October 7, 2011
Volume 55, Issue 38

Details Emerge on Department of Health Services Reform Initiatives

New information and analysis of the 39-plus proposals included in a package of reforms released by the Department of Health Services (DHS) last week finds several Medicaid program changes that will affect both providers and recipients. The proposals include initiatives to reduce provider payment variation, a hospital pay-for-performance program, moving over 200,000 recipients into the Benchmark Plan, medical home models as well as eligibility and enrollment changes.

Dennis Smith, Wisconsin DHS Secretary, describes the overall effort and the need to develop long term cost savings solutions, "The challenge to us, simply put, is how do we continue to serve the most vulnerable among us while putting the program on a sustainable fiscal path?" (See Guest Column in this issue.)

Others have assailed elements of the plan, saying it will increase costs for more Medicaid enrollees or swell the ranks of the uninsured.

WHA Executive Vice President Eric Borgerding noted that WHA supports the reform approach as opposed to across-the-board cuts to enrollment or provider payments. WHA wants reforms to Medicaid that maintain coverage for vulnerable populations and that do not supplant employer-sponsored coverage and increase cost shifting.

"It is a delicate balance to be sure, that started with the $1.3 billion included in the budget for Medicaid. We applaud the funding that was included for Medicaid in the budget and now the direction of this reform package—avoiding across-the board cuts in payment and enrollment, keeping as many vulnerable people covered as possible, making sure Medicaid is a safety net preserved for those with no other options and not slowly crowding out commercial coverage," Borgerding said. "But there are some elements that need further scrutiny that could complicate reimbursement and add red tape. We’re focusing on the yet-to-be designed payment reforms and the impact they could have on access in underserved areas and cost shifting. We will continue working with policymakers at the state and federal levels as this package moves forward."

Reducing payment variation is clearly a theme in the DHS reform package. DHS states that because Medicaid has varying reimbursement rates depending on the setting, providers have an incentive to provide care in the setting that yields the highest reimbursement rate. One proposal would reduce physician payments when the service is provided in a hospital setting if the physician could have provided the service in an office setting. In addition, DHS expresses an interest in reviewing cost-based reimbursement out of a concern that such payment methodologies don’t incent the most cost effective care. Cost-based reimbursement for rural critical access hospitals helps maintain access to care in underserved areas. DHS staff has indicated that they have not decided on any specific payment modification associated with cost-based reimbursement, but is looking at options.

A hospital pay-for-performance initiative is also included in the proposal. Although the program was announced to hospitals earlier this year, its implementation has been delayed until spring 2012. In the meantime, WHA continues to meet with DHS to provide input on appropriate and meaningful measures, as well as on the payment methodology.

DHS also plans a significant benefit package change for Medicaid recipients. Right now, about 17,000 individuals are enrolled in the BadgerCare Plus Benchmark Plan. Under the DHS plan, over 200,000 recipients will move from the richer Standard Plan to the Benchmark Plan. The proposal is intended to bring government benefits more in line with those in the private sector, and allow individuals to accept overtime wages and promotions without fear of losing their BadgerCare benefits.

In addition to some service limitations, a key difference between the Standard and Benchmark plans is the level of copayments required for various services. The Standard Plan has lower, more nominal copayments, while the Benchmark Plan has higher copayments, including a $60 co-payment for ER visits. Hospitals often see copayments as simply a reimbursement cut, because they are difficult to collect from enrollees, and hospitals also face a greater obligation to serve all patients, regardless of payment.

Several cost savings measures included in the DHS proposals are consistent with recommendations from the WHA Medicaid Reengineering Group (MRG), which met earlier this year. Chaired by WHA Board member, Nick Desien, the MRG developed 47 recommendations for Medicaid reforms, including better coordination of care. Several elements of the MRG recommendations can be seen in the DHS proposals. For example, proposals to encourage private coverage options such as requiring young adults to enroll in their parent’s policies instead of Medicaid were part of the MRG recommendations and are included in the DHS package. Other DHS proposals, such as the creation of medical homes for certain high cost populations also appear to be consistent with MRG recommendations. These models are not yet fully developed, and WHA will continue to be engaged on all reform initiatives to ensure consistency with WHA guiding principles for Medicaid and MRG discussions.

