2011 ANNUAL REPORT

COLLABORATION

Arizona Association of Community Health Centers

2011 ANNUAL REPORTArizona Association of Community Health Centers

A message from David RogersBoard President,Arizona Association of Community Health Centers

The end of fiscal year 2011 marks the close of my term as Board President. When reflecting on my time serving in this role, I am particularly struck by the improved collaboration and growth Arizona’s Community Health Centers (CHCs) have undergone, not just as individual organizations but also as a collective group of centers. We have watched the healthcare landscape in our country change rapidly as a result of the Affordable Care Act and have witnessed the strides that Community Health Centers in Arizona and across the nation have made to meet objectives set forth through this legislation, while continuing to deliver cost-effective, high-quality, culturally-sensitive primary healthcare services.

As we have faced state and federal budget shortfalls, we have watched as AACHC, CHCs, and partners have collaborated in identifying new ways to work together despite challenges, to promote accessible healthcare for all. When the potential for federal cuts to the Health Center Program loomed this year, Arizona’s health center leadership, staff, patients, and community supporters participated actively in providing information to help educate Congress and the White House on the importance of primary and preventive healthcare provided by health centers. While state budget cuts have continued to impact our government agencies, our patients, and our health centers, we have worked diligently and in collaboration with one another to include our partners to assure continued access to care in Arizona’s communities.

At AACHC, we recognize that 2012 will not be without challenges. As Arizona’s health centers continue on a path towards achieving Patient Centered Medical (Health Care) Home certification, examining how best to integrate our services, expanding our use of Health Information Technology, and reaching Meaningful Use, we know that we will have to explore new, innovative approaches and potentially redesign the way we deliver care. We will keep in mind that it is not always possible to accomplish our objectives alone. It is our collaboration with other health care entities that strengthens us and allows us to move forward and grow. I am confident that we will continue to serve as resources to each other on this journey through Healthcare Reform and that next year’s Annual Report will demonstrate our continued commitment to work together in moving Arizona’s Health Centers forward so that we will continue to meet the diverse and varied healthcare needs of all Arizonans.

Sincerely,David Rogers, MBA2011 Board President

4

PresidentDavid Rogers, MBAChief Executive OfficerSunset Community Health Center

Vice PresidentTravis J. RobinetteChief Executive OfficerSun Life Family Health Center, Inc.

TreasurerAvein Saaty-Tafoya, MBA, HCMChief Executive OfficerAdelante Healthcare

SecretaryKathy ByrneExecutive DirectorEl Rio Health Center

Member at LargeElizabeth Latham, FNP-C, MSNChief Executive OfficerCanyonlands Community Health Care

Lisa Cummings, OTR/LDirector, Outpatient ServicesCopper Queen Medical Associates-RHC

Fran Driver, RN, MSN, MBAChief Executive OfficerDesert Senita Community Health Center

Dianna Gonzales, RN, BSNChief Executive OfficerUnited Community Health Center, Inc.

Arthur Martinez, MD, MSHAChief Clinical OfficerEl Rio Health Center

Betty MathisExecutive DirectorWesley Community Center

Walter Murillo Chief Executive OfficerNative Health

Peggy Nies, RN, BSN, MHSADirectorCommunity Health Center of Yavapai

Eladio Pereira, MD, MBA, FACPChief of Medical Staff and Clinical ServicesMariposa Community Health Center, Inc.

Ann Roggenbuck, MPH, MBA, PhDChief Executive OfficerNorth Country HealthCare

Jennifer “Ginger” Ryan, MBA, PhDChief Executive OfficerChiricahua Community Health Centers, Inc.

John Swagert, MDChief Executive OfficerMountain Park Health Center

William F. Vanaskie, MSExecutive Vice President/Chief Operating OfficerMaricopa Integrated Health System

Clarence Vatne, MHAChief Executive OfficerMarana Health Center, Inc.

James R. WeldenChief Executive OfficerMariposa Community Health Center, Inc.

2011 AACHC TeamJohn C. McDonald, RN, MS, CPHQChief Executive Officer

Chandra Jennings Jackson, MPHOral Health Coordinator

Christine MahlstedeAssistant Director of Program Development

Deborah Bonicelli KaminskiFinance Officer

Diane DaneauExecutive Assistant to the CEO

Haley GrigaitisAdministrative Assistant/Office Manager

Jenna LoweryAccounting Assistant/Bookkeeper

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

Joanna Martori, RNWomen’s Health Program Coordinator

Lisa Nieri, MSMigrant Health Program Manager

Lourdes PaezSEARCH Coordinator

Mark TowsleyActing Director of Human Resources

Shelli HorningDirector of Data Services and Planning/Corporate Compliance Officer

Tara McCollum Plese, MPADirector of Government and Media Relations

Tunde Kiss (TK)Coordinator of Special Projects

Wendy ArmendarizDirector of Outreach and Enrollment/SEARCH

2011 The Arizona PartnershipFor Immunization (TAPI) TeamDebbie McCune DavisProgram Director

Jennifer TinneyProgram Manager

Karin SzymanskiProject Manager

Sharon SmithProject Coordinator

Annie McGuireSpecial Projects Manager

Heather HertzelAdministrative Support

Kaleen KahlPublic Health Educator

Tom BrewerMedical Billing Specialist

Tom ClyneMedical Billing Specialist

The Healthcare Connect TeamEric DugarDirector of NetworkDevelopment and Marketing

