nd center for nursing€¦ · web view2018/02/15 · university of north dakota college of nursing...
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Culture of Health Rural Population Draft Framework
Rural Population Group Member List
Contact Name Organization Email Loretta Heuer Steering Committee, Group Co-
Mary Sahl Steering Committee, Group Co-Lead
Gabrielle Petri Steering Committee Member [email protected] Denise Andress Western North Dakota AHEC [email protected] Brad Gibbens Center for Rural Health [email protected] Jody Ward ND CAH Quality Network- [email protected] Susan Mormann Womens Way [email protected] Vigen ND CAH Quality Network [email protected] Pete Antonson Northwood Deaconess Health
Center [email protected]
Darrold Bertsch Sakakawea Medical Center [email protected]
Gretchen Dobervich
ND Rural Health Association [email protected]
Sue Heitkamp CHI Health at Home [email protected]
Jan Quandt CHI Oakes Hospital [email protected] Johnson NDSU Extension [email protected] Jane Myers ND Department of Health [email protected]
Tracy Evanson University of North Dakota College of Nursing and Professional Disciplines
Katherine Dean Essentia Insitute of Rural Health [email protected]
Tracee Capron Hospice of the Red River Valley [email protected]
Amy Elliott Sanford Rural Health Research Group
Marilyn Yellowbird-Baker
Elbowoods Memorial and Health Center
Jessica Thomasson Lutheran Social Services [email protected] Zacher ND Association of Rural Electric
Cooperatives [email protected]
Marsha Waind Altru Health System [email protected] Jennifer Nuelle-Dimoulas
Altru Health System [email protected]
MaDonna Azure Otter Woman Consulting [email protected]
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Tony Looking Elk Otto Bremer Foundation [email protected]
Red Fox Sanchez MHA Tribal Health [email protected] Lindquist Candeska Cikana Community
Jolene Keplin Quentin Burdick Health Care Facility
Erik Holland State Historical Society of North Dakota
Ken Knight North Dakota Home Schooling Association
Llora Knight North Dakota Home Schooling Association
June Herman American Heart Association- ND [email protected]
Stacie Garland CHI Oakes Hospital [email protected] Bloomberg Blue Cross/Blue Shield of ND
Caring Foundation [email protected]
Cindy Gohner Blue Cross/Blue Shield of ND [email protected]
Ben Gates North Dakota Emergency Management Association
Brianna Foote MHA National Tribal Home Health [email protected] Hertz ND Center for Nursing Board [email protected] Shila Thorson ND State Department of Health [email protected]
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Making Health a Shared Value: How can individuals, families and communities work to achieve and maintain health?
Driver 1: Mindsets and Expectations: Awareness of how our individual health affects others- and how the health of our communities influences our own- is key to building a culture of Health. Do our policies reflect our communities’ needs and values? These measures reflect how we as individuals, families and communities, and as a nation- think about health and well-being.
Examples: Value on Health Interdependence, Value on well-being, public discussion on health promotion and well-being.
What is happening in North Dakota for this driver? Is there work being done in this area now? Use Asset map information and expertise of group members to fill in framework. Add additional rows as needed.
Entity/Organization Brief description of Action
Location Funding Source
BCBSValue based program, blue alliance for quality care and prevention, manage chronic patients. Case managers coordinate community resources.Education and coordination of benefits.Disease management to help members become more engaged and manage diseases at home.
Statewide Private
Social ServicesCare management and support for seniors and families.Counseling services. – SWInclusion Specialists for Behavioral and Mental health – SWEmpowering and capacity building that
Statewide State/Federal
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fills gaps for seniors. Senior companionships.Home visiting support for young families for abuse and neglect - Gambling addiction treatment. Affordable Housing for seniors – SWLong-term Recovery Assistance.Therapeutic foster care. – Minority Youth
USDA Rural DevelopmentGrants to support job training. Technical assistance and financing for local grocery stores. Prove community economic development and financing – telepharmacy, safe housing, rental assistance, utilities, broadband.
Federal
North Dakota Rural Health Association
Advocating on the state and federal level for rural health Access to care.
State State/Federal
Center for Rural Health Community health needs assessment for hospitals and public health.
- Will be focusing on 5-8 communities to help strengthen community based palliative care with CAH network
Statewide Federal/Private.
