Fiscal Year 2017 and 2018 Annual Report

Fiscal Year 2017 and 2018 Annual Report

A Legacy of Care

“WE PROVIDE QUALITY HEALTH CARE TO EVERYONE IN THE COMMUNITIES WE SERVE.” -MISSION STATEMENT

Locations Health Center Locations 1 2 3 4

5 6 7 8

Cutler/Orosi Dinuba Farmersville Fresno

Deran Koligian ACC Surgical Services Center Disease Management Center

Goshen Hanford Ivanhoe Mobile Health Center Medical Dental

9 Pixley 10 Porterville – 2 Locations Porterville Health Center Porterville Dental Center 11 Springville 12 Strathmore 13 Terra Bella 14 Three Rivers 15 Traver 16 Tulare – 2 Locations Tulare Pediatric Group Tulare Health Center 17 Visalia – 3 Locations Visalia Bridge Visalia Oak Health Center Visalia School Health Center 18 Woodlake

Additional Locations

1 Annex 2 Corporate Office

Corporate Finance

3 Resource Center 4 Ventanilla de Salud

Services • Adult & Children’s Dentisty • Behavioral Health • Case Management • Chiropractic Care • Community Health & Outreach • Enrollment & Eligibility Assistance • Family Medicine • Health Education • Imaging/Ultrasound

• Internal Medicine • Nutrition Counseling • Obstetrics & Gynecology • On-Site Lab Services • Optometry • Pediatrics • Pharmacy • Podiatry • Transportation

• Allergy • Cardiology • Ears, Nose, and Throat • Endocrinology • Gastroenterology • General Surgery • Hematology • Infectious Disease • Neurology

• Ophthalmology • Orthopedic Surgery • Perinatology • Pulmonology • Rheumatology • Urology • Vascular Surgery • Urology

Board of Directors Steve Kabot Chairperson

John Zapalac Vice Chairperson

Emzy Cope

Maria Gonzalez Secretary

Minetta Costa

Teresa de la Rosa

Senior Leadership Kerry L. Hydash, MPA President & CEO

Marisol de la Vega Cardoso Chief Business Development Officer

Paramvir Sidhu, MD Chief Clinical Officer

Paul Curtis Treasurer

Michael Botello

Olivia Gamboa

Brandon Foster, P.h.D Chief Quality and Compliance Officer

Chad Vawter, MBA Chief Financial and Strategy Officer

Michelle Cano

Sandi Miller

Jay Kelley, MSHAI Chief Information Officer

Norma Verduzco, MPA Chief Operations Officer

A Message from the President & CEO Family HealthCare Network (FHCN) stands by its mission to provide quality health care to everyone in the communities we serve. For over 40 years, this focus on the needs of our communities has made us one of the largest networks of community health centers both in California and in the United States as a whole.

Highlights from fiscal years 2017 and 2018 (FY 17/18) serve to illustrate our commitment to the communities around us. In FYs 17-18, we served over 253,000 active patients at 30 sites. Our staff size exceeded 1,200 members, which allowed us to work cohesively to ensure that we provide quality care for all, regardless of their ability to pay.

For much of FHCN’s history, we have focused on providing high-quality comprehensive primary care and support services.

Recently, to better serve our communities, we have expanded our service area to include Tulare, Kings, and Fresno Counties, and added or expanded 15 specialty services to our network. Having enhanced access to these specialties has had a tremendous positive impact on our patients who otherwise would have continued to struggle to access timely specialty care.

As the seventh largest community health center in the United States, and the third largest in California, FHCN is also very honored to serve more agricultural workers than any other community health center in the nation. I invite you to learn more about FHCN and its progress in FYs 17-18 in the pages of our annual report.

Sincerely,

Kerry L. Hydash, MPA President & CEO

Migrant/Seasonal Patients 123,506 113,865 114,040 2014

2014 2017

114,597,659

103,627

100,914,904 2014

563,346

2017

2014

619,283

2015

123,000,000

78,035,086

Operating Expenses** 108,218,852

98,183,553 90,069,735 2014

2015

635,546

806

Revenue**

2015

2016

687,341

902

2016

2017

2015

188,413

Total Billable Visits

2017

932

2016

2014

207,346

2016

956

2015

2015

211,983

2017

230,422

Total Employees

2016

Total Active Patients*

2016

2017

2016-2017 FAMILY HEALTHCA

75,700,154

FISCAL YEAR RE NETWORK DATA Total Utilization of Services

Patient Income Level by Federal Poverty Level

Medical - 76.50% Dental - 14.43% Other Professional Services - 2.04% Behavioral Health - 2.53% Enabling Services - 4.50%

100% and Below - 82.13% 101-150% - 11.32% 151-200% - 3.10% Over 200% - 2.30% Unknown - 1.15%

Primary Language of Patients

Who we Serve

*Data obtained from Family HealthCare Network’s Electonic Health Record system. **Revenue and Expense Totals were obtained from Family HealthCare Network Financial Reports.

