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Cordova Community Medical Center Cordova, Alaska

Community Health Needs Assessment

2013

Prepared by: Wipfli LLP

Minneapolis, Minnesota

Cordova Community Health Needs Assessment - 2013

Table of Contents Introduction .................................................................................................................................... 1 CHNA Methods and Process ........................................................................................................... 2 CHNA Advisory Committee ............................................................................................................. 3 Community Served Determination ................................................................................................. 5 Data Collection and Analysis ........................................................................................................... 5 Information Gaps ............................................................................................................................ 6 Summary of Key Findings ................................................................................................................ 7 Summary of Prioritized Needs ...................................................................................................... 11 Existing Health Care and other Facilities and Resources .............................................................. 11 Implementation Plan .................................................................................................................... 13 References .................................................................................................................................... 14 Appendix 1 ‐ List of Interviewees for Community Input Appendix 2 – Demographic, Primary and Secondary Data Appendix 3 – Community Health Survey Appendix 4 – Community/Demographic Profile Appendix 5 ‐ Resource List Appendix 6 ‐ Community Health Needs Assessment Implementation Plan Appendix 7 – Community Health Needs Assessment/Implementation Plan Executive Summary

Cordova Community Health Needs Assessment - 2013 1

Introduction

Cordova, Alaska The community of Cordova, Alaska is a remote, rural community located near the Copper River Delta on the eastern shore of Prince William Sound. Cordova has a population of approximately 2,300 and is served by two main health care providers. Cordova Community Medical Center (CCMC) is owned by the City of Cordova and governed by the Health Services Board. The Ilanka Community Health Center is a Federally Qualified Health Clinic (FQHC) operated and governed by the Native Village of Eyak and the Ilanka Community Wellness Advisory Council.

Cordova Community Medical Center Cordova Community Medical Center is a publicly‐owned Critical Access Hospital (CAH), offering medical services that include preventive, inpatient, outpatient, and long‐term care. Services include emergency, laboratory, radiology, physical and occupational therapy, and swing‐bed. Sound Alternatives offers an array of outpatient mental health and substance abuse services. Clinic services include primary care, with quarterly specialist visits for orthopedics, pediatrics, optometry and women’s health services.

Cordova Community Health Assessment Project Overview The Cordova Community Health Needs Assessment helps provide an understanding of the health issues in Cordova based on data derived from community interviews, surveys and other State and Federal sources. This community assessment report is a baseline of the quality of health and health care in Cordova. It is also a tool for concerned community members to come together to review data and form a picture of where Cordova could be headed. The goal of the 2013 Cordova Community Health Needs Assessment is to aid the community in its effort to continually improve the quality of health and health care in Cordova by:

Giving community members the opportunity to share their personal experiences, insights and opinions on health and health care in Cordova;

Raising public awareness of health needs, changing trends, emerging issues and community problems;

Providing accurate, credible and valid information to health care providers; and

Providing a baseline for the hospital to continue its efforts to address the health needs of the community


Methods Wipfli’s Role In February of 2013, Wipfli LLP (Wipfli) was engaged by leadership at CCMC and Providence Health Services – Alaska Region to facilitate the community health needs assessment (CHNA) process on behalf of the hospital. This CHNA report was completed in compliance with the IRS requirements described in section 501(r)(3) of the Internal Revenue Code.

CHNA Process The CHNA process that Wipfli utilized to conduct the assessment has been adopted from several of the leading sources on the subject. These sources include:

Association for Community Health Improvement,

Flex Monitoring Team, and

Rural Health Works. The following outline explains the process that Wipfli followed to conduct the CHNA. Each process is described in more detail throughout the report. 1. Formation of a CHNA advisory committee 2. Definition of the community served by CCMC 3. Data collection and Analysis

a. Primary data b. Secondary data/Demographics c. Existing health care facilities and resources

4. Identification and prioritization of community health needs and services to meet

community health needs

5. Adoption of goals and implementation strategy to respond to prioritized needs in collaboration with community partners

6. Dissemination of priorities and implementation strategy to the public


CHNA Advisory Committee The CHNA Advisory committee was formed by Leadership at CCMC. The committee was tasked with completing key objectives outlined by the IRS CHNA requirements, including the identification of health issues and prioritized health needs within the community. The committee consisted of the following members:

Cordova Community Medical Center Leadership and Staff: o Theresa Carté, CEO o Kari Collins, Director of Nursing o Tim James, HR o Tim Kelly, CFO o Stephen Sundby, Executive Director of Sound Alternatives

Cordova Community Medical Center is a 23‐bed Critical Access Hospital dedicated to providing the best possible health care to the Cordova community. Owned by the City of Cordova and governed by a City‐appointed Health Services Board, the Medical Center is the community’s center for health care. Sound Alternatives offers assessments for mental health or substance abuse, psychiatric evaluations for medication management, help managing a mental health issue, individual outpatient psychotherapy for children, youth and adults, substance abuse treatment in a group or individual outpatient setting, and help obtaining referrals to in‐patient long‐ or short‐term residential treatment programs. In addition to health counselors for substance and mental health issues, Sound Alternatives staff can assist individuals in completing applications for heating assistance, public assistance such as food stamps, and Medicare and Medicaid social services. Sound Alternatives can also assist individuals with disabilities and families caring for children with disabilities, including respite care. Other services include domestic violence intervention and Employee Assistance Programs for hospital employees and the U.S. Coast Guard.

Kristin Carpenter, Executive Director, Copper River Watershed Project The Copper River Watershed Project employees 4 people in the Cordova community and works to maintain the watershed in the surrounding area of Cordova. Kristin is also a City Council member and therefore a member of the Health Service Board for CCMC.

Jim Kacsh, City Mayor Jim has just begun his 3 year term as elected mayor of Cordova. He holds an important role in representing the voice of the people in this community. He chairs the City Council which meets twice a month.

Native Village of Eyak/Ilanka Community Health Center Leadership and Staff: o Joel Azure, Native Village of Eyak Executive Director


o Ron Ray, ICHC Provider and CCMC Medical Staff member

Native Village of Eyak is a federally recognized tribal government located on the

southeastern shores of Prince William Sound in the North Gulf Coast of Alaska. It is

governed by a five member elected Council who uphold its constitution and bylaws and

direct an executive director to implement projects and programs according to an approved

strategic plan.

Ilanka Community Health Center offers Preventative Care, Acupuncture, Behavioral Health,

In House Labs, Free Blood Pressure Checks, Epidural Steroid Injections, Women’s Health,

Prenatal Care, Free Nail Care for Seniors and Diabetics, Immunizations, Laceration Repairs,

Diabetic Education and Home Visits. NVE also operates a transportation program.

Don Moore, Interim City Manager (start of work) Randy Robertson, City Manager (completion of work) The City Manager administers all City operations and oversees Department and Personnel activities. The Cordova Community Medical Center is a City Owned entity and reports through the Health Service Board and City Council to the City Manager. The City Manager plays an important role in supporting the services that maintain the health and well being of the people of Cordova.

George Wintle ‐ Chief of Police, City of Cordova The Cordova Police Department is committed to the protection of life and property of all citizens of Cordova, Alaska. They partner with health care providers in Cordova to ensure the health and safety of the people in our community.

Kelsey Appleton, Cordova District Fisherman United Cordova District Fishermen United is a non‐profit organization dedicated to preserving, promoting, and perpetuating commercial fishery in Area E.

Joanie Behrends – Ambulance Squad Captain, EMT, Cordova Volunteer Fire Department Cordova Volunteer Fire Department led by Fire Chief Mike Hicks and Deputy Fire Chief Robert Mattson, between 20‐30 volunteer fire‐fighters and medics work directly with the City's Fire Marshall and a City‐employed fire‐fighter/medic to provide 24‐7 Fire and Ambulance service to the community.

Barb Bunte ‐ Public Health Nurse, State of Alaska Public health nursing is contributing every day to the improvement of the health of Alaskans and their families. The Public Health Nurse solves public health concerns and creates community solutions that will improve the health of all Alaskans in the years to come.


Nicole Songer ‐ Executive Director, Cordova Family Resource Center Cordova Family Resource Center (CFRC) works hard to support the families and community of Cordova, Alaska. CFRC provides child and client advocacy with police, court, hospital, and social services. CFRC has a 24‐hour help line. They have safe homes, crisis intervention, and transportation outside of Cordova to a shelter for victims of domestic violence. CFRC provides educational workshops, support groups, parenting classes, and supervised visitations. They have Public Assistance fee agents, notary services, and can make referrals to other agencies.

Community Served Determination The service area for CCMC was created with input from CCMC and Providence’s leadership team. The CHNA focused on the needs of the greater Cordova community. While every effort was taken to gather detailed data for the Cordova community, it was necessary in certain areas to expand the definition of the service area to the Valdez‐Cordova Census Area. This was done for the purpose of collecting census and County Health Rankings data that is only available for the Census Area.

Data Collection and Analysis Primary Data Key informational interviews were conducted with members of the community served by CCMC. These individuals were identified by the CHNA Advisory Committee based on their qualifications to represent the broad interest of the community served. Generally, the interviewees included persons with special knowledge or expertise in public health and persons who represent the medically underserved and vulnerable populations. Interviewees were contacted and asked to participate in the key informational interviews. A list of the interviewees can be found in Appendix 1. A summary of the key findings from the key informational interviews can be found later in this document, and the interview notes can be found in Appendix 2. A community survey was published online and distributed at the annual health fair and locally by the advisory committee and CCMC staff. The survey was developed based on an existing template utilized by Providence Health Services – Alaska Region among its affiliated hospitals, and augmented to capture input regarding unique health‐related characteristics that exists within the Cordova community. Results from the community survey can be found in Appendix 3. Secondary Data Collection Secondary data was collected from two major sources:


ESRI, 2013 (Based on US Census Data)

County Health Rankings The secondary data includes a variety of service areas, state and national measures to present a community profile, birth and death characteristics, access to health care, chronic diseases, social issues, and other demographic characteristics. Data was collected and presented at the service area level and wherever possible, compared to the state of Alaska and National Benchmarks. Results of the secondary data can be found in Appendix 4. County Health Rankings data is aggregated from the following national data sources:

The Behavioral Risk Factor Surveillance System (BRFSS)

National Vital Statistics System (NVSS)

US Census Bureau's Small Area Health Insurance Estimates (SAHIE) program This report presents a summary that highlights the data findings, presents key priorities identified through the CHNA, and CCMC Board‐approved implementation plan.

Information Gaps Primary data was collected via surveys and a series of interviews. The responses reflect the opinions of the survey and interview respondents and may not reflect the needs of the entire community. Quantitative information for demographic and health status was available at the Valdez‐Cordova Census Area level. Therefore, to the extent that health status differs between the Valdez‐Cordova Census Area and the community of Cordova, health information was not available at that granularity. An extensive community survey was conducted in Cordova to compensate for the weaknesses of secondary data sources.


Summary of Key Findings Results from the three data collection methods including demographic data, primary data, and secondary data were analyzed. Significant findings were grouped into health issues under three distinct categories. The categories, which include continuum of care, access to health care, and health and wellbeing were used to organize the health issues into common themes so that they could be combined later on in the prioritization phase of this process.

CONTINUUM OF CARE The following factors play a significant role in the health care continuum in Cordova. The organizations providing health care within the Cordova community, and their collaboration in providing a full continuum of care to individuals, plays a vital role in maintain the health of the community at large. 1. Elderly and Disabled According to US Census data, the service area population is expected to continue aging over the next five years, as the proportion of people ages 65‐74 continues to rise. This trend was the focus of discussion from interviewed stakeholders, who indicated that additional services for the elderly, including home health and assisted living should be considered to improve the current health care system in Cordova. Home health was also viewed by stakeholders as a significant health care need, along with disability services. In general, stakeholders viewed the elderly as an underserved group. According to community survey results, nine out of 314 respondents indicated that a member of their household had a need for in‐home health care, while eight respondents indicated needing support for activities of daily living. 2. Care Coordination Across Health Care Providers Care coordination among health care organizations and with patients was viewed by some stakeholders as a significant health care need within the community. Other stakeholders indicated that collaboration among organizations and the community, along with talented, caring staff were strengths of the current Cordova health care system. Stakeholders also viewed the relationship with Providence Health Services as a strength. Lastly, the annual health fair was indicated by stakeholders as a strength of the current health care system in Cordova.


