OP PO NIT RTU Y N OPPORTUNITY

2010 ANNUAL REPORT

WHO WE ARE In 2010, the Arizona Association of Community Health Centers (AACHC) celebrated its 25th year as the Primary Care Association (PCA) for the state of Arizona. All states have a designated PCA charged with advancing the expansion of Federally Qualified Health Centers (FQHCs), other safety net primary care providers, and advocating for the healthcare interests of the medically underserved and uninsured. As a PCA, AACHC also helps its members meet a variety of challenges through training and technical assistance programs. The Association—a non-profit 501c3 tax exempt organization—offers an array of programs designed to improve the health status of the indigent and medically underserved in our state.

Canyonlands CHC

Tuba City Regional Health Care Corporation

NAVAJO

COCONINO

Northern Apache County Special Health Care District/ St. Michales Clinic

MOHAVE Navajo Health Foundation/ Sage Memorial Hospital

Native Americans For Community Action Family Health Center

River Cities Community Clinic

North Country Healthcare

Fort Mojave Indian Health Center

APACHE

Yavapai Apache Nation

CHC of Yavapai

YAVAPAI GILA

Scottsdale Healthcare

LA PAZ

John C. Lincoln CHC Adelante Healthcare

MARICOPA

Native Health Wesley Community Center

Maricopa Integrated Health System

St. Vincent de Paul Sunset CHC

The Excel Group

Maricopa Health Care for the Homeless

Sun Life Family Health Center, Inc

Regional Center for Border Health

GREENLEE

Mountain Park Health Center

NHW Community Health Center

YUMA

ASU-CONHI - Clinical Practice & Community Partnerships

PINAL

Pinal County Division of Public Health

GRAHAM

Marana Health Center, Inc El Rio Health Center

Desert Senita CHC

PIMA

Rural Health Office

University Physcians Healthcare Progressive Healthcare Group

Legend FQHC

Pascua Yaqui Tribe

United CHC, Inc

SANTA CRUZ COCHISE Mariposa CHC, Inc

Associate Member FQHC Look-A-Likes

Chiricahua CHC, Inc Copper Queen Medical Associates

A message from David Rogers Board President, Arizona Association of Community Health Centers What a year 2010 has been! A year full of opportunities and successes related to primary healthcare and especially to understanding health care reform and its impact on the health center world. Much of the dialogue has centered on the continued need for access to high-quality, affordable, culturally-sensitive healthcare. It has been documented in various studies that many Americans do not seek preventive healthcare due to prohibitive costs and limited access, which ultimately negatively impacts the health of communities across the country. With the passage of the Patient Protection and Affordable Care Act, creating and increasing access to care for people across the country and in our state has become an imperative. However, the looming budget cuts in our state and in some others across our great country continue to create a challenge for Community Health Centers (CHC) as they strive to deliver affordable healthcare. With the federal focus on quality care and integration of services, our efforts regarding the use of health information technology have increased, including electronic health records and telemedicine, while we are also beginning to adopt the Patient Centered Medical Home Model and preparing to become Accountable Care Organizations. We continue to examine the value of integrating behavioral health services and other complementary services to the CHC primary care model. With the Health Resources and Services Administration’s New Access Point opportunity, a number of Arizona’s Federally Qualified Health Centers have sought funding for expansion into new communities to address unmet need, and other organizations providing healthcare to underserved populations are also on the path to seeking Federally Qualified Health Center status. We recognize the passage of Healthcare Reform was a success in relation to our grassroots advocacy efforts; it could not have been accomplished without our patients and other CHC advocates. We are aware the Patient Protection and Affordable Care Act recognizes health centers as excellent models of quality, cost effective primary care and the future of the healthcare delivery system. Accordingly, the opportunity for Arizona’s Community Health Centers to expand and increase access to care in communities throughout the state is not without challenges. As the healthcare landscape and marketplace change so rapidly, we continue our strides to be at the forefront of these opportunities. We must ensure that Community Health Centers continue to be synonymous with delivering high-quality, affordable, accessible, culturally-sensitive primary healthcare. At the AACHC, we recognize the opportunities and challenges awaiting us in 2011 are great, with the addition of our new CEO John McDonald we look forward to meeting them, driven by the knowledge that our work ultimately provides much-needed services to individuals and families throughout the state and continues to improve the health status of thousands of our patients.

AACHC’s members: Include 37 not-for-profit, community based, primary care organizations; and Encompass more than 175 locations throughout the state. 2

Sincerely, David Rogers Board President

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MEET AACHC’S MEMBERS Adelante Healthcare, Surprise

Mariposa Community Health Center, Inc., Nogales

Canyonlands Community Health Care, Page

Mountain Park Health Center, Phoenix

Chiricahua Community Health Centers, Inc.,Douglas

Native Health, Phoenix

Community Health Center of Yavapai, Prescott Valley

North Country HealthCare, Flagstaff

Copper Queen Medical Associates, Bisbee

River Cities Community Clinic, Bullhead City

Desert Senita Community Health Center, Ajo

Sun Life Family Health Center, Inc., Casa Grande

El Rio Health Center, Tucson

Sunset Community Health Center, Yuma

Marana Health Center, Inc., Marana

Wesley Community Center, Phoenix

Maricopa Health Care for the Homeless, Phoenix

United Community Health Center, Inc., Green Valley

Maricopa Integrated Health System, Phoenix

oard of Directors B C H C AA 2010 President David Rogers, MBA Chief Executive Officer Sunset Community Health Center Vice President Travis J. Robinette Chief Executive Officer Sun Life Family Health Center, Inc. Treasurer Avein Saaty-Tafoya, MBA, HCM Chief Executive Officer Adelante Healthcare Secretary Kathy Byrne Executive Director El Rio Health Center Member at Large Elizabeth Latham, FNP-C, MSN Chief Executive Officer Canyonlands Community Health Care Fran Driver, RN, MSN, MBA Chief Executive Officer Desert Senita Community Health Center Jennifer Genua-McDaniel Executive Director River Cities Community Clinic