Local Public Health Units Contribute to filling gaps in resources while providing a bridge to convene partners.
Statewide county/state/federal
North Dakota Public Health Advocating for Statewide Private
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Association public health education
Fargo/Moorhead American Indian Community Health Needs Assessment
Fargo/Moorhead
What are ND’s gaps (geographic and programmatic) for this driver?
Reservations Provider gap – Southwest corner of the state Behavioral health and mental well-being Palliative Care (community based) is not covering the entire state at this time Tribal Communities- tribal health educators
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Making Health a Shared Value: How can individuals, families and communities work to achieve and maintain health?
Driver 2: Sense of Community: Residents of socially connected communities are more likely to thrive. Research suggests that individuals who feel a sense of security, belonging, and trust in their environment have better health. People who don’t feel connected to the community are less inclined to engage in health-promoting behaviors or work together for positive change. These measures indicate to what extent people feel a part of their communities.
Examples: Sense of community, social support.
What is happening in North Dakota for this driver? Is there work being done in this area now? Use Asset map information and expertise of group members to fill in framework. Add additional rows as needed.
Entity/Organization Brief description of Action
Location Funding Source
NDSU ExtensionCommunity health and nutrition.Family Consumer Science Agents.Family Nutrition Program.SNAP referrals.Diabetes Prevention.Community gardens.Capacity building for teachers.Smarter lunch rooms – creating a healthier environment.Health insurance literacy program.Community economic community program.Rural leadership program and Rural Health grants.
State/County State/Federal
Kiwanis, Lions ClubsService/educational clubs that organize volunteer hours and donations to strengthen communities and serve children.
Community based
Community/Private
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Center for Rural HealthBe a resource, increase knowledge and improve the health in ND.Emphasize partnerships with others because no one has enough resources or staff.Building local capacityTry to help communities find solutions.Community Health Needs Assessments Strategic planning with organizations and communities.Grant writing workshops.
StatewideFederal funds, ND legislature, private foundation funding (e.g. Cargill Foundation)
Amvets, Elks clubsPromote membership from the community to strengthen relationships and serve as meeting places.
Community based
Community/Memberships
NDDOH Cardiac ready communities – educate on CPR, 911, BP screenings, heart healthy lifestyles; go beyond the hospital, community grassroots efforts
State
Boys and Girls clubs on Reservations, youth recreation program
Promote family after school and weekend activities
Opportunities for volunteerism, Parent, Teacher Organizations (PTO), Support Groups (AA,Al Anon, Alzheimers Support Group, Parkinson Support Group)
Promote sense of belonging and community
Parish Nurse/Faith Community Nurse
Provided in home Community
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nursing services, typically, supported by a group of churchesProvide support, lead support groups
Based
ND Public Health Association
Honoring Tradition of Health and Wellness for Cancer Prevention
Digital Stories
Fargo Moorhead Native American Center
Statewide
North Dakota Comprehensive Cancer Control program
Private
What are ND’s gaps (geographic and programmatic) for this driver?
Sense of community in some areas is a gap because the post offices, grocery, and gas stations. Hard to be poor in a rural community. There is a lot of hidden poverty. Won’t use some services such as food bank because they know people. Senior centers can be used as a resource but limitation is in its size and audience. Churches and faith-based communities can also serve as resources- education, financial barriers.
Churches and Senior Centers closing - e.g. daily wellness check Not being able to recruit and retain young families and having jobs with good wages Improved bandwidth – would be able to maintain people in their homes Tribal communities- connection to traditional culture and community linked to physical,
mental and behavioral health, what is being done in each of the ND tribal nations? How is it being funded? What more can be done?
Traditional culture preservation- ex sodbuster days, thrashing bees, language preservation, etc
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Making Health a Shared Value: How can individuals, families and communities work to achieve and maintain health?
Driver 3: Civic Engagement- Civic engagement creates healthier communities by developing the knowledge and skills to improve quality of life. Voting and volunteering are among the many measures of an engaged population. In both cases, people’s actions show they care about the outcomes of their community or their nation, and they want to cultivate positive change. These Measures reflect whether individuals feel motivated and able to participate and make a difference.
Examples: Volunteer engagement, voter participation
What is happening in North Dakota for this driver? Is there work being done in this area now? Use Asset map information and expertise of group members to fill in framework. Add additional rows as needed.
