ENGAGING WITH HEALTHCARE COMMUNITIES TOOLKIT

GROWING HEALTHY FUTURES

Updated 5/2019

OREGON WIC PROGRAM2

TABLE OF CONTENTS

Partnering with Healthcare Providers ...........................................3-4

Partnering with Coordinated Care Organizations (CCO) ................ 5

• Innovator Agent Tips to Better Align with Your CCO ......... 6-7

• CCO Incentive Measures and WIC ................................. 8-11

APPENDIX - OUTREACH RESOURCES

A–ResourcesandLinksforWICStaff.........................................12

B – Fax Request for a WIC Presentation ...................................... 13 (Created by Marion County WIC)

C – Oregon WIC Breastfeeding Support ................................. 14-15

OREGON WIC OUTREACH FOR HEALTHCARE PARTNERS

ThepurposeofthistoolkitistohelplocalagencyWICstaffconnectwithhealthcare providers & coordinated care organizations.

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ThistoolkitisdesignedtoofferresourcesandinformationtohelpWICstaffconnectwithphysicians,medicalstaffandcoordinatedcareorganization(CCO)representatives.

HereareafewbenefitsofWICpartneringwithhealthcare:

•Improvedcommunicationandcoordinationmoreeffective,preventivecare, happierfamilies,healthiercommunities

•Alignedmessagingaroundhealthyweight,earlyfeedingpractices,child nutrition and breastfeeding less confusion and stress for parents, lends credibilitytoWICwhendoctors’recommendationsmatch

• More referrals = increased WIC caseload! Depending on the county, between 50-79%ofpregnantwomenwithOHParealsoinWIC.Ifhealthcareproviders andmedicalstaffreferredallOHPpatientstoWIC,itcouldmakeadifference in caseload!

GETTING STARTED - OUTREACH TO YOUR COMMUNITY HEALTHCARE PROVIDER

OurroleascommunitynutritionprofessionalsistoensurethatourmedicalpartnersunderstandthebreadthofWICservices,andhowWICcanplayanimportantroleincare coordination.

LocalWICcoordinatorsweresurveyedoneffectivewaystocommunicatewiththeirhealthcarecommunitypartners.Resultsshowedthattalkingwithmedicalprovidersface-to-faceatmeetingsandemailingthemweregoodwaystoconnect.Hereareotheroutreachideastoconsider:

• Pinpointthemedicaldemographicyouwouldliketotarget.Doyouwantto increaseenrollmentofpregnantwomen?Infants?Orchildren?Generatealist ofthemedicalpracticesinyourareabasedonyourtargetpopulationandreach outtothem.

• Call and scheduleabriefvisitwiththeclinicmanagerandbringWIC outreachmaterials.Ask,“whatquestionsdoyouhaveaboutWIC?”or“howdo youseeWICbettersupportingyourpracticeandpatients?”tostartthe conversation.

• Share WIC datawiththemedicalpracticeorpractitioner.Bringyourlocal agency data sheet andyourperformancemeasuredata.Youcansharethe differencebetweenthenumberofpregnantwomenenrolledinOHPverses thosewhoareenrolledinWIC.Talkabouthowyoucouldbettercommunicate and share data for higher nutrition-risk patients.

PARTNERING WITH HEALTHCARE PROVIDERS

OREGON WIC PROGRAM4

• Gather and deliver a WIC healthy food and outreach basketforamedicalclinic.Includebrochures,aposter,a WIC food list and any WIC swag!

• ScheduleaWICpresentationatamedicalstaffmeeting to discuss how you can better coordinate care and refer patients.

WAYS THAT OREGON WIC PARTNERS WITH HEALTHCARE PROVIDERS • Facilitatesandleadscommunitybreastfeedingcoalitions

• Meets regularlywithhospitalstaff(includingobstetricnursesandlicensed clinical social workers)

• Communicatesregularlywithco-locatedprogramstaffincludingfamily nursepractitioners,medicalprovidersandthecountyhealthofficer

• Promotescross-trainingofhomevisitingnursestobecomeWICcertifiers allowingnursingstafftoconductWICcertificationsduringvisits

• MeetsmonthlywithFQHCmedicalstafftoprovidebettercarecoordination and wrap-around services for higher nutrition-risk participants

OTHER IDEAS FOR WIC TO STRENGTHEN HEALTHCARE PARTNERSHIPS

• Have a WIC breastfeeding specialist or dietitian schedule a visit with an OB/GYNorpediatricpracticetopromotebreastfeedingandWIC.Thisvisit couldincludeabriefmeetingwiththeclinicmanagerorbeapresentationtostaff.

