CHAD Connection July 20, 2023

CHAD’s mission includes a commitment to “foster healthy communities” and to “increase access to affordable, high-quality care for all.” I am so proud of those aspirations, and of the work health centers do every day to provide great care to a range of communities, populations, and individuals who need it most. AND, if we are honest, we have a long way to go to achieve great health outcomes for ALL in our two states. The deepest disparities we see are by race.

There are many ways to illustrate these disparities. For example, the Centers for Disease Control and Prevention (CDC) collects data by race on mortality amenable to health care. North Dakota and South Dakota rank right behind Mississippi as having the highest mortality amenable to health care for any single population, with 206.7 (ND) and 215.1 (SD) deaths per 100,000 for American Indian/Alaska Native populations. Their mortality amenable to health care rates for Whites is 69.4 (ND) and 68.5 (SD), leaving a difference of more than 300%.

While the story that has led to these disparities is long and complex, the bottom line for CHAD is that we deeply want to help our states do better. We want to do better ourselves by being a more diverse and inclusive organization that is actively working to promote health equity. At CHAD, we have looked across our entire organization and identified opportunities to infuse the goals of diversity, equity, inclusion, and belonging (DEIB) throughout our work, whether that be hiring practices, organizational culture, programming, training, or other areas. We have created a detailed DEIB action plan and an internal DEIB work group that is committed to learning together and moving forward our collective priorities.

As part of those efforts, CHAD’s internal DEIB action team has worked collaboratively with the full CHAD staff team to develop language which expresses our commitment to DEIB both internally and externally. This language is meant to both give context to the disparities we see and to express our commitment to addressing them. After much discussion and reflection, this statement was developed by staff and approved by our Board of Directors:

“We acknowledge that unfair policies and practices have led to health inequities across race, ethnicity, gender identity, sexual orientation, geography, and other identities. Health centers are rooted in the civil rights movement, and we aspire to build on this legacy by working collaboratively with others to see equitable health outcomes in our communities. We bring with us a commitment to continued learning and growth, as well as a recognition of the need for urgent action.”

You can find this language under the “About Us” section of the CHAD website, and you’ll also notice us utilizing it in presentations and other communications. In addition, the action team updated CHAD’s diversity hiring statement, which now reads:

“CHAD is committed to cultivating and preserving a culture of inclusion and belonging. We welcome the unique contributions that candidates bring and strive to attract staff from diverse backgrounds, including Black, Indigenous, & people of color (BIPOC), people with experiences of poverty, LGBTQ+ individuals, people living in rural areas, veterans, immigrants, and people with disabilities. We understand that the more inclusive we are, the better we can serve our members and their communities.”

The use of this statement is part of a more comprehensive effort to ensure that career opportunities at CHAD reach a diverse group of candidates and that our organization continues to grow in diversity. Both statements help to formalize CHAD’s ongoing commitment to DEIB and offer our staff a north star to continuously move toward.

In alignment with these goals, watch for these upcoming opportunities:

CHAD’s upcoming social drivers of health (SDOH) workgroup will kick off in September 2023, with six sessions planned through July 2024. Health centers have made great progress in screening for SDOH in recent years, and this workgroup will build on that success to expand screening to additional populations, optimize documentation and response, and identify opportunities to use this data to drive partnerships within the community.
In 2024, CHAD will launch a DEIB learning collaborative, where health centers will have the opportunity to learn and apply key DEIB best practices.
You may also recall that CHAD recently hosted the Lakota Lands Workshop on Wheels in collaboration with the Center for American Indian Research and Native Studies (CAIRNS). We will be reconvening participants of this workshop via Zoom this summer for further reflection about the applications of these learnings to health care delivery.

If you have questions or would like to learn more about our DEIB efforts, please reach out to Shannon Bacon, director of health equity and external affairs.

Join CHAD in celebrating Shelly Hegerle’s promotion to the director level. Shelly joined CHAD in 2005 and was promoted to director in 2023. She oversees day-to-day operations at CHAD, including recruitment and hiring, staff development, and enrichment.

In this new role, Shelly directs internal operations related to staff growth, development, and HR. She also leads workforce development at CHAD to support staffing needs at community health centers in North Dakota and South Dakota, and South Dakota Urban Indian Health. Before coming to CHAD, Shelly served as the area employee relations manager for Midwest Coca-Cola Bottling Company.

