The North Carolina Medical Care Commission
Reporting for Community Health Improvement and Community Benefits
(Healthcare Institutions)
Definitions:
Community Health Improvement is an active process involving regular community health assessments, the creation of a community health plan, and the measurement of community health outcomes. The process is directed by a multi-disciplinary, community health improvement team that is accountable for producing results. Hospitals are expected to be integral community partners in developing and promoting a community health improvement plan.
Community Benefit is a planned, managed, organized, and measured approach to hospital participation in meeting identified community health needs. It implies collaboration with a community” to “benefit” its residents - particularly the poor, minorities, and other underserved groups - by improving health status and quality of life. Hospitals are expected to organize a plan to regularly measure and evaluate their community benefits.
POLICY~
Borrower organization shall submit at the time of borrowing and every year thereafter commencing with fiscal years ending in calendar 2001 the following information to the Medical Care Commission:
1. North Carolina Medical Care Commission Executive Summary of the organizations Community Health Improvement Plan. (Exhibit A)
2. North Carolina Medical Care Commission Community Benefits Report. (Exhibit B)
3. A copy of the most recent IRS Form 990 (if the organization is required to file one), part III, and any supplementary reports that describe Community Health Improvement/Community Benefit programs and expenses.
Borrower is encouraged to adopt a standard methodology for gathering and reporting above items. (Exhibit C) lists several suggested resources for information on Community Benefit Assessment tools.
Borrower is encouraged to additionally submit any organization annual reports that highlight Community Health Improvement/Community Benefit activities.
(EXHiBIT A)
North Carolina Medicare Care Commission
Executive Summary: Community Health Improvement Plan
(Healthcare Institutions)
Organization: Wake Forest University Health Sciences
Address: Medical Center Boulevard
Winston-Salem, NC 27157
Telephone: (336) 716-4454
Contact: Mr. Terry L. Hales, Jr.
For Fiscal Year Ending: June 30, 2005
1. Statement of organizations mission and commitment to community health improvement:
See attached.
2. Describe geographic service area and target populations for community initiatives:
See attached.
3. How are the programs in which you are involved funded?
See attached.
4. Describe your methodology for determining community priorities and how you collaborate with others:
See attached.
5. List current community service programs sponsored or co-sponsored:
See attached Exhibit C.
(EXHIBIT A)
North Carolina Medicare Care Commission
Executive Summary: Community Health Improvement Plan
(Healthcare Institutions)
1. Statement of organizations mission and commitment to community health improvement:
Wake Forest University Health Sciences (WFUHS) along with the North Carolina Baptist Hospitals, Inc. (NCBH), make up the Wake Forest University Baptist Medical Center, a nonprofit North Carolina corporation organized and jointly controlled by WFU and NCBH, and is one of 125 academic medical centers in the United States. The Medical Center was formed to coordinate shared service activities, such as facilities planning, risk management, security, information services, marketing and public relations, fund-raising activities, strategic planning and program development, and community service activities for both NCBH and WFUHS. The Medical Center’s Mission Statement includes a commitment to serve society by “cooperation with the community, region, and nation through active participation in efforts to improve the health and well being of the community.”
2. Describe geographic service area and target populations for community initiatives:
WFUHS employs the Wake Forest University Physician (WFUP) group which provides patient care in both inpatient and outpatient settings at Wake Forest University Baptist Medical Center. The inpatient care is primarily conducted at NCBH while outpatient care services are primarily provided within clinics located at various sites in Winston-Salem, NC. Furthermore, the clinical faculty members of WFUHS have more than 90 active contracts with outside providers (typically community hospitals) for satellite clinic or consulting arrangements throughout northwest North Carolina and southwestern Virginia. The Medical Center supported by the WFUP serves a regional, national and international resource of medical education and biomedical research as well.
Many of WFUHS’ community health initiatives are focused in Forsyth County, at the medically underserved populations, which are made up, generally, of lower socioeconomic groups. An example is the NCBH facility at Downtown Health Plaza for which our physicians and residents provide patient care at these facilities.
