A Quarterly Resource Bulletin from Capital Link

Winter 2016 Issue    

Message from the CEO

Allison Coleman, CEO

2015 was certainly a roller coaster ride, with many highs and lows: we celebrated the 50th anniversary of the health center movement and fixed the Primary Care Cliff, while also weathering threats to the annual appropriation and attempts to repeal the Affordable Care Act. Throughout the year, the health center family showed its resilience as we faced these hurdles together. What’s encouraging is the steadfast commitment to the health center mission and the many ways health centers are growing and improving to meet the needs of their communities.

As we begin 2016, Capital Link applauds the achievements of health centers and offers information that may help ongoing efforts to expand access to care and impact patients’ overall well-being. This issue contains a call for health centers to apply to participate in a new Healthy Futures Fund Readiness program, and highlights our new report exploring the relationship between financial, clinical and operational excellence at America’s health centers. We also provide new resources, including an updated infographic illustrating the growing economic impact of health centers nationwide.

We’d like to update you on a few staffing changes here at Capital Link and our lending affiliate, Community Health Center Capital Fund. Mary Ann Wayne, Director of Loan Programs at Capital Fund, will be retiring this spring. We’re grateful for her six years of hard work and dedication and wish her all the best in this next chapter in life. Brandon Boyle has joined us as Capital Fund’s new Director of Loan Programs, bringing strong CDFI and banking experience. We’d also like to welcome Muna Majekodunmi as Capital Link’s new Boston-based Staff Accountant, and Dale S. Johnson, who will join our California-based team in the spring as Consultant, Financial and Operations Improvement. We’re delighted to have them aboard.

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 NACHC Policy and Issues Forum—visit us at booth #217). Best wishes for a successful 2016!

Federal Update

Keep Up to Date!

Below is a selection of recent health policy and regulatory news and information relevant to health centers and PCAs. For regular updates, subscribe to Capital Link’s blog and access the following links:

NACHC’s Health Centers on the Hill and Policy Shop blogs

The Health Resources and Services Administration’s health center tab

The newsroom at the U.S. Department of Health and Human Services

FY17 Budget Proposes Funding for Health Centers through FY19

On February 9, 2016, it was announced that the President’s FY 2017 budget proposes a total of $5.1 billion in funding for Community Health Centers, including $1.35 billion in discretionary funds and $3.75 billion in mandatory funds. The budget also calls for extensions of mandatory funding for health centers for two additional years beyond the funding currently in place through FY17. Read more, including NACHC's statement on this proposal, here.

FY16 Omnibus Appropriations Legislation Includes Funding for Health Center Growth

On December 17, 2015, after long negotiations, Congress passed a $1.8 trillion spending package, which includes discretionary funding of almost $1.5 billion for the Health Center Program. This is in addition to the $3.6 billion in mandatory funding provided earlier this year through H.R. 2. The legislation specifies that no less than $150 million be spent on construction and capital improvements and no less than $200 million be spent on expansions of health center capacity, including new delivery sites and the addition of services such as dental and behavioral health. Read more here and here.

New Markets Tax Credit Program Updates

FY17 Budget Proposes to Make the NMTC Permanent at $5 Billion in Authority

February 9, 2016 – The President's fiscal year (FY) 2017 budget includes a proposal for the permanent extension of the New Markets Tax Credit Program (NMTC), which promotes investments in low-income communities, providing $5 billion in annual allocation authority. Read the more on the NMTC Coalition blog.

Five-Year NMTC Program Extension

On December 18, 2015, the House and Senate passed the Protecting Americans from Tax Hikes Act (PATH Act) for FY16, which includes a five-year extension of the NMTC Program at an allocation level of $3.5 billion annually. Read more here.

NMTC Coalition Celebrates 15th Anniversary of the NMTC

On December 21, 2000, President Bill Clinton celebrated the signing of H.R. 4577, appropriations legislation that included the provisions of the Community Renewal Tax Relief Act and the New Markets Tax Credit. Since then nearly $75 billion in capital has flowed to distressed rural and urban communities nationwide. Health centers have benefitted from almost $1 billion in financing through the NMTC program. A video of President Clinton's 2000 speech can be found here.

CMS Announces Funding Opportunity to Discover How Addressing Social Needs can Improve Health 

On January 5, 2016, the Department of Health and Human Services announced a new funding opportunity of up to $157 million to test whether screening for health-related social needs and facilitating navigation of community-based services will improve quality and affordability in Medicare and Medicaid. The goal of the five-year Centers for Medicare & Medicaid Services (CMS) Innovation Center program, called the Accountable Health Communities Model, is that beneficiaries struggling with unmet health-related social needs are aware of the community-based services available to them and receive assistance accessing those services. A link to the funding announcement can be found here.

