Holzer Health System

ARP ECONOMIC DEVELOPMENT GRANT FOR RURAL HEALTH CARE FACILITIES

SMALL HEALTH CARE PROVIDER QUALITY IMPROVEMENT - HOLZER HEALTH SYSTEM, ON BEHALF OF THE APPALACHIAN COMMUNICATION CONSORTIUM (ACC), SEEKS FUNDING FROM THE HRSA SMALL HEALTH CARE PROVIDER QUALITY IMPROVEMENT PROGRAM (HRSA-22-093) FOR ITS COMMUNICATIONS IMPROVEMENT PROJECT (CIP) TO REDUCE HOSPITALIZATIONS AND IMPROVE RURAL HEALTH OUTCOMES FOR ADULTS 60 AND OLDER. WITH ITS PROPOSED QUALITY IMPROVEMENT MODEL CENTERED ON TEAMSTEPPS, THE ACC WILL ENHANCE TEAM COMMUNICATION AS A FOUNDATION FOR STREAMLINING CARE TRANSITIONS AND COORDINATION, BUILDING SERVICE CAPACITY, ADDRESSING SOCIAL DETERMINANTS OF HEALTH, AND ADVANCING READINESS TO EXPAND PAYMENT AND REIMBURSEMENT STRATEGIES FOR SUSTAINABILITY. CIP WILL CREATE A MULTIDISCIPLINARY QUALITY INFRASTRUCTURE THROUGHOUT OUR CONSORTIUM THAT IS PRIMED FOR IMPROVEMENT INITIATIVES AND CAN CREATE COST SAVINGS THAT CAN SUSTAIN AND GROW THE MODEL IN OUR REGION. WE WILL FOCUS ON REDUCING HOSPITALIZATIONS (ADMISSIONS AND READMISSIONS) FOR SOME OF THE MOST COMMON AND COSTLY CAUSES OF HOSPITAL ADMISSIONS FOR OLDER ADULTS IN OUR EIGHT-COUNTY REGION OF SOUTHEASTERN OHIO AND WESTERN WEST VIRGINIA. OUR OLDER ADULT PATIENT POPULATION IS PRONE TO HIGH LEVELS OF PNEUMONIA, CONGESTIVE HEART FAILURE, SEPSIS, AND OTHER CHRONIC DISEASES THAT ARE AMONG THE LEADING CAUSES OF AVOIDABLE HOSPITALIZATIONS, READMISSIONS, AND DEATH. WHILE THIS PARTNERSHIP SEES POTENTIAL TO APPLY THIS QUALITY IMPROVEMENT STRATEGY ACROSS MANY MAJOR CONDITIONS OF CONCERN, OUR PROJECT WILL FOCUS OUR COMMUNICATIONS QUALITY IMPROVEMENT MODEL ON PNEUMONIA, CONGESTIVE HEART FAILURE, AND SEPSIS IN YEARS 1 AND 2, THEN APPLY THE MODEL TO COPD AND UTI IN YEARS 3 AND 4. TO DO THIS WORK IN A COORDINATED, CROSS-SYSTEM FASHION, HOLZER HEALTH SYSTEM WILL FORMALLY PARTNER WITH OHIO VALLEY PHYSICIANS (OVP), AND THE AREA AGENCY ON AGING DISTRICT 7 (AAA7) TO COMMISSION AND TRAIN MULTIDISCIPLINARY QUALITY IMPROVEMENT TEAM(S) TO EXTEND A SUITE OF SERVICES TO DEFINED SETS OF OLDER ADULT PATIENTS 60 AND OLDER. OUR GOAL IS TO ENABLE EXCELLENT COMMUNICATION AND COORDINATION ACROSS PROVIDER TYPES AND WITHIN MULTIPLE LEVELS OF CARE, TRANSITIONING AND STABILIZING OLDER ADULTS THROUGH CARE SERVICES AND INTO THE COMMUNITY. MULTIDISCIPLINARY TEAM COMPOSITION SHOULD REPRESENT A CROSS-SECTION OF STAFF ACROSS LEVELS OF CARE, INCLUDING