Community Health Needs Assessment Implementation Plan FY 14-16

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1 Community Health Needs Assessment Implementation Plan FY 14-16

2 Doctors Hospital conducted a community health needs assessment in 2013 to better understand the healthcare needs of the community it serves in Miami-Dade County. The assessment identified five priority areas: n Access to Care n Availability of Primary Care and Prevention n Chronic Disease Management n Healthy Lifestyles: Exercise and Nutrition n Elder Care/Geriatrics This plan addresses each of these five priority areas. Specific implementation strategies are organized around each area.

3 Access to Care Community Clinics for the Uninsured Doctors Hospital, through its parent entity, Baptist Health South Florida, directly funds the operations of local community clinics that provide healthcare to uninsured and underinsured members of the South Florida community. Baptist Health funds four clinics: the Good Health Clinic, Good News Care Center, Open Door Health Center and South Miami Children s Clinic. In some instances, the Baptist Health operating contribution amounts to more than half of the operational budget for these clinics. In 2013, the combined contribution exceeded $2 million, enabling these clinics to handle more than 15,000 patient visits. Recognizing the great need for healthcare access, and recognizing that many individuals, such as undocumented residents, will continue to remain ineligible for federal healthcare subsidies, Baptist Health plans to commit additional resources to existing providers to improve access to care for the uninsured. These existing community clinics have needs beyond just funding their continuing operations. They require partners to donate needed medical supplies and pharmaceuticals and to provide follow-up services such as advanced diagnostic testing and surgery necessary to treat the patient s condition and prevent it from worsening. Doctors Hospital s Pharmacy, in collaboration with the Social Work Services department, identifies indigent patients who are eligible for a five-day supply of medications post-discharge until community resources are available. Support Providers in Caring for the Uninsured Doctors Hospital directly supports the care of the uninsured in two ways: free hospital care to individuals qualifying under the Baptist Health charity care policy, and direct payments to community physicians to treat these patients at the hospital. Baptist Health s charity care program has been an integral part of fulfilling our mission to care for those less fortunate throughout our history. As Florida s insurance crisis has worsened, Baptist Health has increased its effort to provide free care to those who need it and raised public awareness of this assistance through community outreach and information given to patients. The program provides free care to individuals and families with incomes up to 300 percent of the federal poverty level. In FY 13, more than 600 Doctors Hospital patients received charity care at a cost of more than $4 million. In addition, Doctors Hospital encourages its affiliated physicians to care for uninsured patients in the hospital and in their offices on a timely basis by providing direct subsidies to them. In 2013, Doctors Hospital payments to affiliated physicians for uncompensated care and emergency department coverage totaled more than $250,000. Healthcare Coverage Education and Assistance Baptist Health believes that all members of the community should have a medical home with a secure relationship with a trusted primary care physician. The lack of health insurance coverage is a longstanding barrier to this objective. Baptist Health plans to educate patients about the importance of primary and preventive care, and thus the importance of health insurance coverage to accessing this care. Essential elements of this education will include available coverage options through government programs, and commercial health insurance through traditional means and the health insurance marketplace. Baptist Health plans to expand its existing Medicaid enrollment assistance resources to include healthcare marketplace application assistance. 1

4 Education and application assistance alone are not enough to ensure access to timely care. Insurance premiums not covered by government subsidies, high deductibles, co-payments and coinsurance are often financial barriers to timely care. To prevent minor health issues from escalating into acute episodes that require expensive emergency and/or inpatient care, Baptist Health is committed to identifying innovative ways to remove these barriers for patients to access timely primary care. Miami Health Action Network Healthcare Access Initiative Baptist Health supported the Health Council of South Florida s MD-HAN Health Access Initiative (HAI) through a grant that helped establish the program. The HAI promotes access and affordable care to the uninsured and underserved in Miami-Dade County. The anticipated results of the initiative will be improved access to primary care, promotion of care coordination, reductions in uncompensated care and preventable hospitalizations, and improved overall health of the community. 2