New and Noteworthy

Health Centers Invited to Apply to Healthy Futures Fund Readiness Program

The Healthy Futures Fund (HFF), a collaboration between the Local Initiatives Support Corporation (LISC), Morgan Stanley, and The Kresge Foundation that launched in 2012, recently announced that it will invest an additional $100 million in projects that promote healthy communities and address the social determinants of health. Utilizing New Markets Tax Credit (NMTC) financing, HFF is seeking to finance innovative, groundbreaking projects that will serve as models for the unique ways in which FQHCs are collaborating with partners to improve the health of their communities. 

Ideal projects can best be defined as “gazelle projects,” or FQHC-sponsored capital projects that are ahead of the pack, moving quickly to address the social determinants of health in their communities; characterized by nimble leadership, discerning vision and swift progress.  Projects should involve collaborations between health centers and other community partners that expand access to health care while also addressing at least one other critical community need, such as affordable housing, access to healthy food, job training, schools, elder care and other projects to advance community wellness.

In addition to providing attractive financing, HFF is offering a free HFF Readiness Program, sponsored by LISC and Kresge, for a limited number of FQHCs interested in obtaining financing through the HFF. Offered through Capital Link, the HFF Readiness Program is available to select health centers through a competitive application process; those that successfully complete the technical assistance program will be eligible for HFF grant funding to advance their project planning.  

Health centers are invited to apply to participate in the HFF Readiness Program by accessing our call for proposals here. Applications are due March 4, 2016.

Learn more by visiting the Healthy Future Funds website or Capital Link’s Healthy Futures Fund Readiness Program webpage. Contact Jonathan Chapman, Capital Link’s Director of Community Health Center Advisory Services at This email address is being protected from spambots. You need JavaScript enabled to view it. for details.

Help Us Report on the Capital Needs of Health Centers!

For the past seven years, Capital Link has conducted a study, with support from HRSA, to determine the extent of existing and future health center capital needs and funding requirements. By providing an estimate of the additional capital investment required for health centers to meet growth targets, this national capital needs assessment helps focus attention on the evolving needs of health centers as they work to support high-quality patient care.

Your participation helps:

• Quantify the capital needs of health centers nationally in order to inform public sector stakeholders;

• Encourage private sector foundations and lenders to develop new funding sources to help health centers meet their needs;

• Identify new or emerging needs, beyond “brick and mortar” capital — such as working capital to support rapid growth or acquisition of private practices;

• Identify areas for additional technical assistance to help your health center reach development goals; and

• Position your health center to receive information on emerging funding sources targeted to your specific needs.

We’re preparing to send our new assessment to all health centers in a few weeks, so stay tuned! Your assistance in this important effort is greatly appreciated.

Resources

New Study Examines the Relationship between Health Center Clinical, Financial, and Operational Excellence

Health centers are experiencing greater demands on their services as health reform implementation proceeds, often necessitating growth and operational transformation. As their role as key providers of primary care increases, health centers need to assess their current performance and develop strategies for improvement. Prior Capital Link studies have provided health centers, Primary Care Associations, and other stakeholders with insight into financial and operational trends. This analysis furthers our knowledge by examining the operating models, strategies, and practices of high-performing health centers to better understand the factors that work for and against the co-occurrence of strong clinical performance and financial sustainability.

This research sought to answer the following questions for the first time:

1. Do health centers that excel in providing high-quality patient care do better or worse than other health centers financially?
2. What are the characteristics of health centers that achieve both high-quality care and strong financial results?
3. What do high-performing health centers do differently or better than their peers?

The results of this analysis show that it is possible to reach quality targets while also performing well financially. Quality Awardee health centers achieve key quality targets and invest more in enabling staff and services, but are also able to produce strong financial results through revenue maximization, efficient medical care teams, and higher utilization through positive engagement with patients. The data further indicates that the highest performers have a greater ability to control costs—in particular, staffing costs—even though they are more heavily staffed with generally higher-cost physicians.

Key findings are illustrated in our infographic. Access a free download of the complete report at www.caplink.org/resources/publications.

New National Economic Impact Analysis and Special Pricing for State and Individual EIAs

Using economic modeling software, an Economic Impact Analysis (EIA) measures the effect a health center’s current operations has on the communities it serves, including job creation, tax impact, and cost savings. Health centers and PCAs have used this information in the past to educate policymakers, seek community support, and pursue funding opportunities.
 
In preparation for the upcoming NACHC Policy and Issues Forum, Capital Link updated the National Economic Impact Analysis with the latest data and is offering discounted pricing on our statewide and individual EIA reports. In order to receive your EIA before the P&I, you must submit all necessary information by February 28th. To find out more and order, please contact Steve Rubman, Director of Data and Information Systems, at This email address is being protected from spambots. You need JavaScript enabled to view it..

NACHC Payment Reform Readiness Assessment Tool

The NACHC Payment Reform Readiness Assessment Tool identifies key competency areas needed for successful health center engagement in the most prevalent and emerging payment reform models. It is designed to help health centers assess their current state of readiness, and to identify areas for improvement. The tool is not specific to one payer type or payment reform model. Rather, it is designed to capture core readiness areas that are needed for participation on in a variety of payment reform models in use by both public and private payers. The readiness assessment tool is designed to begin the conversation among health center leadership and staff about successful engagement in payment reform models. Access it here.