ACUTE, POST-ACUTE, AMBULATORY, PRIMARY CARE, HOME HEALTH, SPECIALISTS, AND COMMUNITY-BASED SERVICES. THE ACC WILL 1) DEDICATE STAFF CAPACITY TO CROSS-SYSTEM MULTIDISCIPLINARY QUALITY IMPROVEMENT TEAMS (INCLUSIVE OF CARE MANAGERS AND DISCHARGE PLANNERS) TO IMPROVE TRANSITIONS OF CARE AND EXPAND SERVICES FOR INDICATED OLDER ADULT PATIENTS; 2) TRAIN TEAMS IN PROVEN COMMUNICATION QUALITY IMPROVEMENT MODELS LIKE TEAMSTEPPS, TEACH BACK AND ENHANCED CARE MANAGEMENT METHODS; 3) TEST AND EXTEND EFFECTIVE QUALITY IMPROVEMENT PRACTICE CHANGES, CARE HANDOFFS AND DISCHARGE PLANNING THROUGH SERVICES TO OUR PATIENTS; 4) LINK ELIGIBLE PATIENTS TO THE AAA7’S HOSPITAL2HOME SERVICE AND OTHER SOCIAL SERVICE REFERRALS; AND 5) EXPAND AND EXPLORE PAYMENT AND SAVINGS STRATEGIES TO SUSTAIN THESE ENHANCED SERVICES FOR OLDER ADULTS. WE BELIEVE THESE ACTIONS WILL RESULT IN POSITIVE OUTCOMES IN EACH OF THE THREE REQUIRED IMPACT AREAS: 1) IMPROVED HEALTH OUTCOMES EVIDENCED BY OLDER ADULTS LIVING HEALTHIER LIVES AT HOME, AVOIDING UNNECESSARY HOSPITALIZATIONS AND READMISSIONS FOR PNEUMONIA, CHF, COPD, SEPSIS AND UTI; 2) EXPANDED CAPACITY FOR ESSENTIAL HEALTH CARE SERVICES BY INCREASING CARE MANAGEMENT SERVICES WITHIN A SUSTAINABLE COMMUNICATIONS AND QUALITY INFRASTRUCTURE FOR OLDER ADULT PATIENTS; AND 3) INCREASED FINANCIAL SUSTAINABILITY DEMONSTRATED THROUGH NEW OR EXPANDED BILLING OR PAYMENT INCENTIVE STRATEGIES AND POTENTIAL COST SAVINGS FROM REDUCED ADMISSIONS AND READMISSIONS. WE BELIEVE THAT THIS INITIATIVE WILL SERVE AS A CRITICAL STEPPINGSTONE FOR OUR HEALTH SYSTEMS TO BENEFIT FROM THE VALUE-BASED OPPORTUNITIES OFFERED BY CMS AND OTHER ENTITIES OVER TIME.

RURAL HEALTH CARE SERVICES OUTREACH GRANT PROGRAM - HOLZER HEALTH SYSTEM WILL FORM A NEW OUTREACH CONSORTIUM WITH THE GALLIA, JACKSON, AND MEIGS COUNTY HEALTH DEPARTMENTS, THE MATERNAL HEALTH OUTREACH CONSORTIUM (MHOC), TO ADDRESS HIGH-RISK PREGNANCIES IN A MATERNITY DESERT IN THREE RURAL APPALACHIAN COUNTIES IN SOUTHEASTERN OHIO. IN 2024, 84% OF DELIVERED PREGNANCIES AT HOLZER HEALTH SYSTEM WERE HIGH-RISK, UNDERLINING THE CONSORTIUM’S MOTIVATION TO ORGANIZE FOR ACTION. MHOC’S GOALS ARE TO ENGAGE COUNTY HEALTH DEPARTMENT COMMUNITY HEALTH WORKERS (CHW) AND PUBLIC HEALTH NURSES (PHN) IN A PERINATAL OUTREACH WORKFORCE PROJECT THAT IMPROVES HIGH-RISK PREGNANCY OUTCOMES WITH INTERVENTIONS AT THE COMMUNITY LEVEL AND AT THE INDIVIDUAL LEVEL IN RURAL COMMUNITIES