5 Availability of Primary and Preventive Care Increase Primary Care Providers The United States has a recognized shortage of primary care physicians, and Miami-Dade County has fewer primary care physicians per 1,000 residents than the national average. Making these key healthcare providers available to deliver routine care and manage chronic disease conditions before they flare up into acute episodes is critical to a well-functioning healthcare system. Recognizing this, Baptist Health plans to invest heavily in increasing the supply of primary care providers within our community. In the planning stages are eight primary care clinics, each following the best-practice, patient-centered medical home model, several of which will be located near Doctors Hospital. Success in this endeavor will be measured by reduced emergency department use and a reduction in preventable admissions. Support Florida International University s Herbert Wertheim College of Medicine Through Mentorship of Family Medicine Medical Students The medical school at Florida International University (FIU) opened it doors with a commitment to focus on family medicine and primary care to address the national and state shortage of primary care physicians, particularly in areas with underserved minority populations, such as Miami-Dade County. Historically, a majority of physicians have set up practice in or near the communities where they trained, so the community is optimistic that the school will result in an influx of new primary care physicians. Through the FIU affiliation, Doctors Hospital is directly contributing to the training of these future primary care physicians by providing clinical rotations to more than 200 third- and fourth-year medical students in The hospital expects to expand that relationship over the next three years. Sponsor FIU Neighborhood Help Program to South Miami-Dade Community The Herbert Wertheim College of Medicine has developed a program to address the social determinants of health. This program pairs interdisciplinary teams of health students medical, nursing and social work with families in low-income areas. The teams regularly visit these families, make comprehensive assessments, provide basic care and devise treatment plans. Part of this care is also provided through a mobile health clinic. This support is coordinated with the families regular medical care providers. Currently, FIU offers this program to families in northwest Miami-Dade. Baptist Health is proposing to sponsor the program to target families in low-income areas of south Miami-Dade County, some of which are within the Doctors Hospital service area. This program will reduce costly emergency department visits, avoid preventable admissions and increase health literacy. Support of Primary Care Providers Through Continuing Medical Education Activities Baptist Health provides ongoing medical education for physicians and allied health professionals through its accredited Continuing Medical Education department. In the past year, more than 1,300 CME credit hours were available to physicians through attendance at some 700 courses. This benefits the community greatly by keeping our community physicians up to date on the latest techniques in primary care and prevention Continuing Education Courses Conferences and Symposiums Approved for Continuing Medical Education (CME) and Continuing Education (CE) Credits for Doctors, Nurses and Allied Healthcare Professionals BaptistHealth.net/CME 3

6 Primary Care and Prevention Activities High School Pre-participation Athletic Screenings Doctors Hospital supports Miami-Dade County public schools by providing pre-participation athletic screenings to clear high school student athletes for participation in sports and address any primary care or prevention needs. Doctors Hospital physicians travel to the schools to conduct screenings four separate times throughout the year, with the fall cycle having the most volume by a large margin. The student athlete screenings are hosted at 37 different Miami-Dade County public school sites. During 2013, more than 6,600 students received screenings and physicians spent more than 300 hours of time providing care. The cost to Doctors Hospital to provide this service to the school community is $52,000. Primary Care and Prevention Activities Sports Outreach Program Doctors Hospital s physicians, nurses and athletic trainers cover the basic medical care and first-aid needs at many community athletic events, including high school football games, Miami Dolphins games, ING Miami Marathon, Miami Corporate Run and various sports camps. Doctors staff members treat injuries and minor illnesses of the participants as well as fans at the games for free. During FY 2013, Doctors Hospital staff time at these events exceeded 4,000 hours at a cost of more than $175,000. Educate School Athletic Trainers About Injury Prevention and Treatment Doctors Hospital holds three continuing education seminars for Miami-Dade County public school athletic trainers each year, usually at the hospital. Topics include recognizing common sports injuries, strategies to prevent injuries and injury treatment. Doctors Hospital also participates in educating future athletic trainers by hosting an annual seminar for high school athletic training students at Florida International University. 4

7 Chronic Disease Management Community Health and Wellness Education Doctors Hospital provides community health and wellness educational programs throughout the year featuring physician speakers and other clinicians, with sessions focused on diabetes, heart disease and cancer. During the past year, Baptist Health held 29 health and wellness educational events on behalf of Doctors Hospital. Community Screenings and Health Fairs The Community Health department holds free health fairs including screenings for cholesterol, blood pressure, glucose, body composition and osteoporosis at the hospital and at public events. Participants are counseled regarding their results and given information and instructions on how to manage any chronic disease that may be identified by the screenings. During the past year, Doctors Hospital conducted screenings at four community events. Support Groups An important psychosocial component of managing chronic disease is to provide support groups at which people with similar diseases can get together and share the challenges they face. These groups can be a source of hope and strength to the participants, as well as an opportunity to educate them on community resources that may benefit them. Baptist Health and Doctors Hospital encourage and promote support groups through advertising and the use of our facilities to host the groups. More than 10 chronic disease support groups take place at nearby Baptist Health hospitals and are open to Doctors Hospital community members. The groups are coordinated at the corporate level by the Community Health department. 5

