Creating an Infrastructure of Collaboration: Tools and Models from North Carolina’s “Healthy...

Creating an Infrastructure of Collaboration:

Tools and Models from North Carolina’s “Healthy Carolinians” Network of

Local Health Partnerships

Sarah Thach, MPHKathy McGaha, BSBA

Terri Wallace, BSW

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Session ObjectivesSession Objectives

Describe NC’s statewide network of local Describe NC’s statewide network of local health partnershipshealth partnerships

Outline milestones in its developmentOutline milestones in its development

Share two examples of local partnerships’ Share two examples of local partnerships’ accomplishments, focusing on:accomplishments, focusing on:– Community health assessmentCommunity health assessment– Chronic disease management for uninsuredChronic disease management for uninsured

Share concrete tools for collaborationShare concrete tools for collaboration

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Healthy Carolinians Partnerships…Healthy Carolinians Partnerships…

Consist of:Consist of:– Hospitals and health departmentsHospitals and health departments– Social service agencies and organizationsSocial service agencies and organizations– Local governmentLocal government– BusinessesBusinesses– Faith communitiesFaith communities– Community groupsCommunity groups

Assure communities’ ability to assess and Assure communities’ ability to assess and address local needs rapidly, address local needs rapidly, collaboratively, and effectivelycollaboratively, and effectively

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Certification criteriaCertification criteria

1.1. Recruit diverse membershipRecruit diverse membership2.2. Share leadershipShare leadership3.3. Base priorities on community assessment Base priorities on community assessment 4.4. Align with NC 2010 health objectivesAlign with NC 2010 health objectives5.5. Create effective action plansCreate effective action plans6.6. Reduce health disparitiesReduce health disparities7.7. Communicate partnership’s activitiesCommunicate partnership’s activities8.8. Demonstrate members’ commitmentDemonstrate members’ commitment9.9. Develop funding for sustainabilityDevelop funding for sustainability

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Scotland

Guilford

Rockingham

Moore

AnsonUnionRichmond

Mecklenburg

CabarrusStanly

SurryAshe

WilkesYadkin

Forsyth

Stokes

DavidsonRandolphRowan

Lincoln

ClevelandGaston

Iredell

CaldwellAlexander

Catawba

BurkeMcDowellBuncombe

Rutherford

Polk

MadisonYancey

Watauga

Cherokee

Graham

ClayMacon

Jackson

Swain

AveryDavie

Montgomery

Mitchell

HendersonTransylvania

HaywoodWake

GranvillePerson

Orange

Lee

Hoke

Robeson

Brunswick

PenderBladen

Sampson

Duplin

Onslow

Jones

LenoirWayne

Johnston

Harnett

Carteret

CravenPamlico

BeaufortHyde

TyrrellDare

Gates

Hertford

Bertie

Martin

Pitt

Greene

Wilson

NashFranklin

Warren

Halifax

Northampton

Edgecombe

Vance

DurhamAlamance

Cumberland

Washington

CurrituckCamden

Pasquotank

PerquimansChowan

NewHanover

Chatham

CaswellAlleghany

73 certified partnerships cover 80 of NC’s 100 counties

Columbus

Pilot sitesPartnerships represented here

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Healthy Carolinians MilestonesHealthy Carolinians Milestones

1993: Governor’s Task Force1993: Governor’s Task Force

1993: NC 2000 objectives1993: NC 2000 objectives

1993: Pilot project1993: Pilot project

1994: Certification1994: Certification

1999: 2010 objectives1999: 2010 objectives

2002: Health departments’ community 2002: Health departments’ community assessment integrated into Healthy Caroliniansassessment integrated into Healthy Carolinians

2006: Health department accreditation2006: Health department accreditation

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Success FactorsSuccess Factors

Information sharingInformation sharing– Regional meetingsRegional meetings– Annual conferenceAnnual conference

Technical assistanceTechnical assistance

Financial supportFinancial support– FoundationsFoundations– Minimal: State General AssemblyMinimal: State General Assembly

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Macon County, NCMacon County, NC

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Macon County, NCMacon County, NC

County seat: Franklin, NCCounty seat: Franklin, NC

Total population, 33,797Total population, 33,797

Median Family Income, $33,375Median Family Income, $33,375

Approximate uninsured 17% (5745 Approximate uninsured 17% (5745 residents)residents)