Entity/Organization Brief description of Action
Location Funding Source
North Dakota Public Health Association
This association is planning to do community education on legislative issues.
ND State Governor’s Office
Education Innovation Initiative – schools can seek waiversWorkgroup – examine the nursing shortage in ND.
Statewide
Governor’s Higher Education Task
State
Dollars for Doer’sGo out and volunteer two days out of the year, can request the donation to be made.
Hold
North Dakota Rural Health Association
Advocating on the state and federal level for rural health Access to care.As a legislator – passing legislation that is responsible, ethical, evidence based.American Indian Public Health Resource CenterDevelop public health needs, cultural
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competence, and culturally sensitive policy.
Center for Rural HealthOn website
Community of Engagement Tool Kit
State-wide CDC
NRECA Coop vote that we use to promote rural issues.
Issues come from the NDAREC.
State-wide Cooperative effort, comes out of the association
North Dakota Public Health Association
Mission and activitiess include advocacy, educating membership on being an advocate, identifying member advocacy opportunities, letters to the editor and op eds related to health
Statewide Private
What are ND’s gaps (geographic and programmatic) for this driver?
Issue voting vs. Party voting – are we electing people who value health and supporting health?
Do North Dakotan’s recognize the importance of health? – How engaged are North Dakotans in understanding a variety of issues?
Communities are not contacting their elected officials to tell them what the health needs are for the area.
Providing Information vs. Lobbying; providing information to citizens of ND and state employees alike.
Declining population in rural areas limit volunteers; generational differences in the value of volunteering.
Limited skill set on the part of the public to be actively engaged.
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Fostering Cross-Sector Collaboration to Improve Well-being: Are Individuals, institutions and communities doing all they can to prevent illness and promote health?
Driver 1: Number and Quality of Partnerships: Research indicates that building relationships among partners is the most challenging aspect of creating change. Measures look at how organizations are working together to improve health and well-being.
Examples: Health department collaboration with community organizations, school districts, workplace health promotion
What is happening in North Dakota for this driver? Is there work being done in this area now? Use Asset map information and expertise of group members to fill in framework. Add additional rows as needed.
Entity/Organization Brief description of Action
Location Funding Source
BCBSWorksite Wellness grants, Worksite Wellness tool kit available to employersPhysical Activity Grants
ND Community Foundation Grants
Private
NDDOHBuilding Cardiac-Ready communities, building relationships in the community.
Redoing the new 6 year plan so there will be more information regarding health promotion and screening.
Community State$96,000 grant to work with the communities – American Heart Association?
NDSUProvides assessment of workplace employee health, assist in collaborating with other entities to address issues/concern areas
Workplaces statewide
State/Federal
NDSU School of Nursing
Collaborates with tribal nations and reservations to provide health care advisement and development.
State-wide Federal/private
UND College of Nursing and
Collaborates with tribal nations and reservations
State-wide Federal/private
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Professional Development and Center for Rural Health
to provide health care advisement and development.
Sanford HealthProviding screening opportunities and wellness incentives to employeesFamily Wellness-20% membership for employeesHeart Screen-Low costProfile Weight Management (New Clinics) Profile Plan.net
Sanford facilities Private
Sanford Health Community Health Needs Assessments*What questions should be asked in the needs assessment?Can we work together to develop questions so that we get the information that is needed?-Carrie McCloud
Sanford facilities Private
Essentia Health Community Health Needs Assessments*Leigh stated that Essentia is ready to roll out their next needed assessment questionnaire. Have a worksite wellness program (internal and external)NDSU Extension – National Diabetes ProgramCommunity Needs Assessment – Greater Fargo/MoorheadCommunity Paramedic Program – go out to homes and help manage their care. Prediabetes/
Essentia facilities
Private
Grant
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hypertension/Diabetes. Higher risk, chronic users of the ER
Center for Rural Health Partnership development, creating alliancesWork with statewide organizationsCommunity Health Needs AssessmentsToolkitDakota Conference of Rural and Public HealthCAH Quality NetworkProgram and Grant DevelopmentHealth Workforce DevelopmentRural Health Information Hub
State-wide
National/state
Federal/private
ND Community Foundation Grants/ND/Regional Based Foundations
Available to be used for health related activitiesOtto BremerDakota Medical FoundationBush Community Innovation GrantsAlex Stern
Private/Foundations
RECs Home Care Cooperative Model to address care shortages in rural areas. Would complete a market assessment. Home care worker that provides the quality of life so the individual could stay in the home. Housekeeping, reminders of medications, personal hygiene.-Need to have money first. -The model has been implemented in Wisconsin for 16 years. -People would own the business (e.g. home care
Cash flow
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workers). Would be looking for owners.
