2016 UNC REX Healthcare Community Needs Health Assessment Action Plan

This past March, Wake County was again ranked as the healthiest county in North Carolina and is consistently ranked as one of the best places to live, work, play and learn. This continued success cannot be attributed to any one entity, yet to the collaborative efforts of various partners, including those involved in the development of the Wake County Community Health Needs Assessment (CHNA).

The Community Health Needs Assessment is a systematic, data-driven approach to determining a population’s health status, behaviors and needs. In completing the assessment, items and issues of greatest concern can have resources committed to those areas, thereby making the greatest possible impact on improving community health status. In general, a CHNA provides detailed information for communities to focus their efforts. This comprehensive survey and action process takes place every three years, with the last effort in 2013.

At the conclusion of each survey, an implementation plan is written by Wake County with input from residents to address the identified issues and drive action. UNC REX Healthcare is required to produce its own implementation plan to maintain its 501(c)3 status. Wake County Health and Human Services also will write its own implementation plan. As a core stakeholder, UNC REX will contribute to the County’s efforts by meeting bi-annually with the CHNA partners.

2016 CHNA

The following entities managed the 2016 Wake County CHNA: Wake County Human Services; Duke Raleigh Hospital, WakeMed Health & Hospitals and UNC REX Healthcare; Advance Community Health (formerly known as Wake Health Services); United Way of the Greater Triangle and Wake County Medical Society Community Health Foundation. Co-chairs of the 2016 CHNA are Donald Gintzig, President and CEO of WakeMed Health & Hospitals and Dr. James West, Chairman of the Wake County Board of Commissioners.

A CHNA core team, comprised of a representative leader from each organization above, provided oversight of the process. Additionally, a steering committee of more than 50 community partners including local government, hospitals, schools, faith-based organizations, non-profit organizations, businesses and other stakeholders provided input and feedback.

This process included the following steps:

  • Evaluate the impact of implementation strategies and action plans that resulted from the 2013 CHNA
  • Collect and analyze primary (new) and secondary (existing) data to identify areas of need within the county
  • Report findings to the residents of Wake County, hospitals, community agencies, and the North Carolina Department of Health and Human Services.
  • Engage the community to determine the priorities to be addressed.
  • Develop a community-based action plan to address the priorities.

The 2016 Wake County CHNA, which includes quantitative and qualitative data, was compiled and written by Ascendant. The goal is to improve the overall health and wellness of Wake County residents over the course of the next three years. Information collected through the 2016 CHNA will guide UNC REX Healthcare’s community support efforts.

UNC REX Implementation Plan

Once the completed report was delivered to UNC REX Healthcare, an internal team met to review it and develop the action plan.

  • Knowing the best way to address community health planning is to identify health disparities, gaps and unmet needs alongside a balance of community resources, strengths and perceptions, UNC REX used the CHNA as a roadmap to assist in achieving three basic goals:
  • To improve residents’ health status, increase their life spans, and elevate their overall quality of life. A healthy community is not only one where its residents suffer little from physical and mental illness, but also one where its residents enjoy a high quality of life.
  • To reduce the health disparities among residents. By gathering demographic information along with health status and behavior data, it will be possible to identify population segments that are most at-risk for various diseases and injuries. Intervention plans aimed at targeting these individuals may then be developed to combat some of the socio-economic factors, which have historically had a negative impact on residents’ health.
  • To increase accessibility to preventive services for all residents. More accessible preventive services will prove beneficial in accomplishing the first goal (improving health status, increasing life spans, and elevating the quality of life), as well as lowering the costs associated with caring for late-stage diseases resulting from a lack of preventive care.

Based on data findings and the input gathered from community organizations and residents in the 2016 CHNA, the following four priority areas have been identified as needing greatest attention.

These four priority areas will be addressed through community health improvement planning initiatives over the next three years. It is important to note that health, healthcare and associated community needs rarely exist in a vacuum. Instead they are very much interrelated with each other, with improvements in one need area driving advancements within another.

