Initiatives Lead to Improved Health in Fort Myers Sally Jackson

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1 Initiatives Lead to Improved Health in Fort Myers Sally Jackson System Director, Government & Community Relations Lee Memorial Health System Fort Myers, Florida

2 Who We Are Professional Research Consultants, Inc.

3 Lee County Quadrants

4 Lee Memorial Health System Regional safety net hospital 4 hospitals with 95% of county s beds Largest U.S. public hospital without local tax revenues Largest regional employer Employed physicians Specialties include: Golisano Children s Hospital Regional cancer center Rehabilitation hospital Skilled nursing home Home health agency Outpatient services Physician clinics

5 Economic Impact Region s largest employer with 11,000 employees 1,200 medical staff 100 LMHS employees = additional 78 regional jobs

6 Our Community Unemployment rate went from among the lowest in the U.S. to among the highest 15 % of residents below poverty level 2 nd highest uninsured rate in FL 25% of residents are ages 65+ Twice the national average 50% above the state average and rapidly growing

7 Unemployment

8 Employment Growth In 2012 Lee County tied for 2 nd highest growth. 50,300 New Jobs 34,300 Lost Jobs

9 Poverty All Ages Under 18

10 Building Permits

11 Inpatient Commercial Payor 20% of inpatient cases at Lee County hospitals paid by commercial payors.

12 Community Benefit 56% increase

13 How We Started Engaging our Community Professional Research Consultants, Inc.

14 Step 1: Committee Selection Community Health Visioning 2017 CEO identified and LMHS Board approved Steering Committee 38 community leaders representing business, clergy, government, education, social services, healthcare, & neighborhoods. Chose long term board members for organizations, not staff. No elected officials. Almost all were CEOs & agreed to personally participate. No surrogates. Diversity in race, ethnicity, gender, age, geography. Chairman of preeminent community respect and influence. Professional Research Consultants, Inc.

15 Step 2: Written Charter Priorities: Improve health status Improve delivery system Goals: Get outside daily challenges and obstacles that create burdens and competition Participants work on a vision of what can be, not how to get there or even if we can get there Become aspirational Sometimes magic happens Professional Research Consultants, Inc.

16

17 Step 3: Logistics Before the first meeting: CEO personally invited each committee members System Director of Government & Community Relations followed up with personal visit & briefing distribution list included each member s assistant

18 Step 3: Logistics During First Meeting: Established attendance and participation expectations Set meeting dates and sent calendar invitations Monthly meetings first 7 months Reminder phone calls between meetings Agreed to 6-month working agenda to: Review published data & design Implement additional engagement tools/processes to gain information and increase awareness and involvement Set priorities for recommendation to LMHS Board and the broad community

19 Step 3: Logistics Ongoing Logistics: Open meetings covered by media Led to several news stories Ongoing LMHS support: CEO One board member VP Strategic Services Marketing & Media Relations Government/Community Relations, Organizational Development Clinical, Legal & Finance as needed Final meeting of facilitated break-out sessions to define priorities to meet the Charter

20 Step 4: Meeting Dynamics Pre-Meeting: Branded graphics for continuity Members requested breakfast meetings Good food is key! White table cloths look professional Table tents with names Formal agenda prepared and distributed in advance Personal large binders with all materials & news articles

21 Step 4: Meeting Dynamics During Every Meeting: Chairman role facilitated All members always have input PowerPoint presentations Supports common understanding of new data, situations, & opportunities Professional facilitators & consultants as needed Meeting minutes distributed electronically soon after meeting Reinforces materials and decisions Goal is to generate buy-in!

22 Begin with the End in Mind LMHS support role Convener/facilitator Community leaders are engaged Leaders use their spheres of influence Community becomes engaged Build Community ownership/lmhs support Vision = Collaborating for Community Health Healthy Lee. Choose. Commit. Change.

