WYTHE-BLAND MOBILE MEDICAL CLINIC

Mount Rogers Health District

Scott Honaker Marlene Peters Anna Stevens

VA2 BLUE COHORT

HEALTH WORKS FOR EVERYONE

Mount Rogers Health District Wythe and Bland Counties, Virginia

EXECUTIVE SUMMARY

One of the major barriers to health care in Southwest Virginia according to Health Care Access in Southwest Virginia (2001) is a “lack of coordination for resources and services.” Our plan provides coordination of resources currently available in Southwest Virginia by bringing needed services to the worksite through the use of a mobile medical clinic and by making appropriate referrals to other health care providers and agencies in the communities of Wythe and Bland Counties. Only one of the sixty-eight industries in the target location provides medical care (other than emergency and first aid) at the worksite. Most industries have to seek educational and training resources to meet Occupational Safety and Health Administration (OSHA) requirements from outside the geographic area at great expense, or do not have the means to meet these requirements. While health insurance is available to the majority of industries in Wythe and Bland Counties, not all employees are enrolled in a health plan, and most industries do not encourage time away from work to receive routine health exams. Thus many employees receive no preventative health care or education. Lack of preventative health care and education contributes to the high disease death rate for cardiovascular (heart disease), cerebrovascular (stroke), malignant neoplasms (cancer) and diabetes for these two counties. Over the past 15 years, the Mount Rogers Health District Wellness Team has provided prevention-focused education programs and limited health screenings at eleven of the sixty-eight industries in Wythe and Bland Counties. This program has been beneficial in educating and screening employees with minimal loss of production time. Improvements in health and lifestyle have been demonstrated. Wellness Team statistics show a 5-10% improvement in annual screening rates for participating industries. However, because the majority of worksites have no available space to use for medical screenings, these efforts have only scratched the surface of need. Our plan is to purchase a fully equipped mobile medical unit which will be staffed with a nurse practitioner, nurses, and support staff, and be available to the industries and worksites in Wythe and Bland Counties on a published, rotating schedule. While industries will be the initial focus, future plans include expanding services to local agencies and small self-employed businesses. We anticipate long-term success since there is an on going need for screening and educational services to be provided on site. We will seek reimbursement for services through the industry or business’ health plan, and through mutual contract with each industry, agency and business. We will make the mobile medical unit and staff available in the community for special health screenings and health fairs. Using fee-for-service, the mobile medical clinic will be self-supporting after the first year.

TABLE OF CONTENTS

I. DEFINITION OF THE PROJECT PAGES 1-3 II. INDUSTRIAL ANALYIS PAGES 3-4 III. TARKET MARKET DEMOGRAPHICS PAGE 4 RISK GROUPS PAGE 5 NEEDS ASSESSMENT PAGE 5-6 TRENDS PAGE 6 IV. COMPETITION PAGE 6 PARTNERS PAGES 6-7 V. MARKET STATEGY MESSAGE PAGE 7 MARKET PENETRATION PAGE 7 DIRECT MARKETING PAGE 7 MEDIA PAGE 8 VI. PROJECT OPERATIONS AND MANAGEMENT KEY PERSONNEL PAGE 8 ADMINISTARTIVE OVERSIGHT AND

PROGRAM MANAGEMENT PAGE 9 EQUIPMENT AND SUPPLIES PAGE 9 INFORMATION MANAGEMENT PAGE 9 VII. IMPLEMENTATION PLAN AND TIMELINE PAGE 10

VIII. RISKS AND EXIT PLAN RISKS PAGE 10 EXIT PLAN PAGE 10 IX. FINANCIALS PAGE 11 KEY BUDGET ASSUMPTIONS PAGE 11 CASH FLOW STATEMENT PAGE 11 FIVE YEAR BUDGET PROJECTIONS PAGE 12 X. APPENDICES APPENDIX I PAGES 13-15 APPENDIX II PAGES 16 APPENDIX III PAGES 17-19 APPENDIX IV PAGE 20

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DEFINITION OF THE PROJECT The mission of the Health Works for Everyone Project is to increase access to preventative health care for employees and citizens living in the Communities of Wythe and Bland Counties of Southwest Virginia. The goals of Health Works for Everyone are

• to improve the death rate statistics for cardiovascular, malignant neoplasm, cerebrovascular and diabetes

• to improve OSHA compliance for employers in the communities of Wythe and Bland Counties.

The Health Works for Everyone Project will address the need to coordinate services and resources in Wythe and Bland Counties, beginning with the worksite needs for annual OSHA training and compliance. The ability to assist the industrial sites in meeting this yearly requirement (or risk serious monetary fines) will open the door to providing preventative health care for industry employees. The establishment of a mobile medical clinic will enable expansion of services to industries, businesses and agencies that do not have facilities conducive to the confidential nature of health screenings and testing. In particular, the ability to provide respiratory services associated with fit testing and pulmonary function testing, as well as hearing screening (required by OSHA for many industries) will be especially helpful, since those services are identified as difficult to obtain in this geographic location. The mobile medical clinic will allow three to four patients to be seen at the same time, at different stations. Initial contact has been made to the sixty-eight industries in Wythe and Bland Counties through a survey designed to assess the availability of health insurance, medical services available on site, and interest in receiving preventative screenings, education and training. Eighty percent of the surveys returned to date indicate a strong interest in receiving these services. (Survey, Appendix I) Health Works for Everyone is an expansion of the small-scale wellness program currently serving eleven of the industries in Wythe and Bland Counties. This program has proven effective, and has been very highly accepted due to the reduced loss of production time. Testing currently offered includes height and weight, cholesterol, blood pressure, PSA and blood sugar. Additional screenings will include: bone density, skin cancer, colo-rectal cancer, blood profile, adult immunization, complete physicals, pap smears, sexually transmitted diseases, breast exam, birth control, audiometric and visual screening, pulmonary function studies, and fit testing. The following measurable objectives will insure that our mission and goals are met: Objective 1: By the end of the first year, the number of employers using Health Works for Everyone

will have increased thirty-three percent (33%) over the eleven industries in the current Mount Rogers Wellness Program. (Fifteen industries will be participating in the program.)