In addition, throughout all our departments, we work collaboratively with other providers throughout our service area to identify other opportunities to meet community health needs.
3. How are the programs in which you are involved funded?
In order to ensure the economic viability of the Medical Center, all external funding sources are pursued in support of our various community benefit initiatives, including governmental and private reimbursement, foundation grants, and reasonable user fees, when appropriate. Some of the outside funding organizations include: Forsyth County, The Duke Endowment, United Way, Winston-Salem Foundation, NC Department of Health and Human Services, March of Dimes, CMS support for Residency training programs, BB&T, and Wachovia Bank.
4. Describe your methodology for determining community priorities and how you collaborate with others:
WFUHS works and collaborates with a number of community organizations and resources in the establishment of community health initiatives and objectives. The primary source of cooperation exists with the Forsyth County Health Department, and other area county health departments, which are required to perform a community health assessment every other year. Some of these assessments are very elaborate, and identify targeted populations and diseases where community resources should be devoted. The Forsyth County Health Department, along with other community organizations, including WFUHS, worked to form the Healthy Carolinians Coalition, whose primary purpose is identifying the community’s health needs and addressing those needs.
WFUHS supports numerous organizations within the community either financially or through active participation. Please see the attached description of activities. All of the organizations listed have a methodology for determining community priorities through the collaboration of multiple community organizations.
(EXHIBIT B)
North Carolina Medical Care Commission
Community Benefits Report
(Healthcare Institutions)
Organization: Wake Forest University Health Sciences
Address: Medical Center Boulevard
Winston-Salem, NC 27157
Telephone: (336) 716-4454
Contact: Mr. Terry L. Hales Jr.
For fiscal year ending: June 30, 2005
1. Cash donations $ 127,089
2. In-kind donations (estimated) $ 0
3. Non-billed services $ 748,395
(e.g. free clinics, patient education, screenings, immunizations,
health promotions, support groups, free outreach programs)
4. Subsidized Community Services
(Community Benefits expense “minus” offsetting revenues) $ 2,192,089
(e.g. preventive medicine, community wellness, Hospice,
Medication Assistance, Safe-Kids/Injury Prevention, mobile services)
5. Total Charity Care
(Charity care charges “times” cost/charge ratio) $ 9,623,154
6. Non reimbursed cost of treating Medicare and Medicaid
Patients $ 0
7. Non reimbursed medical education and research costs $23,672,374
TOTAL $36,363,102
(EXHIBIT C)
Resource Information for Community Benefits Assessment Tools
Best Health
The Piedmont Triad’s leading resource center for health care information, offering over 350 classes and dozens of health screenings each year at it Hanes Mall location. The center includes a reference library for visitors, and is staffed by RNs.
Forsyth Early Childhood Health Alliance
Members of the Department of Pediatrics formed an alliance of early childhood educators, service providers, and health professionals to address the health and educational needs of children from birth to age 5. This collaboration has resulted in programs to enhance developmental and behavioral screening performed in pediatric offices.
Health On-Call® (336) 716-2255 and Physician’s Access Line (PAL®) (336) 716-4654
Both of these 24 hours a day, 7 days a week call centers provide a link to consumers with health services, not only at the Wake Forest University Baptist Medical Center. General Health Information calls along with information on continuing education programs, research protocols, and updates on new technological advance all benefit the community at large. Only a small portion of these programs have been included in the Community Benefit Report which apply to services that benefit the community in general.
Mental Healthcare Access and Reimbursement
Two members of the WFUSM Department of Pediatrics serve on the NC Pediatric Society’s Committee on Mental Health and School Health: Jane M. Foy, MD, served as chair from 1999-2004; she and Kurt Klinepeter, MD, currently serve as task force members. The group successfully negotiated for improved reimbursement for mental health services and for expansion of Medicaid provider enrollment to include social workers, psychologists, and nurses with specialized psychiatric training.
