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CHAMPIONING THE HEALTH OF OUR RURAL COMMUNITIES: AROOSTOOK COUNTY'S TOP PUBLIC HEALTH PRIORITIES

September 28, 2016

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Changing incentives under the Affordable Care Act (ACA) and value-based reimbursement to keep people healthy and out of acute care settings have fostered greater attention to the impact of health outcomes on population health across the nation and the State of Maine, and within Aroostook County. 

In May 2014, to meet its concurrent goals of improving efficiency and infrastructure and to further protect and promote the health of Maine people by enhancing the quality and performance of public health programs and services, the Maine CDC sought national public health accreditation. The accreditation recognition best positions the Maine CDC to seek future federal funding, which is likely to be limited to accredited agencies. As a result, Maine CDC educated and organized staff to create and enhance several new plans and processes to include a State Health Assessment, a State Health Improvement Plan, and an agency-wide Strategic Plan.   

To maintain public health accreditation, the Maine CDC and local health departments are required to conduct community health assessments and to develop health improvement plans every five years. Additionally, to meet Internal Revenue Service 990 reporting requirements, non-profit tax-exempt hospitals in the United States are also required to conduct a community needs assessment every three years and to use that information to develop plans that address top health concerns. These requirements are both time and resource intensive and can lead to duplication of efforts. Thus, to maximize the efficient use of resources and to encourage collaboration between health care and public health partners in community health planning, a Shared Health Needs Assessment and Planning Process (SHNAPP) with 4 phases was initiated as the first state-wide public/private partnership of its kind in the nation. The planning process was developed through a memorandum of understanding to coordinate and leverage resources among Central Maine Health System, Eastern Maine Health System, Maine CDC, MaineGeneral Health, and MaineHealth with input from other healthcare and public health agencies to ensure the health needs of the people of the state are met. The four phases included data collection and analysis, needs assessment reporting, community engagement, and health improvement plans.

SHNAPP provided a framework for evaluating the health of communities in Maine, identifying priorities, and taking action. As a result of the Maine SHNAPP findings, health care organizations are better positioned to look beyond their walls to understand the strengths and needs of their communities and to focus on improving population health and well-being. By working together, healthcare agencies and partners are able to respond to the needs of their communities and identify new or creative ways to solve community health problems better than any of them could working alone. The current goal is collaboration and coordinated effort rather than competition and leveraging resources to create a single state health implementation plan. Data analyses of the SHNAPP was completed in September of 2015.

According to Dr. Rachel Albert, Professor of Nursing at the University of Maine at Fort Kent and Chair of the Aroostook District Coordinating Council (DCC) for Public Health, “During the third phase of the SHNAPP process, from October 2015 through March 2016, the DCC held several successful community engagement sessions with local public representatives including diverse healthcare consumers, community leaders, educators, businessmen, and healthcare and hospital administrators in northern, central, and southern Aroostook County to obtain broad stakeholder input on identifying significant health needs based on review of the SHNAP data; solicit stakeholder feedback and prioritize significant health needs, and identify gaps and local assets and resources that could potentially address local health priorities for the county.  The community engagement forums provided the momentum to bring together public and healthcare stakeholders and find alignment in the next steps of the planning process and prioritize goals and strategies for the next District Public Health Improvement Plan. The broad experiences and knowledge of health consumers and healthcare providers, and resources and services contributed by hospitals and community agencies, helped to highlight collective solutions to barriers impacting the rural health of our communities.”

During the community engagement forums held at Northern Maine Community College, University of Maine at Fort Kent, and Houlton Regional Center, Stacy Boucher, Maine CDC District Liaison, shared the survey results of the overall Maine Public Health SHNAPP. Discussions focused on the three top health issues for Aroostook County based on information provided by 110 county respondents on the stakeholders’ survey.  People who responded to the survey were asked to rank health issues on a Likert scale of 1 to 5, where 1 was not at all a problem and 5 was a critical problem. Obesity was identified as the most important health issue in Aroostook County by 85% of the respondents as compared to 78% in the State of Maine. Drug and alcohol abuse was identified as the second leading health priority in Aroostook County by 80% of the respondents as compared to 80% in the State of Maine. The third priority in Aroostook County reported by 80% of the respondents was cardiovascular health, which compared to 63% in the State of Maine. Using the same Likert scale, the critical issues affecting where we live, work, learn, and play in Aroostook County included access to behavioral care/mental health care (70%); poverty (69%); and employment/healthcare insurance (63%). The top three factors reported for the State of Maine by 1,639 respondents were poverty (78%), access to behavioral care/mental health care (67%), and transportation (67%). The full report and further information about the county’s top health issues can be accessed at www.maine.gov/SHNAPP.

The feedback received during the SHNAPP Community Engagement forums conducted in the fall of 2015 and spring of 2016 were summarized to foster discussion and to facilitate the development of the 2016 District Health Improvement Plan. According to both Dr. Albert and Stacy Boucher, “Championing the health of our communities calls for Aroostook District action that links public health strategies to the reduction of avoidable hospitalizations. Shared ownership for health is currently underway through the development of DCC ad hoc committees with diverse experts for each health priority who will collaborate on identifying a course of action and critical strategies to address the top health issues in Aroostook County via the development of a District Community Health Improvement Plan.” DCC members are asked to remain informed and involved in addressing gaps and identifying action steps as a collaborator and contributor to the overall District Health Improvement Plan, which will inform the Maine State Health Improvement Plan.