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Okanogan County Public Hospital District No. 3
Community Health Needs Assessment
Implementation Plan
December 31, 2016
Table of Contents
Priority: 1 Mental Healthcare Access ........................................................................................................... 1
Priority: 2 Access to Healthcare.................................................................................................................... 3
Priority: 3 Education ..................................................................................................................................... 5
Priority: 4 Obesity ......................................................................................................................................... 8
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Priority: 1 Mental Healthcare Access
Objective
Increase mental health services in the community
Tactics
Meet quarterly with local/regional mental health providers to coordinate care/problem
solve;
Increase “on-site” services to meet the needs of mental health patients in the ED
Develop policy and procedures specific to behavioral health needs
Programs/Resources to Commit
Clinic/ED resources/time/staff
Telepsychiatry services available at the rural health clinic
Impact of Programs/Resources on Health Need
Increased access to onsite mental health/substance abuse services
Accountable Parties
Okanogan County Public Hospital District No. 3 d/b/a Mid-Valley Hospital and the
regional collaborative group.
Partnerships/Collaboration
Okanogan Behavioral Healthcare
Opioid Summit
Mental Healthcare Access Update
ED: Mid Valley Hospital provides Mental Health Exams via Okanogan Behavioral
Health Center. We provide a safe space to detained psychiatric patients waiting for
inpatient treatment. Implemented a sitter program.
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Clinic: MVC implemented tele-behavioral health services starting Spring, 2017 with
three different providers:
o A psychologist, Terri Greer, in Wenatchee
o Forefront – who sees Medicare and other insurances, but is not currently seeing
Medicaid patients. These psychiatrists manage medications
o Pathways – who bills Medicaid and other insurances, but not Medicare yet, and
who provides both Behavioral Health and Chemical Dependency Counseling.
o In addition to chemical dependency counseling, we have invited Dr. Haeger
with New Start Clinic to speak to our Family Practice Provider Group in
November regarding his new chemical dependency services and about his plans
to have clinic held at OBHC. Administration: Our participation is based on regional involvement to form a cross
system of care utilizing patient centered model to enhance and provide greater service
for the population of north central Washington. We will continue to partner with the
regional ACH to assist in providing patient center care based on combining physical
health and behavioral health through alternative methods in addition working
collaboratively on the Opioid Issue. Opioid Summit Meetings: The NCACH (North Central Accountable Communities of
Health) CHI (Coalition on Health Improvement) Meets quarterly to bring stakeholders
together to find creative ways to combat the opioid crisis in our community.
4/2/18 Dr. Terri Greer’s office added an MSW and Chemical Dependency Counselor
adding additional services to our patients. OBHC added the WISE Program for
troubled teens. Dr. Haeger, New Start Clinic, met with our FP team as scheduled. We
have implemented PHQ9 surveys and working on implementation of Short Brief
Intervention Referral to Treatment (SBIRT).
6/4/18 MVC received $9600 in grant funding to purchase narcan kits to combat opioid
overdose. In addition, research continues on opportunities for bringing a psychologist
in-house with the clinic by working with several other CAH/RHCs.
10/2/18 Board of Directors approved a new position and recruiting underway for a 1.0
Psychologist or MSW to see patients in the clinic setting.
3/18/19 Interviews continue to find a qualified behavioral health specialist.
4/22/19 2019 Nutritional Campaign promotes mindfulness and improving mental
health through different strategies. Interviewed several psychiatric providers.
11/6/2019 Leslie Hite, PsychNP started 9/23/19 offering services in the clinic. Mid
Valley is beginning efforts to communicate general mental health awareness/education
to the community. Traci Miller, RN, presented to a local high school on mental health
awareness and services provided at MVHC. Materials were developed.
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Priority: 2 Access to Healthcare
Objective/Strategy
Reduce patient out-migration
Increase services available to patients
Tactics
Increase primary care options
Provide additional mental health services through telemedicine
Increase orthopedic surgical services
Informing the community through advertisement for local available services
Programs/Resources to Commit
Clinic/ED resources/time/staff
Orthopedic surgical staff
Marketing
Impact of Programs/Resources on Health Need
Reduction of patient out-migration
Accountable Parties
Okanogan County Public Hospital District No. 3 d/b/a Mid-Valley Hospital and the
regional collaborative group.