A WHA summary of the DHS Medicaid Reform package can be found at: www.wha.org/financeAndData/pdf/SummaryDHSprovisions10-2011.pdf

The Department’s Medicaid reform website can be found at: www.dhs.wisconsin.gov/MAreform

The letter from DHS to the Joint Finance Committee can be found here: www.dhs.wisconsin.gov/MAreform/PacketJFC9.30.11.pdf

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Wisconsin Hospital Leaders Tell Congress "Protect Our Small, Rural Hospitals"

As the 12-member Congressional "super committee" continues meeting to develop $1.5 trillion in deficit reduction, leaders from Wisconsin hospitals descended on Washington, DC to take part in the American Hospital Association’s Advocacy Day on October 4. Hospital representatives met with members of Wisconsin’s Congressional delegation to explain how various proposals would impact hospitals and how several proposals in particular could devastate small, rural communities.

"If you lose a hospital, you lose a town," Rep. Reid Ribble said (R-WI 8th District), in expressing his strong support for the rural hospitals in his district.

The Wisconsin Hospital Association (WHA) estimates eight Wisconsin hospitals could be affected by the President’s recent proposal to eliminate Critical Access Hospital (CAH) designation for hospitals 10 miles from another hospital. Attendees expressed concerns that 10 miles could turn into 20 miles or full repeal of CAH designation altogether and how doing so would strike at the heart of many communities.

WHA continues to strongly oppose proposals that seek to roll-back or outright eliminate CAH designation as well as proposals that reduce hospital reimbursements. Hospital leaders, including CEOs Terry Brenny (Stoughton Hospital), Marian Furlong (Hudson Hospital), Mark Herzog (Holy Family Memorial in Manitowoc) and Bob Van Meeteren (Reedsburg Area Medical Center) explained how cuts to hospital reimbursements could impact services, programs and jobs.

During the meeting with Rep. Ron Kind (D-3rd District), hospital leaders reiterated how Wisconsin hospitals are already anticipating billions in Medicare reductions over the next 10 years from cuts under the federal health care reform law while at the same time continuing to be proactive leaders in pursuing higher quality, more cost-efficient care.

"I think you’re right," said Rep. Kind, a very strong supporter of the rural hospitals and a proponent of reforming Medicare to focus on paying for "value" over volume. "You have given at the store already."

Rep. Duffy, also a strong supporter of rural hospitals, expressed his concerns with the ripple effects cuts on hospitals will have on patients.

"Provider cuts are just a roundabout way of cutting beneficiaries," said Rep. Duffy. "I’ll do the best I can to help." Duffy also encouraged attendees to make sure their communities are aware of what cuts will mean.

"I was impressed with the access we had to legislators and their staff," said Terry Brenny, Stoughton Hospital CEO about the trip. "All of the legislators expressed a good understanding of the value and role hospitals play in their communities and were quite familiar with and supportive of the unique role provided by critical access hospitals."

The October 4 trip to Capitol Hill was yet another element of WHA’s aggressive grassroots campaign against cuts to hospitals stemming from federal deficit reduction talks. The WHA’s grassroots program, HEAT, also launched an action alert to CAH members and will continue pressing the issue in the weeks to come.

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Governor Hosts 4th Job Creation Forum in Eau Claire
"Hospitals represent a significant employment base in Wisconsin"

Job creation continues to top Governor Scott Walker’s "to do" list. At his 4th Job Creation Forum in Eau Claire October 4, he asked local business leaders to share their ideas with him on how to create more private sector jobs. Several health care leaders attended, including Brian Kief, president, Ministry-St. Joseph’s Hospital, Marshfield; Ned Wolf, CEO, Lakeview Medical Center, Rice Lake; Faye Deich, COO, Sacred Heart Hospital, Eau Claire; and Ken Lee, human resources director, Mayo Clinic Health System, Eau Claire.

