Wanted: Young Professional Health Center Leaders

Pages from 2016CHI-Program-online-version-07-19-16If you’ve been to any NACHC events in recent years, you’ve probably heard leadership talk about the importance of training the next generation of health center leaders. I’m still fairly new here, but I know I have. This year, with the introduction of the new Young Professional Leadership Exchange (YP) track at the 2016 Community Health Institute (CHI) and Expo, NACHC is taking its biggest step yet toward ensuring the next generation is prepared to carry the torch of the Community Health Center Movement.

After attending the Young Professionals Leadership Exchange reception at the 2015 Policy & Issues Forum, a group of NACHC employees started thinking about what more the association can do to help young professionals. “We realized we didn’t have a lot of resources here at NACHC specifically geared toward young professionals, and we didn’t know what was going on within the Health Center Movement either,” said Russell Brown, a NACHC staffer and one of the organizers of the YP track initiative.

After a planning session at last year’s CHI, and a flurry of phone calls, the track is finally on the conference program.  The YP festivities at this year’s CHI kick off Sunday, August 28, with three social events for young leaders – a speed networking session, poster presentations, and an evening reception at South Water Kitchen not far from the NACHC conference site in Chicago.  All three Sunday events offer great opportunities to mingle with and hopefully learn from peers and current health center leadership.

Monday, August 29, and Tuesday, August 30, are filled with sessions chosen for the track specifically to advance the leadership potential of young professionals – sessions like Career Development and Succession Planning in the Community and Migrant Health Center World and Best Practices and Lessons Learned for Collecting and Using Data on the Social Determinants of Health, which is designed to educate attendees about the Pro­to­col for Respond­ing to and Assess­ing Patients’ Assets, Risks, and Expe­ri­ences (PRAPARE) and how they can comprehensively meet the needs of patients and communities.

These sessions were chosen for a reason. “Millennials like specific outcomes when they go to a session. They want to learn tangible things. They want to bring back something to their health center that they can apply,” Brown said.

With 24 million patients (and counting!) visiting America’s Health Centers, it will soon be up to the next generation to continue the mission of high-quality, cost-effective, culturally competent care for all.  The YP track is so far receiving good feedback, and the group hopes to keep the momentum going.

“One of the top priorities is the ability to create a network of peers in the Health Center Movement that anchors them and solidifies their foundation in the movement,” said Brown.

Are you planning to attend sessions in the YP track? We’re looking forward to seeing you! Let us know which sessions you plan to attend in the comments below.

Disease Management and Telemedicine in Rural America

Julie-Potyraj (3)Our guest blogger today is Julie Potyraj,  Community Manager for the MPH@GW blog (https://publichealthonline.gwu.edu/blog/).  She is also a public health graduate student at The George Washington University.

There are many benefits to enjoying the peace and quiet of living in a rural setting. However, when it comes to taking care of one’s health, there can be a unique set of challenges.  For instance, staying healthy and disease-free can be a difficult proposition when there are few primary health care providers available or nearby, including oral health providers.  People who live in rural areas may also deal with different types of health issues than those who live in towns and cities, such as asthma, heart disease, diabetes, high blood pressure and exposure to farm-related chemicals.  Since screenings and checkups  that can catch a problem early are often neglected, conditions can become quite serious by the time they’re diagnosed—and chronic diseases may progress more rapidly.

According to the  National Rural Health Association (NRHA):

  • Even though nearly 25 percent of the population lives in rural areas, only about 10 percent of physicians practice there.
  • Individuals in rural areas are less likely to have employer-sponsored health care or prescription drug coverage.
  • On average, per capita income is $7,417 lower in rural areas than in urban areas.
  • 20 percent of nonmetropolitan areas don’t have mental health services compared to 5 percent of metropolitan counties.
  • Suicide rates among men in rural areas is much higher than in urban areas.
  • High blood pressure was reported to be higher in rural areas.