Brenda CardenasCustomer Care Coordinator

Celia MendozaCommunity Relations Liaison

Tania AldayCustomer Care Coordinator

5

2011 AACHC Board of Directors

MARICOPA

PIMA

COCONINO

MOHAVE

APACHE

NAVAJO

GILA

YAVAPAI

YUMA

COCHISE

LA PAZ

PINALGRAHAM

GREENLEE

SANTA CRUZ

Canyonlands Healthcare

Chiricahua CHC, Inc

Adelante Healthcare

CHC of Yavapai

Desert Senita CHCEl Rio Health Center

Marana Health Center, Inc

Mariposa CHC, Inc

Mountain Park Health Center

North Country Healthcare

Sun Life Family Health Center, Inc

Sunset CHC

United CHC, Inc

Maricopa Integrated Health SystemNative Health

Copper Queen Medical Associates

John C. Lincoln CHC

Fort Mojave Indian Health Center

Native Americans For Community ActionFamily Health Center

Navajo Health Foundation/Sage Memorial Hospital

Northern Apache CountySpecial Health Care District/St. Michales Clinic

Pascua Yaqui Tribe

Progressive Healthcare Group

Center for Rural Health

Youth Advocate Programs, Inc.

Regional Center for Border Health

University Physcians Healthcare

ASU-CONHI - Clinical Practice & Community Partnerships

Mountain Health & WellnessWesley Community Center

Tuba City Regional Health Care Corporation

S

Arizona Family Health Partnership

Valle del Sol, Inc.TERROS, Inc.

People of Color Network, Inc.

cottsdale Healthcare

Maricopa Health Carefor the Homeless

LegendFQHC Member

Other Member

FQHC Look-A-Like

The Arizona Association of Community Health Centers (AACHC) is designated by the Health Resources and Services Administration (HRSA) Bureau of Primary Health Care (BPHC) as the Primary Care Association (PCA) for the State of Arizona. All states have a designated PCA to advance the mission of Federally Qualified Health Centers (FQHCs), often known as Community Health Centers (CHCs), and the wide array of primary healthcare organizations who are members. AACHC advocates for the healthcare interests of all Arizonans, including the medically underserved, underinsured, and uninsured. AACHC employs staff specializing in healthcare quality, data gathering and analysis, advocacy, partner collaboration, safety net workforce, oral health, migrant health, women’s health, health center program development, and other areas. AACHC also has strong local, state, regional, and federal partners with which it leverages resources to accomplish goals. AACHC provides a variety of educational opportunities for members, including peer networking committees which provide a forum for sharing of best practices among member colleagues for optimal healthcare delivery.

WHO WE ARE

AACHC’s members:

• Include 38 not-for-profit, community based, primary care organizations; and

• Encompass more than 175 locations throughout state

6

Meet AACHC’s MeMbers

Meet AACHC’s AssoCiAte & AffiliAte MeMbers

Adelante Healthcare

Canyonlands Healthcare

Chiricahua Community Health Centers, Inc.

Community Health Center of Yavapai

Copper Queen Medical Associates

Desert Senita Community Health Center

El Rio Health Center

Marana Health Center, Inc.

Maricopa Health Care for the Homeless

Maricopa Integrated Health System

Mariposa Community Health Center, Inc.

Mountain Park Health Center

Native Americans for Community Action

Native Health

North Country HealthCare

Sun Life Family Health Center, Inc.

Sunset Community Health Center

Wesley Community Center

United Community Health Center, Inc.

Arizona Family Health Partnership

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

Center for Rural Health

Fort Mojave Indian Health Center

John C. Lincoln Health Network - Desert Mission

Mountain Health & Wellness

Navajo Health Foundation/Sage Memorial Hospital

Northern Apache County Special Health Care District

Pascua Yaqui Tribe

People of Color Network, Inc.

Progressive HealthCare Group, Inc.

Regional Center for Border Health, Inc.

Scottsdale Healthcare - NOAH

TERROS, Inc.

Tuba City Regional Health Care Corporation

University Physicians Healthcare

Valle del Sol, Inc.

Youth Advocate Programs, Inc.

7

The Association is proud to recognize our members who, despite reductions in funding for both state and federal

programs, have expanded their services, opened new sites, added departments and mobile units, and continue

to increase access to healthcare services for those that need it most. 2011 accomplishments include:

Adelante Healthcare, Inc. opened Adelante Healthcare, Surprise and Adelante Healthcare, Avondale OB/Gyn.

Canyonlands Healthcare opened their new sites at Beaver Dam and Chilchinbeto, re-opened their Lake Powell

site, and moved to a larger facility in Safford.

Chiricahua Community Health Centers, Inc. opened the 15th Street Pediatric Center of Excellence.

Community Health Center of Yavapai opened new sites at Verde Valley and Cottonwood.

Copper Queen Medical Associates completed their Palominas Clinic expansion, began digital mobile

mammography, and opened their Health Matters site.

El Rio Community Health Center opened their new Birth & Women’s Health Center.

Marana Health Center, Inc. opened their new Main Clinic and opened the Copper Café in conjunction

with their Behavioral Health department.

Mariposa Community Health Center, Inc. opened their new Dental Clinic and WIC program facility.

Mountain Park Health Center opened their new site at Maryvale.

North Country HealthCare opened new sites at Williams and Bullhead; new buildings at Holbrook,

Round Valley, and Flagstaff with new OB/Gyn services; and started their School Based Healthcare

Mobile Unit project.

Sun Life Family Health Center, Inc. opened their new building for the Eloy Family Practice

including the first pharmacy in Eloy in 16 years, and started their Mobile Oral Health Screening program.