Okanogan County Public Health Officer
AeroMethow Rescue Service
Partnerships/Collaboration
Other members of the regional collaborative group.
Okanogan County Public Health Officer
AeroMethow Rescue Service
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Access to Healthcare Update
ACO information and update: The ACO agreement was signed 6.29/17. Partners in
our joint ACO under Caravan have been named, and we have attended three of twelve
pre-launch webinars in preparation. Various key players and their roles have been
identified. Finally, Lightbeam was approved for implementation to accommodate
reporting requirements. Orthopedics update: Stephen White, MD, Orthopedic Surgeon, was hired effective
2/27/17. Greg Fisk, PA-C, with 8+ years of orthopedic experience and who was
working at MVC in family practice is now transitioning over to working full time in
orthopedics. The transition should be complete by the first of November. Dr. J. Heath
Thompson, orthopedic surgeon, just completed his residency, and will be attending a
trauma fellowship before joining the orthopedics practice here effective August 1,
2018, joining Dr. White. Support staff have received cast raining and are attending an
L & I workshop to better manage L & I patients and required documentation.
Choices Hotline was designed and implemented to help mitigate out-migration as well
as bring in additional patients to local services offered through the hospital and clinic.
Choices has been issued through several avenues including reoccurring newspaper ads
in three local newspapers, radio, social media, and print articles.
AeroMethow Meetings: Together under community involvement to assist an
underserved area healthcare options. Our role is as a partner to assist the group in
providing care to the community. Meeting goals are to inform the meeting constituents
of our willingness to actively participate in the good of the community.
A telemedicine program is being developed by partnering with tertiary hospitals.
4/2/18 Update: Implemented telehospitalist program March 26th in partnership with
Confluence Health. An in-house hospitalist model was also established December 1,
2017. A meeting with RoomOne was held March 21st to streamline patient care
services between the Methow Valley and MVH. Our clinic is working to partner with
Bright Start Services, LLC., for pediatric services for child from birth to three years
old. The clinic continues to work with Dr. Haegar’s Central Washington Sleep
Diagnostic Center to assess pediatric sleep disorders. The ACO implementation
continues with an onsite launch January 24th. We continue to work on the ACO
compliance and meeting required metrics.
6/4/18 A Director of Marketing and Public Relations position was created and being
filled in an effort to improve community outreach and comprehension of services
provided within the district.
10/2/18 Healthcare Summit with area medical providers to discuss enhancing OBGYN
services in the County. Collaborated with the other local county hospitals to enhance
general surgical services at their locations. Coordinating with with WorkSource to
improve hiring practices within the County. Entered into affiliation agreement with
Washington State University Elson S. Floyd School of Medicine and began hosting
medical students. Hired Director of Marketing and Public Relations mid-June whom
has effectively developed several key relationships as stated above, created, launched
and collected responses from community members on perception in order to better
strategize marketing efforts. MVC and ED received a grant from NCACH for
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naloxone kits and are developing a M.A.T. program to implement by end of year.
Orthopedic services were enhanced in April and continues to offer these added services
by Dr. Dan Hiersche, orthopedic surgeon. Dr. Heath Thompson, orthopedic surgeon, is
expected to being in clinic in November.
3/18/19 Dr. Heath Thompson withdrew and did not join the practice. OB healthcare
summit meetings continue to be held to streamline OB services in the county.
4/22/19 Collaborated with Family Health Centers on the opioid grant program led by
Kathleen Manseau, NP, who also instructed MVH nursing staff. Traci Miller, RN,
Population Health Nurse, demonstrated usage of narcan kits at a meeting at the school
district in March.
11/6/19 Obstetric services from NVH have closed and are being diverted to Mid
Valley. In conjunction with Family Health Centers, all OB services from TRH will
be managed at Mid Valley as of April 2020. Increased orthopedic walk-in clinic
hours, hired Brian Bonewell, NP, for orthopedics,
Priority: 3 Education
Objective/Strategy
Increase knowledge of services availability to the community
Reduce patient out-migration
Tactics
Publish and continue efforts to “boost” MVH educational offerings on through social
media
Publish ads in the local paper about MVHs educational offerings
Executive Team members to attend local gatherings of businesses and promote
services;
Look for opportunities for the CEO or CFO to speak about these matters at community
events
Establish a streamlined referral system for available local services
Programs/Resources to Commit
Executive time
Cost to publish ads in local paper
Impact of Programs/Resources on Health Need
Reduction of patient out-migration
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Increase patient awareness of Mid-Valley Hospital’s services
Accountable Parties
Okanogan County Public Hospital District No. 3 d/b/a Mid-Valley Hospital and the
regional collaborative group.
