| Name | Jennifer |
|---|---|
| Last Name | Nicely |
| Home Address | 825 Mount Vernon Ave Chattanooga, TN 37405 United States |
| Organization Name | CHI Memorial Foundation |
| Describe Your Role In The Organization | President of CHI Memorial Foundation |
| Organization Address | 2525 de Sales Ave Chattanooga, TN 37404 United States |
| Website | https://memorial.org/foundation |
| Best Phone Number To Reach You | 423.495.4141 |
| Alternate Phone Number | 423.495.4438 |
| Email Address | jennifer_nicely@memorial.org |
| Alternate Email Address | jeremy.riley@memorial.org |
| Please Describe Your Project In Detail | The COVID-19 pandemic has highlighted the existence and impact of health disparities within greater Chattanooga and throughout our Nation. One of the most troubling health disparities is inadequate access to high quality primary care services in socioeconomically disadvantaged communities including minority communities. The United States Department of Health and Human Services has identified a lack of access to primary care services as a Social Determinant of Health (i.e., an environmental condition that an individual is subjected to that can affect a large array of quality-of-life outcomes). Given its focus on preventative care, screening, and chronic disease management, appropriate use of primary care services often results in improvements in overall health status and lessen differences in health outcomes across major patient populations. Further, it has been shown that access to and the regular use of primary care services has been demonstrated to reduce the incidence of avoidable illness and premature death in patient populations.* There is significant evidence that improving underserved populations’ access to evidence-based primary care services will help lessen some of the most critical outcomes associated with health disparities (i.e. patient morbidity and mortality). While the importance of primary care is clear, a shortage of primary care providers exists throughout the country. According to a 2021 report by the Association of American Medical Colleges, the projected shortfall of primary care physicians will range between 17,800 and 48,000 by 2034. Evidence of this shortage includes median wait times for the next available primary care appointment extending out to over 10 days.** In addition to a general shortage of primary care providers, the COVID-19 pandemic has raised unique barriers for those looking to see the providers that are located in their community. It has been documented that primary care visits have declined by more than 21.4% during the second quarter of 2020 as compared to previous years even when the increased adoption of telehealth appointments is taken into account.*** CHI Memorial’s proposal to purchase, outfit and deploy a Primary Care Mobile Coach throughout greater Chattanooga is an attempt to proactively address our area’s primary care provider shortage in a manner that will also begin to erode a critical health disparity that exists in the communities that CHI Memorial serves. Hamilton County is designated as a “Low Income Population Health Professional Shortage Area (HPSA),” in which a shortage of primary care physicians has been documented to exist. As an investment in public health, the proposed Mobile Primary Care Coach will enable effective outreach, screening, and treatment to the people living in communities that have been disproportionately impacted by the COVID-19 pandemic. CHI Memorial intends to collaborate with community partners to ensure that both its Primary Care Mobile Coach has a consistent presence in Chattanooga's underserved neighborhoods and that the vulnerable, uninsured, and underserved individuals residing in these communities are encouraged to take advantage of the services being offered. A mobile coach will utilize a trained nurse practitioner (NP), registered nurse (RN), a driver, and program coordinator to implement this new program in Chattanooga. While this is a new program, the mobile primary care coach will not operate in a vacuum, instead it will follow proven outreach efforts of the hospital. One such program that created this innovative environment was CHI Memorial’s mobile breast health coach. These mobile coaches allowed for the provision of breast cancer screenings for women across three states. Many of these recipients might not otherwise have received a mammogram due to lack of insurance, accessibility, affordability, or some other barrier to care such as lack of transportation. Since 2005, the 40-foot vans travel thousands of miles each year so that more women can receive high-quality, essential breast cancer screenings. Due to the demand of services, the mobile breast coaches have seen an overall patient volume of 2,864 unique patients through the previous year. Similarly, the Breathe Easy mobile lung screening program serves at-risk patients in the region through a low-dose CT lung screening program. With a lung screening program that served more than 2,603 individuals in 2020, the mobile lung screening program served a large portion of individuals with 1,034 unique patients. The low-dose CT scans are offered to all patients with subsequent treatments provided regardless of insurance status. A mobile primary care coach will operate effectively within this established paradigm, with