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National Association of Community Health Centers, Inc.

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Title: National Association of Community Health Centers, Inc.


1
National Association of Community Health Centers,
Inc.
1
2
Americas Voice for Community Health Care
The NACHC Mission To promote the provision of
high quality, comprehensive and affordable health
care that is coordinated, culturally and
linguistically competent, and community directed
for all medically underserved people.
National Association of Community Health Centers,
Inc.
2
3
DEVELOPING EFFECTIVE FQHC PROGRAMS AND
APPLICATIONS
National Association of Community Health Centers,
Inc.
3
4
DEVELOPING EFFECTIVE FQHC PROGRAMS AND
APPLICATIONS SERVICE PACKAGE DELIVERY STRATEGY
5
The Program/Proposal Logic Model
STRONG HEALTH CENTER PROGRAMS
STRATEGIC PLANNING
NEEDS ASSESSMENTS
6
The Program/Proposal Logic Model
  • The Needs Assessment Informs the Strategic
    Planning Process Which
  • Forms the Basis for the Health Care Plan and the
    Service Package, Staffing Profile and Delivery
    Strategy
  • Lays Out a Rational and Logical Approach to
    Implementing that Plan and Strategy
  • Which is Supported by a Reasonable, Realistic and
    Cost Effective Budget

7
Ensuring Legal Compliance
  • All FQHCs must comply with applicable Section
    330-related statutory and regulatory
    requirements, guidelines and policies
  • Community Health Centers Section 330(e)
  • Migrant Health Centers Section 330(e) and
    Section 330(g)
  • Health Care for the Homeless Section 330(e) and
    Section 330(h)
  • Public Housing Primary Care Section 330(e) and
    Section 330(i)
  • New Access Point Applicant compliance at time of
    submission or within 120 days of grant award
  • FQHC Look-Alike Applicant compliance at time of
    submission

8
Need 30 POINTS
  • USE THE NARRATIVE SECTION TO TELL A STORY - DRAW
    A PICTURE
  • FOCUS ON THE TARGET POPULATION
  • COMPARED TO..

9
Program/Proposal Logic Model
  • The Needs Assessment Informs the Strategic
    Planning Process Which
  • Forms the Basis for the Health Care Plan and
    Service Delivery Model
  • Lays Out a Rational and Logical Approach to the
    Implementing that Plan
  • Which is Supported by a Reasonable, Realistic and
    Cost Effective Budget

National Association of Community Health Centers,
Inc.
9
10
Building Strong FQHC Programs
Partners in the Community
Board Member Constituencies
Input from staff
Identified Need
Input from PCA
Environmental Analysis
Input from Patients
Short and Long Term Strategic Goals
Evaluation of Options
Which Patients
What Services
How Provided
How Implemented
How Supported
National Association of Community Health Centers,
Inc.
10
11
IDENTIFYING NEED
National Association of Community Health Centers,
Inc.
11
12
RULE 1A
  • IDENTIFIED NEEDS HAVE TO RELATE TO
  • PROGRAM
  • HEALTH DISPARITIES SERVICE PACKAGE
  • ACCESS PROBLEMS STAFFING PROFILE
  • BARRIER PROBLEMS DELIVERY STRATEGY

National Association of Community Health Centers,
Inc.
12
13
RULE 1B
  • IDENTIFIED NEEDS HAVE TO RELATE TO
  • PROGRAM
  • IDENTIFYING SCORES OF PROBLEMS WITHOUT
    CORRESPONDING PROGRAM IS NOT A WINNING STRATEGY

National Association of Community Health Centers,
Inc.
13
14
From the SAC FY09 Guidance
  • Information provided on need should serve as the
    basis for, and align with, the proposed
    activities and goals described in the health care
    and business plans and throughout the
    application.

National Association of Community Health Centers,
Inc.
14
15
IDENTIFYING NEED
  • Health Disparities
  • Health outcome data demonstrating that the target
    population experiences disparities in health
    outcomes compared to the general population in
    the Service Area or other benchmarks

National Association of Community Health Centers,
Inc.
15
16
IDENTIFYING NEED
  • Access to Care
  • Data demonstrating that there is not an adequate
    quantity of accessible primary health care
    providers for the Target Population

National Association of Community Health Centers,
Inc.
16
17
IDENTIFYING NEED
  • Barriers to Care Even if there are health care
    resources why is it that the target population
    cannot use them fully?
  • Cultural and/or linguistic
  • Geographic/transportation
  • Insurance/available income
  • Other factors creating barriers
  • Unique health care needs

National Association of Community Health Centers,
Inc.
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18
IDENTIFYING NEED
  • ATTENTION EVERYBODY!!!!