ACCESS TO HEALTHCARE The following issues concern Cordova residents' ability to gain access to the care they need. Challenges people face in gaining access to the care they need include cost, service availability, access to primary and specialty care, insurance coverage, and attracting and retaining medical providers to name a few. 3. Uninsured Population County Health Rankings data revealed the rate of uninsured adults in Valdez‐Cordova Census Area was 25% in 2013. According to community survey respondents, the rate of uninsured was 16%. This number is likely skewed due to respondents being more likely to have insurance. Lack of insurance was indicated by stakeholders as a major barrier to obtaining health care. Stakeholders also felt that the uninsured population are far more likely to delay care until their illness becomes more acute. Of those community survey respondents who do not carry health insurance, 73% indicated that they do not carry it because it is too expensive. Fortunately, the majority of community survey respondents with dependent children do have health insurance for them, while slightly fewer have dental insurance for their dependents. One of the greatest strengths of the Cordova health care system according to stakeholders interviewed was the availability of the Ilanka Clinic, which maintains a sliding fee schedule to reduce costs for lower‐income individuals. The seasonal and low income populations were noted by stakeholders to be particularly underserved and therefore vulnerable with regard to their health care needs. 4. Affordability of Care According to community survey results, “lower costs for patients” received the highest response rate (37%) to the question regarding the top health care issues in the community. Stakeholders indicated that care is often unaffordable, especially for those who have insurance with a high deductible plan. The large variance in the cost of services in Cordova, along with the unrealistic pricing of certain services as indicated by some stakeholders may be creating barriers to care among the population of Cordova. On a positive note, the availability of the Ilanka Clinic and sliding fee schedule help to keep costs low for qualifying patients, according to stakeholders. 5. Access to Specialty Care Access to care was identified as a major issue within the Cordova community. Stakeholders recognize that the size of the community creates a natural barrier to providing many specialty and tertiary services. Services like obstetrical and delivery care, cardiology, pulmonology, orthopedics, allergy, oncology, and general surgery were all identified by stakeholders as lacking in Cordova. It should be noted that cancer is the number one leading cause of death in Cordova, followed by heart disease at number two according to Vital Health Statistics data.


According to community survey results, 41% of respondents who left Cordova in the last 12 months to obtain health care did so for a needed specialist, while 33% didn’t leave Cordova to obtain health care; and 29% needed tests that were unavailable in Cordova. Of those survey respondents who left to obtain health care in the last 12 months, 58% left 1‐2 times and 31% left 3‐4 times. Also according to community survey results, 26% of responses indicated more specialists/specialty care as a top health care need in Cordova. 23% of respondents indicated OBGYN/Female health care. 6. Attracting and Retaining Medical Providers Attracting and retaining medical providers was discussed often during the stakeholder interviews as a significant healthcare need in the community, as well as a major weakness of the current health care system in Cordova. There are opportunities to improve on this through better recruitment and retention, according to some stakeholders. The consistency of providers also received many write‐in responses to the community survey question regarding the top health care needs in Cordova.

HEALTH AND WELLBEING The following issues concern the health and wellbeing of Cordova residents. These issues address health status and health behaviors that are known to have significant impact on the community and on the quality and length of individual lives. 7. Overweight/Lack of Physical Activity 38.3% of community survey respondents engage in less than 3 days of physical activity per week. According to County Health Rankings data, adult obesity rates are around 29% vs. 25% national benchmark. Cordova also maintains a higher reported number of poor physical health days over the past 30 days than Alaska or National benchmark. Cordova also has a higher percent of adults reporting fair or poor health (16%) than Alaska (13%). The leading causes of death include heart disease, cerebrovascular disease, and chronic lower respiratory disease according to Vital Health Statistics. 8. Chronic Conditions County Health Rankings data revealed that screening rates for diabetes and mammography in the Valdez‐Cordova Census Area are higher than Alaska, but well below national benchmarks. Stakeholders felt that patients without insurance will not seek care, and will go without care until the illness or chronic condition becomes acute. Moreover, people often delay their care and wait until the medical issue becomes more severe before seeking help. These issues could be due in part to a lack of access to diabetes information and education. These patients with chronic conditions are viewed by stakeholders as an underserved and vulnerable group within the community. It should be noted that patients visit CCMC for a variety of reasons, leading


with acute and chronic issues. 54% have not had biometric screening complete in the past year, and for those who did 38% did not take further action based on the results. 9. Mental Health / Substance Abuse Access to substance abuse services and the lack of inpatient detox services was indicated by stakeholders as a significant health care need in Cordova. Specifically, these are services that community members are forced to leave the community to receive. Stakeholders believe that individuals with substance abuse issues are underserved and vulnerable population groups. The reported poor mental health days in the Valdez‐Cordova Census Area are nearly double the national benchmark. 31% of community survey respondents requiring mental health services were not able to receive it, mainly because they did not have insurance, could not afford the copay or did not know where to go. It should be mentioned that only .6% of respondents indicated needing substance abuse treatment in the last 12 months, and those respondents were able to receive treatment, according to community survey results. 10. Tobacco Use Rates of “Adult Smoking” in Valdez‐Cordova Census Area are nearly double the national benchmark, and above the state rate according to County Health Rankings data. According to community survey results, 8% smoke every day, 7% smoke some days and 85% do not smoke at all. 11. Low Utilization of Primary/Preventive Care Having the two clinics in Cordova is a major strength of the current health care system in Cordova, according to stakeholders. Some stakeholders felt that the ratio of providers to population is better than most rural areas and there is no shortage of primary care providers. Data from the community surveys does show that 39% of respondents did not have an annual exam with a physician for preventive purposes in the past year. Also, 10% of respondents utilize the ER as their main source of health care. The majority of those who went without care went without basic and specialty care according to community survey results.


Summary of Prioritized Needs In July of 2013, members of the CHNA Advisory Committee were asked to rate the health issues identified previously according to three key variables, including:

SIZE = How significant is the scope of the health issue ‐ number of people affected?

SERIOUSNESS = How severe are the negative impacts of this issue on individuals, families, and the community?

ABILITY TO IMPACT = What is the probability that the community could succeed in addressing this health issue? (Consider community resources, whether there are known interventions, community commitment, etc.)

The committee convened after individually rating the health issues to come up with the top priorities as a group. The following five priorities were identified by the CHNA Advisory Committee and are listed on the following page. 1. Attracting and Retaining Medical Providers Cordova has suffered a pattern of physician turnover due to many factors including high cost of living, housing availability, being excluded from key decisions within their organizations and the unique lifestyle demands that come with living in a small isolated Alaskan city in a rainy and wintery climate. The inconsistency in providers has impacted the continuity and quality of care for community members over time. Patients feel poorly understood and disconnected when there is a different caregiver from one visit to the next. The inconsistency in care has negatively impacted patient trust in their care giver. This situation has led to lower utilization of preventive care and people waiting to receive care when they can to travel Anchorage or other larger communities where they can have a consistent provider they can come to know and trust over time. 2. Access to Specialty Care Like many small rural communities, Cordova lacks many specialty and diagnostic services. As a result many are forced to travel to larger communities at great expense and family hardship to get the needed services. The economics of delivering health services to a small population sometimes make it unfeasible to maintain certain specialties and services locally, but ensuring the reasonable access to these services is important to the health and well‐being of the community.


3. Affordability of Care The affordability of health care was identified by the community as a significant barrier to receiving needed health care services. The impact of this barrier is compounded by the high cost of living in an isolated rural Alaskan community, the low rate of residents seeking preventive care, and whether or not a community member has health insurance. 4. Care Coordination Across Health Care Providers Despite Cordova’s small size the community identified fragmentation and lack of coordination of care across the continuum as a problem. Key stakeholders and health providers acknowledged that there is not a common understanding of the services and resources available from organization to organization within Cordova. The community has affirmed that there is a need for better information, education, coordination and patient navigation across the continuum of care in Cordova. Addressing this need will reduce barriers to care, improve the efficiency across the health system in Cordova, and improve the quality of care and outcomes experienced by patients. 5. Mental Health/Substance Abuse Poor mental health and the related issue of substance abuse were identified as problems in the Cordova community. The average number of poor mental health days reported for the previous 30 days was 3.5 compared to 2.3 nationally. Of particular concern for the community was the impact of poor mental health on Cordova’s youth, the risk of suicide, and the lack of healthy activities for youth.


Existing Health Care and other Facilities and Resources A complete list of health care and other facilities and resources available within the community to meet the health needs including location, contact information, and description of services can be found in Appendix 5.

Implementation Plan Once the health needs were prioritized by the CHNA Advisory Committee, the final step in the CHNA process involved developing an implementation strategy. The purpose of the implementation strategy is to develop a clear set of goals to respond to the priorities identified through the CHNA. The implementation strategy addresses top community health priorities identified through the CHNA by the CHNA Advisory Committee and describes how CCMC plans to address the health priorities With input from the CHNA Advisory Committee and leadership at Providence Health Services – Alaska Region, the CCMC Leadership Team developed the implementation strategy. The following implementation strategy components were addressed within each priority identified:

1. Objectives/Strategy 2. Tactics (How) 3. Programs/Resources to Commit 4. Impact of Programs/Resources on Health Need 5. Accountable Parties 6. Partnerships/Collaboration

The Cordova Community Medical Center implementation plan to address community health priorities can be found in Appendix 6, including supporting tactics, programs/resources, accountable parties, and potential partnerships/collaboration for each strategy.


References

Alaska Department of Public Health

Alaska Vital Statistics

Association for Community Health Improvement

County Health Rankings

ESRI Business Information Solutions, 2012

Flex Monitoring Team

Rural Health Works


Appendix 1

Cordova Community Health Needs Assessment - 2013 1 List of Participating Organizations for Community Input The following are a list of organizations that had representatives who participated in the community input process of the CHNA.

Ilanka Community Health Center

Native Village of Eyak

US Coast Guard

Catholic Church

SoA Public Health Nurse

Harbormaster

Tribal Elders' Program

Parks & Recreation

Victim’s Assistance Program

School District Superintendent

Sound Alternatives

CCMC CEO, Director of Nursing, Nurse

Cordova Primary Care Physician There were two other community stakeholders that were invited but due to scheduling difficulties were unable to participate. They were the EMS department and the city Dentist.


Appendix 2


Cordova Stakeholder Interview Results

Response

Patience Anderson Faulkner/Native Village of Eyak

Corpsman Pomeroy/US Coast Guard

Father Tom/ Catholic Church

Barbara Bunte/SoA Public Health Nurse

Tony Schinella/Harbormaster

Jackie Ladd/Tribal Elders' Program

Susie Herschleb/Parks & Recreation

Cheryl Eleshansky/Victim’s Assistance Program

Theresa Keel/School District Superintendent

Stephen Sundby

Theresa Carte, CEO/ Kari Collins, Director of Nursing/ Katie Hoepfner, Nurse

Dr. Gary VanWinkle

Total Responses 12

Cordova Community Health Needs Assessment - 2013 2 Do you or your organization serve or represent a particular population or constituency in the community (i.e., Alaska native, low income, seniors, entire population, etc.)? If so, please give a brief description of the population and how you serve or represent them.

Response

The Alaska native members number 400 (Cordova population 2,100) and range in age from babies to 100 years old. I am on the Eyak Tribal Council, helped write the constitution in 1980, and advocate for them. Being a federal maritime service, we primarily serve commercial fishermen and the Cordova community in medical emergencies. We provide law enforcement of fishing regulations, assist in search and rescue operations, and offer emergency medical services to fishermen and Cordova community. This includes transportation from the fishing boat to a local clinic, or for a more serious emergency from the boat or Cordova to a hospital in Anchorage. I serve people across the board, from the newborn to the dying. My population is multicultural. The State of Alaska focuses on preventative services. We provide immunizations; STD screenings, health education and information, but we do not provide medical care. We serve many who are uninsured or underinsured and the disenfranchised. I serve as harbormaster to primarily fishing boats, but also some pleasure boats. I have only been in this position eight months. I server the Alaska native Elders, 55 and older. There are about 80 people that I serve in that group. I sometimes go into their homes and take meds to them that Ilanka has for them and also dispense information about health issues. I serve youth and adults in the Cordova community. The summer camps are geared for youth in 2nd ‐7th grades, and the after school programs serve 3rd ‐8th graders. Our adult programs have really exploded, serving many more adults than in past years. We offer adult personal fitness which people can do on their own at the pool and the fitness center or through cardio fitness classes. We also have very strong basketball and volleyball teams/programs... I represent Alaska Native women ages 12 and above who are victims of domestic violence and/or sexual assault. I work collaboratively with Nicole from the Family Resource Center in providing abused women with emergency shelter, information, and classes. I represent the Cordova School District, serving 300 K‐12th graders, their parents and the teachers and staff. Executive Director of Sound Alternatives, provide mental health services, behavioral health and those with disabilities Community hospital serves everyone including elderly, including in nursing home, outpatient clinic; do not get as many Alaska natives because they can be served by the clinic; we serve large Caucasian and Filipino population. As hospital, we serve everyone. We do not see many pediatric patients; we believe they could be going into anchorage. We also have swing beds for rehab, which mostly come from out of Cordova. Procedure was done in Anchorage or elsewhere outside of Anchorage. No births, no surgeries. Community Health Clinic; about half of the people in Cordova; FQHC; serve population regardless of their ability to pay; serve both the insured and uninsured, Alaska native beneficiaries, indigent

Total Responses 12

Cordova Community Health Needs Assessment - 2013 4 How, specifically, does the lack of insurance impact the population/constituency you serve or represent? What tools or resources might help address those issues?