In his comments to the Governor, Kief noted, "Not only do hospitals and other health care providers represent a significant employment base, but community health care systems, along with school systems and the local business climate, represent one leg of the three-legged stool that employers and businesses consider when locating in a community."

Kief said Walker responded that there is a need to balance access, quality and cost in decisions and policy related to health care. The Governor took the opportunity to also remind participants that Wisconsin ranks high in quality and is among the best performers in terms of health care costs and access to care.

The Governor told the crowd that there are nearly 34,000 job openings posted on the Job Center of Wisconsin website, but he noted that the key is the skill sets that those jobs require, and he is working to find a way to provide those skill sets.

Lee said Mayo Clinic Health System in Eau Claire gets 13,000 applications for a few hundred jobs each year. He said the area has a strong educational system through its universities and technical colleges but emphasized the need of "continuing to look at our higher education having flexibility."

Job Creation Forums have been held in La Crosse, Green Bay and Milwaukee. Health care executives that participated in those Forums included: Tim Johnson, MD, president/CEO, Mayo Clinic Health System-Franciscan Healthcare, La Crosse; Jeff Thompson, MD, CEO, Gundersen Lutheran Health System, La Crosse; Tom Bayer, chief operating officer, St. Vincent Hospital, Green Bay; and Jim Dietsche, chief financial officer and Linda Roethle, MS, FACHE, vice president, regional business development, Bellin Health System, Green Bay.

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Proposal Would Address Taxable Benefits of Adult Dependents
Under the bill, Wisconsin would adopt newly-amended federal tax provisions

In the 2009-10 Legislative Session, Wisconsin passed an insurance mandate that extended health insurance coverage to adult children up to age 27. Because of this, employers were required to subject the imputed income associated with this coverage to state income tax.

A similar provision was included in the Patient Protection and Affordable Care Act (PPACA), but federal tax law was amended to exempt the value of this coverage from federal income tax. Wisconsin has become the only state not to apply this exemption to state income tax law.

This week, the Assembly Insurance Committee held a hearing on a bill authored by State Representatives Pat Strachota (R-West Bend), Steve Doyle (D-Onalaska) and others that would apply the federal tax exemption to Wisconsin state income tax.

The proposal, Assembly Bill (AB) 277 which WHA registered in support of, would be a welcome fix for employers facing the significant challenge of determining the fair market value of this dependent coverage and the imputed income associated with it.

A companion bill, Senate Bill (SB) 203, has been offered by Senator Van Wanggaard (R-Racine) and others in the Senate and is scheduled for a hearing in the Joint Committee on Tax Exemptions next week.

Action on the bi-partisan measures is expected soon.

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Guest Column: Our Plan to Repair Medicaid
By Dennis G. Smith, Secretary, Department of Health Services

Medicaid plays a variety of critical roles in the lives of 1.1 million people in Wisconsin and in our economy. The challenge to us, simply put, is how do we continue to serve the most vulnerable among us while putting the program on a sustainable fiscal path? To help answer this question, we have engaged every segment of the Medicaid community—those who are served and those who serve. Our plan to bring some much needed repairs to Medicaid calls for changes across all four parts of medical assistance—eligibility, benefits, service delivery, and payment systems.

The discussion starts with the premise that we indeed need to "bend the curve" in the cost of health care. The need to change is quite clear. From the budget perspective, Medicaid is reducing funding for other vital services and priorities. Our budget increased by nearly 33 percent while funding for most state agencies, including education and transportation, was cut. Left unchecked, health care spending will increase to 20 percent of our economy. Small businesses, the backbone of our economy, see the excess cost of health care eating away at the profits they need to reinvest in order to grow and create jobs. The excess cost of health care makes it more difficult for our businesses to compete at the international level.

Government programs at the federal, state, and local levels will control about half of health care spending within the next few years. The cost curve will not bend without changing the way government programs regulate, pay, purchase, and compete.

Few people today argue that we do not spend enough on health care. The real problem is that we spend too much on health care, due, in part, to our payment systems, which hide the true cost of services from patients, purchasers, and even providers.

