STRATEGIC PLAN 2017-2020

PROGRAM HISTORY

The North Baldwin Rural Health Network (NBRHN) was formally established in 2011 with funding from the HRSA Rural Health Network HIT program. The goal was to develop a network that was able to use an Electronic Medical Record (EMR) as the basis for building an integrated healthcare delivery system across the continuum in our rural community. The effort has progressed since the Network’s founding and now 14 members are using an EMR in the hospital setting and are sharing information among providers across the continuum. An increasing number have attested to Stage 1 or Stage 2 of Meaningful Use in their own organizations. Our strategy as a network is to continue to support members in their efforts to sustain and further develop their EMR capabilities. In 2014, the Network was awarded a Rural Health Network Development grant which has allowed the network to expand to include members in the Atmore, AL community in adjacent Escambia County. The project also included the development of a care transitions program in Bay Minette to reduce readmissions among COPD and CHF patients. The grant supported the recruitment of a lactation consultant to increase childbirth and breastfeeding education in the community to improve perinatal outcomes in the area.  These programs have led to the development of new support groups to serve the community and an increase in patient and provider engagement overall. Also, the network has expanded its use of technology to include implementing telemedicine projects in each community to meet the needs of its residents. The objective of the telemedicine program thus far has been to increase access to services like behavioral health and cardiac services.

During the first round of Network Development grant funding, the network was successful in achieving the following:

  • Expanding the network membership into Atmore, AL to include an acute care hospital and home healthcare agency
  • Improved Perinatal Outcomes
    • Established a Childbirth and Lactation Education program at North Baldwin Infirmary
    • Established the Baby Bistro Breastfeeding Support Group and Facebook page to educate the community
    • Achieved Baby Friendly Designation for North Baldwin Infirmary for its breastfeeding program
    • Increased breast feeding rates from 10% to 33%
    • Implemented the Centering model to better serve mothers
  • Reduced readmissions and increased patient access and engagement
    • Established a Care Transitions Program that follows COPD and CHF patients
    • Established smoking cessation programs in Bay Minette and Atmore and a Better Breathers Club in Bay Minette;
    • During our first year, we helped 10 people kick the habit
    • Established a behavioral health clinic using telemedicine in Bay Minette and a Cardiology telehealth program at ACH
  • Developed the initial network branding and communication platforms to increase awareness in the community

In 2017, the Network was awarded a second Rural Health Network Development grant to continue to expand services into Escambia County and to ensure that the projects that have been established mature and can be  sustained as the organization strives to fully mature as a network. The activities outlined in the strategic plan will detail our approach to becoming a mature network that has effectively integrated and is demonstrating a capacity to improve the health and quality of healthcare delivery for the residents in our communities.

The Network membership includes a broad cross section of the providers in our communities including two acute care hospitals, a Veterans Administration nursing home, and a community based skilled nursing facility. It includes primary care providers including the FQHC and specialists including behavioral health. As we began expanding the network to include Escambia County, we recognized the importance of establishing a partnership with the Poarch Band of Creek Indians in Atmore, AL. The network also seeks to include other strategic community based organizations that can play a meaningful role in the development of the care transitions program. We expect these members to be key partners in our ability to successfully implement our chronic disease management efforts. These partners may not always be clinical providers but instead help us as we attempt to address the social determinants of health and its impact on building a healthy community. By expanding our focus beyond EMR expansion but rather on how best to use patient data to drive quality improvements, our network seeks to become more sophisticated in our abilities to evaluate our programs and improve the quality of healthcare delivery. The NBRHN is developing a health care delivery system that at its core is patient centered, evidence based and uses technology to achieve higher levels of quality and connectivity between patient and provider. This project will continue to improve engagement and ultimately health outcomes in our targeted patient populations while strengthening our rural healthcare systems

Network Mission and Vision Statements

MISSION

The North Baldwin Rural Health Network and its members will work to address the needs of our communities by acting within available resources and consistent with agreed upon strategic priorities, to:

PROMOTE CLINICAL INTEGRATION

• To coordinate our patient’s care delivery needs and experiences across the continuum of care

• To provide a timely, complete and accurate electronic health record detailing the patient’s encounters with North Baldwin Health Network members

• To provide clinicians secure access to patient data at point of care

ACHIEVE HEALTH STATUS IMPROVEMENT

• To have as its primary goal, the continual improvement of the health of the communities we serve

• To elevate the quality and widen the breadth of care to the residents of our community through the electronic sharing of health information

• To eliminate medical mistakes, improve coordination of care, and reduce unnecessary or redundant tests and procedures

FACILITATE ADMINISTRATIVE INTEGRATION

• To maintain financial viability

• To accept and manage financial risk

• To take a leadership role in health care public policy

VISION

By working together as a network of providers, we will help our communities become the healthiest in America.