Partnerships/Collaboration
Other members of the regional collaborative group.
Okanogan County Public Health District
Local services such as Omak Rotary, Omak Chamber of Commerce, Kiwanis, Omak
Economic Alliance, Omak Fit For Life, and Okanogan County Community Action
Council.
Education Update:
Orthopedic surgeon, Dr. White, to schedule time to conduct PSAs on the local radio
station in both English and Spanish this fall.
Ongoing scheduled advertisements promoting services in area newspapers, radio
stations, social media, and local public events.
Scheduled career fair for September 28th open to the public. Education on what steps
need to be taken to find a job in health care for any field. Also review of current open
positions. Attended the WVC Nursing program open house September 7th to speak
with future graduates about the opportunities available at Mid-Valley. Plan to attend
the local high schools job fairs when announced by the respective schools.
Clinic Open House: The Clinic Open House will be held November 3rd from 4-6 p.m.
and will highlight all providers with special emphasis on four new providers including
Dr. Stephen White, orthopedic surgeon, Dr. Christine Jaquish, Family Practice, Dr.
Jules Sleiman, Family Practice, and Jeremiah Price, PA-C, Family practice (who will
be starting in November and will be replacing Greg Fisk, who moved over to
orthopedics full-time. Insurance companies, including Molina, Coordinated Care, and
Amerigroup have been invited to provide information. Invitations will be sent to local
leaders as well as local residents.
Clinic Other Activities: Flu shot clinic will be held the first and second week of
October on Oct. 2nd, 5th, and 10th.
Community outreach conducted at community events including Healthy Youth Fair,
Omak Back-To-School Night, Okanogan County Fair, Omak Stampede
“Hydration Station” Breast Health Awareness Booth at Zumba Women’s Health Event.
MVH Foundation partnered with Omak Rotary to raise money to fund scholarships for
locals interested in furthering their health care careers.
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CEO attended the local Kiwanis meeting July 5, 2017 to discuss services and offerings
at the hospital and clinic.
10/22/17 Emergency Room Manager, Aliya Quidwai, RN, presented to a group of
local youth at the Border Patrol’s Board Patrol Explorer Post #0023 about the impacts
of opioid abuse. See Attachment A.
4/2/18 Update: Clinic Open House was held November 3rd. CEO, Alan Fisher, hosted
a summit with area hospital CEOs for collaboration on health care services for our
region. Qualis Health provided coaching for clinical practice value-based redesign.
Mr. Fisher presented to Omak Middle School students for Read Across America Day.
Becky Corson, Clinic Administrator, spoke at the NW Rural Health Conference in
Spokane on behavioral health integration in March. Aliya Quidwai, RN, ER Manager,
Erin Andreas, RN, AC/OB Manager, Traci Miller, RN, Population Health Nurse, and
Kathy Lund, RN, Clinical Supervisor, met with Wenatchee Valley College Nursing
Program about employment opportunities. Bryan Bernsten, MLT, Lab Scientist,
attended the Omak High School Career Day. Christopher Freel, IT Manager, lead a
leadership group for the Omak/Okanogan High Schools’ Business Week. Randy
Coffell, HR Director, attended Economic Alliance and Work Source’s Apprenticeship
Workshop. Developing Patient and Family Advisory Committee to meet WSHA
metrics and to further engage the community in health care.
6/4/18 A Director of Marketing and Public Relations position was created and being
filled in an effort to improve community outreach and comprehension of services
provided within the district. The Marketing Director will assume the lead role in the
Patient and Family Engagement Committee.
10/2/18 General and orthopedic surgeons collaborated with northern providers on the
services provide. Dr. White developed and implemented a Pain Protocol and patient
education materials for his orthopedic practice and presented to area providers for
patient safety and quality initiatives. Pedestrian Safety Program was developed by ED
Trauma Program Coordinator partnering with local cities to install pedestrian safety
flags and receptacles at high risk crossings. Community educational materials were
developed and provided to the community beginning at the Healthy Youth Fair and
local county fair. Stroke and Cardiac Awareness educational program was also
developed and launched with the community at the fair. Clinic has developed an
antimicrobial stewardship program and have provided educational materials to their
patients on antibiotic use.
