CHAD Connection

I am excited to announce that South Dakota Urban Indian Health (SDUIH) has become the newest member of the Community HealthCare Association of the Dakotas! A staple of health care in South Dakota for more than 40 years, SDUIH has two integrated clinics providing medical, behavioral health, and cultural services in Pierre and Sioux Falls.

A federally qualified health center, SDUIH’s mission is to provide total quality medical care for Native American people and the underserved residing in urban areas of South Dakota. Their Tiospaye’ Program provides holistic quality care for substance use disorders that address patients’ needs through four traditional components: physical, emotional, mental, and spiritual. In addition to the medical and behavioral services, SDUIH offers many community programs such as patient transportation, medication pickups from IHS facilities, and a diabetes care program that includes fitness and healthy eating components.

New CEO Michaela Seiber, MPH (Sisseton-Wahpeton Oyate), will join the board of directors at CHAD. Michaela first started working at SDUIH in September of 2020 as a grant project manager and took on the role of CEO for the organization in February. One of Michaela’s first goals as leader was creating the cultural health department, Zaniya Oyate. Led by Theresa Henry, BA, HTMC (Turtle Mountain Band of Chippewa Indians) and an advisory committee, the cultural health department aims to promote community connection, family engagement, and relationship development by using traditional values. Some of the cultural best practice programs include positive Indian parenting groups, support groups, a women’s leadership group, a purification ceremony, language and singing programs, and a healing garden.

Please join me in welcoming Michaela and the South Dakota Urban Indian Health team to the CHAD community!

At a White House briefing yesterday, White House officials marked progress in the national effort to vaccinate populations against COVID-19. Dr. Marcella Nuñez Smith, MD, co-chair of the COVID-19 Health Equity Task Force, singled out the work of community health centers in these efforts and noted that "approximately 60 percent of shots have been administered to people of color. And since our community health center program started, about 70 percent of shots administered through those centers have gone to people of color as well."

The National Association of Community Health Centers (NACHC) posted a press release highlighting how community health centers, which serve 30 million people, have been central to ensuring equity and access in the COVID-19 response and vaccination program. They have administered more than 10 million vaccine doses and have increased the number of vaccines they initiate each week by almost five-fold from January 8 to May 7. As they begin the last mile of the vaccination campaign to end the pandemic, their efforts now focus on developing successful models to bring the shots and primary care services to populations in need, whether agricultural workers in the farm fields or urban neighborhoods across America. They are hosting hundreds of pop-up clinic events and sending mobile vans out in care teams to factories, shopping center parking lots, or even sports events.

"This is where the real work of health centers begins," said Ron Yee, MD, chief medical officer of NACHC. "Health centers are going to where the people are to treat and vaccinate their patients. As trusted voices in public health, they are helping to build confidence in the COVID vaccine with direct community care and other important services, such as diabetes and blood pressure checks, mental health services. It is not just about shots in the arm, they are also filling the gaps in care for hard-to-reach populations over the long term."
Over 90 percent of health center patients live in poverty, and over half (63 percent) are racial or ethnic minorities. These populations have been disproportionately affected by COVID-19, with higher rates of death and hospitalizations.

The National Health Service Corps (NHSC), a federal government program administered by the Health Resources and Services Administration (HRSA), received a historic $800 million from the American Rescue Plan Act to support the largest clinician workforce in the program’s nearly 50-year history. The NHSC loan repayment programs help medical, dental, and mental and behavioral health clinicians pay off their student loan debt in exchange for working in an underserved area with too few providers.

The NHSC is taking applications for three loan repayment programs until Thursday, May 27. Eligible disciplines include physicians, nurse practitioners, physician assistants, dentists, behavioral/mental health clinicians, and more. Qualified clinicians may receive up to $100,000 in educational loan repayment, depending on the award. To learn more and apply for an NHSC loan repayment program, visit the HRSA NHSC webpage.

Providers may apply for one of three NHSC loan repayment programs.

NHSC Loan Repayment Program – This two-year commitment program supports clinicians with up to $50,000 to pay off their student loan debt in exchange for service at an NHSC-approved site.
NHSC Substance Use Disorder (SUD) Workforce Loan Repayment Program – This three-year commitment supports the recruitment and retention of health professionals with up to $75,000. Providers must provide SUD treatment and work at an NHSC-approved SUD treatment facility.
NHSC Rural Community Loan Repayment Program – This three-year commitment addresses the pressing need for qualified SUD providers in rural communities and awards up to $100,000 in loan repayment funds. Applicants must work at an NHSC-approved SUD treatment facility located in a rural area.

