CHAD Connection

In our June 11 edition of this newsletter, I shared that CHAD staff has been contemplating our response to the death of George Floyd and the ensuing national conversation about racial justice in our country. We have been participating in discussions at the state and national level about how we respond as individuals, as a primary care association, and as a national movement that was founded with the mission of equal access to health care for all. We know health centers are making a difference every day in promoting equality and reducing health disparities, and we know that there is more we can do.

As we looked at our own work, it became apparent to me that there was more we could do from a data perspective to shine a light on the work we are doing to address health disparities by race. So, we have been working on an insert to our annual data book (your CEOs will receive the full report in the next week) that shares several metrics by health center and by race.

The following two charts show the number of racial/ethnic minority patients by health center and then compares health center patient to overall state demographics. You can see our health centers vary widely in the percent of racial/ethnic minority patients served, but that, in general, the proportion of racial/ethnic minority patients served by health centers is much higher than the statewide average in both states.

CHAD will be publishing weekly data representing the number of positive COVID-19 tests for the current week as compared to the previous week, the cumulative number of cases diagnosed, current and cumulative hospitalizations, the percent of health center visits compared to the determined baseline, and the percent of visits that are being done virtually. This data will be compiled for North Dakota and South Dakota each week. This week’s data covers the week beginning Thursday, July 16 to Wednesday, July 22.

Republican leadership in the Senate and the White House have reached an agreement on a fourth stimulus package that is being dubbed CARES 2. According to a story from Roll Call, the bill will likely be several smaller bills that address COVID relief instead of one large bill. The bills are expected to be released on July 23. According to the policy researchers at the National Association of Community Health Centers (NACHC), $7.6B in emergency funding for health centers is expected to be included in the bill. CHAD will have more information in the next few days regarding any other specifics related to health centers. This bill is expected to serve as a starting point for negotiations with the House. The House passed their version of a fourth stimulus bill in May, the HEROES Act. Neither CARES 2, nor the HEROES Act includes long term funding for health centers.

There are currently several pieces of legislation being considered by Congress that address telehealth. There are four main changes that would help health centers provide telehealth care including: continue to bill as distant sites under Medicare for telehealth visits; continue to allow telehealth reimbursement for patients who are at home; remove geographic restrictions on telehealth sites; and require Medicare to pay health centers their usual prospective payment system (PPS) rate. CHAD is coordinating efforts to advocate for telehealth provisions in current legislation. Stakeholders can expect to receive an email invitation to contact their members of Congress to encourage support of telehealth legislation.

Positive cases of COVID-19 in North Dakota are trending up. On Tuesday, July 22, the state reported its largest number of positive cases at 160, the highest number of active cases at 864, and the highest number of hospitalizations at 52. The daily positive rate was 3.8%, which is calculated by dividing the number of positives by the total number of tests administered that day. The cumulative positive rate is 3.9%, which is calculated by dividing the total number of positives by the total number of individuals who have been tested. The state does not include the total number of tests administered in the cumulative positivity rate to account for serial or repeat testing. The state is at its highest level of completed tests each day, but the increase in active cases is outpacing the rate of the testing increases. Contact tracing from recent weeks indicates the spread of COVID-19 in situations of close contact, including baseball and softball games, a party bus, bars, wedding parties, offices, and construction sites.

Governor Doug Burgum and State Superintendent Kirsten Baesler released K-12 school reopening guidelines last week. The guidelines were developed collaboratively with the North Dakota Department of Health and the Department of Public Instruction. Districts will be required to have a health and safety plan in place, along with a distance learning plan. Local communities can decide if teaching and learning should be conducted face to face, via distance learning, or a hybrid of the two. Both plans must be created in consultation with faculty, families, staff, and students and published on the district’s website.

August 9-15 is National Health Center Week, and health centers in North Dakota and South Dakota are taking this moment to celebrate. The Dakotas’ network of nine community health center organizations will be using this opportunity to thank their patients and the communities they serve, and to highlight the important contributions health centers make to the health care system in both urban and rural communities. It is also a great opportunity for health centers to recognize their outstanding staff for all they do and to give back to the communities they call home.