LOOK FOR REQUIRED NEEDS DATA!!!! BUT DO NOT
LIMIT YOUR ANALYSIS TO THOSE INDICATORS!!!!
National Association of Community Health Centers,
Inc.
18
19
IDENTIFYING NEED
Community Based Needs Assessment
Need for Primary Care Services
National Association of Community Health Centers,
Inc.
19
20
LEVELS OF DESCRIPTION
PATIENTS
TARGET POPULATION
SERVICE AREA
National Association of Community Health Centers,
Inc.
20
21
LEVELS OF DESCRIPTION
SERVICE AREA
National Association of Community Health Centers,
Inc.
21
22
Service Area
  • Define Service Area
  • A geographic area from which your target
    population will be drawn (census tracts,
    counties, MUAs, HPSAs, etc.)
  • A logical and rational area for providing health
    care services
  • That relates to your target population and their
    accessibility and barrier issues
  • This is the character of the area
  • Environmental/geographic characteristics
  • Housing
  • Economy types of economic activity

National Association of Community Health Centers,
Inc.
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23
Service Area
  • This is how the people here live
  • Education
  • Income
  • Livelihood
  • Transportation
  • Socio-demographic information
  • And all of these things relate to potential
    health risks and barriers to care

National Association of Community Health Centers,
Inc.
23
24
Service Area
  • And all of these things relate to
  • Potential health risks
  • Decreased access
  • Barriers to care

National Association of Community Health Centers,
Inc.
24
25
LEVELS OF DESCRIPTION
TARGET POPULATION
SERVICE AREA
National Association of Community Health Centers,
Inc.
25
26
Target Population
  • These are the people in the Service Area that I
    am focusing on serving
  • Socio-demographic indicators
  • Race Ethnicity
  • Income Language/culture
  • Education Insurance status
  • Age Free/reduced lunch
  • Employment/unemployment

National Association of Community Health Centers,
Inc.
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27
Target Population
  • Health Status Indicators/Health Disparities
  • Maternal child health indicators
  • Infant mortality
  • Low birth weight
  • Prenatal care
  • Teen pregnancy
  • Immunizations
  • Lead paint exposure/poisoning
  • Others

National Association of Community Health Centers,
Inc.
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28
Target Population
  • Health Status Indicators/Health Disparities
  • Chronic Diseases
  • Cancer
  • Diabetes
  • Asthma
  • Coronary Heart Disease
  • Hypertension
  • Others

National Association of Community Health Centers,
Inc.
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29
Target Population
  • Health Status Indicators/Health Disparities
  • Mental Health Problems
  • Depression
  • Suicide
  • Substance abuse
  • Serious mental health conditions
  • Add/ADHD
  • Oral Health Problems
  • Caries
  • Other?

National Association of Community Health Centers,
Inc.
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30
Target Population
  • Health Status Indicators/Health Disparities
  • HIV/AIDS
  • Nutrition/hunger
  • Obesity
  • Conditions Specific to Special Populations
  • Environmental Exposure
  • Pesticide exposure
  • Skin disorders
  • Accidents

National Association of Community Health Centers,
Inc.
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31
IDENTIFYING NEED
  • Define Special Populations
  • specific health problems and health care needs
  • significant changes in the past year impacting
    specific special populations

National Association of Community Health Centers,
Inc.
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32
IDENTIFYING NEED
  • Special Populations Additional Descriptions
  • MCH agricultural environment/crops growing
    seasons special circumstances impacting demand
  • HCH availability of housing and other factors
    that impact demand for services
  • PHPC recent changes in availability of public
    housing and impact on demand

