CHAD Connection

In March, health centers across the Dakotas and Wyoming wrapped up a six-month learning collaborative focused on assessing and responding to patients’ social determinants of health (SDOH) using the Protocol for Responding to and Assessing Patients’ Assets Risks and Experiences (PRAPARE). PRAPARE helps identify social needs such as food insecurity, housing stability, transportation, insurance, social support, intimate partner violence, and other areas. As we know, clinical care accounts for about 20 percent of health outcomes, while the other 80 percent is attributed to social and economic factors, the physical environment, and health behaviors. Understanding patients’ social needs is a critical component of achieving improved health outcomes. Half of the health centers across the Great Plains Health Data Network are currently implementing PRAPARE, while others are preparing to implement it in the future. We have already heard some early successes in PRAPARE implementation.

For instance, at Northland Health Centers (NHC), the tool has raised new awareness of intimate partner violence (IPV). Within the first week of PRAPARE implementation, a patient completed the questionnaire during a routine dental visit and shared that they were experiencing IPV. Staff responded to the individual patient’s needs and recognized the need to develop an organizational protocol for responding to IPV. They created a resource guide outlining crisis resources in each of their clinic communities and the statewide hotline. The medical director emailed the resource list, along with a response protocol, to all staff. They also adapted their questionnaire so that it is set up to flag a positive IPV screen as an "act now" need. In addition to this powerful story, staff have also seen an increase in insurance enrollment since the implementation of PRAPARE.

"Northland is always looking for resources to serve the health center population better and meet the needs of the community. PRAPARE is a terrific tool to help staff identify the needs of their patients. With this tool and training, staff are better prepared to help the patient as needs arise," says NHC CEO Nadine Boe. We know there will be many more success stories to come in this work. If you have a success story to share or are looking for support with PRAPARE implementation, we’d love to hear from you!

This summer, we look forward to peer-to-peer PRAPARE coaching calls paired with additional technical assistance based on the individual needs of each health center. The 2021 CHAD Conference will feature a variety of SDOH content, including an examination of the impact of COVID-19 on American Indian communities and success stories from local health centers advancing enabling services. The upcoming implementation of the population health management tool Azara across the Great Plains Health Data Network will open new doors for responding to PRAPARE data, including the opportunity to incorporate SDOH into risk stratification and understand SDOH at the community and state levels. During the conference, we’ll hear how one health center in Montana uses Azara and other strategies to center equity in its delivery of care.

As we look to the future, we know there will be many opportunities to use PRAPARE data to respond to individual patient needs and advocate at the state and community levels for important resources, services, and payment structures. The opportunity to impact patients’ health and wellness through this work is incredible!

Registration is open for the 2021 CHAD Conference on September 14 and 15 in Rapid City, SD. Paired with the Great Plains Health Data Network summit, the 2021 CHAD Conference will feature speakers and panelists who will look at the history of the health center movement as a way to inform the current moment and look forward to the future’s potential. Participants will connect to the past through stories and learn how to use stories to continue to be community-driven, equity-oriented, and patient-centered organizations and how we can continue to live out the values of the health center movement in the current context. Tracks include workforce, leadership, health equity, clinical quality, and behavioral health. Visit our conference website for registration, schedule, and room details.

On June 11, 2021, the Health Resources and Services Administration (HRSA) released revised reporting requirements for Provider Relief Fund (PRF) payments recipients. The announcement included expanding the amount of time providers will have to report information and extends key deadlines for recipients who received payments after June 30, 2020. The press release regarding the notice can be accessed here.

The revised reporting requirements supplanting the January 15 requirements can be found here. These reporting requirements do not apply to the Rural Health Clinic COVID-19 Testing Program or claims reimbursements from the HRSA COVID-19 Uninsured Program and the HRSA COVID-19 Coverage Assistance Fund (CAF).

The purpose of the program is to establish, expand, and sustain a public health workforce to prevent, prepare for, and respond to COVID-19. This includes mobilizing community outreach workers, which includes community health workers, patient navigators, and social support specialists, to educate and assist individuals in accessing and receiving COVID-19 vaccinations.