• Become involvedwithyourcommunitypediatricorOB/GYNassociation. TheymaybeinterestedtohearthepercentageofpregnantOHPwomeninWIC (fromperformancemeasures).

• Develop a closed loop referral system. Continuity of care works best whenthehealthcareprovidersworkingwithafamilyreceiveinformationback whenareferralismade,oftencalledaclosedloopreferral.Findoutwhat programsinyourorganizationuseclosedloopreferrals.Theseprogramscould includefamilyplanning,immunization,Mother’sCareand/orhomevisiting.

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HERE IS WHAT YOU NEED TO KNOW ABOUT CCOs

Understand coordinated care organizations (CCO) – A CCO is a network of all types ofhealthcareproviders(physicalhealthcare,addictionsandmentalhealthcareanddentalcareproviders)whoworktogetherintheirlocalcommunitiestoservepeoplewho receive health care coverage under Oregon Health Plan (Medicaid). CCOs focus onpreventionandhelpingpeoplemanagechronicconditions,likediabetes.Thishelpsreduceunnecessaryemergencyroomvisitsandgivespeoplesupporttobehealthy.LocalWICagencieshavereportedthatemailingaCCOmaternityadministratorcanbeaneffectivewaytoinitiatecommunication.

Coordinated Care Organization Service Areas Map

GET INVOLVED WITH THE CCO COMMUNITY ADVISORY COUNCIL

EachCCOhasatleastoneCommunityAdvisoryCouncil(CAC).OregonHealthPlanmembersinterestedinsharingtheirhealthcareexperiencescanapplytoparticipateona CAC.

HereareafewquestionstoconsiderwhengettinginvolvedinalocalCAC: •WhoparticipatesinCACmeetings? •HowcanWICbeinvolved?Doyouorastaffmemberhavethebandwidthto applytobeamemberofCAC? •IsthereaWICparentthatcomestomindthatmightbeagoodCACmember? Howcanyouencouragethatengagement?

More voices with WIC experience on a CAC ensures that WIC is at the table when advisinghowCCOscanbestsupporttheircommunities’health.

PARTNERING WITH COORDINATED CARE ORGANIZATIONS

Featured WIC participant from Columbia County in a CAC promotional flyer!

OREGON WIC PROGRAM6

Innovator Agents help CCOs and the Oregon Health Authority (OHA) work together to achieve the goals of better care, better health and lower costs. Innovator Agents are strongadvocatesforWICandareavaluableCCOresourceinyourcommunity.

Link here to the Innovator Agent in your area.

INNOVATOR AGENT TIPS*:

1.GettoknowyourCCObyreadingtheirpublicdocuments.Someofthosedocumentscouldincludethetransformationplanandprogressreports,transformationandqualitystrategic plan, CHIP progress reports, or review the Innovation Café presentations.

2.MeetyourInnovatorAgentandlearnaboutthehistoryofyourCCO,theirpriorities,strategiesandinvestmentdecisions,andtheirperformance.ArethereparticularcontactpointsinsidetheCCOthatyoumightbeabletoapproach?WouldtheCCObereceptivetoaprojectproposalaboutwaysWICmightsupportthem?

3.Formulateaproposalbydevelopingabusinesscaseforwhatyouwanttohavehappen.HowwilltheCCObenefitfromworkingwithyou?Howdoesyourproposedprojectlinktotheirgoalsandexistingwork?HowwillOHPmemebersbenefitfromtheproject?Whatdatacanyoucontributetodemonstratetheimpactofwhatyouareproposing?

INNOVATOR AGENT TIPS TO BETTER ALIGN WITH YOUR CCO

* from Joell Archibald, Innovator Agent for Columbia Pacific CCO & Yamhill Community Care and InterCommunity Health Network

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CCOs WICEffectivecontraception,pre-conceptionplan-ning

Linkingwomentoreproductivehealthservices

Early prenatal care Early pregnancy WIC services

Breastfeeding support Breastfeeding support & education

Immunizations Referralstoimmunizations

Developmentalscreening Referrals to early intervention and others

QUESTIONS TO ASK YOUR CCO MATERNAL ADMINISTRATOR

•Whendoyouknowwhenawomanispregnant?Whatisyourknowledgeofpregnantwomen?Canyouidentifyhigh-riskpregnantwomenandifso,how?

•Whatdoyoudoforoutreachorcommunicationtopregnantwomen?

•Ifyousendinformationtopregnantwomen,isWICincluded?Ifnot,howcanWICbereferencedtoincludecliniclocation,hoursandhowtosignup?