AFLAC insurance Pays for mammogram, check-ups.-Offer cancer insurance.
ND Public Health Association
Dakota Conference of Rural and Public Health
Blue Campaign with Dept of Homeland Security
North Dakota Comprehensive Cancer Control program
Statewide
Statewide
Fargo/Moorhead
What are ND’s gaps (geographic and programmatic) for this driver?
Resources limited to be able to designate employees to go after these wellness and workplace assessment opportunities
Need a resource book listing the available coalitions, grants, foundations, etc. More input into the community health assessment process. Essentia and Sanford
Community Health Assessment surveys together (including Cass and Clay County Public Health).
What collaborations for health are happening in ND tribal communities? Need for oral health education and access to supplies such as toothbrushes in rural,
low income and tribal communities
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Fostering Cross-Sector Collaboration to Improve Well-being: Are Individuals, institutions and communities doing all they can to prevent illness and promote health?
Driver 2: Investment in Cross-sector Collaboration: In addition to measuring the quality and quantity of cross-sector collaborations, it is important to track investments that support these partnerships. Corporate and federal contributions have the power to influence our nation’s health, both directly and indirectly. Measures help identify whether there is adequate financial support to enable cross-sector partnerships.
Examples: US Corporate Giving, Federal allocations for Health Investments.
What is happening in North Dakota for this driver? Is there work being done in this area now? Use Asset map information and expertise of group members to fill in framework. Add additional rows as needed.
Entity/Organization Brief description of Action
Location Funding Source
Co-ops (USDA?)Providing some loans at zero-rates, or low ratesProvide technical assistance
Rural areas USDA – 50,000 or less, $1.0 mil
RDFC, nonprofit by the utility co-op, needs to be in a rural area. 10,000 or less population
ND Dept. of CommerceWorkforce Development
Governor BurgumMainstreet Initiative*Website mainstreet.org or com
USDA Rural DevelopmentFinancing loans and grants for healthcare facilities, telehealth, telepharmacyCommunity Facility Loan and Loan Guarantee program
Economic Development Corp./Job Development Corp.
Community and workforce development
State-wide
Consensus CouncilThrough the Bush foundation, grants available to pull
Three times a year funding
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communities together for discussion/solutions
Reservations: Small business loans, small loans program, home mortgage programs
Financing available to tribal members backed by the tribe
Tribal Tribal
QSP Workers that collaborate with county social services to travel off-reservation (Spirit Lake) Elders Programs that collaborate with many entities.
Helping Native elders age in place.
One stop shop for aging services.
Medicaid reimbursed services.
Increasing tribal employment
Tribal Nations Tribal/grants
Center for Rural Health Rural Hospital economic impact analysis.
State Federal
What are ND’s gaps (geographic and programmatic) for this driver?
Formal cross-sector partnerships seem to be missingo Educatorso Law Enforcemento Community Health Workers
Listed above likely to work together on a case by case basis but are there formal partnerships anywhere?
Difficult to identify US corporate giving and federal allocations that facilitate rural community collaborations. Yes, there are federal dollars and programs operating in communities but most programs seem to be “silos”.
Federal government does not fully fund Indian Health Services, slow process for state Medicaid certification of eligible tribal services that would expand access to services and generate revenue to sustain them, lack of skilled clinical and public health workforce in tribal communities to meet needs, identify what is being delivered by state services in tribal communities with block grant funds in which federal trust responsibility resources are included in “block” to state
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Fostering Cross-Sector Collaboration to Improve Well-being: Are Individuals, institutions and communities doing all they can to prevent illness and promote health?
Driver 3: Policies that Support Collaboration: Policies play a key role in encouraging and maintaining collaboration across sectors, as well as creating incentives for different sectors to contribute what they can to the cause of improving our nation’s health. Measures highlight some of the policies that have the potential to catalyze widespread improvement in health and overall well-being.