National Health Center Week will look and feel a little different this year. Most health centers are holding off on in-person events and tours. Instead, they will use social media to draw attention to different aspects of health center services and the people that drive their mission. Focus days for the week include:

Sunday, August 9 – Whole Person Day, bringing attention to the social and economic factors that impact our health;
Monday, August 10 – Health Care for the Homeless Day, honoring the work being done at community health centers to provide high-quality, comprehensive primary care, behavioral health care, case management, outreach, and other services to meet the needs of the unhoused;
Tuesday, August 11 – Economic Impact Day, highlighting the combined economic impact of health centers across North Dakota and South Dakota of over $160,000,000 in 2019;
Wednesday, August 12 – Patient Appreciation Day, celebrating patients and board members who keep health centers accountable and abreast of community needs;
Thursday, August 13 – Legislative Day, thanking local partners and government officials at the local, state, and national level for their support and collaboration;
Friday, August 14 – Staff Appreciation Day, spotlighting the diligent work of health center staff and volunteers; and,
Saturday, August 15 – Children’s Health Day, celebrating the more than 42,500 children in the Dakotas get their primary health care from a community health center.

The Great Plains Health Data Network (GPHDN) kicked off their Data Aggregation and Analytics System (DAAS) workgroup last week. The DAAS will allow for individual health center and network level data aggregation and analysis to drive clinical quality improvement and advance payment reform efforts. The workgroup will consist of representatives from each participating health center in the GPHDN that will work towards identifying a solution that will aggregate medical, dental, and behavioral data from several sources into a central data repository to be presented in a useful and simple manner. The solution will be supported in part by the GPHDN and have the ability to analyze the data and provide robust reporting options ranging from an individual patient view to the network at large.

A webinar titled Data-titude: Using Data to Transform Health Care will be held on August 4 for members and non-members of the GPHDN. This webinar will be an overview provided by CURIS Consulting of how the use of a population health tool, an imperative component of the DAAS, can support collaborative quality improvement and payment reform efforts in a network environment. This training will assist attendees in identifying elements to look for when selecting a population health tool along with the risk and return on investment with population health management. This training will also provide insight on how the data collected within a network can set up future services for the network.

Please join us for this webinar to understand the importance of having a population health tool as part of the DAAS and how it can impact quality initiatives and assist with the population health management of health center patients. The intended audience for this training is quality improvement staff, health center leadership, and data and health information technology staff. Register here.

In this highly interactive virtual meeting, participants will explore the highs and lows of the last four months, and how to apply hard-won new knowledge to be more prepared for what lies ahead. Speakers from Coleman Associates will help health centers assess readiness for future pandemic waves, do some scenario planning, hear a bit of what other health centers are doing during these times, and share some tools that will help health centers prepare for an uncertain fall/winter/spring regarding staffing, safety, testing, and more.

Held on Wednesday, August 5, this workshop is designed for health center leaders across a range of disciplines, including clinical, information technology, emergency preparedness, human resources, operations, and executive leaders. Please note that it will be an interactive workshop, so participants should come prepared to join the discussion! Register here.

When thinking of the leaders of an organization, who are labeled as "leaders?" Perhaps the executives who make difficult strategic decisions and have overall responsibility for the organization. But also, those who lead daily in the clinics to carry out the mission and goals. These employees often are promoted to their second role as a leader because they perform their first role so well. When these individuals attend trainings, it is most likely to continue their skills or education in their first role. Many times, these individuals have not had formal leadership training or education to perform well in their leadership roles.

According to the Employee Engagement Group, a consulting firm specializing in engagement surveys, over 35% of employees would like to see their direct supervisor fired. The good news is most individuals can learn to be a better leader and supervisor. It takes education, willingness to try new ideas, learning from peers, and an assessment of growth needs.

This fall, CHAD is hosting a Supervisor Leadership Academy to help people leaders at all levels to gain these crucial skills. The series, presented by Ann Hogan of Ann Hogan Consulting, will kick off with the True Colors ® personal success workshop. True Colors ® offers a research-based approach to understanding human behavior and motivation. This interactive, energizing seminar will guide participants through how understanding the similarities and differences of all people leads to developing improved communication skills, a greater appreciation of the uniqueness of self and others, and more meaningful relationships. Session topics will include cohesive teams, critical conversations, retention, recognition, and employment law. Registration information will be coming soon. Learn more about Ann here. 

