The Albion Plan

Health Promotion, Health Care, and Wellness for "The Smart Community"

Presented on May 7, 2002 to an Open Forum at Albion High School

Albion Health Care Index

 

The greater Albion area - like many small communities - is facing a crossroads in health care. Our community hospital closed after struggling for several years. This defining moment has galvanized the community - comprised of the City of Albion, surrounding townships, and neighboring communities - to work together in assessing our health care needs and in formulating an innovative plan to ensure quality health care for our citizens. After the closing of Trillium Hospital, the Greater Albion Alliance (GAA)-a nonprofit, activist think tank of community leaders-established a special Health Care Task Force to design a comprehensive community-based plan. To provide direction and context for the health plan, the Greater Albion Alliance Health Care Task Force (GAA-HCTF) identified five core values:

1. All citizens must have access to high quality health care;

2. We will build on the assets - tangible and intangible, relationships and facilities - already present in the community and in neighboring communities;

3. We will seek long-term and enduring solutions and avoid short-term quick fixes;

4. Collaboration among the major health care providers is critical to producing cost-effective and sustainable health care services;

5. While respecting the right of each entity to pursue its economic goals through the power of the marketplace, we will engage each entity in such a way that creative and innovative partnerships will produce a model health care delivery system.

Our goal is to partner with high quality health care providers, as well as insurers, regulators, foundations, and elected officials at the local, county, state and national level, to create a model system for the delivery of health care in our small community that is no longer able to support a local hospital. To be successful, we will draw upon the expertise and dedication of health care professionals, as well as political, religious, business, and community leaders.

The Albion community has been extremely fortunate in having Foote Hospital as a partner in health care over the last four years. Foote has invested $7.5 million dollars in the health care of Albion through various initiatives including: repaying Trillium Hospital loans, providing needed health care services, and underwriting deficits associated with efforts to improve emergency room care. Our proposed health care plan would not be possible without the generosity of the Administration, Physicians, and Board of Foote Hospital, leaving a legacy of care and concern.

As we look to long-term needs and expansion of health care services for community residents, the GAA-HCTF believes it is critical that Albion partner primarily with Calhoun County health care providers. With ever shrinking federal, state and local dollars, regional collaborations become pivotal for success and sustainability. Albion is part of Calhoun County and, therefore, part of the service area of the Regional Health Alliance (RHA). The RHA is a public-private health care resource partnership committed to improving the health of all citizens in Calhoun County. Collaboration among RHA and all Calhoun County health care providers will enhance the health care delivery system for Albion directly and Calhoun County indirectly.

For decades, the major health care providers and even the citizens of the major population centers in Calhoun County have been unable or unwilling to collaborate on health care. The crisis created by the closing of Trillium Hospital has produced a pledge and commitment from the GAA-HCTF, Oaklawn Hospital, Battle Creek Health Systems, Battle Creek Family Health Center, Battle Creek Community Foundation, Albion Community Foundation, and W.K. Kellogg Foundation to work together to design and implement a comprehensive health delivery system for the citizens of Albion that would extend throughout Calhoun County. The Albion Health Care Model has seven major components:

1. High quality primary care: The backbone of a community health care delivery system is the primary care provided in local physician practices and clinics. Primary care, delivered by competent and dedicated health care professionals, forms the foundation for our comprehensive and innovative health care plan. While the Albion community rightfully feels remorse over the loss of our hospital, in the final analysis, the most important component of an effective health care delivery system must be excellent primary care. Primary care for Albion will be comprised of two major elements: local physician practices and a full-service clinic.

A. Local physician practices: Albion is fortunate that - in the midst of the changes brought about by the hospital closing - all local physician practices continued to function and plan on remaining in the community. High quality physician practices are achieved and maintained when the physicians have an investment in and commitment to the local community and when they have ready access to X-ray and laboratory services on a day-to-day basis to support their practices. To solidify the quality of physician practices, conscientious efforts will be made to engage local physicians more directly and meaningfully in the life of the community, including home ownership, service on boards and commissions, and involvement in promoting economic development. X-ray and laboratory services are critical in attracting and retaining physicians and other qualified health care providers. Partnerships with Oaklawn Hospital and Battle Creek Health System will ensure that X-ray and laboratory services are provided in Albion to support local physician practices. Foote plans to continue operating its Cherry Hill facility, including basic laboratory services.