Response

Alaska native tribal members are covered under a federal contract with Indian Health Services (IHS) and receive full medical services when they use the Ilanka Community Health Clinic. Up to two days hospitalization is also covered and most emergency transportation to outside facilities. We are also covered under Medicare and Medicaid, and Denali Kid Care which is on a sliding scale. Dental care is limited. I cannot speak to insurance or the community since we are primarily maritime and not based in Cordova. We provide emergency Medevac service, but we are not here to undercut the transportation available to Cordova. The older people are covered by Medicare, some have Medicaid and Denali Kid’s Care, and the fishermen and factory workers have either no insurance or just workers comp. If the employer does offer health insurance it sometimes is unaffordable or has a very high deductible. There are a significant percentage of people who are noninsured or underinsured. Many are waiting to see if the Affordable Care Act will make health insurance more affordable. There is a huge variance in the cost of medical services in Cordova. For instance, a shingles vaccination at CCMC costs $480; at Ilanka Clinic, which has a sliding scale based on income, it could cost you $130; at Public Health the vaccine may be free but you’d pay a $28 administrative fee if you qualify. I do not know since I have only been here a short time and am not familiar with the fishermen’s insurance or lack of it. For this particular population it is not a big issue. Many have Medicare and/or Medicaid, and all have access to the federal IHS monies for health care available through the Ilanka Clinic. It is hard for me to tell. The hospital and city workers that come here do have insurance. Our population probably triples in the summer with fishing, and they do not have insurance. I do not know the impact their insurance or lack of it has.

There are IHS monies for medical care and victims' compensation.

The teachers have excellent health insurance, although they will be penalized next year, so it is not an issue for them now. I cannot speak to the insurance situation of the families since I do not know if they have insurance or not. Sound Alternatives operates through grant money and therefore has a sliding fee schedule; can work with patients to create a payment plan (mandated by grant) regardless of ability to pay. 1. Patients without insurance will not seek care, and will go without care until the illness or chronic condition becomes acute. 2. No tools to help address those issues, other than applying for charity care. However many make too much to qualify, but not enough to afford insurance. We do have two unit clerks who are trained to help assist patients apply for Medicaid (one in hospital, one in behavioral health). Cordova does not advertise the availability of charity care, and does not proactively provide outreach to help people navigate the health insurance system. Similar to anywhere, people without insurance only seek health care when they are sick; Ilanka clinic has the resources to help these people because fees are reduced.

Total Responses 12

Cordova Community Health Needs Assessment - 2013 6 Based on your experience, what are the three most significant health care needs in your community?

Response

1. Access to extended testing and specialists. Tribal members need to go to Anchorage for these services, at a significant cost by ferry or plane as well as lodging if overnight stays are required. There are some specialists (eye doctors/ Rx glasses) who do occasionally come here. 2. EMTs can cover most emergencies but could not handle disasters. 3. There is one dentist who lives in Cordova (has been here for almost 30 years), but is sometimes gone on a fishing boat for up to six weeks in the summer.

1. More geriatric services. 2. Birthing facilities and services. 3. Major surgical services.

1. Lack of home care for the elderly. 2. Affordable family planning. 3. Affordable medical care for the uninsured. 4. Lack of specialty medicine.

I do not know since I have only been here a short time.

Many of my people are unhappy with the inconsistency of health care providers, since they don't seem to stay long.

The lack of continuity of doctors. Having to travel to Anchorage for more than basic care.

Provide for victims of ‐Substance Abuse ‐Heart disease –Cancer.

1. Not having stable doctors and nurses here with whom one can build a relationship. Most people go to Anchorage, at considerable expense, for even routine care. 2. The lack of cooperation between the two clinics in Cordova. There seems to me to be competition rather than cooperation. 1. Substance Abuse treatment ‐ Sound Alternatives is the only provider today, but also the Ilanka. 2. Detox ‐ inpatient services not available. 3. Stability in medical providers, not possible due to locums; hospital is working to get permanent providers. 1. Continuity of medical providers in the community; 2. Care Coordination/case management ‐ people need help navigating the health insurance system and other health‐related problems related to disabilities, home health, etc. 3. Specialty clinic ‐ pulmonology studies, allergist and sleep studies, podiatry, endocrinologist, rheumatology, audiology 1. Preventive Care ‐ has enough providers. 2. Acute Care ‐ get transferred to Anchorage to most acute care services. 3. Long‐term Care

Total Responses 12

Cordova Community Health Needs Assessment - 2013 7 What are the main barriers to obtaining health care in the community or taking care of significant health needs? How can those barriers be addressed?

Response

Transportation to other or emergency facilities outside Cordova, especially in the winter, is a problem for tribal members. While Cordova has some support services (small airport, Coast Guard Medevac) the costs are prohibitive, and the ferry is limited in the winter. If staying in Anchorage you also contend with the difference in summer and winter rates at hotels and other amenities. 1) There’s never enough money. 2) There are no long‐term doctors. The doctors travel and are only here 3 months at a time. Lack of insurance; health care is unaffordable; no full‐time doctors so there is a lack of continuity of care. Have an urgent care facility so people don't have to use the ER at a prohibitive cost. At CCMC if the prices were lower the increase in volume of patients might make up for it. Providence now manages CCMC and it has been a huge improvement. Things are turning around.


We need more resident doctors and nurses. We also need birthing services in Cordova. Having to leave for the birth of a baby puts a strain on the entire family‐‐financially for the overnight stays in Anchorage, and also on providing care for other children in the family during that time, as well as the separation of the family, which may be an extended period of time. I’d like to see specialists come to Cordova on a regular basis, a doctor who will deliver babies here, and a female doctor for women’s health care. I see the barriers as the availability of having access to specialists here, and then the travel that is involved to see a specialist. The travel is all cash forward, and I have had to put off a needed checkup with a specialist until another paycheck to go to Anchorage. The location of Cordova and transportation are two big barriers that I see. While we do have access to Ilanka Clinic, CCMC, and Public Health, many with seasonal income, primarily fishermen and migrant workers, are not eligible for health insurance or Medicaid, which is another barrier. Any kind of assistance with transportation costs and for seasonal workers would be helpful. I see the main barrier as the lack of stability in the medical staff, which leads to expensive trips to Anchorage. This creates hardships not only for the families, but it also impacts the workplace. I have high absenteeism on my staff for doctors’ visits, most times involving several days, because they cannot get care they trust in Cordova. 1. Market is small so it is difficult to support all the services that the community desires. 2. Geographically isolated so it is difficult to get to specialty services outside of Cordova. 1. Not having continuity of care in our providers. 2. People often delay their care for chronic conditions until it becomes too acute and must be sent out of town. 3. Lack of insurance Solutions 4. Education on health care, how to take care of yourself. 5. Monthly diabetic education workshops; perhaps we could do other workshops to help educate the community. 1. Preventive Care ‐ has enough providers. 2. Acute Care ‐ get transferred to Anchorage to most acute care services. 3. Long‐term Care ‐ we have long‐term care facility takes up most of the beds in the hospital; very expensive; very good care provided.

Total Responses 12

Cordova Community Health Needs Assessment - 2013 9 Have you or anyone you know had to leave Cordova to receive needed health care services? If so, what was it for what? (If provider: Have you referred any of your patients to locations outside of Cordova? If so, for what?)

Response

Someone close to me had a tumor that required surgery in Anchorage, and some tribal members had an emergency appendectomy and cancer treatment. While pregnant women can receive basic prenatal care in Cordova, for the actual delivery and birth of their babies most women go to Anchorage. This usually involves staying in Anchorage before and after the birth, which can be costly. Anyone who has had a serious condition or injury or needed testing, screening or surgery has left Cordova for additional services, from colonoscopies to cancer. A friend had knee replacement and was hospitalized for two days but chose to return to Cordova for the physical therapy that could be received here. Many people I know have had further screenings, mammograms, biopsies, ultrasounds, delivered babies, and seen an ophthalmologist. For almost everything other than routine care you need to leave Cordova. Some have to go to a military base outside of Cordova for a military physical. Others in the community have had to go out for a serious illness, broken bones, and pregnancy. Yes. Women have left for the birth of their babies. Others have had to go to Anchorage for colonoscopies, cancer treatment, and residential stays for addictions, primarily alcohol. I know people personally who needed travel to Anchorage to see a specialist for epilepsy, autism and mastectomy.

I have needed surgery and my parents had cancer.

Anything other than very basic care requires travel to Anchorage. Many choose to have even regular checkups in Anchorage where they can build a relationship with a doctor. Birthing is another big reason people go to Cordova. One of my teachers was due at the end of the school year but had to be gone the last six weeks so she could be in Anchorage at the time of the baby’s birth.

Yes, for services that aren't provided, such as trauma, cardiology, head injuries.

1. Yes Ophthalmology Appendix Back Surgery GYN EGD Any surgical procedures Mainly going to Anchorage, or Wasilla. All subspecialties are referred out of Cordova; CCMC has experimented with bringing pediatrics and orthopedics, ophthalmologist; no surgeries performed in Cordova; can do some wound repair, fractures.

Total Responses 12

Cordova Community Health Needs Assessment - 2013 10 What groups or vulnerable populations in your community are underserved regarding their health care needs? What is the nature of their need(s)? What are the major obstacles to reaching and serving these groups? What individuals or organizations currently serve these populations?

Response

IHS does cover mental health needs, and there are mental health services available here, but we could probably use more. We had a community Peer Listener Training Program 20 years ago during the Exxon Valdez oil spill crisis. These were community people who served as a bridge to mental health experts, and while they still have the skills they need are not as immediate as then. Tribal members and others may need extra help in coping with PTSD, seasonal affective disorder (SAD), and the occasional “apocalypse winters.” The non‐insured are vulnerable because they usually do not seek or receive the care they need because of the expense. We need more resident doctors and nurses. The elderly are vulnerable. Having more home care, assisted living and nursing homes would help them. Many in the Asian and Hispanic communities are uninsured. Many of them have several part‐time jobs and are not eligible for health insurance. Ilanka serves many of these people because they have a sliding fee scale.


Low income or those with no insurance. The Ilanka Clinic has a sliding scale for their fees, which does help this group. Anyone who has special needs is underserved. I know firsthand. Having better rates with Alaska Air to obtain medical services for those with special needs would be helpful or just medical needs in general. The homeless and those with substance abuse. Sound Alternatives, Cordova Family Resource Center, and Ilanka Clinic’s sliding fee scale do provide some help but a lot more could be done. Our Alaskan Native population and other ethnic minorities are well served here. If children don't have their parents' health insurance they usually qualify for Denali for Kids. I am not aware of an underserved population in my position. 1. Populations that require more specialized services like the elderly and cancer patients. 2. Patients with certain chronic conditions (Dialysis, severe diabetes) Obstacles: Lack of services available in the community currently served outside of the community. 1. The people without money or health insurance cannery employees who work long shifts. People who are not eligible for long‐term care but do not have home health due to lack of this service seasonality and rigor of employment and creates financial barriers and time barriers to receiving health care. 2. Mental Health ‐ serious mental health issues that go untreated due to lack of providers in town; Telepsych would be preferred in some ways due to the anonymity; hospital has equipment; need to work out billing. There isn’t anybody that is significantly underserved; some more indigent people living in poor conditions who are brought in via ER; immigrant groups are well connected and have access to care; not many people in community that are left "hanging" in the community; poor people are hesitant to spend any money on medical care which is always a challenge.

Total Responses 12

Cordova Community Health Needs Assessment - 2013 11 What are the greatest strengths of the health care system in Cordova?

Response

Ilanka serves our tribal members 365 days each year. The IHS monies are also strength of the system. The Cordova medical community works hard together, with clinic doctors helping cover the ER at the hospital for the one staff doctor there.

It is well organized and well run.

1) It is wonderful that we have a hospital for this size community. 2) Ilanka is able to offer a sliding fee scale for those un‐ or underinsured because of federal monies through the Section 330 Grant Program.


We have an annual Health Fair in the community sponsored by the Family Resource Center and other agencies in Cordova. It may not be part of the formal health care system but individuals here do a good job of networking and sharing medical information with each other. For my situation it is working collaboratively with other community resources and putting politics aside. We work with police, public health, the clinics and the hospital to provide for victims’ needs. Mid‐level emergencies, based on my experience. I needed the ER for dehydration due to the flu and was impressed with the care I did receive. I feel we do well with the resources we do have. Providence is working hard to turn things around, and from what I see they are serving Cordova well. 1. For a community this size to have a critical access hospital is strength. 2. Sound alternatives is well staffed, provides great services for size; agreements with other local organizations. 3. Two clinics create patient choice. 1. Talent of staff, great teamwork. 2. Personalized care. 3. No long wait‐times. 4. Quality no quantity. Because of the small population, we have a strong ratio of providers to patients; ER care is high quality given the size of the community.

Total Responses 12

Cordova Community Health Needs Assessment - 2013 12 What are the greatest weaknesses of the health care system in Cordova?

