IPHCA 2020 Annual Leadership Conference Agenda

While measurement and accountability are crucial to high quality care, it is becoming evident that current policies and practices may have unintended consequences. Specifically, many clinical settings have implemented workflows, potentially at the sacrifice of efficiency, staff optimization, and patient satisfaction, to increase adherence to performance metrics. To further explore this issue, we examined utilization data from 30 health centers on screeners tied to performance metrics (depression, anxiety, smoking status, passive smoking status, health literacy, preferred learning style). We also conducted a time study to understand the impact on workflow and efficiency. This session will present a quantification of the extent of the problem, describe its impacts, and include a discussion of operational and policy recommendations to address the unintended inefficiency associated with performance metrics.

The saying is, “if it were easy, everyone could do it”. We know that leadership in healthcare is anything but easy. This session will focus on the core concepts and principles of Transformational Leadership as a style that brings about positive change, in even the most difficult times we encounter in healthcare. We know that being an engaging and effective leader can be challenging in the best of circumstances. So, when faced with adversity, significant stress on our systems, and even an emergency crisis situation; leadership requires extraordinary poise, commitment, and the ability to influence others in a positive way. Transformational leadership promotes a focus on goals and outcomes and does so by inspiring, motivating, and empowering others and leading by example in a vision-oriented way.

The community health center sector has matured and grown more sophisticated over recent decades. Increasingly, capable administrative teams, coupled with more effective governing boards, have strived to develop and maintain strong organizational financial positions, while providing high-quality care to a growing patient population. This knowledge and success however is being put to the test during the current COVID-19 Public Health Emergency and health centers are forced to respond to ever evolving circumstances clinically, operationally and financially.

This session will address financial and revenue considerations, including: sophisticated financial and other operating capacities, strong billing and collection practices; tight fiscal controls; diverse revenue streams; and the ability to make effective use of health information technology.

Attendees will learn:

• The importance of financial planning and contingency planning
• Actions for sustainability
• Operational considerations in response to changing delivery modalities

One of the most common types of office-based opioid treatment (OBOT) interventions typically involves a prescription for the opioid agonist/antagonist Buprenorphine in concert with other medical and psychosocial interventions to initiate and sustain remission. Even though this was made possible through the Drug Addiction Treatment Act 2000 (DATA 2000), this law alone has not reduced the treatment challenges that patients can often face when seeking help; nor has the patient experience evolved. There are still significant gaps in treatment including our inability to recognize the unique individual needs for patients that will ensure the best outcomes, preparing patients for treatment with Buprenorphine, involving extended treatment members (friends/family), and communicating with peers in a meaningful way to empower patients. Attendees will acquire best practice tips which can help their patients to reduce their illicit drug use, strengthen treatment retention, increase employment, and enhance personal relationships. The appropriate audience for this session includes clinical and healthcare professionals currently working with (or considering working with) patients who seek MAT with Buprenorphine.

What constitutes a "brand?" What are elements of a "good brand?" in the healthcare space? What can and/or should this translate to in terms of business? How do I know if my brand is where it should be? What are some pitfalls to avoid? These are all important questions to consider when developing and refining your organization’s brand; we’ll take a closer look at why branding is so important and steps you can take to distinguish yours.

Chestnut Health Systems™ is a large FQHC and community behavioral health organization delivering integrated care to individuals and communities in central and southern Illinois affected by substance use, mental health disorders, and other chronic health conditions. In 2019, Chestnut looked at its entire enterprise to assess how, with limited state funding, the system could aspire to do more for more people. Chestnut now has a multi-year strategic plan and a new senior leadership organizational structure to carry it out. This refresh challenges Chestnut to remain focused on four strategic initiatives shared by everyone from board members to front line staff. This presentation describes the strategic planning process, the ways in which the process differs from past strategic planning, and employee engagement in achieving goals.

