Regional Healthcare Partnership 8 (RHP 8) Interactive Tool This interactive tool is designed for...

Regional Healthcare Partnership 8 (RHP 8)

Interactive ToolThis interactive tool is designed for providers and community stakeholders to better understand the 40 projects being

implemented in RHP 8 as part of the Texas Medicaid 1115 Waiver. With this tool, users can navigate projects by provider, county, project focus, or outcome measure(s) by which each project is working to improve.

Contact information for providers is included, and stakeholders are encouraged to contact them to learn more about their projects and identify opportunities for collaboration.

If you have questions regarding the tool or the 1115 Waiver, please contact the RHP 8 Anchor Team.

What is the Texas 1115 Waiver?

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mailto:[email protected]

What is the Texas 1115 Waiver?

In December 2011, the Centers for Medicare and Medicaid Services (CMS) approved the Texas 1115 Medicaid Transformation Waiver. The Waiver enables Texas to: 1) expand Medicaid managed-care programs across the state, 2) preserve hospital funding with healthcare costs that are currently uncompensated, and 3) achieve savings while improving quality of care.

The 1115 Waiver is funded at $29 billion over five years (2011-2016) through a split of matching local funds. This split represents roughly 60% of funds coming from the federal level, and roughly 40% of funds coming from local public dollars.

There are two distinct payment pools associated with the 1115 Waiver, these pools are Uncompensated Care (UC) which reimburses hospitals for care provided to the Medicaid and low-income/uninsured populations, and the Delivery System Reform Incentive Payments (DSRIP) pool.

This interactive tool focuses on the later of the two pools. Through DSRIP, nearly 300 healthcare providers across the state are implementing over 1,400 transformational projects that are changing the delivery of healthcare in Texas.

To learn more about the 1115 Waiver, please visit the HHSC website.

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Back to the Home Page

http://www.hhsc.state.tx.us/1115-Waiver-Overview.shtml

Select One of the Following to Begin: Provider, County, Project Focus, or Outcome Measure

Hint: These four navigation buttons are found throughout the tool.

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Provider

• RHP 8 includes 12 DSRIP providers, including:

- Hospitals (6) - LMHAs (4) - Public Health Departments (2)• There are 40

Category 1 and 2 projects underway in this region

County

• Formed in March 2012

• Comprised of 9 counties

• 8,547 square miles• 860,803 residents

(2010 US Census)• Expected to grow

to 1,120,992 residents by 2030 (Texas Workforce Commission)

Outcome Measure

• Thirty (30) Category 3 outcome measures were selected by RHP 8 providers

• DY4 incentives will be paid for reporting and performance

• DY5 incentives will be paid for performance only

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Project Focus

• Providers selected project areas from the RHP Planning Protocol

• Proposed projects were reviewed and approved by HHSC and CMS

• Incentives are paid to providers for achieving pre-defined milestones and metrics

Return to List of Providers/Counties/Project Types/

Outcome Measures

Click on a Performing Provider Type to View DSRIP Providers

Hospitals

Local MentalHealth Authorities

Local PublicHealth Departments

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Click on a Hospital to View Projects Related to that Provider

St. David’s Round Rock

Medical Center

Little River Healthcare

Seton Highland

Lakes Hospital

Scott & White Llano

Seton Medical Center Harker

Heights

Scott & White Memorial

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Click on a Local Mental Health Authority to View Projects Related to that Provider

Bluebonnet Trails Community Services Center for Life Resources

Central Counties Services Hill Country MHDD Centers

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Click on a Local Public Health Department to View Projects Related to that Provider

Bell County Public Health Department

Williamson County and Cities Health District

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Click on an Outcome Domain (OD) to View Projects Reporting on that Measure

Primary Care and Chronic Disease Management

Potentially Preventable Readmissions Patient Satisfaction Right Care, Right Setting

Quality of Life/ Functional Status

Behavioral Health/ Substance Abuse Care

Primary Prevention Infectious Disease Management

There are a total of 15 possible outcome domains (ODs) and those options listed above only display ODs being addressed by RHP 8 DSRIP projects.

Each project has at least one OD that aims to measure outcomes associated with that project. These outcomes show meaningful improvement and impact on the target population served through the DSRIP project.

For example, a hospital patient navigation project may measure Right Care, Right Setting. If patients are successfully being navigated to receive the medical care they require, there should be a decrease in number of persons admitted to the emergency department because those serviced through the DSRIP project would be receiving the care they need in the right place, at the right time, and in the right setting.

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Primary Care and Chronic Disease Management Click on the Project ID to View the Project Narrative

Provider Category 1 or 2 Project ID

IT-reference number Measure Title

Central Counties Services 081771001.2.1 IT-1.11 Controlling high blood pressure

Seton Medical Center Harker Heights 013122392.1.100 IT-1.11 Diabetes care: HbA1c poor control (>9.0%)


126936702.1.3 IT-1.29 Weight assessment and counseling for nutrition and physical activity for children/adolescents


126936702.2.1 IT-1.7 Controlling high blood pressure


126936702.2.100 IT-1.29 Weight assessment and counseling for nutrition and physical activity for children/adolescents


126936702.2.2 IT-1.7 Controlling high blood pressure

Return to List of Outcome Measures

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http://tamhsc.edu/1115-waiver/rhp8/documents/tool/ron/c2/ccs08177100121.docx

http://tamhsc.edu/1115-waiver/rhp8/documents/tool/ron/c1/setonhh0131223921100.docx

http://tamhsc.edu/1115-waiver/rhp8/documents/tool/ron/c1/wcchd12693670213.docx




Potentially Preventable ReadmissionsClick on the Project ID to View the Project Narrative


IT-reference number

Measure Title

Bluebonnet Trails Community Services

126844305.1.2 IT-3.14 Behavioral health /substance abuse 30-day readmission rate


126844305.1.4 IT-3.14 Behavioral health /substance abuse 30-day readmission rate

Central Counties Services 081771001.1.5 IT-3.14 Behavioral health /substance abuse 30-day readmission rate


