# Presentation: 288485

## Health Department with a  Community Health Center

- East Central District Health Department
- & Good Neighbor Community Health Center

## Demographics of our area

- Rural Nebraska
- Agriculturally based
- 52,400 individuals in 2,200 sq miles
- Prior to 1990 mostly Caucasian
- 904% increase in Latino Population between 1990 and 2000

## History of care for uninsured

- “La Clinica”  Free clinic from 1996 until 1999
- Not under the Health Department
- Started by one committed Physician
- No funding, all volunteer staff
- Borrowed clinic, begged supplies
- Used “medication samples”
- Open two evenings per month
- Served between 20-55 individuals/night

## Health Department forms

- November of 1998 Health Department was incorporated
- July of 1999 First Executive Director was hired for Health Department
- “Free Clinic”  founding physician has moved and a very committed social worker is operating the clinic on her own time

## Direct Services are Started

- In November of 2000,  Board of Health accepts the move of the “Free Clinic” under the Health Departments Authority
- Health Department begins to formalize clinic
- Health Department looks for options to expand the clinic

## Planning for Expansion

-  Application for a Healthy Communities  Action Program (HCAP) HRSA Grant
- 85% Infrastructure
- 15% Direct Services
- Funded in September of 2001
- Already had very strong community support in place

## HCAP 

- One year of funding
- Strategic Planning  for future services
- Management Information System
- Equipment
- Physician Assistant added to Staff
- 50% of time in planning
- 50% of time for direct services

## Strategic Planning Tool

- MAPP (Mobilizing for Action through Planning and Partnership
- A set of assessment methodologies
- A blueprint for partnership building
- A process for community driven change
- www.naccho.org

## MAPP compliments CHC

- MAPP has a very comprehensive assessment process that will assist in your successful application.
- MAPP builds community support and partners needed to support a CHC.
- MAPP has a clear process that is supported with multiple tools.

## Results of MAPP

-  28 Agencies with formal MOA’s with MAPP
- One overall committee
- Nine sub-committees based on assessment findings
- Sub-committees include Access to Medical Care, Pharmacy, Mental Health, Substance Abuse, Dental, Transportation, Web-sites

## Initiative to Expand Health Centers

- President Initiative to Expand Health Centers:
- Five year plan beginning in FY 2002
- 1,200 new or expanded health center sites
- 6 million new patients served by health centers
- Maintain commitment to community-based projects
- Of the 1,200 new sites:  630 will be new sites and 570 will be expanded sites

## Steps taken to become CHC

- Four MAPP assessments
- Visit CHC models, look at Governance
- Read the CHC Expectations PIN 98-23
- Education of Board of Health Members
- Mobilize the Community Players
- Education of Medical Community
- Stay focused and persevere
- Approval of Medical Community

## Application Process Tips

- Talk to the State Office of Primary Care
- Talk to State Primary Care Association
- Read the CHC Expectation PIN
- Discuss Governance Plan
- Talk to other CHC’s that are operated using your chosen governance

## Public Entity Governance

- Health Department is the grantee
- Health Department and Good Neighbor Community Health Center are co-applicants
- Good Neighbor is incorporated
- Two Separate Boards
- Board of Health has usual board
- CHC has Board with 51% true CHC users

## Our Governance

- Health Department retains authority over accounting and personnel policies
- Good Neighbor Board is the governing board of the CHC
- All employees are employees of the Health Department (FTCA insurance)
- Executive Director of Health Department and CHC are the same individual

## Financial Separation

- Same Accounting Polices
- Separate Accounting for each entity
- Separate Bank Accounts
- Separate Banks
- Separate Auditors
- Most employees work in one entity or the other (ED, COO, CFO)

## Challenges

- FTCA insurance application
- Medicare FQHC – Cost Based Reimbursement
- Beginning Insurance Billing
- Pharmacy 340 application
- JACHO Accreditation

## Thank You

- rrayman@ecdhd.com