The COVID-19 pandemic required health center dental clinics to respond by limiting care to emergencies. Recovery issues addressed by successful dental programs included procedure classification by risk, revised workflow, infection control, and tele-dentistry. NACHC’s Quality Center Value Transformation Framework provides a conceptual model to guide systems change in three domains: Infrastructure, Care Delivery, and People. Reimagined oral health care must address these domains, including expansion of care team members involved in the provision of oral health services and use of dental care team members for the services they are uniquely trained to provide. Lessons learned during reopening can be applied to maximize dental care in a value-based care environment. This session will provide a view of these issues from national, state, and local perspectives.

In response to COVID-19 and the lack of testing in the area’s most vulnerable communities, Access Community Health Network (ACCESS) developed a systematic approach to building testing sites that would be able to respond and adapt to the immediate and changing crisis. In this session, participants will learn how ACCESS leveraged its patient centered medical home model and its strategic-focused, integrated team structure to quickly respond to the crisis and assure that patients and community residents were not only tested but had the support they needed in a medical home. As of the end of June 2020, ACCESS has tested over 5,000 patients, with close to 700 testing positive and requiring follow up.

The COVID-19 pandemic led to rapid implementation and expansion of telehealth across the country. Erie Family Health Centers, an FQHC based in Chicago, IL presents their ongoing telehealth work refining this service to maintain access for their over 80,000 patients. Erie team members will briefly describe their telehealth implementation and discuss the optimization process from both a clinical and operational lens. The presentation will focus on three pillars:

• Staff engagement: Training and eliciting feedback from a broad care team.
• Standard procedures: Through an interdisciplinary team continuing rapid adjustments to optimize the workflow and ensure clinical quality.
• Patient satisfaction and quality: Continued evaluation underway to understand patient barriers and satisfaction with telehealth, as well as adjustments needed to maintain quality.

Our relationships with patients, clients and teammates can be easily impacted by the judgements we make about others, often fueled by cognitive processes about which we are not aware. These assumptions and the decisions that grow from them can negatively impact health equity for individuals and communities. This presentation will explore the nature of implicit bias and the potential negative impacts on patient care and teamwork. Through experiential and reflective exercises, participants will be invited to self-reflect on bias and stereotypes. Participants will also be provided with resources and strategies to better manage implicit bias for themselves and their colleagues. This presentation will empower participants to find their voice as leaders and advocates toward the delivery of culturally responsive care.

Even under the most optimistic scenarios, the health care system that returns to “normal” will be different from its pre-pandemic status. We should be discussing which approaches our practices should modify, which we should start, and which we should accelerate. We should strive for an agile ability to reconfigure strategy, structure, processes, people, and technology quickly toward value-creating and value-protecting opportunities. We must enhance analytics capabilities that allow us to ask the right questions and provide the basis for answers. We can no longer be hampered by a fee-for-service payment methodology that limits the most efficient use of our care teams and requires face-to-face visits. This session will discuss why the IPHCA is pursuing a capitated alternative payment option for its members.

“Branding” means giving attributes to your health care operation so that people can identify it and differentiate it from other programs, products, and businesses. The goal of branding is brand recognition (I say Nike, you think swoosh) and brand recall (I say shoes, you think Nike). In this session, we will explain why branding is so important and offer five simple, specific ways you can increase your brand’s presence. From how it plays out in your waiting rooms to where you appear online, a strong brand is essential to draw new patients to your health center and retain current/lapsed patients.

When health centers found ourselves in an unprecedented health crisis, we swiftly and drastically adjusted clinical care protocols and operational procedures. Our communications efforts needed to adjust just as quickly, and just as significantly. In this session led by Erie Family Health Centers, participants will learn the best practices for communicating with staff, patients, donors and the public in a time of crisis. Erie will use its recent experience creating new, responsive internal communications vehicles, culturally-sensitive patient outreach and a pro-active public relations strategy as a case to discuss how the goals of crisis communication – timeliness, accessibility, transparency and even empathy – are useful communication guideposts to follow even in normal times.

Disparity in quality health care for African Americans is well chronicled. Many African Americans with behavioral or medical complications may avoid seeking services. This presentation focuses on how to create a welcoming environment for African American patients who seek behavioral health or medical services. You’ll learn strategies to help create and foster a welcoming environment, with emphasis on initial engagement and retention strategies. Topics include engagement within the first 10 minutes of contact, how to partner with African American patients, and awareness of biases which may impact medical care for this community.