Health Insurance Coverage

A continued focus on education will permeate this area. Greater education to internal audiences, most specifically patient financial services and nurse navigators, will allow for expanded conversations regarding health insurance coverage, options, and means of obtaining them. UNC REX will form a stronger partnership with Enroll America, the nation’s leading health care enrollment coalition, an independent non-profit, non-partisan organization to create and share cutting-edge tools, analyze data, inform policy and capitalize on best practices to maximize the number of Americans who enroll in and retain health coverage under the Affordable Care Act (ACA). In addition, changes to the UNC REX co-worker benefits structure, including a $750,000 supplement from the organization, will increase the number of co-workers who can afford coverage; this is key as one of the largest Wake County employers. UNC REX will evaluate it support of the Triangle United Way ACA program to fund premiums of those who cannot afford them. Expansion of the UNC REX Angel Fund, which supports patients undergoing cancer treatment, can be of greater assistance to patients with post-insurance financial obligations. Plans are in review to create chronic disease care plans to align patients who frequent the Emergency Department with case management workers.

Transportation

Given that UNC REX has a geographically diverse footprint of primary and specialty offices across the county, internal evaluation of transportation options for patients will be a priority. A new internal effort to coordinate appointments for patients with chronic conditions to reduce travel will assist in efficiencies for both patients and providers. Greater internal education around mass transit, use of vouchers and other transportation options can provide patients with more, or any, option to access needed preventive or emergency health services. Expansion of mobile health outreach, mammography and heart & vascular screenings, including potential new options to reach people closer to where they live and work, especially in underserved areas is in review. In addition, advancements in telemedicine alternatives will reduce a patient’s reliance on transportation to receive care. Provisions for corporate support of the 2016 Wake County transportation plan and bond referendum as well as continued leadership on the Greater Raleigh Chamber of Commerce Regional Transportation Alliance will ensure transportation is incorporated into plans for UNC REX whenever possible.

Access to Health Services

New ways to reach patients, their families and prospective patients to prevent illness, promote wellness and improve the overall health of our community will require dedicated resources and greater effort. Focused efforts on population health will help reduce costs and improve medical care and prevention across the community. Strategic analysis of the Wake County market to expand the UNC REX primary care and urgent care footprint are ongoing. Continued education to address proper utilization of emergency departments, urgent care centers, and primary care facilities will occur. Further expansion of the UNC Health Alliance clinically integrated network (which includes community physicians, hospitals and employed physicians.) will engage physicians across the county and beyond in the transformation of patient care. As the market moves from volume-based to value based reimbursement through improved quality and controlling healthcare costs, this is of high importance. Adding primary care and specialty providers, expanding surgery, oncology, pulmonary, thoracic, neurosurgery and heart and vascular practice sites across the Triangle as well as heart and vascular, surgical and hospitalist programs in Johnston County has provided residents with greater access to quality healthcare options. Expansion of services in Holly Springs, including the future Holly Springs Hospital, will provide residents of southern Wake County greater access to quality healthcare and additional job opportunities.

From another perspective, use of smartphones will only continue to rise. UNC REX will explore new and interactive ways to reach people, through community outreach, telehealth or other alternatives. Access to My UNCChart electronic medical records also a tool to empower consumers with taking a more active approach to their healthcare and their wellbeing. The five Rex Wellness Centers geographically spread across the County will continue to be an integral part of improving fitness and nutrition, supporting community activities, providing education and access to mobile heart and vascular screenings. Additionally, greater integrated partnerships with the American Heart Association and others to provide no-cost interaction with health experts are essential. A demonstration kitchen in the new Heart and Vascular Hospital will be a hands-on resource to teach and provide alternative, healthier options to combat the #1 killer of Americans, cardiovascular disease. Expansion of free, online tools such as HeartAware and StrokeAware risk screenings for health assessment and will help identify high-risk health issues at an earlier stage. Increasing the number of navigators to assist patients from point of diagnosis through referral visits and surgical procedures will be reviewed, along with other efforts to reduce system complexity, making it easier for patients to navigate the healthcare landscape.