Last week, the US Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) authorized the emergency use of the COVID-19 Pfizer vaccine in adolescents aged 12-15. On Friday, May 14, Advisory Committee on Immunization Practices (ACIP) updated its Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States to include this recommendation.

ACIP has also updated its guidance for all COVID-19 vaccines to be administered without regard to timing, meaning that they can be administered simultaneously with other vaccinations.

Find updated fact sheets and additional information at the links below.

The CDC has updated guidance for individuals who have been fully vaccinated against COVID-19. Changes are based on emerging evidence that has confirmed the effectiveness of COVID-19 vaccines at preventing COVID-19 disease and preliminary data which suggests vaccinated individuals are less likely to have an asymptomatic infection and may be less likely to spread COVID-19 to others. Learn more about the science behind these changes here.

Fully vaccinated people can:

Resume normal activities without wearing masks or physical distancing, except when required by laws or local business or workplace guidance;
Resume domestic travel and refrain from testing before or after traveling; and,
Refrain from quarantine following a known exposure if asymptomatic.

For more information, see the Interim Public Health Recommendations for Fully Vaccinated People. If anyone experiences any symptoms of COVID-19, they still need to be tested regardless of vaccination status.

Personal protective equipment recommendations for health care facilities have not been updated. Health care facilities should continue to utilize universal source control while in direct contact with patients regardless of staff or patient vaccination status.

On Monday, the Health Resources and Services Administration (HRSA) sent letters to six pharmaceutical manufacturers stating that their refusal to ship 340B-priced drugs to contract pharmacies is a direct violation of the 340B statute, and they must immediately resume shipping 340B-priced drugs to contract pharmacies. The letter goes on the say that the pharmaceutical manufacturers must credit or refund all 340B providers for overcharges that resulted from their policy; it is the manufacturers’ responsibility to contact the 340B providers and pursue "mutually agreed upon refund arrangements."

HRSA further warns if manufacturers continue to refuse to ship 340B-priced drugs to contract pharmacies, it may result in the US Department of Health and Human Services (HHS) imposing civil monetary penalties, not exceeding $5,000 for each instance of overcharging. Manufacturers must provide HHS with an update on their plans to resume shipping 340B-priced drugs to contract pharmacies by June 1.

There are still many questions to consider, including if manufacturers comply with the HHS letter or continue their restrictions while pursuing litigation. It is also unknown if health centers will be made whole for the impact of the manufacturers’ policies – not just the direct costs but also the burdens resulting from working around these policies to ensure patients’ well-being. Despite these questions, this is still excellent news. This is the first time HHS has said directly to manufacturers that their actions violate the statute and that monetary penalties could result.

On May 10, the US Department of the Treasury announced the launch of the COVID-19 state and local fiscal recovery funds in the amount of $350 billion, established by the American Rescue Plan Act. Local governments will receive the first portion in May and the remaining 50% balance 12 months later. The funds can be used for the negative economic impact caused by the pandemic, replace lost public sector revenue, provide pay for essential workers, invest in water, sewer, and broadband infrastructure, and support public health response.

The Treasury has posted the portal link for states to request fiscal recovery funds of $1.7 billion for North Dakota and $974 million for South Dakota. This site provides fact sheets, answers to frequently asked questions, and reference guides on how to utilize the funds.

On May 18, the United States Preventive Services Task Force (USPSTF) released a final recommendation, evidence summary, and modeling study on screening for colorectal cancer. The new recommendation aligns with the American Cancer Society’s (ACS’s) 2018 recommendation that average-risk adults are now recommended to start screening at age 45.

The recommendation to begin screening at age 45 follows research indicating a rising incidence of colorectal cancer in young adults. The median age of colorectal cancer diagnosis has dropped from age 72 in 2001-2002 to age 66 during 2015-2016. Half of all new colorectal cancer diagnoses are in people 66 or younger.

Although some health plans have already begun to cover colorectal cancer screening beginning at age 45 following the ACS’s 2018 recommendation, under the Affordable Care Act, coverage of screening by most commercial plans beginning at age 45 will now be mandated by law. The American Cancer Society issued a press release featuring responses from Bob Smith, Ph.D., senior vice president, cancer screening, American Cancer Society, and NCCRT co-chair.