Disparity in quality health care for African Americans is well chronicled. Many African Americans with behavioral or medical complications may avoid seeking services. This presentation focuses on how to create a welcoming environment for African American patients who seek behavioral health or medical services. You’ll learn strategies to help create and foster a welcoming environment, with emphasis on initial engagement and retention strategies. Topics include engagement within the first 10 minutes of contact, how to partner with African American patients, and awareness of biases which may impact medical care for this community.

For a variety of reasons, the substance use disorder (SUD) treatment field in the United States is undergoing an historic transformation. Among those reasons: a host of effective behavioral and pharmacological interventions to treat and manage SUD have been developed over the last two decades; health care reforms and policies concerning equity and parity are creating opportunities to make treatment available to a wider patient population than ever before; the pandemic has led to an explosion of telehealth use that many believe is here to stay; the use of peer support specialists has surged in the past five years; and – sadly - the opioid epidemic continues to plague us in record numbers.

Directly related to all this change is the widespread adoption of the American Society of Addiction Medicine’s (ASAM) levels of care and Patient Placement Criteria. ASAM level of care definitions are contributing to a landscape of services and providers many medical practitioners may not be so familiar with. This session will explore the most contemporary thinking surrounding a modern and evidence-based system and continuum of care, giving healthcare providers and systems of care managers the opportunity to consider how they treat SUD in their practice and in relation to the broader continuum in the community.

Understanding the full continuum will help physicians, nurses and care managers/coordinators manage transitions in care, referrals to providers in the local system of care, and better understand how relapse can sometimes be prevented by a well-coordinated network of providers.

The federal 340B drug discount program is a vital lifeline for community health centers, but we face threats on multiple fronts in 2020 and beyond. This session will address strategies for protecting 340B reimbursement from increasingly aggressive payers, protecting pharmacy operations from attempts by some drug manufacturers to undermine retail pharmacy operations, and identify opportunities to use 340B to increase patient access through telemedicine and clinical pharmacy operations.

Coordinating care, engaging patients, and succeeding in an increasing value-based healthcare environment is extremely challenging without access to accurate, timely information on patients’ care events. By leveraging networks for real-time data sharing on ED presentations, hospital admissions, and discharges health centers can enable care teams to strengthen our relationship with patients and other providers across the healthcare system to improve outcomes and experience for our shared patients.
The session will explore the impact of access to real-time data when it comes to reducing ED visits, shortening hospital stays, and reducing the time to post-discharge review and re-assessment. We will explore the ways real-time data supports care coordination strategy and patient engagement while reducing healthcare utilization and total cost of care.

Stigma around mental illness continues to be one of the leading taboos in historically marginalized communities. Whether it's depression, anxiety, or worst-case scenario, suicide, there is a longstanding belief in communities of color that the impact of these taboo subjects is the problem of "the other." Though historically marginalized communities, because of socioeconomic challenges, may be at higher risk for poor mental health, there is a reluctance to recognize the need for the help of a physician or therapist. As a result of stigma, socioeconomic challenges, and the added stressors of systemic racism and lack of access to culturally competent mental health resources, suicide rates continue to rise in these communities. In this session Victor Armstrong will discuss the historic challenges of African Americans, and other historically marginalized communities, as it pertains to suicide, while also incorporating recent events such as the disproportionate impact of COVID19 in communities of color and the recent civic unrest resulting from the deaths of George Floyd, Breanna Taylor, and others.

Common sense suggests that appointment reminders lead to lower incidence of late cancellations/no shows. Analysis of historic schedule data at PrimeCare Chicago strongly suggests this conclusion is mistaken. In fact the only variable positively affecting patient adherence is shortening the lag time between the request for appointments and the encounter. Focusing improvement efforts on targeted backfill appointments for slots where historic analysis indicates the highest probability of late cancellations/no shows can increase provider productivity to the range of 95%. The session will describe the results of applying KairoiOptimize scheduling to several PrimeCare Chicago clinics.

