Fulfilling the VNA Mission with Primary Healthcare Services

1. Fulfilling the VNA Mission with Primary Healthcare Services Presented at VNAA Annual Meeting on April 26, 2007 by..... Linnea Windel, President/CEO Darlene Varney, VP of Patient Services/COO Lisa Hill, VP of Finance/CFO

2. Outline I - Overview of organization II - Why develop a primary care program? III - History of the Community Health Center movement IV - Common terms and acronyms

3. Outline V - Community assessment steps VI - Governance structure VII - Community support steps VIII - Grant application process

4. Outline IX - Key financial considerations X - Program development XI - Where we are today XII - Resources XIII - Contact information

5. I - Overview of organization VNA of Fox Valley history VNA programs VNA key statistics

6. VNA of Fox Valley History 1918 � VNA (Aurora Child Welfare Clinic Association) opens in Aurora with focus on caring for crippled children 1930-1940 � VNA begins school nursing services and provides mother/baby care 1946-1954 � VNA takes the lead in communicable disease control, providing tuberculosis treatment clinics, home lead investigations and immunizations

7. VNA of Fox Valley History (cont.) 1965 � VNA becomes first agency in Illinois to become licensed to provide Home Health under the Medicare benefit 1980 � VNA begins the Women, Infants and Children (WIC) Nutrition Program for Southern Kane County 1988 � VNA�s Women�s Wellness Clinic opens; VNA flu shot program established 1993 � VNA adds Medicare-certified Hospice Program; VNA introduces new Healthy Families America program to reduce incidence of child abuse and neglect

8. VNA of Fox Valley History (cont.) 1994 � VNA provides more than 3,300 tetanus shots in just a few days in response to devastating flood in area 2002 � VNA becomes a Federally Qualified Health Center and begins offering comprehensive primary healthcare at Aurora and Elgin locations 2002 � VNA Dental Clinic opens 2006 � VNA purchases new facility 2007 � New VNA Health Center opens in June

9. VNA programs VNA Home Health VNA Hospice VNA Community Wellness VNA Health Centers

10. VNA Home Health VNA Nurse Specialties Home Infusion Therapy Wound Care Mother, Baby & Pediatric Care Advanced Nurse Practice Service Mental & Behavioral Healthcare Palliative Care Rehabilitative Therapies Nutrition/Dietitian Services Medical Social Work Certified Nurse Aide Care

11. VNA Hospice For the final stages of illness � medical, psychosocial, emotional and spiritual support for patients and their families Bridge home care for those with serious illnesses Grief support groups, programs and resources

12. VNA Community Wellness Women, Infants and Children (WIC) Program Healthy Families America Breast and Cervical Cancer Screening Reach Out and Read Community Immunization Program Health Screenings School-Based Health Center

13. VNA Health Centers Located in Aurora and Elgin Complete primary healthcare Wellness and annual preventative services Complete obstetrical services Diagnosis and treatment of acute and chronic illness Pharmacy assistance Laboratory testing Dental Clinic

14. VNA key statistics Over 40,000 people served annually 200 employees $13m operating budget 6 locations

15. II - Why develop a primary care  program? Community need Approximately 53 million underinsured and uninsured people in U.S. By 2010, Community Health Centers are projected to care for 20 million people

16. Why develop a primary care program? (cont.) Community Health to care for people of all ages...in home and clinic settings Improves existing home care and community health programs

17. Why develop a primary care program? (cont.) Diversification of services Increases organization�s visibility and prominence in community

18. III � History of Community Health Center Movement 1960s � Activists worked to secure federal funding for healthcare in low-income communities Dr. H. Jack Geiger led the movement when President Johnson declared �War on Poverty�

19. History of Community Health Center Movement (cont.) 1965 � Federal funding approved; Health Center model combined local community resources with federal funds to establish neighborhood clinics Bipartisan support throughout its history

20. History of Community Health Center Movement (cont.) Major expansion during Bush Administration Today � 1,000 Federally Qualified Health Centers with 5,000 sites

21. IV � Key terms and acronyms FQHC � Federally Qualified Health Center �Look-alike� � Clinic that has FQHC status without federal funding CHC � Community Health Center (generally denotes federal funding) BPHC � Bureau of Primary Health Care FTCA � Federal Tort Claims Act

22. Key terms and acronyms (cont.) 330(e) Funding � Federal funding for CHCs MUA � Medically Underserved Area MUP � Medically Underserved Population HPSA � Health Professional Shortage Area 340B Pharmacy Provider � Physician, Nurse Practitioner or Physician Assistant PCA � Primary Care Association