Everyone should understand there are no easy choices left and our proposed changes will only partially repair our various Medicaid programs. Long-term, authentic, transformation of Medicaid will not occur until policymakers at the federal level are convinced that a return to a true partnership with states with stable and predictable funding is the only way to make the program sustainable in the years ahead.

First, we intend to submit a waiver to the federal government that will restore common sense and fairness to Medicaid eligibility. Our changes include closing loopholes and transitioning individuals into managed care and private coverage faster. No doubt our changes to eligibility are likely to draw the greatest amount of scrutiny. But our proposals must be examined in the context of our determination to avoid the alternative—terminating eligibility for more than 50,000 individuals—which is the option the federal government gave us to find the savings needed to keep Medicaid financially viable in the short term.

Second, in the area of benefit reform, we will put more of our working individuals and families into a benchmark benefits package that looks more like the coverage other working Wisconsin families are able to access in the private market. Medicaid benefits are typically more generous and require lower cost sharing than what most Wisconsin families can buy through their employers. As eligibility has been expanded over the years, the result has been a massive migration from private sector coverage to public benefits.

In 1997, the year the state Children’s Health Insurance Program became law, 76 percent of children in Wisconsin with family income between 100 and 200 percent of the federal poverty level had private insurance coverage and 15 percent had public coverage. The most recent data shows that private coverage has dropped to 56 percent as public coverage increased to 43 percent for this age and income group. We believe that it is fair to align public benefits more closely with the private sector. No family below the poverty level will be asked to pay for their coverage, but those above the poverty level should be expected to contribute to the cost of their care. Even with increased cost sharing, BadgerCare will still be an excellent value for working families.

Changes to how services are delivered are in our third category of reforms. Most Medicaid costs are for a relatively small number of people who are elderly, have a life-long disability, or multiple medical conditions (or a combination of all three). We are developing a series of medical homes targeted to these specific high cost populations. Our proposals do not include any reductions in benefits for individuals who are elderly or who have a disability. While their benefits are protected, we will ensure that their care is delivered as part of a coordinated system. Appropriately coordinating their care will lower costs by reducing duplication of services, reducing overutilization of services, and substituting a less expensive but still appropriate health care setting for the delivery of care.

These new service delivery models will emphasize self-direction, recovery, evidence-based practices, value, and accountability. They will increase the number of people extending care, such as pharmacists, licensed midwives, and peer counselors, and give them a greater role.

Finally, we believe payment reform is also necessary. The traditional fee-for-service rewards volume rather than value. Though many have worked on performance-based payment ideas for some time, we need to incorporate them more quickly into public sector payment systems.

Those who rely on Medicaid deserve access to the quality care our outstanding health care systems provide and the supports they need to help them maintain their independence. Taxpayers deserve to know that their dollars are being stretched to realize the greatest potential value. We believe our modest proposals meet both objectives. Yet, everyone should also understand these changes are just the first steps needed to make Medicaid sustainable in the long term.

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WHA Focuses on Improving Wage Index and Occupational Mix Reporting

WHA again this year is working with RC Healthcare on its wage index improvement project. This is a major WHA commitment and member benefit aimed at helping hospitals accurately report data in their cost reports, which is used to calculate the hospital wage index, a key component of Medicare payment for PPS hospitals.

As the kickoff to this year’s wage index improvement project, WHA and RC Healthcare will be offering a wage index education webinar on October 18 at 10:00 am. This year, important wage index changes will be discussed, including new rules for determining allowable pension expense and CMS’ proposal to Congress to make changes to the wage index process. PPS hospital members are encouraged to participate. More detailed information about the upcoming webinar was recently emailed to hospital chief financial officers.

While the education component of the wage index improvement project is important, it is only one component of the overall effort. RC Healthcare also identifies a wage index contact at each hospital and then either visits or makes individual phone calls to each facility as they work on wage index reporting issues. These additional proactive efforts have led to more accurate reporting and increased reimbursement to Wisconsin hospitals.

RC Healthcare also helps hospitals prepare the occupational mix survey which is an additional adjustment factor used to modify Medicare PPS rates. Through several rounds of occupational mix survey submissions, RC Healthcare has educated Wisconsin hospitals on how the survey works and how it should be completed.