The COVID-19 pandemic has truly compelled the healthcare industry to adopt digital platforms at a lightning speed as health systems moved to virtual environments to continue offering services to their patient population. This session chronicles the journey of Friend Health in transforming their practice by leveraging technology to service patients, build stronger patient care teams and innovate their healthcare delivery mode. The presentation makes for a compelling argument for community health centers to be more strategic in leveraging technology to innovate healthcare delivery to offer access and bridge care gaps in hard-to-reach vulnerable populations through our learnings from navigating through the COVID-19 pandemic.

The Chicago Collaborative for Maternal Health, led by AllianceChicago and EverThrive Illinois, aims to improve maternal health outcomes in the ambulatory care setting via quality improvement initiatives, community engagement, and policy advocacy. AllianceChicago is developing the first quality improvement initiative, a population management approach to linking high risk patients to primary care providers in the postpartum period, and has an engaged ten ambulatory care partners, including FQHCs and hospital clinics, to inform and implement this initiative for their patient populations. This session will discuss the landscape, process, lessons learned, and next steps for developing this perinatal care quality improvement initiative with ambulatory care partners, along with discussing the impacts of COVID-19 to the approach and implementation.

Staffing Medical Assistant positions is a constant challenge for many health center HR and nursing departments. Once hired, MAs often require re-training on skills and training on team-based care and the health center mission. In this interactive session, health center nursing department leaders and MA educators will help participants explore benefits and challenges of three strategies health centers use to secure a high-functioning MA workforce: internal training programs, serving as a clinical placement site for a traditional MA program, and partnering with a school focused on preparing MAs for a team-based primary care setting. Participants will gain talking points that can be used to advocate for a new MA training model, best practices in MA training, and strategies for MA retention and career ladder development.

Come learn from the 340B team at Erie Family Health Centers about our journey in elevating our 340B program! The co-presenters will cover 340B enhancement efforts through the lens of multiple roles. Erie’s CFO will affirm the critical role of executive leadership engagement in 340B. Learn the benefits of investing in compliance and strategically assessing opportunities for pharmacy network expansion and capturing eligible referral scripts. Discover how to upgrade your compliance activities, including concrete tips for ease in navigating OPAIS and compliantly tracking Clinically Administered Drugs. Learn about Erie’s extensive self-audit process for 100% of claims. Come learn about Erie’s one-of-a-kind Pharmacy Services Team – a central agency resource that optimizes patient medication access by troubleshooting patient, provider, and pharmacy issues.

Telehealth plays an essential role in addressing provider shortages and ensuring access for patients to primary care services and critical specialty care services. Recent policy changes during the COVID-19 pandemic have reduced barriers to telehealth access and have promoted the use of telehealth as a way to deliver acute, chronic, primary and specialty care. Despite the changes, many FQHCs have not implemented telehealth for a broad scope of services. Attendees will learn why telehealth is essential for their future survival; how telehealth is being utilized by FQHCs; and potential new business opportunities. The session will provide an in-depth review of Medicare, Medicaid and commercial payor coverage and reimbursement for telehealth services; and key telehealth regulatory and compliance considerations, including HRSA Program Assistance Letter 2020-01, scope of project, and UDS reporting requirements.

Primary Care is uniquely positioned to play a critical role in prevention and treatment of depression, especially in the time of COVID-19. During this session, the speakers will give an overview of why integrating primary care and behavioral health in the collaborative care model is critical. This session will provide practical knowledge and tips on how to create or improve existing depression management. Attendees will get insight into using validated screening and measurement tools, tracking patient progress, and building a behavioral health care coordinator workforce within their clinics. Measurement of true patient outcomes has been notoriously difficult for mental health, and there will be a focus on a measurement-based treat to target framework, making sure organizations can track successful patient outcomes.

