Overview of Community Health Services Development

1. Overview of Community Health Services Development Roosevelt Medical Center June ___, 2008 Prepared by: Montana Office of Rural Health & Rural Health Resource Center

2. Community Health Services Development (CHSD) A process created 20 years ago with the University of Washington To help communities understand what health services they need, and to engage the community in strengthening the healthcare system Over 30 communities in Montana have used the CHSD process over the past 20 years

3. The current CHSD Project Montana’s Critical Access Hospitals are supported through the “Flex Grant” at the Montana Hospital Association Funds support projects that strengthen and improve CAH’s This year, funds are available to support the CHSD project with 6 or more hospitals

4. CHSD Philosophy Health care is a local affair Health care delivered in rural communities is affordable, high quality, and necessary to the good health of the entire community Citizens of rural communities/counties should take responsibility for the health of the community, Most communities face a larger number and greater array of issues than usually acknowledged, Adequate dollars exist to maintain local health care delivery systems and Effective problem-solving by communities is the most important factor in the survival of rural health services.

5. CHSD Communities Chester Conrad Culbertson Fort Benton Red Lodge Roundup

6. Montana Office of Rural Health MORH has managed the CHSD process in Montana over the past 20 years Offices of Rural Health work with the Critical Access Hospital Programs. Funds come from the Federal Office of Rural Health Policy MORH is located at Montana State University, and is also affiliated with the WWAMI Medical Program

7. Issues Affecting Rural Health • Reimbursement • Workforce Shortages • Technology – Electronic Health Records • EMS/Bioterrorism • Aging Population • Cost of Health Care and Insurance/Access Issues • Quality and Performance Improvement

8. Rural Hospital Facts • Medicare patients days at 63% in small rural hospitals compared to 54% in 200+bed hospitals • Outpatient services account for 50% of charges • Outpatient surgeries increased 72% the past 10 years • Rural hospitals employ an average of 3.3 physicians and dentists • 44% of rural hospitals are community owned and 39% government owned Source: Rural Hospitals: New Millennium and New Challenges, University of Minnesota Rural Health Research Center, 2003

9. Critical Access HospitalsMedicare Rural Hospital Flexibility Program • Licensure changes hospital from PPS to a cost-based reimbursement system for out/inpatient services • Required Services: Inpatient care, ER, Lab, Radiology • Network agreement with at least one hospital • No more than 25 acute beds + 10 swing beds • Average annual acute LOS may not exceed 96 hours

10. Critical Long-Term Care Issues • Increasing need for long-term care • Needs of family caregivers • Over-reliance on institutional model • Need for more community-based options • Current and future worker shortages • Regulations and reimbursement

11. Other Rural Health Care Trends • Aging and Declining of Health Professions Workforce • Continued growth in health care industry – employment projected to increase by 21% • By 2030, 1 in 5 Americans will be >65 years old • Aging of healthcare workforce – many providers over 50 in rural areas

12. Patient Satisfaction Overall Satisfaction by Type of Community n=680, Mar, Apr, May 2000 (Press Ganey)

13. Patient Satisfaction Overall Satisfaction by Bed Size n=680, Mar, Apr, May 2000 (Press Ganey)

14. Next Steps If you, the local decision makers, wish to promote your health sector, here is how we can help you: Community Health Planning A. Where is the community now? B. Where does the community want to go? C. How will the community get there?

15. Community Health Planning • Update on health care issues and current trends • Review of Economic Impact study and county health information • Determine vision for the local health care system • Identify and prioritize critical issues, solutions, and opportunities for health care • Develop action strategies to address critical issues and a timeline

16. Health Issues – County Health Profile What are the major health issues in Culbertson and Roosevelt County? How does the community compare the rest of the state? What health status indicators could improve? Does the community have resources to address the issues?

17. Economic Considerations – Economic Impact Analysis & Profile The source of the economic impact data is Brad Eldredge, the state economist. In his report, he writes: A quality healthcare system gives communities an advantage when competing for new business…and can provide an opportunity for young people to stay in the community

18. Economic Impact Demographics: 10,524 residents, lower percentage of residents 25 and older and a higher percentage of residents under 25 years of age (US Census, 2006) Median age of 32.3

19. Steps in the Community Health Services Development Process Create a steering committee to advise the project Review economic and health information Conduct a community survey Interview key people in the community Analyze the information Hold a community forum

20. After the information gathering Identifying the strategic issues and opportunities Health goals and healthcare delivery goals Technical assistance on achieving health goals in the community is available

21. Outcome of CHSD Community engagement Community health goals Strengthened healthcare services Community investment in the future of the health system

22. Contact Information Natalie Ryan, Project Director Montana Office of Rural Health Montana State University, Bozeman 406-994-6001 natalie.ryan@montana.edu healthinfo.montana.edu