•AreyouabletoshareyourlistofnewlypregnantwomenwithWIC?Thislistwouldbeused to identify and reach directly out to those not enrolled in WIC.

OPPORTUNITIES TO WEAVE WIC AND CCO WORK

OREGON WIC PROGRAM8

TheOregonHealthAuthority(OHA)isusingqualityhealthmetricstoshowhowwellCCOsareimprovingcare,makingqualitycareaccessible,eliminatinghealthdisparitiesandcurbingtherisingcostofhealthcare.OutcomeandqualitymeasureshavebeendevelopedbytheMetricsandScoringCommittee.FundsareawardedtoCCOsbasedontheirannualperformanceontheseCCOIncentiveMetrics.Checkoutthemostrecent CCOincentivemeasurebenchmarks.

LINKING CCO INCENTIVE METRICS & EXISTING WIC PRACTICES

AmajorityoftheCCOincentivemetricperformancesdemonstrateanopportunityforcollaborationwithOregonWICtoimprovehealthoutcomes.TheMetricsandScoringCommitteehasidentifiedfourmetrics(ingrey)asfocusareasthathaveimpactonearlychildhood health.

CCO INCENTIVE MEASURES & WIC

CCO incentive metrics that offer a WIC collaboration opportunity

Some WIC clinics already

incorporate into practice

Assessmentsin60daysforkidsinDHScustody

CAHPScomposite:Accesstocare

Childhoodimmunizationstatus(WICscreens&refers)

Cigarettesmokingprevalence

Controlling high blood pressure

Dental sealants on for children

Depression screening and follow up

Developmentalscreeninginfirst36months

Diabetes HbA1c Poor Control

Effectivecontraceptiveuse(ages18-50)

Patient-CenteredPrimaryCareHomeenrollment

Timelinessofpostpartumcare

Weightassessmentandcounselinginchildrenandadolescents

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CCO & OREGON WIC COLLABORATIONS AND OPPORTUNITIES TABLE

The table below lists a variety of WIC activities and CCO collaborations and how these linktoCCOincentivemetrics.Therearecollaborationsnotrepresentedhereandsomeofthesepartnershipsmayhavechanged.This is a snapshot of innovative ways to integrate preventive public health nutrition services with coordinated health care.

CCO incentive metric

Examples of WIC & CCO Collaboration and Opportunities

Assessmentsforchildren in DHS custody

WICregularlyservesfamilieswithfosterchildreninDHScustody.

Opportunity - Strengthen organizational connections with DHSleadershiptoimprovereferralsatkeyagesoutlinedinthemeasure.

Childhood immunizationstatus

Standard Practice - WIC screens each vaccine record for every 3to24-month-oldparticipantandrefersifvaccinesarenotup-to-date.WICchildrenhavehigherimmunizationratesthanthose who are not in WIC.

Cigarette smokingprevalence

LaneCountyWIChasanin-housesmokingcessationcounselorthatprovidesawarmhand-offforparticipantsorpartners interested in quitting. This position is funded by the CCO.

Dental sealants onpermanentmolarsforchildren

Dental hygienists are provided by Advantage Dental through PacificSourcetooffer:•dentaleducationandsilverdiaminefluorideafewdaysper week in Deschutes County WIC clinics•dentalservicesonceamonthinWIC’sNorthCentralPublicandHoodRiverHealthDepartments

Afull-timedentalprogram,fundedbyTrilliumCommunityHealth,offersassessmentsandfluoridevarnishingforinfantsand children in Lane County WIC.AllCare Health sends an Advantage dental hygienist once a monthtoJosephineCountyWICfordentalscreenings,toapplysilverdiamineandtooffercleanings.

Depression screening and follow up

TheDeschutesCountyBehavioralHealthprogrampartnerswithPacificSourcetofundaqualifiedmentalhealthprofessionalspecializinginperinatal/postpartumdepressionandanxietyinWIC.

OREGON WIC PROGRAM10

CCO incentive

metricExamples of WIC & CCO Collaboration and Opportunities

Developmentalscreening

PublishedarticlebyDr.JulieReederandDr.KatharineZuckermantitledDecreasingDisparitiesinChildDevelopmentAssessment:IdentifyingandDiscussingPossibleDelaysinWIC.ThisstudyassesseshowWICstaffaddresspotentialdevelopmentaldelaysandparentdevelopmentalconcernsinchildrenunderfive.SeetheabstracthereJDBP.

