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From August 1993 through January 1999, the Robert Wood Johnson Foundation (RWJF) joined in a multi-foundation New York City-State effort to improve access to basic health services to New York City residents through a program focusing on planning, development and construction of new primary care facilities.
The initiative provided start-up support for a new, independent organization, the Primary Care Development Corporation (PCDC), set up by New York City (NYC). A total of $35.1 million from a variety of public and private sources supported PCDC's operations, project development, and capital development.
With $17 million of this funding, received as a capital grant from the city, PCDC set up and administered the Primary Care Development Fund, a revolving loan fund. The bulk of the loan fund proceeds were used for planning and development costs for sponsors of new facilities, including costs for facility design and obtaining regulatory approvals, and special reserve funds to provide additional security for facility capital financing.
PCDC staff also provided technical assistance to the primary care facilities sponsors for identifying sites, completing required land use and environmental reviews, program and facility design, and obtaining health care regulatory approvals.
After the Grant
In Fall 1999, PCDC's governing board decided to expand the organization's mandate by increasing the number of loans to modernize existing primary care facilities and expanding its programs to improve facilities' operational efficiency, effectiveness, and quality.
RWJF made two grants totaling $1,796,704 in support of this project.
During the early 1990s, New York City faced the need to expand and upgrade primary care delivery systems for its residents. At the time, the major barriers to developing new primary care facilities were: (1) lack of access to affordable sources of start-up capital and (2) the complexity of land use and environmental reviews, program and facility design, and the regulatory approval process.
Despite these barriers, as well as serious budget constraints, policymakers and community leaders began to rebuild the city's primary care infrastructure. In 1992, the city launched Communicare I, an effort to open three new primary care centers and convert 17 city health department or public hospital-based sites into primary care health centers.
At about the same time, New York State began to implement a series of initiatives to:
These two grants from RWJF were intended to help improve access to basic health services in NYC through a program focused on planning, development, and construction of new primary care facilities.
RWJF's first grant, ID# 021312, was part of a multifoundation, city-state effort that provided start-up support for a new independent organization. The goal of PCDC was to develop 30 new primary care facilities to be sponsored by private and public organizations such as voluntary hospitals and community health centers.
As of September 30, 1999, a total of $3.2 million had been provided for PCDC's operations by 15 corporations and foundations, including RWJF, JP Morgan, Bankers Trust, the United Hospital Fund, Aetna, The New York Community Trust, and The Commonwealth Fund. In addition, PCDC's operating funds included $3.1 million in financing fees and $836,000 in earnings on investments.
PCDC also received $27.5 million in government capital grants in support of its loan programs: $17 million from the city, $8 million from the state, and $2.5 million from the US Department of the Treasury. The total from all these sources was $35.1 million.
Following the initial start-up period (which included the first RWJF grant, ID# 021312), PCDC planned to be self-supporting, with revenues generated by a 2.5 percent capital financing fee charged to each project at the time of its bond closing.
However, changes in leadership and policy at the state level, the shift toward deregulation and Medicaid mandatory managed care, and the 1995 merger of the New York State Medical Care Facilities Finance Agency into the New York State Dormitory Authority delayed approvals (and fees) on PCDC's first bond financing.
In February 1996, RWJF agreed to provide a $300,000 interest-free loan to PCDC in the form of a recoverable grant, ID# 028538, to help the organization bridge this revenue gap over two years. By late 1998, after repaying approximately $3,300, PCDC staff concluded that the foreseeable volume of loans was unlikely to support repayment of the entire RWJF loan. Shortly thereafter, RWJF reclassified the balance of the loan as an outright grant.
Throughout both RWJF grant periods, the print and electronic media regularly covered PCDC, as well as facilities financed through the project. Each facility was generally highlighted at a groundbreaking ceremony when financing was complete and construction was ready to begin, and for a ribbon-cutting ceremony when the facility opened. Local news media usually covered these events. In addition, PCDC staff made 17 presentations about the initiative to government agencies and interested groups and organizations. See the Bibliography for details.
