2021 AACHC Annual Report

2021 ANNUAL REPORT

We believe that all Arizonans should have access to highquality, affordable primary healthcare that is culturally and linguistically appropriate.

MESSAGE FROM THE CEO & BOARD CHAIR DEAR MEMBERS & PARTNERS, 2021 was a year of duality. A time of optimism tempered by uncertainty. Hope persevering against the undercurrent of anxiety and disquiet.

As the pandemic stretched into a second year, Arizona’s Community Health Centers remained a trusted resource at the forefront of the COVID-19 response. CHCs statewide continued testing efforts while playing a vital role in the vaccine rollout — first among staff and then community-wide.

Over 350,000 COVID-19 tests and 450,000 vaccinations have been administered by Arizona Community Health Center staff. Of all patients who were vaccinated at a CHC, 74% identify as racial and ethnic minorities, reinforcing the critical role CHCs play in promoting equity and reducing disparities within our healthcare system.

The daily work of meeting the healthcare needs of Arizonans continued alongside the COVID-19 response. Across 175 sites, Arizona’s Community Health Centers served 739,833 patients and provided 3,134,715 office visits in 2020, numbers we expect to see increase when 2021 data is available. Increased federal funding equipped CHCs to expand services — chronic disease management, cancer screening and prevention, outreach and enrollment, and more — and deepen their impact on health in Arizona.

2021 also brought some of the most significant workforce challenges that Community Health Centers have faced. Burnout, the Great Resignation, and COVID-19 itself took a toll on staff resources, especially in key support roles like medical assistants and front desk personnel. Despite the strain, the tenacity that’s core to Arizona’s CHCs led to new and innovative ways to continue meeting the healthcare needs of the people they serve.

On a personal note, 2021 brought the opportunity for me to return home to the Alliance and take up the reins as President and CEO. There is no greater privilege than working alongside passionate, purpose-driven people to increase access to the services and resources that help everyone – and anyone — lead a healthy and productive life.

Invigorated by the hopefulness of 2021, wiser as a result of the challenges, we look forward to a strong 2022. In lockstep with our Community Health Center members and as we’ve done for the past 36 years, the Alliance will continue to be a catalyst for health in Arizona.

In health, Jessica Yanow, MPH President & Chief Executive Officer Arizona Alliance for Community Health Centers and Collaborative Ventures Network

Christopher Hansen, MHA Chief Executive Officer Canyonlands Healthcare 2021 AACHC Board Chair

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TABLE OF CONTENTS OUR NETWORK Message from the CEO & Board Chair

3

Board of Directors

6

Members

7

OUR IMPACT Community Health Center Impact

8

Healthcare Heroes

10

Legislative Agenda

11

OUR WORK Training & Technical Assistance

14

Workforce

15

Outreach & Enrollment

16

Quality Improvement

17

Health Center Controlled Network

18

Rural Health

19

Financials

20

Sponsors

21

COMMUNITY HEALTH CENTER MAP

22

BOARD OF DIRECTORS OFFICERS CHAIR

Christopher Hansen, MHA, Chief Executive Officer, Canyonlands Healthcare

VICE CHAIR

John Swagert, MD, Chief Executive Officer, Mountain Park Health Center

TREASURER

Jonathan Leonard, Chief Executive Officer, Desert Senita Community Health Center

SECRETARY

Peggy Chase, Chief Executive Officer, Terros Health

MEMBERS AT LARGE

David Rogers, MBA, Chief Executive Officer, Sunset Health Ed Sicurello, Chief Executive Officer, Mariposa Community Health Center

CVN CHAIR

Clinton Kuntz, DBH, Chief Executive Officer, MHC Healthcare

BOARD MEMBERS Barbara Harding, BAN, RN, MPA, PAHM, CCM - Sr. Vice President of Ambulatory Services, Valleywise Health Blaine Bandi, MLS, MHSA - Chief Executive Officer, Wesley Community & Health Centers Carmen Heredia, LMSW, CPHQ - Chief Executive Officer, Valle del Sol Jeff Axtell, M Ed - Chief Executive Officer, Native Americans for Community Action Jonathan Leonard - Chief Executive Officer, Desert Senita Community Health Center Jonathan Melk, MD - Chief Executive Officer, Chiricahua Community Health Centers Laura Larson-Huffaker, MC, LPC - Chief Executive Officer, Horizon Health and Wellness Kimberly Despres, DHA, RN - Chief Executive Officer, Circle the City Lynette Bonar, RN, MBA, BSN- Chief Executive Officer, Tuba City Regional Health Care Corporation Nancy Johnson, RN, PhD - Chief Executive Officer, El Rio Health Pedro Cons - Chief Executive Officer, Adelante Healthcare Rodolfo Jimenez, DO, MBA - Chief Executive Officer, United Community Health Center Sharon Rickman, MPA - Executive Director, Community Health Center of Yavapai Eddie Estrada, MD - Chief Executive Officer, Sun Life Health Walter Murillo - Chief Executive Officer, Native Health Wendy Armendariz, MBA - Chief Executive Officer, Neighborhood Outreach Access to Health 6