National Association of Community Health Centers,
Inc.
32
33
LEVELS OF DESCRIPTION
PATIENTS
TARGET POPULATION
SERVICE AREA
National Association of Community Health Centers,
Inc.
33
34
Patients
Community Based Needs Assessment
Need for Primary Care Services
National Association of Community Health Centers,
Inc.
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35
Patients Just the Tip of the Iceberg
  • Health Status
  • Access to Care
  • Barriers to Health Care
  • Patient surveys
  • Focus groups
  • Chart audits
  • Anecdotal information

National Association of Community Health Centers,
Inc.
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36
IDENTIFYING NEED
  • For those already providing health care to the
    target population (existing grantees-Service Area
    Competition and Expansion Applicationsand other
    operational applicants)
  • Who are you serving nowhow many?
  • For everyone
  • How many will be served and how many projected
    encounters throughout the proposed project
  • Give data for end of each project year and at
    full capacity!
  • Make sure the data is consistent

National Association of Community Health Centers,
Inc.
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IDENTIFYING NEED
  • Remember
  • Patient Derived Data and Information is Not
    Population-Based Data!
  • Always Use the Correct Data for the Question
    Being Asked

National Association of Community Health Centers,
Inc.
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38
Other Area Providers
Patients
Community Based Needs Assessment
Need for Primary Care Services
National Association of Community Health Centers,
Inc.
38
39
ACCESS TO CARE HOW MANY PROVIDERS ARE THERE?
  • Access to Care Are health care resources
    available to the Target Population?
  • Data demonstrating that the Target Population has
    restricted access to primary health care
  • Numbers of providers available
  • Others providing resources/services to the target
    population
  • Other FQHCs/Section 330 grantees, rural health
    clinics, public health services, etc

National Association of Community Health Centers,
Inc.
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40
ACCESS TO CARE HOW MANY PROVIDERS ARE THERE?
  • Access to Care
  • Discussion of the adequacy and effectiveness of
    the existing network of care for the Target
    Population
  • Absolute shortage of primary, oral, behavioral
    care providers
  • Shortage specifically for Target Population
  • Numbers of providers accepting Medicaid, SCHIP,
    sliding fee scale
  • Waiting times to get appointments, etc.

National Association of Community Health Centers,
Inc.
40
41
Community Based Needs Assessment
Patients
Other Area Providers
Need for Primary Care Services
Barriers to Care
National Association of Community Health Centers,
Inc.
41
42
BARRIERS TO CARE
  • Barriers to Care Even if there are health care
    resources why is it that the target population
    cannot use them fully?
  • Cultural and/or linguistic
  • Geographic/transportation
  • Insurance/available income
  • Other factors creating barriers
  • Unique health care needs

National Association of Community Health Centers,
Inc.
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43
Community Based Needs Assessment
Patients
Other Area Providers
Need for Primary Care Services
Barriers to Care
Environmental Context
National Association of Community Health Centers,
Inc.
43
44
HEALTH CARE ENVIRONMENT
  • Health Care Environment What is happening in
    the state, region, local area that impacts the
    health care status and access to care for the
    target population?
  • Federal, state, county, local Medicaid, welfare,
    other health care reforms
  • Implementation of 1115 and 1915(b) waivers,
    Medicaid PPS, SCHIP, others
  • Direction that state environment and health
    policy is going including trends in state
    budgets, unemployment, etc.

National Association of Community Health Centers,
Inc.
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HEALTH CARE ENVIRONMENT
  • Health Care Environment
  • How do these trends and policies impact the
    future fiscal well being of the proposed program
    and applicant organization?

National Association of Community Health Centers,
Inc.
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ENVIRONMENT-NOT JUST HEALTH CARE
  • What other environmental policy politics
    will impact the proposed program?
  • Immigration laws
  • Changing economic structure
  • Employment trends
  • others????

National Association of Community Health Centers,
Inc.
46
47
Community Based Needs Assessment
Other Area Providers
Patients
Need for Primary Care Services
Barriers to Care
State Priorities
Environmental Issues
National Association of Community Health Centers,
Inc.
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48
STATE PRIORITIES
  • How does the proposed new site fit into the state
    priorities regarding health care for the
    underserved?
  • Market Place Analysis
  • Statewide Strategic Plan
  • Other analyses of health care access

National Association of Community Health Centers,
Inc.
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49
LETS DIG DEEPER INTO DATAUnderstanding
and Describing Your Target Population
50
Data is Your Friend
  • Finding and Generating Relevant Data

National Association of Community Health Centers,
Inc.
50
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Considerations For Using Data
  • Quality counts
  • Look for and recognize bias
  • Doesnt show much unless you can compare it
  • Is it too small to really have meaning
  • Look for supporting evidence to show trends

National Association of Community Health Centers,
Inc.
51
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Primary Data Collection
  • THAT MEANS YOU GO OUT AND GET THE INFORMATION
    YOURSELF

National Association of Community Health Centers,
Inc.
52
53
Qualitative Approaches to Primary Data
  • Qualitative Methods involve going out to talk to
    people and listening to what they say!!
  • So, how we know who to talk to about what??