operation occurring in Fiscal Year 2023. The two-year startup cost will entail the purchase and equipping of a mobile health coach that will be the centerpiece of the new program. The coach will cost an approximate $700,000 with $6,000 in fuel and $1,200 in maintenance costs annually. Staffing will cost approximately $250,000 on an annual basis for the NP, RN, program coordinator, and driver with an additional $150,000 to secure storage of the vehicle. Overall, the estimated start-up cost of the program will be $1.36 million. We request the full two-year start-up cost of $1.36 million in grant funding to establish this innovative program to serve the community. Additional sustaining funding will be secured to maintain operational costs. In the initial year of operation, CHI Memorial will secure the mobile coach and outfit it for the proposed program. As the construction takes place on the coach, the necessary individuals will be hired and assigned to the program. The education and outreach coordinator will be instrumental in creating a schedule for the mobile coaches operation, initially utilizing the contacts and relationships cultivated by the other two mobile programs. The coordinator will secure spots at health fairs, community festivals, religious organizations, and communal gathering points. The appropriately licensed driver will be hired to take the coach to the necessary locations while the NP will provide the medical care for the individuals seen. As a mobile primary care provider within CHI Memorial, the NP will be able to seamlessly refer patients for follow-up appointments with specialists within the CHI Memorial Medical Group, thus ensuring warm handoffs for patients in need. It is important to note that charity care will be utilized as appropriate with the potential patient demographic. The second year of operation will begin to see greater potential in terms of outreach and integration within the community, as the team will have had at least two quarters of operation. The mobile coach will be able to further refine the appropriate demographic for this service over year two and make further inroads into underserved communities through CHI Memorial’s Community Benefits and Diversity department. Additionally, CHI Memorial will utilize Spanish-speaking staff when Spanish-speaking members of Chattanooga are present for medical appointments. Utilizing the vast network of specialty physicians, the mobile clinic can provide warm handoffs to trained geriatric, mental health, pediatric, infectious disease, and other medical service lines. It is also important to note that the NP will be able to assess and refer patients experiencing mental health or substance use related conditions. It has been estimated by the National Alliance on Mental Health (NAMI) that one in five adults experience mental illness each year. This trend has only been exacerbated through the course of the COVID-19 Pandemic with more than half of Americans reporting its negative impact on their mental health. NAMI also reported that Tennesseans struggle to get the help they need, with approximately 39% of adults who did not receive needed mental health care did so because of the cost associated with treatment. With a dramatic shortage of mental health professionals both in Tennessee and throughout the country, mental health care needs to be prioritized for the well-being of those who neither prioritize it nor have adequate health insurance to cover the out-of-pocket cost. The mental health focused Arts Therapies & Well-Being Program at CHI Memorial has the potential to be integrated into the mobile clinic, adding an evidence-based mental health service component to the innovative project. In addition to the potential for addressing mental health-related issues, this platform can also incorporate rotations of medical students and train the future healthcare practitioners of Chattanooga. This includes furthering the opportunity with CHI Memorial’s recent partnership with Morehouse School of Medicine (MSM). With a 10-year commitment to train residents from MSM at CHI Memorial, students from this historically Black medical school in Atlanta can potentially work in the mobile unit to explore this medical outreach within the diverse city. As the greater Chattanooga area’s nonprofit hospital system, CHI Memorial cares for the uninsured, underinsured, and low-income patients of the greater Chattanooga area regardless of their financial means. In 2020, CHI Memorial served more than 21,978 vulnerable people at the inpatient and outpatient facilities of the hospital. As the 2021 federal poverty level benchmark for a household of four is less than $26,500, it is estimated that 22.7% of households within CHI Memorial service area are below this poverty threshold with approximately 33% of total patients residing within ZIP codes that have a high poverty rate. In addition to this poverty rate, CHI Memorial sees a large percentage of Medicare beneficiaries, demonstrating the high volume of care given to this vulnerable demographic. An investment in this proposal will meet the needs of the often overlooked segments of Chattanooga residents. The Mobile Primary Care Coach directly addresses the negative impact of the pandemic on preventative health care. Following in the path of CHI Memorial’s successful mobile programs, providing primary care is a natural extension of the healing work of the hospital. Grant funding will allow for the launch of a program that will be easily adaptable to the future course of the pandemic and will maximize the long-term benefit of Chattanooga residents. * Starfield, Barbara et al. “Contribution of primary care to health systems and health.” The Milbank quarterly vol. 83,3 (2005): 457-502. doi:10.1111/j.1468-0009.2005.00409.x ** Kyle, Michael Anne et al. “Primary Care Access During the COVID-19 Pandemic: a Simulated Patient Study.” Journal of general internal medicine vol. 36,12 (2021): 3766-3771. doi:10.1007/s11606-021-06804-7 *** Alexander GC, et al. JAMA Netw Open. 2020;doi:10.1001/jamanetworkopen.2020.21476. |