Sunset Community Health Center re-opened their new Main Clinic site and opened four

School Based Health Clinics: two in Yuma, one in San Luis, and a mobile medical clinic in Wellton.

United Community Health Center, Inc. opened their new site at Amado.

8

col•lab•o•ra•tion

(k làbb ráysh’n) n. pl. Collaborations. Definition: a working together: the act of working

together with one or more people in order to achieve something

Healthcare Reform has placed increased focus on concepts such as the Patient Centered Medical Home,

Accountable Care Organizations, Health Information Technology, and use of Health Information

Exchange to improve healthcare quality and demonstrate cost-effectiveness. Collaboration with a

variety of partners is integral to successful implementation of initiatives that will help health centers

continue to grow and meet the ever-changing needs of their communities.

2011

9

COLLABORATION

Our MIssIOnTo promote and facilitate the development and delivery of affordable and accessible community

oriented, high-quality, culturally effective primary healthcare for everyone in the state of

Arizona. This will be accomplished through advocacy, education and technical assistance.

Collaboration on Strategic Direction In 2011, the AACHC Board of Directors approved the organization’s updated three-year strategic plan,

which was developed through a collaborative process involving AACHC leadership, staff, and Board

members. The following strategic goals were identified:

Advocacy: Advocate for public policy that supports our mission and the mission of the CHCs.

Patient Centered Medical Home (PCMH): Lead, support and initiate collaborative efforts

to enable Arizona CHCs in achieving the goal of Patient Centered Medical Home status.

Data Collection: Establish a centralized warehouse that will promote meaningful

information sharing among Arizona health centers and key stakeholders.

Outreach: Increase community awareness to promote the value of CHCs,

positioning them as the healthcare provider of choice for all Arizonans.

Workforce: Provide a variety of comprehensive diversified services that assist the health centers

in the recruitment and retention of qualified staff.

Statewide Growth: Lead collaborative efforts that support the sustainability and expansion

of CHCs in Arizona.

Collaboration on Funds to Support its MissionIn 2011, the Association continued to work closely with local, state, and federal partners to address

Arizona’s well-documented healthcare needs. AACHC remained committed to seeking opportunities

to enhance access to primary healthcare, pursuing funding opportunities to support the work

of Arizona’s Community Health Centers. The following timeline outlines AACHC’s 2011 grant activities:

April 2011

AACHC receives funding from the Health Resources and Services Administration (HRSA) Bureau

of Primary Health Care (BPHC) to continue serving as Arizona’s PCA through March 2012.

10

september 2011

AACHC is one of five Primary Care Associations nationwide to receive grant

funds from the DentaQuest Foundation’s Strengthening the Oral Health Safety Net

Initiative to provide oral health technical assistance and leadership development to

support Community Health Centers in expanding oral health services. Through this

project, AACHC is working to build capacity to promote oral health and address

issues of oral health for safety net providers across the state.

HRSA renews AACHC’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.

October 2011

The Arizona Department of Health Services renews AACHC’s Public Health

Emergency Preparedness contract, supporting AACHC activities, in collaboration

with CHCs, to ensure that CHCs are involved in local, regional, and state

preparedness planning and able to respond efficiently and effectively to public

health emergencies.

AACHC receives funding from the Department of Justice Office on Violence Against

Women Rural Program to continue the Rural CHC Domestic and Sexual Violence

Advocacy Program. The three-year grant award will allow four health center sites

in rural areas to retain full-time advocates on staff who will continue to provide

on-site advocacy to patients, participate in coordinated community response efforts,

and provide training and education in each of the participating rural communities.

AACHC is notified of continued funding to support its partnership in Project Connect:

A Coordinated Public Health Initiative to Prevent Violence against Women. Funded by

the Office on Women’s Health (OWH) of the U.S. Department of Health and Human

Services, this collaboration, spearheaded by the Arizona Coalition Against Domestic

Violence, promotes an improved public health and primary care response to domestic

violence.

During 2011, AACHC also collaborated with state and county agencies, universities, and

other partners on grant opportunities to promote the work of Arizona’s CHCs. AACHC

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.

Alone we can do so little; together we can do so much.Helen Keller

11

On the Federal Front

As the Patient Protection and Affordable Care Act provisions have unfolded, health centers have been tasked with meeting a variety of objectives in the quest to increase access to affordable, high-quality primary care, with a focus on integration of services. These changes necessitate education of policymakers as well as creation of policy that supports health centers in meeting these objectives effectively. AACHC’s advocacy team, a collaborative group comprised of the Director of Government and Media Relations, AACHC’s CEO, and the Legislative Advisory Committee has been actively engaged in addressing policy issues regarding areas such as:

Behavioral Health Integration

Health Information Technology

Health Insurance Exchange

While focusing on these areas, AACHC and members also recognize that successful provision of primary and preventive healthcare relies on adequate funding for health service delivery and capital expenditures to upgrade facilities and invest in equipment. It is also important that health center patients are able to retain their Medicaid and Medicare coverage.

At the state Capital

A number of high profile bills were proposed and debated during this year’s legislative session, but issues surrounding the state budget remained the primary focus of legislative leadership. Recognizing that the state needs to be prepared for a significant drop in revenue when the additional 1-cent sales tax, passed by voters last May, expires in 2014, legislative leadership was determined to address the structural deficit this year. A large budget shortfall, a poor economy, large unemployment numbers, and the need for sustainable safety net programs lead to a battle for scarce resources.

In total, the Arizona legislature reduced funding for state programs by $1.1 billion, nearly half of which came from reductions in the Arizona Health Care Cost Containment System (AHCCCS), the state Medicaid program. The Governor’s plan was built around enrollment freezes that are projected to reduce AHCCCS enrollment by approximately 240,000 Medicaid recipients and included a $53 million reduction in the Arizona Department of Health Services’ budget.