126936702.1.2 IT-3.2 Congestive heart failure (CHF) 30-day readmission rate


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http://tamhsc.edu/1115-waiver/rhp8/documents/tool/ron/c1/btcs12684430512.docx




Patient Satisfaction Click on the Project ID to View the Project Narrative


IT-reference number

Measure Title

Bell County Public Health District 088334001.2.1 IT-6.2.b Visit-Specific Satisfaction Instrument (VSQ-9)

Bell County Public Health District 088334001.2.2 IT-6.2.b Visit-Specific Satisfaction Instrument (VSQ-9)

Seton Highland Lakes Hospital 094151004.2.1 IT-6.1.a.v HCAHPS Communication about Medicine


126936702.1.1 IT-6.2.a Client Satisfaction Questionnaire 8 (CSQ-8)








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http://tamhsc.edu/1115-waiver/rhp8/documents/tool/ron/c2/bcphd08833400121.docx


http://tamhsc.edu/1115-waiver/rhp8/documents/tool/ron/c2/setonhl09415100421.docx





Right Care, Right SettingClick on the Project ID to View the Project Narrative


IT-reference number

Measure Title


126844305.1.3 IT-9.1 Decrease in mental health admissions and readmissions to criminal justice settings such as

jails or prisons


126844305.2.2 IT-9.4.e Reduce low emergency department (ED) visits for behavioral health/substance abuse


126844305.2.4 IT-9.1 Decrease in mental health admissions and readmissions to criminal justice settings such as

jails or prisons

Central Counties Services 081771001.1.4 IT-9.1 Decrease in mental health admissions and readmissions to criminal justice settings such as

jails or prisons


jails or prisons


jails or prisons

Little River Healthcare 183086102.1.1 IT-9.2.a Emergency department (ED) visits per 100,000

1 2View page:Return to List of Outcome Measures

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http://tamhsc.edu/1115-waiver/rhp8/documents/tool/ron/c1/littleriver18308610211.docx

Right Care, Right Setting 2Click on the Project ID to View the Project Narrative


IT-reference number

Measure Title

Scott & White Llano 020840701.2.1 IT-9.2.a Emergency department (ED) visits per 100,000

Scott & White Llano 020840701.2.2 IT-9.2.a Emergency department (ED) visits per 100,000

Scott & White Memorial 137249208.2.1 IT-9.2.a Emergency department (ED) visits per 100,000

Seton Highland Lakes Hospital

094151004.2.1 IT-9.5 Reduce low acuity emergency department (ED) visits

St. David’s Round Rock Medical Center

020957901.1.1 IT-9.2.a Emergency department (ED) visits per 100,000

1 2View page:Return to List of Outcome Measures

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http://tamhsc.edu/1115-waiver/rhp8/documents/tool/ron/c2/swllano02084070121.docx


http://tamhsc.edu/1115-waiver/rhp8/documents/tool/ron/c2/swmemorial13724920821.docx


http://tamhsc.edu/1115-waiver/rhp8/documents/tool/ron/c1/sdrrmc02095790111.docx

Quality of Life/Functional StatusClick on the Project ID to View the Project Narrative


IT-reference number

Measure Title


126844305.1.1 IT-10.1.b.ii RAND Short Form 12 (SF-12v2) Health Survey

Central Counties Services 081771001.1.100 IT-10.1.a.iv Assessment of Quality of Life (AQoL-8D)

Central Counties Services 081771001.1.3 IT-10.1.a.iv Assessment of Quality of Life (AQoL-8D)


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Behavioral Health/Substance Abuse CareClick on the Project ID to View the Project Narrative


IT-reference number

Measure Title


126844305.1.5 IT-11.8 Initiation and Engagement of Alcohol and Other Drug Dependence Treatment


126844305.2.1 IT-11.26.c Adult Needs and Strength Assessment (ANSA)


126844305.2.3 IT-11.26.b Aberrant Behavior Checklist (ABC)

Center for Life Resources 133339505.1.1 IT-11.26.e.i Patient Health Questionnaire 9 (PHQ-9)

Central Counties Services 081771001.1.1 IT-11.26.d Children and Adolescent Needs and Strengths Assessment (CANS-MH)

Hill Country MHDD Centers 133340307.2.1 IT-11.25 Daily Living Activities (DLA-20)


Hill Country MHDD Centers 133340307.2.3 IT-11.16 Assessment for Substance Abuse Problems of Psychiatric Patients

Hill Country MHDD Centers 133340307.2.3 IT-11.19 Assessment for Psychosocial Issues of Psychiatric Patients

Hill Country MHDD Centers 133340307.2.3 IT-11.21 Assessment of Major Depressive Symptoms




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http://tamhsc.edu/1115-waiver/rhp8/documents/tool/ron/c1/ctfl13333950511.docx


http://tamhsc.edu/1115-waiver/rhp8/documents/tool/ron/c2/hillcountry13334030721.docx







Primary PreventionClick on the Project ID to View the Project Narrative



Little River Healthcare 183086102.1.2 IT-12.1 Breast cancer screening

Little River Healthcare 183086102.1.2 IT-12.2 Cervical cancer screening

Little River Healthcare 183086102.1.2 IT-12.3 Colorectal cancer screening

Williamson County and Cities Health District 126936702.1.3 IT-12.11 HPV vaccine for adolescents


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Infectious Disease ManagementClick on the Project ID to View the Project Narrative



Central Counties Services 081771001.2.2 IT-15.6 Chlamydia screening in women

Central Counties Services 081771001.2.2 IT-15.9 Syphilis screening

Central Counties Services 081771001.2.2 IT-15.12 Gonorrhea screening rates

Williamson County and Cities Health District 126936702.1.1 IT-15.6 Chlamydia screening in women

Williamson County and Cities Health District 126936702.1.3 IT-15.6 Chlamydia screening in women


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Click on a Project Area to View Projects Addressing those Specific Concerns

Behavioral Health Chronic Care Management Patient Navigation

Emergency Center Utilization

Primary/Specialty Care Process Improvement/ Patient Experience

DSRIP projects are categorized first by project area and then by project option.

