CHAD Connection November 10, 2022

In honor of National Rural Health Day on November 17, I’d like to take a moment to celebrate the impact health centers have on rural communities across the Dakotas. Health centers have a mission of providing care to underserved populations, and in rural and frontier parts of states, that means sustaining primary care, dental services, and behavioral health care in places that otherwise might not have access to care.

Every year, the Community HealthCare Association of Dakotas assesses the economic impact that health centers have on their communities. Check out our locations here and the local impact we’re having on jobs and the economy. In North Dakota, our two primarily rural health centers serving in western North Dakota collectively had a $30 million impact in 2021. The rural health centers in South Dakota had an economic impact of $120 million. When we calculate the jobs created by health centers as well as the jobs created in the community when we buy local goods and services, over 200 rural jobs are created in North Dakota and over 900 in South Dakota.

In addition to the actual dollars that flow to local communities through health centers, their role in maintaining access to health care can have an enormous impact on the long-term economic viability of rural communities. For our smaller communities, access to local health care is crucial to a town’s ability to recruit new companies and maintain a healthy workforce without long out-of-town trips to the doctor or to pick up prescriptions. When a small town is able to retain access to health care, it can serve as a main street anchor, keeping other small businesses viable. Across rural and urban communities, health centers keep health care affordable by providing health care services regardless of the ability to pay
and by helping patients find health coverage options that are right for them.

In South Dakota, the sustainability and impact of health centers got a big boost on election day when voters elected to expand access to Medicaid coverage to those currently in the coverage gap – those who don’t earn enough to qualify for subsidies for private insurance on the Marketplace. Having more people covered will enable health centers to keep doors open in frontier communities and to potentially expand needed services, ensuring that rural residents can get a range of primary, dental, and behavioral health care close to home. For that reason, we will also be encouraging the legislature in North Dakota to add dental benefits for its Medicaid expansion population. The expansion population has gone without access to needed dental care for too long, and it is time we take advantage of the federal matching funds being offered (90%) to close that coverage gap as well.

As we look toward implementing Medicaid expansion in South Dakota, I hope we can continue looking for practical ways to help ensure access to high-quality health care for everyone in the Dakotas. For help spreading the #PowerOfRural, check out the promotional toolkit by the National Organization of State Offices of Rural Health.

North Dakota Update
Statewide voter turnout was around 43%, and statewide congressional races included victories for Senator John Hoeven and Congressman Kelly Armstrong. Initiated Measure 1, regarding gubernatorial and legislative term limits was approved, and Initiated Measure 2, relating to the legalization and regulation of cannabis, failed.

North Dakota legislative races were decided late Tuesday night, except for District 25 (Wahpeton) and District 43 (Grand Forks), which may require a recount. Human Services Committee leader and health center champion, Senator Judy Lee, was re-elected, which is excellent news moving into the 2023 legislative session. In early December, both North Dakota and South Dakota governors will release their budgets, and legislative committee assignments will be determined. The North Dakota legislative session begins on January 3, 2023.

Want to be a part of the CHAD mission in North Dakota? Join the team as the policy and partnership manager. This is a full-time remote position with a physical location in North Dakota. The ideal candidate for CHAD’s policy and partnership manager has advocacy or policy experience at the state or national level and is strategic, articulate, and knowledgeable about health care policy. This position will build relationships with internal and external partners, such as members, key legislative and congressional leaders, state partners, state Medicaid offices, Insurance Commissioners, etc. They will lead statewide efforts by attending meetings, hearings, and conferences with state officials and other partners. For more information or to apply, click here.

South Dakota Update
The big news is that Medicaid expansion passed 56% to 44%, thanks in large part to the efforts of South Dakota’s health centers. The next step will be to see how Governor Noem accounts for the passage of Amendment D in her budget proposal. Initiated Measure 27 legalizing recreational cannabis failed 47% to 53%.

Governor Noem, Senator Thune, and Congressman Johnson were re-elected by wide margins. The Republican and Democrat makeup of the legislature remains the same – just different allocations in each chamber. The Democrats picked up a seat in the Senate; the Senate is now 31 Republicans and four Democrats. In the House, Democrats gave back that gain and lost a seat, taking them down to seven seats out of 70 in the House. There are a few House races within the margin of error for a recount, but history has shown it is doubtful to find enough votes to change the outcome in a recount. The South Dakota legislative session will begin on January 10, 2023.

CHAD and Get Covered South Dakota collaborative partners, including the Community Health Center of the Black Hills, Falls Community Health, the Helpline Center, Horizon Health Care, South Dakota Urban Indian Health, and Western South Dakota Community Action, are busy helping consumers with health insurance options and facilitating enrollment through the Health Insurance Marketplace. They offer free, unbiased assistance to consumers across South Dakota. CHAD has supported outreach and enrollment services statewide since 2013. This year the efforts will reach further thanks to the second year of grant funding and a cooperative agreement with the Centers for Medicare and Medicaid Services (CMS).

