April 2006

Grant Results

SUMMARY

From October 2000 through March 2005, staff at the Community Healthcare Resource Center of New Jersey worked to improve the performance and viability of New Jersey's network of local nonprofit community health centers. The resource center is a nonprofit technical assistance service created and partly staffed by the Community Foundation of New Jersey.

Key Results

  • Center staff forged a formal commitment among community and public health centers in East Orange to create a network — known as the East Orange and Orange Community Health Partnership — to improve the delivery of primary care while sharing resources.
  • Center staff established MedAccess-New Jersey, an initiative to promote simplified access for community health centers to prescription medications offered by pharmaceutical companies' patient assistance programs.
  • The Community Healthcare Resource Center of New Jersey served as a "re-granting" agency, directing more than $680,000 in 17 grants over two years to community health centers, to assist in efforts to improve their facilities and services.
  • Center staff partnered with the New Jersey Primary Care Association to create a Community Health Training Initiative, providing ongoing education and development opportunities to staff at community health centers.
  • Center staff assisted the Plainfield Health Center (which serves the medical and dental needs of 22,000 people living in Union and Middlesex counties) in establishing a nonprofit foundation to raise funds to sustain the center's programs and to build an endowment for it.

The Community Healthcare Resource Center of New Jersey disbanded at the end of the grant because the Community Foundation of New Jersey could not obtain philanthropic funding for administrative expenses.

Funding
The Robert Wood Johnson Foundation (RWJF) supported this initiative of the Community Foundation of New Jersey with an unsolicited grant of $500,000 to support the work of the resource center.

 See Grant Detail & Contact Information
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THE PROBLEM

At the turn of the 21st century, as many as 41 million Americans lacked health insurance. These uninsured paid for care out of their own resources or relied on free care from a network of "safety net" health care clinics, including hospital emergency rooms in or near their communities.

In 1999, a committee of the Community Foundation of New Jersey (a philanthropic organization focused on community leadership and with experience in health-related consulting) made an assessment of New Jersey's network of community health centers. This network of over 60 centers — Federally Qualified Health Centers, hospital-based clinics and faith-based and independent clinics (which are typically smaller) — provided medical care to hundreds of thousands of low-income and uninsured families in the state.

Committee members concluded that:

  • Many of the centers were under-recognized by New Jersey's philanthropic, corporate and government entities (including those in their own communities) and often lacked the financial support enjoyed by more visible nonprofits.
  • Staff at most health centers were overwhelmed by their daily responsibilities and without the time, expertise or resources to focus on organizational efficiency, strategic planning and fund raising.
  • A 1997 state decision to transition New Jersey Medicaid beneficiaries to private managed-care networks further meant — for some community health centers in particular — a steady attrition of their Medicaid patients. Together with rising health care costs and decreased reimbursement rates, this threatened to create an unsustainable financial burden on them.
  • There was in New Jersey "a prospect that more than a few may gradually wither and decay as … managed care continue[d] to 'grind down' this vulnerable part of the state's provider network," according to committee members in the proposal to RWJF.

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RWJF STRATEGY

RWJF has a particular interest in New Jersey, its home state. It funds New Jersey Health Initiatives (also see the Grant Results), which supports innovative approaches to resolve health and health care needs in New Jersey.

RWJF also supported the Small Agency Building Initiative (SABI) that worked with 19 small agencies, many of them in New Jersey, to improve their operations. See Grant Results on ID# 050082.

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THE PROJECT

Under this grant, in October 2000, the Community Foundation of New Jersey established a technical assistance service — the Community Healthcare Resource Center of New Jersey — to improve the performance and viability of New Jersey's network of local nonprofit community health centers. The community foundation's president and chair of the board of directors also contributed a lot of work on the center. Located in Morristown, N.J., the center's goals were:

  • Helping community health centers market themselves as reliable referral resources to hospitals, schools, nursing homes, social service providers and other local institutions involved in providing services to needy individuals and families.
  • Improving community health centers' managerial expertise and networking strengths.
  • Increasing community health centers' level of recognition and support from New Jersey's philanthropic, corporate and community organizations.