To view a complete list of project options, please view the Category 1 and Category 2 RHP Planning Protocols on the HHSC website used during three-year DSRIP project development.

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http://www.hhsc.state.tx.us/1115-docs/CAT3/Category-1-3-Year-RHP-Planning-Protocol.pdf

http://www.hhsc.state.tx.us/1115-docs/CAT3/Category-2-3-Year-RHP-Planning-Protocol.pdf

http://www.hhsc.state.tx.us/1115-waiver.shtml

Behavioral HealthClick on the Project ID to View the Project Narrative


Project Option Project Type

Bluebonnet Trails Community

Services

126844305.1.1 1.12.2 - Expand the number of community based settings where behavioral health services may be delivered in underserved areas

Expand Behavioral Health


Services

126844305.1.2 1.13.1 - Develop and implement crisis stabilization services to address the identified gaps in the current crisis system

Crisis Stabilization


Services




Services




Services




Services

126844305.2.1 2.13.1 - Design, implement, and evaluate research-supported and evidence-based interventions tailored towards individuals in the target population

Integrated Care


Services


Integrated Care

1 2 3View page:Return to List of Project Areas

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Behavioral Health 2Click on the Project ID to View the Project Narrative




Services


Integrated Care


Services


Integrated Care

Center for Life Resources

133339505.1.1 1.11.1 - Procure and build the infrastructure needed to pilot or bring to scale a successful pilot of the selected forms of service in underserved areas of the state (this must be combined with one of two interventions)


Central Counties Services











Integrated Care


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Behavioral Health 3Click on the Project ID to View the Project Narrative






Hill Country MHDD Centers







133340307.2.3 2.16.1 - Design, implement, and evaluate a program to provide remote psychiatric consultative services to all participating primary care providers delivering services to patients with mental illness or substance abuse disorders



133340307.2.4 2.18.1 - Design, implement, and evaluate Whole Health peer support for individuals with mental health and /or substance use disorders

Integrated Care





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Chronic Care ManagementClick on the Project ID to View the Project Narrative


Project Option


126936702.2.2 2.6.1 - Engage in population-based campaigns or programs to promote healthy lifestyles using evidence-based methodologies including social media and text messaging in an identified population

Return to List of Project Areas

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Emergency Center UtilizationClick on the Project ID to View the Project Narrative


Project Option

Scott & White Llano 020840701.2.1 2.8.1 - Design, develop, and implement a program of continuous, rapid process improvement that will address issues of safety, quality, and efficiency

Scott & White Llano 020840701.2.2 2.8.1 - Design, develop, and implement a program of continuous, rapid process improvement that will address issues of safety, quality, and efficiency


126936702.1.2 1.6.2 - Establish/expand access to medical advice and direction to the appropriate level of care to reduce Emergency Department use for non-emergent conditions and increase patient access to healthcare


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Patient NavigationClick on the Project ID to View the Project Narrative


Project Option


137249208.2.1 2.9.1 - Provide navigation services to targeted patients who are at high risk of disconnect from institutionalized healthcare (for example, patients with multiple chronic conditions, cognitive impairments and disabilities, Limited English Proficient patients, recent immigrants, the uninsured, those with low health literacy, frequent visitors to the ED, and others)



Williamson County and Cities

Health District



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Process Improvement/Patient ExperienceClick on the Project ID to View the Project Narrative


Project Option

Central Counties Services 081771001.1.5 1.10.2 - Enhance improvement capacity through technology


126936702.1.3 1.5.3 - Implement project to enhance collection, interpretation, and / or use of REAL data


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Primary/Specialty CareClick on the Project ID to View the Project Narrative


Project Option

Bell County Public Health District

088334001.2.1 2.7.1 - Implement innovative evidence-based strategies to increase appropriate use of technology and testing for targeted populations (e.g., mammography screens, colonoscopies, prenatal alcohol use, etc.)




081771001.1.1 1.1.1 - Establish more primary care clinics


081771001.2.1 2.2.2 - Apply evidence-based care management model to patients identified as having high-risk healthcare needs



Little River Healthcare 183086102.1.1 1.1.2 - Expand existing primary care capacity

Little River Healthcare 183086102.1.2 1.9.2 - Improve access to specialty care

1 2View page:Return to List of Project Areas

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Primary/Specialty Care 2Click on the Project ID to View the Project Narrative


Project Option

Seton Medical Center Harker Heights

013122392.1.100 1.1.2 - Expand existing primary care capacity






126936702.2.100 2.7.5 - Implement innovative evidence-based strategies to reduce and prevent obesity in children and adolescents

1 2View page:Return to List of Project Areas

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Click on a County to View Projects being Implemented in that Area

Mills

San Saba Lampasas

Llano

Burnet

Blanco

Bell

Milam

Williamson

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Bell CountyClick on the Provider Name to View Contact Information

US Census Quick Facts – Bell

Provider Name Description of Provider Projects Serving BellCounty Residents


Provider Type: Local Public Health District Service Area: BellTarget Population: Bell county residentsTypes of Services: Immunizations; sexually transmitted disease (STD) testing and treatment; family planning; pregnancy testing and counseling; preparedness; disease surveillance; environmental health; food protection; and oversee administration of Women Infant Children program

• STD Testing and Treatment for Males• STD Testing and Treatment for Females

1 2 3View page:Return to Map of RHP 8

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http://quickfacts.census.gov/qfd/states/48/48027.html

Bell County 2Click on the Provider Name to View Contact Information



Provider Type: Local Mental Health Authority (LMHA)Service Area: Bell, Coryell, Hamilton, Lampasas, and MilamTarget Population: Bell, Lampasas, and Milam county residents Types of Services: Adult, child, and adolescent mental health services; early childhood intervention; intellectual and developmental disabilities; and veteran’s services

• Provide School-Based Services for Children in Temple Independent School District

• Group Social Skills Training for Persons Diagnosed with High-Function Autism or Asperger’s Disorder