Objective 2: By the end of the first year, fourteen additional screenings and services will be offered

to each work site, over the current core services (blood pressure, height, weight, cholesterol, PSA, blood sugar and vaccination) and a total of 5000 screening procedures will be completed

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Objective 3: Time away from the worksite for medical appointments will be decreased by ten percent (10%) based on each worksite’s records for the previous year.

Objective 4: By the end of the first year, all staff at participating worksites will have received OSHA

health and safety education and screening per the industry specific annual requirements. Objective 5: By end of first year, protection against vaccine preventable communicable disease for all

employees will improve by fifty percent for all participating industries and worksites, measured by the rate of employees with up to date immunizations.

Objective 6: For each participating employer, an initial risk assessment will be completed on

employees, setting a baseline for risk of diabetes, cardiovascular disease, cancer and stroke. Annual reassessment and screening results will be used to determine effectiveness of preventative education. Annual re-screening will show a 5-8% improvement in results.

We will work with the Wytheville and Wythe-Bland Chambers of Commerce to encourage participation by all worksites. The Mount Rogers Wellness Team has the experience to initiate Health Works for Everyone and will provide the initial staffing. Employees from the Wythe and Bland County Health Departments will work with them to establish a rotation schedule based on the individual needs and contracts of each worksite. We anticipate that the unit will be used 3-4 days per week initially, increasing as demand increases. The ability to use current staff to initiate the program will enable delaying hire of additional staff until the program is up and running. Anticipated staffing needs include a nurse practitioner, two nurses (one of whom will be the coordinator), a health educator and support personnel. A brochure will be used to present the available services to each employer and the employees. (Brochure, Appendix II) Employers and employees will be given options for both services and methods of payment. For example, if an industry is only willing to purchase services related to OSHA requirements, but is willing to allow employees the option to purchase family planning services also, we will be able to work out an agreement to individualize services provided. The nurse coordinator will serve as liaison between the clinic and the on-site contact to insure proper coordination of services, both in pre-clinic scheduling and in post-clinic referrals to medical providers. She will provide information regarding the services available and what the patient will need to bring to the clinic for medical and billing purposes. Office services staff will work with the on-site contact to schedule appointments. Depending upon the services purchased by employees and employers, we expect to serve between thirty and forty patients per day. The numbers per day will decrease if all scheduled services include complete physical exam and counseling, and would increase if simple screening(s) and immunizations are the primary service being provided. We expect that there will be a variation in scheduling and staffing needs between work sites. Clinic hours will be determined by each agency, industry or organizations needs. The mobile clinic will operate in shifts when needed. Once coordination of services for a clinic has been completed between the nurse coordinator and the on-site contact, and the expected number of patients to be served has been determined, the date(s) for the clinic will be scheduled. The mobile medical unit will be taken to the site, and ready to go at least thirty minutes prior to the established clinic time. If more than one day has been scheduled in sequence at any site, the unit will remain at the site through the final scheduled date.

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Funding for Health Works for Everyone will be generated from a variety of sources and stakeholders. Application will be made for grant funding from the Wythe-Bland Community Foundation to purchase the mobile medical unit. Funding and partnerships will also include the Rural Development Community Facilities Loans and Grants. Operating expenses, including salaries, will be generated from fees for service. The customer geographic focus will be Wythe and Bland counties in Southwest Virginia. INDUSTRIAL ANALYSIS Health Works for Everyone is a public health and business venture that will compete in the industry of preventative health care. A shortage of programs that bring preventative, screening and educational services to the worksite creates a market niche that we intend to target with Health Works for Everyone. We are unable to locate another preventative health entity in the Southwest Virginia area that provides all of the services planned. Nationally, the health care industry provides services to a very diverse population in a multitude of community and professional settings. Community settings include both specialty and generalized care hospitals, private physicians for profit, and not-for-profit facilities and clinics, as well as industrial sites. Regulations for the health care industry include the Joint Commission of Accreditation of Healthcare Organizations, Medicare, Medicaid, CLIA and OSHA (Occupational Safety and Health Administration). Regulatory agencies assure that the industry is maintaining compliance with health and safety issues. OSHA standards are set forth in Title 29 of the Code of Federal Regulations (CFR). Regulations can be found in Parts 1904, 1910 and 1926. Failure to comply with the standards can result in fines up to $70,000, depending on the severity of the violation in terms of potential harm to workers. OSHA’s mission is to assure the safety and health of American workers by setting and enforcing standards to prevent work-related injuries, illnesses, and deaths. Since OSHA was created in 1971, work-related deaths have decreased by 62% and work related injuries have decreased by 42%. Each industry must have customized safety and health policies that are specific to the product or service that they provide. Requests for assistance in meeting compliance for respiratory protection policies, hearing conservation policies, and blood borne pathogens policies have been made by the industries and worksites in our target area. Providing those services on site will enable the industries to efficiently and economically meet the required standards without having to send employees to health care sites that are over an hour away. In the Wythe and Bland communities of Southwest Virginia, health care is provided by one community hospital, eight private medical practices, two local health departments and one free clinic which operates three days per week for individuals with no income.