| Please explain how your project meets the requirements of the American Rescue Plan | According to the interim final rules set by the U.S. Department of the Treasury, CHI Memorial’s Mobile Primary Care Coach will provide for the medical well-being of patients through the prevention, treatment, and recovery of underserved individuals in Chattanooga. Equipping a mobile clinic with necessary COVID-19 prevention measures will better assist the care of vulnerable individuals through the reduction of health disparities. Hamilton County is a designated “Low Income Population HPSA” by HRSA, and a safe, effective mobile service will allow a clinic to operate with minimal overhead in identified locations throughout the city. As a not-for-profit facility, CHI Memorial is committed to providing the highest quality of care for both uninsured and underinsured patients, covering expenses for patients as needed. A mobile clinic will allow for trained medical staff to attend to the needs of individuals who live in congregant settings, including elderly, homeless, and intergenerational households. Providing annual routine check ups for residents will ensure optimal health levels through the identification of unmet health concerns. Given the disproportionate impact of COVID-19 within underserved communities, a mobile clinic will reach this population in unique ways. An attending NP on the coach will be able to provide referrals for follow-up care including substance use treatment and prevention, mental health therapies, and other behavioral health related concerns. The mobile clinic model has had a proven track record of success at CHI Memorial and we are confident this new program will see similar results to meet the health needs of the most vulnerable in our community. |
| Where would your project take place? | Given the nature of CHI Memorial’s Mobile Primary Care Coach, the project would be utilized throughout the city with a particular emphasis on identified underserved and vulnerable communities. CHI Memorial is able to utilize data provided through Health and Human Resources and CommonSpirit Health’s Policy Map to identify areas of unmet need. Through the guidance of a program coordinator, appointments will be established in these identified locations. This new project will follow in the same successful path of CHI Memorial’s Breathe Easy Mobile Lung Screening Program and the MaryEllen Locher Mobile Health Coaches. Currently, these sister programs perform health screenings for residents of Chattanooga through providing high quality screenings at several high visibility locations within the city. These include, Homeless Healthcare of Chattanooga, Chattanooga Housing Authority, Boynton Towers, YMCA sites, and at local churches and community centers. Please note the hospital also accepts the burden of caring for that patient if there is a need to provide follow-up care for all uninsured or underinsured patients we screen. The beauty of this model is that the care providers can shift their operations with demand, taking health and healing beyond the walls of the hospitals into the general community. |
| How much will your project cost in total? | 136300 |
| Do you have any matching funding sources from other local governments, private entities, non-profits, or philanthropic entities for your project? | No |
| Please describe the source and list amounts of any other funding. | |
| What portion of the project are you asking the city to fund? | |
| If funded, when would your project start? | July 1, 2022 |
| How long would your project take to complete? | Full implementation by 6/30/2024 |
| What milestones would you use to measure your project’s progress? | Benchmarks for success will be the following Year one: Fiscal Year 2023 Quarter 1: ● Funding Secured ● Hiring of Staff Begins ● Mobile Coach Construction Begins Quarter 2: ● Community Engagement Campaign is developed ● Education and Outreach Coordinator Hired ● Driver Hired ● NP Hired ● RN Hired Quarter 3: ● Mobile Coach Arrives ● Community Engagement Campaign Begins ● Program Begins Quarter 4: ● Year 1 outcome analysis and reporting Year 2: Fiscal Year 2024 Quarter 1 ● Community Engagement Campaign Efforts Continue ● Screening Programs Continue Quarter 2 ● Marketing Campaign Efforts Continue ● Screening Programs Continue Quarter 3 ● Marketing Campaign Efforts Continue ● Screening Programs Continue Quarter 4 ● Community Engagement Campaign Efforts Continue ● Screening Programs Continue ● Year 2 Outcomes Analysis & Reporting |