MEMBERS FULL MEMBERS

ASSOCIATE MEMBERS

7

COMMUNITY HEALTH Arizona's Largest Primary Care Network 23

Health Center Program Grantees

175+ Sites Across Arizona

7,205

Staff FTEs (Full Time Equivalent)

Serving ~1 in 10 Arizonans 739,833 Total Patients Served 3,134,715 Patient Visits

GENDER

AGE

59% Female 41%Male 28% Under 18 60% 18 to 64 12% 65 and older Making Communities Healthier 54%

Patients with Hypertension (HTN) Whose Blood Pressure (BP) was Controlled

84%

HIV Patients Who were Newly Diagnosed with HIV and Received Follow-up Treatment Within 30 Days

71%

Children Age 6-9 Who Received Dental Sealants

86%

Adults Screened for Tobacco Use and Receiving Cessation Intervention

8

CENTER IMPACT SPECIAL POPULATIONS

164,514

160,847

33,367

18,711

14,064

10,459

Patients Best Served in Languages Other than English

Individuals in or adjacent to Public Housing

Individuals Experiencing Homelessness

Gender and Sexual Minorities

Veterans

Agricultural Workers or Dependents

PAYOR MIX

FEDERAL POVERTY LEVEL 75%

50% 40%

50%

30% 20%

25%

10% 0%

Ov er 20 0%

15 1– 20 0%

10 1– 15 0%

be lo w an d

47%

10 0%

M ed ica re

No ne /U ni ns ur ed

In su ra nc e Pr iva te

M ed ica id

0%

25% 16%

QUALITY AWARDS

12%

15% 9%

Percentage of Arizona CHCs that received the following awards:

74%

26%

39% 9

12%

2021 HEALTHCARE HEROES 2021 LIFETIME ACHIEVEMENT

Travis Robinette, Sun Life Health

2021 INNOVATION AWARD

2021 PRECEPTOR OF THE YEAR

Brianna L. Hillier, DMD Chiricahua Community Health Centers

Matthew Bertsch, PharmD Sun Life Family Health Center

2021 LEGISLATORS OF THE YEAR

Representative Joanne Osborne

Representative Randall Friese, MD

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2021 LEGISLATIVE AGENDA Elevating the voice of Arizona's Community Health Centers

STATE AGENDA Pass legislation allowing an Arizona Medicaid GME program at accredited Community Health Centers/FQHCs Require reporting of adult vaccinations to the state database (ASIIS reporting for adult vaccines including COVID-19) Secure commercial reimbursement for telehealth and audio-only telephonic services Extend telephonic codes past the extension of the Public Health Emergency and identify Medicaid codes for AHCCCS to maintain Expand support for SDOH (housing, food insecurity, transportation, etc.)

FEDERAL AGENDA Obtain COVID funding for Community Health Centers in COVID stimulus bills ($7.6 billion) Ensure mandatory and special project funding for Community Health Centers in the federal budget

Protect the 340B program (H.R. 4390 & lawsuits pending) Extend telehealth and telephonic services past the Public Health Emergency (Partial- 151 days past the PHE) Monitor the Executive Order on eliminating diversity and inclusion training (Repealed) Secure funding for expansion of broadband services and Internet access

Accomplished

Pending

Not Accomplished 11

ALLIANCE PROGRAMS

Working together to advance the Community Health Center mission

TRAINING & TECHNICAL ASSISTANCE Educating, equipping, and facilitating shared learning

As a Primary Care Association, our role is to provide training and technical assistance to Community Health Centers in Arizona, based on statewide and regional needs, that helps improve programmatic, clinical, and financial performance and operations. In 2021 we continued offering the majority of our learning opportunities virtually while resuming some in-person training activities. We covered a variety of topics geared toward different learners, including both administrative and clinical team members.

