Community Health Needs Assessment Implementation Plan FY 14-16

Community Health Needs Assessment Implementation Plan FY 14-16

Homestead Hospital conducted a community health needs assessment in 2013 to better understand the healthcare needs of the community it serves in southern 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 Maternal and Child Health n Socioeconomic Issues This written implementation plan addresses each of these five priority areas. Specific implementation strategies are organized around each priority area.

Access to Care Community Clinics for the Uninsured Homestead Hospital, through its parent entity, Baptist Health South Florida, directly funds the operations of local clinics that provide healthcare to uninsured 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, Baptist Health s contribution amounts to more than half of the operational budget for the clinic. In 2013, Baptist Health s combined contribution exceeded $2 million, enabling these clinics to handle more than 15,000 patient visits. Recognizing the great need for healthcare access, particularly within the deep south portion of Miami-Dade County, 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 community clinics have needs beyond just funding their continuing operations: They need partners to donate medical supplies and pharmaceuticals and to provide follow-up services, such as advanced diagnostic testing and surgery, to treat the patients conditions and prevent them from worsening. In 2013, clinic patients sought and received follow-up care and diagnostics at Homestead Hospital over 1,200 times. The cost of this free care amounted to over $400,000. As the only hospital within an 18-mile radius, we know how critical it is that our working relationship with local caregivers is built on trust and mutual respect. When the community clinics shared that they were operating above capacity, we responded to the needs of our community by opening a transitional primary care center Baptist Health Follow-up Care. The model of care provision for Baptist Health Follow-up Care is the gap clinic concept a bridge to a permanent medical home. This requires a very tightly knit, well-defined and supported relationship with our collaborating healthcare organizations, primary care physicians and specialists. In efforts to enhance access to care and strengthen our continuum of care, Homestead Hospital will convene key community partners. Local providers and community clinic leaders will be invited to quarterly meetings to share experiences and discuss opportunities for improvement in streamlining referrals and operational efficiencies. This ongoing communication will help mitigate any barriers preventing individuals from achieving optimum outcomes by improving their access to preventive and primary care offered at these community clinics. Support Providers in Caring for the Uninsured Homestead 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 2013, more than 4,900 Homestead Hospital patients received charity care at a cost of more than $23 million. In addition, Homestead 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, Homestead Hospital payments to affiliated physicians for uncompensated care and emergency department coverage totaled more than $10 million. 1

Baptist Health Follow-up Care in Homestead Baptist Health Follow-up Care was started as a groundbreaking means to address the Homestead community s healthcare needs. The program developed from an extreme problem that Homestead Hospital faced in the overuse of its emergency department and extremely high readmission rates for heart failure and diabetes. The high volume of non-emergent cases in our emergency department is a strong indicator of poor access to care and not poor judgment on the part of patients. For our indigent community, the Homestead Hospital emergency department is their only choice. Many patients reported, prior to the opening of Baptist Health Follow-up Care, that the local clinics were inundated with patients and unable to see them for many weeks. Therefore, they would use the emergency department for primary care needs such as monitoring their disease progression and access to free medications. There was an unmistakable need for medical gap services in the Homestead community. The unique service delivery model makes Baptist Health Follow-up Care one of a kind; it is nurse practitioner-managed, with social workers providing intensive case management not only in-office but in the patient s home as well. These services coupled with patient education are what make this center unique. Baptist Health Follow-up Care will successfully transition 75 percent of its patients to a permanent medical home. Avoidable readmission rates for Baptist Health Follow-up Care patients will be reduced. Miami-Dade 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. 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 including 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. Baptist Health understands that 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, the organization is committed to identifying innovative ways to remove these barriers for patients to access timely primary care. 2