In order to effectively address health disparities, FQHCs must be prepared to address the many healthcare and wellness needs of diverse patient populations and community members. A focus on diversity, equity, and inclusion requires attention to internal and external dynamics, workforce training and development, data and evaluation, Board and leadership engagement, and organizational decisions about how to invest time, attention, and treasure to its equity and inclusion priorities. Dimensions of diversity requires an awareness of intersectional identities and comfort naming institutional racism and white supremacy, which persist in society. Founded as an LGBTQ organization, Howard Brown Health has devoted attention to address the many intersectional identities includes within the LGBTQ community. The organization has trained staff on diverse topics such as transgender/gender non-conforming cultural competency to anti-racism practices. The work is iterative and evolving. The session will describe the questions, objectives, and initiatives the Board and agency leadership have pursued to advance DEI outcomes for all stakeholders. Facilitated discussion will address where to start, how to mobilize interested amid other pressing priorities, and discuss the reward and challenges of leaning into DEI as well as the consequences of ignoring the topic.

Grassroots advocacy has long been a critical element of health center success. While the basic tactics of grassroots advocacy remain unchanged, the spread of the coronavirus has made conducting effective grassroots advocacy at health centers more difficult. This session will review the basics of an effective grassroots advocacy program for health centers and offer some adaptations to existing tactics and alternate activities that can help centers continue effective advocacy while the pandemic continues and beyond.

Management of patient with pre-diabetes and diabetes is critical to improving health outcomes. In this presentation, two community health centers will describe how they have created innovative solutions to improving care of diabetic conditions. One health center used the COVID pandemic as an opportunity to create a drive up visit process to manage patients with Diabetes and/or Hypertension. The other used coaching to create a practical application of new knowledge of DSME with longitudinal support and resources. Each health center will discuss their process for implementation, challenges, successes and lessons learned for future program sustainability.

The Future of Telemedicine for 340B Eligibility will explore the quick unprecedented changes that became reality during the COVID-19 breakout, while focusing on ways to remain compliant and achieve expected benefit to the health center. Navigating the world post COVID-19 requires keeping up to date with an evolving 340B landscape. This presentation is designed to discuss recent operational and clinical changes that we have taken to respond to the pandemic in our community, review a list of resources and FAQs from HRSA and discuss their interpretation of compliance, share suggested policy and procedure language and changes to reflect best practices, and understand the importance of credentialing during and after the pandemic.

Healthcare innovation is vital to addressing health disparities and meeting patients where they are. While integrated primary and behavioral healthcare is not a new concept, providers are having to rethink healthcare delivery during unprecedented times. Faced with limited patient interaction and rapid shifts toward hybrid models of care, Federally Qualified Health Centers (FQHCs) are primed to advance integrated care using new and innovative approaches. This session will provide an overview of operational considerations and best practices to adopting integrated care models in today's world.

When the South End Community Health Center was facing financial uncertainty, they turned to the East Boston Neighborhood Health Center, the largest FQHC in Massachusetts and one of the nation’s premier FQHCs, to pitch a win-win merger to increase revenue, improve efficiency and reduce overhead costs. After facing a year of regulatory obstacles and a global pandemic, the merger was successfully completed with the South End center becoming a branch of East Boston Health. This presentation will cover what to consider when contemplating a merger, challenges faced throughout COVID-19, the steps to overcome regulatory hurdles and valuable lessons learned.

Esperanza Health Centers provides health care services to over 30,000 mostly Latinx patients residing on Chicago’s Southwest Side The health center has had great success with HRSA’s UDS quality reporting, having received a National Quality Leader award in three out of the past four years. This presentation will discuss their general quality framework, including the use of performance coaches, incentive compensation, and radical data transparency to achieve quality outcomes. They will also explore their experiences advancing quality in the context of serving the most heavily hit zip codes in the Covid-19 pandemic in Illinois. Finally, the panel will address Esperanza’s bold goal of improving Quality Adjusted Life Years (QALYS) for the communities they serve and ambitions to eliminate inequities among the diverse groups that constitute their patient population.

Validating that this is a hard time and sharing appreciation for all staff who are on the front lines of the fight against an invisible enemy, Chicago Family Health Center developed "Our Health Is Essential: Healthcare Worker Wellness Program." This program is designed to offer structured, multifaceted strategies by which behavioral health providers can support their colleagues during this time of stress by 1) providing education on techniques to manage healthcare worker stress, 2) infuse joy into the workweek, 3) celebrate "Healthcare Heroes" and "Silver Linings," and 4) take a Pandemic Pause in the middle of each week to check-in and take a break.