• Crisis Respite/Transitional Living/Supportive Services

• Improve Data Management and Organizational Process Improvement Capacity

• Provide Work-Adjustment Training to Persons Diagnosed with High-Function Autism or Asperger’s Disorder

• Manage Chronic Health Conditions for Persons with Severe and Persistent Mental Illness (SPMI)

• Sexually Transmitted Disease Testing for Adults and Adolescents with SPMI

• Provide Supportive Day Services to Adults with SPMI

• Jail Diversion


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Bell County 3Click on the Provider Name to View Contact Information



Provider Type: Hospital Service Area: Bell and surrounding regionTarget Population: Bell county residents Highlights: 636 bed hospital; only Level 1 ‐Trauma Center between Austin and Dallas; neonatal intensive care unit ranks among the top in survival of these fragile newborns; more than 50 services available from allergy and immunology to vascular surgery

• Patient Navigation

Seton Medical Center Harker Heights

Provider Type: Hospital Service Area: BellTarget Population: Bell county residents Highlights: 83 bed hospital; more than 15 ‐services available from cardiology to women’s health; offer a wide-range of classes and events for the public to attend to better manage their health

• Expanding Access to Primary Care


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Blanco CountyClick on the Provider Name to View Contact Information

US Census Quick Facts – Blanco

Provider Name Description of Provider Projects Serving BlancoCounty Residents


Provider Type: Local Mental Health Authority (LMHA)Service Area: Bandera, Blanco, Comal, Edwards, Gillespie, Hays, Kendall, Kerr, Kimble, Kinney, Llano, Mason, Medina, Menard, Real, Schleicher, Sutton, Uvalde, and Val Verde Target Population: Blanco and Llanocounty residentsTypes of Services: Adult, child, and adolescent mental health services; substance abuse treatment; early childhood intervention; intellectual and developmental disabilities; and veteran’s services

• Increase Co-Occuring Psychiatric and Substance Abuse Disorder Services

• Provide Trauma Informed Care• Implement Virtual Psychiatric and Clinical

Guidance• Provide Whole Health Peer Support Services• Provide Veteran Mental Health Services

Return to Map of RHP 8

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Burnet CountyClick on the Provider Name to View Contact Information

US Census Quick Facts – Burnet

Provider Name Description of Provider Projects Serving Burnet County Residents


Provider Type: Local Mental Health Authority (LMHA) Service Area: Bastrop, Burnet, Caldwell, Fayette, Gonzales , Guadalupe Lee and Williamson Target Population: Burnet and Williamson county residents Types of Services: Autism; behavioral health; crisis, disaster, employment, and justice involved services; early childhood intervention; family healthcare; intellectual and developmental disabilities; mental health first aid; peer supports; substance use; supportive housing; and veteran’s services

• Expanded Access to Care• 48 Hour Observation Unit• Crisis Stabilization • Outpatient Substance Abuse

Treatment• Youth and Adult Diversion from Jail

System


Provider Type: Hospital Service Area: BurnetTarget Population: Burnet county residentsHighlights: 25 bed hospital; more than 15 services available ‐from asthma services to surgical services; oversees administration of Burnet County Indigent Program

• Patient Navigation


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Lampasas CountyClick on the Provider Name to View Contact Information

US Census Quick Facts – Lampasas

Provider Name Description of Provider Projects Serving LampasasCounty Residents

Central Counties Services Provider Type: Local Mental Health Authority (LMHA)Service Area: Bell, Coryell, Hamilton, Lampasas, and MilamTarget Population: Bell, Lampasas, and Milam county residents Types of Services: Adult, child, and adolescent mental health services; early childhood intervention; intellectual and developmental disabilities; and veteran’s services




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Llano CountyClick on the Provider Name to View Contact Information

US Census Quick Facts – Llano

Provider Name Description of Provider Projects Serving LlanoCounty Residents


Provider Type: Local Mental Health Authority (LMHA)Service Area: Bandera, Blanco, Comal, Edwards, Gillespie, Hays, Kendall, Kerr, Kimble, Kinney, Llano, Mason, Medina, Menard, Real, Schleicher, Sutton, Uvalde, and Val Verde Target Population: Blanco and Llanocounty residentsTypes of Services: Adult, child, and adolescent mental health services; substance abuse treatment; early childhood intervention; intellectual and developmental disabilities; and veteran’s services

• Increase Co-Occuring Psychiatric and Substance Abuse Disorder Services

• Provide Trauma Informed Care• Implement Virtual Psychiatric and Clinical

Guidance• Provide Whole Health Peer Support

Services• Provide Veteran Mental Health Services

Scott & White Llano

Provider Type: Hospital Service Area: LlanoTarget Population: Llano county residents Highlights: 30 bed hospital; more than 15 services ‐available from cardiology to urology

• Reduce Emergency Department (ED) Transports

• Reduce ED Transports for those Patients with Behavioral Health Needs


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Milam CountyClick on the Provider Name to View Contact Information

US Census Quick Facts – Milam

Provider Name Description of Provider Projects Serving MilamCounty Residents


Provider Type: Local Mental Health Authority (LMHA)Service Area: Bell, Coryell, Hamilton, Lampasas, and MilamTarget Population: Bell, Lampasas, and Milam county residents Types of Services: Adult, child, and adolescent mental health services; early childhood intervention; intellectual and developmental disabilities; and veteran’s services



Little River Healthcare

Provider Type: Hospital Service Area: Bell, Milam, and WilliamsonTarget Population: Milam county residentsHighlights: 25 bed hospital; more than 20 services ‐available from emergency and urgent care to weight management

• Primary Care Physician Expansion• Specialty Care Physician Expansion to

Increase Testing and Treatment for Breast, Cervical, and Colorectal Cancers


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Mills CountyClick on the Provider Name to View Contact Information

