2019-2021 Community Benefits Action Plan...Wellness Coalition, Capital Area Public Health Network...

2019-2021 Community Benefits Action Plan

*Investment previously recorded.

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Service / Initiative Populations Served Investment Other Community

Resources

1. Access to Affordable

Health Care

A. Chronic disease

prevention and care

B. Access to financial

information or

resources to make

care (including

prescription

medications) more

affordable

• Population Health Planning

• Center for Health Promotion

• Cardiac Care

• Payson Center for Cancer Care

• Diabetes

• Pulmonary Medicine

• Breast Care Center Genetic

Testing

• COPD Collaborative

• Smart Heart Meal Program

• Financial and Prescription

Assistance

• Downtown Clinic Counseling

• Price transparency

• Concord Hospital website

• Emergency Prescription

Vouchers

• Charitable Care (Hospital, CHMG

practices, Family Health Center)

• Family Health Center

• All

• All

• All; low income

• All

• All

• All; low income

• All; low income

• All

• Low income; elderly

• Low income

• Low income; refugee; elders

• Low income; all

• All

• Low income

• Low income; refugee


*

*

• $430,000

*

• $400,000

• $10,000

• $60,000

*

*

• $600,000

*

*

• $375,000

• $15,000

• $4,500,000

• $9,000,000

• Concord Regional Visiting

Nurse Association (CRVNA)

224-4093

o Home care

o Hospice

o Palliative care

o Better Choices, Better Health

• Concord Human Services

225-8575

• CRVNA

o Walk-in-Wednesday

o MSW for home care and

hospice

• 211 New Hampshire

2-1-1 or 211nh.org

• New Hampshire Insurance

Department

Coveringnewhampshire.org

• Granite United Way VITA

Program

2-1-1 or NHTaxHelp.org



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Resources

C. Improved access to

medical care,

including: shorter

wait times and

improved

transportation

D. Improved access to

dental care

• Walk-In Urgent Care

• Primary Care Development Plan


• Primary Care Subsidy

• Programs of the Family Medicine

Residency (Downtown Clinic and

Frail Elder Program)

• Physician Referral Line

• Navigating Forward Fund

• Family Health Center Planning

• Investigate Telehealth

opportunities

• Family Health Center Dental

Clinic

• Day Surgery Pediatric Dental

Care

• Emergency Dental Support


• All


• All

• Low income; refugee; elders

• All

• Low income



• All

• Low income

*

*

*

• $12,000,000

*

• $35,000

• $50,000

*

*

• $900,000

• $600,000

• $20,000

• CRVNA

o Senior Health Clinics

o Flu Clinics

o Immunization Clinic

o Home care, hospice,

palliative care

o Remote monitoring

• Regional Public Health Network

271-5194

o School-based flu clinics

• Concord Area Transit

225-1989

• American Cancer Society Road

to Recovery

800-227-2345

• Community Action Program

223-3319

• Mid-state Regional

Coordinating Council for

Community Transportation

225-3295

• NH Medicaid Transportation

271-3770

• Boys & Girls Club & Delta

Dental Onsite Dental Care

224-1061

• NH Oral Health Program

271-4568



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Resources

E. Integrated mental

health and

medical/physical

care

F. Need for more

integration, care

coordination,

navigation and

• Behaviorists in Primary Care

Practices

• Safety Huddles

• Medical Psychiatric Rounding

• IDN 1115 Waiver

• Behaviorist in Pelvic Medicine

• Behaviorists in Cancer and

Cardiac Care

• Tuition Assistance for Health

Education and Wellness

Programs

• Medical Home Navigation

• All

• All

• All; low income; youth

• All; low income; youth

• All

• All

• Low income

• Elders; those with chronic

conditions

*

*

*

*

*

*

• $7,000

• $2,600,000

• NH Smiles Program

271-4344

• Women, Infants and Children

(WIC)

271-4546

• Saving People’s Smile

219-0770

• NH Oral Health Coalition

415-5550

• NHTI Dental Hygiene Clinic

230-4023

• CRVNA

o Behavioral Health

Program in Home Care

• Riverbend Community Mental

Health

226-0817

o Integrated Services

• CRVNA and Riverbend

o 1115 Waiver. Delivery

System Reform Incentive

Payment Program

• CRVNA



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Resources

education

• REACH Health Offerings

Newsletter

• Business Partners in Health

initiative

• All

• All; low income

• $40,000

• $8,580

o Community Health

Educators (CHE)

o Transitional Care Nurses

(TCN)