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In the occupational health care industry, only large companies are able to employ on-site occupational medical staff. Of the sixty-eight industries in Wythe and Bland Counties, only one has a nurse on staff. Thus there is a significant need in the community to provide worksite preventative health care, education and OSHA training requirements. Through our Wellness Team’s partnership with employers and our survey responses, we know that there is enthusiastic support of our project to obtain a mobile medical unit. TARGET MARKET The Health Works for Everyone mobile medical clinic will target the industrial workforce in Wythe and Bland Counties. After the program has been successfully initiated, we propose to expand the target population to include government, non-industrial businesses and self-employed individuals in the same area. Demographics The Wythe and Bland County areas of the Mount Rogers Health District are largely comprised of middle to lower income populations. For Wythe County, data from the 2000 Census shows a population of 27,599 with 11,511 households and a median household income of $32,235. Bland County has a population of 6,871 with 2,568 households and a median household income of $30,397. Both of these household income figures are significantly below the Virginia median household income of $46,677. Employee income is mainly derived from worksite production. Wythe County has 716 non-farm establishments that employ 8,922 people (nearly 33% of the county population - 2000 census data). Bland County has 93 non-farm establishments that employ 1,231 people (nearly 18% of the county population – 2000 census data). As of September 2005, 2,686 people work in the 58 industries listed with the Wythe County Chamber of Commerce. 829 people work in the 10 industries on the Bland County Chamber of Commerce list. A breakdown by number of employees shows Wythe County has 42 industries with 1-49 employees, 10 industries with 50-100 employees and 6 industries with more than 100 employees. Bland County has 6 industries with 1-49 employees, 2 industries with 50-100 employees and 2 industries with more than 100 employees. All the listed industries were OSHA compliant at the time of their last survey. Contact with the Virginia Department of Labor and Industry (VDLI) confirmed the industries compliance. Any open or closed OSHA cases may be viewed on the OSHA website at www.osha.gov by clicking inspection data, establishment search, name and state. The remainder of the employed population works for government agencies, the Wythe County Community Hospital, in retail sales or non-industrial businesses, the food and lodging industry, or are self employed Risk Group A survey distributed to those industries listed with the Wytheville-Wythe and Bland County’s Chamber of Commerce reveals that all responding industries offer some type of health plan. However, fifty-three percent (53%) do not elect to participate in the health plan offered. The low ‘take up’ rate of participation in a health plan is two fold. Often, in order for an industry to offer coverage, the health plans will have very high premiums to offset costs. This inversion of high premiums for low health coverage becomes more evident in smaller industries. To compound this situation, the hourly wages or salaries of many industry workers is often modest. Under these circumstances, household budgets and family priorities competing for limited funds place health coverage into a low priority. Furthermore, industry data for lost time due to illness and medical appointments shows a range from 10 days in smaller industries to almost 2000 days in the larger industries. (See Survey, Appendix I).

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Labor Department data from the National Compensation Survey 2005 shows that industrial workers have access to healthcare benefits 59% of the time in small (1-99 employees) industries and 84% of the time in larger (100+ employees) industries. Furthermore, the ‘take up’ rate for those industry workers to participate in a healthcare plan is only 73-77% respectively. Additionally, the Virginia Health Access Survey 2001 by the Virginia Health Care Foundation estimates that 20.4% of the overall Southwest Virginia population is uninsured. This is significantly higher than the Virginia state average of 14.9% uninsured. It is evident from a public health viewpoint that workers in this target market are at elevated health risk. Screenings and education promote healthy employees and help to provide stability for the employer and the community. Needs Assessment Health risk of the industrial work force mimic that of the community. Virginia Department of Health (VDH) statistics show the death rates for cardiovascular, malignant neoplasm, cerebrovascular and diabetes to be 50% to over 100% higher in Wythe and Bland Counties than the statewide average. It is thus a reasonable assumption that the work force in these two communities are at much greater risk of developing illness in one of these four major areas. By providing prevention screenings and education at the worksite, we plan to improve the statistics in these specific disease areas. The VDH table below illustrates these numbers; Disease Death Rate/100,000 Bland Co. Wythe Co. Virginia Cardiovascular (heart disease) 373.0 297.0 198.9 Malignant Neoplams (cancer) 201.0 218.0 185.4 Cerebrovascular (stroke) 57.4 93.1 53.0 Diabetes Mellitus 43.1 71.6 21.4 The Mount Rogers Health District Wellness Team has responded, in some measure, to eleven of these sixty-eight industries that have requested wellness screening for their employees over the past fifteen years. The screenings generally entail height/weight, cholesterol, blood pressure, PSA and blood sugar. These screenings have proven beneficial to industry because having the wellness screenings conducted at the facility allows for less time away from production and also provides the employees with a service for improving their health and lifestyle. Records at the Wythe and Bland County Health Departments indicate that the vast majority of those workers in the target market who have received screening services at the work site would not have taken the initiative to go to the local health department for these same services. Many workers do not view these screenings as high priority. Currently, these screenings contribute to the fundamental concept that the employees are receiving some level of health care. According to Health Care Access in Southwest Virginia (2001), one of the major barriers is a “lack of coordination for resources and services,” creating a gap in health care availability for target population. Health Works for Everyone proposes to bridge this gap by providing services on site. Health Works for Everyone will also be attractive to industry by enhancing ability to meet OSHA safety and health requirements adding a component to the industry’s safety plan which could lower insurance costs. The benefits to industry from a health workforce have been published in many articles and written by both private firms and government agencies. The Health and Safety Executive, the United Kingdom’s version of OSHA, devotes an entire web site to the costs associated with absenteeism and ill health of workers. http://www.betterbusiness.hse.gov.uk/ provides employers with resources to improve work place safety and health. The agency also gives employers the rationale to invest and maintain healthy workers by identifying costs in insurance, medical, and replacement workers as well as the damage

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that the industry may suffer from production delays, reputation among their peers and the ultimate consequence – production shut down and closure. Trends Failure to provide the community with a healthy workforce can have adverse effects that can resonate throughout the community and beyond. Preventative healthcare screenings can reduce the cost of long-term care of diseases that were not detected early. Medical literature shows that early and episodic intervention prevents more costly or injurious disease progression. These effects range from a worker needing time away from the workplace for follow-up treatment to the total loss of ability to sustain productivity. Therefore, employers stand to lose skilled workers, incur lower productivity and recognize reduced profitability due to the workforce health status. The funds expended to provide and sustain the mobile medical clinic for wellness screenings and educational programs will be dwarfed by the potential economic loss to employers should the target community’s workforce lose its efficiency due to increased illness and injury. THE COMPETITION At this time we believe that there are no competitors to provide the full range of services proposed by this mobile medical clinic. The only persons qualified to provide the services would be local physicians. Based on the current caseloads at the local practices they could not deliver the services on-site, and it is not feasible for the worksites to grant time for employees to go off-site to participate. Occupational Testing Services, Incorporated is located 150 miles from the target area and provides only select services. Mount Rogers Health District is one of the thirty-five districts under the Virginia Department of Health (VDH). The Mission of the Virginia Department of Health is “to achieve and maintain optimum personal and community health by emphasizing health promotion, disease prevention, emergency preparedness, and environmental protection”. Implementation of this mobile medical clinic and the following partnerships will increase the effectiveness of VDH to provide valuable comprehensive medical services to the citizens of the community at worksites in Wythe and Bland Counties. Partners Wythe/Bland Community Foundation – The mission of this foundation is to support the community hospital in the identification of qualified programs and projects that will contribute to the improved physical, mental and emotional health status of the citizens of the community in the service area. Rural Development Project - The mission of this project is to enhance the ability of rural communities to develop, grow and improve their quality of life by targeting financial and technical resources in areas of greatest need through activities of greatest potential. Industries - Wythe and Bland Counties have approximately 68 industries employing an average of 3,500 employees. The medical clinic will benefit employers by improving access to preventive screenings resulting in early intervention for chronic disease prevention and control which will result in less time away from work, decreased health insurance expenses, convenient and affordable availability of OSHA screening for compliance, positive morale booster for employees, positive lifestyle promotion for employees and family, and customization to the individual worksite.

