Sarah Thach, MPH Kathy McGaha, BSBA Terri Wallace, BSW

1. Creating an Infrastructure of Collaboration:Tools and Models from North Carolina’s “Healthy Carolinians” Network of Local Health Partnerships Sarah Thach, MPH Kathy McGaha, BSBA Terri Wallace, BSW

2. Session Objectives • Describe NC’s statewide network of local health partnerships • Outline milestones in its development • Share two examples of local partnerships’ accomplishments, focusing on: • Community health assessment • Chronic disease management for uninsured • Share concrete tools for collaboration

3. Healthy Carolinians Partnerships… • Consist of: • Hospitals and health departments • Social service agencies and organizations • Local government • Businesses • Faith communities • Community groups • Assure communities’ ability to assess and address local needs rapidly, collaboratively, and effectively

4. Certification criteria • Recruit diverse membership • Share leadership • Base priorities on community assessment • Align with NC 2010 health objectives • Create effective action plans • Reduce health disparities • Communicate partnership’s activities • Demonstrate members’ commitment • Develop funding for sustainability

5. 73 certified partnerships cover 80 of NC’s 100 counties Gates Camden Alleghany Northampton Currituck Rockingham Ashe Warren Surry Caswell Stokes Hertford Vance Person Pasquotank Watauga Halifax Chowan Wilkes Granville Yadkin Perquimans Mitchell Forsyth Orange Guilford Franklin Bertie Avery Nash Yancey Caldwell Durham Alamance Alexander Davie Washington Madison Edgecombe Dare Burke Martin Iredell Tyrrell Davidson Wake Buncombe McDowell Wilson Chatham Randolph Catawba Haywood Pitt Rowan Beaufort Swain Lincoln Hyde Johnston Rutherford Graham Greene Lee Montgomery Henderson Cabarrus Jackson Harnett Gaston Wayne Lenoir Cherokee Transylvania Polk Stanly Cleveland Craven Macon Moore Mecklenburg Clay Pamlico Cumberland Richmond Jones Sampson Anson Hoke Union Duplin Carteret Scotland Onslow Robeson Bladen Pender Columbus New Hanover Brunswick Pilot sites Partnerships represented here

7. Healthy Carolinians Milestones • 1993: Governor’s Task Force • 1993: NC 2000 objectives • 1993: Pilot project • 1994: Certification • 1999: 2010 objectives • 2002: Health departments’ community assessment integrated into Healthy Carolinians • 2006: Health department accreditation

8. Success Factors • Information sharing • Regional meetings • Annual conference • Technical assistance • Financial support • Foundations • Minimal: State General Assembly

9. Macon County, NC

10. Macon County, NC • County seat: Franklin, NC • Total population, 33,797 • Median Family Income, $33,375 • Approximate uninsured 17% (5745 residents) • 2nd highest percentage of seniors in NC (22.8%)

11. Macon Resources • 2 Hospitals; 3rd has satellite complex • Urgent care center • Free clinic* • Adult and children’s dental clinic* • Health department • Medication assistance program* • Future site of VA clinic • Child abuse and neglect (KIDS Place) • Domestic violence center (REACH)

12. Partnership Accomplishments • Formed in 1998, won state partnership award. • Access to Care: free primary care clinic, dental care for youth and adults, medication assistance • Schools and Youth: 4 school nurses, Youth Risk Behavior Survey, greenway & playground, youth-led sex education • Recreation: County-wide resources website, county-wide recreation master plan • Substance abuse prevention program, recovery house for women, 5 tobacco-free school campuses • Brought in $1.5 million in grants

14. Assessment Phases • Assemble team • Collect data re. community concerns • Review health statistics • Compare community concerns and statistics • Set priorities • Report results to community • Prepare assessment document • Develop action plans

15. Community Health Assessment:Tips for Success • Broad community participation in assessment team from start to finish • Get media involved from the beginning

16. Community Health Assessment:Tips for Success • Be creative to involve disparity groups (i.e. youth involvement)

18. Community Health Assessment:Tips for Success • Worth the $$$ to do it well • Take time to educate/explain when an assessment tool might be controversial (i.e. Youth Risk Behavior Survey, Sex Education Questions) • Report the findings everywhere • Make results easily accessible (i.e. website)

21. Community Health Assessment:It Pays Off In the End • Puts everyone on the same page from the beginning • Decreases hidden agendas • Instills confidence and trust • Used as accepted source of information

22. Henderson County 22

23. Henderson County • Western part of NC • Population 99,033; by 2010: 107,566 • 79% are 18 and over • 21% are 65 and over (3rd highest in state) • 8.3% are Hispanic Median Family Income = $40,097 Uninsured rate is 19% (state rate is 19.5%) 23

24. Henderson Resources • 2 hospitals • Free Clinic • Federally Qualified Health Center • Health department • Sexual assault and domestic violence centers • Many other non-profits to serve the needs of the community 24

25. Partnership Accomplishments • Formed in 1994 (pilot site) • Established free clinic including dental, medical, chronic disease, and psychiatric care • Developed free dental clinic • Schools: school nurse, climbing walls, salad bars in cafeterias, teacher training • Youth tobacco prevention program • Heart disease & stroke prevention • Brought in over $4 million in grants

26. Addressing Uninsured Need identified in community health assessment Wanted to create a system of care for the uninsured Pulled together a community team to brainstorm solution and funding 26

27. Partnership took the lead: • Neutral entity – baggage left at door • Incubator for innovative ideas

28. Community Team • Both hospitals • FQHC • County Mental Health Provider • Local Family Practice Physicians • Free Clinic • Henderson County Department of Public Health • Area non-profits that focused on the underserved • Local funders • Mountain Area Health Education Center • Regional case management agency for Medicaid • Henderson County Department of Social Services 28

29. Project Goals Increase coordination and quality of care for the uninsured Improve efficiency and effectiveness of services Generate cost savings Create network to bridge healthcare services to the uninsured 29

30. Process • Independent grant writer to write federal HCAP grant • Focus conditions of asthma, diabetes, depression • Case management • Community pharmacy • Integrated mental health • 200% or less of federal poverty level • Ages 18-64 • No medical insurance • PFH as fiscal agent • Community team to serve as “Core Partners” to sign Memorandum of Agreement • Sit back and wait !~~~~~~~ 30

31. Grant was awarded and Program began. 31

32. Outreach 32

33. Project Successes Many uninsured who did not have a medical home now have one Community Pharmacy – provides affordable medication to manage illnesses ($3.00 co-pay) Improved care for patients through case management which results in fewer emergency room visits and inpatient hospital admissions Providers working together to address critical health needs of the uninsured Community working together to decrease financial burden the uninsured have on the healthcare industry. 33

34. Project Sustainability In the NC state budget (HealthNet) Health department picked up therapist position Regional Medicaid case management organization picked up case management, administration and enrollment The Free Clinic picked up the community pharmacy 34

35. Tools for Collaboration Assess Plan • Collective assessment/ report out for common understanding of problem • One-on-one lunches to understand underlying interests, agency limitations • Visioning exercise • Nominal group technique • Group road trip to model site Evaluate • Document collaboration, shared leadership Implement • Round robin (sharing events, how each agency works); Rotate leadership; Serve on members’ boards, strategic planning processes, volunteer for members’ activities

36. For more information re. NC: www.healthycarolinians.org Western region: sarah.thach@ncmail.net Macon: http://www.maconnc.org/healthdept/carolinians.html Kathy McGaha: kmcgaha@maconnc.org Henderson: http://www.p-f-h.org/ Terri Wallace: director@p-f-h.org