The program intends to address persistent health disparities by offering support and resources to vulnerable and medically underserved communities, including racial and ethnic minority groups and individuals living in areas of high social vulnerability. The Health Resources and Services Administration (HRSA) will fund recipients that have demonstrated experience and expertise in implementing public health programs, particularly in medically underserved areas. Award recipients will need to clearly describe how the funding will directly serve and impact vulnerable communities; and demonstrate how they will prioritize hiring individuals from the communities they serve by providing outreach, education, and assistance related to the COVID-19 vaccine. For more information and to apply, click here.

Federally qualified health centers (FQHCs) care for 30 million patients in more than 1,400 locations across the country. The last significant infrastructure federal investment in FQHCs was in 2009, when health centers served fewer than 18 million patients. An investment in infrastructure would allow an expansion of services to the growing aging population, public housing residents, the unhoused, agricultural workers, rural residents, and veterans, as well as to expand critical services such as oral health, mental health, substance use disorder, and school-based health center services.

The House of Representatives Energy & Commerce committee recently released a bill called the Leading Infrastructure for Tomorrow’s (LIFT) America Act. The package currently includes $10 billion in capital funding for FQHC capital project grants. The package also includes significant investments in broadband, including $80 billion to deploy secure and resilient high-speed broadband. This level of investment would provide the financial support needed to care for the growing patient base.

For those wishing to participate in the National Day of Action on June 30, the National Association of Community Health Centers’ (NACHC’s) Health Center Advocacy Network has provided an Infrastructure Advocacy Toolkit to assist advocates in telling the story of their health center and sample media drafts, social media posts, and email appeals. Contact Bobbie Will at CHAD for more information or to become more involved in health center advocacy.

On June 5, the world marked 40 years since the first five cases of what later became known as AIDS was officially reported. The Community Health Center of the Black Hills (CHCBH) started providing coordinated care for patients living with HIV in 2017. Our goal was to provide a welcoming location where patients could receive primary care, HIV-related care, labs, mental health, and pharmacy services, all under one roof. Many of our patients living with HIV also struggle with homelessness, mental health issues, substance use, and other psychosocial stressors. As I often say, "HIV is usually the least of our patients’ worries."

While an HIV diagnosis can be scary, I think it’s important for us to remember that HIV is a medical diagnosis, not a character flaw. We can serve our community well by learning more about the HIV disease process. Our patients deserve to be treated by team members who understand that with proper treatment, managing HIV requires the same tools we use for any other chronic illness: proper medications, lifestyle changes, emotional support, frequent follow-up, and education.

Increasing our knowledge of HIV-related disease processes has allowed us to address most patient concerns with their primary care provider. We started with just one patient living with HIV in 2017 and now have more than 30 patients living with HIV enrolled in our care. We spent time building relationships with our community partners and now have a much more streamlined process to care for patients. Our staff are in constant communication with patients, specialty providers, and our local Ryan White organization.

At CHCBH, we have implemented multiple processes and procedures to better care for our HIV patients, including:

An on-staff CNP who is HIV-Credentialed through American Academy of HIV Medicine;
An HIV RN case manager;
PrEP and PEP (pre- and post-exposure prophylaxis) services;
Case management staff and RNs can reach out to patients via call or text;
Reserved block scheduling for patients enrolled in the Ryan White Program. We often see patients same-day and always within 24 hours;
Coordination of infectious disease care with Storm Clinic in Sioux Falls via telemedicine;
Updated vaccine protocol for patients living with HIV;
Staff and provider trainings specific to HIV-related care; and,
Staff contests to increase HIV testing throughout the clinic taking CHCBH from 6 percent in 2017 to 25 percent in 2020.

If you’re wondering where to start, I will encourage you to start with two simple actions: BE KIND and ASK QUESTIONS. If you meet someone who has HIV and you have questions, ask them. You might be surprised by all you learn. Please join CHCBH and me in recognizing National HIV Testing Day on June 27. On this day, we unite with partners, health departments, and other organizations to raise awareness about the importance of HIV testing and early diagnosis of HIV.