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Wythe/Bland Chambers of Commerce – The Chambers of Commerce will join in this partnership to improve their ability to recruit new industries to the area and meet the needs of existing employers. Local Hospital – The local hospital will become a part of this endeavor to foster optimal health, wellness, information, prevention and treatment for our communities. This would decrease their costs associated with seeing the under-insured in the local emergency room. In addition, it would improve their image in the surrounding community. MARKETING STRATEGY Message The Mission of the Virginia Department of Health is “to achieve and maintain optimum personal and community health by emphasizing health promotion, disease prevention, emergency preparedness, and environmental protection.” Health Works for Everyone embraces this mission by providing a unique service to the industrial community in Bland and Wythe Counties. The Health Works for Everyone program provides a variety of health screening and education services that can be accessed without adversely impacting production efficiency. They enhance the overall health and well being of the industry’s workforce and reach a population that may otherwise not seek health services. This program will produce a win-win-win scenario for (1) the industry, through cost and insurance reduction, maintaining a healthier workforce, (2) the employees, through health screenings, early detection, referrals and health education and (3) meeting the mission of the health department. Market Penetration The Mount Rogers Health District plans to market Health Works for Everyone to the industrial community in Bland and Wythe Counties. There is awareness in the industrial community of the current Mount Rogers Health District Wellness Team. This awareness has forged the pathway to provide additional health services through a mobile medical clinic. The wellness team records show positive support by industry for this service. A survey by the Mount Rogers Health District in anticipation of the project has been developed and distributed to industries listed with the Wytheville-Wythe and Bland Counties Chamber of Commerce. The Chambers of Commerce have agreed to support the project. Early survey responses by industries have bolstered the support of implementing the program. More than 85% want to participate in Health Works for Everyone. Of the industry survey responses received thus far, nine industries did not previously have medical services on site. Seven of these nine industries (78%) have indicated they would like to have the mobile medical clinic provide on-site services. This early positive interest will provide a springboard for marketing to other businesses and entities where unmet health needs currently exist. Direct Marketing Upon confirmation that funding for Health Works is approved, contact will be made to directly market Health Works for Everyone to the industries of Wythe and Bland Counties. Those 11 industries currently participating in the wellness team screenings will be the first to be contacted. The remaining industries will be commensurately contacted. Direct marketing at each industry will include a Health Works for Everyone presentation by staff members of the district health department along with a brief power point presentation. A brochure (Appendix II) will also be distributed to the industry management with copies available for employees.

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Media Upon confirmation that funding for Health Works is approved, news media will be notified through press releases outlining the project as well as the time frame for startup. Pictures of the mobile medical unit will be provided to newspapers to accompany articles. As Health Works for Everyone prepares for implementation, media contacts will be invited to participate in a community ‘Kick Off’ event. A brochure (Appendix II) outlining Health Works for Everyone will be presented to media representatives from radio, television and newspapers during the Kick Off event. Community and state stakeholders representing the Wythe-Bland Foundation, health department, Chambers of Commerce, Board of Supervisors and private industry will be in attendance to answer questions. The mobile unit will be on display. PROJECT OPERATIONS AND MANAGEMENT One of the most important factors to the success of the Health Works for Everyone Program will be the employment and retention of personnel. Personnel for the clinic will include two full-time public health nurses, two full-time office services specialists and a health educator in addition to an experienced certified nurse practitioner provided by Mount Rogers Health District. Key Personnel Public Health Nurses: The nursing staff will provide professional nursing care to patients on the mobile clinic. Nurses will perform assessments, lab tests, and develop and implement care plans, including the administration of medication and case management. One of the nurses assigned to the mobile medical clinic will be a senior nurse in charge of program coordination. Health Educator: The health educator will develop, facilitate and evaluate health education programs for the clinic. This employee will work with the public health medical staff to provide appropriate materials for the program. Certified Nurse Practitioner: The certified nurse practitioner will be responsible for providing direct patient care. The services provided will include:

a. Physical examinations b. Requests and interpretations of laboratory procedures c. Development of care plans d. Referrals to specialists for identified medical needs which cannot be followed by this

program Offices Services Specialists: The office services specialists will perform program support duties for the clinic. They will schedule, register and interview patients to secure personal, financial, demographic and medical history information; determine eligibility; verify patient or third party billing; determine charges and collect payments; verify services rendered, exit patients from the clinic, and compose non-routine correspondence.

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Administrative Oversight and Program Management Administrative oversight, program management, daily operations, outcome measures, information management and equipment and supplies are also important considerations for the operation of our project. In addition to hiring and retaining key personnel, the following considerations have been made to ensure the highest level of project operations and management: Administrative oversight for the mobile medical clinic will be provided by the Management Team of Mount Rogers Health District, consisting of the Health Director, Business Administrator and Nurse Manager. The Management Team will oversee the budgetary and financial management of the program, as well as any changes in target market or service delivery. Program management will occur through close communication between the District Management Team and the Program Coordinator of the mobile medical clinic. The Program Coordinator will be ultimately responsible for program management and will serve as liaison between the mobile health clinic and the Health Department administrative staff. Equipment and Supplies Equipment and supplies are essential to the operation of this clinic. A mobile medical unit will be purchased and equipped to address clinic needs. Specifications for the mobile clinic (Appendix III) include reliable and quality instruments and equipment, and supplies will be obtained according to procurement policies and procedures of the state of Virginia. Supplies for the clinic shall be stocked in a manner consistent with their use and storage space available on the mobile clinic. The medical staff will coordinate with the office staff to maintain the proper inventory for the clinic. The office services staff will order supplies on a monthly basis; however, the medical team can request that contact be made with a specific supplier if there is a special need between regular monthly orders. Information Management Information management will be completed by using the Web VISION data processing system in place at the local health department. This system allows the District to complete data analysis and maintain accurate accounts of services rendered. Medical files will be kept on clients served. IMPLEMENTAION PLAN AND TIMELINE The implementation timeline that follows details the steps that Mount Rogers Health District will take to secure funding, purchase the mobile medical unit, hire staff, develop a schedule for daily operation and open the clinic. In the event that approval for the initial grant is not received, the Health District will reapply for grant funding in July 2006. Since the grant application was submitted to the Wythe/Bland Community Foundation, Mount Rogers Health District has been notified of the possibility of receiving a mobile unit from a local school system. The VA2 Blue Cohort will review the options available and re-apply for the full grant or a modified version allowing for the refurbishing of the existing unit.