When members and partners began developing the framework for the North Baldwin Rural Health Network in 2011, they agreed that by working together they would be more effective at meeting the changing landscape of healthcare. They agreed to leverage individual resources in order to collaborate in order to share the cost of EMR implementation and collaborate to develop the new systems that would be required. The efforts of the network would focus on improving communication among providers and patients resulting in improved patient outcomes across the continuum.

Since its formation, the network activities have evolved to include how to utilize the technology to measure and improve quality, improve care transitions across the continuum and ultimately improve access to care in our rural community. Network members have signed a Memorandum of Agreement which outlines the values of the network and confirms their agreement to participate in network activities. Annually, members reaffirm their commitment to the goals of the NBRHN. New members commit to join and actively participate in network projects that are appropriate for their organization.

Strategic Planning Approach and Design

The NBRHN has outlined the focus areas in which its members seek to have impact. By developing a multi-year strategic plan, the NBRHN seeks to specify in more detail the activities the members will undertake in the coming years and apply measures so that the progress of the network can be evaluated. The goals of the current Network Development grant include:

  • Develop a Diabetes Prevention and Chronic Disease Self-Management Programs that will serve both communities;
  • Establish a Care Transition Program in Atmore that can provide robust chronic care management programs for patients with diabetes, COPD and CHF.
  • Develop a prescription opioid reduction program that engages stakeholders from across the community
  • Replicate and expand the telemedicine services offered in our community to improve access to care
  • Provide Mental Health First Aid classes to members of the community to help address the social determinants of health and increase the resiliency of our community
  • Establish robust communications for network initiatives that improve awareness of the network and its initiatives
  • Improve the health of our community by achieving are outcome targets each year

All of the network members were invited to participate in the Strategic Planning session which was held in two sessions during the month of November. The meeting was hosted by North Baldwin Infirmary.

On November 9, 2017, the session began with introductions and a discussion of the Mission and Vision of the NBRHN. It was agreed upon by the members in attendance that the Mission and Vision still reflected the aspirations of the members and no changes were recommended.

Small group discussions took place focusing on the levers and blocks that existed that could positively or negatively affect the network and its ability to reach its goals. Small group summaries were reported to the larger group and the facilitator captured the data on large easel pads that were placed on the walls around the conference room. This allowed members to add input and clarify their understanding of the issues. Each member was asked to select the levers and blocks that they felt could have the most impact on the success of the network initiatives. Their selections were summarized and were used to prioritize our thinking about each project goal. Before leaving the meeting, each member was given homework in which they were asked to identify activities that they felt would help the network achieve success in each of its stated goals.

On November 16, 2017, the members reconvened at North Baldwin Infirmary to complete the strategic objective planning. During this session, each of the grant goals were listed on easel pads sheets around the room. The group broke up into smaller working groups to discuss their proposed ideas and decide what activities they thought should be incorporated into the strategic plan. Following the small group discussions, the groups reported out their suggestions to the larger group for discussion. The facilitator captured their recommendations on the sheets around the room. At the conclusion of these discussions, each member was asked to vote on what activities they felt would be most effective at helping the network achieve its goals. Members prioritized the activities that they thought would be the most important for the network to incorporate into the strategic plan.

The group then reviewed what they had selected to verify that that they were in agreement that each activity was aligned with the network goals.

Additionally, we discussed the current network communication plan and solicited input and suggestions for ways to improve the plan to benefit the members and to increase community awareness of network activities. Suggestions were noted and it was decided to incorporate them into our existing plan. After the meeting, all of the information that was captured was synthesized and consolidated into the strategic planning.