National Association of Community Health Centers,
Inc.
53
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Qualitative Approaches to Collecting Data
  • Step 1 Community Asset Mapping a social "map"
    of the community
  • different sectors of the community business,
    labor, government, religious, health care,
    voluntary/civic organizations, growers, advocates
  • as broad of a picture of the people and
    organizations that will potentially be involved
    in the health center so that you can assess
    clearly the needs in the community and the
    options for meeting those needs. In other words,
    this should be an inclusive activity.

National Association of Community Health Centers,
Inc.
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Qualitative Approaches to Collecting Data
  • Step 1 Community Asset Mapping
  • Once the sectors have been identified, make a
    list of the people, groups and organizations that
    make up each sector for example, all of the
    schools and school districts for the education
    sector.
  • Next, identify the key influences in each sector
    key people and organizations as well as
    political and social trends.
  • Lastly, identify which components of the
    community are likely to be barriers or
    facilitators to a new health center and why.

National Association of Community Health Centers,
Inc.
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Qualitative Approaches to Collecting Data
  • Key Informant Interviews
  • Use the Community Assets Map to identify key
    stakeholders and to inform what questions you
    should ask of whom
  • The list must represent the entire community
    across race, ethnicity, age, sex, years of
    residency and other community characteristics you
    deem important. Informants should also be
    chosen based upon the longevity and/or the nature
    of their involvement with the community to cover
    a full range of community opinion.

National Association of Community Health Centers,
Inc.
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Qualitative Approaches to Collecting Data
  • Key Informant Interviews
  • Develop an interview format/questionnaire
  • touch on attitudes about the community as a whole
  • specifics areas perhaps economics, education,
    health, leadership
  • what is being done to address these concerns, and
    his/her ideas about what should be done
  • Pay attention going in to your asset map and the
    position of the stakeholder the power they
    wield

National Association of Community Health Centers,
Inc.
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Using Knowledgeable Experts
  • Persistence pays off
  • They wont think your questions are dumb
  • They are great sources
  • - The right person will want to answer your
    questions
  • - May have a special unpublished study
  • - May know the perfect referral
  • Great for hard to find information
  • Give local slant
  • Speak to what does it mean for your target
    population

National Association of Community Health Centers,
Inc.
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Qualitative Approaches to Collecting Data
  • Focus Groups
  • a small, selected discussion group individuals
    from similar backgrounds guided by a trained
    facilitator or moderator. It is used to learn
    more about viewpoints on a designated topic in
    combination with other information and data, to
    guide future action.

National Association of Community Health Centers,
Inc.
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Qualitative Approaches to Collecting Data
  • Community Forums And Listening Sessions
  • offer valuable insights into community dynamics
  • opportunities for linkages where people who are
    willing and able to help will surface
  • raise the credibility of the needs assessment
    process by enhancing openness and inclusion
  • raise the level of awareness and understanding
    about your issue and the community planning
    initiative

National Association of Community Health Centers,
Inc.
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Quantitative Primary Data Collection Approaches
  • Direct Surveys Be sure you use a method that
    will actually connect you with the target
    population!
  • Telephone - now thats not going to work!!
  • Mail-survey probably not that one either!!
  • Door-to-door/field-to-field now we are getting
    somewhere!!
  • Use available resources to assist university
    students
  • Actual counts e.g., labor camps, homeless
    shelters, gathering places

National Association of Community Health Centers,
Inc.
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Quantitative Primary Data Collection Approaches
  • Provider Surveys
  • Be sure you focus on availability for the target
    population!