Examples: community relations and policing, youth exposure to TV ads, climate adaption and mitigation, support for working families
What is happening in North Dakota for this driver? Is there work being done in this area now? Use Asset map information and expertise of group members to fill in framework. Add additional rows as needed.
Entity/Organization Brief description of Action
Location Funding Source
Department of HealthFund marketing campaigns for health-related PSA’s, posters, take-home materials.Manage Vaccine sites in rural communities.Chronic disease, smoke-free communities, and Diabetes projects state-wide.
Policies in place that support flexible work schedules, family friendly environments.
Hypertension Summit
Cancer Coalition
Statewide State/Federal/Grant
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Dakota Diabetes Coalition Provides education to the communities esp. providers and increases of Diabetes EducatorsDiabetes Coalition Summit
USDA Rural DevelopmentFinance- telepharmacy, quality safe housing, rental assistance, all rural utilities, broadband, electricity. Grants to support job training.Prove community economic development and financing.
Communities/State Federal
Center for Rural Health
Building local capacity.Try to help communities find solutions.Community Health Needs Assessments for over half the hospitals in ND.Strategic planning with organizations and communities.-Through assessment and research the center is able to contribute to policy formation. Collaborate with the ND Rural Health Association.
Community/State Federal
ND Public Health Association
Honoring Traditions of Health and Wellness for Cancer Prevention education and sewing circle program
Fargo/Moorhead PrivateNorth Dakota Comprehensive Cancer Control program
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What are ND’s gaps (geographic and programmatic) for this driver?
Service limited/unknown/lack of understanding in Tribal communities Behavioral and Mental health gaps Workforce limits Proposed legislation that was closed (e.g. tobacco tax). There is not an interest to increase
taxes even if it would deter use. When policies are evidenced based but they are not pushed forward.
Creating Heathier, More Equitable Communities: The places where we live, learn, work and play contribute to our ability to become and stay healthy.
Driver 1: Built Environment: Health-promoting environments are safe, affordable and provide access to exercise and nutritious food. Feeling safe in our neighborhoods will also allow us to take full advantage of the space around us. Measures gauge whether our physical environments support well-being.
Examples: housing affordability, access to healthy foods, youth safety
What is happening in North Dakota for this driver? Is there work being done in this area now? Use Asset map information and expertise of group members to fill in framework. Add additional rows as needed.
Entity/Organization Brief description of Action
Location Funding Source
Lutheran Social ServicesSupport childcare providers for those who are trying to start their business. Respite care/companion programs.Care management and support for seniors and families.Counseling services.Affordable housing for seniors.
State-wide but work in communities
Federal/private
Federal/private
ND Coalition for FoodHunger-free ND initiative.Food Pantries.
State
NDSU ExtensionsCommunity health and nutrition instruction.Family Nutrition
State-wideCommunity locations
State/Fed/Grant
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Program, SNAP referrals.Community Gardens.Health insurance literacy program.4-H for teenagers
RECSRural grocery initiative – accessibility and affordability of food in rural areas
Aging Senior Services Senior meals and senior centersRural Transportation
State/Federal
Department of Transportation
Active transportation plan, to enhance biking and walking across the state. ND Move. Hoping to have a proposed plan out next year.
Cass County Survey on transportation in cass County
Chamber of Commerce Pembina County, writing a grantfor bike path improvement
Chamber is intertwined with city and county government
ND SchoolsNorth Dakota Safety Council
Practice safety if there are active shooter situations
?State funded
ND Council for Abused Women Services (ND CAWS)
Services for domestic violence
?County and state funding
Prevent Child Abuse ND/Children’s Advocacy Center/Childrens Advocacy Center
Bismarck, Fargo, Minot
?funding
What are ND’s gaps (geographic and programmatic) for this driver?
Lack of resources, income guidelines, limited number of caregivers/volunteers, caregiver burden, family caregiver burden trying to care for aging parents, role changes with aging, adaptability to responsibilities to run a home. Lack of understanding for Medicaid, medicare, who pays for what, how long before they need to pay, how/when to access
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their own long-term care. Nursing home or assisted living financial regulations. If hospitalized or in assisted living, what are the resources for the caregivers.