IN SOUTHEASTERN OHIO. THE PROJECT WILL BUILD AND STRENGTHEN THE CIRCUITRY BETWEEN CONSORTIUM HEALTH SYSTEMS, COUNTY HEALTH DEPARTMENTS, AND OUTREACH WORKFORCE AND BRIDGE CARE GAPS FOR MORE WOMEN EXPERIENCING HIGH-RISK PREGNANCIES, REMOVING THEIR BARRIERS TO CARE. THE MATERNAL HEALTH OUTREACH PROGRAM (MHOP) IS DESIGNED TO SERVE WOMEN BETWEEN THE AGES OF 15 TO 35 WITH HIGH-RISK PREGNANCIES THAT PARTICIPATE THROUGH HEALTH DEPARTMENT ACTIVITIES AND THROUGH HOLZER OBSTETRICS AND GYNECOLOGY (OBGYN) SERVICES THAT COVERS FIVE COUNTIES, THREE OF WHICH ARE PROJECT AREA-FOCUSED: GALLIA, MEIGS, JACKSON, LAWRENCE, AND ATHENS. COMMUNITY-LEVEL PERINATAL OUTREACH SERVICES WILL BE FOCUSED ON PREGNANT WOMEN WHO MAY BE AT-RISK, AND WOMEN IDENTIFIED WITH HIGH-RISK PREGNANCIES WILL RECEIVE MORE INDIVIDUALIZED OUTREACH SERVICES AND CARE CONNECTIONS. THE MODEL WILL ENABLE HAND-OFFS BETWEEN COMMUNITY-CLINICAL CARE, EMPOWERING CONSORTIUM PARTNERS AND OUTREACH WORKFORCE TO PROVIDE HIGH-NEED PREVENTION AND RISK REDUCTION SERVICES IN THE MOST ACCESSIBLE SETTINGS POSSIBLE IN THESE THREE RURAL, APPALACHIAN COUNTIES. OVER THE FOUR-YEAR PERIOD OF PERFORMANCE, THE CONSORTIUM EXPECTS THAT CONDUCTING COMMUNITY-LEVEL AND HIGH-RISK PREGNANCY PROTOCOLS IN GALLIA, JACKSON, AND MEIGS COUNTIES WILL RESULT IN THE FOLLOWING OUTCOMES: • INCREASED RATE OF WOMEN GETTING SCREENED ROUTINELY FOR PERINATAL RISKS (E.G., DIABETES, HYPERTENSION, DEPRESSION). • INCREASED NUMBER OF WOMEN WITH AT-RISK PREGNANCIES RECEIVING ULTRASOUND • DECREASED RATE OF HYPERTENSION IN WOMEN AGES 15-35 WITH HIGH-RISK PREGNANCIES. • DECREASED RATE OF TOBACCO USE IN WOMEN AGES 15-35 WITH HIGH-RISK PREGNANCIES. • INCREASED RATE OF WOMEN WITH HIGH-RISK PREGNANCIES SUCCESSFULLY REFERRED TO AND RECEIVING MENTAL HEALTH CARE. • INCREASED RATE OF WOMEN WITH HIGH-RISK PREGNANCIES ACTIVELY MANAGING GESTATIONAL DIABETES AND A DECREASED RATE OF WOMEN DIAGNOSED WITH GESTATIONAL DIABETES. • INCREASED AWARENESS OF RISK FACTORS AFFECTING PERINATAL HEALTH (E.G., MENTAL HEALTH, DIABETES, TOBACCO USE). • INCREASED ACCESS TO SUBSTANCE USE DISORDER EDUCATION, PREVENTION, AND SERVICES BY WOMEN WITH AT-RISK PREGNANCIES. • INCREASED RATE OF SUCCESSFULLY COMPLETED SDOH SCREENINGS AND REFERRALS TO SERVICES. • INCREASED RATE OF WOMEN WITH HIGH-RISK PREGNANCIES WHOSE HEALTH-RELATED SOCIAL NEEDS ARE BEING MET. THE CONSORTIUM WILL CONSULT EVIDENCE-BASED MODELS AND TOOLS THAT