HomeMy WebLinkAbout03182013 City Council Work Session Notes - CHC New Access Point 61-r3 fftlij
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3/18/2013
SEWARD
COMMUNITY HEALTH CENTER
City Council Worksession
• March 18, 2013,6:00 pm
•
•
DESIRED OUTCOME OF THIS WORKSESSION:
o Provide guidance to consultant for NAP
application
o No final decisions will be made
o Any `recommendations' beyond the
"status-quo" cannot be implemented
without further Council action
- -
3/18/2013
WHY IS THE CITY INwIYED IN CHC?
o City has responsibility to address
healthcare needs of community
(consistent with home-rule city
obligations)
o A CHC could operate independent of City
but would require City Code change
4
WHY IS THE CITY INwIYED IN CHC?
Public entity (current) model:
• Requires funding go thru City to CHC
• Requires joint budget approval
• Designed as system of checks and balances
2
3/18/2013
WHY IS THE CITY IN\OLVED IN CHC?
• If CHC were outside of public model, City
would have no financial oversight but may
be asked for continued public funding
support
• City involvement helps ensure clinic
collaborates rather than competes
• If City isn't happy with governing board, can
pursue different partnership
•
IF WE DO NOTHING:
• CHC and City will share responsibility for
grant reporting
• CHC will employ personnel
• City will transfer funding to CHC
r
3
4
3/18/2013
$
IF WE DO NOTHING, CONT.:
• City will not have Finance and/or Personnel
oversight or responsibility
• City will lease clinic space to CHC for a
nominal fee
To STRENGTHEN THE APPLICATION:
• Employees are employed by City but
managed by CHC
• City maintains financial oversight but
CHC manages its own finances
• City offers initial support (e.g. payroll
processing, accounts payable processing)
I
4
3/18/2013
8'
To STRENGTHEN THE APPLICATION:
o CHC does its own billing
o City offers support for start-up costs
o CHC board hires CEO and is solely
responsible for employment of CEO
• CEO has sole responsibility for employees
but requires City review of terminations
411
WHY EMPLWEE STATUS MATTERS?
• A new start-up will benefit from:
o Employer with longevity
o Employer with established benefit package
Health insurance
Retirement package
o Established system of policies and procedures
o Solid financial support of City
Lack of successful track record makes these jobs
less `stable' or`attractive' 411)
5
3/18/2013
City as employer:
Improved recruitment'. d retention
More choice for health' surance
More choice for retire o; t plans
Existing personnel poi -s
More Council control . r clinic costs
Possible Council appr. 1 of pay plan?
Potential political infl ce on governance?
Increased oversight of dget process?
CHC as employer-.
City not involved = tl, l oyment issues at all
Avoids public oppositie to more City
employees
Potential higher costs" benefit package
More flexibility for cli M'`, to pay market rates
Less City control over .ts
City still has budgeta oversight
May be unable to attr.a retain qualified
applicants
6
3/18/2013
• Employees are employed by City but managed by
CHC
• City maintains financial oversight but CHC man i
its own finances
• City offers initial support (e.g. payroll processing,
accounts payable processing)
• CHC does its own billing
• City offers support for start-up costs
• CHC board hires CEO and is solely responsible for
employment of CEO
1 responsibility
CEO has so e f or employees but
requires City review of terminations
• City provides clinic space to CHC for a nomina fee
7
3/18/2013
Future work ssions to discuss pros/cons of
City involvem' t in financial and/or
personne + -`{ .ight
City assists h start-up costs?
April 3 — September 1St (5-month) window to
discuss and decide
be involved in either of these
wires Council approval
THE MISSION OF SEWARD CHC
To identify and serve the
healthcare needs of our
community by providing
quality, affordable
services and promoting
wellness, prevention and
partnerships.
8
4.