Each week, the Health Resources and Services Administration (HRSA) requests information from community health centers across the country to track the impact of COVID-19 on capacity, operations, patients, and staff. The data is used to plan for training and technical assistance, funding, and additional resources. A few highlights from the latest report, dated July 10, include:

Patient Testing

COVID-19 testing capacity is 100% of health centers for both North Dakota and South Dakota.
ND reported 75% of COVID-19 test results are returned in 2-3 days with the balance returned in 4-5 days. SD reported half of the test results are returned in less than an hour, with the balance returned in 2-5 days. Note that there have been some delays in South Dakota due to nationwide disruptions in the supply chain.
Both states reported an increase in the total number of tests performed. Since reporting began on April 3, ND reported a total of 1,887 patients tested with SD reporting 2,829 patients tested for COVID-19.

Operations

Weekly visits compared to pre-COVID-19 visits in ND increased from 72.5% to 88%. SD increased from 56.67% to 82.5%.
Both states reported an increase in the number of visits conducted virtually; ND from 21.25% to 23.75% and SD from 3.33% to 6.25%.

Throughout the COVID-19 pandemic, health care providers have had to deliver care in some of the most extreme conditions. Many providers lost colleagues to this disease, and others barely survived it. In the middle of all of this are patients who have the novel coronavirus with no specific treatment and a wide variation of symptoms that makes this virus difficult to understand and treat.

Psychologist Kelly Wilson often asked his students or colleagues who came to him for consultation with difficult clients if they saw their clients as math problems or as sunsets. Were they problems to be solved, or were they colorful and unique objects of wonder? The more complex the situation, the more of a problem the client would become. Wilson was neither trying to diminish the severity of the situation, nor deny that clients had real issues that needed attention. Instead, he was pointing out that in the zeal to solve the issue, they could sometimes sacrifice attention and appreciation of the whole person. Anyone who has ever been made to feel like they are a problem that needs to be fixed can attest to how painful and impersonal it can be.

It is touching to read stories from survivors of COVID-19 who describe how hard their providers tried to make a connection with them even with face masks, face shields, and gloves that completely prevented actual skin contact with them. Some taped big smiling pictures of themselves to their uniforms, so patients know what they looked like and could see a friendly face. This is an example of seeing patients as sunsets and not math problems. It demonstrates compassion and an understanding that these patients are more than just a list of symptoms and complications. They see the whole person.
Burnout and highly stressful, high stakes health care could lead to situations where health care providers may be more inclined to see the disease and not the whole person. Asking ourselves the math problem or sunset question may help us or others recognize when we forget to humanize our patients.

Utilizing Telehealth Technologies to Improve Screening for SUDs, Behavioral Health, and Chronic Disease Management

CHAD and Great Plains Health Data Network staff have developed this 2-session series, intended for medical providers, behavioral health providers, IT staff, and clinical managers, will provide strategies for enhancing and extending your integrated behavioral health efforts and for adapting these services to use telehealth technologies in novel and effective ways. Throughout both sessions, experienced trainers from Great Plains Telehealth Resource and Assistance Center (gpTRAC) will provide ways of increasing provider comfort, fluency, and effectiveness in using live video to provide clinical care. The presenters will provide attendees with specific and actionable information with steps to improve their program and its effectiveness. Opportunities for further follow up with specific health centers will also be available.

In the second session, presenters will provide examples of how telehealth technologies can be used to simplify and streamline procedures like handoffs, referrals, case reviews, and other critical parts of an integrated care program.

Friday, July 24
11:00 am MT/ 12:00 pm CT
Register here.

Implementing Telemedicine Webinar Series

The COVID-19 pandemic is demanding that health care providers rethink how they deliver care in ways that reduce the risk of further spreading infection. In response, the Mountain West AIDS Education Training Center (MWAETC) has designed a 6-session webinar series on implementing telemedicine. The focus of the series will be on helping providers build a successful telemedicine strategy for their clinics, and will be led by John D. Scott, MD, MSc, associate professor of medicine, Division of Allergy and Infectious Diseases, and medical director of digital health at the University of Washington.

Session #6: Telemedicine Q&A

Monday, July 27
11:30 am MT/ 12:30 pm CT

Register here https://mwaetc.org/event/?ER_ID=39114

Today with Macrae: Health Center Program Updates 

Join Jim Macrae for updates on COVID-19 and other topics, such as the multi-year transformation effort to advance community health. Missed recent Today with Macrae calls? Recordings and transcripts are posted on the Bureau of Primary Health Care’s Emergency Preparedness and Recovery Resources for Health Centers webpage as soon as possible after each call.

