Each state was asked the following question:
Please provide information about Collaboration/Shared Services (specifically connected to population health management).
AzFlex continues to collaborate with Arizona Department of Health Services (ADHS) Bureau of EMS and Trauma System, and the 40 trauma centers (Level I, III and IV) in the state. The Arizona Trauma Managers Workgroup, established 2010, continues to meet quarterly with rotating in-person meetings at trauma center sites around the state. In addition, over 100 people actively participate in a trauma program manager listserv (managed and maintained by AzFlex) to share ideas, policies and best practices. One significant outcome of this workgroup has been the design and distribution of a Trauma Injury Prevention Survey, used to better understand the current status of injury prevention programs in Arizona's 40 trauma centers. Efforts began in January 2016 with the formation of a Survey Development Committee. The survey was distributed during the summer and fall and analysis is expected to be complete by Spring 2017. Based on survey results, ADHS, Arizona's trauma centers and other partners will determine suitable objectives and initiatives for a possible statewide injury prevention project.View Arizona's State Flex Profile >
The community paramedicine project is in collaboration with the state EMS branch in order to better provide services to rural communities and to better utilize those with training in paramedicine.View Hawaii's State Flex Profile >
IRCCO, a new statewide rural ACO, has 23 CAHs participating and one small rural hospital, which is in its second year of a Medicare Shared Savings Program. Seventeen other CAHs participate in a system ACO. ICAHN is also working to improve collaborative relationships with local colleges and universities by developing a pilot rural health worker/health coach model. This will benefit both the students looking to gain practical experience while receiving course credit, as well as assist the CAHs in addressing population health needs. ICAHN is also working to address the opioid crisis in Illinois by assisting the CAHs to develop partnerships and develop local coalitions to begin to address substance abuse in rural communities.View Illinois's State Flex Profile >
Maine is organized into eight public health districts and one district which supports the five recognized Native American tribes. It is through these districts and the community benefits activities of Maine’s hospitals where public health concerns are met and addressed. Each district has varying initiatives from oral health to poverty and poverty related issues, to farmer’s markets and improving drinking water. The overall Maine Rural Health and Primary Care Program is involved with the work of each district and has supported initiatives that are high priority and affecting the rural parts of each district. Maine’s CAHs are involved in these activities in a variety of ways and state this on their 990 tax forms.
Each hospital is involved in the public health needs assessments as well as the community health needs assessments and is invested in a variety of issues that negatively impact the hospital and communities they serve. Some of the more common issues are:
- Ambulance services to include reimbursement, staff recruitment, insurance liabilities and whether they should be hospital or community-based services
- Serving the needs of psychiatric patients with ongoing and persistent issues to include bed days, referral to in-community services, lack of distinct psychiatric beds in the state
- Obstetrical services where hospitals are making the determination to maintain or remove their obstetrical beds and associated services
- Use of the emergency room for non-emergent issues or issues that could be addressed in the community instead
Minnesota Flex collaborates in nearly all of the activities for CAHs. In the area of Quality Improvement, Minnesota works with Stratis Health (QIO) and MHA to provide technical assistance to CAHs and to analyze improvement and areas of need for improvement. In the area of Finance and Operations, Minnesota works closely with MHA for the same reasons, as well. And in the area of population health management, Minnesota collaborates with others to achieve results. In the IBH project, Minnesota subcontracted to provide technical assistance to CAHs. As part of that project, participating CAHs are expected to form working collaborations with the appropriate organizations in their service area in order to achieve their objectives; a variety of organizations are included in those collaborations, depending on the specific objectives of each participating CAH. In the area of EMS sustainability, collaborative partners are the MDH Heart Disease and Stroke Unit, the MDH Injury and Violence Prevention Unit, the Minnesota State Trauma System and the MDH Office of Emergency Preparedness; outside of MDH, collaborating partners are the Emergency Medical Services Regulatory Board and the Minnesota Ambulance Association.