To some extent, telemedicine has helped bridge the access gap.  This method uses technology to link rural patients and providers to those in urban areas to increase access to care. With improvements in technology, advances in telecommunications systems, and the wide availability of affordable mobile devices, the use of telemedicine is booming across the country—with more than 15 million Americans receiving some type of remote care in 2015, according to the American Telemedicine Association (ATA).  Some health centers  in rural areas make use of telemedicine services with promising results. Community Health Care Systems, a health center in Sparta, GA,  for instance,  has been using the program to conduct electronic home visits.  Ravenswood Family Dentistry, a health center in San Mateo, California, has been using teledentistry to provide dental exams to children at a Head Start center in an area where dental care is limited, or dentists do not accept new Denti-Cal patients, according to a previous NACHC blog post.   However, a July 2015 study of California health centers by the Center for Connected Health Policy (CCHP), stated that most of the current reimbursement models for telemedicine pose a financial hardship.  The report also cited other challenges, such as shortages of providers, interoperability of data systems, and coding of telehealth claims and encounters.

To learn more, NACHC has published an issue brief about the telemedicine issues that affect health centers and their patient populations.



Technology Advances into Community Health

PNG_-_Texting-on-Smartphone-332x508Our guest blogger today is Jason Patnosh, Associate Vice President, Partnership and Resource Development, NACHC.
Health care technology is improving health outcomes one community at a time. With sizeable support from Silicon Valley firms, CareMessage was launched to bring short message service (SMS) technology tools to the medically underserved.

“The founding team at CareMessage has had deep experiences both working in safety net settings and personally benefiting from community health centers while growing up,” explains CEO and co-founder Vineet Singal. “We are excited about partnering with hundreds of health centers over the next several years, moving us closer to our goal of ensuring that America’s underserved populations have the medical resources they need to live healthy, fulfilling, and productive lives.”

Using basic phone technology makes sense for a lot of reasons, as 92% of Americans own a cellphone according to the Pew Internet Project. Text messaging accounts for 79 percent of cell and smart phone use. Also, low income households are increasingly reliant on cell phones for online access.  CareMessage has committed $1 million to year-long engagements with health centers, Primary Care Associations (PCAs) and Health Center Controlled Networks through a pilot with NACHC. There is also a project underway to target health centers in California through a partnership with the California Primary Care Association (CPCA).

Health centers are using the SMS technology in a variety of ways, such as texting reminders to patients for flu shots, health fairs, and prescription refills. A case in point is ARCare,  which serves rural residents at 30 locations over northeaster Arkansas. Chief Information Officer Greg Wolverton says SMS was a logical next step because patients “love to be able to receive proactive information and education regularly.” So far, the results are paying off.  Since July 2015, over 25,000 messages, including reminders and diabetes health education messages, have gone out to more than 14,000 patients through ARCare’s use of CareMessage. Less than one percent opted out.

Another health center, ChapCare, in Pasadena, CA, uses the SMS platform on two fronts: “First, we utilize CareMessage to send reminder texts to clients along the health insurance enrollment continuum,” explains Steven Abramson, Director of Development and Marketing. “For example, we may have someone who has enrolled, but our records show they have not made their first payment. We would send them a specific message. For this purpose, we utilize CareMessage in conjunction with PointCare (a web-based health insurance screening tool). We run client reports in PointCare, export the reports into excel, and upload them into CareMessage to send the specific message to the clients we want.”  The health center is also taking part in pilot-study in conjunction with UC-Berkeley, “Under the pilot (study), 50 ChapCare patients with diabetes were enrolled on the CareMessage platform, and have been sent health education text messages for 12 weeks to test whether the enhanced health education supports improved outcomes. Early qualitative input has shown that patients seem to like the program, and we’ve had very little patient dropout. If successful, we plan to conduct an expanded rollout at our other health center locations.”

CareMessage has drawn interest from other funding partners, such as the National Institutes for Health, The Pershing Square Foundation, and The David and Lucile Packard Foundation to name a few. This ensures CareMessage can support their non-profit status and bring SMS technologies to Community Health Centers at affordable rates.

A Partnership in Seattle Launches a Family Medicine Residency Program

From left: Dr. Tiffany Ho, Dr. Lisa Chan, ICHS CEO Teresita Batayola, and Dr. Christopher Yee. ICHS International District clinic site director.

