4/7/2011. Describe the national, state, and local grant funding options for nurse managed health clinics

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1 Describe the national, state, and local grant funding options for nurse managed health clinics Patricia Dennehy, DNP, FNP-BC Kathryn Fiandt, PhD, FNP-BC, FAANP Joanne Pohl, PhD, ANP-BC, FAAN, FAANP Ramona Benkert, PhD, ANP-BC Attendees will have a greater awareness of the successes and challenges of achieving long term sustainability for nurse managed health clinics. HRSA Division of Nursing NEPQR (Nursing Education, Practice, Quality and Retention) BPHC (Bureau of Primary Health Care) FQHC (Federally Qualified Health Centers) FQHC Look-alike AHRQ or NINR R-18 R-01 R-03 R-21 Nursing Education, Practice, Quality and Retention (NEPQR) Annual call usually due in December May resubmit revisions Funding up to $1.5 million over 4-5 years Two purposes p support NMHC (called nursing practice arrangements ) Purpose 1 (P1) establishing or expanding a NMHC to improve access to primary care for medically underserved Purpose 2 (P2) provide care to underserved populations and high-risk groups (e.g. elderly, people with HIV/AIDS, substance abusers, homeless, and victims of domestic violence Affordable Care Act: Nurse Managed Health Clinics Initial $15 million; this year $20 mil in budget but unlikely to be funded Initial $15 mil - 10 grants awarded (each) $1.5 million over 3 years More focused on sustainability, esp. moving to FQHC Priorities/Preferences Administrative Priorities electronic data system University and practice have affiliation for student placement Administrative Preference University has an advanced practice nursing program Must meet complex set of primary care guidelines The funding in ongoing and supports sustainability: Cost based reimbursement for patients with Medicare or Medicaid Grants monies for uninsured people living in poverty Special Federal Tort Claims protection Complex relationship between NMHC and the university with which most NMHC s are affiliated 1

2 Most NMHCs that become FQHCs start as look-alike Only get cost based reimbursement You should plan on the process taking several years and require consultation Resources: National Nursing Center Consortium (Alex Lehr and HRSA BPHC (hrsa.gov) for free consultation Research grants R-18 demonstration projects R-01 research studies R-03 - R-21 Multiple challenges: Neither agency has much of a track record with NMHCs These are research grants and are funded accordingly so not designed to support or sustain a practice enterprise BUT can be used for preliminary data collection or program evaluation Examples: Ryan White HIV/AIDS primary care or support services Title X and XX Family planning Title V Maternal child health and family planning SAMHSA (Substance Abuse and Mental Health Services Administration) substance abuse and mental health services Special Populations Women s Cancer Screening Student health Special Pots of Money Tobacco Money Other Lawsuit settlement Resources State Department of Health Special programs in state health departments (targeted groups, e.g. family planning, women s cancer screening) Medicaid match dollars County health plans with grants in them National Kresge, W.K. Kellogg, Robert Wood Johnson State State health department Local Health department funding for outreach independent providers for STD testing, family planning, medications varies United Way Local foundations, e.g. Independence Foundation in Philadelphia, PA 2

3 Be sure your purpose is a match for the funder Get lots of strong support letters from community partners Use the outline and evaluation criteria read the instructions over and over and over..know the grant call WELL Follow the formatting rules and be neat..no typos! Have a compelling justification and a catch something you could argue is unique about your proposal; TELL STORIES Flow is essential from abstract to justification to work plan to evaluation Re-write the abstract until you are done; it must tell the whole story! Many reviewers will only see or spend much time on the abstract External/Mock reviews Get feedback and input from people who have been successful don t try to go alone and don t expect the first draft to be the final one BE SURE TO NOTE ANY FUNDING PRIORITIES Joanne Pohl University of Michigan Ramona Benkert Wayne State University W.K.Kellogg Foundation funding for the Michigan Academic Consortium (MAC) $4.4 million Funded 4 universities and their 9 NMHCs over 5 years to study models of care, outcomes of care and cost of care Medicaid Match Funding for UM SON NMHCs Caution: this was ended after Federal audits of 54 funded projects in the state and 30 were cancelled including ours $2.2 million County Health Plan that uses Federal match dollars to fund uninsured and also includes grants; $~100,000/year Significant provost funding, line item for educational mission of NMHCs AHRQ funding (R18) for electronic health records in 3 NMCHS nationally: Glide at UCSF, ASU s NMHCs, & Student Health that serves WSU students : HRSA grant through the DON, $1.5 million for 3 years to expand services and training of students in primary care Major institutional support: Provost, President, Board plus local political leadership Started with Dean and Provost funding for small grant Successful with DON funding (1 million over 3 years) through NEPQR (Purpose 2) for funding primary care for uninsured students (special populations) at WSU clinic 3

4 University funding through student fees came in 4 th year of operation Partner with INC and Alliance for EHR funding Exploring FQHC look-alike status for expanding primary care Pat Dennehy University of California-San Francisco Mission: Service 1997 Initial funding: local partners $100K - Catholic HealthCare West St. Francis Memorial Hospital In kind space and operating expenses Glide Foundation Staff and malpractice UCSF School of Nursing Dept of Community Health K for behavioral health - Schwab Family Fund On-going In Kind support K - Goldman Fund for licensing and billing At this point began to interface more with the community and collaborate for sustainability 2002 joined San Francisco Community Clinic Consortium (SFCCC) 2003 New access point for 330H in collaboration with SFCCC 2005 $750K NEPQR, P2 after 2 unsuccessful tries 2005 One of clinics on AHRQ R-18 for EHR 2006 $2.2 mil funding to re-model $238 K from SAMHSA $2.7 mil NEPQR $238 K capital grant for Wellness Center $1.5 mil NEPQR $1.5 mil NMHC from HRSA Kate Fiandt University of Texas Medical Branch 4

5 University practice operation - $250 K per year to for ER and hospital diversion Federal block grant $639 K for hurricane relief allowed significant upgrade of space NEPQR Fall not funded (not close) Project unclear and complex Insufficient community partners NEPQR Fall 2008 not funded (very close) Hurricane Ike caused problems with formatting (remember formatting is important) NEPQR Fall 2009 not funded (very close) Am not sure why not funded something you have to get over October 2010: Funded $1.5 million over 3 years Affordable Care Act: NMHC Expanding Primary Care to Vulnerable Residents of Coastal Texas Summary Know funding options at all levels Make sure funding matches YOUR mission, i.e. avoid mission creep to obtain funding Use resources; don t trytodoitalone to Have strong business model and good data Write a clear, logical proposal that addresses all criteria for evaluation Keep trying Questions? Comments? 5