Impacts on the AHCCCS program included the elimination of the Medical Expense Deduction category on May 1, 2011, which affected approximately 6,000 people who have spent down their resources due to a serious or debilitating health condition. The freeze on adults without dependent children (“Childless Adults”) began on July 8, after it was approved by the Centers for Medicare and Medicaid Services (CMS). Other AHCCCS reductions included reduced reimbursement rates for doctors, hospitals, and other healthcare providers, and required co-pays from patients.

Collaboration on the AACHC Advocacy Agenda

12

AACHC’s goal was to minimize the negative impacts of these severe budget cuts to healthcare services. With that goal in mind, AACHC collaborated with the Keogh Health Foundation and a variety of healthcare, behavioral health, and community organizations to mitigate the impact of the freeze on the Childless Adult Medicaid population. AACHC and Keogh moved quickly to initiate a campaign called “Don’t Get Dropped Arizona!” (DGDAZ). The purpose of the campaign was to ensure that current enrollees and their healthcare providers were aware of the importance of renewing AHCCCS membership in a timely manner to prevent loss of Medicaid benefits. The campaign continues to create awareness of the possible loss of benefits through a website, community outreach projects, trainings, fliers, posters and wide ranging media exposure.

The campaign has had a tremendous impact on reducing the number of people who lost their AHCCCS coverage. For those who lose their Medicaid coverage, DGDAZ has also been promoting a program established through the Affordable Care Act, the Pre-existing Condition Insurance Program (PCIP). The PCIP program was incorporated into the DGDAZ campaign as a reasonable alternative for former AHCCCS patients and provides healthcare coverage to individuals who are not eligible for health insurance due to pre-existing conditions.

Grassroots Advocacy

Grassroots advocacy is a vital component of AACHC efforts. Health center CEOs, CHC Board members, staff members and patients of Arizona’s CHCs assist in AACHC’s and the National Association of Community Health Centers’ (NACHC) advocacy efforts by providing data, fact sheets, and personal stories that inform their legislators and congresspersons of the activities in which CHCs in their districts are involved to improve access to healthcare in their communities. A strong grassroots advocacy effort also enables Community Health Centers to obtain the resources along with the support they need to continue delivering affordable, high-quality, comprehensive healthcare to medically underserved and uninsured people in Arizona.

This year the grassroots network focus was on critical issues at the federal level. Worldwide economic problems, a large U.S. deficit, and high unemployment numbers created a sense of urgency for President Obama and the U.S. Congress. As members of Congress concentrated on reducing the federal deficit through deep budget cuts, the President’s proposal of raising revenue coupled with cuts to “entitlement” programs put critical healthcare programs in jeopardy.

The deficit reduction plan included the formation of a Congressional Super Committee that would determine the best approach to reducing the federal deficit. Arizona Senator John Kyl was appointed to the Super Committee, and his position as a key decision maker on deficit reduction proposals stepped up Arizona health centers’ grassroots efforts. With the future of critical health center services on the line, AACHC staff and members met with Senator Kyl’s staffers in Washington, DC and the district offices in Arizona to discuss the importance of sustaining key health center services. They also met with other members of Arizona’s Congressional delegation and their staff to discuss the importance of health centers to the communities they serve. NACHC’s national mobilization effort enhanced efforts to educate members of Congress on the necessity of retaining current programs. Arizona’s health center grassroots participation reached an all-time high, as AACHC members and partner organizations made phone calls to their members of Congress and the White House. They also circulated petitions and sent hundreds of e-mails and letters imploring policy makers to consider the importance of investing in primary and preventive healthcare. For their efforts, the Association is deeply grateful, as engaged grassroots participation is key to continued success of the health center movement.

13

search

The Arizona Student/Resident Experiences and Rotations in Community

Health (SEARCH) program, funded by the U.S. Department of Health

and Human Services, Health Resources and Services Administration,

offers training opportunities to qualified health professional students

at CHCs and eligible practices located in urban/rural areas of the state.

Students gain valuable, hands-on clinical and community health experi-

ences by working in

multidisciplinary teams providing care in medically underserved areas.

SEARCH collaborates with several partners, including: Arizona Area

Health Education Centers, the Arizona Department of Health Services

Bureau of Health Systems Development (Arizona’s Primary Care Office or PCO), various academic

institutions, and community organizations to ensure a positive experience for program participants.

In 2011, the Arizona SEARCH program:

Provided support to 67 participants (exceeding target of 60) in primary care disciplines

Worked in conjunction with 15 clinical training sites

Received over 120 inquiries from individuals interested in participating in SEARCH, demonstrating

the successful promotion efforts of the program and the strong need for its existence

The majority of participants agreed or strongly agreed that, as a result of their SEARCH rotation, they:

Have become more comfortable counseling patients with different cultural and economic

backgrounds (99%)

Are better able to identify the health status of the community (98%)

Can better identify those groups in the community that are “at risk” or that have special needs (93%)

Have a greater understanding of the roles of other health professionals (94%)

Can better identify those public and private institutions that provide services to the community (95%)

Had an opportunity to engage in health center operations and community events (81%)

Community projects are required during SEARCH rotations to help participants engage with the communities and

gain new perspectives from their rotation. These projects help students/residents learn about the social, cultural,

and political pulse of the local community. Projects are selected according to the participant’s interests, needs of the

community members and/or the needs of the clinical staff.

