Foundation Karen Bissonnette, Community Health Center of Cape Cod. Annette Graczewski, Dennis Health Department Veronica Palladino, Cooking Matters

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1 CAPE COD & ISLANDS COMMUNITY HEALTH NETWORK AREA ~ CHNA 27 Minutes for Thursday, December 10, :00-11:00 am Harborview Room at the Barnstable County Courthouse Complex, 3195 Main Street, Barnstable, MA Brenda Vazquez, Chairperson Present: Judith Reppucci, Harbor Health Services Brenda Vazquez, New England Wellness Foundation Tracy Johnson, WE CAN Karen Bissonnette, Community Health Center of Cape Cod Heidi Nelson, Duffy Health Center Bob Collett, Cape Cod Regional Tobacco Control Annette Graczewski, Dennis Health Department Veronica Palladino, Cooking Matters Ronnie Gullette, SHINE/MS Society Deborah Diamond, OCHS L. Forest Malatesta, OCHS Deirdre Arvidson, BCDHE, PHN Yssabella Sartori, Barnstable School District Ceci Phelan-Stiles, Cape Cod Healthcare Amanda Haddad, Grad Student Trudy Avery, Caron Jennifer Nocella, Tufts Health Plan Senior Care Patty Watson, BCDHS Options Valerie Pereira-Brown, Health Imperatives/Cape Cod Regina Correira, CHC WIC Cynthia Mitchell, Island HC CHC Melanie Braverman, Alzheimer s Family Support Center Gabrielle Hathaway, Outer Cape WIC Vanessa Ford, Healthy Children Project Inc./Center for Breastfeeding Chris Morin, Independence House Eleni Kontogli, Harbor Health Services, Inc. Dan Driscoll, Harbor Health Keli Maibaum, Elder Services Cape Cod & Islands Len Thatcher, PIER Recovery of Cape Cod Melissa Weidman, HopeHealth Kelly Hewitt, CHCCI Dayanne Leal, Tufts Health Plan Senior Care Option Meghan Kemp, Cape Cod Children s Place Brittany Brady, Harbor Health Services Anne Colwell, Cape Cod Child Development Gina Kupski, Healthy Living Cape Cod Krystina Allen, CCCC Welcome, Introductions: Brenda Vasquez welcomed attendants and wished all Happy Holidays. She also reminded attendants to please take a holiday card/gift and to please enjoy the Holiday Meeting refreshments. Judith Reppucci read the Purpose of CHNA. Those in attendance introduced themselves. Regular Business: November Meetings minutes were reviewed by the membership present. It was noted there were a few misspellings in the announcement section of the minutes corrections will be made. A motion was made by Ceci Phelan-Stiles to approve November Meetings minutes. Motion was seconded by Anne Colwell. All were in favor. Financial report: Copy of Financial Report was handed out to membership present. Chris Morin reviewed the report with the membership. Presentation: Community Health Awareness (50 th Anniversary) - Panel consisted of Dan Driscoll, President and Chief Executive Officer of Harbor Health Services; Karen Bissonette, Chief Development Officer of Community Health Center of Cape Cod; Heidi Nelson, Chief Executive Officer of Duffy Health Center; Cynthia Mitchell, Chief Executive Officer of Island Health Care.