23 Timeline LMHS Board launches Steering Committee, Gary Trippe chairman, first PRC survey, and goals set Scorecard Developed, Start Recruiting Champions Robbie Roepstorff, Chairman Ongoing work, annual Steering Committee updates Fourth PRC survey, decade of accomplishments Executive Committee Formed Second PRC survey, goals revised Healthy Lee Brand adopted, Vision confirmed Third PRC survey

24 Our Priorities 1. Healthy Lifestyles 2. Primary Care Alternatives 3. Chronic Disease 4. Behavioral Health 5. Public Awareness 6. Healthcare Workforce Shortage 7. Electronic Medical Record

25

26 Favorable Direction Healthy Lifestyles Healthy Lee Dashboard U.S. Average 2007 Lee County Most Current Lee County Trend Florida Healthy People 2020 or Other Target % of population obese (BMI >= 30) 28.50% 23.00% 29.3% a 6.30% 26.50% 23.00% Tobacco Use 16.60% 15.60% 17.9% a 2.30% 17.1% 12% or below Infant Mortality 6.90% 7.30% 6.1% b 1.80% 6.00% 6% or below Low Birthweight <2500 grams 8.70% 8.40% 8.6% b 0.80% 8.60% 7.8% or below Prenatal Care in the First Trimester? 71.20% 70.9% b 2.00% 80.00% 77.9% or higher Primary Care Alternatives Fair or Poor Physical Health 16.80% 17.90% 17.60% a 0.30% 16.50% 16.80% Chronic Disease $ $ $ $ # $ $ $ $ $ No Increase Prevalence of Diabetes 10.10% 12.50% 13.50% a 1.00% 10.70% 13.50% Emergency Department Diabetes Diagnosis 627 c 785 d 0.90% TBD Prevalence of Asthma 7.50% 6.10% 9.10% a 3.00% 6.90% TBD Emergency Department Asthma Diagnosis 564 c 750 d 2.50% TBD = at or better than Target = belowtarget, no immediate concern = below Target, immediate concern a PRC 2011 b 2012 Florida Charts c FY2008 LMHS Data d FY2012 LMHS Data e LMHS Survey

27 Behavioral Health $ Fair or Poor Mental Health 11.70% 9.20% 10.80% a 1.60% Public Awareness of Service PRC Survey Results - TBD # Pending - to be added to PRC Survey Workforce Shortage Current Physician Shortage 29% e 25% f $ 322 FTEs e 294 FTEs f Electronic Medical Record Meaningful Use Stage 1 Stage 2 Stage 3 LMHS/LPG Yes Partial Pending PPC Y/N Yes Partial Pending FHC Yes Partial Pending IMA Yes Partial Pending Interoperability (long term) Y/N TDB = at or better than Target a PRC 2011 b 2012 Florida Charts c FY2008 LMHS Data d FY2012 LMHS Data = belowtarget, no immediate concern e 2011 CMS-defined Estimated Community Need f 2013 CMS-defined Estimated Comm = below Target, immediate concern

28 Behavioral Health Case Study

29 Favorable Direction Goal Convene a community collaborative to develop a comprehensive continuum of care for Behavioral Health based on a current needs assessment for Lee County. U.S. Average 2007 Lee County Most Current Lee County Behavioral Health $ Fair or Poor Mental Health 11.70% 9.20% 10.80% a FINANCE BOD Requested Indicators = at or better than Target = belowtarget, no immediate concern = below Target, immediate concern a PRC 2011 b 2010 Florida Charts c FY2008 LMHS Data d FY2011 LMHS Data e LMHS Survey

30 Step 1: Assemble Community Collaboration Assembled Community Mental Health & Addiction Coalition Primarily business people and advocates who sit on various community organization boards United Way leadership Hospital served as convener and facilitator Hospital CEO hosted and launched first meeting and regularly attended Co-Champions recruited from community County Commissioner & Business Executive

31 Step 2: Develop Strategic Plan Purpose Improve the lives of individuals with mental health and addictions needs. Mission Define workable solutions to end the mental health crisis in our community. Goals Each chaired by a business leader. Community members serve as task force for 1+ years. 1. Implement a mental health and addictions delivery model to meet the existing and future needs of consumers. 2. Obtain and responsibly allocate funding adequate to meet the needs. 3. Develop a community leadership group to guide implementation of strategic plan on behalf of Community Health visioning. 4. Create awareness of mental disorders as a serious health issue.