Response

The greatest weakness I see is providing information and education to the community and tribal members of the services that Cordova provides and how to access them. Meals are available to school kids and seniors but not everyone knows that or how to get them. Diabetes is a big health issue in the tribe, and we need to access information on how to take care of ourselves. We do not have resident doctors and nurses; we cannot receive surgery locally; women cannot have their babies in Cordova.

Lack of continuity of care.

Keeping the doctors here‐‐they seem to change quite often.

There is no residential substance abuse treatment in Cordova.

The lack of continuity in doctors here has led to misdiagnoses. People have then gone to Anchorage, at considerable expense, time, and anxiety, to see a specialist which turned out to be unnecessary. I think misdiagnoses could be avoided if there were a long‐term relationship with one doctor who knew you well. Addressing mental health issues and people receiving information about them. (Example: Some wonder why they seem so depressed in winter. They have no information about Seasonal Affective Disorder. Knowing and understanding it would at least be a start and may relieve some anxiety.) CONFIDENTIALITY. Cordova is a small community where everyone knows everything about everyone else. People have police scanners in their homes, they see you going to a clinic or a shelter, and if you need to be medevac‐ed by helicopter it is known to the whole community. The competition between the two clinics. Having no specialists in Cordova. Even routine hearing screening and eye exams/glasses are not available here, let alone women’s health services. No Ob/Gyn and birthing services here. 1. Historical turnover and change in staff, administration, medical providers. This is starting to change with management agreement with Providence.

1. Lack of continuity between providers and organizations in the community

Inherent with our isolation, people have acute needs or critical care that we can't treat well such as cardiac needs given our size; no obstetrics in the community.

Total Responses 12

Cordova Community Health Needs Assessment - 2013 13 What could be done to improve the health care system in Cordova?

Response

1. Get more mental health services. 2. Our isolation makes it hard to attract doctors to Cordova. Our tribal members and the community would benefit.

Stabilize the medical care with resident doctors and nurses.

1. Provide home care, especially for the elderly. 2. Have more specialty clinics, at least once or twice a year. 3. Provide more continuity of care by hiring more resident doctors and nurses. .

I don't know.

An assisted living facility for the elderly in Cordova would be an asset. I am able to assist with taking medications to the tribal elders from the Ilanka Clinic thanks to a federal Title VI Grant which benefits Alaska Natives. See if more grant monies are available for other health needs. Attract resident doctors and nurses for continuity of care. ‐Alleviate the expense of travel outside of Cordova for medical care. . More agencies working together collaboratively, putting the victims’ safety first, and setting other issues and politics aside. Stabilize the medical staff. ‐Provide more stable services that people can trust. I would use local services if I could build a relationship and be assured due confidentiality. Expand the types of services that are offered to include routine specialties, including more dental, vision, and hearing.

1. Stabilize the providers so you have consistency for patients for longer‐term relationship

1. Improve cooperation and communication between different health care organizations operating in Cordova. 2. More proactive public communication, current events/news of hospital.

Ensure that the hospital remains financially viable over the long‐term.

Valid Responses 11


Appendix 3


Cordova Community Health Survey 1. Have you needed health care in the last 12 months and were you able to receive it?

Response Chart Frequency Count

Yes / Oo 71.2% 227

No / Hindi 9.1% 29

Didn’t need heath care / Hindi nangailangan ng pangangalagang pangkalusugan

19.7% 63

Not Answered 1

Valid Responses 319

Total Responses 320

1a. If yes, what was the primary reason for your most recent visit?


Emergency care / Pang-emergency na pangangalaga

14.0% 31

Acute (new) problem / Malalang (bagong) problema

22.2% 49

Chronic (ongoing) problem / Pangmatagalang (nagpapatuloy) problema

21.7% 48

Preventive care / Pangangalaga sa pag-iwas sa sakit

19.0% 42

Required physical/annual examination / Nangailangan ng pisikal/taunang eksaminasyon

14.5% 32

Other (specify) / Iba pa (pakitukoy)

8.6% 19

Not Answered 7

Valid Responses 221

Total Responses 228

Cordova Community Health Needs Assessment - 2013 2 1a. If yes, what was the primary reason for your most recent visit? Other (specify)

Response

Acupuncture

Birth control

Bph

Checked out hernia operation

Dental

Flush port & periodic blood tests for cancer

Lab tests

Med refill

Medication

Meniscus surgery

Migraine

Ob

Port flush

Pregnancy

Skin sore

Toe nail

Unbalanced hormones

Valid Responses 17

Total Responses 296

Cordova Community Health Needs Assessment - 2013 3 1b.If no, why couldn’t you receive it?


No insurance/couldn’t afford it --- Walang insurance (seguro)/hindi ito kayang bayaran

36.4% 8

Insurance wouldn’t cover it --- Hindi ito sakop ng insurance

0.0% 0

Couldn’t afford co-pay --- Hindi kayang bayaran ang co-pay (hating-bayad)

0.0% 0

Needed a specialist that was not available in Cordova --- Nangailangan ng espesyalistang wala sa Cordova

22.7% 5

Services not available --- Hindi available ang mga serbisyo

9.1% 2

Confidentiality issues --- Mga isyu sa pagiging kumpidensiyal

4.5% 1

Wanted but couldn’t find same gender provider --- Nangailangan ngunit hindi nakahanap ng tagapangalagang may kaparehong kasarian

4.5% 1

Other (specify) --- Iba pa (pakitukoy)

22.7% 5

Not Answered 8

Valid Responses 22

Total Responses 30

Cordova Community Health Needs Assessment - 2013 4 1b.If no, why couldn’t you receive it? Other (specify)

Response

Did not need

Need ultrasound of cyst or needle biopsy

No emergency ultrasound available, needed to fly to Anchorage

Vet. Didn't know where to go.

Went to Ilanka

Valid Responses 5

Total Responses 230

1c. If no, what type of health care did you go without? Response Chart Frequency Count

Basic care --- Basic care (Karaniwang pangangalaga)

47.4% 9

Preventive care/annual exams --- Pangangalaga sa pag-iwas sa sakit/mga taunang eksaminasyon

31.6% 6

Specialist --- Espesyalista 47.4% 9

Chronic (ongoing) problem --- Pangmatagalang (nagpapatuloy) problema

15.8% 3

Acute (new) problem --- Malalang (bagong) problema

15.8% 3

Prescription medications --- Mga inireresetang gamot

21.1% 4

Other (specify) --- Iba pa (pakitukoy)--

21.1% 4

Valid Responses 19

Total Responses 29

Cordova Community Health Needs Assessment - 2013 5 1c. If no, what type of health care did you go without? Other (specify)

Response

Consistency in care

Dental

Thyroid

Valid Responses 3

Total Responses 229

2. Do you use the emergency room for your main source of health care? This would be for illness as well as for emergencies.


Yes --- Oo 10.0% 31

No --- Hindi 90.0% 280

Not Answered 7

Valid Responses 311

Total Responses 318

3. Do you have health insurance?


Yes --- Oo 83.8% 264

No --- Hindi 15.9% 50

Don’t know --- Hindi alam 0.3% 1

Not Answered 3

Valid Responses 315

Total Responses 318

Cordova Community Health Needs Assessment - 2013 6 3a. If yes, where do you get your health insurance?


Employer or spouse’s employer --- Pinagtatrabahuhan o sa pinagtatrabahuhan ng asawa

71.7% 190

Private insurance you purchased on your own --- Pribadong insurance na kayo ang bumili

6.4% 17

State or federal program (such as Medicaid or Medicare) --- Programa ng estado o pederal (gaya ng Medicaid o Medicare)

15.5% 41


6.4% 17

Not Answered 2

Valid Responses 265

Total Responses 267

Cordova Community Health Needs Assessment - 2013 7 3a. If yes, where do you get your health insurance? Other (specify)

Response

Board Member and Medicare

Federal employee health insurance

IHS

IHS; NVE beneficiary

MILTERY

Alaska Native

NVE

Parents

Parent's insurance (age 21-26)

Parents, but will expire when I turn 25 this year

Retired

St of AK - retired

Tricare

VA

VA

VA

Wife worked for years for State in 70s & 80s

Valid Responses 17

Total Responses 307

Cordova Community Health Needs Assessment - 2013 8 3b. If no, why not?


Employer doesn’t offer health insurance --- Hindi nag-aalok ang pinagtatrabahuhan ng insurance sa kalusugan

24.4% 11

Too expensive --- Napakamahal

73.3% 33

Don’t need or believe in health insurance --- Hindi kailangan o naniniwala sa insurance sa kalusugan

17.8% 8

Not eligible for employer health insurance --- Hindi karapat-dapat para sa health insurance sa pinagtatrabahuhan

13.3% 6

Unable to find health insurance --- Hindi makahanap ng health insurance

8.9% 4


6.7% 3

Valid Responses 45

Total Responses 50

3b. If no, why not? Other (specify)

Response

> Affordable

Seems like it is a bit of a scam and benefits the insurance companies. Wish we had single payer like much of Europe.

Unemployed

Valid Responses 3

Total Responses 231

Cordova Community Health Needs Assessment - 2013 9 4. Does your health insurance cover or do you have additional coverage for:

Yes / Oo No / Hindi Don't know Hindi alam

Total

Prescriptions? --- Mga reseta?

Count 217 47 9 273

% by Row

79.5% 17.2% 3.3% 100.0%

Treatment for substance abuse? (alcohol/drugs, etc.) --- Panggagamot para sa mapang-abusong paggamit ng substansiya? (alak/droga, atbp.)

Count 98 46 110 254

% by Row

38.6% 18.1% 43.3% 100.0%

Preventive care/annual exam? --- Pangangalaga sa pag-iwas sa sakit/taunang eksaminasyon?

Count 202 35 24 261

% by Row

77.4% 13.4% 9.2% 100.0%

Long-term care? (nursing home) --- Pangmatagalang pangangalaga? (nursing home)

Count 45 92 113 250

% by Row

18.0% 36.8% 45.2% 100.0%

Dental care? --- Pangangalaga sa ngipin?

Count 194 63 8 265

% by Row

73.2% 23.8% 3.0% 100.0%

Home health? --- Pangangalaga sa bahay?

Count 44 76 127 247

% by Row

17.8% 30.8% 51.4% 100.0%

Vision care? --- Pangangalaga sa paningin?

Count 190 55 8 253

% by Row

75.1% 21.7% 3.2% 100.0%

Total Count 990 414 399 1803

% by Row

54.9% 23.0% 22.1% 100.0%

Cordova Community Health Needs Assessment - 2013 10 5. Do your dependent children have:

Don't have dependent children Walang umaasang mga anak

Yes / Oo

No / Hindi Don't know Hindi alam

Total

Health insurance? --- Insurance sa kalusugan?

Count 146 103 27 4 280

% by Row 52.1% 36.8% 9.6% 1.4% 100.0%

Dental insurance? --- Insurance sa dental?

Count 125 92 37 5 259

% by Row 48.3% 35.5% 14.3% 1.9% 100.0%

Total Count 271 195 64 9 539

% by Row 50.3% 36.2% 11.9% 1.7% 100.0%

6. In the last 12 months, have you needed mental health services (counseling or other help)?


Yes --- Oo 11.2% 34

No --- Hindi 88.8% 269

Not Answered 11

Valid Responses 303

Total Responses 314

Cordova Community Health Needs Assessment - 2013 11 6a. If yes, were you able to receive the needed mental health services?


Yes --- Oo 69.4% 25

No --- Hindi 30.6% 11

Not Answered 10

Valid Responses 36

Total Responses 46

6b. If no, why couldn’t you receive needed mental health services?


No insurance/couldn’t afford it --- Walang insurance/hindi ito kayang bayaran

45.5% 5


9.1% 1

Couldn’t afford copay --- Hindi kayang bayaran ang copay

36.4% 4

Didn’t know where to go --- Hindi alam kung saan pupunta

27.3% 3


9.1% 1


18.2% 2


18.2% 2

Valid Responses 11

Total Responses 20

Cordova Community Health Needs Assessment - 2013 12 6b. Why couldn’t you receive needed mental health services? Other (specify)

Response

Was told I needed to first pick up a packet and fill it out and I was too depressed to make that step-at the time it was all I could do to call and make an appointment and when I was told there was an initial step, it was too much. Was told I first had to pick up a packet & fill out a bunch of info—was too demeaned to do that—wish I could have had an appointment and filled it out then as part of the appt.

Valid Responses 2

Total Responses 224

7. During the past 12 months, did you ever feel so sad or hopeless almost every day for two weeks or more that you stopped doing some usual activities?


Yes --- Oo 9.5% 29

No --- Hindi 90.5% 275

Not Answered 10

Valid Responses 304

Total Responses 314

8. Have you thought about committing suicide at any time in the past 12 months?


Yes --- Oo 3.2% 10

No --- Hindi 96.8% 300

Not Answered 4

Valid Responses 310

Total Responses 314

Cordova Community Health Needs Assessment - 2013 13 9. In the last 12 months, have you needed substance abuse treatment?