If you have questions about WHA’s Wage Index Improvement Project, contact Brian Potter at WHA at bpotter@wha.org or call 608-274-1820.

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WHA Sends Letter of Support to Joint Finance for Transfer to Fund Physician Survey

On October 6, WHA sent a letter to the Joint Finance Committee in support of the Physician Workforce Survey. Funding for such projects is inevitably an issue, and in today’s challenging budgetary times, could have become the decisive factor that prevented a physician survey from being developed, conducted and analyzed. Instead, because of great collaboration around the issue of Wisconsin’s physician workforce, a fund transfer can make the survey and its analysis possible. In the letter, WHA endorsed the transfer of $60,000 in funding from the UW School of Medicine and Public Health for a one-year project position to allow the Department of Workforce Development to perform and analyze a survey of Wisconsin physicians.

WHA’s letter stated, in part, "The collection of health care workforce data is critical for the accurate planning and forecasting of future health care workforce needs. The Wisconsin Hospital Association has studied and reported on the physician supply in Wisconsin and has repeatedly discussed the need to understand the current supply of health care workers and how to be proactive in ensuring that future shortages be addressed."

An upcoming WHA physician workforce report will outline the many challenges Wisconsin faces in recruiting and retaining an adequate number of physicians to meet the growing demand for health services in the state.

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Grassroots Spotlight: Special Visits to Children’s Hospital of Wisconsin

Last month, Children’s Hospital of Wisconsin (Children’s) in Milwaukee hosted tours of the hospital’s NICU, PICU, Herma Heart Center, Family Resource Center and inpatient school classroom with federal and state policymakers. In the course of each of the tours, Children’s Hospital leaders focused discussions on access to care, importance of Medicaid, and critical funding for children’s hospital graduate medical education. These visits included Governor Scott Walker; DHS Secretary Smith and Deputy Secretary Rhoades; Senator Johnson’s D.C.-based health policy staff; and Congressman Reid Ribble.

"There is no better way to advocate before policymakers and explain what we do at Children’s Hospital than have them see it for themselves." said Peggy Troy, president & CEO, Children’s Hospital of Wisconsin. "Every time they think about Medicaid or children’s hospital graduate medical education funding they can reflect back on the children and families they met."

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Daubert Comes to Wisconsin—CLE SUMMIT on Expert Opinion

The Wisconsin Hospital Association is co-sponsoring the Wisconsin Civil Justice Council’s "Daubert Comes to Wisconsin – CLE SUMMIT on Expert Opinion." This one-day summit is for trial lawyers who are engaged in the defense of civil litigation as well as those lawyers who represent businesses and professionals, and whose litigation fate relies heavily on the admissibility—or non-admissibility—of expert testimony, including the elimination of "junk science." A comprehensive understanding of decisions and trends from other jurisdictions will be critical for lawyers to assist in helping to shape Wisconsin law in the manner intended by the adoption of the Daubert standards for Wisconsin in January of this year.

The summit will be held November 8 at The Kalahari Resort in Wisconsin Dells and November 9 at the Milwaukee Marriott West. The registration brochure is available on the WHA website at www.wha.org/WCJCbrochure.pdf.

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Fale, Schafer Named AHA Delegates

Bob Fale, president/CEO of Agnesian HealthCare/St. Agnes Hospital, and Mike Schafer, CEO/administrator, Spooner Health System, have been approved as state delegates and members of Regional Policy Board 5 by the American Hospital Association’s Board of Trustees. Their terms are effective January 1, 2012 through December 31, 2014. The AHA RPBs meet three times a year, serving to provide input to the AHA Board and senior staff on major policy issues. Fale and Schafer replace Gerald Worrick and Mary Starmann-Harrison whose terms expire this year.

Fale served on the WHA Board from 1999-2008 and chaired it in 2007. He also was a member of the Council on Finance and chaired the Council on Workforce Development and Advocacy Committee. He was an AHA Board Alternate in 2009 and is currently an AHA Board Representative.