Shelly holds a master’s certification in human resources from the University of Mary in Bismarck, ND, and a Bachelor of Science degree in business administration from North Dakota State University in Fargo, ND. Her current credentials include a professional in human resources (PHR) from the Human Resources Certification Institute and a society of human resources management certified professional (SHRM-CP) distinction from the Society of Human Resources Management. She lives in Fargo with her husband and has two grown children.

The North Dakota and South Dakota Medicaid departments’ approach to the Medicaid unwind has differed in many ways, though both states are now reporting data on the drop in individuals covered by Medicaid.

In North Dakota, the Medicaid renewal process began in April, with recipients who are no longer eligible for coverage receiving first terminations in June. The North Dakota Department of Health and Human Services Medicaid Eligibility report shows a net decrease of 4,049 enrollees from May to June during the first month of the unwind.

In South Dakota, the Medicaid unwind began in February, with recipient disenrollment beginning on April 1. In total, more than 25,707 South Dakotans lost Medicaid coverage in April and May.

On April 1, the South Dakota Department of Social Services (SD DSS) reported that a total of 16,078 recipients were disenrolled from Medicaid coverage, including approximately 1,747 who would likely be eligible for Medicaid expansion.
In May, SD DSS reported Medicaid enrollment saw a net decrease of 8,143 enrollees, which included 4,206 children.

In June and July, SD DSS reported that 1,800 people have been approved for Medicaid expansion coverage of the estimated 52,000 deemed eligible throughout the state.

Managers and supervisors have witnessed a dramatically changing workforce in health care in the past several years. Many of these changes created new challenges to people management that require a new mindset and approach to building engaged teams.

This uniquely designed, one-day workshop was created by FutureSYNC in partnership with CHAD in response to needs expressed in an HR and leadership focus group to help answer the needs of managers and supervisors in community health center organizations today. This highly interactive event is designed to encourage personal growth, peer-to-peer learning, and idea sharing. Participants will explore the dynamics of current management challenges, such as building trust within teams, holding people accountable, aligning teams to goals and achieving outcomes, and improving communication across teams and locations.

This workshop is intended for health care people managers at every level. Sessions are available in Sioux Falls, Pierre, Fargo, and Bismarck. Register here.

Join CHAD in its mission to foster healthy communities by promoting and supporting programs that increase access to affordable, high-quality care for all. The human resources (HR) and program specialist position is responsible for assisting in day-to-day internal HR functions and operations by supporting the interview process, applicant tracking, new employee onboarding, benefits administration, and the employee exiting process. CHAD utilizes an applicant tracking system (ATS) and human resources information system (HRIS), so the ability to quickly learn and master technology is needed.

Outside of the primary human resources duties, this position will assist with grant and financial operations within the organization. This is a full-time remote position with a physical location in North Dakota or South Dakota. Learn more here and apply today!

Since not all educational programs prepare individuals adequately to be successful in community-based primary care settings like community health centers, CHAD, in partnership with CareerStep, has designed on-the-job training programs for dental assistants which utilize online learning modules and simulations combined with hands-on job training. Participants will complete the program within 9-12 months, take certification exams, and commit to work at the health center for up to two years upon completion of the program.

CHAD has purchased five spots for in-house talented and promising staff to go through a program to grow their expertise. We are excited to announce that three spots are already filled with two learners enrolled and working in the program since mid-June. It is CHAD’s goal to fill all five spots and seek funding to create additional programs in medical assistance and billing and coding. For more information about this program, view the training program toolkit or contact Shelly Hegerle with CHAD.

August 6-12 is National Health Center Week (NHCW), and health centers in North Dakota and South Dakota have many exciting activities and promotions planned to showcase their centers, recognize their staff, and engage their communities. This year’s NHCW theme is Road Trippin’: Health Centers – the Road to Better Health. The CHAD team will once again be hitting the road to visit as many of the 66 delivery sites in 52 communities across the Dakotas as possible. NHCW is a great opportunity to meet providers and ask questions about health center programs and services. For more information about health centers in the Dakotas and their plans for NHCW, visit their websites by clicking here.