Yes --- Oo 0.6% 2

No --- Hindi 99.4% 307

Not Answered 5

Valid Responses 309

Total Responses 314

9a. If yes, were you able to receive the needed substance abuse treatment?


Yes --- Oo 100.0% 2

No --- Hindi 0.0% 0

Not Answered 7

Valid Responses 2

Total Responses 9

Cordova Community Health Needs Assessment - 2013 14 9b. Why couldn’t you receive needed substance abuse treatment?


No insurance/couldn’t afford it --- Walang insurance/hindi ito kayang bayaran

0.0% 0


0.0% 0

Couldn’t afford copay --- Hindi kayang bayaran ang copay

0.0% 0

Didn’t know where to go --- Hindi alam kung saan pupunta

0.0% 0


0.0% 0


0.0% 0


0.0% 0

Valid Responses 0

Total Responses 0

Cordova Community Health Needs Assessment - 2013 15 10. Mark any services below that you or a member of your household needed in Cordova during the last 12 months.


Hospice (end of life care) --- Hospisyo (pangangalaga sa pagtatapos ng buhay)

12.5% 2

Respite care --- Pangangalaga habang nagpapagaling

25.0% 4

In-home health care provided by licensed personnel --- Pangangalaga sa loob ng tahanan na ipinagkaloob ng lisensyadong tao

56.3% 9

Support for activities of daily living (Personal Care Attendant) --- Suporta para sa mga araw-araw na gawain (Personal Care Attendant)

50.0% 8

Valid Responses 16

Total Responses 314

10a. Were you or a member of your household able to receive the needed services?


Yes --- Oo 38.5% 25

No --- Hindi 61.5% 40

Not Answered 249

Valid Responses 65

Total Responses 314

Cordova Community Health Needs Assessment - 2013 16 11. In the last 12 months, if you left Cordova to obtain health care elsewhere was it because: (Mark all that apply)


I didn’t leave Cordova to obtain health care elsewhere --- Hindi ako umalis sa Cordova upang makakuha ng pangangalagang pangkalusugan sa ibang lugar

32.5% 91

Needed specialist opinion/surgery/procedure (specify specialty) --- Nangailangan ng opinyon/operasyon/panggagamot ng espesyalista (pakitukoy ang espesyalidad)

41.4% 116

Needed tests that were unavailable in Cordova (e.g. MRI) --- Nangailangan ng mga pagsusuring hindi available sa Cordova (hal., MRI)

28.9% 81

Not insured in Cordova (VNT, USCG, etc.) --- Walang insurance sa Cordova (VNT, USCG, atbp.)

1.8% 5

Cancer treatments --- Mga panggagamot sa kanser

1.4% 4

Concerns with local care --- May mga alalahanin sa lokal na pangangalaga

13.6% 38


7.1% 20

Prefer the quality of out of town health care --- Mas gusto ang kalidad ng pangangalagang pangkalusugan sa labas ng bayan

15.0% 42

Employer reimburses travel costs for health care --- Binayaran ng pinagtatrabahuhan ang ginastos sa pagbibiyahe para sa pangangalagang pangkalusugan

3.2% 9

I had other business to take care of in a larger city --- May iba pa akong mga kinailangang gawin sa mas malaking lungsod

13.6% 38

Referred to another provider by your family doctor --- Ini-refer sa isa pang tagabigay ng serbisyo ng doktor ng inyong pamilya

14.3% 40


11.1% 31

Valid Responses 280


Total Responses 313

Cordova Community Health Needs Assessment - 2013 18 11. In the last 12 months, if you left Cordova to obtain health care elsewhere was it because: Other (specify)

Response

Annual check up

Cancer

Cardiology / optometry

Colonoscopy

Colonoscopy

Colonoscopy

Ct

Daughter was dehydrated from flu. Mark Boyd, PA. Was unsure how to treat

Dermatologist

Dermatologist

Egd

Endocrinologist

Eye doctor

Eye doctor

Eye doctor, dentist

Eyes

Eyes

Flight physical

Follow up after surgery

Gastro int.

GI

Internal med

Knee replacement

Knee replacement

Mallet finger brace

Mammography for previous concerns

Neurology

Ophthalmologist

Ortho

Orthopedic surgeon


Orthopedics, cardiologist

Periodontal

PRP / tendon damage

Surgery

Surgery

Thyroid

Valid Responses 36

Total Responses 316

11a. If yes, how times did you leave to obtain healthcare in the last 12 months?


1-2 57.6% 99

3-4 31.4% 54

5-6 7.0% 12

7-8 2.3% 4

9-10 1.2% 2

Over 10 times 0.6% 1

Not Answered 141

Valid Responses 172

Total Responses 313 12. Do you smoke cigarettes or use smokeless tobacco?


Every day --- Araw-araw 8.3% 25

Some days --- Paminsan-minsan

7.3% 22

Not at all --- Hindi 84.5% 256

Not Answered 10

Valid Responses 303

Total Responses 313

Cordova Community Health Needs Assessment - 2013 20 13. Considering all types of alcoholic beverages, during the past 30 days about how many times did you have 5 or more drinks on an occasion? An occasion is considered about 2 hours. (The definition of a drink of alcohol is 1 can/bottle of beer, or 1 glass of wine, or 1 cocktail, or 1 shot of liquor)


0 67.4% 182

1-2 18.9% 51

3-4 8.1% 22

5-6 1.1% 3

7-8 0.0% 0

9-10 1.5% 4

11-12 0.4% 1

13-14 0.0% 0

15-16 1.9% 5

17-18 0.0% 0

19-20 0.0% 0

21-22 0.0% 0

23-24 0.0% 0

25-26 0.0% 0

27-28 0.4% 1

29-30 0.4% 1

Not Answered 42

Valid Responses 270

Total Responses 312

Cordova Community Health Needs Assessment - 2013 21 14. How acceptable do you find the use of the following for recreational or non-medicinal use?

Very Acceptable Lubos na Katanggap-tanggap

Somewhat Acceptable Bahagyang Katanggap-tanggap

Not at all acceptableHindi Katanggap-tanggap

Total Mean Std Dev

Alcohol --- Alak Count 67 131 94 292 2.092 0.738

% by Row

22.9% 44.9% 32.2% 100.0%

Marijuana --- Marijuana

Count 37 79 170 286 2.465 0.714

% by Row

12.9% 27.6% 59.4% 100.0%

Prescription Drugs --- Mga Inireresetang Gamot

Count 14 32 235 281 2.786 0.518

% by Row

5.0% 11.4% 83.6% 100.0%

Total Count 118 242 499 859 N/A N/A

% by Row

13.7% 28.2% 58.1% 100.0%

15. Would you say that, in general, your physical health is: Response Chart Frequency Count Excellent --- Talagang napakabuti

11.8% 35

Very good --- Napakabuti 41.9% 124

Good --- Mabuti 37.8% 112

Fair --- Karaniwan 7.4% 22

Poor --- Hindi mabuti 1.0% 3

Not Answered 14

Valid Responses 296

Total Responses 310

Cordova Community Health Needs Assessment - 2013 22 16. How many days per week do you engage in physical activity (such as running, walking, aerobics, etc.) for a total of 30 minutes or more?


None --- Wala 11.1% 33

1-2 days --- 1-2 araw 27.2% 81

3-4 days --- 3-4 na araw 36.2% 108

5 or more days --- 5 o higit pang mga araw

25.5% 76

Not Answered 12

Valid Responses 298

Total Responses 310

Cordova Community Health Needs Assessment - 2013 23 17. Within the past year have you made a personal lifestyle change related to better health? For example, lost weight, changed diet, became more physically active, reduced stress, decreased alcohol or tobacco use.


Permanent lifestyle change --- Permanenteng pagbabago ng pamumuhay

35.3% 102

Made lifestyle changes that lasted more than a month but was not permanent --- Nagsagawa ng mga pagbabago sa pamumuhay na tumagal nang mahigit sa isang buwan ngunit hindi naging permanente

18.7% 54

Made short-term changes that lasted a month or less --- Nagsagawa ng mga panandaliang pagbabago na tumagal nang isang buwan o mas maiki

13.5% 39

Considered it but didn’t take action --- Pinag-isipan ito ngunit walang ginawa

7.3% 21

No --- Hindi 25.3% 73

Not Answered 21

Valid Responses 289

Total Responses 310

18. In the past year have you had an annual exam with a physician for preventive purposes? For example, a wellness screen, mammogram, or prostate exam.


Yes --- Oo 61.1% 184

No --- Hindi 38.9% 117

Not Answered 9

Valid Responses 301

Total Responses 310

Cordova Community Health Needs Assessment - 2013 24 19. Have you had biometric screening complete in the past year (cholesterol, blood glucose, Body Mass Index - BMI)?


Yes --- Oo 46.1% 136

No --- Hindi 53.9% 159

Not Answered 15

Valid Responses 295

Total Responses 310

19a. Did you take further action based on the results?


Physician consultation --- Pagpapatingin sa doktor

25.8% 46

Make lifestyle changes (diet or physical activity) --- Gumawa ng mga pagbabago sa pamumuhay (diyeta o pisikal na aktibidad)

25.8% 46

Went on medication --- Nagpagamot

21.3% 38

Online research --- Naghanap ng impormasyon online

15.7% 28

Compare new results to previous results --- Kinumpara ang mga bagong resulta sa mga naunang resulta

18.0% 32

None --- Wala 38.2% 68


3.9% 7

Valid Responses 178

Total Responses 310

Cordova Community Health Needs Assessment - 2013 25 19a. Did you take further action based on the results?

Response

Always take tests to physician

Cannot make changes until moving from Cordova.

Meditation

No changed needed, results good

Tried to increase physical activity and diet

Valid Responses 5

Total Responses 314

Cordova Community Health Needs Assessment - 2013 26 20. About how much do you weigh without shoes?


Under 80 0.4% 1

80 - 89 0.0% 0

90 - 99 0.4% 1

100 - 109 0.7% 2

110 - 119 3.5% 10

120 - 129 3.9% 11

130 - 139 7.4% 21

140 - 149 10.9% 31

150 -159 8.8% 25

160 -169 10.9% 31

170 - 179 10.5% 30

180 - 189 8.8% 25

190 - 199 4.9% 14

200 - 209 7.4% 21

210 - 219 6.0% 17

220 - 229 5.6% 16

230 - 239 2.5% 7

240 - 249 3.5% 10

250 - 259 1.8% 5

260 - 269 0.4% 1

270 - 279 0.7% 2

280 - 289 0.4% 1

290 -300 0.0% 0

More than 300 1.1% 3

Not Answered 25

Valid Responses 285

Total Responses 310

Cordova Community Health Needs Assessment - 2013 27 21. About how tall are you without shoes?


Under 4' 6" 0.7% 2

4' 6" - 4' 7" 0.0% 0

4' 8" - 4' 9" 0.3% 1

4'10" - 5' 0" 6.4% 19

5' 1" - 5' 2" 10.8% 32

5' 3" - 5' 4" 12.9% 38

5' 5" - 5' 6" 21.4% 63

5' 7" - 5' 8" 13.6% 40

5' 9" - 5' 10" 11.5% 34

5' 11" - 6' 12.2% 36

6' 1" - 6' 2" 5.8% 17

6' 3" - 6' 4" 2.7% 8

6' 5" - 6' 6" 0.7% 2

6' 7" - 6' 8" 0.3% 1

6' 9" - 6' 10" 0.0% 0

6'11" - 7' 0.0% 0

Over 7' 0.7% 2

Not Answered 15

Valid Responses 295

Total Responses 310

Cordova Community Health Needs Assessment - 2013 28 22. Where do you get information about health care?


Doctor/provider --- Doktor/tagabigay ng serbisyo

80.1% 237

Internet --- Internet 61.5% 182

Television --- Telebisyon 19.3% 57

Newspaper/magazines --- Pahayagan/magasin

22.0% 65

Friends and family members (word of mouth) --- Mga kaibigan o pamilya (nasabi o napag-usapan)

41.6% 123

Radio --- Radyo 8.1% 24

Scanner Channel (Community Bulletin Board Channel) --- Scanner Channel (Community Bulletin Board Channel)

9.1% 27

Work --- Trabaho 17.6% 52


6.8% 20

Valid Responses 296

Total Responses 310

Cordova Community Health Needs Assessment - 2013 29 22. Where do you get information about health care?

Response

Books

Books

Books

Books, courses

Don't get any

Fb

Fire dept.

Healthcare letters

Here

I do not

Massage therapist

Medical newsletter

Medical studies found in researching statistics and procedures to further emt skills

My private nurse

Personal sources

School - uaa

Self

Wife

Valid Responses 18

Total Responses 314

Cordova Community Health Needs Assessment - 2013 30 23. What do you consider to be the top two greatest health care needs in Cordova?