22ndnd highest percentage of seniors in NC highest percentage of seniors in NC (22.8%)(22.8%)

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Macon ResourcesMacon Resources2 Hospitals; 32 Hospitals; 3rdrd has satellite complex has satellite complex

Urgent care center Urgent care center

Free clinic*Free clinic*

Adult and children’s dental clinic*Adult and children’s dental clinic*

Health departmentHealth department

Medication assistance program*Medication assistance program*

Future site of VA clinicFuture site of VA clinic

Child abuse and neglect (KIDS Place)Child abuse and neglect (KIDS Place)

Domestic violence center (REACH)Domestic violence center (REACH)

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Partnership AccomplishmentsPartnership Accomplishments

Formed in 1998, won state partnership award. Access to Care: free primary care clinic, dental care for youth and adults, medication assistance Schools and Youth: 4 school nurses, Youth Risk Behavior Survey, greenway & playground, youth-led sex educationRecreation: County-wide resources website, county-wide recreation master plan Substance abuse prevention program, recovery house for women, 5 tobacco-free school campusesBrought in $1.5 million in grants

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Assessment PhasesAssessment Phases

1.1. Assemble teamAssemble team

2.2. Collect data re. community concernsCollect data re. community concerns

3.3. Review health statisticsReview health statistics

4.4. Compare community concerns and statisticsCompare community concerns and statistics

5.5. Set prioritiesSet priorities

6.6. Report results to communityReport results to community

7.7. Prepare assessment documentPrepare assessment document

8.8. Develop action plansDevelop action plans

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Community Health Assessment:Community Health Assessment:Tips for SuccessTips for Success

Broad community participation in Broad community participation in assessment team from start to finishassessment team from start to finish

Get media involved from the Get media involved from the beginningbeginning

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Be creative to Be creative to involve disparity involve disparity groups (i.e. youth groups (i.e. youth involvement)involvement)

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Worth the $$$ to do it wellWorth the $$$ to do it wellTake time to educate/explain when an Take time to educate/explain when an assessment tool might be controversial assessment tool might be controversial (i.e. Youth Risk Behavior Survey, Sex (i.e. Youth Risk Behavior Survey, Sex Education Questions)Education Questions)Report the findings everywhereReport the findings everywhereMake results easily accessible (i.e. Make results easily accessible (i.e. website)website)

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Community Health Assessment:Community Health Assessment:It Pays Off In the EndIt Pays Off In the End

Puts everyone on the same page from Puts everyone on the same page from the beginningthe beginning

Decreases hidden agendasDecreases hidden agendas

Instills confidence and trustInstills confidence and trust

Used as accepted source of Used as accepted source of informationinformation

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Henderson CountyHenderson County

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Henderson CountyHenderson County

Western part of NCWestern part of NC

Population 99,033; by 2010: 107,566 Population 99,033; by 2010: 107,566 – 79% are 18 and over79% are 18 and over– 21% are 65 and over (321% are 65 and over (3rdrd highest in state) highest in state)– 8.3% are Hispanic8.3% are Hispanic

Median Family Income = $40,097Median Family Income = $40,097

Uninsured rate is 19% (state rate is 19.5%)Uninsured rate is 19% (state rate is 19.5%)

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Henderson ResourcesHenderson Resources

2 hospitals2 hospitals

Free ClinicFree Clinic

Federally Qualified Health CenterFederally Qualified Health Center

Health departmentHealth department

Sexual assault and domestic violence Sexual assault and domestic violence centerscenters

Many other non-profits to serve the needs Many other non-profits to serve the needs of the communityof the community

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Partnership AccomplishmentsPartnership Accomplishments

Formed in 1994 (pilot site)Formed in 1994 (pilot site)

Established free clinic including dental, medical, Established free clinic including dental, medical, chronic disease, and psychiatric carechronic disease, and psychiatric care

Developed free dental clinicDeveloped free dental clinic

Schools: school nurse, climbing walls, salad Schools: school nurse, climbing walls, salad bars in cafeterias, teacher trainingbars in cafeterias, teacher training

Youth tobacco prevention programYouth tobacco prevention program

Heart disease & stroke preventionHeart disease & stroke prevention

Brought in over $4 million in grantsBrought in over $4 million in grants

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Addressing UninsuredAddressing Uninsured

