Maine Shared Community Health Needs Assessment

1. Maine Shared Community Health Needs Assessment New England Rural Health Roundtable November 8, 2018 Newry, Maine

2. Saco City Hall, Saco, ME. 9/27/18 Introductions

3. Why do we do what we do?

4. 2007 The OneMaine Health Collaborative forms (three hospital systems) First round of statewide forums take place 2010 CHNA Reports published 2010 Maine CDC creates the 2012 State Health Assessment, and joins the OneMaine Health Systems in the Shared CHNA 2012 Central Maine Healthcare joins the Maine Shared CHNA partnership. Maine CDC develops the 2013-2017 State Health Improvement Plan 2013 2014 Formal MOU signed IRS CHNA rules come into effect 2016 CHNA Reports published; Second round of forums held; 2016-2018 hospital Implementation strategies adopted; District Public Health Improvement Plans developed 2016 2018-2020 SHIP developed Renamed Collaborative to: Maine Shared CHNA 2017

5. Purpose of the Maine Shared CHNA Provide a timely, consistent, comprehensive compilation of health-related data for each of Maine’s sixteen counties every three years. Engage individuals and communities to solicit feedback about the reports and identify priorities for action. Assess changes in metrics included in the CHNA reports over time.

6. Guidance, Regulations & the Law Maine Shared Community Health Needs Assessment Images of PHAB and IRS from the internet

7. Maine Shared CHNA Governance

8. Maine’s Structure: • 4 Maine Shared CHNA partners (“major health systems”) • 22 affiliated hospitals, including: • 2 mental health hospitals • 1 rehab specialty hospital • 8 critical access hospitals • 14 “independent hospitals” • Not part of any of the four “health systems” • 7 critical access hospitals • Many are non-funding partners in the Maine Shared CHNA

9. Maine’s Structure: • One accredited State Health Agency (Maine CDC) • Nine Public Health Districts • Eight are county-based (serving 16 counties), • Tribal Health District serves Maine’s four federal recognized Tribes • One accredited Local Health Department (Portland) • One yet-to-be accredited Local Health Department (Bangor)

10. Health Improvement Process Partners Partners Partners Partners Partners Partners

12. Putting it all together • Community Health Needs Assessment • Community Engagement Summary • Hospital Implementation Strategy • District Public Health Improvement Plans • State Health Improvement Plan (SHIP)

13. Partners • Health care providers • Employers • Community health workers • Community paramedics • Head start • Area Agencies on Aging • Health Homes • Behavioral Health Homes • Schools • SNAP-ED coordinators • Behavioral health community agencies • Hospitals • Crisis service programs • HIV service organizations • Universities • Community colleges • Job training programs • WIC community agencies • Early Childhood education providers • Community prevention sub-recipients

14. Partners • Health Equity Alliance • Maine Lung Cancer Coalition • United Ambulance • Office of MaineCare Services • Maine CDC • Mainer Office of Aging and Disability Services • Let’s Go! • Department of Education Child Nutrition Services • Maine Roads • University of New England • University of Maine System (Rise-Up) • Federation of Farmers Markets • NAMI Maine • Rinck Advertising • AdCare Educational Institute • Maine Harm Reductions Alliance • Change Health • Department of Public Safety • Maine Health Center for Tobacco Independence

15. Maine Shared CHNA Timeline January 2018-December 2019 County Health Profiles released By 9/1/2018 CHNA reports Released 3/29/2019 Local Hospital and MaineHealth Board Adoption Deadline for CHNA’s 9/30/2019 forums and other outreach held between 9/2018 and 12/2018

16. Shared CHNA Products • Health Profiles • County • State • District • City • Health Equity Handouts • Presentations • Highlights from profiles • Community engagement • Initial priorities selection • Final Reports • With feedback from forums • Website • All products posted • “Find a forum” • Interactive site www.mainechna.org

17. About the Data Master List of Indicators: 100 indicators on Outcomes 32 indicators on Behaviors 46 indicators on Health Care Access and Quality 19 indicators on Social, Community, and Physical Environment 197 Key Indicators: Mirrors the make-up of Master List 33 total indicators to provide health profile ‘snapshots’ FMI visit www.maineCHNA.org

18. How to Read a Health Profile

19. How to Read the State Health Profile

20. Key Findings

21. Demographics Maine: Age Distribution Percent of Population Living in Rural Areas, 2012-2016

22. Demographics • Change in Percent of Population Age 25+ With Associates Degrees or Higher, 2000-2016 Change in Percent of Population Living in Poverty, 2000-2016

23. Health Access and Quality Unable to Obtain Care Due to Cost, 2014-2016

24. Health Equity Data Handouts include selected data for: Sex Race Ethnicity Sexual orientation Education Income Rurality

25. Leading Causes of Death

26. Years of Potential Life Lost YPLL measures premature death, or the years of potential life lost before the age of 75.

27. Social Determinants of Health Percentage of Households that are Food Insecure, 2012-2016 • Unemployment Rate, 2012-2016

28. Health Outcomes- Cancer All Cancer Deaths, 2012-2016 New Cancer Cases and Deaths 2011-2016

29. Health Outcomes- Chronic Disease Chronic Disease Obesity and Physical Activity

30. Health Behaviors-Substance Use High School Alcohol and Marijuana Use Current Cigarette Smoking

31. Health Outcomes- Mental Health Current Depression (Adults), 2014-2016 Maine: Sad/Hopeless for 2 Weeks in a Row (High School) 30%

32. Health Outcomes- Substance Use Maine: Drug-Affected Infant Reports per 100,000 Population Overdose Deaths per 100,000 Population, 2012-2016 2017 77.9 2011 52.6

33. Health Outcomes- Substance Use Overdose Deaths 2017 77.9

34. Forum Discussion

35. Question #1: Based on your own knowledge and experiences, are there any major rural health issues that are not represented in the data? Maine Veteran’s Home, Machias, ME. 9/20/2018

36. Question #2: Based on the data, past priorities, and your observations, what do you see as the top needs of our state? (Are there needs particular to rural areas?) Northern Maine Community College, Presque Isle, ME. 9/17/2018

37. Question #3: What resources are available to address these needs, and what more may be needed? St. Mary’s LePage Conference Center, Lewiston, ME. 10/11/2018

38. Choose your top four (4) community health priorities • Access to care (including youth engagement) • Mental health (including depression, LGBT, youth, screen time) • Health education • Substance use (including opioids) • Tobacco use (including vaping) • Infectious disease and sexual health (including STIs/STDs) • Human trafficking • Social determinants of health/environmental health • Immigrant and refugee health

39. Next Steps: • Finish Community Forums • Conduct Key Informant Interviews to fill in gaps in the feedback. • Analyses data from the community engagement activities • Update the data in the health profiles • Produce final CHNA reports (March 2019) for use in health improvement planning.

40. Maine Shared Community Health Needs Assessment www.mainechna.org Jo Morrissey, Shared CHNA Program Manager JLMorrisse@mainehealth.org Nancy Birkhimer, Maine CDC nancy.birkhimer@maine.gov