120+

2,400+

TRAINING & TECHNICAL ASSISTANCE ACTIVITIES

PARTICIPANTS

4.3/5

3.1 to 4.0/5

3/5

AVERAGE SATISFACTION RATING

AVERAGE KNOWLEDGE GAIN

AVERAGE BEHAVIOR CHANGE RATING

SPECIAL PROJECT With support from the Maricopa County Department of Public Health, we developed a 3-part video series focused on reducing stigma around substance use disorder among Community Health Center providers.

1,500+ Views since being released

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WORKFORCE Strengthening the workforce of today and building the workforce of tomorrow

Workforce continues to be one of the most significant challenges our Community Health Centers (CHCs) face, particularly in recent years as a result of the COVID-19 pandemic. The Alliance carried out activities in the following areas to support our CHCs with recruitment and retention:

HEALTH PROFESSIONS EDUCATION & TRAINING Focused on enhancing health centers' capacity to recruit, develop, and retain their workforce by exposing health and allied professions students, trainees, and residents to education within CHCs Readiness to Access Training (RTAT) Survey Workforce Strategic Plan

GRADUATE MEDICAL EDUCATION (GME) ADVOCACY Advocated for health centers' ability to draw down Medicaid funding and receive service reimbursement for their primary care residency programs

NATIONAL HEALTH SERVICE CORP (NHSC) SCHOLARS Provided support to NHSC scholars and clinicians through the NHSC Scholars Conference and the AZ SEARCH (Students and Residents Experiences and Rotations in Community Health) Program

127 680

Health professions students placed for clinical rotations

High school students engaged in health career exploration and pipeline programs

51

Continuing education trainings provided to 2,465 health care professionals

51

Trainings on contact tracing provided to health professions student volunteers in partnership with Navajo Nation’s Community Outreach and Patient Empowerment (COPE) Program resulting in a total of 3,019 contacts with 2,364 positive COVID cases in Navajo Nation

180

Health profession student volunteers engaged in community immersion and service learning through the Street Medicine Program in partnership with ADHS resulting in ~900 patient services being provided to homeless individuals.

15

OUTREACH & ENROLLMENT Ensuring access to quality healthcare for all Arizonans Our Outreach and Enrollment (O&E) team focuses on healthcare coverage and access. We do this work by providing support and technical assistance to Community Health Centers, including the dissemination of updated O&E best practices. This work was crucial in 2021 as Arizona communities continued to rely on CHCs for their healthcare needs throughout the pandemic. Through funding provided by the Centers for Medicare and Medicaid Services, the Alliance worked with our CHCs and partners to provide education on health insurance options and facilitate enrollment in health insurance.

ENROLLMENT SERVICES

1,248 30,070 4,689 182

OTHER ACTIVITIES

MARKETPLACE

AHCCCS

SNAP

WIC

8,352

800# CALLS

37,055

INQUIRIES

3,317

REFERRALS

8,354,014

MEDIA IMPRESSIONS

PROVIDING ASSISTANCE, CONNECTING TO COVERAGE, AND GIVING PEACE OF MIND "Sue" came to the United States from the Philippines. She found herself uninsured because her employer did not offer health coverage. Sue had a medical issue the year prior, and due to her self-pay status she ended up with an outstanding balance at both the hospital and CHC. The CHC Navigator Sue and her family worked with assisted with financial hardship paperwork and setting up a payment plan at the hospital. The Navigator also assisted Sue with applying and enrolling in a Marketplace Plan. Sue was relieved that she was able to find medical coverage in case she had another medical issue in the future.

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QUALITY IMPROVEMENT Developing partnerships that support the provision of high-quality care While the pandemic presented numerous challenges for our Community Health Centers (CHCs), it also fostered a tremendous amount of innovation. In many cases CHCs had to re-think care delivery in order to ensure the continued provision of high-quality care. The Alliance was able to support some of these quality improvement efforts through the programs described below.

DIABETES & HEART DISEASE PREVENTION & MANAGEMENT In partnership with the Arizona Department of Health Services and the American Heart Association, the Alliance facilitated a third cohort of Community Health Centers for our Diabetes & Heart Disease Prevention Program. As a cohort, participating CHCs increased rates of controlled hypertension by 6%, despite many other quality measures decreasing during COVID-19.

%OF PTS WITH CONTROLLED HYPERTENSION, COHORT 3

2020

2021

75% 50% 25% 0%

CHC 1

CHC 2

CHC 3

CHC 4

CHCs also saw value gains through quarterly cohort collaborative meetings and the annual Quality Improvement Symposium and increased innovation in hypertension management due to COVID-19.

Piloted hypertension self-management programs, which included home-monitoring and new workflow pathways.