2 Judith reminded us that this month, we are marking the 50th anniversary of the founding of the nation s first community health center and with that, the launching of a national movement committed to providing locally accessible, affordable and high quality health care to millions of medically underserved individuals and families. America s health centers owe their existence to a remarkable turn of events in U.S. history, and to a number of strong-minded community health and civil rights activists who fought to improve the lives of Americans living in deep poverty and in desperate need of healthcare. Among those determined to change these conditions were Dr. Jack Geiger and Dr. Count Gibson, who submitted proposals to President Lyndon B. Johnson s Office of Economic Opportunity to establish health centers in medically underserved inner city and rural areas of the country. Funding was approved in 1965 and Columbia Point Community Health Center, later renamed Geiger Gibson Community Health Center, opened its doors in a disadvantaged area of Dorchester. Geiger Gibson Community Health Center is now part of Harbor Health Services, Inc. which owns and operates a number of Community Health Centers serving Boston, Plymouth and the Cape, including Harbor Community Health Center-Hyannis. That ground-breaking medical home model was the leader in what is now the largest and most successful primary care system in the country. Fifty years later, there are more than 1200 community health centers nationwide. In Massachusetts, community health centers represent the Commonwealth s largest primary care network, serving more than 935,000 patients or one of every seven state residents. Health centers care for patients of all ages and racial and ethnic backgrounds, and represent a major source of care for medically underserved women and children. The 49 community health centers in Massachusetts support 14,000 jobs across the state and contribute nearly $2 billion in statewide economic output every year. Because of the impact community health centers have in reducing emergency room visits, hospital stays and the need for higher-cost specialty care among patients, health centers help generate more than $1 billion in annually, with savings passed on to the state Medicaid program, other insurers, taxpayers and consumers. Judith then introduced the panel speakers and asked each speaker to tell us a little about themselves and their programs. Dan Driscoll, Harbor Health Services Harbor Health Services operates five community health centers plus the Ellen Jones Community Dental Center. Two of Five centers are here on Cape Cod. Also, have a program called PACE (Program of All-Inclusive Care for the Elderly). Provides programs to keep elderly out of nursing homes. Currently operates in Mattapan, MA. Opening in Brockton, MA in Here at meeting because in addition to being part of Cape community Harbor Health Services is part of the first community health center in the country Columbia Point Health Center. Will see more in a video that will be played after introductions. Heidi Nelson, Duffy Health Center Mission at Duffy Health Center is to improve quality of life for people who are homeless or unstably housed through healthcare. They provide a blend of medical services: mental health and substance abuse counseling and substance abuse counselling and case management for those individuals that have the greatest challenges finding and keeping housing. Over last twelve months served over 3200 people. Duffy is smallest of the group. Federal definition of homelessness is broad can serve more people. 25% of patients are people who would be recognized as homeless such as people who stay at the NOAH Shelter, people who are living in

3 camps, transitional housing CHAMP homes and Homeless Not Helpless. Vast majority of patients are people who struggle with housing instability. Discussed quality indicators. 700 patients with hypertension diagnosis. Goal is to have 70% with hypertension under control. Currently at 65%. 400 patients with diabetes. Goal is 2/3 to have diabetes under control currently meeting that outcome measure. Goal for women s health preventative exams is modest at 50%. Last year was only 44%. Karen Bissonnette, Community Health Center of Cape Cod Started as the Falmouth Free Clinic in 1998 in the basement of Falmouth Hospital. Had about 600 patient visits. Had about 70,000 last year with 16,000 patients that are seen in three locations Mashpee, Falmouth and Bourne. See people mostly from upper Cape. Do primary care, mental health, dental, pharmacy, and optometry. Have imaging in Mashpee building. Karen has been there eleven years. There were only 22 employees when she started in Now there are about 165 employees. Cynthia Mitchell, Island Health Care In the year 2000 the Cape, Vineyard and Nantucket went in together for a Federal grant for what was originally called Mid-Upper Cape Community Health Center. Established using funds from the HCAP grant. One of the goals of the grant was to enhance/improve capacity for primary care and that health center was the Cape s answer. The Vineyard s job was to pilot a community health insurance program. The Dukes County Health Council s first project was to develop a health insurance plan community wide. Along the way got a rural outreach health care grant. It gave them funding to establish their own primary care point which was called Island Health Care. It was then a rural health center. MA Regulatory Department decided to treat them as a full community health care center. Island Health is one of the newest centers in the country. They have 3000 patients. The Vineyard has only 16,000 year round residents and 2000 Brazilian immigrants. They are the only primary care home for the Brazilian residents