Okanogan County Public Hospital District No. 3...identified. Finally, Lightbeam was appr oved for...

Okanogan County Public Hospital District No. 3

Community Health Needs Assessment

Implementation Plan

December 31, 2016

Table of Contents

Priority: 1 Mental Healthcare Access ........................................................................................................... 1

Priority: 2 Access to Healthcare.................................................................................................................... 3

Priority: 3 Education ..................................................................................................................................... 5

Priority: 4 Obesity ......................................................................................................................................... 8

Page 1

Priority: 1 Mental Healthcare Access

Objective

Increase mental health services in the community

Tactics

Meet quarterly with local/regional mental health providers to coordinate care/problem

solve;

Increase “on-site” services to meet the needs of mental health patients in the ED

Develop policy and procedures specific to behavioral health needs

Programs/Resources to Commit

Clinic/ED resources/time/staff

Telepsychiatry services available at the rural health clinic

Impact of Programs/Resources on Health Need

Increased access to onsite mental health/substance abuse services

Accountable Parties

Okanogan County Public Hospital District No. 3 d/b/a Mid-Valley Hospital and the

regional collaborative group.

Partnerships/Collaboration

Okanogan Behavioral Healthcare

Opioid Summit

Mental Healthcare Access Update

ED: Mid Valley Hospital provides Mental Health Exams via Okanogan Behavioral

Health Center. We provide a safe space to detained psychiatric patients waiting for

inpatient treatment. Implemented a sitter program.

Page 2

Clinic: MVC implemented tele-behavioral health services starting Spring, 2017 with

three different providers:

o A psychologist, Terri Greer, in Wenatchee

o Forefront – who sees Medicare and other insurances, but is not currently seeing

Medicaid patients. These psychiatrists manage medications

o Pathways – who bills Medicaid and other insurances, but not Medicare yet, and

who provides both Behavioral Health and Chemical Dependency Counseling.

o In addition to chemical dependency counseling, we have invited Dr. Haeger

with New Start Clinic to speak to our Family Practice Provider Group in

November regarding his new chemical dependency services and about his plans

to have clinic held at OBHC. Administration: Our participation is based on regional involvement to form a cross

system of care utilizing patient centered model to enhance and provide greater service

for the population of north central Washington. We will continue to partner with the

regional ACH to assist in providing patient center care based on combining physical

health and behavioral health through alternative methods in addition working

collaboratively on the Opioid Issue. Opioid Summit Meetings: The NCACH (North Central Accountable Communities of

Health) CHI (Coalition on Health Improvement) Meets quarterly to bring stakeholders

together to find creative ways to combat the opioid crisis in our community.

4/2/18 Dr. Terri Greer’s office added an MSW and Chemical Dependency Counselor

adding additional services to our patients. OBHC added the WISE Program for

troubled teens. Dr. Haeger, New Start Clinic, met with our FP team as scheduled. We

have implemented PHQ9 surveys and working on implementation of Short Brief

Intervention Referral to Treatment (SBIRT).

6/4/18 MVC received $9600 in grant funding to purchase narcan kits to combat opioid

overdose. In addition, research continues on opportunities for bringing a psychologist

in-house with the clinic by working with several other CAH/RHCs.

10/2/18 Board of Directors approved a new position and recruiting underway for a 1.0

Psychologist or MSW to see patients in the clinic setting.

3/18/19 Interviews continue to find a qualified behavioral health specialist.

4/22/19 2019 Nutritional Campaign promotes mindfulness and improving mental

health through different strategies. Interviewed several psychiatric providers.

11/6/2019 Leslie Hite, PsychNP started 9/23/19 offering services in the clinic. Mid

Valley is beginning efforts to communicate general mental health awareness/education

to the community. Traci Miller, RN, presented to a local high school on mental health

awareness and services provided at MVHC. Materials were developed.

Page 3

Priority: 2 Access to Healthcare

Objective/Strategy

Reduce patient out-migration

Increase services available to patients

Tactics

Increase primary care options

Provide additional mental health services through telemedicine

Increase orthopedic surgical services

Informing the community through advertisement for local available services


Clinic/ED resources/time/staff

Orthopedic surgical staff

Marketing


Reduction of patient out-migration

Accountable Parties



Okanogan County Public Health Officer

AeroMethow Rescue Service


Other members of the regional collaborative group.