Because of a lack of insurance or financial resources, a significant number of our citizens do not avail themselves of primary care physicians in Albion. At the same time, almost all our local primary care physicians report that they can accept new patients, but financially must limit the number of Medicaid and uninsured patients. The primary care needs of those in our community without a local physician can be best met by a combination of all the local physician practices agreeing to share caring for the current load of under and uninsured patients, plus the addition of a new clinic focusing on the health care of those with limited financial resources i.e., under and uninsured community residents (See B below).

B. Full-service clinic for uninsured and underinsured citizens: Albion has a significant proportion of uninsured and underinsured citizens. A top-notch Federally Qualified Health Center (FQHC), providing health, dental, and behavioral health services, is ideal for meeting this critical need. This FQHC clinic would be operated under the premise that all patients are individuals of dignity and worth and should be treated accordingly by all medical staff and support staff. Calhoun County is fortunate that the Family Health Center in Battle Creek (FHC-BC) is regarded as one of the finest FQHCs in the country. Dr. A. J. Jones, President of the Family Health Center, submitted a grant application on April 30, 2002 to the Bureau of Primary Health Care requesting an annual appropriation of $550,000 on behalf of the GAA-HCTF to establish a satellite FQHC in Albion. We are encouraged by the fact that our ìletter of intent" received a score of 92 out of 100 points in assessing the need for an FQHC in Albion. Moreover, while waiting for approval of the grant for the FQHC, the GAA-HCTF and others will explore establishing an "FQHC Look Alike" that can function as an FQHC. Our goal is to have an FQHC or a plan for an FQHC Look Alike operational by November 1, 2002. When fully operational, the Albion expansion location of the Family Health Center (FHC) FQHC will employ 26 people.

The Albion FQHC expansion site represents a deep and abiding commitment to provide health care, dental and behavioral health services to ALL our citizens. Often, these underinsured and uninsured patients use the emergency room for their primary care needs, thereby creating a financial drain on the ER and an unnecessary resource burden on the whole health care delivery system. An effective FQHC not only meets the needs of citizens who currently fall through the cracks of the health care delivery system, but, addressing their health care needs earlier is a far more financially viable model than the current expensive use of emergency room health care for this group of community members.

2. Access to urgent and emergency care: In most suburban communities, being within 20 minutes of a good emergency room is viewed as excellent access. Albion residents are 15 minutes from Oaklawn Hospital in Marshall, 20 minutes from Foote Hospital in Jackson, and 25 minutes from Battle Creek Health Systems Hospital. As a community, we must refocus our expectations for high quality emergency care from a local to a regional perspective. Albion, like many small towns, simply cannot afford the cost of operating a full-service, hospital-based emergency room. Accepting this reality enables us to focus on the three crucial elements that ensure access to emergency care: (a) an excellent ambulance service; (b) an expanded urgent care concept; and (c) a 24-hour health advisor response line. The closing of Trillium makes it imperative that these elements receive immediate attention and long-term focus for sustainability.

A. Ambulance Service: An excellent ambulance service would enable every citizen to have rapid and responsive access to emergency care within 15-20 minutes. In Albion Community Ambulance, a subsidiary of the well-respected Huron Valley Ambulance (HVA) and the Jackson Community Ambulance (JCA), we have a strong partner committed to increasing and enhancing service to our area. We will continue to work with ACA, HVA, and JCA to ensure the highest quality ambulance service. HVA and Foote Health System will continue operating and subsidizing ACA through December 31, 2002, and are committed to working with the community on developing support for the future.

B. Urgent Care: Since the vast majority of emergency room visits are for urgent, but not life-threatening situations, a strong urgent care facility would complement the ambulance service. Foote Health System opened an ìExpress Care" facility, located at Footeís Cherry Hill site on the North side of I-94 at Exit 121 on April 29, 2002 with hours from 6:00 to 10:00 p.m. Monday through Friday and 9:00 a.m. to 5:00 p.m. on Saturday and Sunday. Complementing urgent care will be the training of local citizens in identifying a true life-threatening situation (needing emergency care). Over time, training in CPR, the ability to detect signs of potential strokes, the use of defibrillators, and other emergency care related activities will become a regular part of Albionís community culture. Smart communities foster a network of "health partners," individuals who look out for the health care needs of their fellow citizens. With this comprehensive model in place, emergency services will truly be for emergencies.