Housing income guidelines are too low for most working families to qualify for Food deserts in rural areas and tribal committees-cost of food high and not high quality Quality of rural housing and tribal communities Lack of access to home care and hospice in rural areas and tribal communities. Lack of access to health care and community services for homeless individuals. Care after sexual assaults (men and women). Do residents of rural and tribal communities have access to “fitness without a gym”
information, do they have safe places to exercise, are playgrounds safe, if classes are available are they being promoted
Gap in affordable housing
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Creating Heathier, More Equitable Communities: The places where we live, learn, work and play contribute to our ability to become and stay healthy.
Driver 2: Social and Economic Environment: Our social environment influences a community’s sense of trust and cohesion. Factors like enduring racial and socioeconomic segregation have an impact on community health. Research points to strong connections between our environment, economic prosperity and health. Measures identify social and communal factors that influence wellness.
Examples: residential segregation, early childhood education, public libraries
What is happening in North Dakota for this driver? Is there work being done in this area now? Use Asset map information and expertise of group members to fill in framework. Add additional rows as needed.
Entity/Organization Brief description of Action
Location Funding Source
Head StartGives preference to low-income families for early childhood learning opportunities.
Community Based
Federal
ND State HousingGrants available to build housing/apartments in rural communities
State State/Federal
Jeremiah Project Affordable housing Community
Parks and RecreationSports programs for children.Maintenance of green spaces and equipment.
Community based
State funding- cities have park boards- funded by that city
Enbridge Energy 2002-first response emergencies-rural areas
Community based
Private grant driven
Department of Human Services/Social Services
Who drives the financial categories that determine assistance for programs
Community Federal/state??
EPA/Environmental Health and DOH/Planting for Future- Outdoor Heritage,
Trees/groundwater repair because of pipeline
Community Federal / State- 108,000 – will plant 2 trees for every 1 tree removed, in-
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(Energy development revenues)Dakota Access Pipeline/Roadways
kind contributions- private also
Historical Society Annual events that celebrate the history of rural America, Pembina county, or Polka fest, Rollag
Community
Dam Diversion South Fargo
State, federal funding
Safe Place/Groups to come and encounter each other/Colleges/Newman Center/Clash of values from rural values to college values/ND League of Cities
How can someone who is different or other speak to each other without feeling threatened
Community Community
ND High School Athletic Association/Energy Companies/ IT services
Open enrollment- if coming from outside the district, busing is not included
communities Energy companies, provide diesel fuel for buses, equitable for all schools-?tax break somehow?
What are ND’s gaps (geographic and programmatic) for this driver?
Many segregated “poor” neighborhoods exist in rural and urban communities. Housing assistance income guidelines is too low for most working families.
Daycares are limited, many family have to start paying for daycare before the child is born in order to secure the spot. Very high daycare costs, the income guidelines for daycare assistance is too low for most working families.- Social Services licenses daycares, so they probably have some of the stipulations regarding that.
Lack of fully funded initiatives to create safe areas for activity, e.g. sidewalks, bike paths, new parks
School consolidation, some children may have to quit their respective after school activities
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Creating Heathier, More Equitable Communities: The places where we live, learn, work and play contribute to our ability to become and stay healthy.
Driver 3: Policy and Governance: Do our policies support us in living our healthiest lives? Too often, we see health-promoting initiatives fall short without the policy structures in place to sustain them. Measures spotlight the role of policy in creating health environments, with an emphasis on collaboration between community members, government and large institutions.
What is happening in North Dakota for this driver? Is there work being done in this area now? Use Asset map information and expertise of group members to fill in framework. Add additional rows as needed.
Entity/Organization Brief description of Action
Location Funding Source
Legislature, RegulatorsState Government
Developed, monoitored, evaluated policies
Bismarck State and Federal funding, private funding
National Rural Health Association, NoSORH-National offices of State Rural Health
www.CRCAIH.orgCollaborative Research Center for American Indian Health , Sanford Research Sioux Falls, SD 605-312-6232
UND Center for Rural Health
Support of Health Professionals to be placed in rural areas, resources, to help strengthen rural citizens
UND/ Rural Areas
UND/State/Federal
ND Hospital Association,ND Heart Assocication, EMS Association, NDCancer Coalition, NDCFN, grassroots level organizations that promote healthy living(NDPHA
Promote nursing entrance into legislation, work with policies, work to bridge government and large institutions with communities
Rural
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Tobacco free ND, state association of city/county health officials)CMS Regulators Who determines CMS
reimbursementIndividual Federal?