Okanogan County Public Health Officer

AeroMethow Rescue Service

Page 4

Access to Healthcare Update

ACO information and update: The ACO agreement was signed 6.29/17. Partners in

our joint ACO under Caravan have been named, and we have attended three of twelve

pre-launch webinars in preparation. Various key players and their roles have been

identified. Finally, Lightbeam was approved for implementation to accommodate

reporting requirements. Orthopedics update: Stephen White, MD, Orthopedic Surgeon, was hired effective

2/27/17. Greg Fisk, PA-C, with 8+ years of orthopedic experience and who was

working at MVC in family practice is now transitioning over to working full time in

orthopedics. The transition should be complete by the first of November. Dr. J. Heath

Thompson, orthopedic surgeon, just completed his residency, and will be attending a

trauma fellowship before joining the orthopedics practice here effective August 1,

2018, joining Dr. White. Support staff have received cast raining and are attending an

L & I workshop to better manage L & I patients and required documentation.

Choices Hotline was designed and implemented to help mitigate out-migration as well

as bring in additional patients to local services offered through the hospital and clinic.

Choices has been issued through several avenues including reoccurring newspaper ads

in three local newspapers, radio, social media, and print articles.

AeroMethow Meetings: Together under community involvement to assist an

underserved area healthcare options. Our role is as a partner to assist the group in

providing care to the community. Meeting goals are to inform the meeting constituents

of our willingness to actively participate in the good of the community.

A telemedicine program is being developed by partnering with tertiary hospitals.

4/2/18 Update: Implemented telehospitalist program March 26th in partnership with

Confluence Health. An in-house hospitalist model was also established December 1,

2017. A meeting with RoomOne was held March 21st to streamline patient care

services between the Methow Valley and MVH. Our clinic is working to partner with

Bright Start Services, LLC., for pediatric services for child from birth to three years

old. The clinic continues to work with Dr. Haegar’s Central Washington Sleep

Diagnostic Center to assess pediatric sleep disorders. The ACO implementation

continues with an onsite launch January 24th. We continue to work on the ACO

compliance and meeting required metrics.

6/4/18 A Director of Marketing and Public Relations position was created and being

filled in an effort to improve community outreach and comprehension of services

provided within the district.

10/2/18 Healthcare Summit with area medical providers to discuss enhancing OBGYN

services in the County. Collaborated with the other local county hospitals to enhance

general surgical services at their locations. Coordinating with with WorkSource to

improve hiring practices within the County. Entered into affiliation agreement with

Washington State University Elson S. Floyd School of Medicine and began hosting

medical students. Hired Director of Marketing and Public Relations mid-June whom

has effectively developed several key relationships as stated above, created, launched

and collected responses from community members on perception in order to better

strategize marketing efforts. MVC and ED received a grant from NCACH for

Page 5

naloxone kits and are developing a M.A.T. program to implement by end of year.

Orthopedic services were enhanced in April and continues to offer these added services

by Dr. Dan Hiersche, orthopedic surgeon. Dr. Heath Thompson, orthopedic surgeon, is

expected to being in clinic in November.

3/18/19 Dr. Heath Thompson withdrew and did not join the practice. OB healthcare

summit meetings continue to be held to streamline OB services in the county.

4/22/19 Collaborated with Family Health Centers on the opioid grant program led by

Kathleen Manseau, NP, who also instructed MVH nursing staff. Traci Miller, RN,

Population Health Nurse, demonstrated usage of narcan kits at a meeting at the school

district in March.

11/6/19 Obstetric services from NVH have closed and are being diverted to Mid

Valley. In conjunction with Family Health Centers, all OB services from TRH will

be managed at Mid Valley as of April 2020. Increased orthopedic walk-in clinic

hours, hired Brian Bonewell, NP, for orthopedics,

Priority: 3 Education

Objective/Strategy

Increase knowledge of services availability to the community

Reduce patient out-migration

Tactics

Publish and continue efforts to “boost” MVH educational offerings on through social

media

Publish ads in the local paper about MVHs educational offerings

Executive Team members to attend local gatherings of businesses and promote

services;

Look for opportunities for the CEO or CFO to speak about these matters at community

events

Establish a streamlined referral system for available local services


Executive time

Cost to publish ads in local paper


Reduction of patient out-migration

Page 6

Increase patient awareness of Mid-Valley Hospital’s services

Accountable Parties





Okanogan County Public Health District

Local services such as Omak Rotary, Omak Chamber of Commerce, Kiwanis, Omak

Economic Alliance, Omak Fit For Life, and Okanogan County Community Action

Council.