Opportunity -Sharepromisingpractices,provideadditionalsupportforreferralsintheWICsetting(e.g.warmhandofftoadevelopmentalspecialist).Toimprovecommunicationsregardingreferralsmade,followupwithreferringagency.AdditionalWIC-specificresourcesfordevelopmentalandbehavioral concerns in early childhood are needed.

Diabetes HbA1c poor control

WIC screens for gestational diabetes and is in a good position to provide counseling and referral in this area.

Opportunity - WIC to convene additional training for registered dietitians on this topic; coordinate with HPCDP NationalDiabetesPreventionProgram(NDPP).

Effectivecontraceptive use

Opportunity - Screen and refer for contraceptive use that is applicabletoWIC’speriodicityandcounselingofpostpartumcontacts.

Patient-Centered PrimaryCareHome(PCPCH)enrollment

WashingtonCountyworkswithProjectAccessNowtoenrollWICfamiliesintotheOregonHealthPlan(OHP).AnOHPassistor works at WIC clinic sites.

Opportunity - Expand outreach to PCPCH; Partner with Patient-Centered PrimaryCareInstitute

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CCO incentive metric

Examples of WIC & CCO Collaboration and Opportunities

Timelinessof Prenatal /PostpartumCare

Integrating lactation support into a pediatric office - A Spanish-speakingIBCLCworksparttimeinapediatricofficeandfacilitatestwobreastfeedingsupportgroups.ThisintegratedworkbetweenWICandtheInterCommunityHealthNetworkCCOhasinitiallyallowedforover500clientstoreceivelactationand/orWICservicesintheSamaritanLebanonHealthCenter (Linn County). A plan is in place to bill for these services to sustain this integrated lactation support.

Integrating nutrition & referral services in OB/GYN clinics - WIC,Mother’sCare,twoOB/GYNpracticesandPacificSourcehave integrated WIC and Mother’s Care services into the OB/GYNpracticesinDeschutesCounty.

Coordinating services for pregnant women-YamhillCommunityCareOrganization(YCCO)partnerswithSaludWICtocoordinateservicesfornewlyensuredpregnantwomen.TheYCCO provides weekly secure lists of new prenatal Medicaid participants to WIC, and WIC reaches out to those clients not yet receiving WIC services.

Opportunity-ExpandpromisingpracticestohelpCCO’smeetthemetric“Percentageofwomenwhohadapostpartumcarevisitonorbetween21and56daysafterdelivery”

BONUSVIDEO

FruitsandVeggiesforFamiliesProject

CollaborativeprojectbetweenCCO,CommunityActionAgency,OSUExtensionandWICinUmatillaandMorrowCounty.

OREGON WIC PROGRAM12

WIC-ONLY SHOPIFY MATERIALS

• Good Health Begins with Good Nutrition – This brochure is for theproviderorclinicleadstaff.It’snotmeantforgeneralWICparticipantoutreach.

• WIC Rx Nutrition pads – These are an optional tool for medicalprovidersthatpreferpaperreferrals.

NWA POINT OF CARE OUTREACHAllAboutWIC–This9.5x6.5brochurewasdevelopedbytheNationalWICAssociation(NWA)asapartofamarketingcampaign.ItstargetaudienceispotentialWICparticipantsvisitingthedoctoroffice.AnelectroniccopycanbedownloadedandprintedfromtheNWAonlinecommunitywebpage.ThesebrochuresaresentdirectlyfromNWAeachyeartohealthcareprovidersthatoptin.WICneedstosubmitnamesandaddressesofproviderofficestoreceivethesematerials(acceptedeachfall).EmailJolene with any questions or request for this outreach piece.

WIC MATERIALS FOR DOWNLOAD • WICFAQsforHealthcareProviders • WICImprovesHealthOutcomes (visual provided) • BreastfeedingPromotionalMaterials • WIC Food List • OregonWIC-APHAVideo • County Data Sheets

ADDITIONAL DOCUMENTS TO SUPPLEMENT YOUR OUTREACH PACKET • Resources for Medical Providers WIC webpage • Center on Budget and Policy Priorities. Infographics:WICWorks • NWAPublications •AmericanAcademyofPediatrics–AdvocacyforImprovingtheFirst1000Days toSupportChildhoodDevelopmentandAdultHealth

RESOURCES AND LINKS FOR WIC STAFF

APPENDIX A

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APPENDIX B

Fax Request to Schedule a WIC Presentation___________________________________________________

___________________________________________________

WICisavailabletopresentatastaffmeetingtotalkabouteligibility,benefits,carecoordinationorservices.Ourprogramiscontinuallyevolving,andwewantyoutofeelconfidentwhentalkingaboutandreferringpatientstoWIC.WhypartnerwithWIC?