Collaboration on Programs to Address Shortages of Medical Professionals

14

15

During 2011, the SEARCH program:

Successfully launched a mentorship program with the enrollment of six community preceptors representing rural

and underserved communities throughout Arizona. The mentorship program provided SEARCH participants the

opportunity to connect with community members/mentors in hopes of promoting longitudinal relationships

Hosted three Preceptor Trainings: Dr. Ed Paul hosted preceptor trainings for all SEARCH providers to discuss effective

techniques for teaching students in a clinical setting

Hosted six Student/Resident Forums: Dr. Eric Henley hosted forums for all SEARCH participants to discuss

rotations, community projects, barriers and conduct mini-case studies

Continued to track recruitment of previous program participants and verified at least 4 SEARCH alumni are now

providers practicing within an FQHC

Workforce Development

Arizona communities continue to grapple with a physician shortage. As noted in the Center for American Progress 2009

report Closing the Healthcare Workforce Gap, “Rural Americans and those living in other underserved areas across the country

are especially vulnerable to these current and growing health workforce shortages.”

To help address workforce recruitment and retention challenges, AACHC hosted a training series targeting

health centers and small non-profit primary care clinics. The training series included educational sessions on

how to maximize marketing efforts for recruitment, onboarding, developing a mentoring program for new

clinicians, and best practices for staff retention.

In 2011, AACHC also began development of a recruitment and retention model to assist member health centers with

workforce development efforts and began partnering with the Primary Care Organization (PCO) around recruitment

and retention and outreach targeting National Health Service Corps Scholars and Loan Repayors in the state. Without

appropriate staffing levels, CHCs in Arizona cannot undertake the growth and expansion necessary to provide healthcare

services needed in their communities.

Eric Henley, MD,Chief Medical OfficerNorth CountryHealthCare andMedical DirectorSEARCH Program

Ed Paul, MD, DirectorClinical EducationalPrograms for YumaRegional MedicalCenter and facilitatorfor SEARCH

Health Fair

Health Screen

Staff Education

Patient Education

High School Presentation

Chronic Disease Management

Other

2%3%

Helping strengthen Community resources and servicesAACHC’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 of FQHC best practices. AACHC works to meet community development needs through the provision of tailored training and technical assistance to ensure compliance with federal regulations and the provision of relevant information and resources.

Technical Assistance

Through a comprehensive process of mapping assets, identifying need, and facilitating community meetings, the Community Development Program helps target rural and urban communities develop and strengthen primary care delivery networks. The Association offers resources and technical assistance by:

Identifying and working with community leaders to help communities address concerns about primary healthcare access

Providing assistance on needs assessments, health status indicators, barriers to care, and community, and marketplace dynamics

Facilitation of partnership development and coalition building to identify, educate, and motivate potential partners

Provision of comprehensive assistance on regulatory and legislative guidelines to help navigate the federal assistance guidance and regulatory expectations

In 2011, AACHC and the PCO worked with over 14 organizations in Arizona to provide information and resources for Federally Qualified Health Center (FQHC) and FQHC Look-Alike (FQHC LAL) designation. Unfortunately, with the competitive nature of New Access Point (NAP) applications, Arizona did not receive any NAP awards. However, six organizations throughout the state received Planning Grant funds to help plan and conduct needs assessments for the development of future FQHCs. AACHC is providing technical assistance and support to these organizations and is looking forward to the growth of these organizations.

Training

During the summer, AACHC partnered with the PCO and the Arizona Center for Rural Health to provide a two-day training, “Arizona Health Care Forum: Improving Access to Care for Arizona’s Most Vulnerable Populations.” Over 100 individuals participated in the forum representing organizations interested in developing an FQHC or rural health clinic or improving access by minority populations to current safety net facilities. Themes highlighted during the forum included starting and operating a successful community health center and addressing barriers to care.

Assessing need and Planning

In 2011, AACHC developed the Statewide Growth Strategy Plan (SGS Plan) to identify potential areas of unmet need, explore partnerships/collaboration with existing health center grantees, and assist in better planning for future growth and expansion of FQHCs during the next two years. AACHC, in partnership with the PCO, reviewed Need for Assistance scores to identify high need areas in the state for which it was crucial to promote access to primary care services. The 2011 SGS Plan detailed a total of 44 new/expansion projects (18 NAP/9 Expanded Medical Capacity/9 Behavioral Health Expansion/5 Oral Health/ 3 Pharmacy) throughout the state. Financial resources needed for the proposed projects totaled $11.2 million dollars and included workforce projections of 80 new clinicians and 174 support staff, demonstrating a considerable growth in FQHCs in the coming years if resources are available.

Collaboration on Programs to Expand Access to Community Health Centers, Primary Healthcare, and Enabling Services

16

Building a Health network for the Working PoorAACHC 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 the 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 2011, HealthCare Connect:

Partnered with Children’s Action Alliance and several well-known non-profit agencies to form the Kids Health Link Coalition, funded by First Things First to provide outreach and enrollment assistance to families and children with a primary focus on children ages 0-5 to ensure that these children have some sort of health care coverage.

Collaborated with Catholic Healthcare West, East Valley, providing application assistance and resources for parents and children through an Oral Health Outreach program.

Contracted with over 1,300 healthcare providers, 17 hospitals, 28 urgent care facilities, and 15 private dental offices committed to providing healthcare services at discounted rates to over 3,100 active members.

Enrolling needy Arizonans in Assistance ProgramsAACHC conducts outreach activities by raising awareness of the availability of high-quality, community-based, culturally-sensitive, and affordable primary and preventive healthcare services available at Community Health Centers and providing training and technical support to CHCs for their outreach efforts.