English - 47.13% Spanish - 52.21% Arabic - 0.23% Laotian - 0.10% Hmong - 0.05% All others - 0.28%

Medi-Cal - 70.24% Private - 11.64% Commercial - 9.11% X-Over - 4.46% Family Planning - 1.51% Medicare - 2.15% Other - 0.90%

Migrant/Seasonal Patients 132,002 123,506 113,865 2015

2015 2018

123,000,000

114,040

114,597,659 2015

619,283

2018

2015

635,546

2016

141,072,655

100,914,904

Operating Expenses** 126,947,356

108,218,852 98,183,553 2015

2016

687,341

902

Revenue**

2016

2017

756,121

932

2017

2018

2016

211,983

Total Billable Visits

2018

956

2017

2015

218,337

2017

1,219

2016

2016

230,422

2018

253,850

Total Employees

2017

Total Active Patients*

2017

2018

2017-2018 FAMILY HEALTHCA

90,069,735

FISCAL YEAR RE NETWORK DATA Total Utilization of Services

Patient Income Level by Federal Poverty Level

Medical - 76.71% Dental - 14.56% Other Professional Services - 3.20% Behavioral Health - 1.73% Enabling Services - 3.80%

100% and Below - 74.83% 101-150% - 16.02% 151-200% - 4.41% Over 200% - 3.41% Unknown - 1.33%

Primary Language of Patients

Who we Serve

*Data obtained from Family HealthCare Network’s Electonic Health Record system. **Revenue and Expense Totals were obtained from Family HealthCare Network Financial Reports.

English - 46.89% Spanish - 52.46% Arabic - 0.25% Laotian - 0.09% Hmong - 0.04% All others - 0.27%

Medi-Cal - 69.26% Private - 12.61% Commercial - 9.43% X-Over - 4.35% Family Planning - 1.32% Medicare - 2.18% Other - 0.85%

Humble Beginnings Family HealthCare Network began in 1976 with just one office in a two-room house in Porterville. Then called United Health Organization, the fledgling non-profit clinic was started by a group of dedicated individuals determined to find a way to bring health care to Spanish-speaking farm workers in the area.

At that time, only the county hospital in Tulare was providing access to care, however, prenatal care was nearly impossible to receive. The county’s infant mortality rate at the time was a staggering 14.8 for every 1,000 live births.

In 1978, the organization restructured and the Porterville clinic became known as Porterville Family Health Center, Inc. Two providers were added to the staff and in 1980 the program relocated into a gas station/mini-market on Highway 190. This location was renovated and turned into a clinic with six exam

rooms. During these early years, our organization was so successful at serving individuals in the Porterville area that over the next four decades, the building had to be expanded twice to meet community needs. Currently, this health center has 65 exam rooms—and still sits on the original site.

In 1989, the Board of Directors determined it was time to expand this successful model into other communities also in need of care. The community of Ivanhoe became the first of many expansions that focused on addressing the lack of accessible care.

This was followed over the years by sites in multiple communities. During this same time, we expanded not just in size but in range of services provided.

1976

Oct. 1980 Porterville Health Center on 190 Opened

Nov. 1990 1992 Transportation Dental Program Program Launched Launched

Oct. 1989 Ivanhoe Health Center Opened

1980

April 1999 Visalia Bridge Health Center Opened

July 2001 Three Rivers Health Center Opened

Complementary Alternative Health Program Launched

May 2002 Integrative Behavioral Health Program Launched

Nov. 1999 Woodlake Health Center Opened

Dec. 2000 Springville Health Center Opened

1985 1990 1995

Aug. 2001 Cutler/Orosi Health Center Opened

2000

Feb. 2003 Visalia Oak Health Center Opened

Aug. 2004 Goshen Health Center Opened

Dec. 2006 Hanford Health Center Opened

May 2007 Putnam Dental Opened

Aug. 2007 Promotora Program Launched

Aug. 2012 New Porterville Dental Center Opened

Aug. 2008 A.T. Still University Medical School Established

May 2011 Porterville Pharmacy Opened

July 2008 Ventanilla de Salud Site Opened

2005

2010

Jan. 2012 Farmersville Health Center Opened

May 2012 New Woodlake Health Center Opened

May 2012 Woodlake Community Garden Established

Oct. 2012 New Goshen Health Center Opened

April 2013 Woodlake Community Mural Established

July 2013 A.T. Still PA Program Established

Sept. 2013 Visalia Oak Health Center Pharmacy Opened

Jan. 2014 Terra Bella Health Center Opened

June 2014 Visalia School Avenue Health Center Opened Sept.

2014 Hospitalist Program Launched

Nov. 2014 Visalia Bridge Walk-In Center Opened

Aug. 2015 Tulare West Health Center Opened

Dec. 2015 Optometry Program Launched

April 2015 General July 2014 Surgery Dental Residency Program Program Launched Launched

2015

April 2016 Traver Health Center Opened

Openings & Expansions July 2016 Tulare Pediatrics Opened & Expanded

Family HealthCare Network opened its second health center in the city of Tulare providing pediatric services.

Aug. 2016 Cutler-Orosi Pharmacy Opened

By opening pharmacies inside of health centers, FHCN provides patients convenient and affordable medications.

