Heartland Community Health Center

Proposal for City of Lawrence funding

Summary of Request

This proposal outlines a one-time funding request of $25,000 from the Lawrence City Commission for a medical biller at Heartland Community Health Center.

Heartland Community Health Center (HCHC) has served the medically underserved in Lawrence, Kansas since 2004 from its current location in the lower level of the east end of the Riverfront Plaza.  Because HCHC and other safety net health care providers combined fall well short of meeting the needs of the community, HCHC is bidding to become a federally-funded Community Health Center so as to more ably meet the needs of local residents and serve as a driver of local economic development. Community Health Centers focus on serving the medically underserved, including those without insurance along with those on public insurances such as Medicaid and Medicare who have difficulty arranging for care. Because it provides for a strong federal reimbursement mechanism and meets a huge need, HCHC is working to upgrade its payor mix to 40% insured / 60% uninsured, a strategy that complements the mission of  Health Care Access  which is committed to serving the totally uninsured.  HCHC’s front office staff is responsible for billing insurances part time, but the task has become overwhelming and current staff cannot keep up. HCHC respectfully requests one-time funding for a medical biller whose position will be sustained through the reimbursements generated from his or her efforts.

Organizational History

In 1999, a young physician transitioned out of a successful private practice in southern California to move with his wife to the Midwest in order to live near family in Lawrence. Before moving to the heartland, he imagined serving the underserved through a venture that he envisioned would be called Heartland Medical Outreach. Seeking support for his passion, he pursued partnerships in the venture through a letter he sent to dozens of organizations expressing his interest in serving the medically underserved. The lone response came from the entrepreneurially minded pastor of Heartland Community Church. The coincidence of names suggested something special was happening.

Within a matter of months, Sunday school classrooms in the church basement served double- duty as exam rooms, and a makeshift all-volunteer staff treated four patients at no charge on the first day. The enthusiastic ‘staff’ forged ahead with only a vague understanding of the population it wanted to serve and the magnitude of the need. Because the need was great, word spread among the underserved population about free medical care so the clinic grew, and in time it threatened to overwhelm the tiny church.

In 2004, following an outpouring of support and donations from several local churches and the community at-large, the clinic became a bona fide nonprofit 501(c)3 and moved to its current home in downtown Lawrence in the Riverfront Plaza. The current facility includes about 8,000 square feet of well-appointed space with room to expand.  Out of this location, the organization has been quietly serving the needs of local residents since.

As the enthusiasm of the start-up venture began to wane and the reality and enormity of the challenge set in, the Board of Directors in 2008 began to set its sights on a new plan for business. Without a significant change, the organization did not seem to be on a trajectory to sufficiently or sustainably help meet the enormous needs in Lawrence and Douglas County, such as access to care and staggering health disparities. Without a dramatic change, HCHC and companion clinic Health Care Access combined don’t meet half of the identified need in Lawrence.

After exhaustive research into other models for delivery of care to the underserved and after visits to clinics in places across the state and as far away as Chicago, the HCHC Board of Directors committed to pursue the Community Health Center model.  Community Health Centers receive significant financial resources along with specialized clinical support and technical assistance through the Health Resources and Services Administration. With the federal resources available through this program, HCHC’s plan for expansion includes growth from about 5,000 patient visits annually to 12,000 visits in the first year as a Community Health Center. A Community Health Center will serve as a significant economic driver for the local economy by providing professional and entry level jobs and through the purchase of local goods and services. 

Although many of the names and faces at HCHC have changed along the way, the mission remains to transform the health and lives of those in need.  Although the organization has served diligently but quietly so far, it stands poised now to make a splash in the local health care scene.

The Community Health Center Model

Because Douglas County is the second-largest county in Kansas without a Community Health Center, federal status will bring in desperately needed resources through a large annual grant and cost-based Medicaid and Medicare reimbursements, buttressing the current infrastructure and creating sustainable growth through increased revenue.  Perhaps most importantly, the resources of a Community Health Center can serve to shift the focus from simply treatment of sickness, toward primary prevention and to a culture of health and wellness. HCHC stands to serve approximately 20,000-25,000 individuals annually after receiving federal status.

As a federal program that originated in the 1960s and one that has enjoyed tremendous bipartisan support, Community Health Centers serve as a model of not just medical care for the poor, but as a powerful model for high quality, cost-effective care for everyone. The American Academy of Family Physicians’ Robert Graham Center found that in spite of serving a high-risk population, the total cost of all health care for Community Health Center patients to be 41% lower annually than the total cost of all health care for individuals served by other primary care providers. The White House Office of Management and Budget ranked CHCs as one of the top 10 most cost-effective government programs. All of this while serving a population with few resources and requiring very complex care. 

Nationwide, CHCs save communities millions of dollars each year in lower costs and through reduced hospitalization and emergency room usage while stimulating the economy. These dynamics hold true in Kansas. A total of 13 distinct CHCs deliver high quality, cost-effective care in high-need urban and rural contexts and have long made major contributions to the state’s public health and economic foundation.  Douglas County is the second largest county in Kansas without a community health center (Johnson County is the largest).