C. 24-Hour Health Advisory Call-in: The 24-hour nurse response line or health advisor line will provide our citizens with a point of contact for help. This first point of contact will assist Albion residents in deciding what level of care is appropriate for the situation and, in doing so, will help us to make the best use of our resources. A high-quality 24-hour nurse help line or health advisor line will answer urgent questions, plus respond to general issues of health and wellness. Currently, Foote Health System is underwriting the cost of a 24-Hour Health Care Advisory line and plans to continue this service. Should those plans change, the GAA-HCTF will explore a partnership with a Calhoun County provider and also welcome the implementation of the 211 help line being proposed to connect all citizens in Calhoun County to the full array of human services.

3. Cost-effective outpatient diagnostic services: The local physician practices, FQHC, urgent care facility, and any visiting specialists need to use diagnostic services in Albion to better treat their patients. Oaklawn and BCHS have pledged to collaborate with Albion to maximize basic diagnostic services that are offered locally and to create a financial infrastructure that will enable the local diagnostic center to maintain and periodically upgrade the diagnostic equipment for the long term.

4. Competent specialists: Collaboration and cooperation among Oaklawn, BCHS, and Foote, physician practices, and an FQHC will result in the availability of a broad array of specialists. Playing to the strengths of each partner should attract the highest quality specialists, as well as ensuring the strongest financial viability.

5. Alliance of hospitals creates a network of effective inpatient options: We anticipate that Oaklawn and BCHS will collaborate in their efforts to market inpatient opportunities for the greater Albion market. An effective strategy of outpatient diagnostic services should be augmented with a collaborative strategy of sharing the inpatient market, thereby enabling hospitals to carve out a niche and be profitable. Because local citizens need to have the freedom of choice in selecting their in-patient care in a hospital, local physician practices and the FQHC will continue to advise their patients as to which hospital will offer the best care for each illness.

6. Integrated array of enhanced services for special audiences such as minority groups, senior citizens, occupational medicine, children, and those with behavioral health problems: These audiences need specific plans and strategies to ensure their special needs are met. For over a decade, the GAA Health and Wellness Action Team (GAA-H&WAT) has been working to address various health care problems in our community. More recently and prior to the closing of Trillium Hospital, the GAA-H&WAT has worked closely with the Regional Health Alliance to identify and prioritize the health initiatives both in the county and in the greater Albion area. Integration and coordination of services for all Albion residents has been at the forefront of their work. Recently, the GAA-H&WAT has focused its efforts on planning and implementing three core projects - the clinic for under and uninsured residents, expansion of the school-based health initiative, and bringing a senior wellness center (Burnham Brook East) to Albion - while also developing a comprehensive plan to identify and coordinate all Albion health initiatives.

The Regional Health Alliance (RHA) is moving forward with its Healthy Ventures 2010 project. The goal of this project is to facilitate Calhoun County becoming the healthiest county in Michigan by the year 2010. Maternal and child health, minority health, teen pregnancy prevention, school-based health centers, bioterrorism preparation and access to care have been identified as key areas for this initiative. The Minority Health Partnership (MHP) is playing a key role in identifying disparities in health care and in formulating strategies to address these disparities. MHP is one of several county-wide agencies and initiatives in health care coordinated by the RHA.

The GAA-H&WAT plays a pivotal role in keeping Albion's health care needs in focus for the RHA. We expect the H&WAT to continue its work in developing a comprehensive health and wellness plan and to work collaboratively with the RHA and other organizations as needed to accomplish this goal. Also important is developing strong occupational medical services. As Albion enhances its economic base through expanding current factories and attracting new manufacturers, consistent and high quality occupational medicine will improve productivity and safety. We plan to work with Oaklawn and BCHS to design and deliver exemplary and innovative occupational medicine services.

7. Community-based health and wellness programs: Albion has embraced the concept of "The Smart Community." Smart communities are healthy communities - communities that promote health and wellness. The GAA Health & Wellness Action Team will design and implement a network of volunteers who will work with the community to identify health care needs and improve the general health of the community. Our citizens will be educated in the many ways that they can promote health, monitor each other's health, and make the best choices in the appropriate places for care, should the need arise. Building on the efforts of the GAA-H&WAT, health and wellness programs will be developed for our senior citizens, industrial manufacturers, small businesses, municipal governments, service organizations, and the four major educational entities (Albion Public Schools, Albion College, Kellogg Community College, and Starr Commonwealth). These educational institutions will work to help train the health care volunteers. More citizens will be trained in CPR and EMT procedures, so they can be urgent health care providers to people in Albion. Defibrillators will be located in several places within the community and many citizens will be trained in their use. The clergy of our area churches have volunteered to be the driving force in mobilizing citizens to be proactive in promoting good health. With 42 churches in a community of 9100, along with other active congregations in the surrounding area, this network will have a profound impact on communicating information and inspiring their parishioners to make more healthy life choices.