The CHAD road trip-style visits aim to raise awareness about the important role that health centers play in promoting health equity and providing access to health care for all. Limited sponsorships are available to cover the costs associated with marketing and promotional materials and travel expenses. Sponsors will be recognized for their contributions via the CHAD website, social media, and NHCW promotional materials. Those interested in supporting CHAD's NHCW activities and joining us in celebrating the vital work of health centers should contact Darci Bultje.

Launching with the iconic “I Heart My Health Center” design, the CHAD Store will surely have the right merch for folks to show their health center pride. Buying items from the CHAD Store is a great way to support CHAD’s mission to foster healthy communities by promoting and supporting programs that increase access to affordable, high-quality care for all. It's a win-win – supporters get cool stuff AND help make a difference in the Dakotas. Check out the CHAD Store and showcase some health center love today!

Today, more than 147,000 people advocate for health centers every year, ensuring that more than 30 million people in the United States have access to health care. For more than five decades, advocates have continued to answer the call to support equitable policies and sustainable funding for America’s health centers. CHAD is dedicated to educating, equipping, and mobilizing advocates to take action by joining the Health Center Advocacy Action Team (HCAAT).

The HCAAT is a short-term workgroup that will educate members on key policy issues for health centers and how to engage locally to advocate for patients and health centers. The primary focus of the group will be protecting federal health center funding. Health center staff from across the Dakotas are invited to join. People should consider joining if they are passionate about protecting health center funding, are interested in policy issues, or simply want to learn more about how to engage in advocacy efforts aimed at access to health care.

Sign up for the HCAAT by Friday, August 11. CHAD will host four virtual, one-hour sessions in 2023:

September: Federal Issues: Health Center Funding, Workforce, 340B, Telehealth;
October: Advocacy 101;
November: State Issues & Advocacy (breakout groups by state); and,
December: Next Steps: Staying Informed & Advocating Effectively.

Health centers depend on bipartisan support from elected officials to ensure continued funding and further public health legislation. The CHCF is currently set to expire on September 30. Congress must once again take action to avert a lapse in funding before the end of the fiscal yea

Use this link to contact North Dakota and South Dakota congressional members. Remember to personalize the email with one or two sentences in the middle paragraph about valuing health centers and invite friends and colleagues to email them too.

It’s important for Congress to know how health centers strengthen communities by increasing access to high-quality mental, physical, and dental care. Interested in getting more involved? Sign up for the Health Center Advocacy Action Team at CHAD.

Medication expansion went into effect on July 1, and the All Women Count! (AWC!) program is excited to announce a change in income guidelines. With this change, approximately 16,000 additional women will be considered for eligibility for breast and cervical cancer screening and diagnostic services.

Effective July 1, the AWC! program is now covering South Dakota women with a family income at or below 250% Federal Poverty Level. See here for the updated income guidelines, and be sure to replace the previous version that was sent in February 2023. Updated AWC! rack cards are also available for order; visit the AWC! website for more information. The South Dakota Department of Health Office of Disease Prevention and Health Promotion can provide stickers to update the income section on existing rack cards. For any questions, additional copies of the income guidelines, or individual training for clinic staff, reach out to the cancer program at 1-800-738-2301.

Blue Cross Blue Shield of North Dakota (BCBSND) Caring Foundation continues to build on efforts to support health and well-being throughout North Dakota. As evidence continues to grow to show that social drivers of health have a significant impact, the Caring Foundation will continue to invest additional resources at the community level to strengthen opportunities to build collaboratives that invest locally to enhance healthy lifestyles, address service gaps, and promote health equities.

The BCBSND Caring Foundation will provide a limited number of one-year grants annually of up to $50,000 to North Dakota communities and organizations undertaking efforts to support health and community-based wellness and prevention. The goal of the SPARK (strengthening people, access, resources, and knowledge) grants is to enhance collaborative efforts and community involvement that results in long-lasting change.

For grants to be considered, the project must support initiatives that encourage health and well-being within North Dakota communities, be sustainable, a priority in the community, exhibit collaboration with stakeholders in the community, and align with evidence-based, best practices and principles.

Those interested in applying for a grant must first submit a letter of intent (LOI) form by 5:00 pm on August 15 to be considered for the fall funding cycle. Eligible organizations must be North Dakota-based 501(c)(3) nonprofits, municipal entities (i.e. park boards, public health), or school systems in order to submit an LOI. All LOI must be electronically submitted to caringfoundation@bcbsnd.com. For more detailed information, please view the BCBSND website.