Education Update:

Orthopedic surgeon, Dr. White, to schedule time to conduct PSAs on the local radio

station in both English and Spanish this fall.

Ongoing scheduled advertisements promoting services in area newspapers, radio

stations, social media, and local public events.

Scheduled career fair for September 28th open to the public. Education on what steps

need to be taken to find a job in health care for any field. Also review of current open

positions. Attended the WVC Nursing program open house September 7th to speak

with future graduates about the opportunities available at Mid-Valley. Plan to attend

the local high schools job fairs when announced by the respective schools.

Clinic Open House: The Clinic Open House will be held November 3rd from 4-6 p.m.

and will highlight all providers with special emphasis on four new providers including

Dr. Stephen White, orthopedic surgeon, Dr. Christine Jaquish, Family Practice, Dr.

Jules Sleiman, Family Practice, and Jeremiah Price, PA-C, Family practice (who will

be starting in November and will be replacing Greg Fisk, who moved over to

orthopedics full-time. Insurance companies, including Molina, Coordinated Care, and

Amerigroup have been invited to provide information. Invitations will be sent to local

leaders as well as local residents.

Clinic Other Activities: Flu shot clinic will be held the first and second week of

October on Oct. 2nd, 5th, and 10th.

Community outreach conducted at community events including Healthy Youth Fair,

Omak Back-To-School Night, Okanogan County Fair, Omak Stampede

“Hydration Station” Breast Health Awareness Booth at Zumba Women’s Health Event.

MVH Foundation partnered with Omak Rotary to raise money to fund scholarships for

locals interested in furthering their health care careers.

Page 7

CEO attended the local Kiwanis meeting July 5, 2017 to discuss services and offerings

at the hospital and clinic.

10/22/17 Emergency Room Manager, Aliya Quidwai, RN, presented to a group of

local youth at the Border Patrol’s Board Patrol Explorer Post #0023 about the impacts

of opioid abuse. See Attachment A.

4/2/18 Update: Clinic Open House was held November 3rd. CEO, Alan Fisher, hosted

a summit with area hospital CEOs for collaboration on health care services for our

region. Qualis Health provided coaching for clinical practice value-based redesign.

Mr. Fisher presented to Omak Middle School students for Read Across America Day.

Becky Corson, Clinic Administrator, spoke at the NW Rural Health Conference in

Spokane on behavioral health integration in March. Aliya Quidwai, RN, ER Manager,

Erin Andreas, RN, AC/OB Manager, Traci Miller, RN, Population Health Nurse, and

Kathy Lund, RN, Clinical Supervisor, met with Wenatchee Valley College Nursing

Program about employment opportunities. Bryan Bernsten, MLT, Lab Scientist,

attended the Omak High School Career Day. Christopher Freel, IT Manager, lead a

leadership group for the Omak/Okanogan High Schools’ Business Week. Randy

Coffell, HR Director, attended Economic Alliance and Work Source’s Apprenticeship

Workshop. Developing Patient and Family Advisory Committee to meet WSHA

metrics and to further engage the community in health care.

6/4/18 A Director of Marketing and Public Relations position was created and being

filled in an effort to improve community outreach and comprehension of services

provided within the district. The Marketing Director will assume the lead role in the

Patient and Family Engagement Committee.

10/2/18 General and orthopedic surgeons collaborated with northern providers on the

services provide. Dr. White developed and implemented a Pain Protocol and patient

education materials for his orthopedic practice and presented to area providers for

patient safety and quality initiatives. Pedestrian Safety Program was developed by ED

Trauma Program Coordinator partnering with local cities to install pedestrian safety

flags and receptacles at high risk crossings. Community educational materials were

developed and provided to the community beginning at the Healthy Youth Fair and

local county fair. Stroke and Cardiac Awareness educational program was also

developed and launched with the community at the fair. Clinic has developed an

antimicrobial stewardship program and have provided educational materials to their

patients on antibiotic use.

