Presenter Benjamin Money, MPH, President & CEO, North Carolina Community Health Center Association, on The North Carolina Health Center Incubator Program as presented at The Strengthening Ohio’s Safety Net Roundtable April 29, 2011. For more info, visit http://www.healthpathohio.org/

1. The North Carolina Health Center Incubator Program Strengthening Ohio’s Safety Net Conference April 29, 2011 Benjamin Money, MPH – President & CEO NC Community Health Center Association

2. Project Overview

3. North Carolina Community Health Center Association Our 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.

5. 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

6. 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.

7. Counties with an FQHC

9. 136 Clinical Service Sites, 19 migrant voucher program sites

10. 8 Migrant Health Center Grantees

11. 3 Healthy Schools/Healthy Community Grantees

12. 4 Homeless Health Care Grantees

13. 2 Federally Qualified Health Center Look-Alike organizations with 5 clinical service sitesFederally Qualified Health Centers Currently in NC

15. 1,318,320 patient visits

16. 51% of patients were uninsured (203,644)

17. 21% of patients receive Medicaid (85,691)

18. 94% of patients live below 200% of the federal poverty level (FPL)*

19. 72% live below 100% of FPL

20. 54,400 migrant and seasonal agricultural workers

21. 6,716 homeless patients

22. 2,873 school health patientsNC Health Center Patients (2009)

23. 3 year trend

24. $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

25. Potential Grant Awards

26. 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

27. Collaborative Partners

28. Collaborative Networks

29. High Need Counties

30. 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

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

32. Hospital & Health Department Conference Call 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

33. 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

34. 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

35. 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

36. NCCHCA Annual Meeting & Conference – 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

37. 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

38. Review Criteria Need Response Collaboration Evaluative Measures Impact Resources/Capabilities Support Requested Governance New Access Points (NAP) Guidance Issued August 9, 2010

39. 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

40. 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

41. 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

42. 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

43. 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),

44. 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

45. Results/Impact

47. New Access Point Development 2011

48. 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

49. Health Center Planning Grants Collaboration with NC Care Share Health Alliance 3 organizations representing 6 counties applied

50. 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

51. Lessons Learned

52. What worked Collaboration with Safety-net partners Promulgating models of collaboration Partnering with a neutral convener - (Care Share Health Alliance)

53. 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

54. New Directions

55. July 17th – Tornados Ravage North Carolina

56. 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?

57. 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