Jennifer A. Sobolik, CNP, is a family nurse practitioner at the Community Health Center of the Black Hills in Rapid City, SD. She delivers primary medical care to patients living with HIV and serves as the medical provider for the organization’s family planning program.

The Ryan White HIV/AIDS Program’s AIDS Education and Training Center (AETC) Program launched a new Ryan White HIV/AIDS Program AETC Program HIV Care Tools app. Developed by the AETC National Coordinating Resource Center, the HIV Care Tools app provides one-touch access to key HIV care information. The resource includes AETC Program reference materials, tools, and information from other federal programs. It’s free, and apps are available for both iPhone and Android devices. Learn more about the new resource and access the app.

Men’s Health Week is a national observance focused on encouraging boys, men, and their families to practice and implement healthy living decisions. According to the Centers for Disease Control and Prevention (CDC), men in the United States, on average, die five years earlier than women. The higher death rates are primarily a result of three leading causes of death: heart disease, cancer, and unintentional injuries.

Health centers are committed to providing whole-person health care that integrates behavioral health services with primary care and meets the specific health care needs of every individual they serve. During Men’s Health Week, men are encouraged to take control of their health and to teach young boys healthy habits throughout childhood.

Summer is almost here, as is National Health Center Week (NHCW)! CHAD and member health centers will be using the theme "Celebrating Successes, Looking to the Future." The NHCW website has resources and tools to help organizations begin planning NHCW celebrations.

Remember to enter events on the NHCW website by June 30. Health centers planning a community-wide event, inviting Congressional members, and using social media to promote health centers and NHCW with lawmakers and the local media will be considered for a National Association of Community Health Centers (NACHC) or corporate NHCW sponsorship.

The COVID-19 pandemic resulted in many people putting elective procedures on hold, including cancer screenings. Delays in screening for breast, cervical, colorectal, prostate, and lung cancers could lead to cancers that are undiagnosed, untreated, and advanced, which makes them harder to treat. The American Cancer Society Get Screened campaign aims to increase cancer screening rates by raising awareness about the importance of recommended screenings and getting people back on track with their regular screening tests. Regular screening can help save lives.

The American Cancer Society has provided CHAD with a Get Screened partner toolkit. This toolkit includes several collateral items to support CHAD’s and health centers’ preventive health messaging. This toolkit aims to support partners in the public Get Screened campaigns that are currently happening. Many of the resources can be co-branded to promote screening with patients. Contact Kayla Hanson at CHAD or Jill Ireland at the American Cancer Society to receive the toolkit.

It’s time to verify and, if necessary, update health centers’ Patient-Centered Medical Home (PCMH) recognition status. Download this table to view the number of sites with PCMH recognition for each health center. Please review the table to make sure the information is correct. If health center organizations serve multiple states, check the number of sites for each state. Use those numbers to calculate the total number of PCMH-recognized sites in the Health Resources and Services Administration’s (HRSA’s) electronic handbook (EHB).

If the information is correct, there is no need to take further action.
If the information is incorrect, submit an update in EHB by no later than Friday, July 9. See instructions for submitting an update, including the acceptable forms of required documentation.

Best Practices for Improving Cyber Security

Criminals are escalating their cyberattacks and are continually altering their methods to exploit a vulnerability in critical information technology infrastructure to install ransomware. This is evident with the recent attacks in the US at a meat processing facility and the Colonial Pipeline. Internationally, hospitals in Ireland, Germany, and France have been impacted along with banks in the United Kingdom. In response, the White House and the Cybersecurity and Infrastructure Agency (CISA) have published a memo, "What We Urge You to Do to Protect Against the Threat of Ransomware," which includes the following list of best practices:

Implement the Five Best Practices from the President’s Executive Order. President Biden’s "Improving the Nation’s Cybersecurity" executive order is being implemented with speed and urgency across the Federal Government. These five best practices are high impact: multifactor authentication (because passwords alone are routinely compromised), endpoint detection and response (to hunt for malicious activity on a network and block it), encryption (so if data is stolen, it is unusable), and a skilled, empowered security team (to patch rapidly, and share and incorporate threat information in your defenses). These practices will significantly reduce the risk of a successful cyberattack.
Backup Data, System Images, and Configurations, Test Regularly, and Keep Backups Offline. Ensure that backups are regularly tested and not connected to the business network, as many ransomware variants try to find and encrypt or delete accessible backups. In addition, maintaining current backups offline is critical because if the network data is encrypted with ransomware, organizations can restore systems.
Test the Incident Response Plan: Run through some core questions and use those to build an incident response plan.
Check the Security Team’s Work: Use a 3rd party pen tester to test the security of the systems and the ability to defend against a sophisticated attack.
Segment the Networks: There’s been a recent shift in ransomware attacks from stealing data to disrupting operations. It’s critically important that the corporate business functions and manufacturing/production operations are separated. Regularly test contingency plans such as manual controls to maintain critical safety functions during a cyber incident.

CHAD has compiled a list of ransomware attack preventative resources and will continue to update it as needed. Contact Kyle Mertens at CHAD for more information or specific requests.

Measuring and Maximizing Provider Satisfaction

Join CHAD for this three-part series explaining the importance of provider satisfaction, its effect on health center performance, and how to identify and measure provider satisfaction. The webinar series will culminate in a final session at the CHAD in-person conference in September, discussing how to improve satisfaction using health information technology (HIT). Presented by CURIS Consulting, the series will include the process of distributing a survey to providers to evaluate satisfaction and analyze the results of CHAD members and the Great Plains Health Data Network (GPHDN). The intended audience for this three-part series is c-suite staff, HIT staff, clinical leads, and human resources staff.

Importance of Assessing Provider Satisfaction     
This webinar will explain the role providers and their satisfaction levels have on the overall health center performance. The presenter will share different tools used to measure provider satisfaction, including surveys.

Wednesday, June 30
11:00 am CT / 10:00 am MT
Register here.

Identification of Provider Burden
In this presentation, attendees will focus on identifying contributing factors and triggers associated with provider burden. The presenter will discuss questions included in the CHAD and GPHDN provider satisfaction survey tool and the process to distribute the survey.

Wednesday, July 21
11:00 am CT / 10:00 am MT
Register here.

Measuring Provider Satisfaction
In this final webinar, presenters will share how to measure provider satisfaction and how to evaluate the data. The CHAD and GPHDN provider satisfaction survey results will be analyzed and shared with attendees during the presentation.

Wednesday, August 25
11:00 am CT / 10:00 am MT
Register here.

The Internet of Medical Things and the Effects on Patient Safety

Join Mark Jarret MD, MBA, MS, senior vice president, chief quality officer, and deputy chief medical officer at Northwell Health and professor of medicine at Zucker School of Medicine at Hofstra/Northwell as he discusses the Internet of Medical Things (IoMT). Everything from home Wi-Fi to medical devices poses a security risk to patients. Participants will learn more about the changing nature of IoMT and how to continue to protect patients from cyber threats.

Wednesday, June 23
12:00 pm CT/ 11:00 am MT
Email cisa405d@hhs.gov to receive a calendar invite.

Enhancing Cyber-Resilience with Timely Threat Intelligence

In this webinar, leaders will discuss the best sources for threat intelligence, the top threats currently facing health systems, and the most promising defenses against those dangers. HealthsystemCIO hosts this presentation in partnership with HHS 405(D).

Attendees who hold the CHIME CHCIO certification earn 1 CEU. Attendees who have the AEHIS CHISL certification earn 1 CEU for attending security-focused Webinars. Other programs — such as those offered by AHIMA and NAHQ/HQCC — may also award CEUs.

Tuesday, June 29
11:00 am CT/ 10:00 am MT
Register here

Evaluating and Caring for Patients with Post-COVID Conditions

During this Clinician Outreach and Communication Activity (COCA) call, participants will learn about the Centers for Disease Control and Prevention’s new interim guidance, which provides a framework for health care providers in their initial assessment, evaluation, management, and follow-up of persons with possible post-COVID conditions. Post-COVID conditions are still being characterized and include symptoms such as cognitive difficulties, fatigue, headache, dyspnea, and palpitations. Subject matter experts, physicians, and patient representatives from across the United States collaborated to develop the new guidance. Rapid recognition by health care providers of patients with post-COVID conditions and multidisciplinary care using the assessments and approaches described in this guidance could improve the wellbeing and treatment of people with post-COVID conditions.