Availability of Primary and Preventive Care Baptist Health Follow-Up Care in Homestead We understand and promote the benefits of an academic collaboration through a partnership with Florida International University s (FIU) College of Nursing and Health Sciences. Our collaboration with FIU includes an opportunity for advanced registered nurse practitioner (ARNP) students to learn and develop their skills in a real clinical setting. ARNP students work alongside clinic staff throughout the patient s plan of care a new facet to their curriculum that is being tested in this transitional primary care environment. FIU will track all student and patient feedback related to the students to identify the strengths and gaps in this educational setting. We know that our collaboration with government, higher education, private business, physicians and healthcare organizations is fundamental to the value of the services we provide to our patients. It is our goal to ensure that we can meet the needs of our patients in innovative, creative and unique ways. We will continue to collaborate with local universities to offer clinical experience for allied health professional students to better prepare them as future primary care providers. As a transitional primary care center, Baptist Health Follow-up Care serves as a gap clinic to ensure that patients have access to care. Managed by an ARNP, with social workers providing intensive case management services at the center and follow-up at the patients homes, is innovative. This model allows our staff to better assess the social needs of the patient and how they affect the patient s progress and compliance. We know that noncompliance is a major reason why many patients return to the hospital. We want to provide them with the means to self-manage as well as offer them a safety net should they face a situation they are unable to navigate alone. Our use of Stanford University s Chronic Disease Self-Management Program (CDSMP) model for educating the patients about self-management is also an innovative approach to patient education in a clinical setting. The majority of research indicates that patients need a deeper level of intervention in addressing their healthcare needs than has historically been the norm. We know that our patient demographics play a significant role in their success as well. This is why we provide educational materials in multiple languages, interpretation services in 170 languages, if necessary, and CDSMP classes in both English and Spanish. Complementing our community-integrated approach, we invite local primary care physicians to refer their patients to our intensive disease education as a free community resource to improve disease self-efficacy. 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. Eight primary care clinics, each following the best-practice patient-centered medical home model, are in the planning stages, including two in deep south Dade, the area in the study exhibiting the greatest need. A strategically located, walk-in primary care center is necessary to positively impact our patient population s utilization behavior and improve overall community health. Serving as a 3

medical home, the center will be a high-quality, low-cost option for primary care outside of the hospital s emergency department. As a result, patients seeking primary care will have greater access to needed services, as well as enhanced focus on prevention, early identification and management of chronic health problems. This is one of our many strategic initiatives to ensure that our community receives the highest quality care at the lowest possible cost. Success in this endeavor will be measured by reduced emergency department utilization for diagnoses typically treated in a primary care setting, a reduction in preventable admissions, and the increased number of individuals able to have a trusted, secure relationship with a primary care provider in their newly established medical home. Support of Primary Care Providers Through Continuing Medical Education Activities Baptist Health South Florida provides continuous medical education in support of its primary care providers and allied health professionals through its accredited medical education department. In the past year, more than 1,300 CME credit hours were available to physicians by attendance at the more than 700 courses offered. This benefits 2014 the community greatly by keeping our community physicians up to date with the latest techniques in primary care and prevention on an ongoing basis. Homestead Hospital is also very appreciative of our close proximity and working relationship with the Homestead Air Reserve base. We take pride when military personnel don their uniforms when visiting our hospital, and we especially are pleased to offer free CME opportunities to our military medical professionals. 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 Sponsor FIU Neighborhood Help Program to South Miami-Dade Community Florida International University s 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 a low-income area. 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 in south Miami-Dade, the area of greatest healthcare need. This program will reduce costly emergency department visits, avoid preventable admissions and increase health literacy. 4

Chronic Disease Management Community Health and Wellness Education Certified Baptist Health fitness instructors hold free total body conditioning classes at the Homestead Hospital campus twice a week. The Homestead community is also encouraged to participate in free exercise classes offered by Baptist Health throughout South Florida. Homestead 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 maternal and child health concerns. In 2013, Baptist Health held nine health and wellness educational events on behalf of Homestead Hospital. Community Screenings and Health Fairs Homestead Hospital sponsors community health screenings to identify early markers of chronic disease. In partnership with Baptist Health s Community Health and Congregational Health departments, the hospital conducts screenings at such events as the Homestead YMCA s Healthy Kids Day, a backpack giveaway located in the heart of a migrant camp and a specialized screening for elderly patients at the Palace Gardens convalescent center. 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. Homestead Hospital also offers an annual community health fair. Based on the needs identified in our assessment, we decided to refine our approach and are focusing on offering a Family Health & Wellness Fair. Our goal is to increase community screenings at all events by 10 percent. 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 Homestead Hospital encourage and promote support groups through advertising and the use of our facilities to host the groups. Five support groups meet regularly on the Homestead Hospital campus to address various chronic diseases and ailments, such as diabetes, heart disease and stroke. The groups are coordinated at the corporate level by the Community Health department. 5