Want better care for older adults? Dakota Geriatrics can assist clinics and long-term care programs to become certified “Age-Friendly Healthcare Systems.” The certification process is sponsored by the Institute for Healthcare Improvement. To be age-friendly certified, there are three main levels: gaining knowledge of the 4M’s: What Matters Most, Medications, Mobility and Mind, educating your team as age-friendly, and developing an age-friendly plan with ongoing education. By applying this framework, better outcomes are achieved with older adult health care. The Dakota Geriatrics program provides 1:1 counseling and training videos to assist in the process of becoming age-friendly. To learn more, click here or visit the Dakota Geriatrics website.

Telebehavioral Health for American Indian and Alaska Native Communities

July is National Minority Mental Health Awareness Month. American Indians and Alaska Natives have higher mortality rates and lower health outcomes than the general population in a variety of behavioral health categories. Telehealth.hhs.gov includes resources to help health centers increase the use of telehealth for these communities.

Recording: Providers, Panels, and Population Health: Empanelment Tools in DRVS
When it comes to creating patient-provider assignments, there are many factors to consider - supply and demand, full-time providers vs. part-time providers, residency programs, patient choice, risk distribution and provider burden - the list goes on. However, traditional EHR systems have limited ability when it comes to accessing the information needed to consider and integrate these moving targets. During this session, participants will learn about the measures available within DRVS that can help practices make more informed decisions around patient-provider assignments and put data into action to advance population health. Access the recording here.

Recording: Part 1: The Quality Director's Toolbelt
The QI Director is often at the helm when it comes to setting up DRVS for success. Matching the right tools to the right role, for the right situation and goals can be tricky. In this first session, speakers reviewed the elements of DRVS that are foundational to success: data validation and data hygiene. Access the recording here.

Part 2: The Quality Director’s Toolbelt
The QI Director is often at the helm when it comes to setting up DRVS for success. Matching the right tools to the right role, for the right situation and goals, can be tricky. In this second session, speakers will focus on strategies for configuring and customizing DRVS to advance a practice's unique priorities and goals. During this session, participants will review functionalities such as Alert Admin, Provider Groups, Cohorts, Report Customization, and DRVS for PCMH.

Thursday, July 20
1:00 pm CT/ 12:00 pm MT
Register here.

Register Today: HRSA 2022 UDS Trends Webinar
Join the Health Resources and Services Administration (HRSA) for the 2022 UDS Trends webinar to learn about 2022 UDS data trends in health center patient demographics, staffing, and clinical quality measures. During the webinar, participants will gain insights into the delivery of high-quality and comprehensive health care to 30.5 million health center patients. The 2022 UDS data will be available on the data.hrsa.gov Health Center Program Data and Reporting webpages during National Health Center Week in early August. This webinar is open to HRSA staff, health center leadership and staff, and health center stakeholders, such as PCAs, HCCNs, and NTTAPs.
 
Tuesday, August 8
12:00 – 1:15 pm CT/ 11:00 am – 12:15 pm MT
Register here.

HIV/STI/TB/Viral Hepatitis Lunch and Learn: Long-Acting ART: What You Need to Know
This month, Dr. Gary Meyers, director of pharmacy at the Community Health Center of the Black Hills, will discuss intramuscular cabotegravir-rilpivirine (CAB-RPV) as the first approved long-acting antiretroviral treatment regimen. He will discuss who is eligible and why long-acting therapy may help patients. He will also explain why usage has been limited thus far due to clinical factors, insurance coverage, and logistical barriers. Presented by the Dakotas AIDS Education and Training Center (DAETC) and the ND Department of Health.

Wednesday, July 26
12:00 PM CT/ 11:00 AM MT
Register here.

South Dakota Infection Control Council Conference October 5-6
Registration for the 2023 South Dakota Infection Control Council Conference is now open. The theme is Spread Knowledge, Not Germs. The conference is intended to provide continuing education in infection prevention to all persons with an interest in or responsibilities related to the infection control field in the state of South Dakota and the surrounding areas.

In-person in Sioux Falls or online attendance options.
Register here.