32 Step 3: Community Ownership Focused on defining community ownership broadly. Collaboration models were practiced and learned. Year 1 successes included: 28-bed Triage Center/Low Demand Shelter. Converted 15 beds at Lee Memorial Hospital to geriatric psychiatric program. Launched development of private for-profit investment in new psychiatric hospital. Jennings Behavioral Health new private investment in psychiatric partial hospitalization/intensive outpatient beds.

33 Barriers & Challenges 1. Fragmented delivery of services and silos 2. DCF restructure left no local presence 3. Funding allocation and reallocation 4. Physician shortage 5. Merge of medical and recovery model for psychiatric care 6. Community understanding of mental illness as a legitimate medical condition 7. Ongoing community volunteer leadership to drive strategy implementation 8. Expanding Triage Center to a full 24/7 operation 9. CON approval of The Pavilion at HealthPark

34 Critical Success Factors 1. Community awareness 2. Leadership structure 3. Boundarylessness of providers 4. Funding 5. Merging of models 6. Appropriate number and type of psychiatric physicians 7. Bed availability 8. Triage Center s Policy Board and Management Council structure 9. Clinical competency, management experience and new funding sources for psychiatric care via The Pavillion. 10. Anticipate Jennings Behavioral Health Medicaid provider number for reimbursements

35 Next Steps 1. Review and define the best practices for mental health delivery: Driven by evidence-based psychiatric practices and incorporating medical and recovery models 2. Develop and implement a comprehensive communication & marketing plan: Increase community awareness 3. Complete and implement other details of the strategic plan 4. Expand leadership structure

36 Next Steps Triage Center Continue operational improvements, data collection and evaluation. Seek long term funding solutions. LMHS Geriatric Psychiatric beds/the Pavilion Complete construction and open in Jennings Behavioral Health Continued expansion from current 35 patients, 2 psychiatrists, and 4 therapist in outpatient treatments.

37 Awards and Accomplishments 365 Beds!

38 2007 Adult Behavioral Health Services in Lee County Emergency Care Hospital Partial Hospitalization Intensive Outpatient Psychiatry/Outpatient Services Primary Health Care Community/Schools/Businesses/Government/Police/Etc. - People

39 2013 Adult Behavioral Health Services in Lee County Emergency Care Hospital Partial Hospitalization Intensive Outpatient Psychiatry/Outpatient Services Primary Health Care Community/Schools/Businesses/Government/Police/Etc. - People

40 Major Accomplishments United Way Houses w/health care focus/fhc clinics AHA Start! Gage Award Jennings Behavioral Health, Bob Janes Triage Center, Launch HP Fit-Friendly SWFL, Complete Streets, NOVA Award (Triage), FHA Community Benefit Award (Triage), LPG United Way - Dunbar FSU Medical Residency, Park Royal Open, LMHS Academic Council We Care 15 bed LMH 3- W, Park Royal CON, Hope Clubhouse, SWFAS: 69 detox beds, Women s Halfway House 16-bed Adult Residential Park Royal Ground Breaking, NAMI CIT Training, LPG United Way NFM, FHC Renovation/Expansion, Edison/FGCU Expand LPG United Way Cape Coral, Healthy Lee

41 Seven Priorities 1. Healthy Lifestyles 2. Primary Care Alternatives 3. Chronic Disease 4. Behavioral Health 5. Public Awareness 6. Healthcare Workforce Shortage 7. Electronic Medical Record

42 2014 Soon We Will See How We Measure Up!

43 Questions? Sally Jackson System Director, Government & Community Relations Lee Memorial Health Janna Binder Director of Marketing & PR PRC Professional Research Consultants, Inc.

44 Want to Learn More? For information on PRC s Community Health Needs Assessments, or to register for any of the remaining sessions, visit August 21: Leveraging the CHNA in Strategic Planning Children s Mercy Hospitals & Clinics August 28: Regional Assessment Strengthens Partnerships WNC Health Network Professional Research Consultants, Inc.

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