Search Results for: "community benefit"
Community Health Centers serve more than 22 million people at more than 9,000 sites located throughout all 50 states and U.S. territories, and have become needed health centers in particular for people newly insured under the Affordable Care Act (ACA) who have not previously had relationships with healthcare providers.
The National Association of Community Health Centers (NACHC) was organized in 1971 and works with a network of state health center and primary care organizations to serve health centers in several ways, including to:
- Provide research-based advocacy for health centers and their clients.
- Educate the public about the mission and value of health centers.
- Train and provide technical assistance to health center staff and boards.
- Develop alliances with private partners and key stakeholders to foster the delivery of primary health care services to communities in need.
Ronald A. Yee, MD, became chief medical officer of the NACHC last year. NewPublicHealth recently spoke with Yee about the mission of health centers and their new roles under the Affordable Care Act.
NewPublicHealth: What field of medicine did you practice before taking on your new role?
Ronald A. Yee: I am a family physician. I worked for 20 years at a community migrant health center in Fresno County. I basically practiced full-scope family medicine including obstetrics, so I was delivering babies up until October of last year when I came to NACHC. So I was on the frontlines doing patient care and I was also the chief medical officer for our health center. I got involved earlier in my career with NACHC on a state and then national level, was on the board and then became chief medical officer.
NPH: Who is most likely to use the services of a community health center?
Yee: Health centers provide about one quarter of all the primary care visits for low-income populations, which include about one in seven people who are uninsured, or one out of every 15 Americans. With the roll out of the Affordable Care Act we’re seeing a big surge in demand among the newly insured, whether that’s through Medicaid expansions or the health insurance exchanges. Many of our patients who previously paid on a sliding scale basis are now covered through the ACA, which is helping us extend the funding we have.
The changing environment for health departments under the Affordable Care Act (ACA) was the focus of a very well attended early morning session at the American Public Health Association (APHA) annual meeting in Boston today, moderated by APHA public health policy analyst Vanessa Forsberg, MPP.
Hospitals and private health care providers will soon be competing with health departments for clinical services such as immunizations for a newly insured population, according to Forsberg. However collaboration may help departments keep and grow clinical services, as well as collaborate with new partners under other new ACA rules, such as community benefit requirements for hospitals to improve population and individual health.
“There’s a lot of innovation, a lot of people moving into that space and this is a clarion call to say public health had a head start and don’t let the space be taken from you, learn the finance side,” said James Corbett, M.Div, JD, an ethics fellow at the Harvard Medical School and vice president of charity care and ethics at the Steward Health Care System in Boston.
Opportunities for health departments, says Corbett, include focusing on addressing disparities, preventive health, innovative programs and partnerships that improve care and reduce costs.
A key example Corbett shared was a decision by Steward to hire community health workers whose services can be billed for under the ACA beginning January 1. Corbett says he looked at the hospital’s bad debt documentation by language and found trends, then convinced the hospital’s CEO to allow him to hire community workers who got iPads and then went out into the community to visit patients who hadn’t paid bills. They were able to use the devices to record identification and other information, then help the patients sign up for Medicaid and other assistance that allowed them to be covered and the health system to be paid.
At the recent Place Matters: Exploring the Intersections of Health and Economic Justice conference in Washington, D.C., David J. Erickson, PhD, was a key member of a panel called “What Works for America’s Communities?” Dr. Erickson, who is director of the Center for Community Development Investment at the Federal Reserve Bank of San Francisco, has been a key leader in a Healthy Communities collaboration between the Federal Reserve and the Robert Wood Johnson Foundation. The joint effort has convened more than ten conferences around the country and released numerous publications, including an article in Health Affairs about partnerships to improve the wellbeing of low-income people.
>>Read more reporting from the Place Matters conference, in a Q&A with David Williams of the Harvard School of Public Health and the RWJF Commission to Build a Healthier America.
NewPublicHealth spoke with Dr. Erickson at the Place Matters meeting.
NewPublicHealth: Are the Healthy Communities conferences continuing?