People enrolling in a plan on HealthCare.gov are guaranteed comprehensive coverage with no pre-existing condition exclusions or markups. These plans cover essential benefits, including doctor and hospital visits, prescription drugs, mental health treatment, and maternity care. In addition, enrollees receive free preventive care services, such as vaccines and health screenings.

Thanks to the American Rescue Plan Act and the Inflation Reduction Act, most people have access to affordable premiums that help lower costs for families. Four out of five consumers will be able to find plans for $10 or less per month after tax credits. Families who have found employer insurance unaffordable in the past should look at new opportunities for savings on HealthCare.gov. Open enrollment runs through January 15, 2023. However, if consumers want their insurance coverage to start on January 1, 2023, they must complete their enrollment by December 15.

While all communities benefit from outreach, education, and enrollment assistance, some experience additional barriers to accessing coverage and care. Trained navigators with ties to their local communities have the knowledge to educate and give impartial guidance to those seeking affordable health coverage. Consider how organizations can work to raise awareness and ensure every uninsured South Dakotan has the opportunity to learn about affordable health insurance options. For access to a social media toolkit promoting open enrollment, contact Kayla Hanson at CHAD. To find a trained professional to help navigate enrollment, visit www.GetCoveredSouthDakota.org or dial 2-1-1.

Health center HR and marketing professionals gathered for an in-person, interactive workshop in last week in Fargo, ND. The two-day meeting focused on marketing the great things health centers and their communities offer to attract high-quality job candidates. Attendees learned how to polish each facet of the recruitment process, including creating attractive job postings, maximizing the use of social media and websites for recruitment, and other best practices to ensure great candidates don’t scroll by the Dakotas when exploring where they want to work.

A follow up session on retention is planned for 2023. For more information, contact Kayla Hanson or Shelly Hegerle at CHAD.

Join CHAD for the 2022 Uniform Data System (UDS) training sessions on November 15 and 17 from 1:00 – 4:15 pm CT/ 12:00 – 3:15 pm MT. These free web-based trainings are designed to provide assistance navigating and preparing the 2022 UDS report. This training is for people of all levels of prior UDS experience and covers all aspects of the UDS report.

Effective reporting of a complete and accurate UDS submission depends on understanding the relationship between data elements and tables. This interactive training is an excellent way for new staff to understand their UDS reporting effort role. This training has been designed for attendees of all levels. All financial, clinical, and administrative staff are invited to learn updates, hone reporting skills, and share questions and experiences with their peers. Register here.

The first session will allow participants to gain an understanding of the UDS reporting process, review key materials, and a walk-through of the patient demographic and staffing tables 3A, 3B, 4, and 5.

Tuesday, November 15

1:00 – 4:15 pm CT / 12:00 – 3:15 pm MT

The presenter will cover the clinical and financial information required in tables 6A, 6B, 7, 8A, 9D, and 9E in addition to the forms (health information technology, other data elements, and workforce training) during the second session. The presenter will also share valuable tips for success in completing the UDS report.

Thursday, November 17

1:00 – 4:15 pm CT / 12:00 – 3:15 pm MT

CHAD is inviting members and partners to raise awareness and recognize diabetes this November. According to the American Diabetes Association (ADA), National Diabetes Month was established 47 years ago in 1975.

Health centers play a vital role in the communities they serve to screen, address social determinants of health, and provide diabetes education, resources, and self-management tools for patients to achieve better outcomes and healthier living with diabetes. According to the ND Department of Health, diabetes is a chronic condition that affects 9.1 percent of adults in North Dakota. The South Dakota Department of Health reports diabetes affects more than 62,000 South Dakotans. The prevalence of diabetes has been steadily increasing for the past several years in both states. As the rates and prevalence of obesity increase, diabetes rates are also expected to increase substantially.

With the high risk for hospitalization and the complexity of this condition, people living with diabetes need to have access to healthy food, transportation, insurance, housing stability, and nutritional counseling. Through the consistent collection of social determinants of health data, individuals living with diabetes can be connected to the resources they need to improve their quality of life and help better self-manage their diabetes and overall health. Improved access to care via telehealth services for nutritional counseling and provider visits has proven to be a success for those who struggle with transportation to the clinics. An article from the Diabetes Journal gives a great example of how the emphasis on value-based care and social determinants of health has risen to the forefront as essential targets to achieve greater health equity in diabetes and health outcomes.

North Dakota Diabetes Prevention Program and the South Dakota Diabetes Prevention Program work to educate the public and promote healthy choices. They address

Self-assessment of the risk factors for pre-diabetes and diabetes;
Diabetes self-management strategies and resources; and,
Awareness of recommended care options, including evidence-based programs like the National Diabetes prevention program and the Diabetes Self-Management Education and Support (DSMES).