on the Vineyard. They see visits per year. They are on a growth pattern. They only have three exam rooms and a separate admin. Space. After introductions the movie 50 th Anniversary of Geiger Gibson Community Health Center was played. Go to the following link - to view the movie or go to and search for 50 th Anniversary of Geiger Gibson Community Health Center. After the movie panel discussion ensued: Dan Driscoll movie was produced by MA League of Community Health Centers on the 50 th Anniversary of Health Centers. Strong Columbia Point/Harbor orientation to it. Common theme in video that applies to the work that all here do overcoming obstacles, broaden definition of health, not just medical care providers. When Neponset Health and Columbia Point Health Center came together. For those of you who know Boston in the 70 s that was a very unlikely marriage. The entire neighborhood of Neponset was white, Irish, Catholic and the Columbia Point Housing Project was arguably one of the two worst housing projects in the city in terms of crime and poverty and was almost entirely at that point African American and Hispanic. The inspiring thing is that the two board of directors of each facility came together and overcame those differences and focused on the fact they had a commonality which is they had to provide services to communities that came up short of just relying on the private marketplace. Not in competition with private doctors but understand a private doctor s office are primarily focused on medical care. Compare what people in this room do to strictly providing only medical care. Imagine going into a private doctor s office and have different home problems, worried about kids and drugs, being abused by partner, if don t speak English too well or had trouble getting to the office because don t own a car what does that

4 private doctor do for a person not really much. Compare that to the work people in this room do. We would embrace those problems, confront the medical part but also try to knock down all the other obstacles. We could embrace them and see it as part of what we do. Regular medical doctor doesn t/wouldn t have the staff to do it. The ability to provide that extra stuff costs money. That s part of the financial challenge. And, that s what happened to Columbia Point in its first twenty years. The message in the film applies to the work everyone in this room does. Judith Reppucci Question: What is a community health center and what makes it one? Heidi and Cynthia Baseline commonalities we all have, and each health center has a neighborhood, a population, a service that makes it unique or different from others. The basics for community health centers are that you have to define a service area that is served. Duffy on top of that adds the layer of the homeless population on top of the geographic area. Duffy s service area is all of Barnstable County but specifically focusing on a particular population. The second requirement is consumer directed. So community health centers have to be independent not controlled by a hospital on another kind of organization. There has to be an independent board that is more than 50% made up of people who actually use the services of the health center. Can t deny services to people based on their ability to pay. All serve people insured and uninsured. Insurance enrollment people work at the center to help people who are uninsured get health insurance in order. Many have messed up health insurance and we help get it straightened out. Those who are uninsured we provide a sliding fee scale. People would have to pay cash for their services, but the amount they pay for services they receive is based on their income level. Can be insured and use sliding fee scale as well many people s insurance fees are higher than they can afford. Another aspect of being a community center is there are all sorts of reporting requirements. Teams from HRSA (Health Resources and Services Administration) of health and human services is obligated to make a visit to every community center once every three years. We are obligated to offer services birth to end of life. Patient center team based care is another feature. There is outgoing operational funding helps pay for things can t get revenue for. Great technical assistance comes from the Federal Government. Obligated to track performance measure. Judith Reppucci Question: Often asked about the role of community health centers in the development and implementation of the affordable care act. Can some of you explain to the group the connection that health centers have? Cynthia Must provide outreach and enrollment in public program such as the affordable care act. There is training involved. Massachusetts does its own good job of that. Karen Five organizations on the Cape & Islands assisted 35,000 people with insurance and the like in the last twelve months. Have 55,000 patients on the Cape & Islands. Matter of keeping people covered by insurance. Coverage maintenance is an issue with the population that are dealt with. Hard to keep track of. Question: Are healthcare navigators staff of your organization? Karen We have a full time outreach and enrollment person but also collaborate and contract and use some of grants funds to do the same thing the full time person does. Heidi Duffy has three fulltime certified application counselors that help people with insurance issues. One of these individuals does outreach independent of Dufy. Just helps people with

