A Community Health Center in a Local Public Health Department

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A Community Health Center in a Local Public
Health Department

• Opportunities, Challenges Successful Strategies

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Cooperative Health Center, Inc.

• Operates as a unit of the Lewis and Clark City
  County Health Department
• Co-applicants CHC, Inc., non-profit entity, and
  Lewis and Clark County, public entity
• In operation since 1993 federal funding obtained
  in 1994

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Cooperative Health Center, Inc.

• 1994 Two medical providers, 10-12 staff, approx
  8,000 visits, 600,000 budget
• 1999 3 providers, 15,000 visits, 25 staff, 1
  million budget

• 2004 4 full time providers, full time dentist,
  19,000 visits, 36 staff
• 2 million budget
• (1 million revenues, 1 million grants)

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CHC, Inc. Services

• Primary medical care
• Dental clinic
• Counseling services
• Diabetes collaborative
• Medication assistance program
• Two satellite clinics Health Care for the
  Homeless, Parker Medical Center
• JCAHCO accreditation November 2002
• Applying for mental health funds

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Some Strategies for Success

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Clear Legal Relationships

• Critical for Co-Applicants to clarify and
  establish legal responsibilities and
  relationships
• In our case, MOA signed by Cooperative Health
  Center, Inc., LC County Board of County
  Commissioners, LC City County Board of Health

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Key Concepts in LC MOA

• Health Center Governing Board
• - Agrees to operate as unit of Health Dept.
• - Holds all programmatic and policy-making
  authority
• - Management of Health Center (including hiring
  and dismissing Executor Director)
• - Setting and approving annual operating budget

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Memorandum of Agreement

• Health Center agrees to operate under
  administrative authority of public entity
  co-applicant.
• - Comply with county administrative, fiscal,
  risk management, and personnel procedures
• - Employees subject to County policies,
  benefits, bargaining units

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Health Center Governing Board

• Self-appointing Board -
• Accepts all liability for actions and decisions,
  and maintains liability coverage for individual
  members

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Memorandum of Agreement

• County Commission and Board of Health
• - Agree to provide fiscal management and
  oversight
• - All funds in separate account
• - County accepts liability for employees
  arising in course and scope of employment
• - County provides recruitment, training, legal
  representation if requested

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Coordinating Committee

• In order to implement and clarify MOA
• - Three entities plus Health Officer Health
  Center Executive Director agree to participate in
  coordinating committee, to meet semi-annually or
  at request of any one member
• - Agree to mediate if any entity wishes to
  terminate MOA

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Financial Management

• Critical to have strong financial manager and
  separate financial oversight

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Board Training and Development

• - Members participate in local and regional
  training opportunities
• - Strategic Planning

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Some reasons for our success

• Consistent and continued County support
• Strong community partnerships
• Strong medical community support not viewed as
  competitor
• Already had small primary care clinic in
  operation
• Clarified legal and operating relationships ahead
  of time (MOA)

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• Strong leadership, strong management
• Capable governance excellent, diverse board
  ready to go into action
• Clear mission compatible with Health Department
  mission
• Utilized successful model from other communities
  quick start-up for clinic
• Continually thank and recognize volunteers

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Opportunities

• Increases access to comprehensive services and
  improves continuity of services
• Enhances ability to meet mission of both health
  department and health center
• Economy of scale - particularly with respect to
  ancillary staff positions

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Opportunities

• Significant economic advantage eliminates need
  for health center to fund personnel, payroll,
  information services, legal, and risk management
  positions, etc.
• Public health services higher profile in
  community
• Strengthens competitive position for other
  funding (infrastructure in place)

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Challenges

• What you need to be prepared for what you need
  to overcome
• Getting a co-applicant proposal approved
• Staff need to be prepared for significant changes
  as you try to blend public health and medical
  models
• Rapid growth can lead to an imbalance very
  rapidly (Space demands)

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Challenges

• Maintaining separate identities (among staff,
  within community, within county structure
• Maintaining cohesiveness of staff
• Pace of a successful health center can be
  extremely challenging
• Fitting a medical model within a county structure
  
• Loss of ability for Health Center Board to fully
  manage expenditures (fixed costs within county
  structure)

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A Community Health Center in a Health Department
-

• The right decision?
• For LC County, Yes.

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