PDF Annual Report HCAN FINAL

2017ANNUALREPORT

MESSAGE FROM THE BOARD PRESIDENT As we reflect on 2017, we have witnessed a year full of challenges, great successes, and affirmation that Nebraska’s health centers are integral to the health care safety net. As an association of seven health centers serving the entire state, Health Center Association of Nebraska (HCAN) and Nebraska’s health centers continue to promote access to high quality, affordable health care for all. Our health centers contributed over $132.5 million to Nebraska’s economy and saved the health care system $107 million. We witnessed a 10% growth in our patient population – serving nearly 85,000 Nebraskans across 296,000 visits. Nebraska’s health centers rank 2nd among the nation’s 1,400 health centers in the quality of care we provide to our patients – ranking 1st in four quality measures. Kenny McMorris, MPA, FACHE, CHCEF CEO, Charles Drew Health CenterThe heart of our work continues to be the patients we serve. Community-based efforts, including farmers markets,partnerships with Women, Infants and Children (WIC) and local health departments, and medical-legal partnershipscontinue to address the health impacts of factors occurring outside of the health center walls. Health centers continueto be community-focused sources of care, advocacy, and assistance for our patients.Looking to 2018, HCAN will continue to play a key role in supporting the work of Nebraska’s health centers. As BoardChair, I look forward to another year of patient growth, expanding comprehensive services, and providingcompassionate, high quality health care to all Nebraskans.MISSIONTo support Community Health Centers as they provide comprehensive healthcare homes for the underserved.VISIONNebraska Community Health Centers are recognized for quality, affordable, accessible patient-centered healthcare.WHO WE AREHealth Center Association of Nebraska (HCAN) is Nebraska’s nonprofit Primary Care Association, representing the state’sseven Federally Qualified Health Centers (FQHCs) also known as community health centers. HCAN is committed toexpanding and enhancing access to quality, community-responsive care for Nebraska’s health centers. HCAN leadstraining and technical assistance for Nebraska’s community health centers while providing advocacy and education forthe patients within their communities.HCAN BOARD OF DIRECTORS  Kenny McMorris, Board Chair, Charles Drew Health Center, Inc.  Brad Meyer, Vice Chair, Bluestem Health (formerly People’s Health Center)  Kathy Nordby, Secretary/Treasurer, Midtown Health Center  Margo Hartman, Community Action Health Center  Will McInnis, Good Neighbor Community Health Center  Andrea Skolkin, OneWorld Community Health Centers, Inc.1  Tami Smith, Heartland Health Center ASSOCIATE MEMBERS  Bill Wypyski, All Care Health Center  Mari Kaptain-Dahlen, Siouxland Community Health Center

WHAT IS A COMMUNITY HEALTH CENTER?Federally Qualified Health Centers (FQHCs), or community health centers, serve as the primary medical home for morethan 27 million people nationally, which includes nearly 85,000 Nebraskans. FQHCs are community-based and patient-directed organizations that serve populations with limited access to health care. Below are illustrations of Nebraskacounties and patients served.NEBRASKA HEALTH CENTERS AT A GLANCE● Bluestem Health ● Charles Drew Health Center ● Community Action Health Center1021 North 27th St | Lincoln, NE 68503 2915 Grant St | Omaha, NE 68111 975 Crescent Dr. | Gering, NE 69341Ph. 402.476.1455| www.bluestemlincoln.com Ph. 402.451.3553| www.charlesdrew.com Ph. 308.632.2540 | www.capwn.org4 service delivery locations 15 service delivery locations 3 service delivery locations● Good Neighbor Community Health Center ● Heartland Health Center ● Midtown Health Center4321 41st Ave | Columbus, NE 68601 3307 West Capital Ave | Grand Island, NE 68803 302 West Phillip Ave | Norfolk, NE 68701Ph. 402.562.7500| www.ecdhd.ne.gov Ph. 308.382.4297| www.heartlandhealthcenter.org Ph. 402.371.8000| www.midtownhealthne.org6 service delivery locations 1 service delivery location 2 service delivery locations● OneWorld Community Health Centers, Inc.4920 South 30th St | Omaha, NE 68107Ph. 402.734.4110| www.oneworldomaha.org13 service delivery locations 2