Need identified in community health Need identified in community health assessmentassessment

Wanted to create a system of care for the Wanted to create a system of care for the uninsureduninsured

Pulled together a community team to Pulled together a community team to brainstorm solution and fundingbrainstorm solution and funding

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Partnership took the lead:Partnership took the lead:

Neutral entity – baggage left at doorNeutral entity – baggage left at door

Incubator for innovative ideasIncubator for innovative ideas

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Community TeamCommunity Team– Both hospitalsBoth hospitals

– FQHCFQHC

– County Mental Health Provider County Mental Health Provider

– Local Family Practice PhysiciansLocal Family Practice Physicians

– Free ClinicFree Clinic

– Henderson County Department of Public HealthHenderson County Department of Public Health

– Area non-profits that focused on the underservedArea non-profits that focused on the underserved

– Local fundersLocal funders

– Mountain Area Health Education CenterMountain Area Health Education Center

– Regional case management agency for MedicaidRegional case management agency for Medicaid

– Henderson County Department of Social ServicesHenderson County Department of Social Services

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Project GoalsProject Goals

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1.1. Increase coordination and quality of care Increase coordination and quality of care for the uninsuredfor the uninsured

2.2. Improve efficiency and effectiveness of Improve efficiency and effectiveness of servicesservices

3.3. Generate cost savingsGenerate cost savings

4.4. Create network to bridge healthcare Create network to bridge healthcare services to the uninsuredservices to the uninsured

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ProcessProcessIndependent grant writer to write federal HCAP grantIndependent grant writer to write federal HCAP grant– Focus conditions of asthma, diabetes, depressionFocus conditions of asthma, diabetes, depression

Case managementCase management

Community pharmacyCommunity pharmacy

Integrated mental healthIntegrated mental health– 200% or less of federal poverty level200% or less of federal poverty level– Ages 18-64Ages 18-64– No medical insuranceNo medical insurance

PFH as fiscal agentPFH as fiscal agent

Community team to serve as “Core Partners” to sign Community team to serve as “Core Partners” to sign Memorandum of AgreementMemorandum of Agreement

Sit back and wait !~~~~~~~Sit back and wait !~~~~~~~

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Grant was awarded and Grant was awarded and Program began.Program began.

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OutreachOutreach

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Project SuccessesProject Successes

Many uninsured who did not have a medical home now Many uninsured who did not have a medical home now have onehave one

Community Pharmacy – provides affordable medication Community Pharmacy – provides affordable medication to manage illnesses ($3.00 co-pay)to manage illnesses ($3.00 co-pay)

Improved care for patients through case management Improved care for patients through case management which results in fewer emergency room visits and which results in fewer emergency room visits and inpatient hospital admissionsinpatient hospital admissions

Providers working together to address critical health Providers working together to address critical health needs of the uninsuredneeds of the uninsured

Community working together to decrease financial Community working together to decrease financial burden the uninsured have on the healthcare industry.burden the uninsured have on the healthcare industry.

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Project SustainabilityProject Sustainability

In the NC state budget (HealthNet)In the NC state budget (HealthNet)

Health department picked up therapist Health department picked up therapist positionposition

Regional Medicaid case management Regional Medicaid case management organization picked up case management, organization picked up case management, administration and enrollmentadministration and enrollment

The Free Clinic picked up the community The Free Clinic picked up the community pharmacypharmacy

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Tools for CollaborationTools for CollaborationAssess

Plan

Evaluate

Implement

• Collective assessment/ report out for common understanding of problem

• One-on-one lunches to understand underlying interests, agency limitations

• Visioning exercise

• Nominal group technique

• Group road trip to model site

• Round robin (sharing events, how each agency works); Rotate leadership; Serve on members’ boards, strategic planning processes, volunteer for members’ activities

• Document collaboration, shared leadership

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For more information re. NC: For more information re. NC: www.healthycarolinians.orgwww.healthycarolinians.org

Western region: Western region: [email protected]@ncmail.net

Macon: Macon: http://www.maconnc.org/healthdept/carolinians.htmlhttp://www.maconnc.org/healthdept/carolinians.html

Kathy McGaha:Kathy McGaha: [email protected] [email protected]

Henderson: Henderson: http://www.p-f-h.orghttp://www.p-f-h.org//

Terri Wallace: Terri Wallace: [email protected]@p-f-h.org

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