3/18/19 MVH participated in a county career fair hosted by WorkSource with a turnout
of over 200 students. The first of a planned series of community newsletters was
developed and launched mid-December. Partnered with North Valley Hospital to
provide nutritional education at local grocery stores. Continued to provide awareness
campaign education on different topics such as lung and breast cancer prevention.
Participated in North Valley Hospital’s strategic planning meeting.
4/22/19 Partnered with Eastern Washington University’s Scrubs Camp by providing
medically related education on selected topics to local high school seniors. Held kick-
off meeting for the Patient and Family Advisory Committee with community education
regarding the PFAC on the radio. Registered Dietician and laboratory staff provided
community education via radio about services, new equipment, and general
information. Presented at the Economic Alliance meeting about the state of healthcare
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in the county. Participated in Family Health Centers’ strategic planning meeting. Stop
The Bleed training conducted by Aliya Quidwai, RN, Erin Andreas, RN, and Julie
Kruse continues in the community by partnering with local fire departments, Life Line,
and civic service groups.
11/6/19 developed Total Joint Program educational materials, all OB patient
education materials have been redesigned and distributed. Developed free
birthing education classes offering to patients throughout the county. Materials
have been developed for cardiac, stroke, and fall prevention awareness and will be
distributed to local senior centers. We continue partner with WVC and Omak
High School on their advisory boards for nursing and healthcare related
programs.
Priority: 4 Obesity
Objective/Strategy
Promote healthy eating habits through regular public education
Raise awareness about the importance of regular exercise
Tactics
When providing education to the community, emphasize healthy diet and consistent
exercise
Look for ways to provide healthy dieting plans to the community
Plans to hire the practitioners noted above
Partner with local schools to provide “open gym” hours to the community
Programs/Resources to Commit
Registered Dietician time
Physical Therapy space available for public use
Diabetes Road Map classes
Patient Care Coordination
Transitional Care Management
Chronic Disease Management
Impact of Programs/Resources on Health Need
Decrease obesity rates
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Increase in physical activity
Healthier patients
Accountable Parties
Okanogan County Public Hospital District No. 3 d/b/a Mid-Valley Hospital and the
regional collaborative group.
Partnerships/Collaboration
Other members of the regional collaborative group.
Partnering with an Accountable Care Organization
Obesity Update:
Omak Fit4Life campaigns and events:
o Hoofin and Woofin Run – Run with your dogs – April
o Orchards in Bloom Run –Orchards in Bloom Run is a rural race that one can
choose to run a 10K or the 1/2 Marathon. Participants will meander among
orchards in full bloom with a 360 degree view of spectacular Eastern
Washington Mountains. Held on April 29, 2017.
o Kids Healthy Kids Fair- This event has provided education opportunities to our
local kids and their families learn; how to be healthy; how to prevent diseases;
and how to grow strong physically, mentally, emotionally and intellectually.
Held July 8th at the Okanogan Legion Park.
o Autumn Leaf Run- In this annual event held in the Fall, participants choose
between a 1 Mile, 5K or a 10K is 1 Mile distance walk/run. It was held
September 23, 2017
o Zombie Fun Run and Harvest Festival October 28, 2017
o Turkey Tangle – Kick Ball Tournament
o Jingle Bell Jog –Fun Run in December
Mid Valley Hospital
o Stress Awareness Day - May
Omak Fit 4 Life Omak HS Gym
o Winter Wellness – Gym open for 2 hours with wellness activities. January -
March
Diabetes Road Map
o The Diabetes Road Map began June 8, 2017 and meets weekly and has a
variable participation rate ranging from 1-5 individuals participating at a time.
Mid-Valley Hospital and Mid-Valley Clinic have advertised the program on the
local radio station, as well as having posters throughout the Omak and
Okanogan communities. This program has been of assistance in helping
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individuals learn about diabetes and assist them in actively participating in their
diabetes health care.
Chronic Disease Management
o The Chronic Case Management program (CCM) was implemented January 1,
2017 and serves approximately 40 patients, with one-on-one appointments
ranging from monthly to as needed. CCM has started participating in warm
hand-offs from providers for at-risk patients that are in clinic. We currently
offer our patients telehealth for mental health, behavioral health, and co-
occurring diseases. The CCM program is continuing to look at ways to serve
more patients, improve patient investment in their healthcare, improve quality
of life for patients, and reduces exacerbations and uncontrolled disease
processes.