Although HCHC has submitted a federal New Access Point application as part of the most recent Community Health Center program expansion under the Affordable Care Act, changes in funding have made an award appear to be less certain. HCHC is currently preparing a Community Health Center Look-Alike application as an interim step. Should HCHC become a “Look- Alike”, the financial challenges become more significant and dependence on local funding becomes even more crucial. Because Look-Alikes do not receive the large annual grant that fully funded Community Health Centers receive growth will be more gradual. However this step will be simply an intermediate step toward becoming fully-funded. 

The need for HCHC’s services

The concentration of poverty is higher in Lawrence and Douglas County than that of the State and nationally. In the Census tracts surrounding Heartland Community Health Center, 40.5% of individuals subsist below 200 percent of the Federal Poverty Level (FPL). Comparatively, in Douglas County, 30.4% of individuals live below 200 percent FPL, and in Kansas, 26.4% of individuals live below 200 percent FPL.

Access barriers have led to declining health indicators among HCHC’s target population. The following table describes Douglas County’s health disparities compared to the rest of Kansas.

Health Disparity	Target Population Data Douglas County	Comparison Data Kansas (unless otherwise indicated)
Diabetes Mortality Rate	23.8	23.3 (U.S.)
Essential Hypertension and Hypertensive Renal	7.7	5.8
Alzheimer’s	27.4	25.2
Breast Cancer Incidence Rate (female)	138.7	122.3
Estimate of Binge Drinkers (youth)	18.8%	15.6%
Rate of Cancer Incident	459.0	451.7
Source(s):  KDHE KIC Birth, Death, and Cancer Incidence Tables 2006/2007; CDC BRFSS 2007; Annie E Casey Foundation CLIKS 2007; rates per 100,000.

The documented health disparities among the poor and uninsured in the service area correlate to the limited access the target population has to affordable health care services. Increased access to affordable and accessible health care is a major need for Lawrence residents.

HCHC community collaboration

A Bert Nash Community Mental Health Center clinical social worker is contracted to work along-side HCHC’s primary care providers in order to provide integrated, holistic health care to every patient who walks through HCHC’s door. An office visit at HCHC includes a visit with a behavioral health specialist right on the clinic floor in the exam room. The behavioral health consultant routinely provides screenings for, among other things, depression, anxiety, and/or substance abuse as well as brief therapies and referrals right in the exam room during regular patient visits.  If needed, she uses a broad referral network to connect patients to more intensive treatment. While this model has proven wildly successful in improving outcomes and increasing patient and provider satisfaction, it exists on a scale that must grow in order to more fully meet the need.

Along with Bert Nash, Douglas County Dental Clinic, Lawrence-Douglas County Health Department, Lawrence Memorial Hospital, the Kansas Association for the Medically Underserved and the Kansas Department of Health and Environment are all supportive of this strategy to pursue Community Health Center status. All have pledged to actively work together to share in the resources and responsibilities of a Community Health Center and each have written public letters of support for the endeavor of pursuing Community Health Center status. With Community Health Center status, Heartland Community Health Center will be poised to serve as a catalyst to bring together local agencies and more.

Although companion clinic Health Care Access serves a similar size of the underserved population in Lawrence, the organization is committed to serving only the uninsured. Even though the two organizations collaborate closely, the two combined fall well short of meeting the entire need. HCA and HCHC work closely together to stretch resources for the uninsured, but HCHC is also committed to serving the Medicaid, Medicare and under-insured populations. Because of low reimbursements, many private practices have stopped accepting these patients. With Community Health Center status, HCHC will be able to generate revenue through enhanced reimbursements available through the program and provide increased care for these underserved patients.

Funding for a medical biller

While HCHC does accept Medicaid and Medicare, it has not been able to grow its Medicaid and Medicare patient population as rapidly as needed simply because of the specialized training required to bill these insurances effectively. HCHC must fill a position for an employee with the training, skills and knowledge base to bill insurances, monitor the claims and maximize revenues.

In order to generate revenue sustainably which will lead to better and more comprehensive health care for the underserved, HCHC seeks funding for a billing specialist who will more effectively bill insurances for primary care services, navigate the complexities of billing for integrated mental health and substance abuse screening services (current services for which we are unable to bill) and improve the overall payor mix. This combination will increase program revenue through the primary economic driver of a CHC and sustain important health services for the underserved.

Not only will a billing specialist generate more revenue and help create a more sustainable operation, when HCHC receives FQHC Look-Alike status, reimbursements from Medicaid and Medicare will increase from approximately $29 for a standard office visit to approximately $110 per office visit, further increasing revenue, which will allow for expanded services and growth of capacity. It’s important to build the infrastructure for effective billing now, so when HCHC receives FQHC Look-Alike status, we can take full advantage of enhanced reimbursements.

Because the demand for access to health care is so great in Lawrence and because HCHC is eager to increase its capacity to serve more people and expand services in spite of a shrinking economy, HCHC requests support from the City Commission to hire a billing specialist.  The specialist will be able to be able to generate revenue for and provide access to integrated health care for more people and become a medical home for under-served residents

In carefully selecting the right person for the role as biller, HMC will alter its payor mix, increase revenue and expand its services, creating a more sustainable solution for the medically underserved community members and contributing to a culture of health and productivity

This proposal requests $25,000 to pay for one year’s salary of a billing specialist who will increase revenue and improve HCHC’s payor mix.