunwillingtohelp

35%ofLowincome,Uninsured,andMedicaidpopulationsfeeltheycannottrustpeopleintheircommunity

25%ofHispanic/Latino/Other,Lowincome,Uninsured,andMedicaidpopulationscannotcountonadultsintheircommunity

20%oftheUninsureddonotfeelsafeintheircommunity

SocialSupport

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BasicNee

dsCom

mun

ityand

Soc

ialE

nviro

nmen

t

About1in4intheHispanic/Latino/Other,Lowincome,Uninsured,andMedicaidpopulationshadtogowithouttransportation

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Adults(ages18-98)

ChronicMedicalConditions

MentalHealthConditions

TraumaandResilience

GeneralHealth

Alcohol,Tobacco,OtherDrugs

PhysicalHealthcareAccess

MentalHealthcareAccess

DentalHealthcareAccess

SubstanceUseTreatment

Medications

Specialists

1in4ratedtheirhealthasfairorpoor

Highbloodpressureisthemostcommonchroniccondition

Depressionisthemostdiagnosedmentalhealthcondition

3outof4experiencedoneormoretraumaticevent

21%havethreeormoredrinksonthedaystheydrink19%usetobacco

1in5donothaveaprimarycareproviderandaregoingwithoutneededcare

Greatestunmethealthcareneed:344peoplearegoingwithoutcare

Accessgreatlyimprovedfrom2013

7%neededsubstanceusecare,ofthose68%arereceivingtreatment

1in10cannotgetalltheirmedications

Neurology,substanceusetreatment,andcancertreatmenthadhighestunmetneed

2outof3areoverweightorobese

Morethanhalfhaveachronicmedicalcondition

About4outof10hadsomeonedosomethingharmfultothem

Mostpeopleuselocalservices

ColumbiaGorgeRegionalHealthAssessment-2016

46%gotcarefromprimarycareprovider30%gotcarefromcountymentalhealthclinics

1in3haveamentalhealthcondition

1in4aregoingwithoutneededcare

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15%usemarijuana7%useotherdrugs

Hea

lthStatus

Hea

lthca

reAcc

ess

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Adultswithdisparitiesbyrace/ethnicity,income,orinsurance(ages18-98)

ChronicMedicalConditions

MentalHealthConditions

TraumaandResilience

GeneralHealth

Alcohol,Tobacco,OtherDrugs

PhysicalHealthcareAccess

MentalHealthcareAccess

DentalHealthcareAccess

SubstanceUseTreatment

Medications

Specialists

35%ofLowincomeandMedicaidpopulationsratedtheirhealthasfairorpoor

AnxietyisthemostdiagnosedmentalconditionforLowincomeandMedicaid

TheUninsuredandMedicaidpopulationweremorelikelytohavethreeormoredrinks,usetobacco,anduseotherdrugsthangeneralpopulation

HalfoftheMedicaidpopulationhasexperienced3ormoretraumaticevents

1in4oftheUninsuredandMedicaidpopulationsaregoingwithoutneededcare

15%ofMedicaidrecipientsneededsubstanceusecare

Nosignificantdisparities

Lowincomehadmoreunmetorthopedicneedsthanthegeneralpopulation

Privateinsurancehadmoreunmetcardiologyneedsthanthegeneralpopulation

Medicaidhadmoreunmetskinconditionneedsthanthegeneralpopulation

3outof4onMedicarehaveachronicmedicalcondition

Lowincomewasmorelikelytousetobaccothanthegeneralpopulation

ColumbiaGorgeRegionalHealthAssessment-2016

NearlytwiceasmanyMedicaidrecipientsaregoingwithoutneededcarethanthegeneralpopulation

2of5oftheLowincomepopulationhaveamentalhealthcondition

About37%oftheLowincome,Uninsured,andMedicaidpopulationsaregoingwithoutneededcare

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HealthStatus

HealthcareAccess

HalfofMedicaidrecipientshaveamentalcondition

MorethanhalfoftheUninsureddonothaveaprimarycareprovider

Highincome,Uninsured,andPrivateinsurancepopulationsweretwiceaslikelytogowithoutneededcarethanthegeneralpopulation