ND Public Health Association
Supports public health policy
Statewide Private
What are ND’s gaps (geographic and programmatic) for this driver?
Are we electing officials that are making policies based on the community’s needs? Why do we have the lowest CMS reimbursement of all the states with the exception of
Puerto Rico, why aren’t the policy makers going after better reimbursement, do they understand the resources needed to carry out care in rural communities?
Lack of healthcare representation at the state-level.- state officials cannot lobby without prior approval
Residents of tribal nations are also ND residents, are tribal government and local leaders, and health directors empowered to fully exercise their right to lobby in state government
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Strengthening Integration of Health Services and Systems: Integrated care empowers patients and providers.
Driver 1: Access to Care: Access goes beyond simply having insurance. Access must be defined more broadly as ensuring that all people have continuous, comprehensive care, as well as the opportunity and tools to make heathier choices. Measures help us to see whether care is available to those who need it, when and how they need it.
Examples: access to public health, access to stable health insurance, access to mental health services, routine dental care
What is happening in North Dakota for this driver? Is there work being done in this area now? Use Asset map information and expertise of group members to fill in framework. Add additional rows as needed.
Entity/Organization Brief description of Action
Location Funding Source
Public Health UnitsCounty NursingPreventative care and educationVaccinations.Child fluoride treatments. Radon testing in homes
CountiesCounty Mill Levy dollars, some money from state and federal at times
Critical Access HospitalsManage stable patients in the community/ER sites
Communities County Mill
Social ServicesSliding scale fee schedules for mental health care, treatment.
Communites
ND Dental AssociationCommunities
EMS services Emergency care Communities Mill levy, grantsVision Services, Physical Therapy, Prescriptions, hearing screening, hearing aids
Eye surgery, preventative screening, some do not accept Medicaid so need to travel 90 miles
Communities, urban areas
Insurance reimbursement,private pay
IT telemedicine Skyping, Avera e-care
Patients Would need computer. Or I-phone
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What are ND’s gaps (geographic and programmatic) for this driver?
Oral Health Care not provided in all communities, many services are referred out, oral surgery requires payment up front. Also, mental health services most likely to be referred to a larger or urban community. Distance can be staggering, lack of transportation, resources to get to appointments.
Access to health care – 8% of ND do not have health insurance, because the ACA plans are too expensive and the employer is too small to be required to provide insurance
Cost of health care for family plans, ACA and through employers, is very expensive in comparison to the average wages of a working families.
Increase preventative oral health education efforts in rural and tribal communities, include access to tools for preventative care- toothbrushes, floss, paste
Not enough clinical, behavioral, mental and oral health private providers accept Medicaid, providers who do are overwhelmed with patients, and patients have long waits and many long distances to travel to find a provider who will see them. This also leads to human service centers, CHADs and other public providers having long waits, patients traveling long distances
Lack of HIPPA approved telemedicine technology in rural and tribal communities’ limits access to telemedicine, results in travel long distances and at expense for patients who may not have reliable vehicles, a ride if they don’t drive or gas money.
Strengthening Integration of Health Services and Systems: Integrated care empowers patients and providers.
Driver 2: Consumer Experience and Quality: Patients thrive through quality care that is safe, equitable, accessible, efficient and timely. Consumer experience can influence whether people delay or seek care. In a Culture of Health, patients are actively engaged in decision-making, and providers are responsive to cultural and linguistic needs. Measures illuminate how patients feel about their health care and outcomes.
Examples: positive patient experiences, population covered by an accountable care organization
What is happening in North Dakota for this driver? Is there work being done in this area now? Use Asset map information and expertise of group members to fill in framework. Add additional rows as needed.
Entity/Organization Brief description of Action
Location Funding Source
Sanford, CHI, AltruMajor hospital corporations branching out into small communities to provide care.
Statewide, based in communities
Private, public such as Medicare and Medicaid
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EBP cares implemented.Highly regulated.
Critical access hospitals (CAH Quality Improvement Network)
Stabilize trauma patients, coordinate delivery of care, offering quality improvement training and metrics. State Stroke System of Care. Network serves as a linkage between the critical care hospital and tertiary.
