Working and Educating Lifestyles for Living in Lansing, Michigan WELL Center Working and Educating Lifestyles for Living in Lansing, Michigan Lansing, Michigan Rebecca Dick, Julie Erickson, Amber Goetz, Marijo Johnson, John Richardson Ferris State University – Organizational Strategic Plan Project

Mission Statement To provide education, preventative and wellness services to community members including the underserved to achieve optimal health of community and conserve medical resources by providing continuity of care and preventing hospital readmissions.

Philosophy WELL Center: Working and Educating Lifestyles for Living The WELL Center is committed to providing services to all community members with dignity and respect. The philosophy is based on Relationship Based Care, identifying that building trusting relationships with patients and families will assist in developing individual plans of care while eliminating barriers to improved optimal wellness and prevent rehospitalizations.

WELL Center Patients We Believe: Access to care is critical regardless of income or ability to pay All patients deserve to be treated with dignity and respect Patients and families need to be active participants in identifying health care needs and developing a plan of care

WELL Center Nurses We Believe: Education and prevention is key to maintaining wellness and preventing rehospitalizations. Building relationships with patients and families assists in identifying barriers and will increase compliance, improve optimal wellness and prevent rehospitalizations. Holistic nursing care encompassing mind, body and soul.

WELL Center Nursing Practice We Believe: Nurses can provide education and preventative services using evidence based practice to improve the health of the community. Nurses can build relationships with patients and families to identify individual barriers and develop plans to achieve optimal wellness. ------------------------------------------------------------------------------------- Services provided will be based on evidence based practice. Services provided will be within the scope of nursing practice and ethical guidelines. Nurses will collaborate with community providers and the medical director as needed to ensure appropriate services are provided.

Lansing, Michigan Health Data As the capital city of Michigan, Lansing’s population of 114,000 is served by 90 physicians per 100,000 population and 100 specialty physicians per 100,000 population (Tu, Ha, et al., 2011). This population is served by two hospitals, Edward W. Sparrow Hospital and Ingham Regional Medical Center

Lansing Michigan Health Data Data from the Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, 2008 was reviewed to gain an understanding of the health status of Lansing. The percentage of obesity in the Lansing population was 58.9%. Adult smokers made up 18.9% of the population. Those who reported themselves to be in fair or poor health status were 10.9%. Chronic conditions identified were asthma at 12.4% of the population, diabetes at 6.4% and angina or coronary heart disease at 3.9% of the population (Tu, Ha, et al., 2011).

United States Health Data The center for Medicare and Medicaid Services states that in 2009 almost 18% of patients were readmitted within 30 days of hospital discharge with 13% of those were potentially avoidable (Atlantic Information Systems, 2008). Quality improvement initiatives to prevent hospital readmissions for chronic conditions such as asthma, diabetes and heart disease will help to increase the quality of health care delivered, increase patient safety and save valuable healthcare dollars (Atlantic Information Systems, 2008).

WELL Center Commitment Providing holistic care for prevention of hospital readmissions requires an interdisciplinary team approach within the acute care setting as well as the outpatient care setting. The WELL Center is actively committed to participate with Lansing’s healthcare providers to reduce hospital readmissions by 5% in providing optimal wellness for patients and ensuring appropriate allocation of health care resources.

WELL Center Staff The WELL Center clinic will be staffed with a mix of qualified personnel. This will include nurse practitioners (NP), bachelor prepared registered nurses (RN), medical assistants (MA), a secretary/scheduler and a billing/coding expert. The WELL Center director will answer to a voluntary Board of Trustees appointed by the city council.

WELL Center Staff Organizational Chart Board of Trustees Case Manager/ RN Medical Assistants Receptionist Biller/Coder Medical Director Nurse Practioners WELL Center Director

Monday, Wednesday and Friday 8am – 5pm Tuesday and Thursday 11am – 8pm Hours of Operation Monday, Wednesday and Friday 8am – 5pm Tuesday and Thursday 11am – 8pm During the Hours of operation one NP, one RN, two MAs and a secretary/scheduler will be present. The coder/biller will be present during the schedule as the work load allows assisting in covering the desk if needed.

Funding The WELL Clinic has three basic sources of funding: Private pay/co-payments, insurance reimbursements and grants. As an innovator in reducing the readmission to hospitals for our patient population we have three generous grants one from the City of Lansing for $50,000 annually, another from the United States Government through its community health center –section 330e program (Taylor) and the third from the common wealth fund matching the two government grants under their delivery system innovation and improvement grant program (The commonwealth).

Sources of Reimbursement Budget The WELL clinic’s total annual budget is $470,000 in reimbursements with total annual expenditures of $469,998. A two month cash budget is maintained at all times for the daily operational expenses. Sources of Reimbursement Health Insurance $243,000 Grants $200,000 Co-pays $27,000 Total $470,000

Annual Staffing Budget Position Full Time Equivalency Cost Nurse Practitioner 1.5 $115,241 Registered Nurse 1.5 $81,788 Medical Assistant 2.6 $93,675 Secretary 1 $26,484 Billing/Coding 0.5 $17,810 Total $334,998

Annual Expenditures Staffing $334,998 Medical Supplies $36,000 Training/Education/Orientation $20,000 Office Supplies $12,000 Insurance $12,000 Rent $30,000 Utilities $4,800 Cleaning $5,200 Capital expenditures $15,000 Total $469,998

Summary Proper allocation of financial resources combined with quality outcomes for complete and comprehensive care of patients in the Lansing area is congruent with the goals and objectives of the WELL Center clinic. We are excited and committed to this adventure and it is our hope that you support and join us in this venture.

References Tu, Ha, Anglin, Grace, Felland, Laurie E., Grossmand, Joy M., & Stark, Lucy B. Lansing's dominate hospital, health plan strengthen market positions. (2011, March). In Center for studying health system change. Retrieved from http://www.hschange.org/CONTENT/1194/ The common wealth fund. (2011). Delivery system innovation and improvement. Retrieved from http://www.commonwealthfund.org/Program-Areas/Delivery-System-Innovation-and-Improvement.aspx Taylor, J. (2004, August 24). The fundamentals of community centers. Retrieved from http://www.nhpf.org/library/background-papers/BP_CHC_08-31-04.pdf Atlantic Information Systems Inc. CMS targets readmission through payment, audits; ‘coaching’ model reduces rates. (June 30, 2008). 17(24). Retrieved from: http://www.cfmc.org/files/rmc063008.pdf