• 3/18/2013
NEW ACCESS POINT APPLICATION
o Deadline for submission: April 3
o Anticipated announcement of awards:
September 2013
o Nationwide, competitive process
oCurrent funding for approx. 25 new health
centers = $19 million dollars
PROPOSED MODEL
Responsible $$
for Receives
Hires operations HRSA
Executive of clinic funding
Director Finance
and/or
Seward CHC Personnel
Board ministratio, City of Seward
Grant
Governs, Reporting
Sets
policies Patient
Billing
9
3/18/2:)13
END
1,
SEWARD CHC BOARD MEMBERS
o Patty Beals, President o Lois Daubney
o Maya Moriarty, VP o Kris Erchinger
o Marianna Keil, Sec o Shane Hand
o Dick Cruse, Treasurer o Stacy Lane
o Jean Bardarson o Dave Norcross
o Keith Campbell o Dave Paperman
o Mike Craytor
10
3/11/2013
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• March 11,2013,5:30 pm a
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COMMON ACRONYMS
OHRSA
•Health Resource and Services Administration
•Division of the Department of Health and Human Services
(DHHS)
OBPHC
•Bureau of Primary Health Care(the Bureau)
•Division of HRSA
•
OCHC ti
•Community Health Center
a
•Program of the BPHC
•Also known as Section 330 or FQHC .® to
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COMMON ACRONYMS(compo) j it
I ii
OFQHCti
• Federally Qualified Health Center j t
• An organization that receives enhanced reimbursement I I
from Medicare and Medicaid(CHC,LAL,Tribal) I i
OI,AL I Ie
I ti• Look-ALike-entities that do not receive funding under j t.
section 330 of the Public Health Service(PHS)Act,but I ti
received enhanced reimbursement and operate/provide i
services consistent with grant-funded programs.
ONAP ;i'
• New Access Point '.H
• An organization or site seeking CHC grant funding p'
ii
II
1
I.
A
3/11/2013
DESIRED OUTCOMES OF THIS WORKSESSION:
o Better understanding of the CHC model
o Identify questions/concerns to be
addressed
o Support of the CHC program by City
Council members
o Identification of action needed by the City
O
Council i 1
DISCUSSION POINTS
o Why a CHC? €'
o Seward CHC Accomplishments
o New Access Point Application
o Next Steps
o Appendix Information: Program
Requirements;Clinical &Financial S
Measures
WHY A CHC?
o A need for increased access to healthcare has
been identified
o The CHC public-entity model allows the City to
exercise a level of oversight of the
program(consistent with home-rule
city obligations).
2
3/11/2013
WHY A CHC?<corrr'rn
o Expand Access to Primary Care,
especially to uninsured and underserved
o Improve efficiency
o Reduce cost to patients
o Increase collaboration of community providers
e
WHY A CHC? (Conan)
o Ensure community involvement in governance
o Bring$$into the community to assist in
meeting identified needs
•Annual base grant funding
• Future opportunities for dental and
behavioral health funding
•
1
WHY NOW AND WHY US?
o Community Need!
o Planning Grant
o Application Cycle
o Public-Entity Model 1101
3
3/11/2013
BENEFITS OF A CHC
o Program has been in place since 1965
o Program has bi-partisan support
o Community Health Centers have been
identified as major players in the"Obama
Care"model
® '
•
BENEFITS OF A CHC (cUNTD)
o Ongoing Grant funding
• Up to$650,000 annually !''
• Steady funding source(program>45 years) i t.
o Enhanced Medicaid/Medicare payments
o Medicare deductible costs waived
o Medical malpractice coverage through the i s
federal government i f.
:E.
BENEFITS OF A CHC tconn'n)
o Voice thru consumer majority Board
o Provider loan repayment
o Educational scholarship programs for
providers
o Prescription drug discounts of 20%-50%
3/11/2013
BENEFITS OF A CHC (cor-rc)
o Grant pays for enabling services
(transportation,case management,etc.)