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Inc.
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Secondary Data Collection Using Other Peoples
Stuff
  • Locate secondary sources
  • - Web sites, links, internet searches
  • - Gather reports and other documentation
  • Manipulate databases
  • - For example 2000 Census - can build
  • tailored report
  • - Conduct records review
  • - Ask someone to run tailored report
  • - Find someone elses report from database

National Association of Community Health Centers,
Inc.
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Secondary Data Collection Using Other Peoples
Stuff
  • Careful!!
  • Know what question was asked and how it was asked
    BIAS!!!!
  • Understand the definitions and assumptions are
    we talking about the same thing?
  • Is it trend data or a snapshot?
  • Does the person making data for you know what
    they are doing?

National Association of Community Health Centers,
Inc.
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Before You Begin Data Guidelines
  • To show a current health disparity
  • Compare data from the same years
  • National vs. local
  • To show deteriorating conditions
  • Compare across years
  • Read the technical notes first
  • Making bad comparisons can easily loose you
    credibility
  • Read the technical notes to avoid data potholes

National Association of Community Health Centers,
Inc.
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Some places to look for data
  • Census
  • Local foundations and funding sources
  • National foundations
  • Academic institutions masters and doctoral
    theses
  • State vital statistics
  • State, county, local health departments
  • Historical Society
  • Labor Unions
  • Water and Sewer Commissions????

National Association of Community Health Centers,
Inc.
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Describing Your Target Population
  • Dont Settle For What Is
  • Find Legitimate and Valid Approaches to
    Developing Accurate and Relevant Data
  • Projecting Data

National Association of Community Health Centers,
Inc.
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Before You Begin Data Guidelines
  • To show a current health disparity
  • Compare data from the same years
  • National vs. local
  • To show deteriorating conditions
  • Compare across years
  • Read the technical notes first
  • Making bad comparisons can easily loose you
    credibility
  • Read the technical notes to avoid data potholes

National Association of Community Health Centers,
Inc.
68
69
Doing an Extrapolation
  • When the data does not exist to appropriately
    describe your Target Population Do an
    extrapolation from the FY 09 SAC Guidance
  • In some cases, it may be difficult to find data
    specific to the proposed service area or target
    population, especially for applicants proposing
    to serve only special populations (homeless,
    migrant and/or public housing) at the appropriate
    level to effectively describe the need in the
    proposed service area or target population. In
    such situations, applicants may utilize
    extrapolation techniques to estimate the correct
    value in the service area or target population
    from data available at higher levels, including
    the use of national data sources.

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Inc.
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Doing an Extrapolation Based on Race/Ethnicity
Using Census and BRFSS Data
  • This is an example you do not have to use these
    data sources or population categories!!

National Association of Community Health Centers,
Inc.
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Doing the Math Step 1 Get the Denominator Data
National Association of Community Health Centers,
Inc.
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Doing the Math - Step 2 Creating Your Target
Population
  • Add together the population data in the
    respective sub-populations to create the
    groupings that reflect your aggregated target
    population
  • You can use data sources other than in this
    example (state county etc.)

National Association of Community Health Centers,
Inc.
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Doing the Math What Percent of Your Target
Population Does Each Sub-Population Group
Represent?
  • Percentage
  • ethnicity divided by total population
  • Excel Tips
  • To reference a fixed cell use a before the row
    and column labels
  • Use Fill Down or Fill Right function to
    automatically get values

National Association of Community Health Centers,
Inc.
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Doing the Math Step 3 Getting Prevalence Data
  • BRFSS Prevalence Data - Start Page
    http//www.cdc.gov/brfss/
  • Choose Nationwide or Your State
  • Must use 2000 data
  • Choose health issue
  • Input overall prevalence rate into Excel
    worksheet
  • Click on No Grouping and choose Grouped by
    Race
  • Input data into Excel worksheet

National Association of Community Health Centers,
Inc.
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Doing the Math Step 3 Getting Prevalence Data
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Inc.
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Doing the Math Step 4 Calculate the Target
Population Prevalence
  • Multiply the percent of the total population each
    sub-population represents times the prevalence of
    the condition for that group statewide

