The North Carolina Health Center Incubator Program

Strengthening Ohio’s Safety Net ConferenceApril 29, 2011Benjamin Money, MPH – President & CEONC Community Health Center Association

Project Overview

North Carolina Community Health Center AssociationOur Mission To promote and support patient-governed

community health care organizations and the populations they serve.

Our Vision Every North Carolina community will have access

to a patient-centered, patient-governed, culturally competent health care home that integrates high quality medical, pharmacy, dental, vision, behavioral health, and enabling services without regard to a person’s ability to pay.

North Carolina’s Health Status

NC is ranked in the bottom third of all states for 20 years:◦ obesity◦ smoking◦ premature death◦ infant mortality

35th in overall health status

Uninsured

1 in 5 North Carolinians were uninsured 1 in 4 were uninsured for at least part of the year in

2008. Since 2000, average family health insurance

premiums have increased by 91 percent in North Carolina

The number of uninsured in North Carolina increased by 22.5% from 2007 to 2009, which was the largest percentage increase in the nation

Current estimates from Families USA project that 1,480 North Carolinians lose health coverage every week, and by the end of 2010 some 2 million people in North Carolina were uninsured.

Counties with an FQHC

• 26 Health Center Grantees, 1 Migrant Voucher Program• 136 Clinical Service Sites, 19 migrant voucher program sites• 8 Migrant Health Center Grantees• 3 Healthy Schools/Healthy Community Grantees• 4 Homeless Health Care Grantees •2 Federally Qualified Health Center Look-Alike organizations with 5 clinical service sites

Federally Qualified Health Centers Currently in NC

•400,593 patients•1,318,320 patient visits•51% of patients were uninsured (203,644)•21% of patients receive Medicaid (85,691)•94% of patients live below 200% of the federal poverty level (FPL)*•72% live below 100% of FPL•54,400 migrant and seasonal agricultural workers•6,716 homeless patients•2,873 school health patients

NC Health Center Patients (2009)

3 year trend

Year 2007 2008 2009Uninsured Patients 194,845 192,301 203,644Percentage of Patients Receiving Medicaid 20% 21% 21%Total Patients Served 380,798 389,841 400,593Total Encounters (Visits) 1,222,899 1,255,741 1,318,320Total FTEs 1,890 2,048 2,183Bureau of Primary Health Care Grant Funds (millions) $47.5 $51.2 $52.8

$11 billion in new, dedicated funding for the Health Centers Program over five years.

$9.5 billion ◦ fund new health centers for communities in need◦ expand capacity at existing health centers

By 2015, health centers to double current capacity to 40 million patients.

The remaining $1.5 billion in capital funding will allow health centers to modernize aging buildings and build new facilities to serve more patients.

Affordable Care Act

Federal Fiscal Year

New Section 330 Funding

25% Available for New Starts/New Sites

Prior Grant Success Rate (3% of all Funding)

Total Grants based on Prior Allocation

2011 $1,000,000,000 $250,000,000 $7,525,000.00 12

2012 $200,000,000 $50,000,000 $1,505,000.00 2

2013 $300,000,000 $75,000,000 $2,257,500.00 3

2014 $700,000,000 $175,000,000 $5,267,500.00 8

2015 $1,400,000,000 $350,000,000 $10,535,000.00 16

Potential Grant Awards

Resources:$400,000 grant from the Kate B. Reynolds Charitable Trust to NCCHCA for 18 month initiative

Goal: Establish health center sites in needy counties through organizations prepared to develop high quality and sustainable projects.

Emphasis: Collaboration among safety-net providers within communities to make successful application for funding.

Format: Trainings, on-site technical assistance, professional grant writing

NC Health Center Development Incubator Program

Collaborative Partners

Collaborative Networks

High Need Counties

High Need, Under Served Communities Readiness (Compliance with Program Model) Collaboration within Communities

◦ BPHC Emphasis Collaboration within Safety-Net Collaboration with Critical Access Hospitals

Defining Priority Applicants◦ Limitation of Grant Writing Resources◦ 2 Cohorts ◦ Regional Training – FQHC Look-alike Application

Preparation

Prioritizing Projects

March 26, 2010◦ Health Department 17◦ State Organization 14◦ FQHC 13◦ Private Organization 12◦ Rural Health Clinic 7◦ Free Clinic 7◦ Hospital 6◦ Hospital Affiliate 2◦ School-based Clinic 2◦ Association 2◦ FQHC Look-Alike 1◦ Other 1◦ TOTAL 84

Introductory Webinar: Program Expectations and Performance Measures (Hosted by Care Share Health Alliance)

April 7, 2010◦ Health Department 27◦ Private Organization 6◦ FQHC 3◦ Hospital Affiliate 3◦ Rural Health Clinic 2◦ Hospital 2◦ Other 2◦ Free Clinic 1◦ State Organization 1◦ TOTAL 47

Hospital & Health Department Conference Call

April 15, 2010 ◦ Free Clinics 15◦ Private Organization 5◦ FQHC 3◦ Health Department 3◦ Hospital Affiliate 2◦ Rural Health Clinic 1◦ TOTAL 29

Free Clinic Conference Call

April 19-20, 2010◦ FQHC 8◦ Health Department

4◦ Rural Health Clinic

4◦ Free Clinic

2◦ Hospital

2◦ Private Organization 2◦ Hospital Affiliate

1◦ School-based Clinic 1

◦ TOTAL 24

Regional Training – Winston Salem

April 26-27, 2010◦ Health Department 6◦ FQHC 6◦ Rural Health Clinic 5◦ Hospital 3◦ Free Clinic 3◦ FQHC Look-Alike 1◦ TOTAL 24