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HEALTH WORKS FOR EVERYONE TIMELINE

Time Frame Activities September 15, 2005 – October 15, 2005. Develop specifications and receive estimated costs

associated with the medical unit. September 15, 2005 – September 30, 2005

Develop survey for industries.

October 1, 2005 – December 31, 2005 Survey industries to determine services to be provided and the numbers of participants.

January 1, 2006 – January 31, 2006 Apply for grant from Wythe/Bland Community Foundation.

April 1, 2006 – May 31, 2006 Contingent upon approval of grant, submit RFP for mobile medical clinic.

April 15, 2006 – April 30 ,2006 Based on outcome of grant application, determine the need to re-apply for grant in July. If necessary, revise grant to remodeling mobile unit that has become available through another source.

May 2006 Market the mobile medical clinic to the eleven interested industries.

June 1, 2006 – August 31, 2006 Mobile medical clinic built by contractor. June 1, 2006 – August 31, 2006 Market the mobile medical clinic to other industries

within the service area. July 1, 2006 Re-apply for grant from Wythe/Bland Community

Foundation if initial grant is declined. August 1, 2006 – August 31, 2006 Recruit/Hire Staff for mobile medical clinic. (Health

District staff will be used initially, until new staff is hired and trained.)

August 1, 2006 – August 31, 2006 Develop schedule for mobile medical clinic. September 1, 2006 Kick-0ff Event for mobile medical clinic. Begin

clinics at participating industries. (Contingent upon approval of grant.)

RISKS AND EXIT PLAN Risks Although we have determined there are no direct competitors to this program, future state level decisions could greatly impact our ability to continue this program. One such risk is that state/federal programs could increase their funding for this type of program causing an increase in participation by the private sector. In addition, a state budget crisis could result in reduced funding for services provided by the local health department. Exit Plan If the time comes when adequate wellness care services are available from the private sector to meet the medical needs of all individuals in our community, we will implement our exit plan. This exit plan would most likely include the sale of the mobile medical clinic/equipment to another state agency or a private sector practice in need of a mobile clinic. Any funds from the liquidation of assets would be used to provide similar services through the local health department to ensure the health of the community.

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FINANCIAL RESOURCES Mount Rogers Health District has been in contact with individuals associated with the Wythe/Bland Community Foundation and the Rural Development Project regarding the possibility of receiving funding for this project. Both organizations have voiced interest and strong support of the mobile medical clinic. Grant application will be submitted to the Wythe/Bland Community Foundation by February 1, 2006. Mount Rogers Health District has dedicated in-kind funds to support the project. Our financials statement will show that fee-for-service revenue will sustain our operations within the next five years. Many of the financial projections included in this section of our plan are based on information provided by other successful programs within our Health District. Key budget assumptions, including average number of appointments per day and appointment mix are conservative projections based on the experience of similar programs within the District. Key Budget Assumptions During our first year of operation, Health Works for Everyone will be dependent upon start-up grants from the Wythe/Bland Community Foundation and the Rural Development Project to provide a mobile medical unit to the Wythe/Bland area. We are confident that we can secure $365,000 grant funding to cover the $260,000 mobile unit, operating expenses and 92.67% of salaries and fringes. Mount Rogers Health District agrees to provide $12,936 of in-kind (state/local funding) to cover all expenses involved with the project the first year. Our first key budget assumption is the projected number of services we can expect to provide in a calendar year. We project approximately 4,700 chargeable services the first year the mobile medical clinic is in place (Services, Appendix IV). As the awareness of the medical clinic spreads throughout the community we project that our caseload will double by the fifth year. According to the five year budget projections, the program will experience a $4,629 deficit in year four of the project. Year four is the first year that the program is not supported by grant funding and the deficit would be virtually covered by the profits generated in years two and three ($4,192). The remaining $437 of the deficit would be covered by year five. As shown by our five-year budget projections on page 11, Health Works for Everyone will be a profitable endeavor by the end of the fifth year with a profit of $51,571. The cash flow statement below shows that we can expect to sustain our operations with a fund balance of approximately $51,134 after five years of operations.

Cash Flow Statement

Net Cash Flow Year 1 2006/2007

Year 2 2007/2008

Year 3 2008/2009

Year 4 2009/2010

Year 5 2010/2011

Opening Cash Balance $ 0 $ 0 $ 828 $ 4,192 $( 437) Cash Receipts $565,036 $305,660 $317,807 $319,892 $386,644 Cash Disbursements $565,036 $304,832 $314,443 $324,521 $335,073 Ending Cash Balance $ 0 $ 828 $ 4,192 $( 437) $ 51,134

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Five Year Budget Projections Year 1