As a spin-off of this state-level work on mental healthcare access, Dr. Foy collaborated with Winston-Salem / Forsyth County Schools and the Northwest AHEC to develop an initiative which coordinates care for school-aged children with attention and behavior problems.
Primary Care-Children’s Mental Health Initiative
Northwest Area Health Education Center
Wake Forest University Health Sciences
Centerpoint Human Services
The Primary Care-Children’s Mental Health Initiative represents a new model of collaboration involving the Northwest Area Health Education Center; one of its regional partners, CenterPoint; and the Department of Pediatrics and the Department of Psychiatry & Behavioral Medicine of Wake Forest University Health Sciences. The initiative is designed to meet a critical community health need. In this model, Northwest AHEC and these partners have used in-kind and grant resources to develop curriculum and office-based methods through which primary care pediatricians can expand their capacity to identify and serve children with behavioral health problems.
The principal strategy by which the project will achieve its purpose is enhancing collaboration between primary care pediatricians and mental health professionals. Funds from the Duke Endowment have been used to pilot new models of behavioral health care. In one model a licensed clinical social worker is co-located in a primary care practice to engage with primary care pediatricians in serving children with behavioral problems and their families. In accordance with the practice’s needs, the social worker provides on-site mental health services, facilitates referrals, and coordinates care with school support personnel and other community resources. In a second model, a WFUHS child psychiatrist provided consultation to school social workers and primary care physicians in Stokes County. More recently, the child psychiatrist has moved to a private community practice to provide consultation to the on-site social worker and pediatric clinicians.
The project will receive $535,012 from the Duke Endowment over 3 years. Staff includes Northwest AHEC-supported contributions of Anita Pulley, Dr. Jane Foy (Principal Investigator) and Dr. Kurt Klinepeter in Pediatrics, and Dr. Guy Palmes in Psychiatry & Behavioral Health. Grant funds support Jane Williams, PhD as project manager (Northwest AHEC staff with a formal faculty appointment in Pediatrics), a social worker and part-time psychiatrist (described above), and 0.5 FTE administrative assistant. Total in-kind donation from WFUHS for Years 1-3 totals $429,469.
We anticipate that lessons learned from this project will inform The Duke Endowment’s future efforts in the area of mental health. We hope to replicate successful models in additional NW AHEC counties and, eventually, other regions.
As an out-growth of this and other North Carolina projects aimed at enhancing mental health services in primary care settings, the North Carolina Foundation for Advanced Healthcare Practice (NCFAHP) funded four integrated behavioral health pilots, including one involving WFUBMC. The project is a partnership between CenterPoint Human Services, the Forsyth County Department of Public Health, Central Piedmont Access II (a regional Medicaid managed care program housed within WFUBMC), and WFUHS. NCFAHP funds totaling $260,000 will be used to continue the pediatric co-location model at Winston East after Duke Endowment funding ends in December 05, develop a new co-location model for adults in WFUBMC Out-Patient Department, and create a psychiatry consultation model for both sites. Some of the funds will also support a portion of faculty salaries--Jane Williams', Kurt Klinepeter's, and Jane Foy’s—to do "systems" work, linking mental health providers and case managers, schools, and PCPs and training CCNC case managers to screen for mental health issues as part of their work with patients who have chronic conditions and/or who use the ER.
Resident Involvement in Child Advocacy
A committee of faculty and residents in the Department of Pediatrics has developed a curriculum for involvement of residents in community service and child advocacy. Beginning in 2002 first-year pediatric residents in the Department of Pediatrics completed a block rotation preparing them to address community health issues. Beginning in 2004, second-year pediatric residents have become involved in a health improvement initiative at a local elementary school targeting childhood obesity. In 2005, the next class of second-year pediatric residents became involve in a health improvement initiative at a local middle school targeting behavioral health concerns.
