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COHC BOARD OF DIRECTORS

Dave Blom, OhioHealth

Claus Von Zychlin, Mount Carmel

Steve Allen, Nationwide Children’s

Sheldon Retchin, Wexner Medical Center

COHC MISSION

The Central Ohio Hospital Council serves as the forum for community hospitals to come

together to address issues that impact the delivery of health care to central Ohioans.

Through the COHC, member hospitals collaborate with each other and with other

community stakeholders to improve the quality, value and accessibility of health care

in the central Ohio region.

COMMUNITY

HEALTH

NEEDS ASSESSMENT

IRS REQUIREMENTS

501C3 hospitals must conduct a community health needs assessment and implement a strategic plan, based on assessment, every 3 years;

Must partner with Public Health and a university, where available;

$50,000 penalty (or loss of tax exemption) for those not in compliance.

WHY THE REQUIREMENT?

IRS attempting to tie assessment to hospitals’ community benefit

10 YEAR LOOK AT UNCOMPENSATED CARE

Franklin County hospitals have provided $2.2 billion in uncompensated care over the past decade.

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 $-

$50,000,000

$100,000,000

$150,000,000

$200,000,000

$250,000,000

$300,000,000

$350,000,000

Franklin County Hospital Uncompensated Care -- Charity Care and Medicaid Losses

Franklin County Hospital Un-compensated Care -- Charity Care and Medicaid Losses

5 YEAR LOOK AT TOTAL COMMUNITY BENEFIT

Franklin County hospitals have provided $2.4 billion in community benefit over the past five years.

FRANKLIN COUNTY HOSPITAL COMMUNITY BENEFIT

FY 2013 Community Benefit for Franklin County hospitals

FRANKLIN COUNTY CHNA: A COMMUNITY COLLABORATIVE

Mount Carmel Health System

Nationwide Children’s Hospital

Ohio State University Wexner Medical Center

OhioHealth

Central Ohio Trauma System

Columbus Public Health

Columbus Neighborhood Health Centers

Franklin County Public Health

Heart of Ohio Family Health Centers

Lower Lights Christian Health Center

Ohio State University College of Public Health

United Way of Central Ohio

Ohio Department of Health (Disabled)

Ohio Department of Aging

Healthcare for the Homeless

OUR PROCESS

½ Day Planning Retreat

PLANNING RETREAT OUTCOMES

Social determinants

Health Resource Availability

Behavioral Risk Factors

Wellness care

Maternal and Child Health

Oral Health

Mental and Social Health

Death, Illness and Injury Measures

Infectious Diseases

Youth Issues

Steering Committee identified 170 indicators under 10 categories to be included in report:

2ND HALF DAY RETREATSTEERING COMMITTEE WORK

All indicators were reviewed.

Those where Franklin County fared worse than Ohio or U.S. or where indicator got worse since HM 2013 were pulled

All were rated using 9 criteria (National Association of City and County Health Officials)

1. Cost Effectiveness2. Issue worse here than elsewhere?3. Federal/state mandates prohibit or require addressing issue?4. Is there a valid intervention to positively impact the issue?5. Is a sizeable percent of population affected by the issue?6. Does intervention keep people well?7. Degree to which issue impedes ability to work, attend school, function, etc.?8. Does issue cause severe illness and/or premature death?9. Has the problem worsened or improved in the last 5 years

HEALTH NEEDS IDENTIFIED

Through Grouping

6 Health Needs

HEALTH NEEDS PRIORITIZED

Steering Committee Prioritized Health Needs Based on:

Number of indicators in each group;Rating for the indicators in the group;Internal feedback received from clinicians.

6 PRIORITIZED HEALTH NEEDS

1.Obesity

2.Infant Mortality

3.Access to Care

4.Mental Health and Addiction

5.?

6.?

HEALTHMAP 2016

For each health need, HM 2016

will provide disparity data:

1. Top zip codes

2. Gender

3. Race

4. Age

• April 2016

RELEASE TO PUBLIC

CHNA NEXT STEPS

Each hospital must:• Post CHNA on hospital’s Website;• Develop a written plan that addresses

each health need identified thru the CHNA

Strategies must be adopted by hospital governing boards or executive committees;

Strategies must be attached to IRS Form 990 (Community Benefit Reporting).

CURRENT

COLL

ABORATIVE

INIT

IATI

VES

CURRENT COLLABORATIVE WORK

Infant Mortality/Preterm Birth

• Every week in Franklin County, two to three babies die before the age of 1.

• Every week in Ohio, 3 babies die in unsafe sleep environments. In fact, sleep-related infant deaths are the leading cause of death for babies who are 1 month to 1 year of age.