From left: Dr. Tiffany Ho, Dr. Lisa Chan, ICHS CEO Teresita Batayola, and Dr. Christopher Yee. ICHS International District clinic site director.

Two new family doctors are now seeing patients at International Community Health Services (ICHS) in Seattle, WA, after being matched through a new partnership with Swedish Family Medicine Residency/Cherry Hill. The residents, Drs. Lisa Chan and Tiffany Ho, are onboard as part of the ICHS-Swedish partnership. This is the first year that ICHS hosts family medicine residents as one of the recent additions to the clinic sites of the Swedish Family Medicine Residency/Cherry Hill program.

“We are very excited to welcome our new family medicine residents and kick-off the family medicine residency program at ICHS,” said Dr. Christopher Yee, ICHS International District clinic site director.  “Our patients will benefit from having these talented and skilled medical providers, while our residents will get hands-on experience and hone their skills working with a very diverse group of patients,” he said.

The launch of family medicine residency program at ICHS is part of a broad national trend of health centers “growing their own” providers through training and residency programs. Besides the family medicine residency program, ICHS also hosts dental and advanced nurse practitioner residency programs.  The goal is to provide evidence-based, quality health care to underserved, economically disadvantaged, culturally diverse, and disenfranchised communities.

“As an advocate for community health, I am excited to join an organization that dedicates its services to the local community,” said Dr. Ho.

For Dr. Chan, there were a number of factors that led her to choose ICHS for her residency.   “The vibrant neighborhood, passionate staff, and diverse patients drew me to ICHS,” said Dr. Chan. “I’m excited to work in a clinic that is so active and engaged in the community it serves.”

Nearly all health centers are participating in some kind of education or training—for students, residents, or both, according to a NACHC report.  Family physician and nurse practitioner are the provider types most commonly trained at health centers.  Twenty-two percent of health centers report that they now hold the accreditation for their own residency programs.



Concerns about Zika Ramp Up in Texas

Courtesy: Centers for Disease Control & Prevention

Courtesy: Centers for Disease Control & Prevention

The Texas Association of Community Health Centers (TACHC) and a coalition of state and national organizations are raising concern about state preparedness to address the potential for locally acquired Zika cases. In a letter to Texas Health and Human Services Executive Commissioner Charles Smith the organizations warn that vulnerable populations are especially at risk for Zika because they typically lack access to health services and/or insurance coverage, live in poor housing conditions (such as no air conditioning or window screens), may live close to standing water or work in jobs that require long periods of time in mosquito-prone areas, and have scarce financial resources to buy insect repellant or protective clothing.

“Our concern is based on our experience directly serving patients at high risk of being exposed to this virus or as consumer groups that educate on critical health care topics,” they write. “With 65% of Texas’ population living in areas where the Aedes aegypti mosquito can be found and heavy spring rains, at the forefront of concerted state and local efforts should be vector control, widespread education (PSA’s, posters, etc.), contraceptive counseling, and mosquito bite prevention.”

Especially at risk in Texas are pregnant women with and without health insurance, women of child bearing age without coverage, men without health insurance who have female partners, and uninsured children.  The letter notes the risk for birth defects associated with the virus, including microcephaly, “a condition that could have a long term health and financial consequences for the state given the severe health care needs that babies born with this condition will need throughout their lives.

Among their recommendations were that Texas health officials should:

  • Add insect repellent as a Texas Medicaid benefit immediately without prior authorization and address barriers to getting an insect repellent prescription from the health care provider.  However, the Texas Medicaid program covers “only a very small subset of the at-risk population” since the state did not expand Medicaid benefits.
  • Partner with key relief organizations to organize immediate distribution of insect repellent.
  • Post on a public site the list of emergency respondents through the state so trusted community health providers can work with them to develop locally-based plans to respond to Zika incidents.
  • Work directly with certified promotoras, community health workers and/or organizations and community members to educate communities about the risks of exposure to Zika.

In addition to TACHC, the letter was signed by Texas Academy of Family Physicians, Children’s Hospital Association of Texas, March of Dimes, Center for Public Policy Priorities, Children’s Defense Fund, and Texans Care for Children.