E
o Eligible for Federal funding and/or loan '1
opportunities
•Facility improvements ;�
•Capital construction
tri
1r#
CHC LIMITATIONS
o Limitation on construction or major
capital expenditures
•Able to use up to$150,000 for
equipment or renovation during the 1°t
year of funding
o CHC funds cannot be used for hospital
equipment or operations
SEWARD CHC ACCOMPLISHMENTS
o Board established and functioning
• Bylaws,policies&procedures
• Monthly meetings
• Board member training
• Mission/vision
o 601(c)3 status r
o Professional Memberships
5
•
3/11/2013
SCHC ACCOMPLISHMENTS(Cohn 1,1
o Provider outreach meetings held(3)
o Community education articles published
o Financial feasibility of"look-alike"
completed
o Clinical efficiency study/space assessment
in progress
SCHC ACCOMPLISHMENTS(corrin)
o Using outcomes of Providence-directed
Community Needs Assessment
• Validated need in the Community
• Identified priority Health Care needs
that can be addressed through the
CHC program
JJ
Cl
SCHC ACCOMPLISHMENTS,
o Providence Seward Medical Center has
made incremental changes in support of
the CHC requirements. (i.e.)
• Hiring of Mid-Level Providers(NP /PA)
• Patient Centered Medical Home Model
• Discount Schedule
O
3/11/2013
SCHC ACCOMPLISHMENTS(comr'D)
o HRSA Planning grant awarded and
activities complete
o City funds($50,000)remain for start-up
o Ready to submit New Access Point grant
application no later than April 3,2013
THE MISSION OF SE\VARD CHC
To identify and serve the
healthcare needs of our
community by providing
quality, affordable
services and promoting
wellness,prevention and
partnerships.
POTENTLAL AREAS OF COLLABORATION
IDENTIFIED BY COMMUNITY PROVIDERS
• Case management • Mental health
• Chronic illness • Obesity
management • Independent living
(Diabetes, partnership
Hypertension,etc) • Pain management
• Dental • post-partum depression
• Enrollment Assistance screeningsdnterventions
for Medicare& • Resources and referrals
Medicaid
• Integrated charts/ • School-based services
Electronic Records • Stress management
• Health Education • Transportation
• Lab services
.0
45
7
3/11/2013
NEXT STEPS
o CHC/City of Seward infrastructure` ---.
• City Council recommendation on Finance and
Personnel—need to know model for the grant
• Co-Applicant Agreement in place prior to grant
application
o Affiliation Agreements with providers
(i.e.dental,mental health,ancillary services,tribal,hospital)
o Submit New Access Point grant application fb
J
NEXT STEPS (CONVD)
o Completion of clinic efficiency and space
utilization analysis
o Provider outreach and education
o Meetings with PSMC staff
NEXT STEPS (Comm -� yt z
o Town hall meetings/education ! �`T !,Il+
o Continued Board development&Strategic
Planning
o City,CHC&Providence meetings re:staffing,
cost comparisons,efficiency issues
ik
3/11/2013
NEXT STEPS(CONTD)
o Prepare for funding announcement
• Expected September 2013
• 120 days to be operational
• CEO Recruitment
•Transition Plan development
•Visit other Alaska CHCs
o Consider Look-Alike application
NEW ACCESS POINT APPLICATION
o Deadline for submission: April 3
o Anticipated announcement of awards:
September 2013
o Nationwide,competitive process
oCurrent funding for approx.25 new health
centers=$19 million dollars
S
PROPOSED MODEL
Empa
Rnai,le $3
fl'r'
f
• opentona HASAa
xemtive ddinic fluritng
Director Ammon
and/or
Seward CHC mm nd
Boardtrato City of Seward
Grant
Govema, Reporting
Sete
poloo patent
Bilhng
9
3/11/2013
CITY COUNCIL INPUT NEEDED
o March 18,2013
Recommendations needed for grant application:
• Does the City want to retain Finance and/or Personnel °
oversight and responsibility? ig
• Who will employ staff of the Center?City or CHC?
• Is the City willing to process financial transactions for the is
CHC (i.e.payroll and accounts payable)?
• Can the City cover start-up costs?
111/
CITY COUNCIL INPUT NEEDED(own))
o March 31,2013
Action Needed:
• The CHC application needs to include documentation
that clinic space will be available.
• Is the City able to offer the CHC a lease?
At a nominal rate?