MATCH DESIRED OUTCOMES, THE RISK FACTORS, AND PROTECTIVE FACTORS THEY WANT TO ADDRESS, THE OUTREACH WORKFORCE THEY WANT TO AMPLIFY, AND THE TYPES OF ORGANIZATIONS ENGAGED IN THE CONSORTIUM AND PROJECT. THE SOUTH CAROLINA PERINATAL COMMUNITY HEALTH WORKER TOOLKIT, THE RURAL HEALTH INFORMATION HUB CHW TOOLKIT. ALLIANCE FOR INNOVATION IN MATERNAL HEALTH AIM) PATIENT SAFETY BUNDLES, AND THE PERINATAL HEALTH PARTNERSHIP OF SOUTHEAST GEORGIA. HOLZER HEALTH SYSTEM IS REQUESTING A FUNDING PREFERENCE BASED ON QUALIFICATION 1. HOLZER HEALTH SYSTEM (100 JACKSON PIKE, GALLIPOLIS, OH), IS IN A DENTAL HEALTH, MENTAL HEALTH, AND A PRIMARY CARE HPSA WITH A SCORE OF 19, 16, AND 19, RESPECTIVELY. ATTACHMENT 11 INCLUDES FUNDING PREFERENCE DOCUMENTATION.

RURAL HEALTH NETWORK DEVELOPMENT PLANNING GRANT PROGRAM - ORGANIZATION NAME: HOLZER HEALTH SYSTEM, 100 JACKSON PIKE, GALLIPOLIS, OH 45631; SHORT TERM ACUTE CARE HOSPITAL; HTTPS://WWW.HOLZER.ORG DESIGNATED PROJECT DIRECTOR INFORMATION: TROY MILLER, CHIEF STRATEGIC OFFICER, 740-446-5514, TDMILLER@HOLZER.ORG NETWORK PLANNING PROJECT: RURAL OHIO NURSING EDUCATION (RONE) NETWORK LEGISLATIVE AIMS: THE NETWORK SEEKS TO FULFILL LEGISLATIVE AIMS #1, #2, AND #3. FOCUS AREA: HOLZER HEALTH SYSTEM’S FOCUS AREA IS NURSING EDUCATION AND WORKFORCE. PROPOSED SERVICE REGION: THE PROPOSED PROJECT SERVICE AREA INCLUDES HRSA RURAL COUNTIES IN OHIO (ATHENS, GALLIA, JACKSON, MEIGS, AND VINTON), AND ONE OF HOLZER’S PRIMARY SERVICE AREAS IN HRSA RURAL WEST VIRGINIA (MASON COUNTY). POPULATIONS TO BE SERVED: THE POPULATIONS SERVED BY THE NETWORK ARE MOSTLY RURAL, OLDER ADULTS. THE POPULATION DENSITY IN THIS AREA IS LOWER THAN THE NATIONAL AVERAGE, WITH POPULATION COUNTS FROM THE 2020 CENSUS SHOWING THAT APPROXIMATELY 270,798 PEOPLE LIVE IN THIS 3,588.19 SQUARE MILE AREA THAT ENCOMPASSES SIX APPALACHIAN COUNTIES IN OHIO AND TWO IN WEST VIRGINIA. SOME RESIDENTS OF THIS REGION MAY HAVE SEVERAL MILES BETWEEN THEMSELVES AND THEIR CLOSEST NEIGHBOR. THIS DATA REINFORCES THE RURAL CONDITIONS THAT OFTEN COINCIDE WITH LOWER ACCESS TO HEALTH CARE AND OTHER RESOURCES. A SIGNIFICANT PORTION OF THE POPULATION IS OLDER ADULTS. POPULATION RESEARCH FORECASTS THAT ONE IN FOUR OHIOANS WILL BE 60 OR OLDER BY 2025, AMPLIFYING THE NEED FOR HEALTH SYSTEMS AND NETWORKS TO BE EFFECTIVE IN SERVING THIS POPULATION. WEST VIRGINIA’S TREND IS SIMILAR, PROJECTS TO HAVE 22.9% OF ITS POPULATION 65 OR OLDER