US Census Quick Facts – Mills

Provider Name Description of Provider Projects Serving MillsCounty Residents


Provider Type: Local Mental Health Authority (LMHA)Service Area: Brown, Coleman, Comanche, Eastland, McCulloch, Mills, and San SabaTarget Population: Mills and San Saba county residentsTypes of Services: Adult, child, and adolescent behavioral health services; autism services; early childhood intervention; intermediate care facilities; home and community-based services; intellectual and developmental disabilities; outpatient substance abuse services; Texas home living; veteran to veteran support

• Telemedicine Services


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San Saba CountyClick on the Provider Name to View Contact Information

US Census Quick Facts – San Saba

Provider Name Description of Provider Projects Serving San SabaCounty Residents


Provider Type: Local Mental Health Authority (LMHA)Service Area: Brown, Coleman, Comanche, Eastland, McCulloch, Mills, and San SabaTarget Population: Mills and San Saba county residentsTypes of Services: Adult, child, and adolescent behavioral health services; autism services; early childhood intervention; intermediate care facilities; home and community-based services; intellectual and developmental disabilities; outpatient substance abuse services; Texas home living; veteran to veteran support

• Telemedicine Services


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Williamson CountyClick on the Provider Name to View Contact Information

US Census Quick Facts – Williamson

Provider Name Description of Provider Projects Serving WilliamsonCounty Residents


Provider Type: Local Mental Health Authority (LMHA) Service Area: Bastrop, Burnet, Caldwell, Fayette, Gonzales , Guadalupe Lee and Williamson Target Population: Burnet and Williamson county residents Types of Services: Autism; behavioral health; crisis, disaster, employment, and justice involved services; early childhood intervention; family healthcare; intellectual and developmental disabilities; mental health first aid; peer supports; substance use; supportive housing; and veteran’s services

• Expanded Access to Care• 48 Hour Observation Unit• Child Crisis Respite• Crisis Stabilization • Outpatient Substance Abuse Treatment• Transitional Housing• Reduce Emergency Department Visits by

High-Utilizers• Provide Assertive Community Treatment

for Persons with Intellectual Developmental Disabilities

• Youth and Adult Diversion from Jail System


Provider Type: Hospital Service Area: WilliamsonTarget Population: Williamson county residents Highlights: 173 bed hospital; Level II Trauma Center; ‐more than 20 services available from breast care to lymphedema; offer a wide-range of classes and events for the public to attend to better manage their health; home of Heart Hospital of Austin

• Expanding Access to Primary Care

1 2View page:Return to Map of RHP 8

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Williamson County 2Click on the Provider Name to View Contact Information

Provider Name Description of Provider Projects Serving WilliamsonCounty Residents


Provider Type: Local Public Health District Service Area: Williamson Target Population: Williamson county residentsTypes of Services: Immunizations, sexually transmitted disease testing and treatment, family planning, pregnancy testing and counseling, preparedness, disease surveillance, environmental health, food protection, and oversee administration of Women Infant Children (WIC) and Williamson County Indigent Health programs

• Expand Access to Primary Care• Community Paramedicine Program• Collect and Utilize REAL (Race, Ethnicity, Age, and

Language) Data to Better Serve Population • Patient Navigation• Health and Wellness Promotion Classes • Offer Wellness Classes to Decrease Obesity in Children

and Adults

1 2View page:Return to Map of RHP 8

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US Census Quick Facts – Williamson


Bell County Public Health DistrictClick on the Project ID to View the Project Narrative

Contact Information:Bonnie Scurzi, Executive Director254-773-4457, [email protected] 201 North 8th Street, Temple, TX 76502Visit WebsiteIGT Funding: Bell County Public Health District

Category 1 or 2 Project Name and ID

Brief Project Description Target Population Category 3 Selection(s)

Sexually Transmitted Disease (STD) Testing and Treatment

for Males088334001.2.1

• Increase availability of STD testing for male clients

• Decrease possible related outcomes associated with untreated infections

• Improve access to timely, high quality care for residents

Low-income Uninsured; Young; Adult; Geriatric; Males

OD 6, IT-6.2.b - Visit-Specific Satisfaction Instrument (VSQ-9)

STD Testing and Treatment for Females

088334001.2.2

• Increase availability of STD testing for female clients

• Decrease possible related outcomes associated with untreated infections

• Improve access to timely, high quality care for residents

Low-income Uninsured; Young; Adult; Geriatric; Females

OD 6, IT-6.2.b - Visit-Specific Satisfaction Instrument (VSQ-9)

Return to List of Providers

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http://www.bellcountyhealth.org/



Bluebonnet Trails Community ServicesClick on the Project ID to View the Project Narrative

Contact Information:Andrea Richardson, Executive Director512-244-8335, [email protected] 1009 North Georgetown Street, Round Rock, TX 78664Visit WebsiteIGT Funding: Bluebonnet Trails Community Services

Category 1 or 2 Project ID


Expanded Access to Care

126844305.1.1

• Establish outpatient behavioral health services to low income families in rural areas in Williamson and surrounding rural counties

• Develop robust behavioral health team on site (supported by telemedicine)

• Provide behavioral healthcare that is multi disciplinary, recovery oriented, ‐and comprehensive

• Provide care to those in need regardless of income, insurance status, or diagnosis

Medicaid; Low-income Uninsured; Young; Adult; Geriatric

OD 10, IT-10.1.b.ii - RAND Short Form 12 (SF12v2) Health Survey

1 2 3View page: 4 5Return to List of Providers

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http://bbtrails.org/



Bluebonnet Trails Community Services 2Click on the Project ID to View the Project Narrative



48 Hour Observation Unit126844305.1.2

• Implement 48-Hour Extended Observation Unit in Williamson County supporting involuntary and voluntary admissions

• Provide emergency and crisis stabilization services in a secure, protected, and clinically/psychiatrically supervised treatment environment

• Reduce or eliminate inappropriate utilization of emergency departments, jails, private hospitals, and the State Hospital for short stays by individuals presenting with a mental illness