MEET AACHC’S ASSOCIATE MEMBERS

2010 AACHC Team

Arizona State University College of Nursing and Health Innovation- Clinical Practice and Community Partnership, Phoenix

April Bills SEARCH Coordinator

Fort Mohave Indian Health Center, Mohave Valley John C. Lincoln Health Network, Phoenix NACA Family Health Center, Flagstaff Navajo Health Foundation/Sage Memorial Hospital, Ganado Northern Apache County Special Health Care District, St. Michaels Pascua Yaqui Tribe, Tucson Pinal County Division of Public Health, Florence Progressive HealthCare Group, Inc., Benson

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Regional Center for Border Health, Inc., Somerton Rural Health Office, Tucson Scottsdale Healthcare, Scottsdale St. Vincent de Paul-Virginia G. Piper Medical & Dental Clinic, Phoenix The Excel Group, Yuma Tuba City Regional Health Care Corporation, Tuba City University Physicians Healthcare, Tucson Wassaja Memorial Health Center, Fountain Hills Yavapai Apache Nation, Camp Verde

John C. McDonald, RN, MS, CPHQ

Chief Executive Officer

Becky Howard Director of Quality and Health Education Programs Bonnie Fiacco Coordinator of Educational Services, Events, and Publications Dana Wilson Administrative Assistant Diane Daneau Executive Assistant to the CEO/Office Manager

Dianna Gonzales, RN, BSN Chief Executive Officer United Community Health Center, Inc. Ruth Kish, RN, MN Director, Patient Care Service/Chief Operating Officer Copper Queen Medical Associates-RHC Arthur Martinez, MD, MSHA Chief Clinical Officer El Rio Health Center

Ann Roggenbuck, MPH, MBA, PhD Chief Executive Officer North Country HealthCare Jennifer “Ginger” Ryan, MBA, PhD Chief Executive Officer Chiricahua Community Health Centers, Inc. Atman Singh, MD, MBA Chief Medical Officer Adelante Healthcare

Betty Mathis Executive Director Wesley Community Center

John Swagert, MD Chief Executive Officer Mountain Park Health Center

Walter Murillo Interim Chief Executive Officer Native Health Peggy Nies, RN, BSN, MHSA Director Community Health Center of Yavapai Eladio Pereira, MD, MBA, FACP Chief of Medical Staff and Clinical Services Mariposa Community Health Center, Inc.

Jessica Yanow, MPH Director of Women’s Health Programs and Grant Administration

William F. Vanaskie, MS Executive Vice President/Chief Operating Officer Maricopa Integrated Health System Clarence Vatne, MHA Chief Executive Officer Marana Health Center, Inc. James R. Welden Chief Executive Officer Mariposa Community Health Center, Inc.

The Healthcare Connect Team Eric Dugar

Lisa Nieri, MS Migrant Health Program Manager

Director of Network Development and Marketing

Luke Payne Controller

Brenda Cardenas

Nadine Cummins, SPHR Director of Human Resources

Celia Mendoza

Tara McCollum Plese, MPA Director of Government and Media Relations

Daniel Martin

Wendy Armendariz Director of Outreach and Enrollment/Community Development/SEARCH

Customer Care Coordinator

Customer Care Coordinator Community Relations Liaison Customer Care Coordinator Jessica Cruz

2010 The Arizona Partnership For Immunization (TAPI) Team Debbie McCune Davis Program Director

Eric Dugar, Jr. Input Clerk

Kristen Irizarry Input Clerk

Jennifer Tinney Program Manager

Karin Szymanski Project Coordinator

Bernice Diaz Input Clerk

Annie McGuire Special Projects Manager

Nicole Singleton Billing Project Coordinator

Nan Ath Input Clerk

Andie Denious, RN Nurse Consultant

Sharon Smith Project Coordinator

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FUNDS TO CONTINUE A MISSION OF CARING

2010 op•por•tu•ni•ty Opportunities. 1a. A favorable or advantageous circumstance or combination of circumstances. 1b. A favorable or suitable occasion or time.

In 2010, the Association continued to work closely with local, state, and federal partners to address the well-documented healthcare needs in Arizona. AACHC remained committed to seeking opportunities to enhance access to primary healthcare, and as such, pursued funding opportunities to support the work of Arizona’s Community Health Centers. The following timeline outlines AACHC’s 2010 grant activities:

April 2010

AACHC receives funding from the Health Resources and Services Administration (HRSA) Bureau of Primary Health Care to continue serving as Arizona’s PCA through March 2012. The Arizona Coalition Against Domestic Violence, in partnership with AACHC, the Arizona Department of Health Services, the Arizona Family Planning Council, Dr. Jill Messing and the Southeast Arizona Health Education Center, is selected as one of ten recipients of a nationally competitive grant through the Family Violence Prevention Fund. Project Connect: A Coordinated Public Health Initiative to Prevent Violence against Women is funded by the Office on Women’s Health (OWH) of the U.S. Department of Health and Human Services. It will find new ways to identify, respond to and prevent domestic and sexual violence, and promote an improved public health response to abuse.

June 2010

2. A chance for progress or advancement

AACHC completes activities pursuant to a grant award from the Office of the Arizona Attorney General, which provided more than $783,000 of no-cost and low-cost prescription medications to underserved individuals throughout the state, allowing FQHCs to assist people that might not access necessary medication due to cost.

With Healthcare Reform, Community Health Centers have been presented with the opportunity to

September 2010

advance and create systems change to make healthcare affordable and accessible for all Americans. AACHC invites you to learn more about the challenges and opportunities we faced in 2010 and the opportunities awaiting us in 2011 and the future.