• Cana draft agreement be in place by the end of this
month? 0
RECAP OF DESIRED OUTCOMES
OF THIS WORKSESSION:
o Better understanding of the CHC model I
o Identify questions/concerns to be I
addressed
o Support of the CHC program by City I
Council members
i o Identific4p of action needed by the City
Council
10
3/11/2013
END
SEWARD CHC BOARD MEMBERS
o Patty Beals,President o Lois Daubney
o Maya Moriarty,VP o Kris Erchinger
o Marianna Keil,Sec o Shane Hand
o Dick Cruse,Treasurer o Stacy Lane
o Jean Bardarson o Dave Norcross
o Keith Campbell o Dave Paperman
o Mike Craytor
C
RESOURCES
o Health Resources&Services Administration:
http://bphc.hrsa.gov/
o National Assoc.of Community Health Centers:
www.nachc.org
o Alaska Primary Care Association
www.alaskapca.org
o NorthWest Regional Primary Care Association
www.nwrpca.org
11
3/11/2013
19 CORE PROGRAM REQUIREMENTS
i. Needs assessment
2. Primary,preventive,enabling health services
provided directly or through written
arrangements
a. Core staff licensed,credentialed,and privileged
a Accessible hours of operation/locations
5. After hours coverage
s. Hospital admit privileges and continuum of care
7. Sliding fee discount
s Quality improvement/assurance plan •
19 CORE PROGRAM REQUIREMENTS
9. Key management staff
io. Contractual/affiliation agreements
i�. Collaborative relationships.
12. Financial management and control policies
is. Billing and collections
14. Budget
15. Program data reporting systems
Is. CHC maintains its funded Scope of project
I ,
19 CORE PROGRAM REQUIREMENTS
17. Board authority
(monthly meetings,approval of budget,CEO
hire/fire,services and hours of operations,
measure and evaluate progress,policies)
19. Board composition
(9-25 members;representative of community;
more than 50%consumers of CHC services;
expertise;represent demographic diversity)
9 Conflict of interest policy
(no board member shall be employee or
immediate family member of employee of
health center)
12
•
3/11/2013
SEWARD CHC ACCOUNTABILITY—
CLINICAL MEASURES
o Clinical Measures:
• Prenatal care in first trimester
• Childhood immunizations
• Cervical cancer screening(pap)for women
• Body mass index(screening,counseling)
•Tobacco use screening&follow-up
•Asthma control
•Lipid therapy for coronary artery disease
•Aspirin therapy for ischemic vascular
disease
• Colorectal cancer screening
1
SEWARD CHC ACCOUNTABILITY—
CLINICAL MEASURES
o Clinical Measures-Health Outcomes/Disparities
•Diabetic patients HbAlc levels
•Blood pressure control for patients with
hypertension
• Percentage low weight births to health center
patients
o Additional measures:
of behavioral health
o l oral health
SEWARD CHC ACCOUNTABILITY—
FINANCIAL MEASURES
o Financial Viability/Costs
•Total cost per patient
•Medical cost per medical visit
• Change in net assets to expense ratio
• Working capital to monthly expense ratio
• Long term debt to equity ratio
13
3/11/2013
ALASKA CHC ORGANIZATIONS
o Alaska Island o Bristol Bay Area
Community Health Health Corporation
Services(Wrangell) • o Bristol Bay Borough
o Aleutian/Pribilof (Naknek)
Islands Assoc o Council of Athabascan
o Anchorage Tribal Governments
Neighborhood Health (Ft.Yukon)
Center o Crossroads Medical •
o Bethel Family Clinic Center(Glenallen)
•
ALASKA CHC ORGANIZATIONS
o Eastern Aleutian o Manillaq Association
Tribes (Kotzebue)
o Iliuliuk Family& o Mat-Su Health
Health Services Services
(Unalaska/Dutch o Native Village of Eyak
Harbor) (Cordova)
o Interior Community o Norton Sound Health
Health Center Corporation
(Fairbanks&Healy) o Peninsula Community
o Kodiak Community Health Centers
Health Center (Soldotna)
•
•
ALASKA CHC ORGANIZATIONS
o Seldovia Village o Sunshine Community
Tribes(Homer) Health Center
o City of Skagway (Talkeetna)
o SouthCentral o Tanana Chiefs
Foundation Conference
o Southeast Alaska o Yakutat Tlinglit Tribe
Regional Health o Yukon Kuskokwim
Consortium Health Corporation
14