In Spring 1999, PCCF received an award from Social Compact, a Washington-based national community development organization. PCDC and JP Morgan, which spearheaded development of the PCCF, were selected from among 141 applicants for the award, which recognized excellence and innovation in community development. An award ceremony was held at the National Press Club in Washington, D.C.
Between January and May 1999, PCDC staff and board members engaged in a strategic planning process and concluded that there were two options for the future of PCDC: consider PCDC's original mission fulfilled and phase the organization out, or broaden its mandate. In Fall 1999, PCDC's board voted to broaden the organization's mandate to include "maximizing, preserving, and strengthening primary care providers in the city." They proposed to accomplish this by diversifying PCDC's lending programs from a primary focus on increasing visit capacity through expanding or building new facilities to also modernizing existing facilities; expanding its programs to improve health facilities' operational efficiency, effectiveness, and quality; and taking a more active leadership role in primary care policy in New York City.
To facilitate communication, PCDC created a Web site in November 2000. PCDC will use this site to augment its programs by offering tools and sharing experience, and building a community among primary care centers using its services.
Support for a City-State Partnership to Develop Primary Care Facilities in New York City
Primary Care Development Corporation (New York, NY)
Projects Financed through September 30, 1999, and their Total PCDC Investment
(Listed in alphabetical order)
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
Ronda Kotelchuck, "Primary Care: The Centerpiece of Managed Care," to the Mayor's Conference on Health Care, New York, N.Y., May 17, 1994.
Ronda Kotelchuck, Health Care Forum on Primary Care, American Institute of Architects, New York Chapter Health Facilities Committee, September 10, 1994.
Ronda Kotelchuck, Forum on Health Care Reform, New York State Senator Velmanette Montgomery, October 6, 1994.
Ronda Kotelchuck, "Capital Financing for Primary Care Development," at the United Hospital Fund Conference on Health Care Financing in New York State, December 15, 1994.
Ronda Kotelchuck, "Models for Primary Care Development," at the Second Annual US Department of Health and Human Services Conference on Primary Care, Dallas, Texas, 1994.
Ronda Kotelchuck, "Primary Care Development," at the Community Health Association of New York State Annual Meeting Plenary, February 1995.
Ronda Kotelchuck, "Whither Primary Care in Health Care Reform," at the John F. English Symposium, Hofstra University, Hempstead, N.Y., March 3, 1995.
Ronda Kotelchuck, "Testimony to the City Council Health Committee on Primary Care Capacity," at the New York City Council Health Committee, New York, N.Y., April 27, 1995.
Ronda Kotelchuck, Presentations to the New York State Council on Graduate Medical Education, 1995.
Ronda Kotelchuck, "Briefing for the City Council Health Committee," at the New York City Council Health Committee, New York, N.Y., January 4, 1996.
Richard Cotton, "Briefing for the City Council Health Committee," at the New York City Council Health Committee, New York, N.Y., January 27, 1997.
Marjorie Cadogan, "Briefing for New Members of the New York City Council," to the newly elected members of the New York City Council, New York, N.Y., July 30, 1998. Verbal request from City Council member Victor Robles, Chairman of the Council Health Committee, May 1998.
Ronda Kotelchuck, "Testimony to Federal Reserve Panel on the Merger of Citibank and Travelers," at the offices of the Federal Reserve, New York, N.Y., 1998.
Barbara Chang and Elaine Weitzman, "Strategic Planning for a Capital Project," at the National Association of Community Health Centers Conference, New York, New York, August 1998.
Ronda Kotelchuck, "Testimony to the Institute of Medicine Commission on the Safety Net" at the Commission meeting at New York University, New York, N.Y., January 13, 1999.
Ronda Kotelchuck and Nancy Ylvisaker, "JP Morgan and the Primary Care Development Corporation," presentation to congressional staff of the House Committee on Banking and Financial Services, as part of Social Compact Award program, Washington, D.C., May 5, 1999.
Ronda Kotelchuck, presentation to the New York State Council on Graduate Medical Education, 1999.
Ramping Up Patient Volume, an 8-minute videotape documenting PCDC's marketing collaborative program. New York, N.Y.: Primary Care Development Corporation, 1999. 15 copies produced and distributed to program participants and contributors.