Patient Care Coordination
o The Care Coordinator program was implemented January 1, 2017 and is in the
process of implementing a collaborative care model, which includes behavioral
and mental health services. Working with community resources, including
AIMS at the University of Washington, care coordination will start to include
those patients that are at highest risk for reduced health outcomes. By
coordinating care for those patients, the goal is to address health concerns
before they become uncontrolled and/or unmanageable.
Transitional Care
o Transitional Care Management (TCM) was implemented January 1, 2017 and
provides services for all patients receiving inpatient services from Mid-Valley
Clinic providers, including specialists. TCM has recently implemented meeting
with inpatients at Mid-Valley Hospital on a daily basis during admission to
address any questions, concerns, or needs that they may have, as well as plan
for future needs once they are discharged. Proactive transitional care will help
to reduce hospital readmissions, emergency room visits, and reduce potential
adverse events after discharge.
Caravan Health ACO: We have been with Caravan Health since May, 2016 through
the TCPI (Transforming Clinical Practice Initiative) grant and have atte3nded quarterly
QI workshops and monthly roadmap calls, managing various PDSA action plans. We
are currently participating in ACO pre-launch web series, and will have an onsite team
here in January to help with implementation. Training on the use of Lightbeam and its
reporting tools, will be provided when the program is up and running. Cohort calls
depending on the leadership role will be conducted with Caravan health upon the start
of the ACO on 1/1/18.
Qualis Health: o Qualis Health and NC ACH (North Central Accountable Community of Health)
and Whole Person care Collaborative (WPCC): The NC ACH WPCC charter
and membership agreement was just approved and will be signed. Monthly
WPCC meetings will be attended. As part of the charter, we will be developing
a comprehensive three-year change plan from fee for service to value based
quality payment model. Grant funding for Stage 1 totaling $95,000 will be
disbursed the end of February, 2018 and a budget will be developed as to the
use of funds in the change process.
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o With Qualis – we have been assessed by the PCMH (Patient Centered Medical
Home) and MeHAF surveys and developed action plans accordingly. We have
been working with Gwen Cox, Qualis Health Coach, to move toward integrated
care and PCMH model. We will also be meeting with a DOH consultant to
assess our pediatric services much like the PCMH assessment.
o Qualis Health is videotaping MVC on 10/3 to highlight our efforts to integrate
behavioral and chemical dependency counseling into the clinic via
telemedicine.
4/2/18 Update: Aliya Quidwai, RN, ED Manager, continues to support the Omak
Fit4Life events as MVH’s representative to encourage health and wellness in our
community including a yoga class at East Omak Elementary School. Dr. Errico,
Confluence Health, provided a presentation on ketogenic diet at a Fit4Life event hosted
by Mid Valley Hospital. The Diabetic Road Map courses continue. Traci Miller, RN,
Population Health Nurse, continues to work on empanelment of patients to determine
care gaps using the Healthcare Effectiveness Data and Information Set (HEDIS)
measures.
6/4/18 Partnering with Omak Fit4Life’s Healthy Youth Fair July 7th. MVC will be
hosting an annual wellness day for Medicare patients on July 25th.
10/2/18 The Annual Wellness Day scheduled in July was cancelled and will be
rescheduled. A partnership with North Valley Hospital was developed to provide
nutritional education with both hospitals’ Registered Dieticians. The community is
invited to attend an ongoing series of nutritional guidance at area grocery stores. The
Healthy Youth Fair presented a blind taste test of healthy foods by MVH’s Dietician.
Omak Fit4Life hosted a community fun run, Autumn Leaf Run, on September 29th.
3/18/19 A nutritional campaign is being developed for National Nutrition Month and
general obesity awareness in our county to be launched in March 2019.
4/22/19 Collaborated with Inland Northwest Culinary Academy to offer training to
MVH Dietary staff to enhance skills and to provide higher quality food to patients and
community. Naturally Nourished Campaign was launched and provides information,
resources, and coordinated events for seven months ending at the harvest festival. The
campaign partners with all Registered Dieticians in the area, the WSU Extension
Office, and other health experts.
11/6/19 The Registered Dietician continues to conduct regular radio broadcasts on
nutritional education with different topics each month which is posted to the
hospital website.