Medicaid; Low-income Uninsured; Adult; Geriatric

OD 3, IT-3.14 - BH/SA 30-Day Readmission Rates

Child Crisis Respite

126844305.1.3

• Implement child crisis respite program to help youth in crisis

• Provide a safe and therapeutic environment linking children and their caregivers with meaningful on-going supports

• Divert youth from admission to hospitals or juvenile justice facilities

Medicaid; Low-income Uninsured; Young

OD 9, IT-9.1 - Decrease in MH admissions and readmissions to criminal justice settings such as jails or prisons


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126844305.1.4

• Establish a crisis assessment and referral unit in Burnet County

• Develop a professional and mobile team, including a Mental Health Deputy, to provide assessment of individuals

• Reduce or eliminate inappropriate utilization by individuals with mental illness of emergency departments, jails, private hospitals and the State Hospital for short stays


OD 3, IT-3.14 - BH/SA 30-Day Readmission Rates

Outpatient Substance

Abuse Treatment

126844305.1.5

• Establish intensive outpatient and supportive outpatient substance abuse services in Williamson and Burnet County

• Provide a comprehensive service array for persons with co-occurring psychiatric and substance use disorders through a solution-focused and multi-faceted approach to care including psycho-education, peer support groups and motivational interviewing


OD 11, IT-11.8 - Initiation and Engagement of Alcohol and Other Drug Dependence Treatment


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Transitional Housing

126844305.2.1

• Establish a peer-led transitional services program based on recovery principles

• Recruit, train, and certify peers to provide services to clients

• Provide services to people who have been hospitalized or who have experienced a crisis event and have been in the Crisis Respite facility (126844305.1.4)


OD 11, IT-11.26.c - Adult Needs and Strength Assessment (ANSA)

Reduce Emergency

Department (ED) Visits by High-Utilizers

126844305.2.2

• Establish a team to provide coordination of care, patient education, and linkage to needed services to prevent unnecessary use of emergency medical services and ED services

• Reduce inappropriate emergency transports and ED use

• Improve quality of care and access to healthcare for patients with complex medical needs

Medicaid; Low-income Uninsured; Adult

OD 9, IT- 9.4.e - Reduce ED visits for Behavioral Health/Substance Abuse


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Provide Assertive Community

Treatment for Persons with Intellectual

Developmental Disabilities (IDD)126844305.2.3

• Provide intensive wrap around services for individuals with IDD at the point of crisis and during life transitions

• Provide training to law enforcement, emergency room personnel, healthcare providers, psychiatric hospital providers, and community residential and non‐residential providers regarding the project and how to access services

• Prevent individuals from inappropriate admissions into institutions and emergency departments through timely and effective delivery of crisis services


OD 11, IT-11.26.b - Aberrant Behavior Checklist (ABC)

Youth and Adult Diversion from Jail

System126844305.2.4

• Expand clinical capacity and eligibility criteria for youth and adults arrested or incarcerated in Burnet and Williamson counties

• Provide a collaborative approach to screening, assessment, and case management assisting individuals in navigating services in the community while collaborating with local justice systems

• Collaborate with juvenile and adult court systems and other components of the justice system


OD 9, IT-9.1 - Decrease in MH admissions and readmissions to criminal justice settings such as jails or prisons


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Center for Life ResourcesClick on the Project ID to View the Project Narrative

Contact Information:Dion White, Executive Director325-646-9574, [email protected] 408 Mulberry Street, Brownwood, TX 76801Visit WebsiteIGT Funding: Center for Life Resources



Offer Telemedicine Services

133339505.1.1

• Implement telemedicine to provide clinically appropriate treatment to patients in rural community

• Provide the right care, at the right time, and in the right setting


OD 11, IT-11.26.e.i - Patient Health Questionnaire 9 (PHQ-9)


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Central Counties ServicesClick on the Project ID to View the Project Narrative

Contact Information:Ray Helmcamp, Executive Director 254-298-7007, [email protected] 304 South 22nd Street, Temple, TX 76501Visit WebsiteIGT Funding: Central Counties Services

1 2 3View page: 4



Provide School-Based Services 081771001.1.1

• Provide school-based services for children in Kindergarten-5th grade who are poorly adjusted to scholastic achievement due to personal or familial behavioral health problems

Medicaid; Low-income Uninsured; Young

OD 11, IT-11.26.d - Children and adolescent needs and strengths assessment (CANS-MH)

Group Social Skills Training for Persons

Diagnosed with High-Function

Autism or Asperger’s Disorder

081771001.1.3

• Implement group social skills training for persons diagnosed with High-Function Autism or Asperger's Disorder

• Enhance the quality of life for persons participating in the “Coffeehouse Model” of social skills training

• Transform service delivery system for persons with High-Functioning Autism or Asperger’s Disorder

Medicaid; Low-income Uninsured; Young; Adult

OD 10, IT-10.1.a.iv - Assessment of Quality of Life (AQoL-8D)

5Return to List of Providers

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https://centralcountiesservices.org/



Central Counties Services 2Click on the Project ID to View the Project Narrative

21 3View page: 4



Crisis Respite/Transitional Living/Supportive

Services081771001.1.4

• Provide successful interventions for persons in early stages of crisis before the crisis situation reaches complexity that institutional level of care becomes the only care option

• Establish crisis-responsive residential services that provide a less restrictive/costly level of care for persons in behavior health crisis than admission to the state psychiatric hospitals or jailed for a minor offense

• Divert patients from being sent to the state psychiatric hospitals/justice system


OD 9, IT-9.1 - Decrease in mental health admissions and readmissions to criminal justice setting such as jails or prisons

Improve Data Management and

Organizational Process Capacity081771001.1.5

• Improve data management and organizational processes allowing provider to focus on reducing readmissions to state psychiatric hospital and local jail by improving post discharge follow-up services

• Use data to inform and support the Center’s performance and service capacity


OD 3, IT-3.14 - BH/SA 30-day readmission rates


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1 32View page: 4




Manage Chronic Health

Conditions for Persons with Severe and

Persistent Mental Illness (SPMI)

081771001.2.1

• Provide education, training, and support by a registered nurse for persons with SPMI having chronic health conditions due to prolonged psychiatric medicine use