2006/2007Year 2

2007/2008Year 3

2008/2009 Year 4

2009/2010Year 5

2010/2011REVENUES Wythe/Bland Community Foundation $340,000 $ 85,000 $ 52,500 $ 0 $ 0 Rural Development Project Grant $ 25,000 $ 0 $ 0 $ 0 $ 0 Industry Screenings Cholesterol Screenings $ 48,000 $ 60,000 $ 75,000 $ 93,760 $117,200 Respiratory/Pulmonary Screenings $ 30,000 $ 37,500 $ 46,860 $ 58,560 $ 73,200 Hearing Screens $ 21,000 $ 26,250 $ 32,820 $ 41,040 $ 51,300 Pre-employment Physicals $ 24,000 $ 26,400 $ 31,680 $ 38,000 $ 45,600 PSA Screening $ 8,000 $ 8,800 $ 9,680 $ 10,640 $ 11,720 Bone Density Screening $ 10,000 $ 11,000 $ 12,100 $ 13,320 $ 14,640 Vaccines $ 12,600 $ 13,860 $ 16,632 $ 19,950 $ 23,940 PAP/Family Planning Services $ 33,500 $ 36,850 $ 40,535 $ 44,622 $ 49,044 Mount Rogers In-Kind $ 12,936 $ 0 $ 0 $ 0 $ 0 TOTAL REVENUE $565,036 $305,660 $317,807 $319,892 $386,644 OPERATING EXPENSES Salaries Fringes: Full-time Health Educator 2 Full-time Office Services Specialists 2 Full-time Public Health Nurses * Nurse Practitioner (part-time) *One will be assigned as coordinator

$ 28,707 $ 42,758 $ 74,914 $ 12,934

$ 29,568 $ 44,041 $ 77,161 $ 13,322

$ 30,455 $ 45,362 $ 79,476 $ 13,722

$ 31,369 $ 46,723 $ 81,860 $ 14,134

$ 32,310 $ 48,125 $ 84,316 $ 14,558

VRS $ 14,195 $ 14,621 $ 15,060 $ 15,512 $ 15,977 FICA $ 12,187 $ 12,553 $ 12,930 $ 13,318 $ 13,718 Health Insurance $ 38,154 $ 39,299 $ 40,478 $ 41,692 $ 42,943 Retire Medical $ 1,657 $ 1,707 $ 1,758 $ 1,811 $ 1,865 Long term Disability $ 2,629 $ 2,708 $ 2,789 $ 2,873 $ 2,959 Advertising $ 2,000 $ 500 $ 500 $ 500 $ 500 Fuel $ 7,000 $ 7,000 $ 7,000 $ 7,000 $ 7,000 Insurance $ 600 $ 660 $ 700 $ 740 $ 780 Laboratory $ 21,601 $ 22,600 $ 24,213 $ 26,064 $ 28,192 Medical Supplies $ 16,000 $ 16,312 $ 16,320 $ 16,400 $ 16,480 Mobile Medical Unit Equipped $260,000 $ 0 $ 0 $ 0 $ 0 Pharmacy Supplies $ 15,000 $ 15,150 $ 15,300 $ 15,375 $ 15,450 Office Equipment $ 8,000 $ 200 $ 200 $ 200 $ 200 Office Supplies $ 2,000 $ 2,200 $ 2,400 $ 2,600 $ 2,800 Postage $ 1,000 $ 1,000 $ 1,000 $ 1,000 $ 1,000 Printing $ 1,000 $ 500 $ 500 $ 500 $ 500 Refuge Charge $ 300 $ 330 $ 380 $ 450 $ 500 Rent (Space at Health Department) $ 200 $ 200 $ 200 $ 200 $ 200 Telecommunications (Space at Health Department)

$ 600

$ 600

$ 600

$ 600

$ 600

Telecommunications (Mobile Unit) $ 600 $ 600 $ 600 $ 600 $ 600 Training/Conferences $ 300 $ 300 $ 300 $ 300 $ 300 Vehicle Maintenance $ 0 $ 1,000 $ 1,500 $ 2,000 $ 2,500 Utilities (Space at Health Department) $ 700 $ 700 $ 700 $ 700 $ 700 TOTAL EXPENSES $565,036 $304,832 $314,443 $324,521 $335,073

13

Appendix I Mount Rogers Health District Comprehensive Health and Wellness Needs Survey for Wythe-Bland Counties The Mount Rogers Health District, in conjunction with the Wytheville-Wythe-Bland Chamber of Commerce, Inc., is developing a plan to provide a comprehensive on-site health and wellness program to the employers and citizens of the Wytheville- Wythe-Bland Community. It is our desire to seek information from the community early in the planning stage so that we may adequately meet needs. We have prepared a short survey to assess needs and to help us determine your interest in participating in a health and wellness program. Please complete the short survey form and return in the enclosed addressed envelope BY JANUARY 24, 2006. Attention: Anna Stevens, Business Manager Mount Rogers Health District 201 Francis Marion Lane Marion, VA 24354

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APPENDIX I Health Works For Everyone Project Survey Organization/Industry/WorkSite:___________________________________________ Name of person competing survey___________________________ Title___________ Phone Number:____________________ Fax Number:_________________ E-mail Address:_________________________________________________

1. Total Number of Employees________ 2. How many are male?_______ female?________ 3. How many shifts do you have? __________ 4. Do you have an employee health plan? Yes____ No____ 5. Do all employees participate in the health plan? Yes____ No____ 6. If yes, is coverage provided for:

Annual physical exam? Yes____ No____ Women’s health exam? Yes____ No____ Wellness/prevention? (immunizations/health screenings?) Yes____ No____

7. Do employees have access to Health Care at the worksite? Yes___ No___ If yes, please define: Emergency/first aide only? Yes___ No___ Medical staff: Full time RN Yes___ No___ Part time RN Yes___ No___ All shifts? Yes___ No___ Annual Screenings by Outside Service? Yes___ No___ If yes, name of provider_______________________________________ Health service provided by private physician/group? Yes___ No ____ If yes, name of provider_________________________________ 8. How much time lost from work due to employee illness last calendar year?

