North Country Healthy Heart Network Inc

RURAL HEALTH NETWORK DEVELOPMENT PROGRAM - APPLICANT ORGANIZATION INFORMATION NORTH COUNTRY HEALTHY HEART NETWORK, INC. 132 BLOOMINGDALE AVENUE, SUITE 2 SARANAC LAKE, NY 12983 NON-PROFIT WITH 501C3 STATUS, OTHER THAN INSTITUTION OF HIGHER EDUCATION WWW.HEARTNETWORK.ORG DESIGNATED PROJECT DIRECTOR INFORMATION PROJECT DIRECTOR – T.B.D. BY 1/1/2023 OUTREACH/PRACTICE FACILITATION COORDINATOR – LOUANN VILLANI (518)891-5855, EXT. 5506 LVILLANI@HEARTNETWORK.ORG CONTROLLER – RON BRENNER (518)891-5855, EXT. 5505 RBRENNER@HEARTNETWORK.ORG NETWORK DIRECTOR - ANN MORGAN (518)891-5855, EXT. 5501 AMORGAN@HEARTNETWORK.ORG RURAL HEALTH NETWORK DEVELOPMENT PROJECT PROJECT TITLE: GET HEALTHY NORTH COUNTRY! COMMUNITY INTEGRATED HEALTH NETWORK GOAL #1: TO INCREASE NETWORK CAPACITY TO SUSTAIN ON-GOING, REGULAR DELIVERY OF EVIDENCE-BASED CHRONIC DISEASE PREVENTION SERVICES. GOAL #2: TO REDUCE THE PREVALENCE OF DIABETES IN THE NORTH COUNTRY BY INCREASING PREDIABETIC/DIABETIC ACCESS TO AND PARTICIPATION IN EVIDENCE-BASED PREVENTION/SELF-MANAGEMENT PROGRAMS. FOCUS AREA CHRONIC DISEASE PREVENTION TARGET PATIENT POPULATION THE COALITION TARGETS INDIVIDUALS WITH PREDIABETES OR DIABETES. UNDERSERVED POPULATIONS THAT HAVE HISTORICALLY SUFFERED POORER HEALTH OUTCOMES, HEALTH DISPARITIES, AND OTHER INEQUITIES IN THE TARGET REGION INCLUDE THE AGING, LOW-INCOME, AND NATIVE AMERICAN COMMUNITIES. NETWORK MEMBERS NETWORK NAME: NORTH COUNTRY CHRONIC DISEASE PREVENTION COALITION MEMBER ORGANIZATIONS: THE NETWORK INCLUDES 33 ORGANIZATIONS: AN ACCOUNTABLE CARE ORGANIZATION; A BEHAVIORAL HEALTH INDEPENDENT PRACTICE ASSOCIATION; TWO (2) REGIONAL TECHNICAL ASSISTANCE PARTNERS; SEVEN (7) HOSPITAL-OPERATED COMMUNITY HEALTH CENTERS; ONE (1) INDEPENDENT PRIMARY CARE PRACTICE; ONE (1) NATIVE AMERICAN TRIBE; TWO (2) FEDERALLY QUALIFIED HEALTH CENTERS; SEVEN (5) BEHAVIORAL HEALTH ORGANIZATIONS; TWO (2) SOCIAL CARE COMMUNITY-BASED ORGANIZATIONS; SEVEN (7) AREA OFFICES FOR THE AGING; AND FOUR (4) LOCAL HEALTH DEPARTMENTS. NETWORK PROJECT ACTIVITIES/SERVICES NETWORK EFFORTS WILL BE DIVIDED BETWEEN NETWORK DEVELOPMENT ACTIVITIES ASSOCIATED WITH GOAL #1, AND CHRONIC DISEASE PREVENTION/SELF-MANAGEMENT SERVICE DELIVERY ACTIVITIES ASSOCIATED WITH GOAL #2. EXPECTED OUTCOMES IMPROVED ACCESS: - INCREASED ENROLLMENT IN CDPSM PROGRAMS - INCREASED PROPORTION OF THOSE ENROLLED IN PROGRAMS BEING FROM SUBPOPULATIONS WITH HEALTH DISPARITIES EXPANDING CAPACITY: - INCREASED PROGRAM AVAILABILITY - REDUCTION IN THE NUMBER OF INDIVIDUALS ON WAITLIST - REDUCTION IN THE AMOUNT OF TIME ON THE WAITLIST ENHANCING OUTCOMES: - DECREASE IN PREVALENCE OF TYPE 2 DIABETES - DECREASE IN PERCENTAGE OF DIABETIC POPULATION WITH OUT-OF-CONTROL DIABETES (A1C >/= 9) - DECREASE IN DIABETES-RELATED UTILIZATION OF EMERGENCY AND INPATIENT SERVICES SUSTAINABILITY: - INCREASED PAYER AWARENESS OF THE NETWORK AND ITS VALUE PROPOSITION - INCREASED REVENUE FROM HEALTHCARE PAYER CONTRACTS (VALUE-BASED OR OTHERWISE) CAPACITY TO SERVE RURAL UNDERSERVED POPULATIONS THE APPLICANT AND OTHER MEMBERS OF THE COALITION HAVE A LONG HISTORY OF SERVING UNDERSERVED POPULATIONS. HOSPITAL/PRIMARY CARE MEMBERS ARE SAFETY-NET PROVIDERS IN THE COMMUNITIES THEY SERVE; AREA AGENCY ON AGING MEMBERS ASSIST THE ELDERLY (AND OTHERS) TO ADDRESS BARRIERS AND GET THEM CONNECTED TO NEEDED PROGRAMS AND SERVICES; AND BEHAVIORAL HEALTH MEMBERS PROVIDE SERVICES AND SUPPORT TO INDIVIDUALS EXPERIENCING MENTAL ILLNESS AND/OR ADDICTION. THE APPLICANT AND ITS COALITION CO-LEAD AGENCY, THE ST. LAWRENCE COUNTY HEALTH INITIATIVE, INC., BOTH HAVE SPENT THE LAST 20 PLUS YEARS IMPLEMENTING PROGRAMS THAT TARGET DISPARATE POPULATIONS TO PROMOTE TOBACCO CESSATION, INCREASED ACCESS TO NUTRITIOUS FOODS, MORE OPPORTUNITIES FOR PHYSICAL ACTIVITY, AND INCREASED ACCESS TO HEALTH CARE INCLUDING HEALTH INSURANCE ENROLLMENT SERVICES. NORTH COUNTRY HEALTH HEART NETWORK IS REQUESTING A FUNDING PREFERENCE BASED ON QUALIFICATION 3. THE COALITION IS FOCUSED ON PRIMARY CARE, WELLNESS AN D PREVENTION STRATEGIES.

RURAL HEALTH NETWORK DEVELOPMENT PLANNING GRANT PROGRAM