To accomplish these goals, staff surveyed the needs of all of New Jersey's community health centers, and then identified specific health centers or groups of centers to approach through project initiatives. This survey resulted in a Directory of Community Health Centers listing contact information for and brief descriptions of 86 community health service entities; see the Bibliography for details.

As revised and focused over time and in consultation with RWJF program staff and New Jersey Health Initiatives co-directors, Community Foundation of New Jersey staff pursued the following project initiatives:

  • A networking initiative called the "East Orange and Orange Community Health Partnership," to help centers/clinics in these Essex County communities share resources and records and, by communicating effectively, improve patients' access to and quality of medical services.
  • A pharmaceuticals access initiative to assist New Jersey community health centers/clinics to enhance their ability to rapidly and affordably meet the prescription medication needs of their patients.
  • A "re-granting" initiative to secure funds from philanthropic sources and distribute them to selected medical centers/clinics in the state for capital and program needs.
  • A training initiative to undertake organization/program development and performance improvement at community health centers by providing training and education as well as forums for information sharing.
  • A sustainability effort to establish an ongoing mechanism within a single large community health center to fund its capacity building.

A steering committee provided overall project oversight (see Appendix 1 for a list of its members). In a concluding report entitled 5 Lessons in Community Health Care, staff elaborated on these five principal initiatives.

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RESULTS

  • In the course of its existence, Community Healthcare Resource Center of New Jersey attracted more than $929,000 in other financial support for its work. (See Appendix 2 for a list of other funders.)
  • Networking Initiative: Center staff forged a formal commitment among volunteering community and public health centers to create a network — known as the East Orange and Orange Community Health Partnership — to improve the delivery of primary care and to share resources in two Essex County communities. The network was based on recommendations drawn from a project-funded community health needs assessment (2001–2003).
    • It originally included three health centers: East Orange Primary Care, the East Orange Department of Health and Human Services and the Family Health Center of East Orange General Hospital.
    • It subsequently expanded to include the Orange Department of Health and Human Services, Cathedral Healthcare System (four hospitals or health centers serving the greater Newark area) and Saint Matthew's Neighborhood Improvement Development Association serving Orange and East Orange.
    • In 2005, the federal Bureau of Primary Health Care, Health Resources and Services Administration awarded the initiative a $95,000 planning grant to be used for systems integration and development.
  • Pharmaceuticals Access Initiative. Staff established MedAccess-New Jersey, an initiative to promote simplified access to prescription medications at seven community health centers or health facilities in New Jersey.
    • Starting in February 2004, the initiative permits community health centers, for a $1 per patient per month license fee, to efficiently access free patient assistance programs offered by pharmaceutical companies.
    • Software called the RxBridge™ database (previously developed by staff at a similar project called MedBank of Maryland) allows staff social workers to download and complete the companies' prescription application forms accurately and automatically.
    • The program decreased delivery times of medications for participating patients from six weeks to three weeks.
    • It also freed staff from filling out the forms manually and eliminated the time-consuming return of forms for further information.
    • As of March 2005, more than 1,170 patients had benefited from this initiative.
  • A "re-granting" initiative. Via 17 grants, staff directed more than $680,000 in donated funds to community health centers in the state. From its second year (2002–2003), the Community Healthcare Resource Center of New Jersey acted as "re-granting" agency for donated funds. Typically, funds were used for the purchase or upgrade of medical equipment, physical plant improvements or service expansion.
    • The Livingston, N.J.-based Healthcare Foundation of New Jersey provided more than $450,000 of the funds, with the balance coming from:
      1. The Hyde and Watson Foundation
      2. RWJF's New Jersey Health Initiatives program
      3. The MCJ Foundation
      4. The Grotta Foundation
      5. The Union Foundation
      6. The Wallerstein Foundation for Geriatric Life Improvement.

