FQHC HCH and PH Application Process and Challenges

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Posy Higgins
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1 + FQHC HCH and PH Application Process and Challenges Case Study: Flint, Michigan

2 + The Landscape: Flint, Michigan Birthplace of GM and the UAW Genesee County population 425,800 (Census 2010); 5 th largest in state Flint population 102,400 (Census 2010); 7 th largest in state 1970 s 90,000 GM jobs 2011 less than 8,000 GM jobs

3 + The Challenges Flint leads many state and national lists for bad health and economic indicators: Top 10 Dying Cities (Newsweek ) Top 10 Most Miserable Cities (Forbes ) Top 10 Most Dangerous Cities (Yahoo! ) Many more

4 + Genesee County Community Mental Health Service provider and federally designated Medicaid Manager (Health Plan) Target populations children and adults with a serious mental illness, a developmental disability, and/or a substance use disorder $135M budget; 320 staff; manage over 200 contracts within the CMH Provider Network Have had collaborative relationship with local FQHC for 10 years

5 + Why We Applied for 330 Funding Growing need in the county Expand the safety net Appeared to be a steadily growing funding stream Potential for new federal money and jobs in a dying area

6 + What You Must Know and Must Have in Order to Do This Must have 100% commitment from the top - Board and CEO Must do your homework - how this will fit in your organizational structure Must know where the political landmines are Must realize that if you are a CMH, you will probably not become an FQHC Must know that this process will disrupt your daily operations

7 + What You Must Know and Must Have in Order to Do This (cont d) Must be willing to pay consultant(s) and/or be willing to sacrifice your best and brightest staff for the duration of the project - it will consume them Finally, must be willing to do this for the right reasons - more care for more people

8 + Application Process: 2009 August: Unmet need in Genesee County continued to expand through the recession/depression; began discussions with a consultant who previously brokered the location of a primary health clinic within our psychiatric medication clinic August November: Analysis of community stats and our readiness October: Met with Michigan Primary Care Association and Michigan Department of Community Health; had conversations with other public entity FQHCs in TN, OR, and Ingham County, MI November: Site visit to ICHD FQHC; MDCH and MPCA present December: CEO directed internal team to pursue 330 NAP when offered

9 + Application Process: 2010 January: Established partnership with large local primary care group January: Prepared drafts of core documents; e.g., bylaws and governance plan; phone TA conference with NACHC staff in Washington February: Commenced needs assessment and data analysis activities; discerned the need to serve the most vulnerable (those without insurance, income, safe housing, etc.); recognition that CMH is uniquely positioned as the largest and strongest part of the safety net for vulnerable people February: Staff attended a two-day NACHC seminar in Washington, D.C.

10 + Application Process: 2010 (cont d) March: Decision to make application as a public entity vs. seeking incorporation as a 501(c)(3) April May: First hints from Washington that an NOF/NAP is coming May: Staff attended a HRSA TA conference call and drafted a work plan for the team; began document preparation; e.g., JDs, TOs, policies & procedures, résumés, budgets, contracts, referral agreements, etc. May October: Engaged safety net partners for support

11 + Application Process: 2010 (cont d) June: Presented plan to Genesee County Community Mental Health Board of Directors (the co-applicant board) June September: Medical Director pursued core services contracts and referral agreements August: NAP announcement (HRSA ) released (submission to Grants.gov due 11/17/10; HRSA EHBs due 12/15/10); GCCMH Board of Directors voted to support application September: Hired SPH consultant to (a) perform geo-mapping and in-depth data analysis; (b) conduct surveys; and (c) solicit members for the board and advisory groups

12 + Application Process: 2010 (cont d) September: Staff attended Technical Assistance conference calls re: special populations and performance measures; made decision to pursue 330(h) and 330(i) only, in keeping with intent to meet needs of most vulnerable residents already reliant upon the safety net October: Genesee Community Health Center Board and advisory groups began meeting November: CEO presented the plan to the Genesee County Board of Commissioners to garner support for the co-applicant submission and request for 330 funds (extra step for public entity)

13 + Application Process: 2010 (cont d) November: On-time submission to Grants.gov of the 424, assurances, and project abstract December: On-time submission of all forms, attachments, and narratives

14 Waiting for award announcement sometime in August December (plan): Open 330-funded clinics in the One Stop Housing Resource Center (for homeless), and in the Public Housing development known as Atherton East Decision to pursue ACA Health Center Planning Grant HRSA for 330(e) (in process; due April 8 th ); will be helpful in the event we do not receive 330(h) and 330(i) funding this round

15 + What We Wish We d Known in the Beginning That the National Health Care for the Homeless Council exists!!!! It is relatively easy to get the support of U.S. Senators (Levin and Stabenow) for health care for vulnerable populations The HRSA Call Center is fantastic and very responsive, especially if the published documents are inconsistent (which they are!) and the site breaks down (rare, but it happens) The more team members with access to the EHB, the better; editing is possible right up until the submit button is clicked Obtaining 501(c)(3) status is desirable, but not mandatory for public entities

16 + The GCCMH Primary Team for FQHC Application Development and Submission Danis Russell, CEO, Business Official on application Honor Potvin, Public Health Consultant Pat McLuckie, Assistant to COO, AOR on application, repository manager, and organizer Tisha Deeghan, COO, Designated AOR on application, responsible for submission and assurances

17 + The GCCMH Support Team (it takes a village) Dhannetta Brown, Director of Finance/CFO (budget) Brian Swiecicki, Director of Business Operations (contracts and facilities) Robert Cuthbertson, MD, VP of Medical Affairs/Medical Director (referral agreements and partnerships) Kathy Tilley, CIO/Director of IT (technology plan) Kristie Schmiege, Director of Substance Abuse Services and Prevention (experienced manager of primary care clinic operations) Sharon Lombard, Director of Professional and Consultative Services; manages Medication Clinic (where primary care is already co-located).