3/18/19 MVH participated in a county career fair hosted by WorkSource with a turnout

of over 200 students. The first of a planned series of community newsletters was

developed and launched mid-December. Partnered with North Valley Hospital to

provide nutritional education at local grocery stores. Continued to provide awareness

campaign education on different topics such as lung and breast cancer prevention.

Participated in North Valley Hospital’s strategic planning meeting.

4/22/19 Partnered with Eastern Washington University’s Scrubs Camp by providing

medically related education on selected topics to local high school seniors. Held kick-

off meeting for the Patient and Family Advisory Committee with community education

regarding the PFAC on the radio. Registered Dietician and laboratory staff provided

community education via radio about services, new equipment, and general

information. Presented at the Economic Alliance meeting about the state of healthcare

Page 8

in the county. Participated in Family Health Centers’ strategic planning meeting. Stop

The Bleed training conducted by Aliya Quidwai, RN, Erin Andreas, RN, and Julie

Kruse continues in the community by partnering with local fire departments, Life Line,

and civic service groups.

11/6/19 developed Total Joint Program educational materials, all OB patient

education materials have been redesigned and distributed. Developed free

birthing education classes offering to patients throughout the county. Materials

have been developed for cardiac, stroke, and fall prevention awareness and will be

distributed to local senior centers. We continue partner with WVC and Omak

High School on their advisory boards for nursing and healthcare related

programs.

Priority: 4 Obesity

Objective/Strategy

Promote healthy eating habits through regular public education

Raise awareness about the importance of regular exercise

Tactics

When providing education to the community, emphasize healthy diet and consistent

exercise

Look for ways to provide healthy dieting plans to the community

Plans to hire the practitioners noted above

Partner with local schools to provide “open gym” hours to the community


Registered Dietician time

Physical Therapy space available for public use

Diabetes Road Map classes

Patient Care Coordination

Transitional Care Management

Chronic Disease Management


Decrease obesity rates

Page 9

Increase in physical activity

Healthier patients

Accountable Parties





Partnering with an Accountable Care Organization

Obesity Update:

Omak Fit4Life campaigns and events:

o Hoofin and Woofin Run – Run with your dogs – April

o Orchards in Bloom Run –Orchards in Bloom Run is a rural race that one can

choose to run a 10K or the 1/2 Marathon. Participants will meander among

orchards in full bloom with a 360 degree view of spectacular Eastern

Washington Mountains. Held on April 29, 2017.

o Kids Healthy Kids Fair- This event has provided education opportunities to our

local kids and their families learn; how to be healthy; how to prevent diseases;

and how to grow strong physically, mentally, emotionally and intellectually.

Held July 8th at the Okanogan Legion Park.

o Autumn Leaf Run- In this annual event held in the Fall, participants choose

between a 1 Mile, 5K or a 10K is 1 Mile distance walk/run. It was held

September 23, 2017

o Zombie Fun Run and Harvest Festival October 28, 2017

o Turkey Tangle – Kick Ball Tournament

o Jingle Bell Jog –Fun Run in December

Mid Valley Hospital

o Stress Awareness Day - May

Omak Fit 4 Life Omak HS Gym

o Winter Wellness – Gym open for 2 hours with wellness activities. January -

March

Diabetes Road Map

o The Diabetes Road Map began June 8, 2017 and meets weekly and has a

variable participation rate ranging from 1-5 individuals participating at a time.

Mid-Valley Hospital and Mid-Valley Clinic have advertised the program on the

local radio station, as well as having posters throughout the Omak and

Okanogan communities. This program has been of assistance in helping

Page 10

individuals learn about diabetes and assist them in actively participating in their

diabetes health care.

Chronic Disease Management

o The Chronic Case Management program (CCM) was implemented January 1,

2017 and serves approximately 40 patients, with one-on-one appointments

ranging from monthly to as needed. CCM has started participating in warm

hand-offs from providers for at-risk patients that are in clinic. We currently

offer our patients telehealth for mental health, behavioral health, and co-

occurring diseases. The CCM program is continuing to look at ways to serve

more patients, improve patient investment in their healthcare, improve quality

of life for patients, and reduces exacerbations and uncontrolled disease

processes.