• Servicelink Merrimack County

228-6625

• 2-1-1 New Hampshire

2. Mental Health and

Substance Misuse

A. Prevention,

screening, and

early intervention

efforts

• Family Health Center Integrative

Behavioral Health Care

Management

• Postpartum depression program

• Family Health Center Behavioral

Health Program

• Behavioral Health Doctoral

interns to support Concord and

Hillsboro-Deering Family Health

Centers

• 5 West: A Voluntary Adult

Inpatient Unit

• Behaviorist in Pelvic Medicine

• Electroconvulsive Therapy

Program (ECT):

• Consultation Liaison Services

• Riverbend Community Mental

Health contract for Emergency

Department Service

• Code BERT (Behavioral


• All


• All; low income

• All

• All

• All

• All

• All

• All

• $910,000

• $90,000

• $310,000

*

• $7,700,000

• $50,000

*

*

• $900,000

*

• Riverbend

o Community Support

Program

• Bicentennial Square Counseling

Services

226-1976

• Bureau of Behavioral Health

Suicide Hotline

800-273-8255

• National Alliance on Mental

Illness New Hampshire

800-242-6264

• Riverbend

o Riverbend Counseling

Associates

o Psychiatric Emergency

Services



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Resources

B. Crisis services to

address co-

occurring medical

and mental health

conditions

C. Youth mental

health education,

stigma, early

intervention

services

Emergency Response Team)

• Grants to Riverbend

• Emergency Department

Psychiatric Area: Yellow Pod

• School-based Outreach in

Pittsfield and Hillsboro

• SBIRT (Screening, Brief

Intervention, Referral to

Treatment)

• All

• All

• Youth

• Youth

• $100,000

• $2,500,000

*

*

• Riverbend

o Crisis Treatment Services

• Pittsfield Community Coalition

• Waypoint

224-7479

• Capital Area Public Health

Network:

224-2595

o Youth Leadership Council

o NHIAA Life of an Athlete

o Project Success

o Prescription Drug

Takeback events

o Permanent prescription

drug takeback boxes



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Resources

D. Substance misuse

treatment and

intervention

• Neonatal Abstinence Syndrome

support

• Partnership with Riverbend

Community Mental Health to

develop a substance use disorder

education module for the

community

• Hub and Spoke Services

• Fresh Start Initiative

• Completion of newly designed

• Youth

• All; youth

• All

• All; youth

• All; youth

• $700,000

*

*

• $400,000

*

o “Check the Stats”

• Drug Abuse Resistance

Education (DARE)

223-3862

• Concord Connections

224-7479

• National Alliance on Mental

Illness (NAM()

800-242-6264

• Office of Student Wellness

Nhstudentwellness.org

• Riverbend

o Choices Intensive

Outpatient Therapy

Program

o Children’s Intervention

Program (ChIP)

• Concord Substance Abuse

Coalition

223-2023

• Farnum Center

622-3020

• Hope for Recovery New

Hampshire

232-3758

• Waypoint

• Riverbend

o Opioid Use Disorder



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Resources

webpage for SUS with link to

resources

• Host site for Community Support

Groups

• Medication Assisted Therapy

(MAT)