National Association of Community Health Centers,
Inc.
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Doing the Math Step 4 Calculate the Target
Population Prevalence
  • Sub-Population Percentage X Known Prevalence Rate
    Target Factor
  • .0901 X .0920 0.0083
  • .1514 X .0610 0.0092
  • .6780 X .0840 0.0570
  • .0654 X .0830 0.0054
  • Total All of the Sub-Population Rates
  • 0.00830.00920.05700.00540.0799
  • Multiple by 100 to get a percentage 7.99

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Inc.
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Doing the Math Step 5 Identify the Disparity
  • Target Population Prevalence of Diabetes 7.99
  • Statewide Diabetes Prevalence 7.10
  • EVEN BETTER ROUND THOSE NUMBERS!!
  • Target Population 8.0 State 7.0

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Inc.
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Recapping
  • Use the same years for projections
  • 2000 census
  • 2000 prevalence
  • You should be able to explain how you got your
    numbers without blushing

National Association of Community Health Centers,
Inc.
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Recapping
  • This is projected data.
  • Assumes that the people in your target population
    have the same experiences with disease as people
    in the population at large.
  • Will not flush out specific issues at the census
    tract level
  • superfund site with lots of contamination
    effecting health
  • community specific epidemic

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Inc.
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Incorporating Community Needs
  • RELATIONSHIP TO IDENTIFIED NEEDS
  • HEALTH DISPARITIES SERVICE PACKAGE
  • ACCESS PROBLEMS STAFFING PROFILE
  • BARRIER PROBLEMS DELIVERY STRATEGY

82
RESPONSE 20 POINTS
  • RESPONSIVE TO NEEDS AND INCORPORATING COMMUNITY
    AT ALL LEVELS OF PLANNING AND EVALUATION
  • CREATES A RESPONSIVE AND EFFICIENT SERVICE
    PACKAGE
  • PROVIDES A COMPREHENSIVE SYSTEM OF CARE
  • CONTINUITY
  • ALL REQUIRED SERVICES
  • LINKAGES TO SPECIALTY CARE

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Inc.
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RESPONSE 20 POINTS
  • PROVIDES CULTURALLY AND LINGUISTICALLY CARE
  • PROVIDES AN EFFECTIVE CLINICAL STAFFING PLAN THAT
    REFLECTS THE NEEDS OF THE POPULATION
  • ESTABLISHES AN APPROPRIATE SERVICE DELIVERY
    STRATEGY
  • ELIMINATES COST AS A BARRIER TO CARE
  • ENSURES QUALITY IMPROVEMENT AND RISK MANAGEMENT

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Inc.
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COLLABORATION 10 POINTS
  • COLLABORATES AND COORDINATES WITH COMMUNITY
    PROVIDERS AND PROGRAMS
  • HAS DOCUMENTATION SUPPORTING THE COLLABORATIONS
  • MUST ALWAYS MAINTAIN THE INTEGRITY OF THE FQHC
    PROGRAM AND COMPLIANCE WITH APPLICABLE LAW,
    REGULATION AND POLICY, REGARDLESS OF TYPE OF
    PARTNER

85
GOVERNANCE 10 POINTS
  • DEMONSTRATES CLEARLY THAT THE GOVENING BOARD
  • IS FULLY COMPLIANT WITH COMPOSITION REQUIREMENTS
  • EXECUTES IT AUTONOMOUS AUTHORITIES WITHOUT
    HINDERANCE FROM OUTSIDE
  • RECEIVES AND PARTICIPATES IN TRAINNG AND
    DEVELOPMENT

86
SUPPORT REQUESTED 10 POINTS
  • THE BUDGET EFFECTIVELY REPRESENTS THE EFFORT
    NEEDED TO SUPPORT THE PROGRAM WHILE BEING
  • COST EFFECTIVE
  • EFFICIENT
  • MAXIMIZING REVENUES
  • HAS APPROPRIATE FISCAL CONTROL MECHANISMS

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Inc.
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RESOURCES AND CAPABILITIES 10 POINTS
  • DEMONSTRATES THAT THE ORGANIZATION IS STRUCTURED
    APPROPRIATELY TO SUPPORT THE PROGRAM
  • HAS AN IMPLEMENTATION PLAN THAT IS CONCRETE,
    TIMEBOUND AND REALISTIC

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Inc.
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Sell the Organization!!
  • TOOT YOUR HORN!!!!