PATIENT PROFILEIn 2016, Nebraska’s community health centers served nearly 85,000 unduplicated patients with integrated primary care,preventative services, chronic disease management, and support services addressing medical, dental, and behavioralhealth needs. Of these patients served, nearly 50% were uninsured, 92% had incomes at or below 200% of the federalpoverty level, and 54% had incomes at or below 100% of the federal poverty level.RACE AND ETHNICITY Hispanic “For over 50 years, Federally 47% Qualified Health Centers, or Non-HispaniUc nre6p%orted Other 1% community health centers, have Asian provided comprehensive, 4% community based, medical, dental and behavioral health care to Non-Hispanic everyone, regardless of insurance Black status or ability to pay. In 11% Nebraska, our seven health centers served nearly 85,000 Non-Hispanic patients last year. Ninety percent White of our patients are low income, 31% and one out of every four uninsured individuals in our state receives care at a health center.” – Amy Behnke, HCAN CEO, September 2017PAYOR SOURCE GENDER 18% 4% Medicare Private Insurance Male 44% 29% Female Medicaid 56% 49% Uninsured % OF NEBRASKANS RECEIVING CARE AT A FQHC 40% 34% 35% 30% 29% 26% 25% 23% 20% 16% 11% 15% 10% 12% 10% 5% 0%3

CLINICAL QUALITY RANKINGSNebraska FQHCs provide exceedingly high-quality care relative to their peers nationally. Overall, Nebraska FQHCs rank2nd in quality among the nation’s 1,400 health centers. In addition to being in the top half of states in 14 out of the 16UDS clinical quality measures, Nebraska FQHCs are 1st in the nation in the following four measures: • Weight Assessment and Counseling for Nutrition and 1st Physical Activity for Children and Adolescents • Adults Screened for Tobacco Use and Receiving 1st Cessation Intervention 1st • Childhood Immunization Status 1st • Screening for Clinical Depression and Follow-up PlanVALUE IMPACT OF HEALTH CENTERSCommunity health centers are an important part of the health care system in Nebraska, providing comprehensive healthservices to the medically underserved. They collectively provide tremendous value and impact to their communities,from access to care, savings to the health care system, jobs and economic stimulus to local communities and state-of-the-art comprehensive care.Nebraska community health centers serve as a critical component of the safety net, serving 26% of the uninsuredpopulation and 34% of the uninsured children. In Nebraska, nearly 50% of health center patients are uninsured and 92%are low income.Nebraska health Cost Savings $132,585,698centers provide 1,214total jobs in Nebraska $54 million savings to Total Economic Medicaid Impact of current Total Jobs operations $107 million savings to the overall health Total Economic system Impact 4

2017 | A YEAR IN REVIEWTraining and Technical AssistanceHCAN’s principal responsibility is to offer training and technical assistance to community health centers to support theircommitment to provide high-quality, comprehensive healthcare services. Throughout the year, HCAN offers monthlyPeer-to-Peer team calls, annual conferences, webinars, in-person trainings, and individual assistance to health centerleadership and staff. HCAN works with regional and national partners to provide timely and high-quality trainings, aswell as guidance on any new or ongoing federal and state initiatives.Peer-to-Peer NetworksThe learning teams establish and foster valuable connections on the state and national levels. Peer-to-Peer networkgroups include: Dental and Oral Health 6 32 440 Financial Operations Management Human Resources Team Total Total Total Communications Team Networks Calls Attendees Outreach and Enrollment Team Behavioral Health (Coming in 2018!)Outreach and EnrollmentCommunity health centers play a vital role in helping Nebraskans understand their options for health insurance andassistance programs in the state. Within the seven health centers, there are nearly 30 Certified Application Counselors(CACs) conducting outreach and in-reach within their communities. In 2017, they were able to educate and assist 58,904individuals about medical and economic assistance programs in Nebraska. In the Health Insurance Marketplace, despitehaving a shorter open enrollment period, the CACs were able to help enroll 88,213 Nebraskans into affordable healthcoverage. Oral Health - Dental Kits Thanks to DentaQuest Foundation funding, HCAN provided the seven Nebraska health centers with 2,625 pediatric dental kits in early June of 2017. These kits were used for summer back-to-school bashes, health fairs, dental screenings and community outreach events. Renewed DentaQuest Grant HCAN was awarded renewed 2017-2018 National Oral Health Innovation and Integration Network (NOHIIN) funding. HCAN's NOHIIN funding allowed for an in-person Dental Directors Learning Collaborative, sponsorship of health center Dental Directors to the National Network for Oral Health Access (NNOHA) conference in San Diego, and the pediatric dental kits provided this past spring.5