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 Arizona 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. Community Health Center staff provides outreach and enrollment assistance for various programs including:

Temporary Assistance for Needy Families (TANF) Public Housing

Food Stamps Medicaid/AHCCCS

Medicare

The importance of outreach and enrollment efforts has never been greater, as freezes were implemented on the AHCCCS childless adult population, the Medical Expenditure Deduction program (MED), and AHCCCS parents between 75%-100% FPL due to state budget cuts, and co-pays for people enrolled in AHCCCS were introduced to reduce state Medicaid expenditures.

17

It is the long history of humankind (and animal kind, too) those who learned to collaborate and improvise most effectively have prevailed.Charles Darwin

reaching Arizona’s Migrant & seasonal Farmworkers AACHC’s Migrant Health Program (one of 7 Regional Migrant Health Coordination programs) 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 through collaborative partnerships, provision of training and technical assistance, and information sharing. Farmworkers work in one of the nation’s most dangerous occupations and continue to be highly economically disadvantaged in this country, with approximately 75% earning less than $10,000 annually. Arizona’s annual agricultural products total over three million dollars, and the migrant and seasonal farmworker population is vital to assuring that crops are planted, picked, and continue to stimulate the economy.

Barriers to access to healthcare and health issues faced by farmworkers often include:

Lack of employer provided medical coverage and no sick, vacation, or personal time to access health care services

Frequent moves determined by where agricultural work is found

Respiratory illnesses and other issues that arise from pesticide use and exposure

Heat related illness

Substandard living conditions

Possible language and cultural barriers

Lack of follow-up treatment for chronic illnesses due to frequent moves, long commutes, and non-typical work hours

Estimates of the farmworker population in Arizona range from 55,000 to 115,000, and in 2010, Migrant and Community Health Centers provided services to 11,525 farmworkers and their family members. Migrant Health Centers are uniquely qualified to provide healthcare to migrant and seasonal farmworkers utilizing:

A comprehensive, high-quality, culturally competent approach to preventive and primary care health services

An understanding of the healthcare needs, challenges, and barriers to care for migrant and seasonal farmworkers

Innovative outreach techniques to make farmworkers aware of available services

Creative ways of providing basic healthcare services and follow-up care to an often highly mobile and hard to reach population

Paramount to assisting the Migrant Health Centers in reaching the farmworker population is the continued relationship building and collaborative efforts between AACHC, Migrant and Community Health Centers (M/CHCs), and other organizations that provide services to the farmworker population. These collaborative efforts help to increase awareness and utilization of the Community and Migrant Health Centers as medical homes and resources for vital preventive care. To support these efforts, the Association’s Migrant Health Program, in the last year, has:

Created a regional profile of the migrant and seasonal farmworker population including demographics, numbers of MSFW served at M/CHCs, types of agriculture and associated revenue, and issues impacting farmworkers’ access to healthcare.

Provided information and technical assistance to organizations considering applying for Migrant Health Center 330(g) funding

Developed partnerships with organizations serving the farmworker population such as Head Start, Migrant Education, and other community based organizations

Participated in the coordination of the Western Migrant Stream Forum

Participated in the coordination and facilitation of farmworker testimonials for the National Advisory Council on Migrant Health

18

Attended NACHC’s National Farmworker Health Conference and facilitated roundtable discussions with the

National Advisory Council on Migrant Health and conference participants about addressing barriers to care for

the farmworker population

Participated in the production of the annual Arizona Interagency Farmworkers Coalition (AIFC) conference

Informed the National Advisory Council on Migrant Health about Arizona and region’s unique challenges

in providing health care services to the farmworker population

Collaborated with the Arizona Health Disparities Center and programs addressing refugee health in the creation

of a survey to determine the capacity of language access services at Community Health Centers in Arizona

Advancing Optimal Oral Health in Arizona CommunitiesIn September 2011, AACHC received a grant from the DentaQuest Foundation to develop programming with the intention

of improving the oral health safety net in Arizona. The new oral health program includes:

Increased focus on oral health within CHCs and partner organizations

Integration of CHC medical, dental, and behavioral departments

Advocacy for policies and programs to enhance oral health services

An oral health focus during AACHC training events, including the AACHC Annual Meeting

and Region IX Leadership Conference

Promotion of the Smiles for Life National Oral Health Curriculum and creation of additional materials to enhance oral

health referral sources for CHCs

Arizona was of particular interest to the DentaQuest Foundation due to the dramatic health disparities in this state, barriers

in accessing oral health services, and lack of Medicaid funding for adult dental care. In Arizona, achieving optimal oral health

in the pediatric population is a challenge, with:

60% of children 6-8 years old having experienced tooth decay

only 57% of children grades K-3 having seen a dentist in the past year

40% of 3rd graders having untreated tooth decay

tooth decay and disease affecting children’s well-being, education, and social development

19

The DentaQuest Foundation sees opportunities for Community Health Centers in Arizona to improve access to preventive dental care, enhance their dental clinics/programs, and assist in preventing dental disease. Through DentaQuest Foundation funding, AACHC is working with Safety Net Solutions (SNS), a division of the DentaQuest Institute, to provide direct and individualized technical assistance (TA) to five health centers to improve operational efficiencies in their dental programs. The five Community Health Centers receiving direct technical assistance include:

Canyonlands Community Health Center

Desert Senita Community Health Center

El Rio Community Health Center

Marana Community Health Center

North Country HealthCare

AACHC hopes to see the strengthening of the oral health safety net in Arizona, and enhancement of management, outreach, and expansion of CHC dental programs.