David Erickson: We still have what we call “consciousness raising” meetings planned in Ohio, Florida, Louisiana and other cities, and these are initial meetings that get together the health and community development world. But then there is another phase, we call it phase two—how do you operationalize this idea? What do we do tomorrow? Who do I call? How do I structure the transaction? Who’s my partner? And that’s harder to answer so we’re trying to figure that out. So we need phase two meetings to get hospitals together with banks to talk about how they might blend some of their community benefit dollars with community reinvestment dollars to help alleviate some of the upstream causes of bad health [like poverty and poor housing].
NPH: What would be examples of such a collaboration?
The Health Systems Learning Group (HSLG) is made up of 43 organizations, including 36 non-profit health systems that have met for the last eighteen months to share innovative practices aimed at improving health and economic viability of communities.
The idea for the learning collaborative came from a series of meetings at the White House Office and U.S. Department of Health & Human Services Center for Faith-Based & Neighborhood Partnerships. The HSLG’s administrative team is based at Methodist Le Bonheur Healthcare Center for Excellence in Faith and Health in Memphis, Tenn., and at Wake Forest Baptist Health System in Winston-Salem, N.C. The Robert Wood Johnson Foundation provided a grant to share the group’s findings and lessons learned.
In addition to its other work, earlier this year the HSLG released a monograph that aims to help identify and activate proven community health practices and partnerships. Once identified, they can be combined with other evidence-based initiatives to reveal new pathways to transform unmanaged charity care into strategic, sustainable community health improvement.
Recently, NewPublicHealth spoke with the Reverend Doctor Gary Gunderson, vice president of the Division of Faith and Health Ministries at Wake Forest Baptist Health and co-principal investigator of the Health Systems Learning Group, about their vision for the future of healthy communities and the role that hospitals and health systems will play.
NewPublicHealth: What are the goals of the Health Systems Learning Group?
Gary Gunderson: The essence of the task was to help each other learn how we can fulfill our most basic mission. All of the Health Systems Learning Group members are not-profit. The vast majority are faith-based, and so in every case our essential mission boils down to improving the health of the community that created us.
All of the HSLG members are financially stable and we all provide a lot of charity care, but that does not add up to necessarily fulfilling our real aspirational mission and that’s what we came together: to see whether it’s possible to do that in the current environment. And our fundamental answer is that it is possible to do that, but we have to have some new competencies and expanded commitments in order to do it.
The Affordable Care Act (ACA), which kicks into high gear in January, was front and center at the recent annual meeting of the National Association of County and City Health Officials (NACCHO) in Dallas. U.S. Centers for Disease Control and Prevention Director Tom Frieden, MD, MPH, addressed the benefits to population health of many of the new law’s provisions and Kathleen Sebelius, Secretary of the Department of Health and Human Resources, which has overall responsibility for the law, spoke about the ACA via video.
For the most part, the role of local health departments under the ACA is still emerging and will become better known as more provisions are implemented and clarified.
To better understand what we know about that role and what will become better known down the road, NewPublicHealth spoke with Michelle Chuk Zamperetti, MPH, Senior Advisor and Chief of Public Health Infrastructure and Systems for NACCHO.
NewPublicHealth: Are there specific provisions under the ACA that apply to local health departments?
Michelle Zamperetti: There are no provisions specifically designated for local health departments but there are many provisions that impact local and state health departments. For example, many will be involved in the outreach and enrollment efforts for the new marketplaces and some will be designated as navigators to help people enroll for health insurance coverage in both the state-run marketplaces and the federally funded exchanges. For example, I recently learned that authorities managing a state-based health insurance exchange were not pleased with some of the navigator program applicants, so they reached out to a local public health director and asked that health department to be the navigator program leader in their region. And even in communities where health departments don’t give direct enrollment assistance—such as filling out paperwork online—we are confident that people with established relationships with their health department may use it as an entry point for finding out about health insurance, and health departments will need to know how to help them enter the system.
In addition to the insurance expansion provisions of the law, there are also important provisions to strengthen the coverage provided through insurance, particularly in the area of clinical preventive services. For health departments that provide direct services, there are opportunities to become in-network providers under the ACA.
NPH: Do you think many health departments will work together with non-profit hospitals, which now have a mandate from the Internal Revenue Service (IRS) to provide some form of community benefit in order to maintain their tax-exempt, not-for-profit status under the ACA?