Schafer chaired the WHA Board in 2009 after serving several terms as a board member. He also was a member of the Public Policy Council and chaired the Workforce Development Council. Schafer has also served as an AHA Board Alternate and Representative.

"Both Bob and Mike are former WHA chairs and perfectly positioned to articulate the issue priorities of Wisconsin’s hospitals and integrated delivery organizations," said WHA President Steve Brenton. "In their new positions as AHA Delegates, Bob and Mike will also return to the WHA Board where their leadership will help advance WHA’s important work."

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Wisconsin Hospitals Help with Community Flu Education, Vaccination Efforts
Hospitals can promote flu clinics online at Wisconsin Flu Finder

The goal among health providers and public health officials in Wisconsin this fall and winter is to keep the spread of influenza in check through education and vaccination campaigns. Wisconsin hospitals have long been advocates for and proponents of getting the flu vaccine.

This year, the Centers for Disease Control reports that vaccine is readily available. The federal Affordable Care Act requires private health plans and Medicare to offer the vaccine coverage without co-pays or deductibles. Uninsured children are covered under the federal Vaccines for Children program.

With the flu vaccine now available, Wisconsin hospitals are already working in their communities to ensure that people receive the vaccine by promoting and hosting flu clinics. Hospitals, clinics and health systems that are sponsoring flu clinics are encouraged to complete the online form for health providers at http://wisconsinfluclinic.info so the information can be added to the online resource, Wisconsin Flu Finder.

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Program to Focus on Improving Care Transitions/Reducing Readmissions
Register by October 12 for Early Bird Discount

On November 2 WHA will initiate a statewide conversation on how to improve transitions from hospital to long-term care or home and how to reduce preventable hospital readmissions with the "Care Transitions Connection." Keynoted by nationally-known care transitions improvement expert Patricia Rutherford, vice president for the Institute for Healthcare Improvement, the full-day session will allow attendees to understand the issues surrounding poor care transitions, as well as recognize and locate resources for tools and approaches. Experts will share several tried and tested methods for improving care transitions, including STAAR, Project RED, BOOST, Care Transitions InterventionSM and INTERACT. Attendees will also spend a portion of the day exploring the design of a statewide collaborative that incorporates all aspects of the care continuum.

An early bird discount is available to those who register by October 12. Hospitals, long-term care center and home care staff are encouraged to attend as a community and participate in shared learning together. The full-day event will take place at the Kalahari Resort in Wisconsin Dells.

A full event brochure and on-line registration are available at http://events.SignUp4.com/CareTrans11-2

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More Hospitals Offering Palliative Care

Access to palliative care in U.S. hospitals has more than doubled since 2000, but continues to vary widely by state and hospital type, according to a report released October 5 by the Center to Advance Palliative Care and National Palliative Care Research Center. The report grades access to hospital palliative care programs by state, giving the nation an overall grade of B, up from a C in 2008. Wisconsin scored a "B." (See the report at www.capc.org/reportcard.)

As of 2009, 63 percent of hospitals with 50 or more beds reported a palliative care team. Hospitals with 300 or more beds were more likely to report a palliative care team (85 percent), while public hospitals (54 percent), for-profit hospitals (26 percent) and sole community provider hospitals (37 percent) were less likely. Seven states and the District of Columbia received an A, meaning more than 80 percent of hospitals reported a palliative care program.

Palliative care focuses on providing relief from the symptoms, pain and stress of a serious illness and can be provided with curative treatment.

"America’s hospitals have a strong history of caring for patients and families during the most difficult of times," said AHA President and CEO Rich Umbdenstock. "Hospitals and other health care organizations are taking the lead in ensuring health care is patient-centered, reflecting patient’s desires including palliative care assistance."

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Action Planning for Impact: Creating an Implementation Strategy
By: Julie Hladky, CHIPP Research and Support Specialist, Wisconsin Association of Local Health Departments and Boards (WALHDAB)

A Series of Articles on Community Health Improvement

In follow up to the previous article on Prioritizing Strategic Issues (9/2/11), this article will outline steps to write an effective implementation strategy. Developing a well-researched and specific implementation plan can be critical to the impact your efforts will have. As always, engaging the community at this stage will strengthen your efforts by generating more support during implementation and helping to assure chosen strategies fit the target population.