Mental Health and Substance Abuse

Coordinating efficiencies to best address those suffering with mental illness will continue to be a priority over the next three years. Patients will have much-needed access to higher levels of specialized behavioral health and medical care at UNC WakeBrook, which receives $2 million in annual financial support from UNC REX. This will continue to be a priority and new inpatient psychiatric beds will be added. In addition, at UNC REX Hospital Emergency Department (ED), a new behavioral health holding area (to be complete by 2017) will positively impact access to the ED and allow for patients to be cared for in a better location than a brightly lit ED. Additional work with Wake County leadership, Alliance Behavioral Health and UNC Health Care will allow for greater access to mental health services to Wake County patients. Meetings with Alliance Behavioral Health to address indigent mental health patients presenting are ongoing. More training for core staff with backgrounds in mental and behavioral health will expand the caregiver pool and allow for more emergency room nurses with mental health backgrounds. There will be a continued effort on collaboration with other community providers to best meet the needs of this special patient population, including the Wake County Crisis Collaborative which identifies resources for wrap around outpatient services and how patients can access them. Efforts with the UNC REX pain management department and the Community Care of North Carolina to expand its collaborative, proactive approach for assisting patients with chronic pain issues will continue to reduce the incidence of overdose and death due to substance abuse. Continued efforts to build awareness around reducing the stigmas surrounding mental health through partnerships with the National Alliance on Mental Illness (NAMI) and the Foundation of Hope’s Walk for Hope are planned.

Measuring and Reporting Results

It should be noted that the Wake County collaborative approach to CHNA execution has served as a model for other communities to replicate as they conduct their own CHNA and subsequent action plans.

Over the course of the next three years, UNC REX will monitor efforts and outcomes directly related to programs and services with a focus on needs identified in the CHNA.

UNC REX will evaluate results for the following:

  • Health Insurance Coverage:

    Measure the percent of uninsured who enroll in an insurance exchange through Rex Healthcare as a result of outreach efforts.

  • Transportation:

    Evaluate the outcome of the 2016 Transportation Bond Referendum and continue to support city and chamber initiatives that allow for greater use of public transit.

  • Healthcare Access:

    Measure the number of new primary care offices and their proximity. Collect data around people reached through wellness initiatives, including online screenings and evaluate the impact of online screenings by assessing changes in high risk health factors. Measure perceptions of health care utilization, chronic conditions and preventive health behaviors through qualitative research.

  • Mental Health and Substance Abuse:

    Track the number of mental health patients diverted from the emergency department to more appropriate care. Put into operation a specialized holding area in the UNC REX Emergency Department to improve care delivery and the patient experience for mental health patients. Measure utilization of beds at UNC WakeBrook to maximize usage.

With changes to healthcare and mental health systems, increases in chronic and communicable diseases, and challenges of the economic climate, building partnerships with public health, hospitals and health care organizations, non-profits and other non-traditional partners is essential for community health improvement. In order to effectively meet the needs of Wake County residents, establishing effective partnerships is essential.

Some key UNC REX partnerships that support community health improvement include:

  • Alice Aycock Poe Center for Health Education
  • Alliance Medical Ministries
  • American Heart Association
  • NAMI
  • North Carolina Prevention Partners
  • Triangle Family Services
  • Urban Ministries

Programs and services will be monitored and reviewed from implementation to execution.

Over the next three years, UNC REX commits to continue to:

  • Monitor and investigate the health needs and issues in the community and discuss with community partners
  • Mobilize community partnerships to improve community health
  • Educate and empower residents to live healthier lives
  • Develop programs and policies that support community health improvement efforts
  • Increase residents’ access to overall health and mental and behavioral health services

UNC REX will utilize global platforms and marketing opportunities to reach all residents in Wake County. Specific educational platforms surrounding primary care, cancer, cardiovascular disease, women’s health, men’s health and mental health will be a priority

Conclusion

Research and evaluation leads to better information about the effectiveness and impact of our work, ultimately leading to better discussions, decision-making and outcomes. UNC REX will continue its commitment to the community through improving access to high quality health care while managing costs efficiently as well as empowering and educating others to take action and improve their health status.

Rex Healthcare is dedicated to supporting the ongoing efforts of health systems and community partners in Wake County to:

  • Encourage collaborations across sectors
  • Guide individuals toward making informed health decisions
  • Measure the impact of prevention activities

For additional information, please contact UNC REX Healthcare Vice President of Communications & Marketing Lisa Schiller at (919) 784-4420 or Lisa.Schiller@unchealth.unc.edu.