Collaboration to Improve Healthcare Qualityresources and Technical AssistanceIn 2011, AACHC provided information, resources, and technical assistance to members and partners 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 & Budgeting for Health Center Expansion Immunization Advancement

Building High Functioning Teams Professionalism & Career Advancement in Support Staff

Customer Service Redesigning Compensation Models

Group Purchasing Chronic Care Management

Telemedicine UDS (Uniform Data System)

AACHC also unveiled its updated website (http://www.aachc.org) in spring 2011. The new website format allows for better

sharing of resources, information on best practices, and promotion of training and technical assistance to health centers and other partners.

networking, Advancing Best Practices, and Peer support OpportunitiesAACHC brings together Community Health Center professionals from across the state to share best practices and discuss health center challenges and successes through a number of peer networking committees:

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 (FOG)

Chief Operating Officers Committee

Human Resource Officers Committee20

utilization of Data & Patient Centered Medical HomeThrough the Patient Protection and Affordable Care Act, achieving Meaningful Use, receiving Patient Centered Medical Home

(PCMH) certification, and participating in Accountable Care Organizations (ACOs) have become high priorities for health

centers nationwide. Data can demonstrate need and illustrate collective impact. It can also help in identifying areas for

operational improvement. Meaningful data is crucial as the Affordable Care Act provisions move forward, with data

collection and analysis becoming increasingly important aspects of day to day healthcare provision. In 2011, AACHC began

to collect and report data from Community Health Center partners, and is working to build more extensive data collection

mechanisms, in collaboration with state organizations and other partners that can position Arizona’s health centers for the

future.

In 2011, AACHC also brought health center Chief Operating Officers, Financial Officers, and Quality Officers together to

discuss Patient Centered Medical Home statuses, challenges, and opportunities. With data serving as a driving force in the

effort to establish medical homes and improve healthcare quality, AACHC will continue to work with members to achieve the

goal of all Arizona FQHCs receiving PCMH certification by 2014.

Education and TrainingAACHC offers and promotes a variety of webinars, conferences and educational opportunities throughout the state, region

and nation. Major AACHC education and training events in 2011 included:

AACHC Annual Meeting: Focus on Healthcare reform

On February 9 and 10, 2011, AACHC members had breakfast at the state capital and visited with their legislators to provide

education regarding health center programs. They then gathered at the Heard Museum in Phoenix for the organization’s 2011

Annual Meeting, focusing on:

Moving Health Centers Forward in Health Care Reform

Exploring the Patient Centered Medical Home

Insight to Challenges in Integration of Behavioral Health and Primary Care

Current Health Center Behavioral Health Models

Role of Community Based Organizations with Accountable Care Organizations

Advancing Health Information Technology

Medicare Cost reporting

Medicare Cost Reporting training was held in April 2011 for Community Health Center partners. The session focused on

operational profitability and the need to engage in proactive financial strategic planning, issues of importance to FQHCs.

Topics covered during the training included:

An overview of Medicare reimbursement for health centers

Data accumulation requirements for cost report preparation

Preparing the Medicare cost report – a detailed discussion of cost report worksheets

Medicare FQHC settlement process

Transition to the Medicare FQHC Prospective Payment System

21

CHC Billing and Coding Webinar series

AACHC hosted an 8 part series of Billing and Coding webinars over the summer months that were geared towards

Community Health Centers. The webinars gave instruction on day to day coding, documentation, benchmarking,

and collections strategies as well as an introduction to ICD-10.

The 10th Annual Invaluable Medical Assistant Day

On October 22, 2011 over 150 medical assistants (MAs) attended this event, held at the University of Arizona

Virginia G. Piper Auditorium in Phoenix. MAs in attendance received education on:

MA Competency & Skill Building Emergency Preparedness

Domestic Violence Street Drugs

Immunizations

AACHC extends its gratitude to all of the partners that participated in planning and providing education during this event.

Collaboration with the following entities was integral to the success of this seminar:

Greater Valley Area Health Education Center Maricopa County Department of Public Health

Arizona Department of Health Services Maricopa Integrated Health System

Mountain Park Health Center Health Careers Department, Central AZ College

Wings to Safety, Maricopa Medical Center Maricopa County Sheriff’s Office

uDs Training

UDS Training to prepare for 2012 report submittal was held on December 13, 2011 at the Cowden Center on the John C.

Lincoln North Mountain campus. Representatives from nearly every Arizona Community Health Center shared in the day of

learning. This training also helped to prepare health centers for the addition of new clinical measures for UDS reports and

assisted FQHC Look-Alikes in preparing to submit UDS reports for the first time due to new requirements.

22

Coming together is a beginning, staying together is progress, and working together is success.Henry Ford

Collaboration on Age-Appropriate Immunization to Improve the Health of All Arizonans

23

Teamwork is the ability to work together toward a common vision; the ability to direct individual accomplishment toward organizational objectives. It is the fuel that allows common people to attain uncommon results.Andrew Carnegie

The Arizona Partnership for Immunization (TAPI)As part of the focus on primary care services, Community Health Centers support the Arizona Partnership for

Immunization’s mission of promoting immunizations against preventable childhood diseases. Measles, mumps, polio and

whooping cough vaccines are among the primary series given in childhood, and additional age-appropriate vaccinations

are encouraged throughout the lifespan. The Arizona Partnership for Immunization (TAPI)—a statewide coalition of more

than 400 members—is housed within AACHC and works closely with AACHC and Arizona’s Community Health Centers

to promote immunization best practices. 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.