Patient Care Coordination

o The Care Coordinator program was implemented January 1, 2017 and is in the

process of implementing a collaborative care model, which includes behavioral

and mental health services. Working with community resources, including

AIMS at the University of Washington, care coordination will start to include

those patients that are at highest risk for reduced health outcomes. By

coordinating care for those patients, the goal is to address health concerns

before they become uncontrolled and/or unmanageable.

Transitional Care

o Transitional Care Management (TCM) was implemented January 1, 2017 and

provides services for all patients receiving inpatient services from Mid-Valley

Clinic providers, including specialists. TCM has recently implemented meeting

with inpatients at Mid-Valley Hospital on a daily basis during admission to

address any questions, concerns, or needs that they may have, as well as plan

for future needs once they are discharged. Proactive transitional care will help

to reduce hospital readmissions, emergency room visits, and reduce potential

adverse events after discharge.

Caravan Health ACO: We have been with Caravan Health since May, 2016 through

the TCPI (Transforming Clinical Practice Initiative) grant and have atte3nded quarterly

QI workshops and monthly roadmap calls, managing various PDSA action plans. We

are currently participating in ACO pre-launch web series, and will have an onsite team

here in January to help with implementation. Training on the use of Lightbeam and its

reporting tools, will be provided when the program is up and running. Cohort calls

depending on the leadership role will be conducted with Caravan health upon the start

of the ACO on 1/1/18.

Qualis Health: o Qualis Health and NC ACH (North Central Accountable Community of Health)

and Whole Person care Collaborative (WPCC): The NC ACH WPCC charter

and membership agreement was just approved and will be signed. Monthly

WPCC meetings will be attended. As part of the charter, we will be developing

a comprehensive three-year change plan from fee for service to value based

quality payment model. Grant funding for Stage 1 totaling $95,000 will be

disbursed the end of February, 2018 and a budget will be developed as to the

use of funds in the change process.

Page 11

o With Qualis – we have been assessed by the PCMH (Patient Centered Medical

Home) and MeHAF surveys and developed action plans accordingly. We have

been working with Gwen Cox, Qualis Health Coach, to move toward integrated

care and PCMH model. We will also be meeting with a DOH consultant to

assess our pediatric services much like the PCMH assessment.

o Qualis Health is videotaping MVC on 10/3 to highlight our efforts to integrate

behavioral and chemical dependency counseling into the clinic via

telemedicine.

4/2/18 Update: Aliya Quidwai, RN, ED Manager, continues to support the Omak

Fit4Life events as MVH’s representative to encourage health and wellness in our

community including a yoga class at East Omak Elementary School. Dr. Errico,

Confluence Health, provided a presentation on ketogenic diet at a Fit4Life event hosted

by Mid Valley Hospital. The Diabetic Road Map courses continue. Traci Miller, RN,

Population Health Nurse, continues to work on empanelment of patients to determine

care gaps using the Healthcare Effectiveness Data and Information Set (HEDIS)

measures.

6/4/18 Partnering with Omak Fit4Life’s Healthy Youth Fair July 7th. MVC will be

hosting an annual wellness day for Medicare patients on July 25th.

10/2/18 The Annual Wellness Day scheduled in July was cancelled and will be

rescheduled. A partnership with North Valley Hospital was developed to provide

nutritional education with both hospitals’ Registered Dieticians. The community is

invited to attend an ongoing series of nutritional guidance at area grocery stores. The

Healthy Youth Fair presented a blind taste test of healthy foods by MVH’s Dietician.

Omak Fit4Life hosted a community fun run, Autumn Leaf Run, on September 29th.

3/18/19 A nutritional campaign is being developed for National Nutrition Month and

general obesity awareness in our county to be launched in March 2019.

4/22/19 Collaborated with Inland Northwest Culinary Academy to offer training to

MVH Dietary staff to enhance skills and to provide higher quality food to patients and

community. Naturally Nourished Campaign was launched and provides information,

resources, and coordinated events for seven months ending at the harvest festival. The

campaign partners with all Registered Dieticians in the area, the WSU Extension

Office, and other health experts.

11/6/19 The Registered Dietician continues to conduct regular radio broadcasts on

nutritional education with different topics each month which is posted to the

hospital website.

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