      (See Appendix 2 for amounts.)
    • These are two examples of re-granting projects:
      • The Parker Family Health Center in Red Bank used a $40,000 grant in 2003 to establish a program to manage the health care of low-income, uninsured patients who have metabolic syndrome (simultaneous disorders of the body's metabolism) with at least three or more serious risk factors for cardiovascular disease or diabetes. From an initial 60 patients, in 2005, the program served 200 patients who were insulin resistant or had diabetes.
      • Overlook Hospital's Community Health Center in Union County used a $40,000 grant in 2004 to offer preventive health care to indigent patients. As a result, hospital staff conducted 164 complete physical examinations and 71 follow-up visits at no cost to the patients.
  • A training initiative. Staff partnered with the New Jersey Primary Care Association to provide seven training or development sessions for staff at community health centers.
    • The one-day and half-day seminars attracted board members, executive staff and staff members of 21 community health centers in Atlantic, Bergen, Camden, Essex, Hudson, Middlesex, Ocean and Union counties.
    • As many as 57 people attended the sessions. The project team engaged experts to lead sessions having the following titles:
      • Customer Service/Patient Satisfaction.
      • Performance Improvement.
      • Improving Operational Efficiency through Revenue Maximization.
      • Practical Pointers from a Panel of Peers.
      • Diversity Training/Cultural Sensitivity.
      • Taking Charge as an Executive.
      • Meet the Funders (focused on sustainability).
    • When some health center staff found it difficult to attend the sessions due to workload and limited staffing, the project team conducted on-site seminars at individual centers and invited staff from nearby centers to attend.
  • A sustainability effort. In 2001, staff helped the Plainfield Health Center create a nonprofit foundation to raise operating funds for its programs and to build an endowment.
    • The center, which serves the medical and dental needs of 22,000 people living in Union and Middlesex counties, created the Plainfield Health Center Foundation to help its board more effectively address the center's sustainability, financial resource development and expansion.
    • A member of the board of the Community Healthcare Resource Center of New Jersey contributed an initial $10,000 to the Plainfield Health Center Foundation for board recruitment and training and to assist in setting up the foundation.
    • By April 2005, the foundation had raised over $1 million.

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LESSONS LEARNED

  1. Focus efforts on the community health centers most in need of financial support. These are usually the ones without an institutional affiliate able to supply representation and other forms of backup. In this project, the New Jersey Primary Care Association represented the Federally Qualified Health; and the New Jersey Hospital Association represented the hospital-based ambulatory care centers. However, no organized association represented the independent, mostly faith-based clinics. The project director notes that concentrating efforts on these independent clinics may provide the most benefit. (Project Director)
  2. Recognize that administrative costs are hard to "sell" to interested foundations and philanthropic organizations. The project director notes that the project team had no trouble generating foundation dollars for the MedAccess-NJ initiative or other programs that directly benefited low-income, vulnerable populations. But this was not true of requests to subsidize the administrative costs required by the Community Healthcare Resource Center of New Jersey — to plan, develop, administer and enhance such programs. This led to the center's closure at the end of the RWJF grant. (Project Director)

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AFTER THE GRANT

The Community Healthcare Resource Center of New Jersey disbanded with the end of the grant. Staff and the board chair from the Community Foundation of New Jersey who were involved in the project's MedAccess-NJ are (2005) exploring an effort to further speed up delivery of patient medications from three weeks to two days through the creation of either a virtual or bricks-and-mortar nonprofit pharmacy to be stocked by cooperating pharmaceutical companies.

RWJF also supported the Small Agency Building Initiative (SABI) (see the Grant Results on ID# 050082, etc.) SABI sought to test the ability of RWJF to improve the business capacities of 19 small, nonprofit, community-based health and social service organizations in New York, New Jersey and Pennsylvania through the provision of targeted technical assistance.