The Primary Care Development Corporation and JP Morgan, a 4-minute videotape describing the partnership between PCDC and JP Morgan. New York, N.Y.: National Broadcasting Company, 1999. Aired at the National Press Club for Social Compact Award program, May 6, 1999.
News Conference on the launch of the PCDC development program, held at the Bedford-Stuyvesant Family Health Center, New York, N.Y., July 29, 1994. Attended by journalists from New York City daily and community newspapers.
News packets with press releases were mailed to approximately 100 newspapers, magazines, and radio and television stations regarding the following events:
"Bipartisan Support For Nonprofit is Prime Goal," in Crain's New York Business, June 24, 1996.
"Filling The Gap," in Empire State Report, July 1996.
"NYC Goes the Extra Mile to Finance Primary-Care Facilities for the Indigent," in The Bond Buyer, September 11, 1996.
"Clinics Funded by Bonds," in Daily News, October 7, 1996.
"Family Care Center Rises In Jamaica," in Daily News, October 7, 1996.
"Nuevo Centro De Salud En NY" in El Diario, October 8, 1996.
"New Gay Health Center Starts," in The New Villager, October 9, 1996.
"Giuliani at Jamaica Center Opening," in Queens Tribune, October 10, 1996.
"Clinic to Foster Preventive Care and Pride," in Queens Newsday, October 13, 1996.
"On Staten Island, Outlook's Healthier," in Daily News, October 14, 1996.
"Sisters of Charity Opening Staten Island Family Clinic," in Catholic New York, October 17, 1996.
"New Home of Gay/Lesbian Health Center," in The New York Times, January 12, 1997.
"Health Clinic Proudly Called A Step Forward," in Staten Island Advance, January 22, 1997.
"Public Hospitals Could Lose 154 Beds," in Newsday, February 4, 1997.
"NY to Open its First Lesbian and Gay Primary Care Center," in Primary Care Weekly, February 10, 1997.
"Nearby Clinic Thrives on Streamlined Approach," in The Wall Street Journal, February 12, 1997.
"Maimonides Going Ahead with Plans For Sheepshead Bay Clinic," in Bay News, February 24, 1997.
"Hospital Bond," in Crain's Insider, March 7, 1997.
"Bond Issue," in Crain's Health Pulse, March 7, 1997.
"$17.7 Million in Bond Sale to Finance Primary Health Care Center," in Brooklyn Daily Eagle, March 11, 1997.
"Northeast Bond-Watch," in The Bond Buyer, March 17, 1997.
"City Council Committees in Brief," in Searchlight, March 1997.
"Report on Institutions," in Oculus, March 1997.
"To Harlem's Health & Hers," in Daily News, April 19, 1997.
"$500,000 Loan Helps Community Health Project Acquire New Home," in Columns, Spring 1997.
"Local Ledger Managing Medicaid," in Empire State Report, May 1997.
"West Bronx Gets Right Treatment," in Daily News, May 22, 1997.
"New Health Center in St. Albans," in Newsday, May 29, 1997.
"New Primary Health Care Facility to be Constructed in St. Albans," in Queens Chronicle, May 29, 1997.
"$8.1 M Health Care Center," in Daily News, May 29, 1997.
"It's a Healthy Day in the Neighborhood," in Capital Ideas, Spring 1997.
"Ferrer Breaks New Ground For Health Facility," in Bronx Times, June 5, 1997.
"Lesbian and Gay Health Center Gets Boost," in The Westsider, July 31August 6, 1997.
"$44.8 Million for Primary Care Projects," in New York Construction News, August 25, 1997.
"In The Zone," in The EZ Works, Summer 1997.
"What a Difference Investment Makes," in The EZ Works, Summer 1997.
"Poor NYC Neighborhoods Get Funds for Primary Care Sites," in State Health Watch, August 1997.
"Celebrate NYAAC 1997," in Ambulatory Cares, Summer/Fall 1997.
"PCDC Builds Primary Care Infrastructure in New York City," in State Health Notes, September 29, 1997.
"PCDC Gets $2.5 Million," in Crain's Health Pulse, September 29, 1997.