To learn more, register for the National Colorectal Cancer Roundtable webinar, 2021 USPSTF Colorectal Cancer Screening Recommendation Lowers Screening Age from 50 to 45: Implications for NCCRT Partners on Monday, June 7, from 11:00 am CT/ 10:00 am MT.

Join Health Resources and Services Administration’s (HRSA’s) Bureau of Health Workforce (BHW), the Northwest Regional Primary Care Association (NWRPCA), and CHAMPS for a three-part webinar series designed to introduce participants to BHW programs. Speakers will provide information about how to successfully apply for BHW grants to increase access to behavioral health services and enhance health centers’ capabilities to recruit, develop, and retain their staff by exposing them to education and training programs. Sessions will occur on June 2, 10, and 24 at 2:00 pm CT / 1:00 pm MT. To learn more and register, please visit the CHAMPS Upcoming Live Distance Learning Events webpage.

It has been noted both nationally and locally that food insufficiency increased during the pandemic. Health center patients may be eligible for additional nutrition benefits. See below for more details:

Supplemental Nutrition Assistance Program (SNAP)

The 15% increase to SNAP benefits will continue and has been extended through September 2021. This increase is included in the SNAP benefit issued on the first of every month.
North Dakota: The Great Plains Food Bank SNAP Hotline (1-855-405-000) has staff that can help individuals submit an application and navigate other available resources in their communities.
South Dakota: SNAP program

WIC Program (Women, Infants, and Children)

In June, July, August, and September, WIC participants can receive an extra $35 per month to purchase fruits and vegetables.
North Dakota WIC
South Dakota WIC

Summer Meal Sites for Kids 18 and Under

The USDA Summer Food Service Program, available in certain communities, will provide free meals to any child aged 18 and under.
Visit the Summer Meal Site Finder, text "Summer Meals" to 97779, or call (866)-348-6479 to find the nearest site. Sites are currently being expanded, so check back for updates.

Local Food Assistance Lists

North Dakota: Visit the FirstLink website or call 2-1-1. NDSU Extension has also developed county food resource lists for Cass County, Grand Forks County, Rolette County, Ward County, and Williams County.
South Dakota: Visit the Helpline Center website or call 2-1-1.

2022 Optimizing Virtual Care (OVC) one-time funding is available for up to 25 health centers on a competitive basis. The purpose of the OVC funding is to support health centers to develop, implement, and evaluate innovative, evidence-based strategies that:

Optimize the use of virtual care to increase access and improve clinical quality for underserved communities and vulnerable populations; and,
Can be adapted and scaled across the health center program.

If funded, award recipients will actively participate in collaborative learning and evaluation activities with other OVC award recipients through a coordination and evaluation center. Award recipients will provide data and progress updates to the coordination and evaluation center that will facilitate peer learning and evaluate progress and effectiveness of the funded projects to optimize the use of virtual care.

This funding opportunity will support health centers to systematically design, implement, and evaluate ways to optimize the use of virtual care into the future. Health Resources and Services Administration (HRSA) is hosting am OVC applicant question and answer session on Tuesday, June 1. For webinar information and more on how to apply, visit the HRSA website.

The North Dakota Department of Health – Division of Health Promotion is working with the Center for Rural Health to provide free training with education credits for members of health care teams in North Dakota. A total of four free, virtual, one-hour sessions will be included between May 20 – June 17. The live TeleECHO™ events include didactic, and case presentations focused on various hypertension topics, including:

An overview of hypertension prevalence in North Dakota and how to use data and stats to prevent, control and treat hypertension;
Complementary and alternative hypertension treatment options;
Statin use for hypertension treatment; and,
Managing hypertension through lifestyle modification.

The goal of this TeleECHO™ series is to improve the overall health of patients in North Dakota. All trainings will be recorded and available online for later viewing with continuing education credits. Please see this flyer for more information on the first session coming up on May 20 and register now. For any questions about this ECHO series, please contact Julie Reiten, project ECHO coordinator at the University of North Dakota.

Great Plains Health Data Network Announces New Partnership

The Great Plains Health Data Network (GPHDN), affiliated with the Community HealthCare Association of the Dakotas (CHAD) and the Wyoming Primary Care Association (WYPCA), is partnering with Azara Healthcare to help health centers to improve the quality and efficiency of care for their patients.