Regional Training – Greenville

– June 11-12, 2010

◦ Pre-application clinics for Cohort #1◦ Section 330 Grant Workshop conducted by◦ Pam Byrnes (NACHC) and Tanya Bowers (BPHC)◦ Clinical Quality◦ Meaningful Use

NCCHCA Annual Meeting & Conference

Incubator Participants eligible to receive: $10,000 Scholarship for Grant Writing

Services Contingent on participation in Incubator

Trainings Installments

◦ $3,000 at initiation of contract◦ $3,000 after narrative completion◦ $4,000 upon submission

Full copy of Grant required for final installment

Grant Writing Support

Review Criteria

1. Need2. Response3. Collaboration4. Evaluative Measures5. Impact6. Resources/Capabilities7. Support Requested8. Governance

New Access Points (NAP) Guidance Issued August 9, 2010

January 29, 2011—This one-day interactive training covered the program requirements of a Federally Qualified Health Center (FQHC) and provided board members the tools needed to fully understand their role.

Facilitated by a retired health center CEO and current field reviewer of FQHC program administration and governance for HRSA.

Training included◦ overview of the FQHC program◦ role of the board◦ recruitment of board members◦ ethics◦ strategic planning◦ board’s authority◦ board composition◦ conflict of interest ◦ ready-to-use tools, resources and forms

49 total attendees, 3 from Rural Health Centers, 8 from a Hospital affiliated organization, 37 from Community Health Centers, and 1 from a Free Clinic.

Repeated February 26, 2011—44 total attendees, 9 from Rural Health Centers, 22 from Community Health Centers, and 13 from Health Departments.

Community Health Center Governance Training

February 3 & 4, 2011 Chronic disease management Quality Improvement 174 total attendees, 6 from Rural Health

Centers, 19 from Hospital affiliated organizations, 37 from Community Health Centers, 14 from Health Departments, and 2 from Free Clinics.

Janet Reaves Memorial Conference on Clinical & Quality Care

February 17, 2011 Facilitated by NC Division of Medical Medicaid site certification Provider enrollment 35 total attendees, 4 from Rural Health

Centers, 2 from Hospital affiliated organizations, 19 from Community Health Centers, 1 from a Health Department and 1 from a Free Clinic.

Site Certification & Provider Enrollment Webinar

March 2 & 3, 2011 Facilitated by Priority Management Group, BKD, NC AHEC Regional

Extension Center, NCHIMA. RSM McGladrey 2-day workshop included the key components for a financially

successful health center.  Designed for Chief Operating Officers as well as other Executive

Management, billing staff, and front desk staff, this innovative seminar provided clear strategies to maximize health center’s resources and productivity. 

Sessions on Billing & Coding, Optimizing the Billing Process, Performance Indicators & Benchmarks, Medicaid Cost Reporting, Financial Grants Management and Patient Centered Medical Home.

47 total attendees, 4 from Rural Health Centers, 8 Hospital affiliated organizations, 23 from Community Health Centers, and 5 from Free Clinics.

Financial Management and Operations Workshop

March 7, 2011 Presented by the Division of the North

Carolina Department of Insurance. Overview of Medicare and SHIPP program 30 total participants, 2 from Rural Health

Centers, 2 from Hospital affiliated organizations, 20 from Community Health Centers, 2 from Health Departments, and 1 from a Free Clinic.

Seniors' Health Insurance Information Program (SHIIP),

April 1, 2011- Presented by Capital Link 1-day seminar focusing on developing a

successful FIP project and application  updates on HRSA funding, and the three main

components◦ 1) Market and need assessment ◦ 2) Operations and facilities planning ◦ 3) Financing structure (Using New Market Tax Credits,

HRSA loan guarantees, USDA financing, Tax exempt bond financing, Bank financing, and Foundation financing)

8 participants representing 4 health centers attended.

Facility Improvement Programs (FIP) Training

Results/Impact

TOTAL APPLICANTS

Health Center Program Number of Applicants in North CarolinaCommunity Health Centers 27Health Care for the Homeless 2Migrant Health Centers 4Public Housing Primary Care 2Existing/New Start

Exsting CHCs 16New Starts 14

New Access Point Development 2011

Potential Impact 25 new counties served in North Carolina –

bringing the total counties with an FQHC up to 68

A total of $40.3 million in HRSA funds requested by North Carolina’s applicants.

Potential for 308.5 FTE jobs created

Health Center Planning Grants Collaboration with NC Care Share Health

Alliance 3 organizations representing 6 counties

applied

Golden LEAF Foundation ◦ established in 1999 with funds from the Tobacco

Master Settlement Agreement◦ support economically-distressed, rural, and/or

tobacco-dependent communities◦ earmarked $1 million for the Rural Hope Initiatives

Funders collaborative including Kate B. Reynolds Charitable Trust

enable better care delivery create jobs by assisting in the construction and

expansion of rural health care facilities Incubator participation used as leverage by Rural Hope

applicants

Leveraged Funding

Lessons Learned

What worked Collaboration with Safety-net partners Promulgating models of collaboration Partnering with a neutral convener - (Care

Share Health Alliance)

Contract with participants directly for grant writing scholarships conditional on participation.

Collaboration with local health director’s association regarding public entities at the onset of the project.

What we would do differently

New Directions

July 17th – Tornados Ravage North Carolina

April 12, 2011 – Budget Compromise Ravages Health Center Funding

$600 million cut from health center funding Health Center Trust Fund may be used to

“back fill” base funding. Perhaps $100 million available for New

Access Point Funding?

Continued Collaboration and Support Training & Technical Assistance Diagnostic and Re-application Clinic for

unfunded applicants Parallel FQHC Look-alike applications Focus on Meaningful Use and Patient

Centered Medical Home Development Grassroots Advocacy

Next Steps