Brand new CHroniCles Website

CHroniCles, the dynamic, multi-media website dedicated to the living history of the community health center movement, is newly redesigned. The updated website improves overall user experience and allows visitors to better access the site on mobile and tablet devices.  Check out the newly launched site here. 

Coming Soon from Capital Link: 

• Creating a Culture that Sustains a Patient-Centered Medical Home (Publication)
• Informing the Development of a Patient-Centered Medical Home Facility (Publication)

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. Upcoming additions include Neighborhood Health Association, OH, and Family Healthcare of Hagerstown, MD (formerly Walnut Street Community Health Center).

MLCHC Celebrates 50th Anniversary of US Health Centers
Massachusetts League of Community Health Centers (MLCHC) 50th anniversary op-ed is printed in the latest edition of CommonWealth Magazine.  The piece focuses on how health centers are already living in the future of health care as a result of the seeds sown 50 years ago with the founding of the nation's first medical home at Columbia Point, Dorchester. Read the article here. Also, MLCHC’s Jim Hunt & Harbor Health Services, Inc.'s Dan Driscoll shared the Community Health Center Movement story with WCVB in Boston. Watch here.

Geiger Gibson Health Center, 50th Anniversary
December 14, 2015 marked the 50th Anniversary of Geiger Gibson Community Health Center, originally the Columbia Point Health Center, and the first community health center in the nation. We congratulate their momentous achievement made possible by patients, staff, community partners, and legislative champions. #CHC50!

NEW Health Charlestown, MA Opens New Facility
Capital Link would like to congratulate NEW (North End Waterfront) Health, MA, on the grand opening of a new facility in Charlestown, MA. NEW Health Charlestown will offer a range of services, which include adult primary care, behavioral health, vision and dental services, among others. Capital Link's lending affiliate, Community Health Center Capital Fund, provided financing for this new site.

Upcoming Events

Industry Presentations

Capital Link regularly presents information at industry conferences. Below are a few of our next scheduled events. Complete descriptions are available here on our website.

Identifying the Drivers of Maximum Performance
Thursday, March 17th, 8:30 - 10:00am
Presenters: Jonathan Chapman, Director of Community Health Center Advisory Services, Capital Link; Charles Moore, President, HealthMETRICS
Read more here.

Hallmarks of High Performance: Exploring the Relationship between Clinical, Financial, and Operational Excellence at America’s Health Centers
Thursday, March 17th, 10:30 am - 12 pm
Presenters: Allison Coleman, Chief Executive Officer, Capital Link; Robert Urquhart, Chief Financial Officer, Greater Lawrence Family Health Center
Read more here.

Predictive Analytics
Friday, March 18th, 8:00 - 9:30 am
Presenter: Jonathan Chapman, Director of Community Health Center Advisory Services, Capital Link
Read more here.

OCHIN 2016 Learning Forum
Portland, OR
April 14-16, 2016

Hallmarks of High Performance at America’s Community Health Centers
Friday, April 15th, breakfast keynote session
Presenter: Allison Coleman, CEO, Capital Link
Read more here.

2016 Community HealthCare Association of the Dakotas Annual Conference
Fargo, ND
May 3-4, 2016

“Health Center Strong”: Hallmarks of Operational Excellence at America’s Community Health Centers
Monday, May 3rd
Presenter: Jonathan Chapman, Director of Community Health Center Advisory Services, Capital Link
Read more here.

Northwest Regional Primary Care Association Spring Primary Care Conference
Portland, OR
May 16-19, 2016

Hallmarks of Operational Excellence—Using benchmarking techniques and operational improvement tools for effective high-quality operations
Monday, May16th
Presenter: Jonathan Chapman, Director of Community Health Center Advisory Services, Capital Link
Read more here.

Trainings

Advancing the Financial Strength of California Clinics: 200 Series
February 25-26, 2015
Los Angeles, CA

This fourth installment of the Advancing Financial Strength Project: 200 Series Traning seeks to support Los Angeles’s community clinics and health centers in improving their financial position and internal financial acumen. This project is funded by L.A. Care Health Plan, Cedars-Sinai, and Blue Shield of California Foundation.

PCA Conferences

2016 Community Clinic Association of Los Angeles County Annual Health Care Symposium
April 1, 2016
Costa Mesa, CA

2016 Massachusetts League of Community Health Centers Community Health Institute & Exhibit Fair
May 4-6 2016
Falmouth, MA

California Primary Care Association Chief Financial Officers Conference
May 17-18, 2016
Carlsbad, CA

Webinars

Capital Link offers seasonal series of webinars designed to offer useful information for health centers on a wide range of topics. The webinars have no charge, but participation is limited to the first 100 registrants. Please check our website soon for a description of our upcoming webinars.