A Quarterly Resource Bulletin from Capital Link
Spring 2017 Issue 
Message from the CEO
We are looking forward to seeing many of you at the NACHC Policy and Issues Forum next week as we forge ahead in this time of change and uncertainty. More than ever, it is essential for health centers to become strategically and operationally agile in planning for the future, and this issue of Capital Ink contains information to help you achieve your goals.
Learn about an upcoming opportunity to finance your health center capital project plans utilizing New Markets Tax Credit financing in the article, 2017 New Markets Tax Credit Program Allocation Round − Are You Ready? In Why Should You Do a Market Assessment? you’ll learn why and how to take this essential step in the strategic planning process, especially during periods of rapid industry change. The Value + Impact of Health Centers: New Infographics and Supporting Data will describe how PCAs and health centers are actively communicating the value and impact health centers have communities to legislators and other stakeholders.
As always, there’s also an update on the latest federal issues, health center highlights, and a list of upcoming trainings and presentations – we hope to see you at the P&I!
Warm Regards,
Allison Coleman, CEO
Federal Update
House Republicans Release Proposed Health Care Legislation
March 6 – House Republicans released a draft of proposed legislation to repeal and replace the Affordable Care Act titled the American Health Care Act (AHCA). The proposed bill was next considered by the two primary committees with jurisdiction over health care – the Energy and Commerce Committee (access the section-by-section summary here) and the Ways and Means Committee (access the section-by-section summary here) before going to the Congressional Budget Office for scoring. Read more about the proposed legislation here and the CBO’s analysis here.
Congressional Budget Office Releases Projections for Proposed Republican Health Care Bill
March 13 – The CBO provided analysis of the House Republicans proposed health care legislation, the AHCA. The CBO and staff of the Joint Committee on Taxation project that enacting the legislation would result in a dramatic loss in coverage, especially for patients covered by Medicaid. To read the CBO’s full report, click here.
Op-Ed: Community Health Centers Contribute Significantly to Taxpayer Savings
February 9 – In an op-ed in Roll Call, former Senate Majority Leader Tom Daschle (D-SD) and former Secretary of Health and Human Services and former Governor of Utah Mike Leavitt (R-UT) present health centers as “one health care solution that can help us achieve a high-performing, high quality, and cost-efficient health care system.” Read more here.
NMTC Program Update: CDFI Fund to Potentially Open 2017 Application Round for Allocation This Month
In order to be able to announce the allocation of New Markets Tax Credits (NMTC) in the year for which they are authorized, the Community Development Financial Institutions Fund (CDFI Fund) announced that it will likely open the CY2017 round by the end of the first quarter. Once the announcement is made, the latest information will be available here on the CDFI Fund website.
While health centers do not generally apply directly for credits, it’s important to make your project known to those financing entities that are applying. For information on how Capital Link can help your health center utilize this funding opportunity, see the article, 2017 New Markets Tax Credit Program Allocation Round − Are You Ready?
Bipartisan Call to Make New Markets Tax Credits Permanent
February 16 – Legislation was introduced in the House and Senate to secure the future of the NMTC program. The bills, both titled The New Markets Tax Credit Extension Act of 2017, respectively H.R. 1098 and S. 384, would ensure that rural communities and urban neighborhoods left outside the economic mainstream have access to financing to grow their economies and create jobs. Learn more here.
HHS Funding Opportunity – Homeless Health and Housing
The U.S. Department of Health and Human Services (HHS) Substance Abuse and Mental Health Services Administration (SAMHSA) is accepting applications for grant funding to support the coordination of behavioral health care and housing services for the homeless. SAMHSA will award approximately 24 organizations with up to $400,000 for efforts that connect patients with substance abuse disorders to community services that provide permanent housing and support services. Grant applications are due April 25, 2017. Click here to learn more.
New and Noteworthy
2017 New Markets Tax Credit Program Allocation Round − Are You Ready?
Does your health center have a capital project on the horizon? With the Community Development Financial Institutions Fund (CDFI Fund) likely opening the 2017 application round for allocation at the end of this month (keep checking this link for updates), now is the time to act!
The NMTC program is highly competitive, with demand for credits for worthy projects vastly exceeding the supply. Health centers that want to obtain credits for their projects must carefully align their project planning cycles with the NMTC funding cycle. Capital Link has extensive knowledge of the NMTC financing process and can provide assistance with the complex process of obtaining a commitment of credits and completing a NMTC transaction. We are currently offering a NMTC-focused webinar and free technical assistance. To find out how Capital Link can help your health center capitalize on this invaluable financing option, please contact Jonathan Chapman, Director of Community Health Center Advisory Services at 970-833-8513 or This email address is being protected from spambots. You need JavaScript enabled to view it.. Or if you’re planning on attending the P&I later this month, Capital Link staff will be available throughout the conference to discuss how we can help you achieve your goals, including opportunities for expansion through New Markets Tax Credits. Click here to set up an appointment.