With just 83 days to go until health insurance marketplaces open up to allow otherwise uninsured Americans to sign up for health coverage under the Affordable Care Act (ACA), NACCHO Annual has a good number of plenary and other sessions focused on the role of public health in implementing the law.
>>Read more NewPublicHealth coverage of NACCHO Annual.
In his address to the 1,000 plus attendees at this year’s NACCHO conference, Centers for Disease Control and Prevention Director Tom Frieden, MD, MPH, talked about what local health departments can do to support ACA. “This is an all hands on deck situation,” said Frieden. “We want to do a lot with improving quality of care, but first we’ve got to get people signed up.”
Frieden ticked off actions that local health departments can take to help support enrollment, including:
- Provide resources to the community on getting insured & the benefits of being insured, including free preventive care.
- Educate every resident served by the department, such as immunization, tuberculosis and STD clinic patients, on how they can enroll.
- Educate every organization that the health departments connects with, such as schools, courts and businesses, on how stakeholders can enroll.
NewPublicHealth is on the ground this week in Dallas at NACCHO Annual, the yearly meeting of the National Association of County and City Health Officials (NACCHO). The meeting theme this year is “Public Health by the Numbers” as city and county health departments face increased pressure for limited resources; an increased focus on both new and traditional public health roles; and government accountability and effectiveness.
NewPublicHealth spoke with Robert Pestronk, NACCHO’s executive director, in advance of the conference.
>> Be sure to follow our NACCHO conference coverage all week long, including stories from key sessions and interviews with speakers and thought leaders.
NewPublicHealth: What are the key issues at this year’s NACCHO conference?
Robert Pestronk: We’re focused on a conference theme of public health by the numbers because the availability and use of data is integral to the performance and operations of local health departments. The use of data and metrics is important for quality improvement in health departments, and for the development and communication of messages about health status and disease status within local communities.
A couple of other things that are new for this year’s annual meeting is that we’re recognizing the role that large cities and metropolitan areas play in modeling and demonstrating public health policy and governmental public health practice work. We have a couple of sessions with presenters from big cities to talk about the work they’re doing. And because the Affordable Care Act is influencing the work and funding and future for local health departments, there are sessions to help local health departments consider the effects from the law. We’ve also got a plenary session on reducing health disparities, which is a line of work that is very important to NACCHO. In fact, NACCHO’s work in this area has stimulated work in other parts of the governmental public health structure at the state and federal level.
NPH: What is the role that local health departments will play when it comes to implementing the Affordable Care Act?
Pestronk: I think that the specific role that local health departments play, like in most situations, will depend upon the kinds of assets that are available in a local community and the extent to which their state is implementing provisions of the law. Local health departments can be helpful informing people about the start of enrollment and helping people understand where they can go to enroll. Part of what NACCHO has been doing over the past year is to share with local health departments the kinds of opportunities that are available for implementing and educating about the health law.
Cardiovascular disease is the focus of the 2013 annual report to Congress of the Community Preventive Services Task Force, an independent and unpaid panel of public health and preventive services experts. The report was discussed at a recent Congressional briefing that included health experts, Congressional staff, community health promotion partners and policy-makers.
Each year the Task Force reviews and updates the Guide to Community Preventive Services, a free resource that provides examples of evidence-based strategies to help communities choose programs and policies to improve health and prevent disease.
It’s not hard to understand why cardiovascular disease was the focus topic this year. According to John Clymer, executive director of the National Forum for Heart Disease & Stroke Prevention, almost half of all Americans have at least one of three modifiable risk factors for heart disease: tobacco use, high blood pressure or uncontrolled high cholesterol.
The Task Force has identified effective approaches to address most of the risk factors for heart disease, which include integrated community and health system practices. Some examples of such practices are a team approach to preventive care that includes doctors, nurses and community pharmacists; tobacco quitline interventions at no cost including follow-up counseling calls; and behavioral counseling and support for heart disease risk factor behaviors.
Jonathan Fielding, MD, MPH, co-chair of the Task Force and health director of Los Angeles County in California, says his county used evidence in the Guide that found that mass media efforts aimed at getting people to stop smoking only work in conjunction with other efforts.