________________ 9. How much time lost from work due to medical appointments last calendar year?

_________________ 10. Has your organization participated in any health improvement programs in the

past? Yes____ No____

11. If the following services were available to you and your employees, on site through a mobile medical clinic, please check the screenings, education and prevention services that you would be interested in having provided:

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12. ____OSHA training ____Pulmonary Function Test ____Fit Testing ____Blood Pressure ____Blood Glucose ____Blood Profile ____Total Cholesterol ____PSA Screening ____Colo-Rectal Screening ____Bone Density Screening ____Skin Cancer Analysis ____Hearing Screening ____Vision Screening ____Sexually Transmitted Disease Screening ____Pap Smear ____Contraceptives (Birth Control) ____Breast Exam ____Physical Exam ____Immunizations ____Prevention/ Wellness education only for any/all of the above (Prevention and wellness education is included routinely for all screening services provided)

12. Would your Organization/Industry/Worksite like to have health care and OSHA required services offered on a regular basis at the worksite. Yes____ No____ Thank you very much for taking the time to assist us in planning for the health needs of

your company and the communities of Wythe and Bland County. The Mount Rogers Health and Wellness Team

is funded by

The Wythe/Bland Community Foundation

and a

Rural Development

Project Grant

THE WYTHE-BLAND MOBLIE MEDICAL CLINIC

IS OPERATED BY

MOUNT ROGERS HEALTH DISTRICT

THROUGH GRANTS PROVIDED BY:

THE WYTHE/BLAND COMMUNITY FOUNDATION

and

RURAL DEVELOPMENT PROJECT

AND IN COLLABORATION WITH:

WYTHE COUTTY

CHAMBER OF COMMERCE

BLAND COUNTY CHAMBER OF COMMERCE

WYTHE COUNTY

COMMUNITY HOSPITAL

WYTHE COUNTY HEALTH DEPARTMENT

BLAND COUNTY

HEALTH DEPARTMENT

FOR MORE INFORMATION,

PLEASE CONTACT:

276-228-5507

OR

276-688-3642

HEALTH

FOR EVERYONE

WYTHE – BLAND MOBILE MEDICAL CLINIC

Health Works For Everyone is made possible through a grant from the Wythe/Bland Community Foundation to provide on-site health assessment services to employees and community residents in Wythe and Bland Counties. The Wythe and Bland County areas are largely comprised of middle to lower income populations; the median income in both is below the Virginia state median Employee income is mainly derived from worksite production processes. It is this workforce that the Mobile Medical Unit is targeting to increase health screenings and initiate health awareness and education programs. The Virginia Health Access Survey 2001 by the Virginia Health Care Foundation, estimated that 20.4% of the overall Southwest Virginia population is uninsured. This is significantly higher than the Virginia state average of 14.9% uninsured. It is evident from a public health viewpoint that those workers in this target market need good health screening and education to provide more stability to the employee, their families, and the community.

Eleven industries in the Wythe/Bland area have requested wellness screenings for their employees over the past 15 years and it has been proven beneficial to both employees and employers by: Providing services at the worksite,

decreasing time away from work and encouraging more participation

Increasing the number of

individuals receiving preventative screenings, exams, and health education.

Identifying and improving health-risk

behaviors Decreasing/preventing chronic

disease Improving protection against

communicable disease Assisting employees in meeting

OSHA requirements for occupational health

The unit allows three to four patients to be seen at the same time, at different stations. Staffing includes a Nurse Practitioner, two Public Health Nurses, a Health Educator, and a clerical/support person.

SERVICES

Services may be purchased and scheduled according to the specific needs of the employer and the employees. Payment will also be billed to insurance or other third party vendors when possible.

SCREENINGS INCLUDE:

BLOOD PRESSURE BLOOD GLUCOSE

TOTAL CHOLESTEROL (LDL, HDL, RATIO)

PSA RESPIRATORY/PULMONARY

HEARING PRE-EMPLOYMENT PHYSICALS

BONE DENSITY HEIGHT & WEIGHT

SKIN ANALYSIS COLO-RECTAL

BLOOD PROFILE PHYSICAL EXAMS

PAP SMEARS BREAST EXAM

SEXUALLY TRANSMITTED DISEASE FAMILY PLANNING

VISION PULMONARY FUNCTION

FIT TESTING ADULT IMMUNIZATIONS

Health education programs are also available and will be arranged to meet specific needs identified through the screening process.

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APPENDIX III Specifications 39 foot Class C General Motors Vehicle, Diesel Chassis/Automotive Unit Length - 39’ Chassis - Chevy/GMC C5500 with deluxe front appearance package Engine – Duramax 6600 V8 Turbo Diesel Horsepower 300@3000 RPM Torque LB-FT 520@1800 RPM includes auto engine shut down alarm with reset, heavy duty radiator, engine and transmission oil coolers Gross Vehicle Weight Rating – 19,500 lbs Transmission – Allison 1000 Series 5 Speed Automatic Alternator – 150 AMP (Heavy Duty) Tires – Premium Brand with highway style tread 225/7OR19.5 Brakes – Power 4 Wheel Disc, 4 Wheel ABS General Motors factory air conditioning, heat, defrost, sun visors and windshield wiper systems Steering – Power with Tilt Wheel Suspension – Tapered Multi-leaf Springs, gas shock absorbers, 7000 lbs. Rear axle Chevy/GMC: Standard Chassis Dash Instrumentation Fuel Capacity – 60 Gallons Stainless Steel wheel simulators Cruise Control/Tilt Cloth Seats Power Locks/windows AM/FM Radio with CD player with door speakers Chevy/GMC Mirrors Dual Heated & Illuminated, power with convex mirror Driver/Passenger air bags with on/off switch for passenger air bag CLASS C CONSTRUCTION FORD AND GM CHASSIS Sub-frame of 11 gauge “J” style trusses secured mechanically to vehicle frame with the use of rubber vibration and sound control dampeners. Custom grid of 2x2, 14 gauge box steel welded to trusses to form a perimeter and cross members as needed by the design of each individual coach with a maximum of 24” on center. All steps, storage boxes, generator supports and other support items are welded to the trusses. Side and rear walls are constructed of 1 ½ x1 ½ aluminum structural tubing, .060 wall thickness, welded 16 on center. The entire undercarriage is coated with premium, asphalt based, rust prohibitive undercoating designed specifically for this purpose. All openings (window, door, etc) custom framed design. Rood bows are placed 16 inches on center, directly over wall studs. Roof bows are a bowed truss constructed of 1 ½ x 1 ½ .060 aluminum and feature a flat interior and a 1” rise on the exterior to aid in water run off. All roof openings are custom framed for their intended purpose. Side walls, rear walls and roof are joined together by a continuous, aluminum, running “W” extrusion that is .090” thick.. This extrusion is welded to the walls and roof, forming a stable “uni-body” style structure. The roof and all walls are insulated with 1 ½ inch thick “insul-foam” reflective vapor barrier insulation fitted between the studs and roof bows. A dielectric barrier is utilized between all dissimilar metals. The interior and exterior walls and the interior roof are constructed of one piece seamless fiberglass panels bonded directly to the studs, bows, and running “W” with a commercial grade adhesive specifically for this purpose. Flexible plywood is bonded and mechanically fastened to the exterior roof bows. A seamless, flexible fiberglass panel is bonded to the flexible plywood to finish the exterior roof. The front, rear and skirting of the vehicle is finished with custom 10 piece fiberglass set design specifically to fit the specific chassis. These