To help health centers understand NMTC, Capital Link has prepared a variety of resources, described below:
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Spotlight on Capital Resources: New Markets Tax Credit Program Save Millions by Using New Markets Tax Credits and/or Tax-Exempt Bonds to Finance Your Capital Project |
Why Should You Do a Market Assessment?
In times of change, success requires anticipation and preparation. It is imperative to identify and evaluate opportunities for growth, marketplace competition, projected market share, demand for services, unmet needs, and emerging trends. Whether your health center is expanding to a new site or evaluating changes in its existing service area, a market assessment provides essential information to guide your organization’s strategic direction.
1.Define Market Service Area
Using zip codes, a health center can focus on the general population or specific segments (e.g., children, women of childbearing age, etc.). Sources include:
- American FactFinder by the U.S. Census (http://factfinder2.census.gov),
- Fee-based sites such as DemographicsNow (http://www.demographicsnow.com/)
2. Determine Health Needs
State and county health departments are usually the most up-to-date source for accurate health indicators, such as immunization and mortality rates. The following resources also provide similar health indicators for all states:
- County Health Rankings (http://www.countyhealthrankings.org/)
- Community Health Status Indicators (www.cdc.gov/CommunityHealth)
- HealthLandscape (www.healthlandscape.org)
3. Assess Population Size by Payer Mix in Health Center Service Area
It is important to understand the potential payer mix in your service area and to understand which of the currently uninsured might enroll in Medicaid or the health insurance exchange. The following resources provide payer mix information:
- Medicaid – Enrollment data is available through the state offices of Medicaid
- Medicare – Enrollment by county (http://www.cms.hhs.gov/MedicareEnrpts/)
- Uninsured – US Census (https://www.census.gov/did/www/sahie/data)
- Exchange-Eligible – Uninsurance Explorer Tool (www.udsmapper.org)
4. Estimate Market Share
Compare your health center’s patient base to overall service area market size by payer to estimate its market share. For example, if there are 4,000 Medicaid enrollees in your service area and your health center has 800 Medicaid patients, your market share is 20%. Lower market share suggests greater market potential, while any market share of the Medicaid population that is over 60% merits a close analysis of other Medicaid providers as described below in number 5.
5. Review Competition/Similar Providers
Understanding the market environment in which your health center operates includes an analysis of similar providers. The UDS Mapper (www.udsmapper.org) provides detailed market data on the Federally Qualified Health Centers (FQHCs) and FQHC Look-Alikes providing care down to the zip code level. However, analysis should not stop there. Below are a few resources to help identify other providers in your area who are accepting Medicaid and the uninsured:
- State Medicaid websites often share phone numbers of providers (e.g. family practitioners, OBGYN, and pediatricians) that are accepting new Medicaid patients.
- For rural areas, market data on service site locations can be found via the Centers for Medicare and Medicaid (CMS) website (https://www.cms.gov/center/rural.asp). Note that Rural Health Clinics and Critical Access Hospitals are often the greatest source of primary care, although these entities are not required to serve the uninsured.
6. Estimate Unmet Need/Strategic Program Opportunities
This final step pulls the market information together and establishes the foundation for programmatic decision-making. Planners should answer the following questions:
- Based on the demographic data, health indicators, and insurance mix, what is the unmet need of the population segments?
- How should the health center address those opportunities via program changes/expansions/refocus?
For more information on Capital Link’s Market Assessment services, please click here to visit our website. You can also find a Market Assessment worksheet here on p. 33 of our publication, Creating a Dynamic and Useful Strategic Plan, A Toolkit for Health Centers, and a recording of our webinar, Planning in Uncertain Times: Market Assessment for Service Expansion to Respond to Community Needs, here.
Resources
The Value + Impact of Health Centers: New Infographics and Supporting Data
As we face the prospect of a changing health care landscape, driven by discussion of a potential repeal of the Affordable Care Act, a rollback and potential block-granting of Medicaid, and loss of Section 330 grant funding, many PCAs and health centers are actively communicating their value to legislators and other stakeholders. The story of what health centers bring to their communities can be told along the following domains:
- Employment and Economic Impacts
- Savings to the Health Care System
- Access to Care
- Comprehensive Coordinated Care
- Preventive Care and Chronic Disease Management
Capital Link recently created customized Value + Impact infographics and supporting data for PCAs, consortia, and HCCNs in California, Tennessee, Maine, Arizona, and Arkansas to help demonstrate health centers’ value statewide, within counties and within federal congressional districts. A sample is shown below.