Several community and health leaders of San Bernardino, Calif., the largest geographic county in the U.S., spoke at the recent briefing on use of the Community Guide to help improve population health in their county. San Bernardino ranked 44th out of 57 counties in the 2013 County Health Rankings. “The [Community] Guide has been instrumental in our work looking at population health,” says Dora Barilla, DrPH, Asst. Vice President for Strategy and Innovation at Loma Linda University Health, at the recent briefing. Loma Linda was part of a community initiative begun several years ago to improve population health in San Bernardino, which has 4.2 million residents in San Bernardino, “many with significant disparities,” said Barilla.
“We needed to identify the highest impact initiatives and without the community guide, we could not have done that,” said Barilla. “We used it to move forward fast. We needed science and evidence. Using the guide we were able to galvanize 20 of 24 cities. We were able to use what worked and not waste time on practices that were ineffective and outdated.”
Critical features of the Guide, said Barilla, is that it has targeted approaches for different populations “and does not take a one size fits all approach.” One key outcome, according to Barilla, was that hospitals engaged in community benefit efforts—a requirement for nonprofit hospitals under the Affordable Care Act. “We now had science and metrics to invest in upstream initiatives.”
>>Bonus Link: Watch a County Health Rankings and Roadmaps video on initiatives now in place to help improve population health in San Bernardino.
Under the Affordable Care Act, tax-exempt hospitals are now required to conduct a community health needs assessment at least every three years and develop an implementation strategy to tackle the needs identified by the assessment.
At this week’s AcademyHealth meeting in Baltimore, experts moved from the “guess what you have to do” approach to community benefit heard at some public health meetings to some practical strategies hospitals can follow not only to fulfill the letter of the law, but to actually improve community health.
Peter Sartorius, community benefit director of the Muskegon (Michigan) Community Health Project, which brings together several Mercy hospitals in the region, told the audience that costs of the requirement can range from about $12,000 for a staff person to conduct the needs assessment to about $65,000 if a consultancy, such as a public health institute, does the work. Mercy requires that the County Health Rankings, developed through a collaboration of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, be used by the hospitals in its network as the baseline measures of community health.
Sartorius urged hospitals to choose “collaborative partners” such as community health clinics, United Way agencies and universities, who can help develop the assessment and report and also share in the cost. Others have said that community benefit also offers a ripe opportunity for collaboration between hospitals and public health departments, which already house a lot of data and have similar community needs assessment requirements for voluntary accreditation.
The sixth annual Keeneland Conference begins today in Lexington, Kentucky. Each year hundreds of public health researchers and practitioners meet to share research and translation strategies at the annual conference, is sponsored by the National Coordinating Center for Public Health Services and Systems Research, which is based at the University of Kentucky. This year’s keynote speakers include Paul Kuehnert, MS, RN, senior program officer and director for the Public Health team at the Robert Wood Johnson Foundation; Lisa Simpson, president and CEO of AcademyHealth; and Joe V. Selby, MD, MPH, the first executive director of the Patient-Centered Outcomes Research Institute authorized by Congress.
In advance of the conference, NewPublicHealth spoke with Glen Mays, PHD, MPH, F. Douglas Scutchfield Endowed Professor of Health Services and Systems Research at the University of Kentucky College of Public Health. Mays is also the co-PI of the National Coordinating Center for PHSSR at the University of Kentucky, which is funded by the Robert Wood Johnson Foundation.
NewPublicHealth: What will be some of the key issues at the Keeneland conference this year, both from the plenary podiums and in hallway conversations?
Glen Mays: One area involves looking at the changing roles and responsibilities of health care organizations in the public health enterprise, especially the changing roles of hospitals in helping to deliver public health activities, in part because of new tax incentives for hospitals to be involved and to play a larger role in delivering community benefit services. We have a number of studies taking a look at that issue, as well as other elements of health care reform such as the accountable care organizations that hospitals are playing an important role in and that are part of new health delivery systems. The hospitals are playing roles and engaging public health activities as part of their health care delivery strategy. So there will be a number of studies looking at various angles of hospital and health care system involvement in public health delivery and the larger issue of integration of public health into new health care delivery strategies under health reform, which is a big area.
NPH: How much discussion do you expect about the Affordable Care Act?