Dental Care --- Pangangala sa Ngipin

15.4% 44

Diagnostic equipment (MRI, X-Ray) --- Mga kagamitang pang-diagnostics (MRI, X-Ray)

27.6% 79

Elderly Care/Assisted Living --- Pangangalaga sa Matatanda/Tulong sa Pamumuhay

12.2% 35

Long term care --- Pangmatagalang pangangalaga

4.2% 12

Lower costs for patients --- Mas mababang gastos para sa mga pasyente

37.1% 106

More specialists/specialty care --- Mas maraming espesyalista/espesyal na pangangalaga

26.2% 75

More doctors --- Mas maraming doktor

27.3% 78

Mental health services/counseling --- Mga serbisyo sa kalusugan ng pag-iisip/pagpapayo

7.7% 22

OBGYN/Female Health care --- OBGYN/Pangangalagang pangkalusugan para sa Kababaihan

23.1% 66

Pediatric care --- Pangangalaga sa mga bata

11.9% 34

Substance use rehab/counseling --- Rehabilitasyon/pagpapayo sa paggamit ng substansiya

14.3% 41

Vision care --- Pangangalaga sa paningin

15.4% 44

Other (specify) --- Iba pa (tukuyin)

10.8% 31

Valid Responses 286

Total Responses 310

Cordova Community Health Needs Assessment - 2013 31 23. What do you consider to be the top two greatest health care needs in Cordova?

Response

Better quality

CCMC

Child birth at hospital

Consistent, dependable quality care

Consistent, high quality providers / retention

CT Scan machine

Different Doctor than Van W.

Doc stays here

Don't need more doctors, Cordova needs permanent doctors

Dr. That resides here

Dr. Turgeon

E-ICU for less medevacs

Home health

I pay to use the ER & x-ray

In house labs

Just need a doctor to stay

Lack of knowledge - clueless doctors

Long term doctor

Long term doctor instead of itinerant

Marriage counseling

One doctor who stays here so we get to know her or him.

Permanent doctors

Permanent providers

Quality, new technology

Staff that respect confidentiality

Steady doctor

Surgeons

VA

Vet


Veterinarian

Wellness coaching, Life coaches

Valid Responses 31

Total Responses 314

24. Overall, how satisfied are you with your health care services in Cordova?


Very satisfied --- Lubos na nasisiyahan

16.2% 48

Somewhat satisfied --- Bahagyang nasisiyahan

69.3% 205

Not at all satisfied --- Hindi nasisiyahan

14.5% 43

Not Answered 14

Valid Responses 296

Total Responses 310

25. In the last 12 months did you or your family have to go without basic needs such as food, child care, health care, or clothing?


Yes --- Oo 6.5% 19

No --- Hindi 93.5% 273

Not Answered 18

Valid Responses 292

Total Responses 310

Cordova Community Health Needs Assessment - 2013 33 25a. What did you go without? (Mark all that apply)


Health care --- Pangangalagang pangkalusugan

54.5% 12

Dental care --- Pangangalaga sa ngipin

45.5% 10

Prescriptions --- Mga inireresetang gamot

27.3% 6

Clothing --- Damit 9.1% 2

Child care --- Pangangalaga sa bata

4.5% 1

Food --- Pagkain 27.3% 6

Choosing food we wanted --- Pagpili sa pagkaing gusto namin

9.1% 2

Rent/housing --- Upa/bahay

13.6% 3

Heat/fuel/utilities --- Init/gasolina/kuryente, tubig

18.2% 4


9.1% 2

Valid Responses 22

Total Responses 38

25a.What did you go without? Other (specify)

Response

Glasses

Toilet paper. Using rags saves $50/year--I like this.

Valid Responses 2

Total Responses 224

Cordova Community Health Needs Assessment - 2013 34 26. How much of your total household take-home pay (income after taxes) goes to rent/housing costs? Housing costs are considered any type of payment having to do with housing, such as rent or mortgage payments, and utilities.


Less than 33% --- Mas mababa sa 33%

43.1% 121

Between 33% - 49% --- Sa pagitan ng 33% - 49%

32.7% 92

Between 50% - 74% --- Sa pagitan ng 50% - 74%

18.5% 52

75% or more --- 75% o higit pa

5.7% 16

Not Answered 29

Valid Responses 281

Total Responses 310

27. Which of the following best describes your race/ group?


White/Caucasian --- White/Caucasian

79.4% 231

Hispanic/Latino --- Hispanic/Latino

5.2% 15

Alaskan Native/Native American --- Alaskan Native/Native American

6.9% 20

African American --- African American

0.0% 0

Filipino --- Pilipino 3.1% 9

Pacific Islander --- Pacific Islander

0.7% 2

Asian --- Asian 1.7% 5

Multi-ethnic --- Iba‘t iba ang etnisidad

0.7% 2

Other --- Iba pa 2.4% 7

Not Answered 19

Valid Responses 291

Total Responses 310

Cordova Community Health Needs Assessment - 2013 35 28. Which income range best describes your annual household income?


Less than $10,000 --- Mas mababa sa $10,000

4.0% 11

$10,000 to $19,999 --- $10,000 hanggang $19,999

10.7% 29

$20,000 to $29,999 --- $20,000 hanggang $29,999

7.4% 20

$30,000 to $39,999 --- $30,000 hanggang $39,999

8.1% 22

$40,000 to $49,999 --- $40,000 hanggang $49,999

7.4% 20

$50,000 to $59,999 --- $50,000 hanggang $59,999

11.4% 31

$60,000 to $74,999 --- $60,000 hanggang $74,999

13.2% 36

$75,000 to $99,999 --- $75,000 hanggang $99,999

15.8% 43

$100,000 to $124,999 --- $100,000 hanggang $124,999

12.9% 35

$125,000 or more --- $125,000 o higit pa

9.2% 25

Not Answered 38

Valid Responses 272

Total Responses 310

Cordova Community Health Needs Assessment - 2013 36 29. What is the highest level of education you have completed? Response Chart Frequency Count No high school diploma --- Walang high school diploma

4.1% 12

High school diploma or GED --- Diploma sa high school o GED

15.7% 46

Some college, no degree --- Nag-aral sa kolehiyo, walang degree

29.0% 85

AA degree --- AA degree 9.2% 27 Four year college degree --- Apat na taong degree sa kolehiyo

25.9% 76

Master’s degree or higher --- Master's degree o mas mataas

16.0% 47

Not Answered 17

Valid Responses 293

Total Responses 310 30. What is your age in years?


Less than 25 5.6% 16

25 - 34 13.2% 38

35 - 44 16.4% 47

45 - 64 48.4% 139

65 - 74 13.2% 38

75 or more 3.1% 9

Not Answered 22

Valid Responses 287

Total Responses 309

Cordova Community Health Needs Assessment - 2013 37 31. Are you:


Male --- Lalaki 36.9% 108

Female --- Babae 63.1% 185

Not Answered 16

Valid Responses 293

Total Responses 309


Appendix 4


Community/Demographic Profile – Primary Data Results Population The population for the community of Cordova is 2,270. Population has declined since 1997, however according to future projections provided by ESRI for the Valdez-Cordova Census Area the population is expected to grow slightly over the next five years. We would anticipate the same growth trajectory for the community of Cordova. Alaska is anticipated to grow by 6.6% or 48,688 people over the next five years, while the US population is expected to grow by 3.5%. 2012 and 2017 Population

% Change Change

2012 2017 (2012-2017) (2012-2017)

Cordova 2,270 NA - -

Valdez-Cordova Service Area 10,029 10,382 3.5% 353

Alaska 732,814 781,502 6.6% 48,688

USA 313,129,017 323,986,227 3.5% 10,857,210

ESRI Business Information Solutions, 2013 Population by Age Population was grouped into major age categories for comparison. In general, the Valdez-Cordova Census Area has a significantly higher proportion of people ages 45-64 than Alaska and the Nation. Conversely, the proportion of people ages 20-24 and 25-44 is lower than Alaska and the Nation. The service area population is expected to continue aging over the next five years, as the proportion of people ages 65-74 continues to rise. This will likely cause a rise in health care utilization as older populations tend to utilize health care services at a higher rate. Health needs will also continue to shift toward disease categories that tend to present at an older age.

Cordova Community Health Needs Assessment - 2013 2 2012 and 2017 Population Age Distribution

ESRI Business Information Solutions, 2013 Population by Race and Ethnicity CCMC’s service area is predominantly white, equating to roughly 73% of the total population and Alaskan Native, equating to roughly 13% of the population. Roughly 4% of the service area population is Asian. The racial distribution aligns with that of Alaska, though the proportion of Alaskan Natives in Alaska is slightly higher than Valdez-Cordova. It is important for CCMC to continue outreach with this subpopulation to ensure that the health needs of all population groups within the County are being met.

26%

5%

24%

34%

7%

3%

29%

7%

27% 27%

6%

3%

26%

7%

26% 26%

9%

6%

0%

5%

10%

15%

20%

25%

30%

35%

40%

0-19 20-24 25-44 45-64 65-74 75+

2017 Age Distribution

Valdez-Cordova Alaska USA

26%

6%

24%

35%

6%

3%

29%

8%

28% 28%

5%

3%

26%

7%

26% 26%

7%6%

0%

5%

10%

15%

20%

25%

30%

35%

40%

0-19 20-24 25-44 45-64 65-74 75+

2012 Age Distribution


Cordova Community Health Needs Assessment - 2013 3 2012 and 2017 Population by Race

ESRI Business Information Solutions, 2013 Income Income data was analyzed for the Valdez-Cordova Census Area and compared to the state of Alaska and the Nation. 2012 census data reveals that Median and Average household income for the Valdez-Cordova Census Area is lower than the State but higher than the Nation. Over the next five years, income levels are expected to rise in the Valdez-Cordova Census Area, Alaska, and the Nation in line with inflation.

2012 - Population by

RaceNumber Percent Number Percent Number Percent

White Alone 7,346 73% 485,176 66% 225,289,662 72%

Black Alone 76 1% 25,815 4% 39,536,577 13%

Alaskan Native 1,340 13% 106,729 15% 3,010,559 1%

Asian Alone 400 4% 40,441 6% 15,239,038 5%

Pacific Islander Alone 63 1% 7,633 1% 552,594 0%

Some Other Race Alone 55 1% 12,169 2% 20,008,464 6%

Two or More Races 749 7% 54,851 7% 9,492,123 3%total 10029 732,814 313,129,017

2017 - Population by

RaceNumber Percent Number Percent Number Percent

White Alone 7,426 72% 506,122 65% 228,784,341 71%

Black Alone 138 1% 31,256 4% 41,359,936 13%

Alaskan Native 1,336 13% 111,701 14% 3,244,199 1%

Asian Alone 480 5% 46,571 6% 16,950,165 5%

Pacific Islander Alone 85 1% 8,757 1% 615,508 0%

Some Other Race Alone 68 1% 14,366 2% 22,299,085 7%

Two or More Races 849 8% 62,729 8% 10,732,993 3%



Cordova Community Health Needs Assessment - 2013 4 2012 and 2017 Income Levels

ESRI Business Information Solutions, 2013 Secondary Data Results The County Health Rankings display health rankings of nearly every county in the nation and what influences the health of a county. They measure four types of health factors: health behaviors, clinical care, social and economic, and physical environment factors. In turn, each of these factors is based on several measures. A subset of the major health rankings are analyzed in this report. Overall, the Valdez-Cordova Census Area ranked #14 out of 23 Counties/Census Areas ranked in the state for health outcomes based on the data collected by County Health Rankings. Birth Statistics Rates of low birth rates in a community are often associated with poor health of the mothers. Low birth rates can lead to higher incidences of fetal mortality, inhibited growth, and cognitive developments and chronic disease in later life, and is generally a predictor of newborn health and survival. Low birthweight percentages in the Valdez-Cordova Census Area are slightly lower than in Alaska and the Nation, and have been declining since 2010.

2012

Number Number NumberMedian Household Income 62,095 64,362 50,157

Average Household Income 79,474 81,956 68,162

Per Capita Income 32,631 30,678 26,409

2017

Number Number NumberMedian Household Income 71,739 76,694 56,895

Average Household Income 88,789 93,232 77,137

Per Capita Income 37,204 35,042 29,882

Valdez-

CordovaAlaska USA

Valdez-

CordovaAlaska USA


County Health Rankings, 2013 Teen birth rates were also analyzed for the Valdez-Cordova Census Area and compared to Alaska and the Nation. Teen birth rates in the Valdez-Cordova Census Area are significantly lower than Alaska but slightly higher than national benchmarks. The percentage of children in poverty in the Valdez-Cordova Census Area has also been lower than in Alaska but trending upward over the past two years. This is an important group as poverty among children can often be associated with many negative health consequences throughout childhood.

County Health Rankings, 2013 Insurance Individuals without health insurance often forego care due to high cost, which can lead to a higher prevalence of chronic conditions. The goal of the Affordable Care Act, which should start to take effect in 2014, is to lower the rate of uninsured and thereby reduce the negative health consequences stemming from lack of affordable health insurance. The uninsured rate in the Valdez-Cordova Census Area is higher than Alaska, and more than double the national benchmark.