5 insurance issues. She goes to the community college once a week. And, she also goes to the DTA office and sits in the lobby helping people with insurance issues. Karen Funding from the Federal Government is not 10% of budget that we raise. We raise more money than that for funding. Heidi At Duffy the funds are 20-25% of budget. Cost for visit at Duffy is higher because of the population served. It is $180 per visit but get reimbursed from the Commonwealth at $147 per visit. Judith Reppucci Going back to affordable care, Dan did you want to say anything? Dan On Cape Cod it is hard to find a doctor that accepts all or some insurances. The Affordable Care Act covers people who have these insurances. The number of community health centers almost doubled. Community centers put into place as part of the affordable care act. Heidi Testament to the Affordable Care Act are all the new buildings/centers: Harbor Health in Hyannis, Duffy in Hyannis, Community Health Center of Cape Cod in Mashpee. The money in the pot from the Affordable Care Act for Community Health Centers for the first time allowed money to be used for capital. Not allowed to use grant dollars to build things so the Affordable Care Act was very important. There are a number of new initiatives that more new health centers be created and now opportunities for Behavioral Health Integration Funding. Duffy received one of those grants which allowed them to add a second psychiatrist provider. Plus it funded work doing with the hospital to figure out how to share information back and forth. Judith Reppucci Question: Patients who go to community health centers on Cape and Islands are very diverse could you speak to that? Karen Patients at Mashpee Health Center are very diverse ranging from the homeless to people from Popponesset Island. There are physicians in that community that don t take Medicare or MA Health. Community health centers of Cape Cod want to be the provider of choice. Want people to know who they are. Many people think Community Health Center of Cape Cod is part of the healthcare system on Cape Cod and they are not. Need to get the word out that they aren t. They take care of everyone not just the underserved. Donors have become patients. Cynthia Also have diverse population. There is a large Brazilian population that come to the center on Martha s Vineyard. Because of the language barrier the center is the only place they come. The center has a medical interpreter on staff and available every hour. The center is open 8 a.m. to 7 p.m., four days per week and on Saturday and Sunday. They also have a diverse staff. Heidi Please note there is a 5 th health center on Cape Cod Outer Cape Health Services. And, Massachusetts is the densest state in coverage by community health centers. Many community centers across the US care for underserved and uninsured. But in many places the center is all the healthcare in the area and that is the purpose of the Outer Cape Health Center. Gabrielle Outer Cape Health Services: Found it challenging to keep pediatric providers. There are no pediatricians east of Yarmouth. Wondering if find that challenging in other community centers.

6 Karen In the Falmouth, Upper Cape and Hyannis region pediatricians are great. Great about taking any insurance. The center hasn t needed to have a pediatrician but work pretty closely with the pediatricians in the area. Judith Reppucci Question: Regarding accessibility What are the ways community centers are accessible to the population? Dan Harbor Health is open seven days a week in Hyannis and most holidays. Service hours are appropriate to the population. Heidi Access is particularly importance for health care for the homeless need to be more accessible for homeless population. Outreach is huge. Have a nurse practitioner that goes to the NOAH Shelter and have a clinic that operates at the NOAH Shelter. Have to have liberal policies. Started out as a walk-in hard to have set hours with homeless population. Changed to appointment based and it changed client satisfaction. Leave slots open from providers to see patients that come in ill. Karen Open six days a week and have walk-in in Mashpee six days a week. If regular patient can walk-in during those times to be seen. Not necessarily by their team but can be seen. Open two days per week in Bourne for walk-in. Plan is to have walk-in available in Falmouth by summer Cynthia Accessibility by removing financial barriers. Sliding fee scale allows people to get services. Partner in after hour s nurse triage service. If a person calls Duffy, Community Health Services of Cape Cod or Island Health person would have the services of a nurse by phone 24 hours a day. Karen Added access to pharmacy at Mashpee center. Cynthia Have chosen a virtual model because of size and collaboration with other services in the community. Contract for mental health and substance abuse services with Island Counselling Center and pay them with grant dollars. Goal is to be as virtual as many agencies like all yours. Judith Reppucci Question: What do each of you see in the future with community health care on the Cape? Dan Community health care model is very sustainable. It works in a wide variety of communities. Heidi For Duffy the biggest are of growth is around substance abuse and figuring out what their role is there. People are aware that medication assisted therapy is something that the state and experts are promoting to deal with the opiate and heroin crisis. Trying to promote the idea that there are many different pathways to sobriety. Duffy does Suboxone and Vivitrol. Duffy is actively looking for resources to expand that ability. Have over 200 patients in the program and currently adding services for 16 & 17 year olds. Karen As a fundraiser the public private partnership is so important to do all other wrap around services. Please feel free to refer people to Community Health Center of Cape Cod. Also, communication is important. Working with the other community health centers. Letting our legislative people know what we do, why we do it, how well it s done.