First: Understand the health issue

Before determining how to intervene, it is critical to analyze the particular health issue chosen. Explore:

Next: Choose strategies that will make a difference

There will be many ideas generated about how to tackle the health issues for your community. It is best to choose approaches that have a proven track record. Here are two excellent sources that list evidence-based or promising practices for community health interventions:

Once you have researched the health issue and potential strategies to address it, choose those that best fit your community. Consider what resources are available, who is willing to support the various possible approaches, what has worked in communities like yours, and what the community is ready for. Choose manageable short-term strategies for early success, while also laying the groundwork to implement more complex, long-term strategies.

Finally: Develop a detailed action plan

Many communities falter at the implementation stage. Laying out a detailed action plan may help ensure successful forward movement. Effective action plans include:

(Note: The IRS requires each hospital to have a written Implementation Strategy approved by its governing body. It can include collaborative strategies with other organizations.)


Taking the deliberate approach described above will move a community from a very broad goal such as "reducing childhood obesity" to a very specific, targeted, do-able objective such as: "In the next three years, (Name) Hospital and (Name) Public Health Agency will collaborate with the Boys and Girls Club in (Name) neighborhood to increase by 20 percent the proportion of their K-6 participants who meet recommended levels of physical activity." This specific objective, coupled with evidence-based strategies to achieve it, will focus community efforts and increase local success.

Next article: Implementation – Keeping the Initiative on Track

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Wisconsin Hospitals Community Benefits: Social, Economic and Educational Factors that Influence Health

There is a strong association between social and economic factors and adverse health outcomes. Low socioeconomic status, including poverty, lack of education, and other factors are strong influences on health. Wisconsin hospitals are dedicating resources and developing programs to address these issues and improve the health status of those individuals that often cannot access even basic health services.

Health education for seniors

Senior citizens in the Oconto County community are being proactive about their health by attending free seminars at Community Memorial Hospital. The response to the new Senior Special series hosted by CMH has been outstanding—the seminars have been filled to capacity.

"Folks in our community are glad to have the opportunity to become educated and take charge of their health," said Jim Van Dornick, Community Memorial Hospital CEO.

The CMH Senior Specials series features specialty physicians speaking about the health issues of senior citizens. The series began in May, 2010 with Dr. Colette Salm-Schmid, the area’s leading breast surgeon, who addressed questions about mammograms. In July Dr. Lee Klemens, CMH Internal Medicine Specialist, presented the topic "Aging & Frailty: An Opportunity for Prevention." In August Dr. Jeffrey Bentson, CMH orthopedic surgeon, spoke about knee and joint issues.

"People appreciate that these seminar topics are tailored to the needs of their age group," said Van Dornick. "CMH looks forward to continuing Senior Specials as an ongoing series."

The series continues in September with Dr. Judith Bowers, OB/Gyn with CMH Center for Women’s Care, speaking about Senior Women’s Health.

Community Memorial Hospital, Oconto Falls

Economic Security Initiative for older adults

The Economic Security Initiative (ESI) is led by Aurora Family Service in Milwaukee to assist older adults in reaching a measure of economic security. The program serves adults 55 years and older, federal poverty level of 250 percent or below, to navigate through community programs. The ESI assists clients primarily with financial services such as money management, representative payee, credit counseling, debt management, foreclosure counseling, and a property tax program. Two cases in point:

1. An 84 year-old Milwaukee senior who owned her home for 52 years is at risk of losing her home because she is unable to make payments. She had already used a reverse mortgage line of credit to pay for bills and property taxes. She does not have any other income to pay for her current monthly expenses, which are double what she earns per month.

Her son, who is an Economic Security Initiative client, introduced her to the program at Aurora Family Service. The ESI staff conducted a full assessment to determine her eligibility for Nutrition Stock Box, Homestead Credit, Energy Assistance, Social Supplemental Income (SSI), Medicaid, and Foodshare.

