National Association of Community Health Centers (NACHC)

2. National Association of Community Health Centers (NACHC) Jason Patnosh, Associate Vice President/National Director, Community HealthCorps jpatnosh@nachc.com / www.nachc.com / www.communityhealthcorps.org Twitter: @nachc / @commhealthcorps

3. America’s Voice for Community Health Care The NACHC Mission To promote the provision of high quality, comprehensive and affordable health care that is coordinated, culturally and linguistically competent, and community directed for all medically underserved people.

4. Outline • Federally qualified health centers (FQHCs) • Patient centered medical home (PCMH) • Allied health professions in FQHCs • Identification and pipeline programs

5. Federally qualified health centers (FQHCs) • Federally qualified health centers (FQHCs) were founded over 40 years ago in Boston and Mt. Bayou, MS by Drs. Jack Geiger and Count Gibson in collaboration with the Office of Economic Opportunity. • FQHCs are consumer oriented and directed, located in medically underserved areas, provide primary and preventive heath care, and open to all regardless of ability to pay. • Today, FQHCs see nearly 22 million patients annually across 1200 grantees and over 8000 locations. • NACHC was founded a few years later to serve as the voice for health centers, provide technical assistance and support, and develop programs for FQHCs.

6. Health Center Funding in ACA • The Affordable Care Act (ACA) provides $11 billion in dedicated funding for health center operations and capital for FY2011-FY2015. • $9.5 billion to support health center operations. • $1.5 billion for capital needs • Expanded Services at Existing Health Centers • Serve additional patients by expanding current service capacity, including adding providers/staff and increasing hours of operation • New or expanded oral health, behavioral health, pharmacy, and enabling services Funding Award Announcements were scheduled

8. The Current Environment • The view from Congress is turbulent, with the parties taking very different approaches on many big issues. The nation’s fiscal situation is a considered a serious issue to future prosperity by members of both parties, and will continue to grow. • Funding for FQHCs was reduced by $600M in the FY11 budget deal. This essentially stunts the ability to see up to 5M more patients and grow, potentially reducing growth in the ACA estimates.

9. Patient Centered Medical Home (PCMH) From Health Affairs Blog by Holly Koda (April 26, 2011) • The PCMH is not a one-size-fits-all, and neither are the patients or providers who live, work and play within its walls…Ideally, the PCMH helps to empower patients who can participate fully in their care — and places the patient at the center as part of the care team. • What new skills are needed, and how can we prepare competent patients in the PCMH?  Patients do have responsibilities: meeting appointments and follow up visits, filling and refilling prescriptions, communicating frankly about health concerns, and more.Notably, many will fall short, and disparities will advantage or disadvantage specific patient groups. Low income, culturally diverse and other special populations will likely require enabling support to meet their patient responsibilities in the PCMH. • Experience shows that health care professionals can play better with others on collaborative, inter-professional teams when they understand and appreciate the shifting roles and how they fit together in a patient-centered medical home. 

10. Allied Health Professions in FQHCs • Dental hygienists • Medical or dental assistants • Health information technologists • Some health care administrators • Medical coders • Pharmacist/pharmacy technicians • Phlebotomists • Community health workers

11. Identification and Pipeline Programs World Academy for Total Community Health (Brownsville, NY): Mission:To prepare our students to make healthy choices, lead healthy lives and advocate for the total health of their families, their communities, their nation and ultimately, their world; to expose students to all aspects of the health care field and variety of career options the industry offers; to create a socially supportive learning environment; to offer an academically rigorous curriculum that prepares students for higher education. Lead partners: Brownsville Multi-Service Family Health Center (an FQHC), Long Island University School of Nursing, and Sophie Davis School of Biomedical Education.

12. Identification and Pipeline Programs Central Valley Health Network (Sacramento, CA) • Hold an annual conference for 400-500 young people annually highlighting leadership and careers in health care Area Health Education Centers • Nationwide, are creating programs for youth as early as 1st graders to teach healthy lifestyles and become interested in health careers High School Drop Out Rates MATTER!

13. Community HealthCorps mission: improve health care access and enhance workforce development for community health centers through national service programs

14. Serve Serve Supervision Teams and Roles Recruit Transition Train Community HealthCorps A Standardized Program Design that Works

15. Benefit to Health Centers and AmeriCorps Members • AmeriCorps Members Benefit from Serving • Improved understanding of community health delivery • Improved interest in high need health careers • Obtained job skills and workplace experience that lead to living wage career opportunities • Reduced debt burden from past education and encourage pursuit of further education • Increased self-efficacy Community Health Centers Benefit from Hosting • Increased skilled workforce • Increased engagement of community volunteers • Greater advocacy for community residents and community health issues • Increased third-party health insurance and other revenues • Increased funding diversification

16. A Program Model That Gets Results • Thanks to Community HealthCorps (2009-2010)… • Approximately 1.2 million people who lacked access and inadequately used health services • 123,096 enrollment applications for health insurance (including children’s health insurance), health education workshops and other health center services • 159,932 people in need used preventive and primary health care services two or more times within the last program year • 12,754 community volunteers provided over 25K hours of service (valued at $532,586)

17. Return on Investment • An estimated $11 million was invested in the program during program year 2009-2010 ($6 million from federal and $5 million from matching resources). • Community HealthCorps members provided 689,870 hours of service valued at $14.4 million and leveraged over $1.9 million in educational scholarships for the members…this is 145% return on investment in dollars alone and longer term ROI with healthier children and families, and HealthCorps members seeking further careers and education in primary and preventive health.