Both the QI and IBH projects have advisory committees made up of interested parties outside of the Office of Rural Health and Primary Care (ORHPC)/Flex Program who are experts in their respective areas. Furthermore, the Flex Program in Minnesota has a Flex Advisory Committee that advises the Flex Coordinator on Flex grant activity. That committee has representatives from CAHs, rural providers, EMS, Finance, MHA, Stratis Health, federal congressional offices and others.View Minnesota's State Flex Profile >
MHA and the State Office of Rural Health completed a CHNA assessment which identified gaps in the implementation plans of hospitals as well as some common areas to address for population health activities in the next year.View Missouri's State Flex Profile >
The Montana Flex Program is working with Montana Department of Public Health & Human Services (MT DPHHS) Chronic Disease staff to develop a population health management project for a cohort of CAHs. Employee health plan members will be the targeted population for the project. The project is currently in the planning and development phase.View Montana's State Flex Profile >
The Flex Program works closely with the Office of EMS staff, identifying technical assistance needs and venues for meeting those needs. Members of local EMS systems are invited to participate in regional CAH network meetings.View Nebraska's State Flex Profile >
New Mexico has a strong community support system. New Mexico OPCRH will focus on how all the contractors being utilized in Flex can work together with the hospitals and emergency services in improving quality scores as well as overall improvements in quality of care. Based on assessments conducted, all hospitals and emergency service areas have concerns regarding behavioral health issues. This will be a focus for some of this year’s joint trainings, along with addressing improvements in quality measures.View New Mexico's State Flex Profile >
Through its contract with ORH, the NCHA organized a LAN around mental health best practices and improvement. After conducting several meetings, which brought together regional CAHs and mental health managed care organizations, NCHA compiled a list of possible initiatives to improve mental health across the state. CAHs were sent a survey to prioritize the proposed mental health initiatives, and ORH will utilize this information to initiate programming to provide TA or other resources to CAHs.View North Carolina's State Flex Profile >
The Ohio Flex Program, in collaboration with the Ohio State Office of Rural Health (SORH) and the Ohio Department of Health, is updating the Ohio State Rural Health Plan which will include EMS, population health, CHNA and market assessment data of CAHs, small and rural hospitals, local health departments, rural health clinics and other health care providers and community organizations. Additionally, the Flex and SORH are active participants in the Ohio Healthcare Quality Collaborative (consisting of the Ohio Department of Health Diabetes program, Department of Aging, Ohio Hospital Association, Health Services Advisory Group (QIO), Ohio Pharmacists Association and Ohio Health Information Partnership and its quality innovation network (QIN)).View Ohio's State Flex Profile >
During the spring 2016 semester, Master of Public Health (MPH) students enrolled in the Designing Public Health Programs course selected as their project a health priority from a rural community. The communities and priorities were derived from a cohort of rural hospitals who completed a CHNA in 2014 and 2015. Each student selected one priority, developed further background information about the community and need, and then developed or modified an intervention to help address the priority. After the completion of the course, hospital administration received a video of the student’s program presentation to their peers and a complete resource guide that included the methods, intervention and details of implementation.
This collaboration yielded great results and provided valuable information to participating CAHs of programs to address priorities identified through their CAHs to positively impact the health of their local population. This collaboration has expanded for the spring 2017 semester. The students will work in teams for the Designing Public Health Programs course to address their selected priority. These priorities and programs will then be included in the program evaluation course where a detailed evaluation plan will be developed and made available to participating CAHs.View Oklahoma's State Flex Profile >
PORH is represented by the Rural Health Systems Manager and Deputy Director on the Pennsylvania Department of Health's Pennsylvania Population Health Committee, one of five committees organized to assist the Commonwealth with its Health Innovation Plan.View Pennsylvania's State Flex Profile >
In this program area, South Carolina performed five EMS assessments from the 9-1-1 agencies that serve a CAH community. It was really interesting to see the CAHs from the eyes of EMS. During the individual EMS assessments, a focus was placed on the CAH's strengths and weaknesses, likes and dislikes about the hospital, interactions with emergency department (ED) department and the Chief Officers and a personal assessment of the relationship between their agency and the CAH. This discussion has quickly become a best practice when talking with 9-1-1 EMS agencies that serve a CAH community because it helps get a whole picture of the CAH and reflects the hospital’s dedication to their partnerships with community stakeholders.View South Carolina's State Flex Profile >
Washington Flex is supporting statewide development of a new Stroke Triage Tool initiated in each county through the EMS Regional Councils and local county stroke teams. This will include the development of revised county level protocols. The tool is being introduced in two launches on each side of the state, and will include EMS teams as well as other teams such as prevention, post-acute (home health, rehabilitation in a skilled nursing facility), primary care and other local community resources.
Washington supports the annual Northwest Rural Health Conference by providing program development as well as scholarships to local teams from the state's CAHs and EMS agencies to attend. For the first time last year, the state put rural EMS in the milieu with the CAHs and facilitated discussions about the coordination between settings and established more intentional partnerships between CAHs and EMS. This approach was well-received and assisted in setting a new record for conference attendance. The Flex Program is currently planning the next regional conference for the end of February and will again offer EMS topics to the conference.View Washington's State Flex Profile >
Wisconsin Flex continues to work with three communities (representing four CAHs) on population health improvement projects. The communities were targeted because of high obesity rates. Wisconsin Flex has provided funding and other resources to assist them in developing and implementing evidence-informed obesity reduction programs. These range from worksite-based programs to programs targeting women and families. Wisconsin Flex will provide these resources over three years, which will enable the community coalitions to track participants over time and identify outcomes.View Wisconsin's State Flex Profile >
Previously the Wyoming Flex Program collaborated with Montana and Idaho to offer group rates on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). Pursuit of additional opportunities to collaborate and share services connected to population health will continue.View Wyoming's State Flex Profile >