5.9% 5.9%

5.9%5.9%

6.2%

5.4% 5.3%

6.0%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

2010 2011 2012 2013

Low birthweight - Percent of live births with low birthweight (< 2500 grams)

Alaska Valdez-Cordova National Benchmark (90th %ile)

44 4441 42

3128 23 25

21

0

10

20

30

40

50

2010 2011 2012 2013

Teen birth rate - Teen birth rate per 1,000 female population, ages 15-19


13%12% 15%

15%

10% 10%11% 11%

14%

0%

2%

4%

6%

8%

10%

12%

14%

16%

2010 2011 2012 2013

Children in poverty - Percent of children under age 18 in poverty



County Health Rankings, 2013 Death Statistics The top five leading causes of death in the Valdez-Cordova Census Area were analyzed for 2007-2009 and compared to Alaska. Cancer ranks as the number one leading cause of death, followed by heart disease and unintentional injuries.

Cause of Death (ICD-10 Codes)

Rank DeathsCrude Rate3

Age-Adjusted Rate4

AK Rank

AK Crude Rate3

AK Age-Adjusted Rate4

Malignant Neoplasms (C00-C97)

1 36 127.0 157.0 1 126.0 182.9

Diseases of the Heart (I00-I09, I11, I13, I20-I51)

2 31 109.4 145.3 2 94.9 151.2

Unintentional Injuries (V01-X59, Y85-Y86)

3 21 74.1 77.1 3 50.0 55.3

Cerebrovascular Diseases (I60-I69)

4 12 42.3* 80.8* 5 23.8 43.1

Chronic Lower Respiratory Diseases (J40-J47)

5 11 38.8* 71.5* 4 26.8 46.5

TOTAL DEATHS 164 578.7 769.1 515.6 764.3

Alaska Bureau of Vital Statistics, 2007-2009

18%22% 23%

21%24%

27% 25% 25%

11%

0%

5%

10%

15%

20%

25%

30%

2010 2011 2012 2013

Uninsured adults - Percent of adults under age 65 without health insurance


Cordova Community Health Needs Assessment - 2013 6 General Population Health One measure of health among the community included in the County Health Rankings Nationwide study is reported general well-being. Reported general health of “poor or fair health” in the Valdez-Cordova Census Area was slightly higher than Alaska, and both are higher than the Nation. What this means is that the population in the Valdez-Cordova Census Area considers themselves to be slightly less healthy in general. A similar self-reported measure is “poor physical health days,” which refer to days in which an individual does not feel well enough to perform daily physical tasks. Rates in the Valdez-Cordova Census Area are above Alaska and significantly above the Nation.

County Health Rankings, 2013 A third measure of general health of the population is the percentage of adult obesity. Nationally, the 90th percentile benchmark rate has been around 25% of the population. In Alaska, the percentage of adults who are obese has remained steady at 28% through 2013. The percentage is slightly higher in the Valdez-Cordova Census Area, at around 29% in 2013, but down from a high of 33% in 2011. The health ramifications stemming from obesity are significant.

County Health Rankings, 2013

14% 14% 13%13%

15% 17% 16% 16%

10%

0%

5%

10%

15%

20%

25%

2010 2011 2012 2013

Poor or fair health - Percent of adults reporting fair or poor health (age adjusted)


3.5 3.5 3.5 3.5

3.9 3.9 4.1 4.1

2.6

0.0

1.0

2.0

3.0

4.0

5.0

2010 2011 2012 2013

Poor physical health days - Average number of physically unhealthy days reported in past 30 days (age adjusted)


28% 28% 28% 28%32% 33% 29% 29%

25%

0%

5%

10%

15%

20%

25%

30%

35%

2010 2011 2012 2013

Adult obesity - Percent of adults that report a BMI >= 30


Cordova Community Health Needs Assessment - 2013 7 Another indicator, “Poor mental health days,” refers to the number of days in the previous 30 days when a person indicates their activities are limited due to mental health difficulties. The reported days in the Valdez-Cordova Census Area are higher than Alaska and the Nation. They have risen slightly since 2010 but appear flat from 2012-2013. Mental health has come into the spotlight nationally as an area where continued focus and improvements efforts are warranted.

County Health Rankings, 2013 Adult Smoking Cigarette smoking is identified as a cause of various cancers, cardiovascular disease, and respiratory conditions, as well as low birthweight and other adverse health outcomes. Measuring the prevalence of tobacco use in the population can alert communities to potential adverse health outcomes and can be valuable for assessing the need for cessation programs or the effectiveness of existing programs. The percentage of adults that report smoking in the Valdez-Cordova Census Area has hovered at round 25%, which is slightly above Alaska’s rate and significantly above the national benchmark rate of 13%.


3.0 3.0 3.0 2.9

3.3 3.33.5

3.5

2.3

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

2010 2011 2012 2013

Poor mental health days - Average number of mentally unhealthy days reported in past 30 days (age adjusted)


25%23% 23% 22%

26% 25% 24% 25%

13%

0%

5%

10%

15%

20%

25%

30%

2010 2011 2012 2013

Adult smoking - Percent of adults that report smoking >= 100 cigarettes and currently smoking


Cordova Community Health Needs Assessment - 2013 8 Preventable Hospital Stays Hospitalization for diagnoses treatable in outpatient services suggests that the quality of care provided in the outpatient setting was less than ideal. The measure may also represent a tendency to overuse hospitals as a main source of care. Rates for the Valdez-Cordova Census Area have varied over the past four years, to 40 per 1,000 Medicare enrollees in 2013. The rate has been consistently lower than the Alaska rate, and fell below the national benchmark rate in 2013.

Screening Screening for potential health issues is a major indicator of future health issues within a community. Diabetes, which is one of the major health issues impacting our society today, was analyzed. Diabetes screening rates in the Valdez-Cordova Census Area have fluctuated between 67%-77% over the past four years. Similar to Alaska rates, this is significantly lower than the National Benchmark.


60 6055 55

47 4650

40

47

0

25

50

75

2010 2011 2012 2013

Preventable hospital stays - Rate for ambulatory-care sensitive conditions per 1,000 Medicare enrollees


67%69% 69% 70%

71%77%

73%

90%

0%

20%

40%

60%

80%

100%

2010 2011 2012 2013

Diabetic screening - Percent of diabetic Medicare enrollees that receive HbA1c screening


Cordova Community Health Needs Assessment - 2013 9 Mammography screening rates in the Valdez-Cordova Census Area have climbed from 46% in 2011 up to 63% in 2013, which is still below the National Benchmark rate of 73% but above the Alaska rate of 57%.


55% 58%

57%

46%51%

63%

73%

0%

10%

20%

30%

40%

50%

60%

70%

80%

2011 2012 2013

Mammography screening - Percent of female Medicare enrollees that receive mammography screening



Appendix 5


Existing Healthcare Resources

Cordova Community Medical Center 602 Chase Avenue/PO BOX 160, Cordova, Alaska 99574

− Inpatient, ER, Clinic, LTC − Senior Ride Program (Transportation services) − Senior Lunch Program (free meals to seniors over 60, recommended

donation $3.00) − Sound Alternatives – Behavioral Health (OP) Substance abuse services Personal Care Assistant Tele-psych in sound alternatives Respite program through Sound Alternatives

− Physical Therapy / Occupational Therapy − E-ICU − Lab/Radiology Services − Visiting Specialists Pediatrician comes in quarterly Ophthalmologist twice per year Orthopedist comes in quarterly Optometrist comes in quarterly

Ilanka Community Health Clinic (FQHC)

705 Second Street/PO BOX 2290, Cordova, Alaska 99574 − Operates a transportation program − Preventative Care − Acupuncture − Behavioral Health − In House Labs − Free Blood Pressure Checks − Epidural Steroid Injections − Women’s Health − Prenatal Care − Free Nail Care for Seniors and Diabetics − Immunizations − Laceration Repairs − Diabetic Education − Home Visits

Public health nurse, State of Alaska 110 Nicholoff Way/ PO BOX 359, Cordova, Alaska 99574 − Diabetes Education Program


Dental Provider (Dr. Urata) 301 Browning Avenue/PO BOX 518, Cordova, Alaska 99574 - Orthodontist visits on a regular basis

Chiropractor (Dr. Bartley)

105 W. Council Avenue/PO BOX 579, Cordova, Alaska 99574 Family Crisis Recovery Center (Victims of abuse)

Cordova Family Resource Center 705 Second Street, PO BOX 863, Cordova, Alaska 99574

Retail Pharmacy

516 First Street/PO BOX 220, Cordova, Alaska 99574 Fitness center with pool (City of Cordova)

Bidarki Recreation Center 401 Council Avenue, PO BOX 1210, Cordova, Alaska 99574 Bob Korn Memorial Pool 609 Railroad Avenue, PO BOX 1210, Cordova, Alaska 99574

Waterways Veterinary Clinic (Kenneth A Hill, DVM) Visits from his Petersburg office


Appendix 6


Cordova

Community Health Needs Assessment Implementation Plan

September 30th, 2013

Table of Contents

Priority: 1 .........................................................................................................................................Priority: 2 ......................................................................................................................................... Priority: 3 ......................................................................................................................................... Priority: 4 ......................................................................................................................................... Priority: 5 .........................................................................................................................................


Priority: 1 – Attracting and Retaining Medical Providers Cordova has suffered a pattern of physician turnover due to many factors including high cost of living, housing availability, being excluded from key decisions within their organizations and the unique lifestyle demands that come with living in a small isolated Alaskan city in a rainy and wintery climate. The inconsistency in providers has impacted the continuity and quality of care for community members over time. Patients feel poorly understood and disconnected when there is a different caregiver from one visit to the next. The inconsistency in care has negatively impacted patient trust in their care giver. This situation has lead to lower utilization of preventive care and people waiting to receive care when they can to travel Anchorage or other larger communities where they can have a consistent provider they can come to know and trust over time.

Objective/Strategy

To attract and retain medical providers in order to improve the consistency of care for the community of Cordova.

Tactics (How)

Establish a comprehensive welcome package to send to candidates prior to visit in order to better inform them about the Cordova community and help ensure better fit for the hospital and the Cordova community.

Establish a locum tenens program so that physician candidates may work a minimum of two weeks at CCMC prior to employment in order for the physician and CCMC to better assess fit and help increase physician retention once hired.

Engage key community members to help introduce provider to community.

Coordinate with leadership from NVE/Ilanka Clinic and other key health stakeholders in Cordova to collectively meet with and educate the candidates about health care environment and needs in Cordova to ensure candidates have a clear picture of the health system they would be working in.

Programs/Resources to Commit

CCMC HR

CCMC Administrator support

CCMC Clinical Locum Tenens Program

Impact of Programs/Resources on Health Need

Increased retention of CCMC providers (Time of Service)

Accountable Parties

Theresa Carté, CCMC Administrator

Partnerships/Collaboration

NVE/Ilanka Clinic


Priority: 2 – Access to Specialty Care Like many small rural communities, Cordova lacks many specialty and diagnostic services. As a result many are forced to travel to larger communities at great expense and family hardship to get the needed services. The economics of delivering health services to a small population sometimes make it unfeasible to maintain certain specialties and services locally, but ensuring the reasonable access to these services is important to the health and well being of the community. Objective/Strategy

Access to Speciality Care

Mental Health/Substance Abuse

Tactics (How)

Identify most needed specialties in Cordova

Identify Specialists in Anchorage to meet the needs identified through assessment

Leverage Telehealth technologies at CCMC/Sound Alternatives/ICHC to provide Specialist follow‐up visits and confidential, outside‐Cordova therapy/counseling visits


HR Resources to assist with Contracting and Credentialing of Specialists

Advertising and Marketing of Specialist visits and availability of tele‐therapy

Equipment and space for Specialist to practice


Decreased need for Cordova residents to travel to Anchorage for speciality care (see questions 1b and 11 on survey). Increased access to mental health and substance abuse counseling and therefore decrease in depression, suicide, and alcohol consumption. (see questions 6 through 13 on survey)

Accountable Parties

Tim James (Human Resources Coordinator‐credentialing and privileging providers)

Stephen Sundby (Executive Director of Sound Alternatives‐develop process and therapists for tele‐therapy)

Tim Kelly (CFO‐determine financial model for billing for these services)

Theresa Carté (CEO‐coordinate with ICHC and work with Providence to identify Specialists willing to support Cordova)


Cordova Community Medical Center

NVE/Ilanka Clinic

Providence Health & Services Alaska


Priority: 3 – Affordability of Health Care The affordability of health care was identified by the community as a significant barrier to receiving needed health care services. The impact of this barrier is compounded by the high cost of living in an isolated rural Alaskan community, the low rate of residents seeking preventive care and whether or not a community member has health insurance.

Objective/Strategy

Increase access to care by improving affordability and the number of residents with health insurance

Tactics (How)

Identify Specialists in Anchorage to meet the needs identified through assessment (Also in priority 2)

Leverage Telehealth technologies at CCMC/Sound Alternatives/ICHC to provide Specialist follow‐up visits and confidential, outside‐Cordova therapy/counseling visits (Also in priority 2)

Continue Charity Care services for qualifying community members

Utilize admissions and other entry points to provide information and refer uninsured Cordova residents to Insurance Exchange resources.