Tuesday, July 28
12:00 pm MT/ 1:00 pm CT
Join the webinar on the day of the session.

UDS Mapper Webinars

The UDS Mapper is a collaboration between the Health Resources and Services Administration (HRSA) and the American Academy of Family Physicians (AAFP) and is part of the HealthLandscape online mapping platform. These webinars are open to the public and free of charge.

UDS Mapper Advanced Topics: Data Resources in the UDS Mapper
Join to learn more about different types of data available in the UDS Mapper, including patient data from the Uniform Data System (UDS) and population and health data from various publicly available sources. Speakers will dive deep into why some datasets are included and highlight which data are estimates. This webinar is geared toward users who are familiar with the UDS Mapper.

Tuesday, July 28

9:00 am MT/ 10:00 am CT

Introduction to the UDS Mapper
This webinar is a general introduction to the UDS Mapper, a mapping and decision-support tool-driven primarily from health center patient location data within the Uniform Data System (UDS). This webinar will go over the basics of using the UDS Mapper and is geared toward users who are new to the UDS Mapper or in need of a refresher.

Tuesday, August 4

9:00 am MT/ 10:00 am CT

Wednesday, September 2

12:00 pm MT/ 1:00 pm CT

UDS Mapper Advanced Topics: New Features in the UDS Mapper
Attend this session to learn about recent updates to the UDS Mapper, including new data and enhanced functionalities. The webinar is geared toward users who are familiar with the UDS Mapper.

Thursday, September 17

12:00 pm MT/ 1:00 pm CT

UDS Mapper Special Topics: Food Insecurity and Opportunities for Health Centers
This special topic webinar will focus on examining the relationship between health center service areas and food insecurity. During this session, speakers will highlight how to use the UDS Mapper, including a new functionality allowing users to add area-level data to analyze food insecurity in a community. The webinar is geared toward users who are familiar with the UDS Mapper.

Wednesday, September 23

12:00 pm MT/ 1:00 pm CT

Attaining and Maintaining Patient-Centered Medical Home Recognition

Join Health Resources and Services Administration (HRSA) and the National Center for Quality Assurance (NCQA) to learn about the benefits of attaining and maintaining Patient-Centered Medical Home (PCMH) recognition. Participants will watch a new video featuring Piedmont Health (HRSA-funded health center in Chapel Hill, NC) and receive an introduction to NCQA’s new PCMH Recognition Toolkit. Following the video and toolkit premiere, colleagues and peers will have an opportunity to share perspectives about the value of PCMH recognition, especially during the current pandemic, and there will be time to ask questions.

Wednesday, July 29
12:30-2:00 pm MT/ 1:30-3:00 pm CT
Register here.

COVID-19 Response: Promising Practices in Health Equity

The Centers for Disease Control and Prevention (CDC) is presenting another webinar focused on sharing promising public health practices to reduce COVID-19 related disparities. During this webinar, presenters will discuss actions taken to mitigate the disproportionate impact of COVID-19 on racial and ethnic minorities. Additionally, speakers will take these ideas a step further and examine how they can be integrated into longer-term strategies for a lasting impact that will strengthen future responses and advances health equity.

Wednesday, July 29
1:00 pm MT/ 2:00 pm CT
Register here.

Summer School with the School-Based Health Alliance

The School-Based Health Alliance (SBHA) is hosting a five-part virtual learning series—Summer School with the School-Based Health Alliance to help meet the needs in the current landscape. Please find a description and registration link for all webinars below.

Preparing for a Return to the Classroom: Suicide Prevention in Schools
This webinar will address three evidence-based topics and the resources to support school staff as they manage current or emerging suicidal thoughts and behaviors in their students during the COVID-19 crisis. Presenters will share the rationale and tools to develop an individual and meaningful safety plan via telehealth, equip teachers and school staff with skills to identify and respond to youth who may be at risk, and provide an approach for supporting the school and family should a suicide occur. This webinar is co-hosted with the Suicide Prevention Resource Center (SPRC), the nation’s federally funded resource center devoted to the implementation of the National Strategy for Suicide Prevention. SPRC is a project of the Education Development Center.

Wednesday, July 29

10:00 am – 11:00 am MT/ 11:00 am – 12:00 pm CT

Building Trauma-Sensitive Environments
For those who interact with students or supervise staff who do, an understanding of trauma-informed practices is critical to working with returning students. Webinar presenters will discuss best practices for establishing positive relationships with schools, focusing on trauma-sensitive strategies. Participants will gain a foundational understanding of trauma, practice using strengths-based language to facilitate difficult conversations, and will examine opportunities for collaboration between schools and SBHCs.