CHAD also has created a Diabetes Awareness Month toolkit for social media. Contact Kayla Hanson for access. For additional resources, see the links below.
CDC DSMES Toolkit for Diabetes
Health Equity Resources
Diabetes Fact Sheets
North Dakota Patient and Provider Resources for Diabetes
South Dakota Patient and Provider Resources for Diabetes

The Network Planning Program provides $100,000 to support one year of planning. It brings together key parts of a rural health care delivery system, particularly those entities that may not have collaborated in the past, to establish and/or improve local capacity to strengthen rural community health interventions and enhance care coordination.

In addition to the regular network planning track, applicants can select the Advancing Health Equity (AHE) track. The AHE track intends to focus on collaboration between entities to establish or improve local capacity and care coordination among rural Black, Latino, Indigenous and Native American persons, Asian Americans and Pacific Islanders and other persons of color; members of religious minorities; lesbian, gay, bisexual, transgender, and queer (LGBTQ+) persons; persons with disabilities; and people otherwise adversely affected by persistent poverty or inequality.

For more information or to apply, click here. Applications are due January 6, 2023.

Preparing for UDS+ Submission

Many clients have asked how they can prepare for the release of the UDS+ Implementation Guide and if Azara plans to support new submission functionality. While no immediate actions are needed or updated guidance available, Azara is actively planning to begin development and testing once they have received official specifications and test criteria. Please read and share the Azara DRVS UDS+ Statement. The GPHDN will keep everyone informed with updated information as it becomes available.

Recording: At Risk of What? An introduction to Risk Adjustment Factors and other Azara Risk Tools

A common statement heard from primary care providers is, “My patients are more high-risk.” When discussing risk stratification, the first question is always, “At risk of what?” In health care, risk generally refers to clinical risk or an adverse clinical outcome likelihood. This recorded webinar will explore the different risk tools available in DRVS--including risk adjustment factors (RAF)--and how people can use risk stratification to help focus on those patients and populations that can have the most impact to improve care and reduce costs.

Telehealth Patient Satisfaction Survey with Online Survey Toolkit
The National Association of Community Health Centers (NACHC) has released a Telehealth Patient Satisfaction Survey to measure patient satisfaction with telehealth visits. The assessment aims to help health centers understand patients’ experiences with health center telehealth visits, focusing on three key areas: access/ease of use, quality of patient-clinician interaction, and overall satisfaction. The survey is available through November 30.

Environmental Scan of Telehealth TA Resources
In this publication, the National Association of Community Health Centers (NACHC) and the Center for Connected Health Policy provide a curated list of top telehealth technical assistance (TA) resources for health centers interested in implementing, operating, expanding, or sustaining a telehealth program.

UDS Open Q&A Sessions

The Azara support team will be hosting a series of themed UDS open question hours to help ensure users’ DRVS UDS experience is as clear and accurate as possible. Each session will focus on a subset of the UDS reports and highlight common mapping and data issues that centers may face.

Attendees will be able to ask questions and have them answered live and provided a validation checklist to guide their validation efforts.

Table 6A

Tuesday, November 15

1:00 pm CT/12:00 pm MT

Table 6b/7 – Pediatric, Cancer, HTN, Diabetes

Tuesday, November 29

1:00 pm CT/12:00 pm MT

South Dakota Palliative Care Network Palliative Care Conference

The symposium will provide opportunities for students and health care professionals to learn about the clinical practice world and what is happening in the field by engaging with fellow participants. Topics will cover conducting a family meeting, maternal-fetal palliative care, symptom management, laughter is the best medicine, and medical cannabis in South Dakota. This conference is intended for all health care professionals and includes in-person and virtual attendance options.

Thursday, November 17
8:00 am - 4:00 pm CT/ 7:00 am – 3:00 pm MT
Mt Marty University Marian Auditorium, 1105 W 8th St, Yankton, SD
Register here.

CHAD Network Team Meetings
Monday, November 14 at 1:00 pm CT/ 12:00 pm MT – Operational Excellence/ Compliance Workgroup
Tuesday, November 29 at 1:00 pm CT/ 12:00 pm MT – Outreach and Enrollment Network Team
Tuesday, November 29 at 2:00 pm CT/ 1:00 pm MT – CFO and Finance Manager Roundtable
Thursday, December 1 at 12:00 pm CT/ 11:00 am MT – Clinical Quality Network Team
Tuesday, December 6 at 12:00 pm CT/ 11:00 am MT – Behavioral Health Work Group
Monday, December 12 at 1:00 pm CT/ 12:00 pm MT – Operational Excellence/ Compliance Workgroup
Tuesday, December 13 at 2:00 pm CT/ 1:00 pm MT – Communications and Marketing Network Team