BY 2030. THE 2020 CENSUS ESTIMATES SHOW THAT WHITE (NOT HISPANIC OR LATINO) RESIDENTS REPRESENT A MAJORITY OF 89.7% OF THE POPULATION ACROSS COUNTIES IN THIS SERVICE AREA, WITH AT OR LESS THAN 3.1% OF THE POPULATION FOR ANY OTHER RACE OR ETHNICITY. RESIDENTS OF RURAL APPALACHIAN COUNTIES, SUCH AS THE POPULATION TARGETED BY THIS PROJECT, TEND TO HAVE POORER HEALTH OUTCOMES, DEMONSTRATING THE FAILURE TO DELIVER SUCCESSFUL HEALTHCARE TO THESE POPULATIONS. DATA SUGGESTS THAT MORE OF THIS REGION’S CITIZENS ARE LIKELY TO DIE OF CANCER AND OTHER CHRONIC HEALTH CONDITIONS THAN OTHERS OUTSIDE OF APPALACHIA, WHERE JUST ONE MEASURE OF PREMATURE MORTALITY, YEARS PER LIFE LOST (YPLL), IS 25% HIGHER THAN THE US. DISPARITIES FURTHER EXIST BETWEEN URBAN AND RURAL AREAS WITHIN THE APPALACHIAN REGION. WHEN COMPARING APPALACHIAN RURAL AND METROPOLITAN/URBAN AREAS, MORTALITY RATES ARE PROFOUNDLY HIGHER IN THE RURAL AREAS. THE YPLL IN RURAL APPALACHIAN COUNTIES IS 40 PERCENT HIGHER THAN IN THE REGION’S METROPOLITAN COUNTIES. NETWORK MEMBERS: NETWORK MEMBERS INCLUDE A SHORT-TERM ACUTE CARE FACILITY, HOLZER HEALTH SYSTEM (HOLZER), A 4-YR HIGHER EDUCATION INSTITUTION, THE UNIVERSITY OF RIO GRANDE (URG), AND A 2-YR HIGHER EDUCATION INSTITUTION, RIO GRANDE COMMUNITY COLLEGE (RGCC). ALL NETWORK MEMBERS OF THE PROPOSED PROJECT ARE PHYSICALLY LOCATED IN A HRSA-DESIGNATED RURAL AREA, AS DEFINED BY THE RURAL HEALTH GRANTS ELIGIBILITY ANALYZER. THE RONE NETWORK IS ALREADY HIGHLY INTEGRATED, WITH A CAMPUS, FACILITIES, AND STAFF SHARED BY URG AND RGCC, AND A SUCCESSFUL NURSING PROGRAM OPERATED BETWEEN HOLZER AND URG. THE PREEXISTING SUCCESS OF THESE PROGRAMS INDICATES THAT THE RONE NETWORK WILL INTEGRATE THE THREE PARTNERS SEAMLESSLY. EXPERIENCE IN SERVING RURAL UNDERSERVED POPULATIONS: NETWORK MEMBERS HAVE AN EXTENSIVE HISTORY OF SERVING RURAL UNDERSERVED COMMUNITIES AND EXHIBIT A HIGH CAPACITY TO CONTINUE THEIR SERVICE. FUNDING OPPORTUNITY NOTIFICATION: HOLZER WAS NOTIFIED OF THE FUNDING OPPORTUNITY BY EXTERNAL GRANT MANAGEMENT CONSULTANTS WHO LEARNED OF THE OPPORTUNITY FROM BOTH HRSA STAFF AND GRANTS.GOV. FUNDING PREFERENCE: HOLZER HEALTH SYSTEM IS REQUESTING A FUNDING PREFERENCE BASED ON QUALIFICATION 1. GALLIA COUNTY, OH, IS IN A DESIGNATED HPSA. THE GALLIPOLIS AREA OF GALLIA COUNTY, OH, IS A DENTAL AND MENTAL HEALTH HPSA.

RBDG RURAL BUSINESS COOP RURAL ENTERPRISE GRANT

TELEMEDICINE GRANT

PRIMARY CARE