"After a thorough search for a company that could help us meet our data analytics needs, Azara Healthcare stood out as the best option for our network. We have already begun work and couldn’t be happier with the partnership we’re building," said Kyle Mertens, health information and data analytics manager with CHAD. Azara Healthcare will provide the Azara DRVS solution that provides a centralized data reporting and analytics solution which facilitates care transformation, drives quality improvement, aids in cost reduction, and simplifies reporting for health centers.

The GPDHN collaboration includes 11 participating health centers, consisting of 70 sites and collectively serving over 98,000 patients. "Having access to a robust data source and data infrastructure will allow health centers to improve health outcomes and provide comprehensive health care for patients," said Mertens.

Health Information Technology, Evaluation, and Quality (HITEQ) Center Learning Collaborative Series: Addressing Provider Burden

Join the HITEQ Center in the upcoming learning collaborative for health centers on addressing provider burden. This learning collaborative will provide a space for discussion and sharing compassionate, well-designed, and digital-first solutions. Health center participants will have the opportunity to discuss interventions, implementation, training, and ongoing support for meaningfully integrated digital solutions to effectively support reducing provider burden.

This learning collaborative will provide health centers a series of four structured virtual sessions to engage with subject matter experts and their colleagues in peer-to-peer learning and discussion. Topics will include EHR best training practices, workflow support, and documentation support. Throughout the series, participants will be encouraged to consider the broad scope of provider burnout and the opportunities their particular settings may have for meaningful interventions.

All sessions are scheduled to begin at 12:30 pm CT/ 11:30 am MT and will last between 60 - 90 minutes.

June 09: Session 1 - Scoping Provider Burnout as a Problem with a Solution
June 23: Session 2 - EHR Training Best Practices
July 14: Session 3 - Workflow and Documentation Support
July 28: Session 4 - Provider Burnout Round-Up

Health centers interested in participating in this collaborative learning series can submit one registration form on behalf of their health center. Health center registrations can include up to three participants in their form. For more information and to register, click here.

The National Council for Mental Well-Being (formally known as National Council for Behavioral Health) held their annual conference (NatCon21) virtually in early May, where they unveiled their new name and great ideas for the future of behavioral health. This article will look at current and future strategies in behavioral health as discussed by leaders from Kaiser Permanente, Centene Corporation, PerformCare, and the Association for Behavioral Health and Wellness at NatCon21.

Throughout the pandemic, 40 percent of adults have reported symptoms of anxiety and depression, and this number increases if one is Hispanic/Latino (46 percent) and increases even more for Black/Non-Hispanic (48 percent). These percentages are up from 10 percent of adults who reported these symptoms from January-June in 2019. One survey revealed that 25 percent of young adults started or increased their substance use during the pandemic. From September 2019 through August 2020, the US recorded 88,000 overdose deaths, a record high and almost 27 percent more than the prior 12-month period.

These statistics confirm what many suspected; the pandemic has been extremely detrimental to our collective mental health as a society. Through this lens, the leaders from the previously mentioned organizations discuss what their organizations are doing to help patients and support providers who have been deeply impacted by COVID-19.

It is impossible to talk about health care over the past year without mentioning telehealth, and behavioral health is one element of care that has boomed. One study found that 81 percent of mental health providers first utilized telehealth during the pandemic, with 70 percent reporting a favorable experience and plans to leverage it for at least 50 percent of their patients moving forward. As Cosette Taillac stated, addiction thrives in isolation but dies in community. The outreach that telehealth has permitted has been good for substance use disorders and behavioral health services and has allowed engagement in ways that were not available before.

Currently, the focus of all organizations is on data and research to determine the efficacy of behavioral health services through telehealth as it relates to levels of care, service type, and which populations it is best suited. One organization did a study and found 62.5 percent of Medicaid patients in their membership could not use telehealth due to not having internet or not having the actual device. Therefore, while telehealth is a promising practice, it could lead to health disparities due to the digital divide. At the same time, there is concern about which restrictions lifted during the public health emergency (PHE), which permitted so many of these services, will come back once the PHE expires.

Looking toward the future, leaders pointed to their interest in having value-based contracting for behavioral health based on various quality metrics. They also discussed partnerships with federally qualified health centers to hire community health workers and are considering value-based contracts for these partnerships. They are looking at data of integrated and collaborative care models, and several are looking at expanding into school-based services.

