2003 Model Practice Application (Public)

Healthy Futures

Benzie-Leelanau District Health Department

Healthy Futures is a program that seeks to ensure that every mother-to-be and every child under the age of two has everything needed for a healthy beginning. Healthy Futures is a partnership program between Munson Healthcare, local health departments, and health care providers in northwest lower Michigan. Healthy Futures offers enrolled families support from a registered public health nurse through home visits and phone calls. In addition, families receive Healthy Futures newsletters filled with parenting and prevention information. Healthy Futures was started in the spring of 1998 and has over 2,400 active enrollees. Over 6,500 pregnant women and children have been served to date. Currently, over 50 percent of all births at Munson Medical Center enroll in the program. Additionally, nearly, 65 percent of first time births enroll in the program.

Healthy Futures planning and program development began following the release of 1995 Northern Michigan Community Health Assessment Survey data. The phone survey was conducted in 21 northern Michigan counties and assessed health behaviors of the residents. It revealed that over 10 percent had no health insurance and an even greater number lacked access to a primary care provider. Specifically, the population of families with children from conception to age two was of concern because the need for quality health care for this age group is substantial.

To address the disparities, the major hospital system, local health departments. and health care providers came together and planned the Healthy Futures program. This program was designed to ensure that any pregnant or parenting family would have access to a registered nurse who would help coordinate their health care and ensure that each family had access to primary health care and preventative community resources. The program is innovative because it melds three models of care—public health, institutional, and medical. These three entities had to truly integrate resources to make this program work. Currently, the local hospital system employs the program coordinator and data management staff. The local health department employs the registered nurses. The health care providers make referrals and promote the program in their offices and in the community.

The local health department brought a wealth of knowledge of public health nursing to the planning table. The local hospital system and health care providers understood the need 1) for families to receive insurance application assistance, 2) for families to have access to community resources, and 3) for health promotion and education. Yet, they lacked the knowledge and means to provide those services to families. Local public health was able to offer expertise in this area to ensure that all families regardless of income and health status would have appropriate access to health care. The local hospital and health care providers saw firsthand the problems that result from lack of access to care: missed appointments, women presenting with little to no prenatal care, and families with needs for resources that could not be addressed within the scope of a doctor’s office. Their involvement was essential to understanding the full impact of access-to-care problems, such as poor health outcomes, health care dollars spent on treatment rather than prevention, and fragmented care for families with multiple needs. Collaboration evolved over the years. Today, the collaboration and partnering seem much easier because the partners know and trust each other. Staff feel comfortable and confident in sharing views even though they may not always agree. As in all relationships, communication, compromise, and maturing over time strengthen the partnership.

Total program cost is approximately $400,000 per year. Of that amount, $200,000 is provided from local health departments through Federal MCH block grant funding and local school-based funding. The hospital partner contributes the remaining $200,000. Program costs include the following: staff costs for approximately 3.0 FTEs of public health nurses, 0.7 FTE for the program coordinator, and 1.0 FTE for data management. Additional costs include Healthy Futures newsletter mailings (over 12,000 mailings per year), the unmet health care needs fund, and indirect administrative costs. In addition, the program used over 1,000 hours of volunteer time in the Central Access office to help with basic office operations.

Impact has been measured through client satisfaction surveys that have been conducted over the last year with a 31% response rate. The survey has questioned client satisfaction in several areas that include Healthy Futures newsletter, home visit, phone call, public nurse and overall program satisfaction. Questions were based on a 1 (very poor) to 5 (very good) scale.

• Newsletter: Up to 95% rated the newsletter as good to very good.
  
  
• Home visit: Up to 91% rated the home visit as good to very good.
  
  
• Phone calls (for families with children between the ages of 0-6 months): Up to 62% rated these as good to very good.
  
  
• Phone calls (for families with children between the ages of 6-24 months): Up to 72% rated these as good to very good.
  
  
• Healthy Futures Nurse: Up to 95% rated their nurse as good to very good.

The following summarizes programmatic data collected:

Nurse Services included over 600 home visits and nearly 4,000 phone calls to enrolled families.

Over 4,000 facilitated referrals. Of those referrals, over 200 were made to assist families in accessing health care coverage. Top resources referred to include Nutrition Services/WIC, Immunization Services, Maternal Support Services and health care insurance.

The Healthy Futures program has been in existence for over five years. With the ever-changing health care environment, a changing state and federal budget, a nursing shortage, and health status indicators that continue to show access to care as an ongoing issue for families, Healthy Futures wants to be proactive in assuring that the program can continue to provide quality service to families. The program staff also want the program to be efficient and cost-effective. Program staff efforts are currently focused on understanding the data gathered through client satisfaction surveys and collected by the public health nurses. Currently, the data is being used to refine the Healthy Futures program model of care coordination. As a result, a new model of Healthy Futures will be launched in the summer of 2003. The mission remains the same but there are changes in how the service is provided. The program is limiting the phone call educational efforts and strengthening the home visit component. Program staff are developing three main target areas (breastfeeding, access to care, and immunizations) with measurable objectives so they can do a better job of evaluating the work.

In order to replicate the Healthy Futures program in other communities:

• A community assessment should be conducted to determine a need for services.
  
  
• The partners must be willing. The partnership between the hospital, health department, and health care provider is unique and in order to work, it needs commitment and focused attention.
  
  
• Pooled funding is essential. Pooling financial resources can allow for the planning group to be creative and flexible.
  
  
• Partners have to be willing to commit staff time, because it takes a tremendous amount of time to launch and sustain any program.