OD 1, IT-1.11 - Diabetes care: BP control (140/90mm Hg)

Sexually transmitted

disease (STD) Testing for Adults and Adolescents with severe and

persistent mental illness (SPMI)

081771001.2.2

• Decrease the incidence, prevalence, and long term health effects STDs may pose to persons with SPMI who go left undiagnosed and/or untreated


• OD 15, IT-15.6 - Chlamydia screening in women

• OD 15, IT-15.9 - Syphilis screening

• OD 15, IT-15.12 - Gonorrhea screening rates


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1 2 4View page: 3




Provide Supportive Day

Services to Adults with Severe and

Persistent Mental Illness (SPMI)

081771001.2.3

• Provide supportive day services to adults with SPMI who were recently discharged from a psychiatric hospital or jail, or have recently experienced a crisis

• Provide skills training activities to patients• Enroll patient in benefit programs he/she may

be eligible for (e.g., Section-8 housing, Medicaid, Social Security Disability, etc.)

• Reduce the revolving-door of hospitalizations/incarcerations of chronically and persistently mentally ill persons in the Temple/Belton area


OD 9, IT-9.1 - Decrease in mental health admission and readmissions to criminal justice settings such as jails or prisons

Provide Work-Adjustment Training to

Persons Diagnosed with High-

Function Autism or Asperger’s

Disorder 081771001.1.100

• Provide work adjustment training to patients with High-Function Autism or Asperger's Disorder

• Increase number of persons participating in work adjustment training

• Increase participants employability skills and behaviors


OD 10, IT-10.1.a.iv - Assessment of Quality of Life (AQoL-8D)


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1 2 5View page: 3




Jail Diversion081771001.2.100

• Provide law enforcement officers training about how they may assess behavioral health acuity of a person involved in a minor criminal event

• Divert persons with behavioral healthcare needs to receive appropriate care instead of being sent to the criminal justice system


OD 09, IT-9.1 - Decrease in MH admissions and readmissions to criminal justice setting such as jails or prisons


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Hill Country MHDD CentersClick on the Project ID to View the Project Narrative

Contact Information:Ross Robinson, Executive Director830-792-3300, [email protected] 819 Water Street #300, Kerrville, TX 78028Visit WebsiteIGT Funding: Hill Country MHDD Centers

1 2View page: 3



Increase Co-Occuring

Psychiatric and Substance Abuse Disorder Services

133340307.2.1

• Establish co-occurring psychiatric and substance use disorder services based on each individual’s needs within the community setting

• Increase coordination of prevention, and care for residents, including those with behavioral and mental health needs

• Reduce inappropriate utilization of services


OD 11, IT-11.25 - Daily Living Activities DLA-20

Trauma Informed Care

133340307.2.2

• Implement trauma informed care services to meet need of individuals who experience trauma that is impacting their behavioral health

• Increase coordination of prevention, and care for residents, including those with behavioral and mental health needs

• Reduce inappropriate utilization of services




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http://www.hillcountry.org/



Hill Country MHDD Centers 2 Click on the Project ID to View the Project Narrative2

1 2View page: 3



Virtual Psychiatric and Clinical Guidance

133340307.2.3

• Provide primary care providers (PCPs) and hospitals within Blanco and Llano counties with necessary resources and guidance to adequately treat patients who present with behavioral health conditions through virtual, psychiatric consultation

• Avoid exacerbation of symptoms into a behavioral health crisis


• OD 11, IT-11.16 - Assessment for Substance Abuse Problems of Psychiatric Patients

• OD 11, IT-11.19 - Assessment for Psychosocial Issues of Psychiatric Patients

• OD 11, IT-11.21 - Assessment of Major Depressive Symptoms


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Whole Health Peer Support Services133340307.2.4

• Establish Whole Health peer support • Identify and train peers of mental health

services in the delivery of Whole Health peer support, and integrate their work into the recovery-oriented treatment plan of the individual being served



Veteran Mental Health Services133340307.2.5

• Establish veteran peer and mental health services

• Reduce emergency department utilization, inpatient utilization, and incarceration by developing wrap around services within the community for the targeted population




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Hill Country MHDD Centers 3 Click on the Project ID to View the Project Narrative2



Little River HealthcareClick on the Project ID to View the Project Narrative2

Contact Information:Jeff Madison, Chief Executive Officer512-446-4502, [email protected] 1700 Brazos Avenue, Rockdale, TX 76567Visit WebsiteIGT Funding: Rockdale Hospital Authority



Primary Care Physician Expansion

183086102.1.1

• Increase number of primary care physicians in order to increase clinic hours

• Expand capacity to care for more children and young adults with Rockdale Independent School District by adding clinics in schools

• Reduce inappropriate emergency department (ED) and urgent care utilization, and redirect patients to the primary care clinic


OD 9, IT-9.2.a -ED visits per 100,000

Specialty Care Physician

Expansion 183086102.1.2

• Expand number of specialty providers and clinic hours for highest demand specialties (breast, cervical, and colorectal cancers)

• Install new specialty diagnostic system• Promote early diagnostic and screening services

for at-risk patients


• OD 12, IT-12.1 - Breast Cancer Screening

• OD 12, IT-12.2 - Cervical Cancer Screening

• OD 12, IT-12.3 - Colorectal Cancer Screening


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http://lrhealthcare.com/



Scott & White LlanoClick on the Project ID to View the Project Narrative2

Contact Information:Eric Looper, President 830-201-8671, [email protected] 200 West Ollie Street, Llano, Texas 78643Visit WebsiteIGT Funding: Llano County



Reduce Emergency Transports

183086102.2.1

• Reduce inappropriate utilization of emergency medical services (EMS) and emergency department (ED) services by high-utilizers

• Allow EMS and ED to be readily available for responding to emergencies and transferring patients to higher levels of care outside the county quickly when needed



Reduce ED Transports for those Patients

with Behavioral Health Needs

183086102.2.2

• Reduce inappropriate utilization of EMS and ED services by identifying those patients with behavioral health needs and addressing care before crises occur