2017 | A YEAR IN REVIEW | IN-PERSON EVENTS June 8th, 2017HCAN 2017 Conference, \"Partners for Change: Health Equity for All Nebraskans\"Nebraska City, NE The 2017 HCAN Conference was held on Thursday, June 8th, at the beautiful Lied Lodge & Conference Center in Nebraska City, NE. HCAN was pleased to welcome speakers from Colorado to New York, to share their expertise on: the 340B Drug Pricing Program, Hepatitis C, Social Determinants of Health, Financial Advancement through Performance Evaluation Profile (PEP) Interpretation, and Talent Management.Health Center Advocate of the Year –Senator John StinnerOn June 7th, HCAN’s Board of Directorspresented Senator John Stinner with the HealthCenter Advocate of the Year Award. Thank youfor all your hard work in supporting Nebraskacommunity health centers, Senator Stinner. 6

2017 | A YEAR IN REVIEW | IN-PERSON EVENTS, CONT’DFTLF De-Mystifying the 19 Program Requirements September 6-7th, 2017Kearney, NE  Marcie Zakheim, Partner with Feldesman Tucker Leifer Fidell LLP, and Warren Brodine, President of W. J. Brodine & Co., hosted a 2-day, in-person event for health center staff on the newly released Health Center Program Compliance Manual.CAC Fall Training September 21st-22nd, 2017Omaha, NE  HCAN hosted a Certified Application Counselor (CAC) Training in Omaha that brought CACs together from all seven Nebraska health centers, including associate members. The training focused on the upcoming challenges that Open Enrollment 5 presented (i.e. shorter enrollment time, less assisters in Nebraska, preventing burnout, etc.). Speakers from Centers for Medicare and Medicaid Services, Managed Care of North America, and others led informative sessions.Envolve Vision Van September 25-29th, 2017  The Envolve Vision Van, in partnership with the Association of Clinicians for the Underserved (ACU), visited five Nebraska health centers. In total, 234 patients were screened with over 90% of those patients leaving with a prescription for free eye glasses – regardless of their insurance status or ability to pay. There were patients in such dire need of vision services that they needed assistance completing check-in paperwork. Optometrists identified patients with cataracts, glaucoma, and detached retinas. Patients unable to be seen by the Vision Van that day drove from one closed event to the next, at 6:00am the following morning, to ensure their spot in line.  HCAN is extremely grateful for the Envolve Vision Van, and the 250 miles driven, to provide Nebraska patients with the vision screenings and eye glasses so desperately needed.  September 25th: Heartland Health Center  September 26th: Good Neighbor Community Health Center  September 27th: Midtown Health Center  September 28th: OneWorld Community Health Centers  September 29th: Charles Drew Homeless Clinic7