Finding innovative, effective ways to catalyze the development and effectiveness of new Nurse Practitioner graduates is a critical health care need. Heartland Health Centers, RUSH University College of Nursing, and Howard Brown Health partnered to develop an Integrated Care Nurse Practitioner Residency program. The program places Family Nurse Practitioner and Psychiatric Nurse Practitioner residents in community-based health care settings. Each partner has developed site-specific training plans, workflows, billing/reimbursement structures, and preceptor structures. In addition to each site-specific plan, the partners have developed shared, weekly case-based didactics on a wide range of topics that all residents attend. Presenters will discuss challenges and successes in implementing the training models and will talk about how this training program lays the foundation for other professional training.

Every several years a catastrophe strikes: the September 11th terrorist attacks, Hurricane Katrina, the Gulf of Mexico oil spill, the economic recession of 2008, and, most recently, the trifecta: the interplay between COVID-19, high unemployment rates, and racial conflict. These crises call upon leaders to help create calm in the midst of a storm. In this presentation you will learn about the impact catastrophes and pandemics can have on employees, how to help employees thrive in the midst of catastrophe, and how to build team cohesion in a crisis.

Since its founding in 2009, Medical Home Network has realized a vision to overcome barriers experienced by the over 130,000 Medicaid lives it serves by implementing comprehensive, innovative, and transformational solutions. Essential to their success is a strategically deployed and continuously innovated “Partnership for Patients” transitions of care program. Since first launched in May 2018 through a partnership between the University of Chicago Medicine and Chicago Family Health Center, a federally qualified health center serving the south side of Chicago, the Partnership for Patients program has seen a sustained readmission rate of 13%, an increase in patient engagement and improved continuity of care across the continuum. These outcomes are a direct result of quality partners, sustainable relationships, and dedication to the community and patient-centered care.

Health centers which come together through a merger or acquisition are able to enhance operations and reduce expenses as the result of economies of scale in staffing and administrative functions. They are also able to develop partnerships, enhance reimbursement and gain access to capital to invest in infrastructure needs. For health centers considering such a move, it is critical to closely consider relevant merger and acquisition regulatory requirements and the key legal issues affecting such transactions, including:

• The pros and cons for alternative transaction structures
• The merger and acquisition transaction process (including legal and compliance issues)
• The FQHC Board of Directors role in mergers and acquisitions
• HRSA approval criteria and 330 Grant requirements
• FTCA coverage, Scope of Project and Service Area implications

"Employee centric organization is one where you honor your employees, where you take care of them so that they take care of your customers." Ann Frey - Corporate Leadership Coach Presenters will cover the tenants of an employee centric workplace in a time of crisis and explore tools for assessing employee behavior, stressing the importance on meaningful work and how to bring joy into the workplace. Learn how to create environment where employee ideas, creativity and free flowing communication are encouraged throughout the organization.

Effective January 2020, Illinois required community health centers to train all employees and volunteers on sexual harassment prevention each year. Most available trainings are based in an office environment and present a male harasser and a female harassment survivor. Few of the trainings address the complex relationships that exist at health centers. Instead of using a generic training, Howard Brown Health (HBH) created a community health center specific, LGBTQ affirmative sexual harassment prevention training. HBH’s HR and Education Departments collaborated on the training. Presenters will discuss the trainings, show samples of slides, polls and cases used for training, and discuss the feedback received by staff about the trainings and how this is evolving the agency’s approach to sexual harassment prevention.

Patient safety begins with proper Credentialing and Privileging. Credentialing and Privileging are high risk and heavily regulated areas. This session will describe the fundamentals of developing an effective Credentialing, Privileging and Peer Review process. The importance of a structured and efficient Privileging and Peer Review process from a medical leadership perspective will be reviewed. Helpful tips for mainlining an audit-ready Credentialing process to meet the most challenging HRSA and The Joint Commission standards will be discussed.