TAPI’s 2011 projects included:

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.

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.

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.

Vaccine Congress

TAPI partnered with the Arizona Chapter of the Academy of Pediatrics to determine best practices for vaccine financing

and reimbursement.

whyimmunize.org

24

AACHC Members Earn TAPI Awards

Many AACHC members were honored by TAPI for their commitment to immunization programs during its 15th Annual Big

Shots for Arizona Awards:

Long shot Award - Public Policy Tara McCollum Plese, AACHC

Hot shot Award – Honors public and private sector individuals and organizations that have given a tremendous amount

of time and effort to increase immunizations and gone above and beyond the call of duty.

Priscilla Lopez, Mountain Park Health Center

Scottsdale Healthcare Community Health Services

Penny Whitley, RN, El Rio Community Health Center

Yavapai County Community Health Services

Dr. Daniel T. Cloud Outstanding Practice Awards

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 Chil-

dren’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.

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:

Adelante Healthcare, Surprise, Buckeye, Wickenburg

John C. Lincoln Health Network-Desert Mission Community Health Center, Phoenix

Mountain Park Health Center, East Phoenix, Goodyear, Maryvale, Tempe

North Country HealthCare, Flagstaff

25

Collaboration on Programs to Assist Womenrural Community Health Center Domestic and sexual Violence Advocacy Program

Through a Rural Program Grant from the Department of Justice Office on Violence Against Women first awarded in 2007,

AACHC has worked in collaboration with a number of partners to integrate domestic and sexual violence services into the

healthcare setting. Collaborative partners for this program include:

Chiricahua Community Health Center (Douglas)

Mariposa Community Health Center, Inc (Nogales)

North Country HealthCare (Holbrook)

North Country HealthCare (St. Johns)

Technical Assistance Provider Organizations

The Arizona Coalition Against Domestic Violence

The Southern Arizona Center Against Sexual Assault

The Northern Arizona Center Against Sexual Assault

Local shelters and domestic and sexual violence service providers in the communities served by the program

In 2011, health center partners addressed domestic and sexual violence through:

Universal, confidential screening for domestic violence during healthcare visits

Direct advocacy services to 393 victims of domestic violence and/or sexual assault

Supportive services to 536 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

85 community education events in which over 4,400 individuals received education to increase awareness of dating

violence, domestic violence, sexual assault, and stalking.

Participation in coordinated community response to domestic and sexual violence, including regular collaboration

with a wide variety of community partners to better address accountability for perpetrators and needs of victims

26

reproductive Coercion

In 2011, AACHC continued its collaborative partnership in Project Connect: A Coordinated Public Health Initiative to Prevent

Violence against Women, funded by the Office on Women’s Health (OWH) of the U.S. Department of Health and Human

Services and awarded to the Arizona Coalition Against Domestic Violence. The intent of the project is to identify, respond to

and prevent domestic and sexual violence, and promote an improved public health and primary care response to abuse. The

project emphasizes issues of birth control sabotage and sexual coercion within relationships and the resulting negative impact

on women’s overall health, including reproductive health. Providers and other staff at a number of health centers in Arizona

have received training through the project, which is designed to better equip providers to respond to patients’ needs and

concerns around contraception and safety.

Other Women’s Health Activities

AACHC continues to collaborate with the Arizona Department of Health Services and a wide variety of partners on

programs, activities, and planning to address women’s health statewide. Areas addressed during 2011 included:

Preconception Health

Girls and Women’s Health Across the Lifespan

HIV/AIDS and Sexually Transmitted Infections

Healthcare and health information needs of rural women

Understanding women’s complex healthcare needs and the community context in which women are receiving services

is integral to providing patient-centered care. The Association continues to collaborate with partners on approaches

to improve health outcomes for women through appropriate screening, response, education, and services.

COLLABORATION

27

John McDonald, rn, Ms, CPHQChief Executive OfficerArizona Association of Community Health Centers

Collaboration in 2012AACHC CEO John C. McDonald Promotes CollaborationDuring the past year, I have worked closely with Community Health Centers along with our partners to understand

and address issues that impact health centers as they advocate for and provide healthcare services needed by Arizona

communities. I believe this is work that cannot be done alone. Our collaboration among Association membership and

with a variety of partners is integral to our success. As mission-driven organizations, we are stronger working together

through opportunities and challenges. I look forward to the work that lies ahead of us for the New Year. As Arizona’s

Primary Care Association, we are all proud to have supported health centers and partners in efforts toward making

healthcare accessible to all Arizonans in 2011 by:

Building a greater and more expansive partnership network

Providing more than 20 training and technical assistance opportunities to health centers

Convening meetings around current issues faced by health centers

Expanding our membership and welcoming new members throughout the year

Having an even stronger grassroots advocacy network that will continue to advocate for the issues and concerns

of health centers in the face of continuing state and federal budget cuts

In the coming year, we look forward to continued

collaboration among health centers and partners

to help prepare for further implementation of the

Affordable Care Act provisions, while continuing to

support the work and mission of each Arizona health

center. We are pleased about the accomplishments

of 2011, as outlined in this report, and are excited

to continue existing partnerships and build new

collaborations in 2012! We look forward to meeting

the challenges of helping you create Patient Centered

Medical Homes, integrating behavioral health and

primary care, expanding outreach services and case

management, all in effort to build a strong healthcare

home for all of Arizona.

700 East Jefferson Street, Suite 100Phoenix, Arizona 85034Phone: 602.253.0090Fax: 602.252.3620www.aachc.org

Arizona Association of Community Health Centers