18. Contact Jason Patnosh jpatnosh@nachc.com / 301-347-0400

19. East Boston Neighborhood Health CenterCaring for the Community • The East Boston Neighborhood Health Center has been a vital part of the community for 40 years. We provide easily accessible, high-quality health care to all who live and work in East Boston and the surrounding communities, without regard to age, income, insurance status, language, culture, or social circumstances. Our doors are always open. EBNHC Education and Training Institute

20. EBNHC: Overview • Over 800 Employees • Over 250,000 Patient Visits per year • Full Array of Primary and Specialty Services • 24/7 Emergency Department • Onsite Pharmacy • Elderly Service Plan – PACE Program • Transportation Services • Education and Training Institute EBNHC Education and Training Institute

21. Education & Training Institute Established in 2005. Grow and retain your own! EBNHC Education and Training Institute

22. Challenge: To provide high quality healthcare to a linguistically and culturally diverse community. • 45% of patients are best served in a language other than English • 25 Professional Interpreters • Over 80,000 encounters per year • External Language Line $75,000 • 54,397 minutes • Increasing demand for language assistance EBNHC Education and Training Institute

23. A project of the East Boston Neighborhood Health Center’s Education and Training Institute in collaboration with Bunker Hill Community College Jewish Vocational Service World Education made possible with generous support from The Robert Wood Johnson Foundation, the Hitachi Foundation and the Department of Labor Jobs to Careers:Pathways for Frontline Workers EBNHC Education and Training Institute

24. Jobs to Careers (J2C)Source:http://www.jobs2careers.org/pdf/J2CNewsMarch08.pdf • Jobs to Careers seeks to advance and reward the skill and career development of the low-wage incumbent (health care) workers. • Jobs to Careers supports partnerships of employers and educational institutions to expand and redesign systems which test new models of education and training that incorporate work-based learning. EBNHC Education and Training Institute

25. Target Employees • Medical Assistants • Administrative Practice Support Staff • ESP (Elder Service Plan) Nurse’s Aides EBNHC employs over 300 FLWs! EBNHC Education and Training Institute

26. Partner Roles East Boston Neighborhood Health Center: • Promote J2C to internal staff, especially Managers and Supervisors • Recruit potential participants • Assist employees to access necessary supports, including financial and academic EBNHC Education and Training Institute

27. Partner Roles JVS: • Developed and delivered college prep courses (Reading Comprehension, Writing, ESOL, and Math) • Prepared employees for college placement exam (CPT); • Provided Career Coaching services; • Developed and delivered a preceptor training course for Medical Interpreters. EBNHC Education and Training Institute

28. School in the Summer! MATH …for people who FEAR math! When: Mondays from 5-7 p.m. (Begins Monday June 8th) Where: 155 Addison Street, East Boston EBNHC Education and Training Institute

29. Partner Roles, cont. Bunker Hill Community College: • Developed a 3 credit Medical Interpreting course, based on the EBNHC Certified Auxiliary Interpreter (CAI) training, incorporating Work-Based Learning methodologies; • Developed a Communications course: designed to strengthen employees’ customer service skills and cultural competency EBNHC Education and Training Institute

30. Certified Aux Interpreters (CAI) • Response to the exponential growth in demand for interpreter services • Train bilingual frontline staff to serve as culturally competent medical interpreters • Developed to improve quality and maintain standards of interpreter practice EBNHC Education and Training Institute

31. Medical Interpreting Medical Interpreting 1 COURSE DESCRIPTION: This course is designed for bilingual students interested in becoming integral members of the health care team in bridging the language and cultural gap between patients and providers. Students will examine issues related to interpreter ethics and the role of the interpreter in a variety of clinical settings. Topics include anatomy and physiology, pathophysiology, diagnoses, medical treatments, medical terminology and abbreviations. (3 Credits) EBNHC Education and Training Institute

32. Employees’ Perspective What are the barriers that prohibit (EBNHC) employees from advancing in their careers? (Based on the results of a 2007 ETI employee focus group) • Family responsibilities; lack of time • Limited financial resources • Basic academic skills’ deficits • Lack of information regarding career paths EBNHC Education and Training Institute

33. Addressing Staff Barriers to Career Advancement Family responsibilities/Lack of time ↓ On-site BHCC Classes at ETI and Work-Based Learning! Limited financial resources ↓ Tuition Reimbursement, Financial Aid, and Back to School Incentive! Basic academic skills deficits ↓ JVS College Prep Classes! Lack of information regarding career paths ↓ Career Coaching! EBNHC Education and Training Institute

34. How do we accomplish all this? Through Work-Based Learning! • Curriculum is work-place driven, developed in conjunction with employer • Less time in the classroom • Work process itself is source of learning • Structured assessments • Rewards for achievements (e.g., college credits, bi-annual bonus) EBNHC Education and Training Institute

35. J2C: Outcomes • Over 70 EBNHC employees participated in at least one service component of J2C • CAIs: 28 EBNHC employees completed Medical Interpreting 1 (receiving 3 college credits in the process) • 15 EBNHC employees are working toward an 18-credit Certificate in Medical Interpreting through BHCC EBNHC Education and Training Institute

36. Where are we, post-J2C? • Currently ETI offers 15 BHCC courses over three evenings; • ETI sponsors courses such as Medical Spanish, Medical Terminology and Basic Computer Skills for employees; • Exploring options to provide healthcare training to members of the community EBNHC Education and Training Institute

37. Questions? EBNHC Education and Training Institute