23. V - Community assessment steps Data sources Data analysis Communicating the data

24. Data sources U.S. Census State Primary Care Association CDC Wonder State Department of Public Health State Department of Human Services Local Health Department

25. Data sources (cont.) Local Law Enforcement (crime stats) Department of Labor (unemployment stats) Local health care studies (hospitals, United way, foundations, etc.) University studies Focus groups Community survey Physician survey

26. Data analysis Comparison to local, state and national statistics University resources

27. Communicating data Organization Board of Directors Local, state and federal government Local business and community leaders State Primary Health Care Association

28. VI - Governance structure Consumer majority requirement Size Meeting schedule Affiliations

29. VII - Community support steps Making the case Political advocacy State and national associations

30. VIII � Grant application process Selecting a consultant Completing the Need for Assistance worksheet Develop a rough budget quickly Bylaws development

31. Grant application process (cont.) Board composition Organization�s patient demographics (if applicable) Ability to show readiness Letters of support Floor plan

32. IX - Key financial considerations Revenue increases Increased expenses Expense savings Cash flow implications Critical financial monitoring factors

33. Revenue increases New start grant average $600,000/yr for 2 yrs initially �Cost� based reimbursement for Medicaid and Medicare Attracts additional local government and philanthropic grants

34. Increased expenses Grant writing consultation expertise Facility and equipment needs Recruiting expense to attract and retain providers Provider wages during practice building phase

35. Increased expenses (cont.) Additional auditing expenses to meet requirements of A-133 Additional accounting support to meet all federal reporting requirements Annual updated applications Cost reports to State Medicaid and Federal Medicare Annual Universal Data Set (UDS) report Federal Financial Status Report (FSR) Quarterly report on federal funds drawn

36. Increased expenses (cont.) Software to meet government reporting, billing and accounting and internal practice management needs Initial deeming process and bi-annual provider recredentialing

37. Expense savings Malpractice Insurance: Federal Tort Claims Act (FTCA) of 1992 and 1995 provides umbrella of professional liability coverage to deemed CHC All employees and individually contracted physicians are covered as federal employees without cost Prior to deeming, VNA purchased insurance on each provider (purchase of insurance for OB/GYN prohibitively expensive)

38. Cash flow implications Federal grant is not restricted to retrospective expense vouchering State of Illinois Medicaid program is very slow to pay but a successful expedited payment application speeds payments to 60-day turnaround Patients on VNA sliding-fee scale are requested to pay prior to service

39. Critical financial monitoring factors Payor mix Provider productivity

40. X - Program development Program details Key staff positions Hiring providers Physical space considerations Cultural sensitivity Risk management Monitoring

41. Program details Converted from Public Health to Primary Care Model Preventive, acute and chronic care Men, women and children

42. Program details (cont.) 24-hour-a-day availability Inpatient service Referral for specialty care Casemanagement

43. Program details (cont.) Appointments and walk-ins Managing clinic flow Prescriptions Federal program expectations

44. Key staff positions Director of Clinical Services In charge of day-to-day clinic operations Medical Director Works with providers and medical community

45. Key staff positions (cont.) Nursing staff In charge of clinic flow as well as nursing care One nurse for every 2 providers

46. Key staff positions (cont.) Translation Support staff One CNA or CMA per provider Front line staff

47. Hiring providers Providers need to understand the community health model Began with one gynecologist; added OB/GYN Pediatricians Family practice physicians and nurse practitioners

48. Physical space considerations Started by adding exam rooms Ideal to have 3 exam rooms per provider Added dental offsite Expanding to new 36-exam room site

49. Cultural sensitivity Language barrier Cultural issues related to healthcare

50. Risk management Combined policies and procedures from state-funded programs and incorporated federal guidelines Clinical protocols per federal guidelines Medical Director heads Quality Improvement team

51. Monitoring Volume No-show rates Scheduling

52. XI � Where we are today 4 clinic locations 20,000 patients Establishing mammography and pharmacy services EMR Opening new main location June 11, 2007

53. XII � Resources Bureau of Primary Health Care National Association of Community Health Centers State Primary Health Care Association

54. XIII � Contact information VNA of Fox Valley 400 North Highland Avenue Aurora, Illinois 60506 630.978.2532 www.vnafoxvalley.org Email: lwindel@vnafoxvalley.com dvarney@vnafoxvalley.com lhill@vnafoxvalley.com