•WIChasnutritionexpertswhocanhelpeducateyourpatientstomakehealthy choicesthatworkforthemandtheirfamily. • WIC can give your patients free, healthy foods as well as guidance for how to shopfor,prepare,andincorporatehealthyfoodsintotheirfamily’slifestyle. •WICstaffoftenincludearegistereddietitian,alactationconsultant,nutrition professionalsandpeers—allreadytolisten,shareinformationandprovide guidanceandmoralsupporttoyourpatients. • WIC checks up on the health of your patients and their kids at least every six months.WICcanhelpconnectyourpatientswithresourcesoutsideofWIC- includingdentists,immunizationservices,substanceabusecounselors, domesticabusecounselingandsocialservices.

PleasecompleteandfaxtoscheduleaWICpresentation:

MedicalProviderOffice:______________________________________

Address:__________________________________________________

ContactName:_____________________________________________

Phone/Email:______________________________________________

Desiredpresentationdates/times:______________________________

OREGON WIC PROGRAM14

Oregon WIC promotes breastfeeding as the norm for infant feeding.

Healthcareprovidersandtheirstaffplayacriticalroleinpromotingexclusivebreastfeeding and increasing breastfeeding duration. Successful breastfeeding works bestwhencounselingandsupporteffortsstartearly,andmessagingwithpartnersisaligned.

WICencouragesmedicalproviderstoemphasize:

•Exclusivebreastfeedingforthefirst6months. • Continued breastfeeding after solids are introduced, up to age one and beyond. •Theimportanceofbreastfeedingforthemother,babyandsociety. • A birth plan that supports breastfeeding. • Early skin-to-skin contact and early initiation of breastfeeding. •Twenty-four-hourroomingin. •Feedingondemandandbaby-ledfeeding. •Frequentfeedingstoassureoptimalmilkproduction. •Positionsthatsupportagoodlatch,suchasthe“laidback”positionwherethe motherleansbackinachair.

Observebreastfeedingandlookfor:

• A good latch and swallowing sounds. •Signsofeffectivebreastfeeding. • Any breastfeeding challenges.

Talktopregnantwomenandbreastfeedingmothersabout:

• Hand expression – introduce and teach it. • Resources to support lactation. •VisitingWICforadditionalsupport forincome-eligiblewomen.

OREGON WIC & BREASTFEEDING

APPENDIX C

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Discussreturn-to-workplansand:

• Ask about a breastfeeding plan for returning to work.•ProvidedocumentationtoobtainbreastpumpsthroughOHPorprivateinsurance.WICoffersbreastpumpsforwomenwhocannotobtainapumpthroughtheirinsurerandundercertaincircumstances.WICoffersthefollowingpumps: oMulti-userbreastpumploansforWICmotherswithmedicalneeds(premature birth,multiplebirth,etc.) oPersonalpumpsforWICmotherstemporarilyseparatedfromtheirbabiesfor workorschool(20hours/weekormore) oManualpumpsforWICmotherswithshort-termseparations(lessthan20 hours/week)•Helpbreastfeedingmomsknowtheirrights.Referthemtothestate and federal breastfeeding laws.

WICandhealthcarestaffcandiscuss:

•HowWICcanofferbreastfeedingsupport.SomeWICprogramshaveIBCLCsandpeercounselorsonstafftoprovideenhancedbreastfeedingsupport.•Breastfeedingmessagingandresources.•Howbesttocommunicateandcoordinatecare.•TheschedulingofaWICpresentationatamedicalstaffmeeting.

Collaborative breastfeeding project between WIC and pediatrics

LinnCountyWICandSamaritanMid-ValleyPediatricsteameduptoexpandbreastfeedingservices.Abilingual,WICInternationalBoard-CertifiedLactationConsultant(IBCLC)workedfortwodaysinthispediatricofficeofferingevaluationandconsultationtomotherandbaby.Inalmosttwoyears,over510clientconsultationstookplaceandtwobreastfeedingsupportgroupswerestartedatWICandSamaritanLebanonCommunityHospital.Thiscollaborationresultedinlongerdurationofbreastfeedingformothers,reducedtheneedforphysiciantimespentonlactationcounseling,offeredmoreconvenientappointmentsforfamilies,andhelpedleadtolactation licensure in Oregon. This type of collaboration could be replicable, scalable andsustainablewithabillingcomponentinplace.

Breastfeeding Resources

Public Health Division breastfeeding webpageoffersinformationonbreastfeedingtrainingopportunities,data,informationonmaternitycarepractices,promotionalmaterials,informationonreturningtoworkandmuchmore.