Case Study 5

The Power of Data: Osceola County Secures a Federally Qualified Health Center

Julia Joh Elligers

Funding for this story was provided by the Centers for Disease Control and Prevention under Cooperative Agreement Numbers 5U38HM000449-02 and HM08-80502CONT09. The contents of this document are solely the responsibility of the National Association of County and City Health Officials (NACCHO) and do not necessarily represent the official views of the sponsor.

Osceola County (Florida) has the power of data and knows how to use it to connect residents to services. With a growing population, large percentage of underserved minorities, and high rate of uninsured, Osceola County faced serious health challenges. Assessment data, strategic planning, and cooperative action have allowed Osceola County to improve access to public health services by developing a health center system and obtaining federally qualified health center (FQHC) status.

Located in central Florida, Osceola County includes Poinciana, Kissimmee, and St. Cloud, making it a popular vacation destination. While the county attracts tourists, much of the region is undeveloped. Ninety percent of the population lives on the borders of Polk and Orange Counties near Orlando, while the remainder of the area is rural.

The county has a diverse and growing population. The population grew more than 60 percent since 2000 from approximately 174,000 to over 280,000 in 2010 (Florida Charts, n.d.). Forty-two percent of the county's population is Hispanic or Latino, 40 percent of which is uninsured. Many other residents are uninsured because they do not receive health benefits as part-time employees of the tourist industry.

MAPP as the Catalyst

In an effort to meet the unique public health needs of the county's growing population, Osceola County implemented the Mobilizing for Action through Planning and Partnerships (MAPP) process. MAPP provides a framework for creating, implementing, and evaluating a community health improvement plan. Using MAPP, communities build partnerships, develop a shared community vision, and conduct a series of assessments. MAPP assessment data provide a comprehensive picture of the community's health and are used to identify strategic issues that must be addressed in order for the community to achieve its vision. Communities then formulate goals, strategies, and activities that are implemented and evaluated in an iterative MAPP action cycle. Karen van Caulil, executive director of the Health Council of East Central Florida, made the following comment in regard to MAPP:

The MAPP process is easy to understand. It has been the catalyst for moving things along and looking at them in a comprehensive way. It has been a wonderful process for being able to convene stakeholders in an organized fashion; to get information out to the community on issues and trends; and to do something about the information. Too often we do needs assessment, we present data, and then everybody stands there and says now what? The MAPP process really tells you what to do with that data. It has allowed us to really have great success in identifying initiatives that have made a difference.

Community Vision, a nonprofit organization, facilitated the MAPP process and convened representatives from different entities such as the local health department, hospitals, advocacy groups, school system, and faith-based institutions. Together, these community partners completed three iterations of the MAPP process and developed and implemented three community strategic plans over the course of ten years.

Improving Access to Care

In all three iterations of the MAPP process, access to care was identified as a major strategic issue. While assessment data consistently identified barriers to care, the assessment phase also revealed solutions. In the first iteration of the MAPP process, the county developed a specialty care network and a medical home program and decreased the number of patients using emergency rooms for primary care and ambulatory care visits. In the second and third iterations, the county built the capacity to address access to care through mobile units, a volunteer specialty network, cultural competence training and awareness, and federally qualified health centers.

The county used MAPP assessment data to increase its capacity to improve access to care. “We needed the data to describe the magnitude of the problem so that grant funding could be secured to implement these initiatives,” says van Caulil. “We certainly had compelling statistics, and we had folks who have expertise in writing grants. Now, every organization uses the data from the MAPP process for writing grants, developing initiatives, and targeting their initiatives.”

Osceola County's ability to secure federally qualified health centers was a particularly proud achievement. “Our health issue taskforce initiated a mobile medical express to increase access to remote areas. At the same time, a health center was being created in a modular building. Then, Belinda Johnson-Cornett [Osceola County Health Department director] was able to grab hold of FQHC designation and turn other health centers into FQHCs. It was a rapid fire turnover to FQHC,” recalls van Caulil.

Johnson-Cornett adds, “FQHCs are strategically placed throughout the county. The primary site was in a community that was contained. No one would go there unless they lived there. It is a forty-five-minute drive from there to our other two sites. Transportation is an issue here. Being able to expand it and move it to the other two larger communities was great.”

Furthermore, “I really don't think that the FQHC idea would have necessarily floated to the top had it not been for the MAPP process and people getting together to figure out that we need to increase access to care,” says Johnson-Cornett.

Measuring Outcomes

Osceola County is now monitoring how its hard work is improving health outcomes. Karen van Caulil shares, “Our theory is if you're offering comprehensive and high-quality care in the community and there is ample access, you won't find high rates of admission for chronic conditions in the emergency rooms and hospitals.” The county is monitoring patient health improvements over time in programs associated with conditions like diabetes and cardiovascular disease. The county has also started an emergency room diversion program and is measuring the type of patients referred, costs, retention, and how many patients get into case management programs.

Another example of how the county monitors outcomes is related to infant mortality. The county's Fetal and Infant Mortality Review (FIMR) committee, which is led by the Osceola County Health Department and includes representatives from law enforcement, social services, clinical staff, and community providers, addresses the issue of infant mortality as it relates to access to care. “We track indicators associated with infant mortality and access to care to see if we have programs to address those issues, and if we do not, we decide what we need to put into place as a community to be able to address those issues,” says Johnson-Cornett.

The Way to Get Things Done

While MAPP implementation requires resources, the process also uncovers and secures resources for health improvement. Johnson-Cornett advises:

In this particular environment, with the economy the way it is, [MAPP] is going to be the only way to get things done in your community. You're going to need to get people together, on the same page, willing to share resources and ideas. It's the shared resources that are going to get you there. Individually, it's not financially feasible for any one organization to do all these things. MAPP brings together different levels of expertise to identify where the resources are [and] the best people to provide those resources, and really pulls your community together so you are providing comprehensive care to the population you serve.

For those apprehensive about undertaking the MAPP process, van Caulil says, “There is nothing to be afraid of because the NACCHO Web site lays it out for you very easily. There are so many good case studies and tools that the process can be easily started.”

Discussion Questions