• Reduce need for Sheriff Department deputies to transfer individuals to behavioral health facilities in other counties




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http://www.sw.org/location/llano-hospital



Scott & White MemorialClick on the Project ID to View the Project Narrative2

Contact Information:Candice Gourley, Vice President Surgical Services254-724-5395, [email protected] 2401 South 31st Street, Temple, Texas 76508Visit WebsiteIGT Funding: Bell County



Patient Navigation137249208.2.1

• Provide patient navigation services and link patients with the right care, at the right time, in the right setting

• Reduce avoidable emergency department visits


OD 9, IT-9.2.a - ED visits per 100,000


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http://www.sw.org/location/temple-hospital


Seton Medical Center Harker Heights Click on the Project ID to View the Project Narrative2

Contact Information:Zach Dietze, Assistant Administrator 254-680-6207, [email protected] 850 West Central Texas Expressway, Harker Heights, TX 76548Visit WebsiteIGT Funding: Bell County



Expand Access to Primary Care

013122392.1.100

• Increase primary care clinic visits by hiring additional primary care providers

• Reduce inappropriate utilization of the emergency department by providing preventive care in the right place, at the right time, in the right setting

• Reduce unnecessary healthcare expenses


OD 1, IT-1.11 - Diabetes care: BP control (140/90mm Hg)


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http://setonharkerheights.net/


Seton Highland Lakes HospitalClick on the Project ID to View the Project Narrative2

Contact Information:Denise Watson, Director – Managed Services Organization 512-715-3100, [email protected] P.O. Box 1219, Burnet, TX 78611Visit WebsiteIGT Funding: Burnet County



Patient Navigation094151004.2.1

• Enroll patients in a medical home program with dedicated home health

• Manage long-term relationships with patients and their families through care coordinators

• Provide patient education about appropriate disease and prescription self-management




• OD 6, IT-6.1.a.v - HCAHPS communication about medicine

• OD 9, IT-9.5 - Reduce low acuity ED visits


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http://www.seton.net/locations/highland_lakes/


St. David’s Round Rock Medical CenterClick on the Project ID to View the Project Narrative2

Contact Information:Cindy Sexton, Vice President/Chief Financial Officer512-482-4162, [email protected] 18th Floor, 98 San Jacinto Blvd, Austin, TX 78701Visit WebsiteIGT Funding: Williamson County



Expand Access to Primary Care

020957901.1.1

• Expand availability of primary care services to target low income population that do not have existing health coverage

• Educate patients about managing existing chronic conditions




OD 9, IT-9.2.a - Emergency Department (ED) visits per 100,000


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http://www.stdavids.com/locations/st-davids-round-rock-medical-center


Williamson County and Cities Health DistrictClick on the Project ID to View the Project Narrative2

Contact Information:John Teel, Executive Director512-943-3610, [email protected] 100 West 3rd Street, Georgetown, TX 78626Visit WebsiteIGT Funding: Williamson County and Cities Health District

1 2 3View page:



Expand Access to Primary Care126936702.1.1

• Increase access points to care• Increase availability of same day and next-

day appointments• Offer enhanced level of preventive health

services• Provide preventive care in the right place, at

the right time, in the right setting


• OD 6, IT-6.2.a - OD Client Satisfaction Questionnaire 8 (CSQ-8)• OD 15, IT-15.6 -

Chlamydia screening in women

Community Paramedicine

Program126936702.1.2

• Implement community paramedicine in rural communities

• Increase number of patients connected to a medical home

• Reduce unnecessary emergency department visits and non-emergency medical service calls


OD 3, IT-3.2 - CHF 30-day readmission rate


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http://www.wcchd.org/



1 2 3View page:

Williamson County and Cities Health District 2Click on the Project ID to View the Project Narrative2



Collect and Utilize REAL

Data to Better Serve

Population 126936702.1.3

• Enhance and improve quality and consistency of public health REAL data (race, ethnicity, gender, and language)

• Collect and interpret data to inform policy decisions focused on reducing health disparities

• Enhance information technology infrastructure for public health system to improve ability to exchange data


• OD 1, IT-1.29 - Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents

• OD 15, IT-15.6 - Chlamydia screening in women

• OD 12, IT-12.11 - Percentage of adolescents 13 years of age who had three doses of the human papillomavirus (HPV) vaccine by their 13th birthday

Patient Navigation

126936702.2.1

• Provide navigation services to persons with targeted chronic conditions, or pregnancy, to prevent hospital admissions and readmissions

• Increase number of patients establishing a medical home

• Increase patient satisfaction with receiving timely care, appointments, and information


• OD 6, IT-6.2.a - Client Satisfaction Questionnaire 8 (CSQ-8)

• OD 1, IT-1.7 - The percentage of patients 18 to 85 years of age who had a diagnosis of hypertension (HTN) and whose blood pressure (BP) was adequately controlled (<140/90) during the measurement year


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1 2 3View page:

Williamson County and Cities Health District 3Click on the Project ID to View the Project Narrative2



Health and Wellness

Promotion Classes

126936702.2.2

• Promote preventive health awareness in community

• Offer health education classes, eligibility assistance, and case management services

• Specifically targets women of child bearing age with a high incidence rate of frequent hospitalizations for chronic conditions and/or in need of prenatal care


• OD 6, IT-6.2.a -Client Satisfaction Questionnaire 8 (CSQ-8)• OD 1, IT-1.7 - The percentage of patients 18 to 85 years of age who had a diagnosis of hypertension (HTN) and whose blood pressure (BP) was adequately controlled (<140/90) during the measurement year

Offer Wellness Classes to

Decrease Obesity 126936702.2.100

• Implement innovative, evidence-based strategies, to reduce and prevent obesity in children and adolescents


• OD 6, IT-6.2.a - Client Satisfaction Questionnaire 8 (CSQ-8)• OD 1, IT-1.29 - Weight assessment and counseling for nutrition and physical activity for children/adolescents


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