Seizure Recognition and First Aid Certification LIVE Session Registration in observance of Asian American and Pacific Islander Heritage Month

Join the Association of Asian Pacific Community Health Organizations (AAPCHO) and Epilepsy Foundation for a live seizure recognition and first aid certification training. In observance of Asian Pacific American Heritage Month, and with generous support from the Epilepsy Foundation, this live certification training is being provided to AAPCHO members and partners at no cost.

To register and enroll for the FREE course, carefully read the steps on the registration page before completing the registration for the live Zoom session. If all steps are not complete, you will not become Seizure First Aid Certified and receive a certificate of completion.

The intended audience for this webinar includes AAPCHO members and partners, including health centers, PCAs, HCCNs, and other health care and community-based organizations, including those serving Asian American, Native Hawaiian, and Pacific Islander communities.

Thursday, May 20
5:00 pm CT/ 4:00 pm MT
Register here

Pregnant during a Pandemic: What the Data Says about COVID-19 and the Vaccine

In this CDC COVID-19 partner update, Drs. Romeo Galang and Kara Polen will share information on vaccine safety and efficacy for pregnant individuals, as well as the latest scientific information and what everyone should know about protecting themselves and others. The presentation will be followed by Q & A. The call will be recorded and posted with previous Partner Update webinars here.

Monday, May 24
2:00 pm CT/ 1:00 pm MT
Register here

Improve Your Vaccination Quality Measures – Grab the Low Hanging Fruit

Led by Great Plains Quality Innovation Network, this webinar will help participants better understand how to improve a facility’s vaccination quality measures by "grabbing the low hanging fruit."

Attendees will:

Learn the MDS coding criteria needed to meet seasonal influenza and pneumococcal vaccine quality measure;
Apply tips and strategies related to assessment, monitoring, and tracking of influenza and pneumococcal vaccinations; and,
Plan for the annual seasonal influenza quality measure calculation to maintain 100% assessed and appropriately given the influenza vaccination.

Tuesday, May 25
2:00 pm CT/ 1:00 pm MT
Register here

Crisis Communications in a COVID-19 World

Communicators who can remain agile in a disaster can position their brand for success during and after the crisis. The COVID-19 pandemic has shown us how easily a carefully laid strategy can be disrupted.
Strategic Communication experts ARTEMIA Communications and Connect Consulting Services will share examples of successful public, and private sector approaches to effective initiatives that educate and inform target audiences. Registrants will receive a crisis communications checklist to assist you in creating your custom communication strategy.

Thursday, May 27
12:00 pm CT/ 11:00 am MT
Register here

Today with Macrae Next Week

Join Health Resources and Services Administration (HRSA)’s Maternal and Child Health Bureau Associate Administrator Dr. Michael Warren and Jim Macrae to hear about COVID-19 and back-to-school vaccinations, plus the revised Health Center Program site visit protocol, funding, and more.

Thursday, May 27
2:00 pm CT/ 1:00 pm MT
Join the day of the session
To join by phone, call 833-568-8864 and enter meeting/webinar ID: 161 001 1348 when prompted.

CHAMPS Immunization Update Webcast

Registration is now open for the CHAMPS 2021 Immunization Update webcast. This 90-minute event will be presented by the Centers for Disease Control and Prevention’s (CDC’s) National Center for Immunization and Respiratory Disease. Presenters will discuss the latest recommended immunization schedules and the most recent Advisory Committee on Immunization Practices (ACIP) recommendations for adults, children, and adolescents. In addition, information on improving routine vaccination during the COVID-19 pandemic will be presented.

This presentation is intended for clinical leadership, clinicians, and clinical support staff at Region VIII (CO, MT, ND, SD, UT, WY) health centers, including physicians, PAs, NPs, nurses, MAs, and other interested health care professionals. To learn more, visit the CHAMPS Upcoming Live Distance Learning Events webpage.

Thursday, June 3
12:30 pm -2:00 pm CT / 11:30 am -1:00 pm MT
Register here

Introduction to the UDS Mapper

The Uniform Data System (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. This webinar is a general introduction to the UDS Mapper, a mapping and decision-support tool driven primarily from patient location data within the Uniform Data System (UDS). This webinar will go over basic UDS Mapper functionalities geared toward first-time users or those who need a refresher. It is open to the public and free of charge.

Tuesday, June 8
11:00 am CT/ 10:00 am MT
Register here