The evaluation of SABI found:

  • Fourteen of the 19 SABI participant agencies improved their capacity, based on SOC ratings. The evaluator could "reasonably attribute six agencies' improvements directly to SABI," and the capacity improvements in an additional eight grantees were "possibly related to SABI."
  • The evaluation associated technical assistance focused on fund raising, information systems and communications, with the greatest number of improvements in agencies' capacity.
  • In contrast, the evaluation associated technical assistance concerning governance and strategic planning with the fewest number of agency improvements. None of the organizations that received technical assistance for strategic planning saw any improvements in capacity in this area during their involvement with SABI.

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GRANT DETAILS & CONTACT INFORMATION

Project

Improving New Jersey's Community Health Centers

Grantee

Community Foundation of New Jersey (Morristown,  NJ)

  • Amount: $ 500,000
    Dates: October 2000 to March 2005
    ID#:  039830

Contact

Hans Dekker
(973) 267-5533
hdekker@cfnj.org

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APPENDICES


Appendix 1

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Steering Committee, Community Healthcare Resource Center of New Jersey

2003–2005 Members

Joseph S. Frelinghuysen, Jr. Chairperson
Trustee
Community Foundation of New Jersey
Morristown, N.J.

Albert M. Head, M.H.S., M.S.P.
Executive Director
Community Healthcare Resource Center of New Jersey
Morristown, N.J.

Hans Dekker
President
Community Foundation of New Jersey
Morristown, N.J.

Julane Miller-Ambrister
Trustee
Community Foundation of New Jersey
Morristown, N.J.

Stuart D. Sendell
Chairperson
Community Foundation of New Jersey
Morristown, N.J.

Joshua L. Weisbrod, M.D.
West Orange, N.J.

Past Members, 2000–2003

Roxanne Black
President
Friends Health Connection
New Brunswick, N.J.

Alfred Gaymon, M.D.
East Orange, N.J.

James C. Kellogg
Former President
Community Foundation of New Jersey
Morristown, N.J.

Ellen Kramer-Lambert
President
Healthcare Foundation of New Jersey
Livingston, N.J.

Jamie Reedy, M.D., M.P.H.
Program Director
Pisacano Leadership Foundation
Lexington, Ky.

Richard Weinberg
Quality Improvement Medical Director
University of Medicine and Dentistry-University Hospital
Newark, N.J.


Appendix 2

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Additional Funders, Community Healthcare Resource Center of New Jersey

Board of Directors

  • Community Healthcare Resource Center of New Jersey, Morristown, N.J., $27,500
  • Community Foundation of New Jersey, Morristown, N.J., $94,575
  • Grotta Foundation, Whippany, N.J., $10,000
  • Healthcare Foundation of New Jersey, Livingston, N.J., $562,000
  • Hyde and Watson Foundation, Chatham Township, N.J., $150,000
  • MCJ Foundation, Morristown, N.J., $25,000
  • New Jersey Health Initiatives, Princeton, N.J., $25,000
  • Schering-Plough, Kenilworth, N.J., $5,000
  • Union Foundation, Warren, N.J., $10,000
  • Wallerstein Foundation for Geriatric Improvement, West Orange, N.J., $10,000
  • Mr. and Mrs. Peter J. Wissinger, Glencoe, Ill., $10,000

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Reports

5 Lessons in Community Care. Morristown, N.J.: Community Healthcare Resource Center, 2005.

Directory of Community Health Centers. Morristown, N.J.: Community Healthcare Resource Center, 2005.

Akinosho PE. East Orange Community Health Needs Assessment. Morristown, N.J.: Community Healthcare Resource Center, 2003.

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Report prepared by: Robert Crum
Reviewed by: James Wood
Reviewed by: Molly McKaughan
Program Officer: Terrance Keenan
Program Officer: Marco Navarro