We’ve also developed customized infographics illustrating the projected impact of a rollback to pre-ACA levels of Medicaid eligibility and insurance subsidies, and cuts to federal operating support. Access California Primary Care Association’s recently released Value of Health Centers Today and Tomorrow here.
For more information about our Value + Impact infographics and reports, please contact Steve Rubman, Director of Data & Information Systems, at This email address is being protected from spambots. You need JavaScript enabled to view it. or 617-422-0350.
Two New NACHC Infographics Highlight Health Center Impact
NACHC has developed two new data driven infographics to illustrate how health centers have expanded their reach and their capacity to deliver a variety of integrated services to patients between 2010 and 2015. Health Centers Expanding Reach can be found here, and Health Centers Expanding Capacity is located here.
Health Center Highlights
Capital Link regularly profiles health centers that have successfully completed their expansion plans. These health center stories are available on our website. The next two stories will highlight Mountain Park Health Center, AZ and Family Health Center, MI, which both used Healthy Futures Fund financing—and subordinated loans from Capital Link’s affiliate Community Health Center Capital Fund—for their projects.
Several consortia/Primary Care Associations are also helping their members strengthen business operations during this period of rapid industry change through Capital Link’s Advancing Financial Strengths (AFS) program. Community Clinic Association of Los Angeles County is completing its second year of AFS, while the Missouri Primary Care Association is kicking off an AFS program this spring, and the Massachusetts League of Community Health Centers is hosting a pre-conference session at their upcoming Community Health Institute.
AFS is a technical assistance program that provides health center staff from all levels of the organization with financial and operational benchmarking assistance, tools, and training. At the start of the program, Capital Link provides the participants with a Performance Evaluation Profile, a customized diagnostic tool to help them to better understand their own financial status as well as how they compare to other centers in the region and state. Participants are then invited to a series of webinars and/or onsite trainings which serve as a platform for sharing best practices and building knowledge. As a final phase of AFS, participants can be provided with customized on-site and/or remote technical assistance focused on improving health center business operations and financial health.
Upcoming Events
Capital Link regularly attends industry conferences to exhibit, conduct trainings, and present information related to capital development to health centers and primary care associations. Below are a few of our next scheduled events. Learn more here.
Presentations
NACHC Policy & Issues Forum
March 29 - April 1, 2017
Washington, DC
Booth 512
Establishing a Successful PACE Program in the Health Center Context (PFF1)
Friday, March 31, 8:00-9:30 AM, Virginia
Presenters: Allison Coleman, CEO, Capital Link; Peter Fitzgerald, Executive Vice President, Policy and Strategy, National PACE Association; Jack Cradock, Principal Consultant, The Galway Group
All Board Members on Deck: Using the Strategic Planning Toolkit to Chart Your Health Center’s Path to Success (PFK1)
Friday, March 31, 8:00-9:30 AM, Washington 4-6
Presenter: Jonathan Chapman, Director of Community Health Center Advisory Services, Capital Link
Board Oversight of Financial & Operational Performance: Understanding What Metrics Tell You (PSaK1)
Saturday, April 1, 8:30-10:00 AM, Washington 4-6
Presenter: Jonathan Chapman, Director of Community Health Center Advisory Services, Capital Link
California Primary Care Association Chief Financial Officers Conference
April 6-7, 2017
Rancho Mirage, CA
Identifying the Drivers of Maximum Performance
Thursday, April 6, 4:30-6:00 PM
Presenters: Susan Petrie, Chief Operating Officer, Capital Link; Charles Moore, Founder and President of HealthMETRICS; Sergio Bautista, Chief Financial Officer/Chief Operating Officer, ChapCare
Montana Primary Care Association Spring Symposium
April 19-20, 2017
Helena, Montana
Massachusetts League of Community Health Centers Community Health Institute & Exhibit
May 2-5, 2017
Falmouth, MA
Advancing the Financial Strength of Health Centers - Pre-Conference Session
Tuesday, May 2, 8:45 AM – 5:00 PM
Presenters: Allison Coleman, CEO, Capital Link; Susan Petrie, Chief Operating Officer, Capital Link; Dan Woodman, Project Consultant, Capital Link; Charles Moore, Founder and President of HealthMETRICS
Webinars
Save Millions by Using New Markets Tax Credits and/or Tax-Exempt Bonds to Finance Your Capital Project
Wednesday, March 22, 2017, 2-3 p.m. ET
Presenter: Terry Glasscock, Senior Project Consultant, Capital Link
Register for upcoming webinars here. Access recordings of past webinars here.