36 CAH in rural ND Private, public such
as Medicare and Medicaid
EMS Community members providing cares in community, trustedVolunteer Capacity – Services are at risk because it is a volunteer organization.
Community based
Local funds and public and private reimbursement.
Telehealth NetworkProvides behavioral health services
Major tertiary providers offer telehealth including behavior health
Telepharmacy
Expanding E-emergency, e-pharmacy (Avera Health in Sioux Falls) connect with 30 access hospitals in ND
Across the state (example: LSS offers 10 portals)
Donations for equipment, insurance reimbursable that are delivered by different mediums, public and private insurance.
Helmsley Foundation Grant started the service, now Avera, charging access fees.
What are ND’s gaps (geographic and programmatic) for this driver?
Cultural gaps, perceived cultural insensitivities
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Even critical access hospitals can be a long distance (1+ hours) for rural dwellers Reimbursement issues in terms of the availability and level of reimbursement.
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Strengthening Integration of Health Services and Systems: Integrated care empowers patients and providers.
Driver 3: Balance and Integration: When our systems work together, more people will get the timely, quality services they need. A Culture of Health calls for better balance between prevention and acute care services. This can lead to greater efficiency, fewer hospital readmissions and decreased health costs. Measures reflect whether our public health, social service and health care systems are intentionally balanced and integrated.
Examples: electronic medical record linkages, hospital partnerships, practice laws for nurse practitioners, social spending relative to health expenditure
What is happening in North Dakota for this driver? Is there work being done in this area now? Use Asset map information and expertise of group members to fill in framework. Add additional rows as needed.
Entity/Organization Brief description of Action
Location Funding Source
Case Management/ Social Work
Coordinates care with home and community based services for discharged patients
Hospitals Private
Home Health Care Agencies
Working to keep people in their homes longer, healthier, prevent readmissions
Home Health Care in the Eastern part of the state
Urban areas in North Dakota
Rural areas
Private funding, Medicare, Medicaid, VA
Public Health Agencies Population healthPreventive Services
Across the state Federal, state, local/county
Special Diabetes Programs for Indians on the reservations/Tribal Nations
Prevention with youthWorking with all the schools on the reservationFitness and recreationSpecial clinic days for students at risk
Reservations/Tribal Nations
Federally funded
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Help to pay for initiatives.
Dakota Diabetes Coalition Preventing and managing diabetes.Providing to all provides in North Dakota Diabetes Coalition Summit
State-wide ND State Health Department
QSP Agencies Providing services to elders to keep them in their home.
SLNFort Berthold – not operation yet.
Medicaid
CHR Health educationMedical transportationNon-emergent medical transportationCar seat education
Four Tribal Nations/reservations & Trenton
Federal HIS, Tribal, Medicaid
High Sierra-Great Plains ACO (Accountable Care Organization)
CAH and primary care providersProviding population health services and prevention – Care coordination, nurse consultation, etc.
5 CAH throughout ND
Medicare and Medicaid reimbursement (1 Federal grant started the program)
Aging Life Care Management
Providing care management and coordination for older adults
Across ND Private pay, mostly
Senior Companions Respite care by volunteers
Across ND Volunteers
What are ND’s gaps (geographic and programmatic) for this driver?
Disconnect between hospitals and community based programs Accredited Home Health agencies not reaching all rural communities, strong in urban
areas The federal EMRS for IHS is not compatible with other EMRS software, this is a
challenge for 638 tribal health services in reporting, billing and interfacing with other provider systems
None of the reservations have home health. Western and Central have home health gaps Reimbursement issues for home services especially when non-medical such as care
coordination to decrease readmissions to hospitals.
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Identifying additional critical access hospitals to be involved in ACOs and other alternative payment models.
There is very little technical assistance from the state level in the application process for QSP individuals.
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Ideas on How to Fill Gaps for your Entire Framework
For the group’s entire framework: What could be done to fill in the gaps for ND for your topic?
This list will be used along with the group’s finished framework to develop cross-cutting
recommendations at the May 2018 in-person meeting.
Themes (Gaps):
Affordable housing
Workforce availability
Access to care throughout North Dakota particularly in rural and tribal communities
Due to silos of services in North Dakota, there is a limitation on the ability to garner resources from a variety of organizations.
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