8 Healthy Lifestyles: Exercise and Nutrition Community Offerings: Exercise, Nutrition and Weight Management Living a healthy lifestyle is an important part of preventing illness and disease, and high on the list of healthy living practices are good nutrition and regular exercise. Baptist Health dedicates a registered dietitian through the Community Health department to travel throughout the community to educate residents on healthy eating. Through programs such as Understanding Nutrition Facts Labels and Healthy Eating 101, the dietitian teaches the principles of good nutrition, and also distributes fresh fruits and vegetables and provides healthy recipes through the 5-a-Day The Baptist Health Way program. Not only does Baptist Health place gyms at each hospital and encourage frequent use by employees, it also employs certified fitness instructors to hold monthly free exercise classes in the community, including Zumba, aerobics, Tai Chi, Pilates and walking groups. Healthy Lifestyles 5,000 Role Models Doctors Hospital employees mentor at-risk youth and provide life skills and guidance through the 5,000 Role Models program. About six times a year, approximately 75 boys from various high schools, the majority in the inner city, meet at the hospital for breakfast and hear presentations by community leaders about drugs, crime, communicable disease and general leadership topics. Big Brothers/Big Sisters Doctors Hospital sponsors Big Brothers/Big Sisters through a program in which employees mentor and serve as role models to inner city high school students. Once a month throughout the school year, about 30 students come to the hospital for the day to hear speakers on such topics as nutrition, stress management and exercise, and participate in various activities with their mentors. The students grade point average and school attendance rate are measured prior to and after the program. 6

9 Elder Care/Geriatrics Community Offerings Senior Health Fair Doctors Hospital hosts an annual Senior Health Fair in collaboration with the City of Coral Gables Adult Activity Center. Of the more than 300 people who attended the fair in 2013, 93 percent were over 60 years old. About half of the attendees participated in the free health screenings, mind-body activities (i.e., Tai Chi) and health education. The first 100 participants received free flu shots. Over the next three years, Doctors Hospital plans to increase the attendance and participation in the Senior Health Fair to reach more of this at-risk population. Community-based Care Transitions Program Baptist Health partners with Alliance for Aging to provide care transition services (one-on-one coaching in the hospital as well as in the home or skilled nursing facility) to eligible Medicare beneficiaries discharged from the hospital. Interventions include follow-up phone calls for up to 45 days post-discharge, meal support (up to 10 meals) for patients with short-term nutritional needs and post-discharge medication transition intervention. The objective is to reduce 30-day readmissions. Doctors Hospital plans on increasing patient enrollment in this program Discounted Meals to the Community The hospital cafeteria provides discounted senior and Wellness Advantage meals at lunchtime to promote affordable healthy dining choices. These meals are specially designed by Baptist Health dietitians to be lower in calories and saturated fat. Complete with a bottle of water, the meals cost $3 apiece a low-cost option to encourage healthier eating habits. In FY 2013, 700 senior discount meals were served per month. Congregational Health Baptist Health s Pastoral Care department has a Congregational Health team that focuses on developing Care Team programs. These programs are a faith/health partnership between Congregational Health and area congregations to provide free help for those with needs, such as meals delivered to the home, transportation, errands, light housekeeping and companionship/ visitation. Doctors plans to increase its participation in the Care Team program. Resources for Seniors Transportation Thanks to free transportation provided by Doctors Hospital to and from the hospital, many elderly patients who are homebound or unable to drive or navigate public transportation can get to their medical appointments and therapy sessions. In 2013, 6,583 patient transports of the elderly took place and Doctors plans to continue support for this program targeting the elderly homebound population. Resources for Seniors Discharge Medications One contributing cause to hospital readmissions relates to not taking the right medication or not filling a needed prescription. Often patients are overwhelmed with information at discharge and lack basic support such as transportation to fill a needed prescription. To help alleviate some of these issues, Doctors Hospital is partnering with Walgreens pharmacy to deliver discharge medications to patients bedsides upon discharge, thereby removing the need to visit the pharmacy immediately after leaving the hospital. This program will begin in 2014, with a Walgreens pharmacy technician on-site weekdays to facilitate the bedside delivery of medications. 7

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