National Association of Community Health Centers,
Inc.
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Sell the Organization!!
  • TALK STORY
  • YOUR PATIENTS AND COMMUNITY ARE YOUR BEST
    SALESPEOPLE

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Inc.
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Sell the Organization
  • Why are YOU the appropriate entity to receive
    funding or look-alike designation??
  • history and status as an FQHC or health care
    provider in the community, years of uninterrupted
    service, and Section 330 funds received during
    last 5 years (including special initiatives)
  • Staff skills and organizational capacity
  • Prior clinical outcomes
  • Cultural and linguistic appropriateness
  • Evaluation capabilities
  • Unique characteristics and significant
    accomplishments
  • Prior experience and expertise in
  • Working with target population(s)
  • Addressing identified needs
  • Developing and implementing systems and services
    to meet the needs
  • Capability and commitment of the board,
    management, and local community to support the
    FQHCs operations

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Inc.
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READY SET GO!!Readiness-Implementation Plans
  • All NAP, Expansion applicants should
    demonstrate, and provide documentation, that
    within 120 days of receiving the grant award the
    health center will be operational and ready to
    deliver services
  • Location is appropriate transportation and
    parking, population density, available
    collaborative partners
  • Proposed facility will be available and ready for
    occupancy
  • Size and number of exam rooms are appropriate
    based on projected number of users at full
    capacity, proposed staffing and scope of services
  • Staff and providers will be available and ready
    to provide services

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For the Application - Demonstrating the Health
Center Is Ready to Provide Services
  • As appropriate, applicants should attach signed
    leases, floor plans, renovation plans, provider
    contracts, commitment letters for staff, etc.
  • Additional requirements for HCH and PHPC
    applicants (as well as health centers operating
    clinics in schools) as applicable, include
  • Agreement from the site sponsor that allows
    services to be provided at the location
  • Plan for compliance with certification and/or
    licensure processes

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Readiness-Implementation Plan
  • Readiness Plan
  • Not Quantifiable - but definitely time framed!!
  • No Numerator or Denominator
  • What needs to be done (readiness) to implement
    Proposed Expanded Medical Capacity, New Access,
    or New Service
  • What needs to be done to meet Program
    Expectations/ Requirements
  • Typically no Baseline Available

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Readiness and Implementation Plan
  • Readiness Plan Based On
  • Application Narrative
  • Section 330 Program Expectations
  • Reimbursement Environment
  • Management Work Plans
  • Grant and/or Look-Alike Application Requirements
  • Operational Readiness
  • Sustainable Business Practice

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The Readiness - Implementation Plan
  • Areas Covered in implementation Plan
  • Governance
  • Administrative/Compliance Requirements
  • Fiscal/Financing
  • Management Information Systems
  • Readiness

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Readiness Implementation Plan
  • Collaborations
  • Develop Supply List and Plan Purchase Activities
  • Purchase and Install Equipment
  • Select MIS Patient Management and General Ledger
    System

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Readiness - Implementation Plan
  • FQHC Expectations
  • UDS
  • Federal Procurement Policies
  • Sliding Fee Program
  • FQHC Billing
  • Hire and Train Staff
  • Negotiate Managed Care Contracts

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Readiness Implementation Plan
  • Obtain CLIA Certificates
  • Apply for 340B Covered Entity Status
  • Apply for Medicare (CMS) FQHC Status
  • 855A Application
  • Determine Medicare Cost Per Visit
  • Apply for FQHC Medicaid
  • State Specific
  • Determine Medicaid Cost Per Visit
  • Develop and Implement Marketing/Outreach Plan
  • Ribbon Cutting Ceremony
  • Open Health Center for Patient Services!!!!!

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Readiness Plan - Sample Format
Plan/Activity Completion Date Person Responsible Comments





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EVALUATIVE MEASURES 5 POINTS
  • STRATEGIC PLANNING
  • ORGANIZATIONAL GOALS THAT RELATE TO STRATEGIC
    PLAN AND COMMUNITY/TARGET POPULATION
  • QUANTIFIED PERFORMANCE MEASURES
  • REQUIRED
  • REFLECTING DISPARITIES, ACCESS, BARRIERS

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Business Plan/Readiness Plan
  • The Narrative described in The Need Section
    should serve as the basis for and align with the
    activities described in the Implementation Plan
    and goals of The Business Plan
  • Dont Forget Special Populations