The Ronald McDonald Care Mobile
In 2001, the Department of Pediatrics partnered with NCBH to apply for a mobile dental facility from Ronald McDonald House Charities. The dental staff, on the mobile facility, provides a full gamut of dental services and education to children in ‘Head Start’ centers and elementary and middle schools in Winston-Salem/Forsyth County. Schools with a large percentage of children enrolled in the free lunch program are given priority.
School Health Alliance for Forsyth County (SHA)
The SHA is a collaborative effort of Wake Forest University Baptist Medical Center, Novant Health Triad Region, Winston-Salem/Forsyth County Schools, the Forsyth County Department of Public Health, CenterPoint, Forsyth Futures, and the Forsyth County Medical Society. The Alliance founders and current President and Vice President are Drs. Jane Foy and Robert Dillard, both WFUHS faculty members. The purpose of the Alliance is to improve the ability of students to learn by improving the health and safety of school-aged children and adolescents and by coordinating and targeting the efforts and resources of all types of community health care providers. Grants from each of the two hospitals, the NC Department of Health and Human Services, The Fleshman Pratt Foundation, The Duke Endowment, The Kate B. Reynolds Charitable Trust and the March of Dimes have funded the Alliance. WFUHS in-kind reconciliation for FY01, FY02, FY03, FY04 and FY05was $60,806, $14,979, $18,864, $23,738, and $26,596 respectively. Total cash contributions from NCBH totaled $462,500 from 1999 through the present.
The Alliance developed comprehensive school-based health centers servicing three schools – Independence High School (subsequently closed), Mineral Springs Elementary School, and Mineral Springs Middle School. Faculty from WFUHS’ Department of Pediatrics and Psychiatry participate in delivering nursing, medical, and mental health services at these sites. Models serving two additional schools – Ashley Elementary and Atkins Middle Schools (recently re-named Winston-Salem Preparatory Academy) – provide the services of a school nurse and social worker and a range of screening, prevention and mental health treatment programs. Since the closing of Independence High School in June of 2003, the Alliance has piloted a case management model to support alternative students at North Forsyth High School. A new model of school nursing care has served students at Meadowlark Elementary and Middle Schools since the spring of 2005; a grant-supported contract with the Forsyth County Department of Public Health currently funds this initiative. A health screening pilot identified and referred students with vision, hearing, blood pressure, and weight abnormalities; screening activities focused on vision and weight will expand to 6 schools in the fall of 2005.
School Health Advisory Council (SHAC)
The NC legislature recently mandated that each school system establish a SHAC to guide policy and system changes that will improve the health and safety of school-aged children and youth. Early in 2004, Winston-Salem/Forsyth County Schools designated the School Health Alliance Board of Directors (including 3 WFUHS faculty members) as Forsyth County’s SHAC. Projects during 2004 and 2005 have included nutritional improvements in seven pilot school cafeterias and implementation of the Center for Disease Control’s School Health Index as an assessment and health improvement tool at a pilot elementary school.
United Way
The Medical Center is quite involved with the United Way of Forsyth County, with numerous NCBH and WFUHS employees serving on various agency boards and the Board of Directors of the United Way of Forsyth County. Additionally, during the 2005United Way Campaign, the Medical Center raised over $1,000,000 in contributions.
Wellness & Prevention Services
The program’s purpose is to promote healthier living through education and to provide health outreach programs that represent the mission of the Medical Center. Services provided include screenings and testing for weight, blood pressure, cholesterol, blood sugar, body mass index and other health education services. Intervention programs include flu immunization clinics, smoking cessation, protecting your heart and weight loss.
Winston-Salem/Forsyth County Arts Council
WFUHS permits solicitation of its employees to raise money for the support of the Winston-Salem / Forsyth County Arts Council. Employees are encouraged by the CEO, Dr. Richard Dean, and through internal media (Infinity and the Intranet). The minimal costs of campaign are underwritten jointly by NCBH and WFUHS. Last year’s campaign raised approximately thirty-eight thousand dollars.