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Youth

ChronicMedicalConditions

MentalHealthConditions

TraumaandResilience

GeneralHealth

Alcohol,Tobacco,OtherDrugs

PhysicalHealthcareAccess

MentalHealthcareAccess

DentalHealthcareAccess

SubstanceUseTreatment

Medications

1in10ratedtheirhealthasfairorpoor*

Asthmaisthemostcommonchronicmedicalcondition

Anxietyisthemostdiagnosedmentalhealthcondition

Nearly1outof4hadanadulthurtthemonpurpose*

20%havehadalcohol*14%haveusedtobacco*

1in5youthfeeltheyarenotgettingallneededcare*

1in5teenshaven'tbeentothedentistinthepast12months

7%neededsubstanceusecare,ofthose22%arereceivingtreatment^

1in20teenshaveusedprescriptiondrugswithoutadoctor'sorders*

1outof3areoverweightorobese*

ColumbiaGorgeRegionalHealthAssessment-2016

1in10parentssaidtheirchildrenarenotgettingallneededcare

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1in10parentssaidtheirchildrenarenotgettingallneededcare

8%parentssaidtheirchildrenarenotgettingallneededcare

15%youthfeeltheyarenotgettingallneededcare*

1in4haveamentalhealthcondition

15%haveusedmarijuana*5%haveusedotherdrugs*

VS

VS

Health

Status

Health

careAccess

(ages0-17)

VS

*ThisinformationisfromtheOregonandWashingtonHealthyTeenSurvey^ThisinformationcamefromtheOregonHealthAuthority(OHA)BehavioralProfilesAllotherinformationisfromthe2016CommunityHealthSurvey

Columbia Gorge Regional Community Health Assessment

2016 ResultsNext Steps towards Community Health Improvement Plan

Coco Yackley/John Huffman

Using the Coordinated Care Organization

structure we… • …..“turned an ordinary requirement from Oregon lawmakers into an extraordinary opportunity to improve the health and wellness of all residents.”

-RWJF Culture Of Health Prize

• Columbia Gorge CCO = • PacificSource (Health Plan)• Columbia Gorge Health Council (501c3)• Medicaid (low income) client• ~25% of residents; +50% of kids• Hood River & Wasco Counties

• Community Health Assessment for 7 counties

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A Collaborative Approach …

• Yields a better; more accurate and actionable as community providers agree on the needs within our region and communities and will support our ability to address those needs together.• Maximizes collective resources available for improving population health.

• Requires commitments of cash or in-kind resources from all participants who would use it to satisfy a regulatory requirement.

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Where have we been? Timeline of the Regional Process

2013 Community Health Assessment•First Collaborative Assessment•Broad survey to identify needs•Oregon & WA

2014 Community Health Improvement Plan (CHIP)•Identified 10 Focus Areas•Housing, Food, Transportation, Jobs•Dental for Adults, Physical & Mental Health Integration, Services for Youth, Health Insurance•Collaboration within Healthcare and with Social Services•Healthy Development in the Early Years

2014-2016 Regional Focus brings results•>$3M in additional grant funds•Regional approach to issues•Synergy in Programs across counties

2016 RWJF Culture of Health Prize Winner•Collaborative CHA/CHIP one of the cornerstone reasons

2016 Community Health Assessment•Expanded Cohort•Expanded surveys, included other sources•Incorporated new questions

2017 CHIP•Review/adjust CHIP topics•Community Advisory Council is convener

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Summary points from the 2016 CHA

• Food and housing security are still high concern areas• The number of insured grew; the number of people who got services grew

some• While those receiving dental care did improve, it’s still the largest unmet

healthcare need• Transportation continues to be a barrier • Parents underestimate the needs that their teens face• Households with children 0-5 are more likely to go without basic needs

than those without children 0-5• Most of our community has experienced at least one form of Trauma

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Trauma

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• Haven, Mid-Columbia Center for Living and Sanctuary Institute Instructor partnered to create a single ‘Trauma’ question.

• 3 out of 4 experienced one or more traumatic event

• About 4 out of 10 had someone do something harmful to them

Aging Population

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• 22% say Yes – they are a caregiver

• Of those, only 40% have all the support they need

About 1 in 7 Adults overall are struggling with care giving support to loved ones

Updating the CHIP priorities

Reflection 2017 CHIP List

2014 CHIP

CAC Voices

CHA 2016

Emerging data

Listening Sessions

Final Focus areas

Community Needs

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Regional Solutions Participation

• 2014 CHIP Topics will be refreshed but many are likely to stay• Housing, Food, Transportation, Jobs are outside the expertise of

Healthcare• What active role can Regional Solutions play in leading these efforts?

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