Admission and point‐of‐entry services

Tele‐health equipment and conference room

IT support


Reduce the number of Cordova residents that have to seek specialty care outside of Cordova

Increase the percentage of people who have health insurance coverage in the Cordova service area to improve their access to care

Accountable Parties

Tim James (Human Resources Coordinator‐credentialing and privileging providers)

Stephen Sundby (Executive Director of Sound Alternatives‐develop process and therapists for tele‐therapy)

Tim Kelly (CFO‐determine financial model for billing for these services)

Theresa Carté (CEO‐coordinate with ICHC and work with Providence to identify Specialists willing to support Cordova)


Providence Health & Services Alaska

Alaska Psychiatric Institute

NVE/Ilanka Clinic


Priority: 4 – Care Coordination Across Healthcare Providers Despite Cordova’s small size the community identified fragmentation and lack of coordination of care across the continuum as a problem. Key stakeholders and health providers acknowledged that there is not a common understanding of the services and resources available from organization to organization within Cordova. The community has affirmed that there is a need for better information, education, coordination and patient navigation across the continuum of care in Cordova. Addressing this need will reduce barriers to care, improve the efficiency across the health system in Cordova and improve the quality of care and outcomes experienced by patients.

Objective/Strategy

Care Coordination Across Healthcare Providers

Tactics (How)

Collaborate with coalition of Cordova providers and other key stakeholders to establish a health resources guide/reference for providers and residents of Cordova

Utilize the monthly provider meeting to increase communication and mutual understanding of available resources and services


City of Cordova – web page links and information sharing (Newcomer’s Briefing)

Project leader – individual to head up work, collect information from various sources, and keep work on a timeline

Contributors – CCMC, NVE, ICHC, PHN, Dentist, Chiropractor, FCRC, Pharmacy, Cordova Parks and Recreation department, Massage therapists

Costs of printing and distribution

CCMC will be represented at all monthly provider meetings


Reduce write in responses on survey on “Didn’t know where to go” and question 6b answer “Didn’t know where to go” for mental health services (currently at 27.3%) so that people in Cordova are better informed of their health options and are able to obtain more timely and effective treatment

Healthcare providers in Cordova better informed about what else is available in Cordova (what others offer) so improved referrals to care for people in Cordova

Accountable Parties

Theresa Carté (CEO CCMC – facilitate identification of project leader)

Kari Collins (DON CCMC – support contribution of CCMC to this work)


All Cordova located health care providers and key stakeholders, see Contributor list above


Priority: 5 ‐ Mental Health/Substance Abuse Poor mental health and the related issue of substance abuse were identified as problems in the Cordova community. The average number of poor mental health days reported for the previous 30 days was 3.5 compared to 2.3 nationally. Of particular concern for the community was the impact of poor mental health on Cordova’s youth, the risks of suicide and the lack of healthy youth activities.

Objective/Strategy

Reduce substance abuse – especially in youth

Reduce barriers to utilization of mental health services

Tactics (How)

Establish healthy youth activities in Cordova by o offering Cordova High School students job shadowing opportunities at the

hospital o offering CPR/First Aid classes o Supporting CNA training o Providing Babysitting training/certification o Identifying trainers and creating process

Help address concerns regarding confidentiality as a barrier to seeking mental health services (see Objective /Strategy 1 for this Tactic)


HR efforts for tracking training and job shadowing students and CNA students

Advertising/Marketing of training opportunities

Training


Increased opportunities for young people to be involved in healthy activities as an alternative to substance use during idle time (i.e.health care and learning useful life skills)

Decrease percent of people reporting not being able to receive needed mental health services.

Accountable Parties

Tim James (HR Coordinator‐tracking and documenting students in hospital)

Kari Collins (DON‐create new programs)


CCMC

Prince William Sound Community College

Cordova High School

Cordova Fire Department


Appendix 7

Summary of the Cordova Community Health Needs Assessment and Community Benefit Plan

Summary of 2013 Cordova Community Health Needs Assessment and Community Benefit Plan

Completion Date September 2013 (Approved by Cordova Health Services Board October 2, 2013)

Service Area/Region Cordova Community Medical Center (CCMC) serves the Cordova community in the Alaska Region

Sponsor Theresa Carté, Administrator

Planning/Mission Team

Monica Anderson, Chief Mission Integration Officer, PHSA Nathan Johnson, Strategic Planning, PHSA

Workgroup Participants

See Attachment 1: CCMC and Community Advisory Group

Brief Description of How the Community Benefit Plan Was Developed

In early 2013 CCMC Cordova Community Medical Center (CCMC) initiated the process of conducting a community health needs assessment along with a coalition of experts and key community stakeholders that served as the CHNA Advisory Group (See attachment 1 below)

Both primary and secondary data was collected. Over 300 health needs surveys were completed by community members. This survey information was combined with state and national data to help give a picture of the health status and needs in the Cordova Community.

The Cordova Community Health Needs Assessment data was analyzed and reviewed by community members, agency leaders, public health representatives, providers, and community leaders (the advisory group). The group identified five top health issues based on impact, ability to affect and linkages to other community initiatives.

CCMC leadership reviewed the top health needs, considered the community’s advice and Advisory Group input, and evaluated previous commitments in order to develop a CHNA implementation plan that responds to community health needs.

Geographic Definition The CHNA assessed the Cordova community. CCMC is the only hospital located in Cordova.

Targeted Subpopulations

The CHNA assessed the Cordova community. The assessment was designed to capture specific demographic information, barriers to care, basic needs, insurance status, health status and other risk factors that would identify and affect subpopulations of the greater Cordova community.



Major Issues/Needs Identified Within the Community

Need Priorities Need Description

1. Attracting

and

Retaining

Medical

Providers

Cordova has suffered a pattern of physician turnover due to many factors including high cost of living, housing availability, being excluded from key decisions within their organizations and the unique lifestyle demands that come with living in a small isolated Alaskan city in a rainy and wintery climate. The inconsistency in providers has impacted the continuity and quality of care for community members over time. Patients feel poorly understood and disconnected when there is a different caregiver from one visit to the next. The inconsistency in care has negatively impacted patient trust in their care giver. This situation has lead to lower utilization of preventive care and people waiting to receive care when they can to travel Anchorage or other larger communities where they can have a consistent provider they can come to know and trust over time.

2. Access to

Specialty

Care

Like many small rural communities, Cordova lacks many specialty and diagnostic services. As a result many are forced to travel to larger communities at great expense and family hardship to get the needed services. The economics of delivering health services to a small population sometimes make it unfeasible to maintain certain specialties and services locally, but ensuring the reasonable access to these services is important to the health and well being of the community.

3. Affordability

of Care

The affordability of health care was identified by the community as a significant barrier to receiving needed health care services. The impact of this barrier is compounded by the high cost of living in an isolated rural Alaskan community, the low rate of residents seeking preventive care and whether or not a community member has health insurance.

4. Care

Coordination

Across

Healthcare

Providers

Despite Cordova’s small size the community identified fragmentation and lack of coordination of care across the continuum as a problem. Key stakeholders and health providers acknowledged that there is not a common understanding of the services and resources available from organization to organization within Cordova. The community has affirmed that there is a need for better information, education, coordination and patient navigation across the continuum of care in Cordova. Addressing this need will reduce barriers to care, improve the efficiency across the health system in Cordova and improve the quality of care and outcomes experienced by patients.

5. Mental

Health/

Substance

Abuse

Poor mental health and the related issue of substance abuse were identified as problems in the Cordova community. The average number of poor mental health days reported for the previous 30 days was 3.5 compared to 2.3 nationally. Of particular concern for the community was:

The impact of poor mental health on Cordova’s youth, the risks of suicide and the lack of healthy youth activities

The impact of changing provider base and confidentiality concerns on people’s trust and willingness to seek treatment



How CCMC is Addressing the Major Issues/Needs (projects/programs – Implementation Strategy)

Need Priorities CCMC Implementation Plan to Address Identified Need

1. Attracting

and

Retaining

Medical

Providers

Establish a comprehensive welcome package to send to candidates prior to visit in order to better inform them about the Cordova community and help ensure better fit for the hospital and the Cordova community.

Establish a locum tenens program so that physician candidates may work a minimum of two weeks at CCMC prior to employment in order for the physician and CCMC to better assess fit and help increase physician retention once hired.

Engage key community members to help introduce provider to community.

Coordinate with leadership from NVE/Ilanka Clinic and other key health stakeholders in Cordova to collectively meet with and educate the candidates about health care environment and needs in Cordova to ensure candidates have a clear picture of the health system they would be working in.

2. Access to

Specialty

Care

Identify most needed specialties in Cordova

Identify Specialists in Anchorage to meet the needs identified through assessment

Leverage Telehealth technologies at CCMC/Sound Alternatives/ICHC to provide Specialist follow‐up visits and confidential, outside‐Cordova therapy/counseling visits

3. Affordability

of Care

Identify Specialists in Anchorage to meet the needs identified through assessment (Also in priority 2)

Leverage Telehealth technologies at CCMC/Sound Alternatives/ICHC to provide Specialist follow‐up visits and confidential, outside‐Cordova therapy/counseling visits (Also in priority 2)

Continue Charity Care services for qualifying community members

Utilize admissions and other entry points to provide information and refer uninsured Cordova residents to Insurance Exchange resources.

4. Care

Coordination

Across

Healthcare

Providers

Collaborate with coalition of Cordova providers and other key stakeholders to establish a health resources guide/reference for providers and residents of Cordova

Utilize the monthly provider meeting to increase communication and mutual understanding of available resources and services

5. Mental

Health/

Substance

Abuse

Establish healthy youth activities in Cordova by o offering Cordova High School students job shadowing

opportunities at the hospital o offering CPR/First Aid classes o Supporting CNA training o Providing Babysitting training/certification o Identifying trainers and creating process

Help address concerns regarding confidentiality as a barrier to seeking mental health services (see Priority 1 – tele‐health)



Why CCMC Selected These Projects/Programs/ collaborations

Focusing on areas of core competency for CCMC and leveraging community assets through collaborative efforts is the most effective and sustainable way to address community problems. In addition to building on CCMC’s areas of strength, CCMC chose strategies that involve collaboration with other key community stakeholders to address needs identified in the Cordova needs assessment.

How Others in the Community Are Addressing the Major Issues/Needs

Native Village of Eyak / Ilanka Community Health Center (NVE/ICHC) continues to offer a sliding fee schedule to ensure that no financial barriers to care exist for those who meet certain financial eligibility criteria

NVE/ICHC has purchased ophthalmology equipment to offer those Specialty Services here in Cordova

Other providers have made a commitment to the attend the Monthly Provider meeting regularly to address coordination of care

NVE/ICHC offers an annual Sobriety Event and an array of behavioral health services Emergency Services, PHN, and NVE/ICHC expressed interest in collaborating on a Cordova health resources guide

Major Issues/Needs that Are Not Addressed by CCMC or Others in the Community

CCMC’s implementation plan addresses, to varying degrees, all priorities identified by the Cordova CHNA advisory group and the CHNA.

Goals and Objectives of the Community Benefit Plan

Increased retention of CCMC providers (Time of Service)

Reduce the number of residents that have to leave Cordova for specialty care

Increase the percentage of people who have health insurance coverage in the Cordova service area to improve their access to care

Increase awareness of available services in Cordova so that people in Cordova are better informed of their health options and are able to obtain more timely and effective treatment

Healthcare providers in Cordova better informed about what else is available in Cordova (what others offer) so improved referrals to care for people in Cordova

Increased opportunities for young people to be involved in healthy activities as an alternative to substance use during idle time (i.e. health care and learning useful life skills)

Decrease percent of people reporting not being able to receive needed mental health services



Attachment I: CCMC and Community Advisory Group

Cordova CHNA Advisory Group Member

Position/Organization

Barb Bunte Public Health Nurse/State of Alaska

Faith Wheeler‐ Jeppson Administrative Asst./CCMC

Don Moore/Randy Robertson Interim City Manager/ City Manager/ City of Cordova

George Wintle Chief of Police/City of Cordova

James Kacsh Cordova Mayor (former Health Services Board Member)

Joanie Behrends EMT/Cordova Volunteer Fire Dept.

Joel Azure Executive Director/Native Village of Eyak (Ilanka Community Health Center)

Kari Collins Director of Nursing/CCMC

Kelsey Appleton Fishing Vessel Administrator/SERVS ‐ Cordova Fishermen District United

Kristin Carpenter Executive Director/Copper River Watershed Project

Nicole Songer Executive Director/Cordova Family Resource Center

Ron Ray Advanced Nurse Practitioner/Ilanka Health Clinic

Stephen Sundby Director/Sound Alternatives

Theresa Carté Hospital Administrator/CCMC

Tim James Human Resources Coordinator/ CCMC

Tim Kelly Chief Financial Officer/ CCMC

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