Strategic Issue: Access to Healthcare

Description: Clay County has a very high ratio of population to primary care physicians (1,708:1 in Clay vs. 778:1 state average, County Health Rankings 2012). This creates
access to care issues for Clay County residents who must seek certain medical treatments outside of the county if it is not available locally. While Clay County has an adequate number of Medicaid dental providers, there is a significant shortage in surrounding counties. This places an undue burden on Clay County providers and prevents Clay Co. residents from seeing a dental provider when appointment slots are taken by non-Clay Co. patients. In an effort to better support Clay County residents for comprehensive disease prevention and management, the Clay County Hospital proposes obtain certification as a medical home from AHQR. The medical home model will allow CCH to build infrastructure to support disease prevention and management.

Long-term, 5 yr. Goals

Physician Recruitment By 2017, recruit 2 additional primary care providers. Additional Specialists / Services By 2017, continue to provide dialysis services in Clay County. Recruit two additional specialists by June 2017. (Baseline: current level as of April 2012) Oral Health By 2017, increase access to dental care for Medicaid recipients by collaborating with an FQHC to open at least one additional clinic in a neighboring county. Medical Home Certification By 2017, CCH will implement the medical home model to manage and prevent 4 chronic diseases diabetes, heart disease, cancer and hypertension.

2 3 year Objectives
Physician Recruitment Increase the number of potential Clay Co. young adults in the physician recruitment pipeline to seven by June 1, 2013. [Baseline: 4 recruits] Provide information regarding health careers to at least 25% of high school students, to at least 75% of health occupations class students, and to at least 75% of gifted students in grades 5 through 12 by June 2013. Additional Specialists / Services Establish dialysis services in Clay County by June 2015. Recruit one additional specialist by June 2015. Oral Health By January 2014, 75% of children ages 0-3 in WIC receive the dental varnish. (Baseline: 0%) Community Resources - Education Publish and distribute resource manual to local organizations and the community-at-large by January 2014. Educate residents on the Affordable Care Act as new mandates come into effect in 2014. Medical Home Certification Add 3 additional chronic diseases to the management list by June 2015. Clay County Hospital receives AHRQ Medical Home Certification by December 2014.

1-year Objectives
Physician Recruitment Ascertain number and status of students currently in the medical profession pipeline by March 1, 2013. Create a contact schedule for all students in the pipeline to assist them with educational success and incentivize them to return to Clay County to practice by July 2013. Additional Specialists / Services Identify a potential provider for dialysis to serve Clay Co. residents by June 2012. Determine the need for additional physician specialists (possible specialties include dermatology, general surgery, and orthopedics) by June 2013. Oral Health Implement dental varnish application program in WIC for children ages 0-3 by July 2013. Community Resources - Education Create a community resource manual by June 2013. Educate residents on the Affordable Care Act as new mandates come into effect in 2014. Medical Home Certification Implement electronic health records (EHR) to support tracking of diabetic patients within the primary care setting by December 2012. Reorganize PCC to focus and develop a system of managing chronic disease patients by September 2012.

Measures of Success
Physician Recruitment Signed letters of commitment on file with hospital or Clay Medical Center. Medical Home Certification CCH will continue to operate as certified medical home and generate annual reports to monitor patient outcomes. Physician Recruitment 2 names are added to the list of potential medical students each year. Additional Specialists / Services Dialysis center is established and providing services. CCH recruits one additional specialist. Oral Health By January 2014, 75% of children ages 0-3 in WIC receive the dental varnish. Community Resources - Education Resource manual is published and ready to be distributed to the public. At least 2 community education events on the Affordable Care Act are held by December 2014. Medical Home Certification Complete electronic registry to track an additional 3 chronic diseases. Hospital receives certification from AHRQ by 2015. Physician Recruitment Potential medical student contacts are made by appropriate parties according to schedule. Additional Specialists / Services Options for dialysis services and location for dialysis are identified. The physician-needs assessment identifies which specialists the hospital should recruit. Oral Health WIC nurses and applicable providers are trained to implement dental varnish application program. Community Resources - Education List of community resources compiled. Medical Home Certification Hospitals EHR goes live in Sept 2012. Complete electronic registry of diabetic patients by Nov. 2012

Programs & Interventions: When/Whom

Physician Recruitment Contact is made with high school and community college counselors to identify potential medical school students (CCHD Deena; CCH Darla). Promote health career occupations to local high school and community college students (CCHD Deena; CCH Darla). Promote CCHs medical school tuition assistance program to students in medical profession pipeline (CCHD Deena; CCH Darla). Additional Specialists / Services Open a dialysis center in Clay Co. by June 2015 (CCH). Identify possible specialists that will provide services in Clay County by June 2015 (CCH). Physician Recruitment Ascertain number and status of students currently in the medical profession pipeline by March 1, 2013. Additional Specialists / Services Obtain statistics on the number of Clay Co. residents that need dialysis and develop a plan to provide dialysis services in Clay Co. by June 2012 (CCH). Conduct a physician-needs analysis to determine the need for additional specialists by Dec 2012 (CCH). Oral Health Training for varnish program provided by CCHD providers (RNs, dentists, physicians, hygienists) by September 2012. (by CCHD Tammy)

Medical Home Certification CCH will continue to operate under the medical home model and track patient outcomes with annual reporting.

Oral Health Launch dental varnish program in WIC and promote program at all WIC clients by January 2014 (CCHD Tammy).

Community Resources - Education Gather information on community resources for inclusion in the Resource Manual by June 2013. (CCHD Tammy) Keep up with legislation on Affordable Care Act. (CCHD & CCH). Medical Home Certification Obtain EHR (NextGen) system and integrate into current records system by September 2012. (CCH)

Community Resources - Education CCHD and CCH will post an electronic version of the resource manual on their websites in January 2014. Publish and distribute resource manual to local organizations and the community-at-large by January 2014. (CCHD) Host 2 Lunch & Learn events on healthcare reform by December 2014 (CCH). Medical Home Certification Increase current EHR capability and complete electronic registry to track an additional 3 chronic diseases by December 2014 (CCH). Hospital applies for medical home certification from AHRQ by December 2014 (CCH).

Funding
Physician Recruitment CCH medical school tuition assistance program will pay for tuition in exchange for service in Clay Co. Medical Home Certification CCH funding Community Resources - Education Resource manual posted electronically via websites (minimal cost) Medical Home Certification CCH funding Community Resources - Education CCHD use existing resources (current staff and time) Medical Home Certification CCH funding