Every right implies a responsibility; every opportunity, an obligation, every possession, a duty. John D.Rockefeller

HRSA renews the Association’s Student/Resident Experiences and Rotations in Community Health (SEARCH) contract, allowing AACHC to continue to support the training of medical students and residents while providing mentorship opportunities for preceptors. SEARCH provides community health centers with an excellent tool to attract medical professionals to their facilities.

November 2010

AACHC is awarded supplemental funding from the Health Resources and Services Administration to expand capacity to address training and technical assistance needs in the following core areas related to supporting health centers: community development, expansion planning, patient-centered medical home development, meaningful use health information technology adoption and workforce development.

December 2010

AACHC completes activities related to a HRSA Planning Grant which allowed AACHC to conduct a comprehensive community health needs assessment in Gila County, a county with limited access to primary care services and no Community Health Center. The grant also allowed for comprehensive assessment of existing Arizona FQHCs (Capital Needs Assessment, Financial Trends Analysis, and State Economic Impact Analysis). Information garnered from the Gila County Needs Assessment is ultimately used by FQHCs in seeking New Access Point funding in two communities in this county.

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The Association will continue to explore future funding opportunities to support the work of the Association as well as Community Health Centers and improve access to primary healthcare throughout Arizona.

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THE AACHC ADVOCACY AGENDA On the Federal Front

On March 23, 2010, the Patient Protection and Affordable Care Act (PPACA) was signed into law by President Obama. Community Health Centers were at the epicenter of the law, as their model of primary and preventive healthcare was seen as the optimal way to: • • •

Provide quality healthcare Guarantee access to healthcare Ensure cost savings to consumers and the healthcare industry

Thanks to strong advocacy efforts at the state and federal level, even the most vocal critics of the healthcare reform law supported PPACA provisions to strengthen Community Health Centers and grow the primary healthcare workforce through the expansion of the National Health Service Corps. AACHC members joined in the advocacy efforts of the National Association of Community Health Centers (NACHC) to educate their members of Congress on the importance of the Patient Protection and Affordable Care Act. Five of the eight members of Arizona’s Congressional delegation voted in support of the Stimulus funding and the Affordable Care Act, citing their support for CHCs as one of the primary reasons for doing so.

Despite AACHC’s goal of minimizing the negative impacts to healthcare services, cuts included the elimination of the Primary Care Program, which provided sliding fee funds to health centers and other primary care providers. State vaccine funding, children’s rehabilitative care services for non-title XIX children, and services for non-title XIX behavioral health services were also eliminated from the Department of Health Services. The state Medicaid program, AHCCCS, abolished certain services such as organ transplants, adult dental services, dentures, insulin pumps, podiatry services, non-emergency medical transportation, and well exams. Arizona’s Children’s Health Insurance Program (CHIP), KidsCare, was eliminated in the original budget, but stipulations in the healthcare reform bill forced the Legislature to reinstate the program with an enrollment freeze that was approved by the Centers for Medicare and Medicaid Services. New applicants are now put on a waiting list, while those who fail to re-enroll in a timely manner or neglect to pay their premiums are also removed from the program and placed on a waiting list. This freeze has resulted in a substantial decrease in the number of children enrolled (from 69,000 to 27,000). The Legislature also attempted to roll back the expanded Medicaid population from 100% of the Federal Poverty Level (FPL) to 33% FPL. Strong advocacy efforts and the threat of violating the “Voter Protection Act” in the state constitution did not deter efforts to reduce the Medicaid population in order to balance the state budget. The passage of the PPACA halted the effort to reduce the Medicaid population. PPACA required states to maintain their current healthcare programs, which prevented the Legislature from removing 310,000 Medicaid (AHCCCS) enrollees.

Grassroots Advocacy AACHC’s grassroots advocacy is a vital component of the advocacy efforts. The CEOs, CHC Board members, staff members and patients of Arizona’s Community Health Centers assist in AACHC’s and the National Association of Community Health Centers’ advocacy efforts by providing data, fact sheets, and personal stories that inform their Legislators and Congressmen of the activities in which the CHCs in their districts are involved to improve access to healthcare in the communities they represent. A strong grassroots advocacy effort also enables Community Health Centers to obtain the resources and support they need to continue delivering affordable, quality and comprehensive health care to medically underserved and uninsured people in Arizona. Community Health Center leaders present Congresswoman Gabrielle Giffords, the “NACHC Defender Award” in Washington, DC.

At the State Capital

The second session of the 49th Arizona State Legislature included four special sessions as well as a long legislative session and presented a number of opportunities for AACHC’s advocacy team and grassroots advocates to educate policymakers on the important and necessary work of Arizona’s Community Health Centers. Challenged by the current economy, Arizona was confronted with steep revenue shortfalls and rising demands for safety net services. Arizona’s Governor and Legislature fought to close a $1.2 billion budget shortfall for FY 2010 and FY2011, utilizing a combination of additional cuts to state agencies, fund sweeps and the “sale” of state assets such as the State House and Senate buildings.

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A strong network of healthcare groups, health plans, community groups, business groups, and human services advocates are crucial to the success of AACHC’s advocacy program. The advocacy team works very closely with other organizations to promote legislation that will improve healthcare for all Arizonan’s. The grassroots network was most effective during the elections for state and federal offices. Despite the attention on Health Centers at the federal level, many congressional candidates and candidates for the state legislature were not fully aware of the valuable services that CHCs provide to their communities. AACHC and various health center staff met with candidates in their districts to give them tours of the facilities and educate them on the services that health centers provide to the people in their community. AACHC’s Legislative Dinner, hosted in conjunction with the Association’s Annual Meeting in March 2010, provided an opportunity to educate Arizona legislators on the vital role health centers play in their communities. Additionally, AACHC members make annual visits to Arizona’s congressional delegation in Washington, DC to share information on the work of Arizona’s Community Health Centers as a key component of AACHC’s grassroots advocacy efforts.