Wednesday, August 5

10:00 am – 11:00 am MT/ 11:00 am – 12:00 pm CT

Addressing Challenges for Youth Experiencing Homelessness during COVID
The SBHA and National Health Care for the Homeless Council have invited SchoolHouse Connection to share their knowledge and facilitate discussions on promising practices for addressing and supporting youth through these challenging times. In this webinar, participants will explore those challenges and provide discussions on topics including considerations for youth experiencing homelessness during the pandemic and racial justice movement, connectivity to health care, and school re-entry and access.

Thursday, August 6

11:00 am MT/ 12:00 pm CT

Hearing Hoof Beats from a Distance: Primary Care and Telehealth
As school-based telehealth care becomes more critical to maintaining students’ access to care, many clinicians are venturing into a virtual approach to primary care. This webinar offers an opportunity to learn from presenters who deliver primary care via school-based telehealth. Presenters will use a "rounds-style" collaborative discussion of evaluating, diagnosing, and treating patients remotely based on clinical cases.

Wednesday, August 12

10:00 am – 11:00 am MT/ 11:00 am – 12:00 pm CT

Developing and Implementing Tele-behavioral Health in SBHCs
School-based health centers are rapidly adopting and accelerating tele-behavioral health services. In this webinar, behavioral health care providers and administrators will describe their experiences implementing or adapting tele-behavioral health programs, identify challenges and opportunities discovered through this process, and discuss strategies and best practices for others moving forward.

Wednesday, August 19

10:00 am – 11:00 am MT/ 11:00 am – 12:00 pm CT

Data-titude: Using Data to Transform Health Care

Join the Great Plains Health Data Network for an overview of how the use of a data aggregation and analytic system (DAAS) can support collaborative quality improvement and payment reform efforts in a network environment. Provided by CURIS Consulting, this training will assist attendees in identifying elements to consider when selecting a population health tool along with the risk and return on investment with population health management. Presenters will also provide insight into how the data collected within a network can set up future services. The intended audience for this training is quality improvement staff, health center leadership, and data and health information technology staff.

Tuesday, August 4
10:00 am MT/ 11:00 am CT
Register here.

Strengthening Your COVID-19 Response: An interactive workshop about lessons learned and how to prepare for what comes next exclusively for CHAD member health centers.

In this highly interactive virtual meeting, participants will explore the highs and lows of the last four months, and how to apply hard-won new knowledge to be more prepared for what lies ahead. Speakers from Coleman Associates will assess readiness for future pandemic waves, do some scenario planning, hear a bit of what other health centers are doing during these times, and share some tools that will help health centers prepare for an uncertain fall/winter/spring regarding staffing, safety, testing, and more.

This workshop is designed for health center leaders across a range of disciplines, including clinical, information technology, emergency preparedness, human resources, operations, and executive leaders. Please note that it will be an interactive workshop, so participants should come prepared to join the discussion!

Wednesday, August 5
8:00am – 10:30 MT/ 9:00am – 11:30am CT
Register here.

NACHC Advocacy 101 Summer Training Series: Leveraging Social Media

In the last installment of the National Association of Community Health Centers (NACHC) grassroots advocacy team’s Advocacy 101 Summer Training Series, speakers will discuss how to leverage social media to elevate advocacy messages and best practices for advocacy on social media. This session will provide tools and ideas for health center advocates to engage social media influencers and build a larger audience platform for their messages. Attendees will learn how to reach broader audiences through compelling narrative storytelling.

Thursday, August 6
2:00 pm MT/ 3:00 pm CT
Register here.

Health Center School-Based Dental Programs and COVID-19

As school districts develop plans for the upcoming school year, the ability of health center school-based dental programs to deliver care is unknown. Health centers must be ready to respond to new local requirements and develop new policies and protocols to be able to resume their school-based dental programs. Presented by the National Network for Oral Health Access (NNOHA), this listening session will provide a forum for health centers to listen and discuss strategies on resuming school-based dental services and share challenges and barriers. This session will be an open discussion that will also identify future training and technical assistance opportunities for NNOHA to help health centers restart their school-based dental programs during COVID-19.

Monday, August 10
11:30 am MT/ 12:30 PM CT
Register here.

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