• Adoption of new policy and

protocol for patients identified

with opioid use disorder who

desire and would benefit from

MAT

• All

• All

• All

• $15,000

• $120,000

*

Mobile Crisis Treatment

Center

• Recovery Friendly Workplace

271-2121

3. Healthy Behaviors,

Socioeconomic and

Environmental

Factors

A. Obesity, physical

inactivity, and

nutrition

• Center for Health Promotion

Nutrition Services and Obesity

Programming

• Lead organization for Capital

Area Wellness

• Weight Management

Programming

• All

• All; low income

• All

• $500,000

*

*

• YMCA

228-9622

• WIC

• Capital Area Public Health

Network

• CRVNA

o Dedicated staff time to

support Capital Area

Wellness Coalition, Capital

Area Public Health Network

activities which focus on this



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Resources

B. Cancer Services

C. Cardiovascular

Risk Factors

D. Elevated Radon

Risk

• Hope Resource Center

• Expand cardiac treatments

• Nutritional Counseling

• Smoking Cessation Support

• Stress Management

Programming

• Cardiac Rehabilitation

• Heart Wellness Program

• Cardiovascular Service Line

Planning

• Smart Heart Home Meal Delivery

Program

• All; low income

• All

• All

• All

• All

• All

• All

• All

• Low income

• $1,200,000

*

*

*

*

*

*

*

• $50,000

area

o Aging Mastery Program

o Better Choices, Better Health

o A Matter of Balance

• YMCA

• WIC

• American Heart Association

800-479-2328

• CRVNA

o Community Health

Educators (CHE)

• State of New Hampshire Radon

Program, EPA



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Resources

E. Geographically

Based Social

Vulnerability

• Family Health Center Planning

• Family Health Center Homeless

Resource Center

• Mobile Health Study

• Primary Care Development Plan

• Population Health Planning






*

*

*

*

*

271-4052

• Riverbend

o Residential Supports


• The Children’s Place and Parent

Education Center

224-9920

• Concord Parks and Recreation

225-8690

• Local Parks and Rec Programs

• Concord School District

Homeless Student’s Services

225-0811

• Bow Community Resource

Meetings

• Pembroke/Allenstown

Community Provider Meetings

• Hillsboro Are Resource

Provider Meetings

• CRVNA and CATCH (225-8575)

o PATHS (Positive Aging

Through Home Supports)

current location FCII CATCH

Housing



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Resources

4. Support for

Vulnerable

Populations

A. Elders

• Nurse Navigation

• Health Education and Wellness

Programming / Delirium

Prevention

• Support for Chronic Health

Conditions

• Patient Therapeutic Activities

• Palliative Care Program

• Family Health Center Frail Elders

• Age Friendly Healthy System

Learning Collaborative

• Elders

• Elders

• Elders

• Elders

• Elders

• Elders

• Elders

*

• $250,000

*

• $190,000

• $1,700,000

*

*

• Goodlife

228-6630

• Concord YMCA

228-9622

• Retired and Senior Volunteer

Program (RSVP) Friends

Program

800-536-1193

• Service Link New Hampshire

Resource Center

866-634-9412

• AARP

224-6095

• Slusser Senior Center

746-3800


Merrimack-Belknap Counties

279-4096

• CRVNA

o Home care

o Hospice

o Palliative Care

o Behavioral Health Program

o CHE Programs

o PATHS Program



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Resources

B. Low Income

• Charitable Care / Financial

Assistance

• Downtown Clinic


• CH Trust Scholarship Fund

• Low income

• Low income

• Low income

• Low income

*

*

*

• $35,000

o Penacook Village Fund

o Walk-in-Wednesday

o Leadership level

participation in statewide

and regional initiatives such

as Tri-State learning

Collaboration on Aging and

Alliance for Healthy Aging

o Capital Area Memory Cafe

• Granite State Independent

Living

228-9680

• Local Community Center

• Concord Human Services

225-8575

• CATCH

• Service Link New Hampshire

Resource Center

• Families in Transition

223-6876

• Granite United Way VITA

Program

Supplemental Nutrition

Assistance Program (SNAP)

271-9700 or 800-221-5689

• Concord Homeless Resource

Provider Meetings

• WIC Nutrition Program



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Resources

C. Refugees

D. Veterans


• Interpreter Services

• Red Shirt Friday Awareness

Campaign

• Veterans Employment

Commitment

• Veterans Visits

• Refugee

• Refugee

• Veterans

• Veterans

*

*

*

*

Total Investment:

$49,370,580

800-942-4321


• Concord Head Start

224-6492

• Friends Program

228-1193

• NH Food Stamp Program

271-9700

• Refugee Mental Wellness

Meetings

271-2688

• Ascentria

224-8111

• New Hampshire Catholic

Charities

669-3030

• NH Young Veterans Network

Nhyvn.org

• State of NH

o Veterans Crisis Line

o Employment opportunities

• Easterseals

o Military and Veterans

Services

623-8863

2019-2021 Community Benefits Action Plan...Wellness Coalition, Capital Area Public Health Network...

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