To reinforce the notion that a ìSmart Community" is a ìHealthy Community," we will place the FQHC in the Downtown District, near the Kalamazoo River. We plan to build a ìPar Course" or ìFitness Course" for citizens to walk along the river and through the main street of downtown, enabling them to pause periodically to do exercises along the way. Furthermore, we will intentionally develop other health-related offices and services in or near downtown. Downtown Albion will become a healthy, environmentally sensitive and aesthetically attractive place for health care services, retail operations, leisure activities including Kids ëN Stuff Childrenís Museum, and economic development. In time, Albion will offer a full array of health services, including the FQHC, urgent care, diagnostics, specialists, Burnham Brook East Senior Center services, Calhoun County Health Department services, home health services, social service agencies, and businesses related to health care.

The Battle Creek Community Foundation (BCCF), W.K. Kellogg Foundation (WKKF), Albion Community Foundation (ACF), Oaklawn Hospital, Battle Creek Health Systems, and the Battle Creek Family Health Center have pledged a total of $1 million to help Albion construct the FQHC, to provide bridge funding for its initial implementation, and to assist with making this Albion Health Care Plan a reality with the goal of having Albion serve as a national model for an innovative community-based health care delivery system. The citizens of Albion are deeply appreciative that BCCF, through its work with the Battle Creek Health Systems has committed $500,000 for construction and site preparation for the FQHC, that Oaklawn and BCHS have committed $250,000 between them for the new facility, and that BCCF, ACF, and WKKF have committed $250,000 for bridge financing and to implement the Albion Health Care Plan.

Finally, the greater Albion community must undergird these community-based efforts with a commitment - even a mandate - that individuals take responsibility for their health, particularly in the areas of diet, exercise, and avoidance of detrimental behaviors like smoking and substance abuse. In the final analysis, Albion "The Smart Community" will also be Albion "The Healthy Community" because the citizens make smart decisions about their health.

NEXT STEPS

1.     Develop a start-up plan for an FQHC or an FQHC Look Alike, with A.J. Jones and the Family Health Center of Battle Creek to open November 1, 2002 or early in 2003.

2.     Pursue long term funding sources including foundations, corporations, and state and federal grants.

3.     Enlist state and national elected officials to advocate on behalf of The Albion Health Care Plan in seeking state and federal support.

4.     Finalize the delivery of cost-effective outpatient diagnostic services in collaboration with Oaklawn Hospital and Battle Creek Health System.

5.     Create a network of effective inpatient options in collaboration with Oaklawn and BCHS, conforming to the principle of patient and physician choice.

6.     Identify areas for specialists and attract specialists to Albion in collaboration with Oaklawn, BCHS, and Foote Health System.

7.     Host a community forum where all the health care providers and community members interested in high quality health care identify key concerns and formulate a strategy to implement The Albion Health Care Plan, including services to special audiences.

8.     Develop a governance model that ensures all seven components of the Albion Health Care Plan are implemented with the appropriate blend of autonomy, self-sufficiency, collaboration, and cooperation.

9.     Assist and empower the GAA Health & Wellness Action Team to design and implement a proactive health and wellness plan, including strategies such as focus group sessions and neighborhood watch meetings.

10. Provide frequent communication on progress, interfacing with the City, RHA, Oaklawn, BCHS, area health care providers, and the citizens of the Greater Albion Area.

11. Assist the area clergy to serve as a primary communications vehicle to inform and inspire our citizens to make better-informed and healthier life decisions.

Greater Albion Alliance Health Care Task Force

Harry Bonner, Executive Director of Minority Program Services; Jane Deane Clark, Sr. Managing Consultant, ViPS Healthcare Technologies; Arthur Davis, Albion City Councilor; William Dobbins, Physician and President, Caster Concepts ; Barbara Gladney, Consultant; Mike Herman, City Manager; Thomas Hunsdorfer, Executive Director, Greater Albion Alliance; Sue Marcos, President & CEO of the Greater Albion Chamber of Commerce ; L.J. McKeown, Chief, Albion Public Safety; Peter Mitchell, President, Albion College; Katherine Padgett, Regional Health Alliance & Co-Chair of the GAA Health and Wellness Action Team; Peggy Sindt, President and CEO of the Economic Development Corporation; William Stouffer, Chair, Albion Machine and Tool Company, Kathleen Williams, Consultant

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