18 + Several Challenges, Multiple Purposes My role included: Community outreach efforts Governing board recruitment Data collection, analysis, and mapping within two distinct, but also overlapping communities: Homeless and Public Housing

19 + Getting Started: Learning the Lay of the Land Initial research: identifying and mapping out community resources with common/shared goals Service providers Shelters Hospitals Health Dept Local Businesses Non-profits Public Housing Authorities Universities Community Members Consumers

20 + Results of Initial Research Identified a list of key stakeholders to target for outreach activities, data collection, and governing board recruitment Used list and maps to meet many objectives: Define/refine target service area Plan outreach strategies Data resources

21 + Service Area Map (example)

22 + Outreach Strategy Key components: Utilize existing networks and contacts Making first contact is much easier this way Good way to start getting the word out about CMH s intentions Surveys Use various modes of distribution Two versions: one for community member and one for service provider Advisory Committee meetings Getting face-to-face interaction with most affected stakeholders

23 + Some Key Challenges and Fixes Always thinking about accomplishing multiple goals can be confusing! Make sure you are organized, and keep detailed notes and records of all goals, efforts, and progress Time, time, time Everything takes MUCH longer than you expect, so allow double the time anticipated in order to meet your deadlines

24 + Some Key Challenges and Fixes (cont d) Internal communication Be sure to keep lines of communication open and use them often Things can change from day to day, so keep the whole team informed Follow-up People lose interest Be sure to follow up regularly (and keep notes) Be excited excitement and interest are contagious, so keep it flowing!

25 + Existing Networks and Contacts United Way Information gatherer/disseminator in the community One Stop Housing Resource Center Anchor in both the homeless and public housing communities Internal CMH Resources Kristie Schmiege, Director of Substance Abuse Services Substance abuse recovery programs Bill Doub, Supervisor of Community Housing Housing Authorities Renee Keswick, Manager of Communication and Public Relations Information dissemination strategies

26 + Surveys Distribution: United Way list Targeted (direct mail or ) Advisory Committee meetings Local homeless shelters Public Housing rental office (where residents paid rent, or interacted with management for various reasons)

27 + Surveys (cont d) Most useful aspects: Response was a little low, but still a very helpful part of the process Collected information for grant response: Community s perceptions of CMH Satisfaction with existing primary care resources Existing barriers to accessing care Ideas for effective marketing and implementation of health center

28 + Advisory Committee Meetings Identifying participants: Asked for referrals through local homeless shelters Used existing networks to gain referrals Posted notices at local homeless shelters and public housing site Asked participants at first meeting to spread the word and invite others Outcomes: Community buy-in Getting the word out Collected stories, experiences, and opinions from the most affected stakeholders in the community Identified strong candidates for governing board

29 + Data Collection: Challenges Consistency: So many data sources, with different years, geographic areas, and comparisons Need to decide early on what your parameters will be Clearly define your service area Timeliness: Get in touch with people who can help early on! Requesting specific data can take time Choices, choices, choices: Choosing between different data sources and statistics can be tricky and overwhelming Always check secondary sources if you can - accuracy is important!

30 + Data Collection: Successes! Some of the most useful sources of data: American FactFinder ( U.S. Census American Community Survey Detailed Tables Health Departments (County and State) Homeless Management System Administrator for your service area Primary Care Association U.S. Bureau of Labor Statistics ( UDS Mapper (

31 + Data Collection: Successes! (cont d) HRSA Geospatial Data Warehouse ( Reports from foundations and national councils: (e.g., Robert Wood Johnson Foundation, The Commonwealth Fund, NHCHC, etc.) Local university research centers Watch tutorials and invest time up front to learn what is available and how to access it. It s worth it!

32 + Questions & Answers Honor Potvin, MPH Tisha Deeghan, MHSA, LMSW, ACSW, LMFT

33 + Closing Remarks

34 + Resources 34 Health Center Data: & UDS Mapper: Program Requirements here: HRSA FQHC Site Visit Guide HRSA Call Center: For assistance with HRSA EHBs, contact HRSA Call Center at 877-Go4-HRSA/ ; or or use the questions/comments link available on each page. HRSA Call Center hours are from 9:00 a.m. to 5:30 p.m. Eastern Time (E.T.), Monday through Friday. View Health Center The National Health Care for the Homeless Council has Technical Assistance (TA) and Training resources available to assist you and your organization with the FQHC Application Process. Please contact Victoria Rashcke at for more information. For more information about the NHCHC Community Development Project, contact Melissa Da Silva at To access the Learning about Homelessness and Health in Your Community: A Data Resource Guide, please contact Meleisha MEdwards@nhchc.org

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