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TO EDUCATE & CELEBRATE

AACHC Celebrates 25 Years as Arizona’s Primary Care Association In 2010, the Arizona Association of Community Health Centers celebrated 25 years serving as the Primary Care Association for the state of Arizona. To commemorate this milestone, AACHC and its Board of Directors hosted the dinner event “A Strong Legacy. A Powerful Future.” on November 11, 2010. The event featured presentations from AACHC Founding Board Member, Jim Welden, and AACHC Board Member, Dr. Ginger Ryan. The night continued with remarks from Joseph Gallegos, Senior Vice President for Western Operations for the National Association of Community Health Centers, who recognized AACHC for its 25 years of service. Mr. Gallegos emphasized the importance of Community Health Centers and the future impact and success of PCAs,

AACHC members and partner organizations participate in the 2010 Annual Meeting held at the University of Arizona College of Medicine in Phoenix

outlining new initiatives that will transform the health care system.

AACHC members gather in celebration of the 25th Anniversary of the Arizona Association of Community Health Centers

AACHC Annual Meeting: Focus on Leadership and Innovation On March 9, 2010, AACHC members gathered at the University of Arizona College of Medicine in Phoenix for the organization’s 2010 Annual Meeting, focusing on the following:

Impact of the State Budget on the Delivery of Healthcare Thomas J. Betlach, MPA, Director- Arizona Health Care Cost Containment System Jim Humble, Assistant Director/ Chief Financial Officer- Division of Operations, Arizona Department of Health Services Jane Pearson, RN, BSN, Associate Director for Programs - St. Luke’s Health Initiatives William G. Johnson, PhD, Director, CHIR/Professor, Biomedical Informatics Arizona State University Leadership Lessons are Not Frozen in Time Danny Valenzuela, Executive Coach - Transition Execs, LLC



Immunization Best Practices for Health Centers Debbie McCune Davis, Program Director- The Arizona Partnership for Immunization Jennifer Tinney, Program Manager- The Arizona Partnership for Immunization



New Horizons for Primary Care Joan Shaver, PhD, RN, FAAN, Dean, College of Nursing- University of Arizona

Lessons on Board Strategic Leadership Darlene Bainbridge

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AACHC Staff Celebrate the Evening AACHC’s Anniversary event also featured an awards ceremony that honored exceptional contributors to the growth of Community Health Centers in Arizona. 11

Clarence Vatne, Chief Executive Officer of Marana Health Center was presented with the Association’s Annual Leadership Award by incoming CEO John McDonald and AACHC Board President, David Rogers. Clarence was honored for his leadership on the AACHC Board as well as his success in managing significant growth and change at Marana Health Center over the past decade.

AACHC’s Distinguished Service Award was presented to Kathy Byrne of El Rio Community Health Center. The Distinguished Service Award provides recognition to an individual who has improved access and facilitated the delivery of primary care in Arizona. Kathy’s work on the Southern Arizona Health Information Exchange program has helped to advance the delivery of primary care services.

The Association’s Quality Care Award was presented to Dr. Ching Wang, Chief Medical Officer of Sunset Community Health Center in recognition of more than 15 years of service leading clinical operations and the quality management program while providing high quality medical care to all of his patients.

AACHC also presented an Innovation Award to El Rio Community Health Center for the development of their Employee Mentorship Program.

Lisa Clouse, PA-C for Sun Life Family Health Center was honored as the SEARCH Preceptor of the Year. Ms. Clouse was recognized for her excellence and dedication in training health profession students and building the primary healthcare workforce.

Fatima McCasland, AACHC Board member and Chief Executive Officer of Desert Senita Community Health Center, was presented with an award for her service and leadership on the AACHC Board of Directors.

The AACHC Board of Directors also presented an award to Richard Polheber, AACHC’s Interim Chief Executive Officer, for his service. Mr. Polheber served as the interim CEO for 11 months, leading the Association through the changing primary healthcare landscape in the era of Health Care Reform.

PROGRAM TO EXPAND ACCESS TO COMMUNITY HEALTH CENTERS & HEALTHCARE SERVICES Programs to Address Shortages of Medical Professionals Lisa Peña, Casa Grande Front Desk Manager for Sun Life Family Health Center was presented with the Customer Service Award. Lisa has made significant contributions by providing excellent customer service to health center consumers and by working cooperatively with staff at all levels of Community Health Center operations. “Let’s do what’s right for the patient” is Lisa’s own unspoken goal.

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The Arizona Student/Resident Experiences and Rotations in Community Health (SEARCH) program, funded by the National Health Service Corps (NHSC), offers training opportunities to qualified health professional students at Community Health Centers (CHCs) and eligible private practices located in urban/rural areas of the state. Students gain valuable, hands-on clinical and community health experiences by working on multidisciplinary teams providing care in medically underserved areas. The program works closely with Arizona Area Health Education Centers, Arizona’s Primary Care Office, and various academic institutions to ensure a positive experience for program participants.

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In 2010, the Arizona SEARCH program provided support to 52 students in primary care disciplines working in conjunction with 15 clinical training sites. 87% of the program participants were very satisfied with the overall rotation experience and 96% responded that their desire to work in an underserved area increased with their participation in a community project. The program also focused on providing training to preceptors participating in training students. Over 100 preceptors around the state participated in the SEARCH Preceptor Training series focusing on key topics such as: Teaching in the Office Setting, Feedback Teaching Skills, and Inspiring and Engaging Students.

disproportionate rate to other Arizona counties, and that residents suffer a significantly higher death rate as a result of influenza and pneumonia. The report also found that Payson low-income residents encounter barriers in accessing primary care services due to the lack of providers who accept Medicaid (AHCCCS) and who do not offer a sliding fee scale.

Eric Henley, MD, Chief Medical Officer North Country HealthCare and Medical Director SEARCH Program

Ed Paul, MD, Director Clinical Educational Programs for Yuma Regional Medical Center and facilitator for SEARCH preceptor trainings.