COHC INFANT MORTALITY INITIATIVES

Early Elective Deliveries

• All 8 birthing hospitals prohibits the practice of scheduling deliveries before 39 weeks without a medical reason

Breastfeeding Promotion

• All 8 birthing hospitals following agreed-to standards to promote the initiation of breastfeeding before discharge

Safe Sleep

• All 9 hospitals implementing practices that encourage safe sleep environments

Very Low Birth Weight Babies

• Ensuring VLBW infants are delivered in hospitals with a higher volume of delivering these babies

EARLY ELECTIVE DELIVERIES

All 8 birthing hospitals developed policies that reduce the practice of scheduling early deliveries, without medicalindication, before 39 weeks completed gestation

CURRENT COLLABORATIVE WORK

Behavior Health

Mental Health Bedboard

Goal: Place ED patients needing mental care in an inpatient psych bed in a timely manner

BEDBOARD RESULTS

FUNDING PARTNERS AND LEADERSHIP

PROJECT TEAM LEADERS

Phil Cass, Ph.D. Central Ohio Trauma SystemLisa Courtice, Ph.D. The Columbus FoundationJeff Klingler Central Ohio Hospital CouncilDavid Royer ADAMHMark Hurst, MD Ohio Department of Mental Health

FUNDERS

TASK FORCE MEMBERSNationwide Children’s Hospital David A. Axelson, MD - Chief of Psychiatry & Medical Director of Behavioral Health Ohio Department of Mental HealthMark Hurst, MD- Medical Director Twin Valley Behavioral Health Veronica Lofton - Chief Executive Officer Alan Freeland - Chief Clinical Officer Ohio Hospital for Psychiatry Marcia Berch, RN, MSN, NE – Chief Executive Officer Ohio HealthDallas Erdmann, MD - Medical Director of Behavioral Health & Chairman Department of PsychiatryConnie Gallaher - System Vice President OSU Wexner Medical Center/Harding HospitalJohn Campo, MD - Chair, Department of PsychiatryNatalie Lester, MD - Director, Psychiatric Emergency ServicesAmanda Lucas, MEd, MBA - Executive Director & Chief Operating Officer Osteopathic Heritage FoundationTerri Donlin Huesman - Vice President Program Primary One HealthReed Fraley - Senior DirectorBeth Whitted, MBA, Dr.PH – Director of Regional Operations

ADAMH Franklin CountyDavid Royer - Chief Executive OfficerDelany Smith, MD - System Chief Clinical Officer Central Ohio Hospital CouncilJeff Klingler - President and CEO Central Ohio Trauma SystemPhillip H. Cass, PhD - Chief Executive Officer The Columbus FoundationLisa Courtice, PhD - Executive Vice President Dublin SpringsGarry Hoyes - Chief Executive Officer MaryhavenPaul Coleman, JD - President and CEOSara McIntosh, MD - Medical Director Mount Carmel WestSharon Hawk-Carpenter – Unit DirectorSean McKibben - President and Chief Operating Officer National Alliance of Mental Illness, Franklin Co.Rachelle Martin - Executive Director Netcare AccessKing Stumpp - President and CEOPablo Hernandez, MD - Medical Director

WHY CREATE THE PCES TASK FORCE?

PCES

Escalating community need

Increase in med/surge referrals

Overcrowding in ERs

Medicaid expansion

Other payment reform

RECOMMENDATIONSCENTRALIZED, COLLABORATIVE MODEL

H U B & S P O K E M O D E L

Inclusive model with all spokes engaged and accountable

Netcare and OSU hub

Illustrative spokes Law enforcement EMS Hospitals AOD providers Community health centers Payors Community and civic leaders Others

1OSU

Netcare

Work group co-chairsJohn Campo, MD - Chair, Department of Psychiatry, OSU/Wexner Medical CenterKing Stumpp - President and CEO, Netcare

RECOMMENDATIONS

Identify and develop additional options for intermediate and ambulatory care for individuals in need of mental health and/or alcohol and drug addiction treatment.

2• Expand role of select community mental

health centers (pilot program)• Increase the number of sub-acute detox

beds and ambulatory treatments.• Increase the use of crisis action teams,

mobile crisis teams, and telepsychiatry.

RECOMMENDATIONS

Build collaborative, effective working relationships with the payor community to favorably encourage an improved model which ensures that patients receive access to high quality care in a cost-efficient manner.

3• Foster positive, productive relationships

with payors• Work with public officials to eliminate

barriers to necessary treatment because of the IMD exclusion

• Improve collaboration and communication between clinical service providers and payers by developing a standardized care coordination system that transcends specific levels of care

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0%

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FCBB Referrals by Payer MixMedicaid MedicarePrivate Insurance Uninsured

4

CHRISTMAS IN JULYJULY 27, 2015 FCBB

94 PATIENTS AWAITING PLACEMENTNEARLY ALL SYSTEMS ON SURGE

OF THE 94 PATIENTS:

50 MEDICAID (61%)16 SELF PAY (21%)21 MEDICARE (13%)7 PRIVATE INSURANCE (5%)

GENERAL HOSPITALS HAD 7 BEDS AVAILABLE

POTENTIAL BED CAPACITY

# of existing beds

# of proposed

beds

# of existing

bedsDublin Springs 72 72 18 Mount Carmel

Ohio Hospital for Psychiatry 90 40 39 OhioHealth

Twin Valley 85 53 OSU Wexner

Sun Behavioral Health 116

TOTALS 247 228 110

475 585

IMDs General Hospitals

FEDERAL ACTION

CMS Proposed Rule (CMS-2390-P) Released May 27, 2015 Published in the Federal Register June 1, 2015 Comments due July 27, 2015 Final rule expected February 2016

Clarifies that Medicaid managed care plans could receive a capitation payment for enrollees aged 21 to 64 who have a short term stay of no more than 15 days in any given month in an IMD.

COMMUNITY SUPPORT

PCES Support

Dispatch Editorial Support

Legislative Support

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