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fiberglass pieces form a front cap, left and right down legs, rear cap as well as left and right hand skirts and wheel flairs. Each individual piece is designed to match the contours of the chassis and /or body to form a continuous, aerodynamic structure. The front cap is open on the interior to provide additional storage and can be custom configured as needed. The front cap is insulated with “astro-foil”. The rear cap features a separate (non-integral) bumper. D.O.T approved clearance, stop/turn and C.H.M.S.L. (3rd brake light) are intergraded into the front and rear cap and feature replaceable bulbs. -BROCHURES AND VIDEO CONTAIN ACTUAL PICTURES Front Bumper – General Motors Rear Bumper – Non-integral heavy duty 11 gauge S/S Interior Height – 82” (6’-10”) Interior Width – 95.5” Outside Height – 11’4” (approx. with A/C) Body Style – Square Rear Wall, uni-body Entry Door – 30” door with window & exterior “porch” light Windows with UV tint – (3) 20”x30” with sliders & screens Roof Vents – One (1) Flooring – Exterior Grade ¾ “ Plywood Insulation (all Walls, roof and Front Cap, reflective insulation with dual vapor barrier) Handrails – One (1) Entry Door Lock – F.M.V.S.S. approved with passage and dead bolt locks Exterior Color – White Electrical/Lighting Generators – (2) 7.5K ONAN Commercial Quiet Diesel with access door Coach Battery – Premium maintenance free deep cycle Gel Cell Converter/Battery Charger – One (1) 45 Amp with “smart charge” technology to allow long term float w/o over charging Shore Power Cord – Dual 50 foot 125volt 30 amp marine grade cords with dual matching 30 amp marine grade service inlets Transfer Switch System – Automatic Isolator – Heavy Duty 160 Amp (charges auxiliary battery from vehicle alternator) Interior Lighting and receptacle package – 10-14 interior outlets per design, 12 volt overhead lights with common on/off switch at entrance door. Heating/Cooling System Air Conditioners – (3) @ 13,500 BTU W/HEAT STRIPS Standard Electric Heater 21) @1500 Watt each 2 Way/3 Speed Ceiling Fan Water/Plumbing System On board fresh water capacity – one (1) Fresh water tank – (Size to be determined) Pump – 12V Shurflo with Filter Sink Holding Tanks – Grey Water (Size to be determined) Water Heater (1) Electric 4.5 gal (Point of use) Interior/Cabinetry Interior Cabinetry – Superior Anti-Rattle w/Marine grade slam shut latches (Positive latch) Multiple (TBD) All cabinetry features insets doors and drawers utilizing premium “Grass” name brand 3000 series hinges and “Grass” name brand 6000 series drawer slides. Flooring Covering – Hospital/Commercial Grade (Grey)

19

Overhead Cabinets with Easy View Plexiglas Fronts (with Lift Arm) Multiple (TBD) Countertops & Shelves (Located on floor plan-TBD) Desk Areas with chairs (strapped for mobile use) All interior cabinetry and countertops, etc. constructed from 7-ply prime grade birch plywood laminated inside and outside with easy clean plastic laminate Window Treatments – premium no-rattle pull down blinds Safety Continuous welded uni-body style construction, featuring B-pillar crumple zone technology. Fire extinguisher – F.M.V.S.S. Approved Carbon monoxide detector All wiring conforms to applicable safety standards and codes Serviceable 12 volt auxiliary main fusible link Warranties: Frame, corrosion – 5 yr. unlimited mileage GMC/Chevy – 2 yr. unlimited mileage Duramax 6600 – 5 yr. 100,000 miles Allison 1000 Trans. – 3 yr. unlimited mileage Global Mobile Shell – 12 year Cabinetry & Drawers – 5 year Other manufactured products – warranties pass through (Ex. Awning, heaters, etc) Vehicle can be serviced at most GMC/Chevy dealers. Drivers Requirements: Standard Vehicle Drivers License

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APPENDIX IV

HEALTH WORKS FOR EVERYONE SERVICES

Charge Per

Screening

Year 1 Number

of Services

Year 1 2006/2007

Year 2 Number

of Services

Year 2 2007/2008

Year 3 Number

of Services

Year 3 2008/2009

Year 4 Number

of Services

Year 4 2009/2010

Year 5 Number

of Services

Year 5 2010/2011

Industry Screenings Cholesterol $40 1,200 $ 48,000 1,500 $ 60,000 1,875 $ 75,000 2,344 $ 93,760 2,930 $117,200 Respiratory/Pulmonary $60 500 $ 30,000 625 $ 37,500 781 $ 46,860 976 $ 58,560 1,220 $ 73,200 Hearing Screens $30 700 $ 21,000 875 $ 26,250 1,094 $ 32,820 1,368 $ 41,040 1,710 $ 51,300 Pre-employment Physicals $80 300 $ 24,000 330 $ 26,400 396 $ 31,680 475 $ 38,000 570 $ 45,600 PSA Screening $20 400 $ 8,000 440 $ 8,800 484 $ 9,680 532 $ 10,640 586 $ 11,720 Bone Density $20 500 $ 10,000 550 $ 11,000 605 $ 12,100 666 $ 13,320 732 $ 14,640 Vaccines $21 600 $ 12,600 660 $ 13,860 792 $ 16,632 950 $ 19,950 1,140 $ 23,940 PAP/Family Planning $67 500 $ 33,500 550 $ 36,850 605 $ 40,535 666 $ 44,622 732 $ 49,044 Total Industry Screenings 4,700 $187,100 5,530 $220,660 6,632 $265,307 7,977 $319,892 9,620 $386,644