"Richard Cotton Honored at Fund Gala," in Blueprint, Fall 1997.
"Cotton Feted," in Broadcasting & Cable, October 13, 1997.
"What a Cut Up," in New York Post, October 23, 1997.
"Just What The Doctor Ordered," in New York Blade News, October 24, 1997.
"Mayor Rudy Giuliani Opens New Park Ridge Family Health Center," in Brooklyn Daily Eagle & Daily Bulletin, October 24, 1997.
"Park Ridge Family Health Center Brings Medical Needs to Communities, Many Nationalities," in The Brooklyn Baron, October 27November 2, 1997.
"Union To Revamp Garment Workers Clinic," in Crain's Health Pulse, October 29, 1997.
"Cheers For the New Park Ridge Family Health Center," in Bay Ridge Courier, October 29, 1997.
"Lutheran Opens Primary Care Center," in Bay Ridge Paper, October 31November 6, 1997.
"Health Care Gets Local at Lutheran," in The Sunset Park Paper, October 31November 6, 1997.
"Loan Pool for Health Care," in The New York Times, November 27, 1997.
"Primary Clinics Receive Loans," in Crain's New York Business, December 17, 1997.
"Banking Boon for Medically Underserved Communities," in Brooklyn Heights Courier, December 22, 1997.
"Citibank Commits $5 Million to Help Create First-Ever Loan Pool for Development of Primary Health Care Projects," in Brooklyn Daily Eagle and Daily Bulletin, December 23, 1997.
"Loan Pool Program," in State Health Notes, January 5, 1998.
"Private Banks Create First-Ever Loan Pool for Development of Primary Care Projects," in The Brooklyn Baron, January 511, 1998.
"Health Center," in Crain's Health Pulse, May 8, 1998.
"Clinic," in Crain's Health Pulse, May 13, 1998.
"A Holy Alliance," in Hospital & Health Networks, May 20, 1998.
"Health Center Finds New Home On 18th St.," in The New Villager, June 17, 1998.
"DASNY Asks City For Bond Guarantee," in Crain's Health Pulse, June 19, 1998.
"Primary Care Loans," in Crain's Health Pulse, June 25, 1998.
"Surgeon General Brings His Mission To Queens," in Queens Tribune, August 1319, 1998.
"PCDC Bond Issue," in State Health Notes, August 17, 1998.
"New Health Centers," in Crain's Health Pulse, October 16, 1998.
"A Medical Clinic Leases Lower Floors to Modernize," in The New York Times, November 15, 1998.
"Maimonides Recognized For Improving S'head Bay," in Bay News, December 7, 1998.
"Unite For Health," in The Villager, December 9, 1998.
"From Motors to Patients," in The New York Times, December 27, 1998.
"New Community Healthcare Center Opens In Central Harlem," in Amsterdam News, December 31, 1998January 6, 1999.
"New Health Facility Fills Needs In Central Harlem," in Republic in the Neighborhood, Winter 1999.
"Health Center Opening," in Crain's Health Pulse, January 7, 1999.
"Access To Health Care: A Primary Concern," in Capital Ideas, Spring 1999.
"Good Will Banking," in Daily News, May 5, 1999.
"Health Info" in Crain's Health Pulse, July 21, 1999.
"Parent Advice Line To Aid Inner-City Families," in Queens Tribune, August 1925, 1999.
"Profiles of Partnership Success." Social Compact. Fall, 1999.
"NewsChannel 4 Local News," PCDC and primary care in underserved communities, WNBC-TV, New York, N.Y., May 12 and 15, 1999.
www.pcdcnyc.org presents a full account of PCDC, its programs, and its projects. PCDC offers tools and shares experiences to build a community among primary care centers using its services.
www.calvertfoundation.org. The Calvert Foundation Web site features a database that includes a profile of PCDC. The database was designed to expand access to information on community investment opportunities around the country for investors, brokers, and financial planners.
Report prepared by: Gregory Hall
Reviewed by: Janet Heroux
Reviewed by: Robert Crum
Program Officer: Michael P. Beachler
Program Officer: Susan B. Hassmiller
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