In 2011, the SEARCH program will continue to focus on providing clinical training opportunities for students and residents while also focusing on mentorship activities, enhancing preceptor trainings, and enhancing recruitment opportunities in accordance with the PCA’s role in the development of initiatives to increase the effectiveness of workforce recruitment and retention programs.

Community Development The Patient Protection and Affordable Care Act, enacted into law in March of 2010, designated $11 billion dollars over the next five years to help develop and expand Community Health Centers. With this funding initiative, the Association experienced an influx of new organizations expressing interest in the FQHC program. In 2010, AACHC provided assistance to 8 new organizations and 7 existing FQHCs looking to expand and meet the need for healthcare services for vulnerable populations. AACHC’s Community Development efforts, accomplished in partnership with the Arizona Department of Health Services, focus on increasing access to healthcare through the creation of new FQHCs, expansion of existing FQHCs in areas of the state with the highest need, and sharing FQHC best practices. AACHC accomplished this through the provision of tailored training and technical assistance to ensure compliance with federal regulations and the provision of relevant information and resources.

Training

In June of 2010, AACHC, HRSA’s Office of Regional Operations-Region IX, the Arizona Department of Health Services, AHCCCS, and the Inter Tribal Council of Arizona partnered to conduct the Primary Care Workshop for Native American Communities to offer training to tribal organizations interested in seeking FQHC status. The training offered assistance and sharing of resources to various organizations. The training was extremely successful and efforts were made to replicate the training in the state of Nevada.

Assessing Need and Planning

In 2009, AACHC received a HRSA Planning Grant to develop a community needs assessment and to analyze the growth capacity of existing FQHCs. Gila County was identified as the target area as there is no FQHC located or providing services to area residents. Report findings include that Gila County was ranked as the least healthy county in the state. Areas of concern include that Gila residents die from premature death at a

The Arizona Community Health Centers Report analyzed the State Economic Impact, Financial Trends, and Capital Needs of existing FQHCs in the state and also helped to highlight the significant role health centers play as engines of economic development in their communities. In 2008, Arizona health centers generated an overall economic impact of $439 million, leading to a total of 4,176 jobs throughout the state. Total cost of planned capital development projects for the nine health centers reporting was projected to be $33,590,667, likely a conservative estimate, particularly in light of current efforts on the national level to expand health care coverage and access. The number of people seeking the services at Community Health Centers will likely continue to grow at a fast pace for several years. AACHC staff continues to monitor funding opportunities that support CHC growth and sustainability while providing appropriate resources, data, and other assistance to CHCs interested in expansion of services and/or opportunities for capital improvements. AACHC and the Board of Directors will be working on developing a State Growth Strategy Plan to address the development of health centers in high need areas and assist with the strategic planning of healthcare resources for expansion of existing FQHCs.

Building a Health Network for the Working Poor AACHC serves the working poor through HealthCare Connect, a unique discounted healthcare delivery system that provides access to coordinated and affordable healthcare. The program was established in 2004 with a federal grant. HealthCare Connect is currently supported by enrollment fees, and other grant funds. The program serves as a safety net for families in Maricopa County who earn too much to qualify for Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid program, but who cannot afford private insurance. With HealthCare Connect, families are able to access affordable healthcare services, including: primary care visits, specialty visits, hospitalization, outpatient hospital services, laboratory, radiology, dental services, pharmacy discounts, and vision services. In 2010, HealthCare Connect: Partnered with Children’s Action Alliance and several well-known community organizations to form a coalition to assist children in accessing healthcare, known as the Kids Health Link. The coalition was awarded funding through First Things First, Arizona’s Early Childhood Development and Health Board, to provide outreach and application assistance to uninsured families in the North and Southeast regions of Maricopa County. Contracted with 1,300 healthcare providers committed to providing healthcare services at dis counted rates to members. Provided enrollment services and assistance to pregnant teens/mothers in collaboration with Crisis Pregnancy Centers; and Collaborated with Catholic Healthcare West-East Valley to serve that community’s uninsured population.

A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty. Winston Churchill

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Reaching Arizona’s Migrant & Seasonal Farmworkers

Enrolling Needy Arizonans in Assistance Programs

The Association’s Migrant Health Program works with the Migrant Health Centers in the Southwest Region, which includes Arizona, Utah, New Mexico and Nevada, to reduce health disparities and improve access to healthcare for the farmworkers who work in this region. Farmworkers continue to be some of the most economically disadvantaged people in the country and also work in one of the nation’s most hazardous industries.

AACHC conducts outreach activities by raising awareness of the availability of high-quality, communitybased, culturally sensitive and affordable primary and preventive health care services available at Arizona’s 166 Community Health Center sites and providing training and technical support to Community Health Centers for their outreach efforts.

Barriers to accessing health care and some health issues faced by farmworkers include: Lack of medical coverage Possible language and cultural barriers Frequent moves determined by where agricultural work is found Respiratory illnesses and other concerns that arise from pesticide use and exposure Heat-related illness Repetitive motion injuries Lack of follow-up treatment for chronic illnesses due to frequent moves, long commutes, and non-typical work hours In 2009, FQHCs and Migrant Health Centers in Arizona provided service to 9,422 farmworker patients. This number reflects only 14% of approximately 67,000 farmworkers in Arizona, highlighting the challenges of working with this hard-to-reach population. In 2010, the Association’s Migrant Health Program, instrumental in improving the coordination of healthcare programs that serve farmworkers, has: Provided technical assistance to the Migrant Health Centers as needed. Acted as a liaison between the Migrant Health Centers and the Office of Special Populations at HRSA as well as the Farmworker Health Network. Assisted in the procurement and development of materials, outreach activities, and other support services. Participated in the coordination of the Western Migrant Stream Forum Attended NACHC’s National Farmworker Health Conference. Participated in the production of the annual Arizona Interagency Farmworkers Coalition (AIFC) conference. Created training manual for current and future Migrant Health Centers regarding expectations, requirements, and resources. Obtained certification from the State of Arizona Department of Agriculture for Pesticide Safety Training. Provided information and insight into farmworker health issues and resources at a summit created by a joint effort from the Department of Education and community based organizations; and Informed the National Advisory Council on Migrant Health about unique challenges regionally and in Arizona in providing healthcare services to the farmworker population.