Maternal and Child Health Our primary service area s young population, alarming statistics for key indicators and our experience with increased births have signaled the development of a comprehensive plan to focus our efforts on improving our population s maternal and child health. Our Perinatal Services team has already sprung into action by forging relationships with community partners to offer free programs at our hospital. Community Partnerships and Journey Toward Excellence in Providing Evidence-based Maternal Care Homestead Hospital is making significant progress in earning a baby-friendly hospital designation with the goals of achieving optimal infant feeding outcomes and mother/baby bonding. In addition to receiving a fourth star in the 10-step process toward receiving the baby-friendly designation, the Perinatal Services department was honored by the Miami-Dade Healthy Start Coalition for being a Champion of Change in the area of evidence-based maternity care. The Perinatal Services team has made it a priority to positively impact our community and improve the well-being of our mothers and babies. Other initiatives include offering educational workshops and support groups in lactation, breast-feeding, childbirth and prenatal education. 6

OB/GYN Laborist Program As the data indicates, many of our patients lack prenatal care, which affects outcomes and increases safety risks. Homestead Hospital recently implemented an OB/GYN Laborist program, which provides 24/7 in-house OB/GYN and anesthesia emergency coverage to ensure that our patients have timely access to quality care. Our goal is to meet or exceed all of our perinatal quality measures for the patients we serve. Pediatric Hospitalist Program The healthcare needs of the children in south Miami-Dade County are influenced by the cultural and economic mix of the population. For example, children in our migrant community often suffer from pediatric asthma related to exposure to pesticides. The fact that our pediatric emergency department treated almost 30,000 patients in the past year also highlights the need to focus on improving the health of our community s children. When children need hospitalization or specialty care, they are often taken out of their community for treatment at Baptist Children s Hospital or Miami Children s Hospital. At Homestead Hospital, we want to keep our children close to home. Many of our families struggle daily to take public transportation to visit their fragile children. By having the pediatric hospitalist program, we can keep families close to one another, fostering a parental bond while empowering families. We started our pediatric hospitalist program to provide in-house partners in practice to help our limited pediatricians manage their workload. Pediatric hospitalists are Board-certified physicians who specialize in the care of hospitalized children. Their unique knowledge of hospital medicine ensures that our young patients receive the best possible care. Pediatric hospitalists partner with office-based primary care physicians to admit patients and provide high-quality inpatient care. They also manage the care of children who come to the emergency center and need to be hospitalized but do not have a physician on the Baptist Health medical staff. These dedicated pediatric hospitalists are available 24 hours a day and maintain regular communication with the patient s primary care physician. After the hospital stay, patients return to the care of their community physician or are referred to a local pediatrician for primary care. 7

Socioeconomic Challenges Due to the complex socioeconomic needs of our patients, we know that we have to step outside of our four walls and look at ways to engage community stakeholders to help keep our population healthy. We have learned that while we are meeting our patients healthcare needs, their basic needs are not met. Many of the individuals in our community are challenged with several barriers that impact their health status. Our challenge is to engage and strengthen community support systems after the patients leave the hospital. Healthcare Navigators We support and collaborate with Catalyst Miami, a not-for-profit organization that serves as healthcare navigators and life coaches for patients. Catalyst Miami is conducting community outreach to promote the appropriate use of medical services, assist with traditional and insurance marketplace enrollment efforts and provide support to individuals overwhelmed with challenges (e.g., newly diagnosed diabetics). Congregational Health Baptist Health s Pastoral Care department has a Congregational Health team that focuses on developing Care Team programs. The Care Team 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. In the Homestead Hospital service area, there are two Care Team programs. Congregational Health and Homestead Hospital are in the process of recruiting and training individuals to establish four additional Care Team programs. Eligibility Specialists We offer a professional service to evaluate our unfunded patients applications for government assistance (i.e., Medicare and Medicaid) and our charity program. Baptist Health plans to expand its existing Medicaid enrollment assistance resources to include healthcare marketplace application assistance. Miami-Dade Health Action Network South Dade Baptist Health supports the Miami-Dade Health Action Network, South Dade Chapter, and provides a leadership position in the formation of care coordination in south Dade. Monthly meetings in conjunction with WeCare of South Dade and Catalyst Miami focus on building partnerships between community health workers and clinical navigators to strengthen our communities. The coalition convenes community partners to educate individuals on topics such as cancer prevention and HIV/AIDS. Community Garden The community garden project is intended to improve the overall health of the community we serve. The garden will provide many important benefits, including sustainable food production, an opportunity to educate individuals on healthy produce and its impact on wellness and nutrition, and by addressing a community need through organic methods. Taking into consideration the high levels of poverty, unemployment and the lack of easy access to affordable, fresh food, Homestead Hospital is planning a community garden on land adjacent to the hospital to support the surrounding community by providing fresh vegetables to local organizations.