| How would you ensure accountability and transparency throughout the project lifecycle? | CHI Memorial is governed by a Board of Directors. The board is composed of community members and stakeholders who ensure the proper use of funding and the programmatic offerings of CHI Memorial. Board members review and approve financials in addition to their active engagement with operations. |
| If successful, how would your project benefit the community? | CHI Memorial seeks to utilize this project to overcome health inequities and further the social determinants of health (SDOH) in Chattanooga’s underserved communities. According to the Department of Health and Human Services, “SDOH are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” Health care access and quality is one of the five pillars of SDOH. With the identified need of bridging health disparities through overcoming health inequities by the Chattanooga Chamber Foundation, a Mobile Primary Care Coach will certainly go a tremendous way to undo inequity. Health disparities transpire across status, age, geography, language, gender, disability status, and sexual identity. The proposed program holds the potential to perform significant outreach efforts within these above communities. According to the 2013 and 2017 American Community Survey data from the U.S. Bureau of Census, Chattanooga is growing rapidly with a 68% rate of growth for foreign-born residents in Chattanooga from 2013-2017. With the potential to surpass Knoxville and become the third largest city in Tennessee, Chattanooga will become a larger, more diverse city over the ensuing decade. According to The Business Journals, Chattanooga is also ranked as the 12th of the nation’s top 100 markets for economic inequality. Clearly, more needs to be done to benefit the community. CHI Memorial’s two mobile programs have a proven benchmark on deliverables within the broader community. The Breathe Easy program provided nearly half of all lung cancer screenings for CHI Memorial through mobile offerings throughout the region in 2020. The mobile mammography team provided over 2,800 screenings over the similar timeframe. This second program not only cares for local residents, but it has also contracted with the state in order to offer mammography screenings for the incarcerated. Funding provided will allow CHI Memorial’s Mobile Primary Care Coach to similarly meet unmet needs through offering primary care medicine to homeless, at-risk, underserved, and marginalized populations in Chattanooga. The program will demonstrate its effectiveness through the number of people treated, events scheduled, and ensuing medical metrics listed previously. The CHI Memorial Mobile Primary Care Coach will be evaluated in the following metrics: ● Number of people treated ● Number of people with incidental findings receiving appropriate follow-up care and referrals ● Leveraging advocacy efforts to secure funding to from public and private funders to expand program after year two ● Number of visitors and engagement on website landing page and utilization of project resources ● Number of scheduled events ● Number of neighborhoods/communities served ● Number of people empaneled with a primary care physician (PCP) ● Number of care gaps identified ● Number of open care gaps addressed (e.g. mammograms) ● Number of chronic conditions identified (e.g. HTN, COPD) ● Number of people referred to a SPC (non-behavioral health) ● Number of people referred to a behavioral health provider ● Number of social determinants documented ● Number of social determinants addressed |
| How will you attract community buy-in for your project? | CHI Memorial performs a Community Health Needs Assessment (CHNA) every three years in order to define priorities for health improvement, create a collaborative community environment to engage stakeholders, and further an open and transparent process to listen and truly understand the health needs of the community served by CHI Memorial. Through this process, CHI Memorial engages local community stakeholders to gather information to plan the trajectory of health care services in Chattanooga. Memorial works with community stakeholders and local organizations in order to create smooth transitions for all patients, ensuring warm referrals for patients. Local community stakeholders that will be key for this project will include: local schools, YMCA, the AIM Center, Chattanooga Public Library, Family Justice Center, Boynton Towers, Homeless Healthcare of Chattanooga, Chattanooga Area Food Bank, and local behavioral health providers. CHI Memorial’s Community Benefits and Diversity Manager Nicole Brown will continue to cultivate new relationships with community stakeholders that might work well within the framework of this project. |
| Name | Jeremy Riley |
| Contact Information | jeremy.riley@commonspirit.org |
| Name | Nicole Brown |
| Contact Information | Nicole.Brown516@CommonSpirit.org |
| Name | Brittany Hennessee |
| Contact Information | brittany.hennessee@commonspirit.org |
| Name | John Redding |
| Contact Information | john.redding@commonspirit.org |
| Is there anything else you would like us to know about your project? | CHI Memorial is committed to furthering this project through its continuation after two years of funding support. CHI Memorial Foundation will secure additional funding to help offset costs as the hospital will provide for the operational needs. |