Patients and clinicians achieved a new level of integration and patient outcomes during challenging times

ORAL HEALTH The Alliance continues our participation in the Rocky Mountain Network for Oral Health Integration (RoMoNOH) through funding from the Health Resources and Services Administration's Maternal and Child Health Bureau. In 2021, there were three Community Health Centers (seven sites) from Arizona participating in the project.

2,311

Patients ages 0-40 months received preventive oral health services during a well-child visit 17

HEALTH CENTER CONTROLLED NETWORK Leveraging technology to achieve success

The Alliance supports a HRSA-funded Health Center-Controlled Network (HCCN) through our partnership with Collaborative Ventures Network. HCCN includes 29 participating Community Health Centers across Arizona and Nevada. The purpose of HCCN funding is to improve access to care, enhance quality of care, and achieve cost efficiencies through the provision of management, financial, administrative, technological, and clinical support services.

HCCN GOALS ALIGNED WITH HEALTH CENTER PRIORITIES Enhance data reporting, analysis, and visualization Increase use of Health Information Exchange (HIE) Improve patient engagement Consult on quality improvement activities Enhance interoperability Improve data protection (privacy, security, and cybersecurity) Enhance use of health IT to address emerging issues Identify promising practices and innovation In 2021, HCCN focused on using business intelligence for data integration and visualization dashboards to improve patient care and outcomes and decrease health disparities. %Pts w/ hypertension by race and ethnicity 25%

%Pts w/ HBA1c>9% or Untested 8%

20%

6%

15% 4% 10% 2%

5%

As ia n Na W hi tiv Ot te Am e h H er er a wa ica Pa iia cif n In n ic di Is an l an /A de la Un sk r re a Na po rte tiv e d/ M Re or e fu th se an d on e ra ce

Bl ac k/ Af ric an

Am er ica n

0%

As ia n Na W hi tiv Ot te Am e h H er er a wa ica Pa iia cif n In n ic di Is an l an /A de la Un sk r re a Na po rte tiv e d/ M Re or e fu th se an d on e ra ce

Bl ac k/ Af ric an

Am er ica n

0%

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RURAL HEALTH Addressing the healthcare needs of our most vulnerable populations

Despite being home to large metropolitan areas like Phoenix and Tucson, the majority of Arizona is considered rural. Challenges associated with domestic violence and substance use are often amplified in a rural setting due to a lack of resources. The Alliance supports various programs that assist our Community Health Centers with addressing these disparities.

DOMESTIC AND SEXUAL VIOLENCE ADVOCACY Funded Advocate positions at four Community Health Center (CHC) sites

50,397

CHC patients screened or provided information on domestic and sexual violence during routine patient visits

378

478

Victims of intimate partner violence, sexual assault, and stalking received services Secondary victims (family, including children) received services

Supported equipment upgrades, population health management tools, Forensic Electronic Medical Records (FEMR) implementation, additional training and technical assistance needs, and enhanced services related to COVID-19 Secured three additional years of funding (2021 – 2024) and an additional $200,000 to increase Sexual Assault activities, which will support additional CHC positions

ARIZONA RURAL WOMEN'S HEALTH NETWORK

151 10

Virtual participants for the 6th Annual Rural Women's Health Symposium Virtual Sexual Violence Training for Community Health Workers/Promotoras sessions in partnership with the Arizona Coalition to End Sexual and Domestic Violence

RURAL COMMUNITIES OPIOID RESPONSE PROGRAM IMPLEMENTATION

6 107 28

Consortium members partnered on prevention, treatment, and recovery activities in Gila, Graham, and Mohave counties Participants in a training on Billing and Coding for SUD/OUD Services in Community Health Centers, FQHCs, and RHCs Provider and community trainings on naloxone and other opioid overdose prevention best practices 19

FINANCIAL OVERVIEW ALLIANCE REVENUE Membership Dues 2%

Azara Participation 3%

Group Purchasing 4%

Sponsorships 1%

Admin Contracts 9%

Pass-through Funds* 46%

Other Federal Grants 19%

HCCN Cooperative Agreement** 5%

*Pass-through funds are

PCA Cooperative Agreement 11%

grant dollars received by AACHC but passed on to our members and partners to carry out grant deliverables **Passed through to AACHC

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2022 ANNUAL SPONSORS

2022 COLLABORATIVE PARTNER

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ARIZONA'S COMMUNITY HEALTH CENTERS

Disclaimer: This publication was supported by the following sources: Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $1,762,597, with 0% financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.

Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of financial assistance awards totaling $2,340,145 and $515,765, with 0% funded by non-government source(s). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CMS/HHS, or the U.S. Government.

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