Outreach is accomplished through: AACHC partnerships and collaborations with healthcare and community based organizations AACHC staff membership/leadership in state task forces, advisory and work groups AACHC presentations to health and human services programs AACHC newsletter – Primary News for Primary Care AACHC Membership Directory AACHC, in partnership with AHCCCS and the Department of Economic Security (DES), offers monthly trainings on the use of Health-e-Arizona (HEA), Arizona’s web-based eligibility system as part of an ongoing effort to encourage the use of the Health-e-Arizona (HEA) application to screen FQHC patients for federal and state programs. Federal law requires states to place eligibility workers in sites other than state eligibility offices, specifically naming Disproportionate Share Hospitals and FQHCs, because these are provider sites that see a high volume of pregnant women and children. In 2010, a total of 41,536 applications were completed through HEA, a 4.4% increase in the number of applications created by AACHC Members. Of these applications, 2,348 were eligible for KidsCare, 11, 485 for Food Stamps, and 86,312 eligible for Sliding Fee Scale services. In 2010 AACHC, in partnership with the Area Agency on Aging, coordinated a Medicare 101 Refresher Course for CHC Outreach and Enrollment staff to provide education on general Medicare benefits, enrollment periods, and the effects of Health Care Reform on Medicare so that outreach and enrollment staff are able to provide assistance to Medicare beneficiaries. The Outreach and Enrollment program will focus its future efforts on a statewide public education campaign to promote awareness of the FQHCs as a health care safety net for Arizona’s underserved populations. In addition, support and training will be provided to each FQHC to develop a localized approach for marketing and outreach and enrollment strategies.

As one of the 8 Regional Migrant Health Coordinators, the Migrant Health Program also participates in annual meetings and quarterly calls with HRSA/OSPH and the Farmworker Health Network to share best practices and further expand the ability of Arizona’s Migrant Health Centers to provide outreach and services to the hard-working farmworker population. The Regional Migrant Health Coordinators are also tasked with assisting organizations interested in becoming Migrant Health Centers and providing services to migrant and seasonal farmworkers. In the most recent New Access Point funding opportunity from HRSA, organizations seeking to provide services to special populations, including migrant and seasonal farmworkers, were given priority, further underscoring the urgency of reaching out to and providing services to the farmworker population.

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EDUCATION & TRAINING Sponsoring Clinical Programs that Increase Access to High Quality Healthcare Services These are exciting times for Community Health Centers. Both opportunities and challenges present themselves in health care reform, expansion of health centers and a shrinking primary care workforce. The current mandate for health centers is one of growth and integration. The patient-centered medical home and accountable care organization models have emerged as important strategies in how the nation’s health centers deliver and maintain excellent primary care for underserved populations. Additionally, the need for health centers to compete in a new market place and move from “safety net” to “service excellence” providers continues to be of high importance. The Association’s Quality & Health Education Programs work with Community Health Centers across Arizona to meet these challenges and enhance the accessibility of quality healthcare to low-income, uninsured, vulnerable, and special needs populations by means of technical assistance (TA), training, support, and guidance on a variety of topics including: Health Care Reform Quality and Risk Management Patient Centered Medical Home Emergency and Disaster Preparedness Corporate Compliance Federal Tort Claims Act Meaningful Use/Health Information Technology Cultural Competency Planning and Budgeting for Health Center Expansion Immunization advancement Building High Functioning Teams Professionalism and Career Advancement in Support Staff Customer Service Redesigning Compensation Models Chronic Care Management Telemedicine UDS (Uniform Data System)

Networking, Advancing Best Practices, and Peer Support Opportunities The AACHC and the Quality & Health Education Programs bring together Community Health Center professionals from across the state to share best practices as well as to discuss a variety of health center challenges and success stories. These leadership committees include: Clinical Committee (CHC Medical Directors) Continuous Operational Performance Group or “COPs” (Quality Directors, Nurse Managers and other patient care professionals) Dental Committee (Dental Directors) Behavioral Health Committee, (Behavioral Health Professionals) Pharmacy Committee (Pharmacy Directors) Financial Officers Group or “FOG” (Chief Financial Officers) Chief Operating Officers Committee Human Resource Officers Committee 18

Quality & Health Education Programs also promote a variety of webinars, conferences and educational opportunities throughout the state, region and nation. Major AACHC training vents in 2010 included:

The 9th Annual Invaluable Medical Assistant Training Seminar Over 150 Medical Assistants from across the state gathered at the Phoenix Convention Center in October 2010 for education on: Immunizations Personal and professional emergency preparedness Patient life cycle Professionalism and career advancement Health technology and meaningful use Systems change To ensure excellent content development AACHC sought input from a variety of partnering organizations, including: the Greater Valley Area Health Education Center, The Arizona Partnership for Immunization (TAPI), Mountain Park Health Center, Native Health West, Maricopa Community Colleges, Central AZ College, Maricopa Integrated Health System, University Physicians Healthcare, Maricopa County Department of Public Health and the Arizona Department of Health Services.

Medical Assistants from across Arizona participate in the educational Seminar held at the Phoenix Convention Center.