7 Cynthia Island Health Care does not have any physicians that offer primary care. They are nurse practitioner based and virtual based. Question and Answer Session: 1. Question about the make-up of funding is it Federal, insurance, donors how does it work? Cynthia Money comes from Federal Government, 40% funded/20% grants and donors. Karen 10% philanthropy, reimbursement 40% MA Health, insurance, Medicare. Heidi Health Connector product 2. Question Are all of you non-profit? Yes. And independent. 3. Question Is seeing elders in home in the future? Forest M. Outer Cape Health has a home visit program. 4. Question Are other community health centers trying to do this? Karen Community Health Center of Cape Cod is trying to do it but transportation is a challenge. 5. Question What are collaborations with hospitals on Cape Cod? Dan Off Cape can negotiate with hospitals. On Cape only one choice, Cape Cod Healthcare. Cape Cod Healthcare has been very generous in showing appreciation for what community health centers do. Off cape position centers have with hospitals is greater. 6. Question from Ronnie Gullette from SHINE Do you see such importance to model expanding to other providers? Karen it is all about the money. Heidi Financials aren t aligned yet. Cape Cod Healthcare is a very generous partner. The Community Benefits Program offers direct funding to Community Health Centers. They also provide recruitment services and the hospital does credentialing for Duffy. Judith Reppucci wrapped up the panel session and thank all panelists for speaking with the membership. Announcements: Vanessa Ford, Center for Breast Feeding 22 nd Annual International Breast Feeding Conference in Florida: 1/11/16-1/15/16. Flyer is on the networking table. Gina Kupski, Healthy Living Cape Cod Matter of Balance Leader Training: 1/24/16 in Dennis. Meghan Kemp, Cape Cod Children s Place Parenting Recovery Support Group (for parents who have received substance abuse treatment to provide them with recovery support and also with parenting skills: session starts in January, free for parents. There is transportation, child care and dinner. Call (508) to get more information and dates. Ask for Cindy or Meghan. Trudy Avery, Care and Treatment Centers Documentary produced by HBO: Heroin Cape Cod USA. Premiere on 12/17 at 7 p.m. at the Cape Cod Community College. Free to go. Must register in advance. Premiere on television 12/28 on HBO. Barnstable County Health and Human Services Looking for housing staff. Just hired a substance abuse person. Developing a new website will bring all services together in one space. Molly Perdue, Alzheimer s Family Support Center Celebrating first year of service. Having a party, a brunch on 1/3/16 at the Dennis Inn from 11:30 a.m. to 2:30 p.m. Invitations are on the networking table. Also, left a listing on the networking table of the 27 support groups up and running from Falmouth to Provincetown. Everything is free.

8 Veronica Pallodino, Cooking Matters help people to shop healthy on a budget. Information on the networking table. Tracy Johnson, WE CAN 1. Taking registrations now for the Divorce Support Group. It s a virtual support group. There is an information session at the beginning of February for two hours at the community center in Harwich. Program is 21 days. 2. Replicating Path Maker program. Ten month mentoring program that pairs women in transition with women who work them over that period of time. From all ages and circumstances. Will be replicating program on the upper Cape next year. Flyers for both on the networking table. Eleni Kontogli, Harbor Health Services Insurance Enrollment Event, 10 a.m. to 2 p.m. on 1/9/16. To help people with enrollment. Meeting adjourned at 11 a.m. Meeting minutes respectfully submitted by: Kimberly Perry, CHNA27 Coordinator