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Deciding--Implementation Plan or Business Plan
  • Business Plan
  • Quantifiable Goals with denominators and
    numerators
  • Broad based not down to action step level
  • Based on contributing or restricting factors
  • Office of Performance Review Goals
  • Need Baselines

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Business Plan
  • Required Performance Measures
  • Goals that relate to identified needs
  • Other goals that are important to the centers
    sustainability, fiscal health
  • Remember Special Populations

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LETS LOOK AT SOME PERFORMANCE MEASURES
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IMPACT 5 POINTS
  • RESPONSIVENESS TO AND INVOLVEMENT OF COMMUNITY
  • ADDITIONAL ACCESS-IMPACE FOR THOSE ALREADY
    OPERATIONAL
  • RELATIONSHIP OF GOALS AND PERFORMANCE MEASURES TO
    NEEDS IDENTIFIED IN THE TARGET POPULATION

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Prepare to Go Electronic
  • Register early with www.grants.gov
  • Learn how to navigate the electronic submission
    system
  • Give yourself plenty of time to upload, download,
    scan and test print the document before submitting

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Develop The Work Plan
  • Start at the End
  • Total time to complete is approximately 250 hours
  • Decide at the beginning whether to hire out or do
    it in-house
  • Back up from the deadline and make realistic time
    estimates for each phase (planning, drafting,
    finalizing)
  • Make the LOI Deadline or At Least 45 Days Out
    Your Goal

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Start Organized
  • Develop a written task list with strict timelines
  • Schedule regular check points and stick to them
  • Develop list of outside documents and
    activities (contracts, MOAs, etc.)

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Start Organized
  • Identify individuals responsible for each section
    of the application
  • Needs Assessment/Population Description
  • Scope of Project/Service Delivery
  • Clinical
  • Financial
  • Administration
  • Affiliations/Contracts/MOAs
  • Community Involvement/Outside Support

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Start Organized
  • EVEN IF YOU HIRE A CONSULTANT
  • YOUR STAFF AND BOARD MUST BE INVOLVED AND
    RESPONSIBLE
  • PRODUCING A QUALITY PROPOSAL DEPENDS ON TIMELY
    AND RELIABLE INFORMATION

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Start Organized
  • Agree on format and style
  • Identify who is responsible for assuring
    consistency and doing read throughs and edits
  • Keep track of computer files who, what, where,
    how
  • MAKE BACK UP DISKS/CDs

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Develop The Proposal
  • Work Concurrently Even if you hire in, the
    staff needs to provide information, develop the
    goals and objectives and review the document
  • Focus on the requested information and answer the
    questions
  • KNOW WHERE THE POINTS ARE AND WRITE TO THEM

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Develop The Proposal
  • Write for the Reviewers
  • Lay out a clear road map
  • Be detailed and focused
  • Leave nothing to the imagination
  • Do not leave any questions unanswered even if
    you repeat yourself!
  • Use the format, headers and language in the PIN

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Develop The Proposal
  • State Clearly
  • What funding you are applying for
  • What type of organization you are
  • Any special populations or priorities you are
    addressing or qualify for

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Final Steps
  • Revise proposal as needed based on review
    comments
  • Review document for content and accuracy
  • Make sure all requested information is included
    in the places it is asked for
  • Make sure all numbers match
  • Make sure all document requirements are complied
    with

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RULES TO LIVE BY
  • Everything is related
  • The Needs Assessment
  • Forms the Basis of the Health Plan and Service
    Delivery Model
  • Which are Supported by the
  • Business Plan and Budget

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RULES TO LIVE BY
  • Answer all of the questions wherever and whenever
    they are asked
  • Connect the dots dont leave things hanging

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RULES TO LIVE BY
  • If it is required and you dont submit it you
    are out
  • Get it right the first time there is no 2nd
    chance for funding applications
  • If it is not in the budget it is not happening!!

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THE BIG RULE
  • THIS IS NOT A WORK OF FICTION!!!!

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Reviewers are People Too!!
  • Treat them with respect
  • Let them know you appreciate them
  • Make their job as easy as possible
  • Make giving you what you are asking for a
    no-brainer

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And Most Important of All
  • Remind Yourself and the Reviewers Why You Are
    Doing This!!

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