Thursday, June 17
1:00 pm CT/ 12:00 pm MT

Click on the Zoom link below to join the call at the scheduled time.
https://www.zoomgov.com/j/
1607826639?pwd=L25SbzNYUi80SVo1dU
ZzV1hnRi9MUT09

Webinar ID: 160 782 6639
Passcode: 183098
Telephone: (669) 254 5252

Adolescent Vaccination Town Hall

Join the Health Resources and Services Administration (HRSA) to discuss ways to increase the number of adolescents vaccinated at health centers. Health center providers and pediatric health experts will discuss the challenges and best practices to vaccinate adolescents. Use this peer learning forum to ask questions of the panel and share your strategies in our collective effort to increase vaccination rates for this special population.

Tuesday, June 22
2:30 pm CT/ 1:30 pm MT
Join the day of the session

Investing in Collaboration and Community across North Dakota: An Open Townhall

Host by the North Dakota Department of Health’s Division of Sexually Transmitted and Bloodborne Diseases, this townhall is for community members across the region who are interested in learning more about the department’s engagement in ending the HIV epidemic. The townhall will provide key insights to the department’s activities, provide ample opportunities for feedback and collaborative learning, and introduce the latest iteration of a community planning group, the HIV Prevention and Care Advisory Board.

Tuesday, June 22
4:30 – 6:00 pm CT/ 3:30 – 5:00 pm MT
Register here

Strategies for Building Confidence in Pediatric COVID-19 Vaccination

On-time vaccination throughout childhood is essential because it helps provide immunity before children are exposed to potentially life-threatening diseases. Health care providers and staff should develop strong relationships with parents and patients and provide reliable information to help them make informed decisions.

Please join ERCI for its next Patient Safety Leadership Speaker Series webinar featuring Paul A. Offit, MD, who will explore recent declines in childhood vaccinations and how this may impact expanding COVID-19 vaccinations in adolescents. Dr. Offit will discuss strategies for building confidence in vaccinations, specific considerations for COVID-19 vaccination in children, and tips for communicating with parents, patients, and staff regarding vaccine safety. This free webinar is provided by ECRI on behalf of the Health Resources and Services Administration (HRSA).

Wednesday, June 23
12:00 pm CT/ 11:00 am MT
Register here

Evaluating a Course on Implicit Bias in the Clinical and Learning Environment: Provider Bias-Awareness, Patient-Centeredness, and Reflections

Join HRSA’s Health Workforce TA Center to learn about the implicit race bias that has been associated with poor patient/provider communication, less trust and confidence in the provider, and poor patient-centered communication. These issues are particularly common with Black patients.

Speakers will discuss an online course on implicit bias for academic teaching faculty and others developed by the University of Washington. They will discuss providers’ pre- and post-course bias awareness, pre- and post-patient centered communication, and their reflections on the impact of the course on teaching and clinical practice.

Thursday, June 24
12:00 - 12:45 pm CT/ 11:00 – 11:45 am MT
Register here

The Evolution of LGBTQ Care: The History of Health Centers’ Impact on LGBTQ Health

For over 50 years, community health centers have been at the cornerstone of providing affirming, high-quality health care for LGBTQ people – yet significant disparities in access to health care, chronic disease, health outcomes, and social determinants of health still exist in this community. Health centers have driven monumental change in LGBTQ medical and behavioral health care guidelines, provider and staff training, policy and advocacy, and research, including the standardized collection of sexual orientation and gender identity data to identify and address inequities.

The LGBTQ community has faced a myriad of concerns during COVID-19, from economic insecurity to lack of access to consistent medical and behavioral care, and like many, questions about the vaccines. The National Association of Community Health Centers (NACHC) recognizes the essential voices and resilience of the LGBTQ community. In this webinar, NACHC welcomes national advocates and leaders to discuss their organizations’ historic and continued efforts to assure quality, affordable, and accessible health care to all.

Tuesday, June 29
1:00 pm CT/ 12:00 pm MT
Register here