Teton County’s health care providers are ready to tackle the community’s biggest health needs, including alcohol abuse and mental health, with a particular focus on reducing barriers to care.
As part of the Healthy Teton County initiative, the Teton County Health Department and St. John’s Medical Center have released the latest version of the Community Health Improvement Plan. The detailed report is the guiding document for the future of health care in the county, and it reveals how enmeshed the hospital, nonprofits and agencies are, as well as how much social determinants of health affect access to care.
“What we’re trying to do with this is raise awareness that we can’t fix anything in isolation,” said Julia Heemstra, director of the hospital’s wellness department.
Heemstra partnered with Health Department Director Jodie Pond to author the report, which is an update of the 2015 Community Health Improvement Plan. Under regulations put in place by the Affordable Care Act, community hospitals are bound to collaborate with public health agencies to create such plans every three years.
As the first of its kind, the 2015 report drew on the Community Health Needs Assessment, which set the baseline for many of the health indicators used to create the action plans. The same goes for the 2018 version that was just released. A second needs assessment was conducted to determine the sectors of community health that improved, those that needed more work and health risks that emerged since the initial report.
Taking note of success
One of the highlights in the updated needs assessment was the work the Health Department has done on radon awareness. Radon is a carcinogenic radioactive gas emitted through the natural breakdown of uranium in rocks and soil. It has no smell or color, so homeowners may not be aware it’s in their house. Teton County is a Zone I Radon area, according to the Environmental Protection Agency, which means it has the highest potential for radon to be found in homes, and 41.2% of homes tested in the county show elevated levels above 4 picocuries per liter, the EPA’s safety threshold.
“We’ve seen hundreds and hundreds of people test their homes on an annual basis,” Pond said. “And we make sure we follow up with folks who had high levels.”
Creating the infrastructure to encourage more people to test their homes involved outreach to homeowners, selling kits at the Health Department and working with real estate agents to test homes as they are sold. The department also worked with mitigators and homeowners to ensure high test results led to upgrades.
Success on the radon front allowed new issues to rise to the top of the list, namely mental health, alcohol use, and sexual and reproductive health. The Community Health Improvement Plan includes an action plan for each of the identified sectors, and it specifies agencies or entities responsible for the work.
Putting it into action
Each action — such as providing a sliding cost scale at the Jackson Hole Community Counseling Center — falls under a primary goal, like reducing cost as a barrier for mental health treatment. For each action the improvement plan includes a timeline for implementation and the responsible entity.
The counseling center is the lead agency for much of the mental health action plan. Much of its work is implemented, such as maintaining a 24-hour hotline, working with Teton County School District No. 1 to help students who are having mental health issues and publicizing mental health services.
In the case of sexual and reproductive health, the Health Department is the lead on every action. For both entities, many of the actions have already been implemented and will be maintained at current levels.
However, simply because an action may already be implemented doesn’t mean the Health Department’s work is done. It continues to offer low-cost sexually transmitted infection testing and reproductive and sexual health care from midlevel providers at its clinic.
“A lot of time people don’t know that when you start doing outreach like media campaigns or sending out flyers,” Pond said, “you’re going to see more people come in to get tested, then you might see more instances of chlamydia,” for example.
Health care isn’t just clinical
Woven into the action plans, which can be found attached to this story at JHNewsAndGuide.com, is an understanding that socioeconomic and cultural factors, known as the social determinants of health, must be addressed as part of combating any individual community health risk.
The top three in Teton County are “severe housing,” — defined as a household that lacks complete plumbing, has more than 1.5 people per room or has monthly costs exceeding 50% of income — access to care and food insecurity.
Improving the social determinants of health across the community can have significant impacts on overall health, since 40% of people’s health depends on socioeconomic factors, 30% on their health behaviors and 10% on the physical environment, according to the Centers for Disease Control and Prevention.
With clinical care comprising just 20% of the factors that affect people’s health, social determinants represent an opportunity to effect change. Movement on something like severe housing may take years, but the Health Department has seen its work with other agencies and nonprofits have some effect since the 2015 study.
“We act as conveners to get people working on food insecurity to come up with action items so they can move in the same direction,” Pond said. “The food insecurity rate was 13.5%; now it’s 12%.”
An incremental decrease in the food insecurity rate may not seem like much, but that shift allows some families who in the past may have chosen to buy groceries rather than go to the doctor to focus on their health. Improvement in areas like radon mitigation and food insecurity allows more resources to be devoted to problems like mental health and alcohol abuse, or the third crucial social determinant of health: access to care.
In the 2015 study, access to health services was the No. 1 issue. One of the primary goals in the 2015 plan was to lower the uninsured rate in Teton County. Using data from 2011, the report set 23% as the baseline uninsured rate and 0% as the target rate by 2020. In the 2018 iteration, lowering the uninsured rate is still a goal, but with 11% to 12% in the county without coverage, resources could be allocated elsewhere.
The drop in the uninsured rate is evidence of the success of St. John’s navigator services, Heemstra said. Navigators help people wade through the morass of the private health insurance world and the Affordable Care Act to find the plan that best suits them. The hospital has three navigators on staff, hospital board Trustee Joe Albright is also one, and half are bilingual. Heemstra said the hospital hopes to add two more this year.
Refining the focus on reducing the uninsured rate shows the importance of reassessing the community’s health needs every three years. The process reveals which programs are working and which areas need more resources, giving health care professionals a barometer for their work and providing reassurance that their efforts are successful.
“It’s affirming of the work we’ve been doing,” Heemstra said. “There’s certainly a lot more work for us to do, but every iteration really underscores our commitment to these issues.”