Community Health Center Corporate Compliance training The American Recovery and Reinvestment Act (ARRA) was the first opportunity CHCs received this year to prepare for the expansion and provision of primary and preventive care to all people. With every funding opportunity, CHCs must demonstrate their financial viability and also demonstrate compliance with ARRA’s reporting requirements and state and federal regulations. The two-day training, developed by Feldesman Tucker Leifer Fidell LLP and RSM McGladrey Inc. with financial support from the National Association of Community Health Centers, was specifically designed for Community Health Centers to learn from expert faculty about: The seven elements of effective corporate compliance programs The key legal and financial requirements for Health Centers How to conduct risk assessments, audits and investigations, as well as how to create a compliance program work plan tailored to meet the Health Center needs 19

The 17th Annual Region IX Leadership Training Conference

AACHC has for the past 17 years partnered with the Western Clinician’s Network to organize and host an annual regional conference with the support of the Health Resources and Services Administration (HRSA). The Annual Region IX Leadership Training Conference is designed to enhance clinical knowledge, managerial skills, and team building for clinical, executive, and financial staff of community and migrant health centers and other primary care clinics within the states of Arizona, Nevada, California, Hawaii and the Pacific Islands. The 2010 17th Annual Region IX Leadership Training Conference was held in Burbank, CA and was focused on “Leading the Way in the Era of Healthcare Reform.” Session topics included: Healthcare reform

SUPPORTING IMMUNIZATION TO IMPROVE THE HEALTH STATUS OF CHILDREN The Arizona Partnership for Immunization (TAPI)—a statewide coalition of more than 400 members—is housed within AACHC and works closely with AACHC and Community Health Centers throughout Arizona to promote immunization best practices. As part of their focus on primary care services, Community Health Centers support TAPI’s immunization mission, promoting immunizations against preventable childhood diseases like measles, mumps, polio and whooping cough. Thanks to TAPI and its partners, immunization coverage rates in Arizona have improved dramatically in the past two decades, with nearly three in four children fully immunized by age two.

Patient-Centered Medical Home development Planning and budgeting for health center growth Redesigning compensation models Electronic Health Records and meaningful use Federal Tort Claims Act Workforce development Transforming health centers from “safety net” to “service excellence”

Eladio Pereira, MD, MBA, FACP networks with other Region IX Community Health Center Leaders at the Region IX Leadership

Training Conference in Burbank Highlighted speakers were: Thomas S. Bodenheimer, M.D., UCSF Department of Family and Community Medicine; Betsy Thompson, M.D. Chief Medical Officer, CMS-Region IX; Robert K. Ross, M.D., Chair of The California Endowment; Herb Schultz, Regional Director, U.S. Department of Health and Human Services, Region IX; and Marc Wetherhorn, National Advocacy Director, National Association of Community Health Centers. We want to recognize that the Region IX Leadership Conference draws upon the expertise of its own Clinicians and Health Center leaders. The majority of the speakers for the thirty-four educational sessions were our own Clinicians and Executives from throughout the region.

TAPI’s 2010 projects included:

Learn the Seven Secrets to Streamlining Immunization Delivery TAPI, in collaboration with the Arizona Department of Health Services Immunization Program, presented free trainings to improve immunization practices in public and private providers’ offices. Participants received valuable information on immunization-friendly office practices, vaccine handling, state requirements, how to give shots, and the state immunization registry.

Cocooning Project This project educated family members and medical professionals about the importance of the Tdap vaccine with the goal of vaccinating family members that would be in contact with an infant, to create a protective cocoon against pertussis.

Child Care Project This project’s focus was to develop and distribute parent education materials regarding the value of immunizations in child care centers. The information provided addressed vaccine safety, vaccination schedules and the state registry, ASIIS.

Vaccine Reimbursement Project TAPI piloted an Arizona statewide billing program aimed at recuperating the administration fees for county health departments that provide vaccines to children with Medicaid.

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David Rogers (second from left), Jim Welden and Dr. Ching Wang enjoy the peer networking opportunities available at the Region IX Leadership Training Conference in Burbank, CA.

Vaccine Congress TAPI partnered with Arizona Chapter of the Academy of Pediatrics to determine best practices for vaccine financing and reimbursement. The next Vaccine Congress will include Arizona employers to help educate about the importance of promoting preventative health coverage. 21

PROGRAMS TO ASSIST WOMEN AACHC Members Earn TAPI Awards

In 2010, AACHC Women’s Health Programs focused on the following major areas:

Many AACHC members were honored by TAPI for their commitment to immunization programs during its 14th Annual Big Shots for Arizona Awards.

Domestic Violence Preconception Health Access to healthcare/health information for rural women

Hot Shot Award

The Hot Shot Award honors public and private sector individuals and organizations who have given tremendous amount of time and effort to increase immunizations, and gone above and beyond the call of duty. 2010 recipients included: Lynn Untermeyer and Kerry Henny at Scottsdale Healthcare Community Health Services Scottsdale

Domestic Violence Through a Rural Program Grant from the Department of Justice Office on Violence Against Women, AACHC has worked since 2007 to integrate domestic violence services into the healthcare setting. Five rural Arizona Community Health Center sites have partnered with the Association on the Domestic Violence Medical Advocacy Program:

Chiricahua Community Health Centers, Inc. Douglas

Chiricahua Community Health Center (Douglas) Desert Senita Community Health Center (Ajo)

Dr. Daniel T. Cloud Outstanding Practice Awards

Mariposa Community Health Center, Inc (Nogales)

Daniel T. Cloud, Jr., MD, Arizona’s first pediatric surgeon, passed away in 2010, one month shy of his 85th birthday. Dr. Cloud realized his dream of establishing a children’s hospital in Phoenix when he became Founding President of Phoenix Children’s Hospital and served in that role from 1983 until his retirement in 1990. Over the course of his career, which included service in both the U.S. Navy and Army, Dr. Cloud also served as the President of the American Medical Association, Commissioner of the Joint Commission on Accreditation of Hospitals and American Medical Association delegate to the World Health Organization. Dr. Cloud served as both a co-chair and chair of TAPI, and the Dr. Daniel T. Could Outstanding Practice Award was named in his honor.