A proud and independent woman, she was at first cautious. She told the ESI staff that she would have to think it over with her family and take baby steps. She agreed to start accepting help by having ESI assist with enrolling her for Energy Assistance.

As a trusting relationship was established over the course of several months, she allowed the ESI staff to assist with enrolling her for the other programs that were offered.

Now she receives services from Medicaid, Energy Assistance, Homestead Credit, Nutrition Box, Food share, and Medicare Extra Help. With assistance from these programs, she is able to save over $800 each month. The savings enabled her to pay the first installment of her property taxes, and she will be able to pay the remaining balance after Homestead Credit sends her a check.

Now with so many resources in hand, she is free from financial stress, able to enjoy retirement and most importantly, save her home of 52 years from being foreclosed.

2. Imagine that you are dependent upon another person to provide financial support, but now that person is gone. What would you do?

That was the case for L.A., a 77 year-old senior woman, diagnosed with high blood pressure and diabetes.

After L.A.’s husband passed away, she held rummage sales to help with the out-of-pocket expenses for his funeral. She also found herself faced with a house payment, health insurance and food costs, along with a change in income. Her main concern was getting assistance with the prescription medications she needed because of her health conditions.

She learned that the prescription and pension plans were seized upon her husband’s death and his pension would go to his first wife. L.A. was informed she would get an increase in her social security payment. Still, L.A. was concerned as to how she would afford her medications and qualify for health insurance due to her pre-existing conditions.

L.A. turned to the Economic Security Initiative (ESI) at Aurora Family Service for program assistance. She met with ESI staffer Karen for a full assessment. Karen recommended Food Stock Box, Senior Care, Medicare D, Medicaid Deductible plan, Medicare Extra Help, and Senior Law with regard to the property responsibility to secure the resources she would need. L.A. had already found a senior living facility to move to and joined a prescription discount program for the monthly medications. With Karen’s support, L.A. is now a member of the Senior Care Rx program has the AARP Advantage Plan through Secure Horizon.

Karen reports that L.A is more relaxed about her health and is trying to live a better life. She noted, "In January 2011, L.A. contacted me and said that everything was in place. She does not have to worry about getting sick and medical expenses. I am glad we are able to assist her with the different resources."

Aurora Health Care, Milwaukee

Voucher Program offered to those with immediate needs

Thanks to the generosity of the Howard Young Foundation, inpatients and emergency room patients that are discharged from Ministry’s Howard Young Health Care in Woodruff or Eagle River are provided with the needed essentials to get them through the next day, through a voucher system.

The Spiritual Services and Case Management departments within the hospitals have the ability to provide vouchers to departing patients for their immediate needs. This includes:

Prescription vouchers for patients requiring a medication

Transportation / taxi vouchers for patients that don’t have a ride home from the facility

Food vouchers for the basic and immediate necessities

Hotel vouchers for a night’s stay, for the homeless or other, until arrangements can be made with the nearest homeless shelter, family or friends

Gas vouchers to ensure the patient can get to and from the hospital for needed services

The voucher program is closely monitored through a computer system, and further enables staff to provide follow up and needed assistance. If a hotel voucher is given, staff can follow up with the person to be sure they have the needed arrangements with a homeless shelter, family or friends.

In 2009, 38 vouchers were given, totaling nearly $5,000. Half of that sum was used in transportation vouchers, providing taxi rides or gas cards to those in need. The voucher program was started in 2005.

"We are so fortunate to have the Howard Young Foundation’s assistance in helping to provide the immediate services, such as medications, shelter and food, that are essential in a patient’s recovery, upon their discharge from the hospital," said Chaplain Brian Iverson, Ministry Howard Young Health Care. "Many patients don’t have family or friends they can count on for a ride home, or safe housing for the night, or the needed prescriptions. The voucher program enables them to get the needed supplies that will temporarily get them through the day, until they can make other needed arrangements."

Ministry Howard Young Health Care, Woodruff

Submit community benefit stories to Mary Kay Grasmick, editor, at mgrasmick@wha.org.

Read more about hospitals connecting with their communities at www.WiServePoint.org.

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