2017 | A YEAR IN REVIEW | IN-PERSON EVENTS, CONT’DOral Health in the Safety Net Collaborative October 5-6th, 2017Salina, KS  HCAN and the Kansas Association for the Medical Underserved (KAMU) proudly co-hosted a 1.5 day in-personlearning collaborative geared towards the logistics of successfully operating dental operatories within aFederally Qualified Health Center. The National Network for Oral Health Access (NNOHA) was on-site to educate on best practices in data collection and reporting, in regards to the UDS 6 to 9-year-old Sealant Measure.  Additional topics discussed include: dental program financials, team-based care, quality improvement, and caries management.Motivational Interviewing for the Health Professional October 2017 Staff from all seven Nebraska health centers took part in one of HCAN's three Motivational Interviewingworkshops hosted in October 2017. These workshops were hosted in both urban and rural Nebraska. October 10th, Omaha October 12th, Columbus October 16th, Omaha 8

PATIENT ADVOCACYFor over 50 years, FQHCs have provided comprehensive, community-based, medical, dental and behavioral health careto everyone, regardless of insurance status or ability to pay. During those 50 years, health centers have received strongbipartisan support, and have grown to serve nearly 26 million people nationwide. This bipartisan support and effort iskey to HCAN’s patient advocacy and raising the voice of community health centers and the underserved.HCAN spearheads advocacy efforts at the state and federal level for the community health centers. Policy monitoringand analysis is provided to health centers to help staff, board members, and community supporters be better informedand take action.Through contacts with State Senators, Administrative Staff and Nebraska’s Congressional Delegation, HCAN is able toprovide timely analysis to the health centers on potential impacts of state and national policy changes.Nebraska Legislative Lunch & Learn January 26, 2017Lincoln, NE  HCAN hosted a Lunch & Learn about FQHCs at the Capitol on Thursday, January 26th, to inform Nebraska Senators and staff about HCAN member health centers, the types of patients they serve, and the benefits FQHCs provide the state's citizens.  Participants heard an overview from Amy Behnke, HCAN CEO, as well as specifics from OneWorld Community Health Centers’ CEO, Andrea Skolkin, Midtown Health Center Executive Director, Kathy Nordby, and Bluestem Health CEO Brad Meyer.9

MESSAGE FROM THE HEALTH CENTER ASSOCIATION OF NEBRASKA CEO Amy Behnke, J.D. HCAN was founded over six years ago to ensure that Nebraska’s health centers notCEO, Health Center Association of NE only had a voice in the rapidly-changing health care environment, but to ensure they had the support needed to continue to provide comprehensive, high-quality, accessible health care to all Nebraskans. In those six years, we have witnessed the growth of the health center patient population to 85,000 patients, the expansion to seven health centers, and the inclusion of comprehensive medical, dental, and behavioral health services across all health centers. Through it all, HCAN has been there with technical support and advocacy, supporting the health centers with timely trainings, individualized technical assistance, securing the expansion of state funding for health centers, and the acquisition and maintenance of philanthropic funding, allowing our health centers to continue to grow to meet patient needs.While 2017 has been a tumultuous year, we are energized and excited for 2018. Expanding peer learning teams toinclude behavioral health providers, continuing to partner with our neighboring states on training initiatives, andfocusing on continuous quality improvement will be key components of our work in the coming year. HCAN will alsocontinue to be a powerful voice for our health centers and their patients, educating key policy makers and communitypartners on the valuable role health centers play in Nebraska’s health care industry and the overall economy of thestate.It has been my honor to serve as HCAN’s CEO for the past two-and-a-half years. I am constantly humbled by the work ofour health centers. One needs to spend only a few minutes in a busy health center waiting room to grasp the vital roleeach health center plays in its community. Even outside of the health care provided, Nebraska’s health centers are safe,supportive spaces for our patients. HCAN will continue to fiercely advocate for our health centers, the patients theyserve, and the access to care provided.Thank you for giving us the opportunity to share the important work of our health centers. We look forward to asuccessful 2018!HCAN STAFF  Amy Behnke, Chief Executive Officer  Keshia Bradford, Director of Strategic Initiatives  Nicole Hamill, Executive Assistant  Angela Lindstrom, Integrated Marketing Director  Pat McVea, Research Analyst  Jenna Thomsen, Director of Training and Technical Assistance  Shelly Uhing, Finance Director Thank you for supporting the Nebraska community health centers! 10

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