North Country HealthCare (Holbrook)

The Dr. Daniel T. Cloud Award is presented to practices and clinics that reach 90 percent immunization coverage levels for 2 year olds. The following AACHC members earned this TAPI recognition in 2010:

North Country HealthCare (St. Johns) In 2010, health center partners addressed domestic violence through: Universal, confidential screening for domestic violence during healthcare visits Direct advocacy services to 331 victims of domestic violence and/or sexual assault Supportive services to 421 children and family members in homes where domestic violence occurred 34 trainings to professionals in a variety of fields, including healthcare, child care, law enforcement, and education 64 community education events in which over 3,900 individuals received education to increase awareness of dating violence, domestic violence, sexual assault and stalking. Participation in coordinated community response to domestic violence, including regular collaboration with a wide variety of community partners to better address accountability

Adelante Healthcare, Surprise

for perpetrators and needs of victims

El Rio Community Health Center, Tucson John C. Lincoln Health Network-Desert Mission Community Health Center, Phoenix Mountain Park Health Center, Phoenix

Women’s Health Programs also partnered with the Arizona Coalition Against Domestic

North Country HealthCare, Flagstaff Sun Life Family Health Center, Casa Grande

Violence, the Arizona Department of Health Services, the Arizona Family Planning Council,

Sunset Community Health Center, Yuma University Physicians Healthcare-Children’s Center at Kino, Tucson

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Dr. Jill Messing and the Southeast Arizona Health Education Center on a project, which was

“The secret of success is to be ready when your opportunity comes.”

selected as one of ten recipients of a nationally competitive grant through the Family Violence

Benjamine Disraeli

sexual coercion within relationships and the resulting negative impact on women’s overall

Prevention Fund. Project Connect: A Coordinated Public Health Initiative to Prevent Violence against Women is funded by the Office on Women’s Health (OWH) of the U.S. Department of Health and Human Services. It will find new ways to identify, respond to and prevent domestic and sexual violence, and promote an improved public health response to abuse. The project provides increased emphasis on the issues of birth control sabotage and health, including reproductive health.

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A NEW FOCUS IN 2011 AACHC CEO John C. McDonald Sees Opportunity Preconception Health In 2010, Women’s Health Programs also participated in the Arizona Department of Health Services Bureau of Women and Children’s Health task force on development of a statewide strategic plan for preconception health, with a focus on improving birth outcomes in Arizona. This task force brought together a wide variety of public health and primary care stakeholders to discuss target populations, strategies for bringing attention to this issue, and evaluation measures. Also in 2010, Women’s Health Programs and Quality & Health Education Programs worked with the Arizona Department of Health Services Sexually Transmitted Disease Program to explore opportunities for health centers in preventing infertility in young women by creating systems for early identification and treatment of sexually transmitted diseases.

Access to healthcare/health information for rural women Women’s Health Programs also participated in meetings, surveys, and conversations with the Department of Health and Human Services Office on Women’s Health to examine ways build a streamlined, sustainable, multidisciplinary program to address the comprehensive needs of women in rural and frontier areas. Women’s Health Programs continued to participate in the Arizona Rural Women’s Health Network in 2010. This network is comprised of a variety of organizations, including Community Health Centers and state agencies, examining ways to increase access to healthcare and health resources for women in rural areas of the state.

The passage of the Patient Protection and Affordable Care Act in 2010 has created an opportunity for Community Health Centers to expand to meet the growing national and local need for access to affordable, high-quality, culturally competent primary healthcare. In Arizona, we should not lose sight of those whose health may ultimately be affected by state and federal decisions regarding budgets and healthcare. Now is the time for Community Health Centers and other safety net providers to work together as a network to ensure that Arizonans have access to primary healthcare services to meet their needs. Arizona’s Health Centers are rapidly changing and addressing expanded service needs in order to accommodate the rapid growth in Arizonans needing access to primary care. It is an exciting time for Community Health Centers, a time full of opportunity to serve the health needs of our fellow Arizonans. The Association will continue to improve upon the support given to its members and remain focused on advancing the work of Community Health Centers. For over 25 years, the Arizona Association of Community Health Centers has leveraged resources and partnerships for Arizona’s Community Health Centers. In a new era where the focus is on personalized, coordinated and affordable healthcare, AACHC will continue to foster new partnerships to assist in the transformation of our healthcare landscape. We look forward to making new strides in program development and training to address some of the challenges our members will face and working to create additional opportunities for our members. We are pleased about the accomplishments of 2010 as outlined in this report and are excited about the opportunities and success we will experience in 2011!

The Association recognizes the importance of a comprehensive model of women’s health understanding a holistic approach to women’s health that recognizes there are many components to wellness and that women have unique and complex health-related needs must be taken. The Association maintains a continuing commitment, through the Domestic Violence Medical Advocacy Program and pursuit of further funding related to women’s health, to comprehensive women’s healthcare services.

Other Support Activities Other support that AACHC has provided to Community Health Centers in 2010 has included: Community Health Center Collaborative Ventures (CHCCV), a program developed to address the unique needs and concerns of Federally Qualified Health Centers, which offers group purchasing as well as other opportunities to Community Health Centers. Uniform Data System (UDS) reporting requirements workshop. Sponsorship of statewide Financial Officers Group (FOG) of Community Health Centers. By sponsoring training and fostering communication, FOG helps improves the financial performance of Arizona’s Community Health Centers. AACHC works with Association members and AHCCCS Administration to provide consistent and comprehensive procedures for the reconciliation process. John McDonald Chief Executive Officer Arizona Association of Community Health Centers 24

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OP PO NIT RTU Y N 700 East Jefferson Street, Suite 100 Phoenix, Arizona 85034 Phone: 602.253.0090 Fax: 602.252.3620 www.aachc.org