Aligning Forces Humboldt supports a variety of people through its projects, from patients and community groups to hospitals and health care providers. It works in close partnership with the California Center for Rural Policy, the Humboldt-Del Norte Independent Practice Association (IPA) and St. Joseph Health – St. Joseph Hospital.
The California Center for Rural Policy at Humboldt State University is a research center committed to informing policy, building community, and promoting the health and well-being of rural people and environments.
St. Joseph Health – St. Joseph Hospital runs the Care Transitions Program to assist people during times of transition between hospital and home. The program offers individual coaching and interventions to select populations of patients with an overall goal of providing individuals the tools needed to become active partners in their health management, especially during times of transition between health care settings. Medication self-management, personal health record keeping, disease process education, support for follow-up visits and respite housing are some of the interventions provided.
The Humboldt-Del Norte Independent Practice Association (IPA) is a network of health care providers bringing quality health care to Humboldt & Del Norte Counties. The IPA leads several projects, including:
- The Primary Care Renewal project is a local collaborative of 11 teams from primary care, internal medicine, and pediatric offices working together to transform their practices. In these practices, patient partners collaborate with physicians, nurses, and other personnel to identify strategies to improve quality and the patient experience.
- Priority Care is a new approach through the IPA where nurses work with patients, their doctors, and health care practitioners to better meet patient needs. The goal is to customize and coordinate patients’ health care to fit their specific needs so they get the right care at the right time in the right way.
- Care Improvement meetings are led by the IPA and involve representatives from Aligning Forces Humboldt and other representatives of the local health care community. This bi-monthly meeting focuses on community-wide health issues, determining where collaboration can occur, and how efforts can align across organizations.
- The Community Care Resource Group is a local group for care coordinators aimed at improving coordination across the county. These groups are led by the IPA and care managers from primary to specialty care, social services, and disease specific groups participate.
Several projects involve multiple partners and focus on the development of new relationships to provide better quality care for community members. These include:
- The Care Coordination for Emergency Department Super-Utilizers project is developing a community-based, multi-disciplinary team. Priority Care and Care Transitions programs are taking the lead, providing case management and care coordination, working closely with select Emergency Department staff and primary care providers. The team will study the unnecessary overuse of local emergency departments by selected patients and focus on maximizing appropriate care. This project is funded by the Robert Wood Johnson Foundation.
The Surgical Rate Project is an initiative to examine certain preference sensitive procedures in Humboldt County. The procedures being studied often have alternative treatments, but the patient or doctor may choose one treatment over the other. Humboldt County has high rates for certain procedures. As part of this project, Aligning Forces Humboldt, the California Center for Rural Policy, and the IPA are convening physicians, hospitals, patients, and employers to understand these variations. The project is funded by the California Health Care Foundation and the Robert Wood Johnson Foundation.