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HomeMy WebLinkAbout03182013 City Council Work Session Notes - CHC New Access Point 61-r3 fftlij (;I Oyu ) i/21402- m4 0-9v40)) c41.1(V) P19°1 °? 474 64 rpm 4P1? 5! r7/JA,A (K4d1)' ciaQs141 ********************".*******************************„ _ E - oan ./cci paire /0/W0403193 iyr —0 szaqt-cTow RD-uno:-) )11-di 14.4(0,9 Ill !act ssex) ( ))--- 1 ow \Ap,i4)0!p —1/11:0- : ssocLind \\44.011 IQ& (44(1 ra saioNNOISSgS • 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 E---Ht/L4:-.;) •;: , R II •••(., ; • 1 I j •• I 1 I SEWARD .111 •ti 'i I COMMUNITY HEALTH CENTER j • , f { • k • 1 ti City Council Workeeaaion { • March 11,2013,5:30 pm a •g�I I 111, - , .• I. 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 ti t 1i I it i it 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