Nov. 2016 Pixley Health Center Opened

With the opening of this health center, FHCN was the first FQHC to have a health center in the community of Pixley.

2016 - 2017

May 2017 PRAPARE Program Launched

The Protocol for Responding to March 2017 and Assessing Mobile Mammography Patient’s Assets, Services Offered Risks, Experiences (PRAPARE) aims Through a partnership to address social between Family determinants of health HealthCare Network by providing wholeand Assured Imaging, person care.

FHCN began providing on-site mammography services.

Openings & Expansions Oct. 2017 Hanford Health Center Relocated & Expanded

Family HealthCare Network relocated and expanded services, staff, and exam rooms in the city of Hanford.

April 2018 Mobile Dental Health Center Opened Feb. 2018 Strathmore Health Center Opened

Family HealthCare Network became the first FQHC to provide health care in the community of Strathmore.

The Mobile Dental Health Center began to offer dental services in multiple locations throughout Tulare, Kings, and Fresno Counties.

2017 - 2018

June. 2018 May 2018 Dinuba Health Center Opened

Family HealthCare Network added internal and family medicine services in the community of Dinuba.

Family HealthCare Network opened three new health centers in the city of Fresno, and becomes a training site for the UCSF Medical Residency Education Program.

The opening of the new three-story Hanford Health Center expanded the services we offer in the community of Hanford. The new site more than doubled the size of the former Hanford Health Center, and is home to more than 125 employees.

Hanford Health Center OPENED IN 10 MONTHS!

Continuity of Care with a Provider & Care Team

Coordinated, Integrated Care

In FY 2018 38,050 Sq. ft.

45 Exam Rooms

10 Dental Operatories

4 Optical Lanes

Patient, Family, & Community Centered

Data Driven Quality Improvement

CostEfficient & Payment Alignment

Innovative Partnerships to Expand Care Through an innovative partnership with Community Medical Center, the region’s largest health care system, and UCSF Fresno Medical Education Program, Family HealthCare Network assumed the operations of three primary and specialty care centers located in downtown Fresno. The new locations include the Deran Koligian Ambulatory Care Center, the Surgical Services Center, and the Disease Management Center. Family HealthCare Network will work with the UCSF Fresno Medical Education Program to continue training residents and fellows within our clinics. The innovative partnership builds upon our strengths to meet the growing demand for health care services in the Valley.

104 Exam Rooms

300 Residents

232 Providers

Mobile Health

Family HealthCare Network launched its first Mobile Health Center in May 2017 and expanded with a Mobile Dental Health Center in April 2018. The Mobile Health Centers allow us to offer medical and dental services in communities without a stationary health center, including: preventative screenings, health exams, well child exams, immunizations, lab services, dental services, and enrollment assistance. Through several partnerships with community entities, FHCN has been able to provide convenient access to care for individuals without the resources to travel.

In FYs 17/18 Serving 12 locations

Increased access to 9 rural communities

DIABETIC CLINIC Take Control Today

Family HealthCare Network launched a pilot Diabetic Clinic in January 2017. The Diabetic Clinic gave patients the opportunity to understand risky behaviors, explore ways to manage their nutrition by viewing a cooking demonstration, and set goals with a nutritionist and provider. The Diabetic Clinic pilot produced tremendous success between a cohort and control group of patients.

7.5% decrease in Hgba1c for cohort vs.

1.5% increase for control 60% of cohort with BP under 140/90 vs. 50% of control

Overwhelming positive feedback from participants “I really liked the ability to question people who were experts in their field.�

-Diabetic Clinic Patient

Primary Care As a patient-centered health home, FHCN offers a wide range of comprehensive primary care services to meet the needs of the communities served. Primary care services are also integrated in to one location to improve accessibility for individuals and families to address their health care needs. Services such as family medicine, pediatrics, obstetrics and gynecology, internal medicine, adult and children’s dentistry, optometry, pharmacy, and chiropractic services complement ancillary and specialty services offered at FHCN health centers.

Fiscal years 2017 and 2018 were no exception to FHCN’s continued success in offering a patientcentered model of care as noted in the Fiscal year’s highlights.

In FY 2017

In FY 2018

3,035 infants delivered 97,961 pediatric visits

2,924 infants delivered 98,403 pediatric visits

230,422 active patients

253,850 active patients

687,341 patient encounters

756,121 patient encounters

256,775 prescriptions filled

260,833 prescriptions filled

3,327 vision exams 1,738 prescription glasses sold

7,693 vision exams 4,589 prescription glasses sold

94,329 dental visits

108,917 dental visits

Specialty Services As part of FHCN’s Patient - Centered Medical Home (PCMH) model, FHCN expanded its specialty services during fiscal years 2017 and 2018, offering multiple new specialty services.

DECEMBER 2016 Vascular Surgery

FEBRUARY 2017 Perinatology

MAY 2017 Endocrinology

JULY 2017 Orthopedic Surgery

JUNE 2018 Ears, Nose, and Throat Gastroenterology Infectious Disease Ophthalmology Hematology Cardiology Neurology Rheumatology Urology Allergy

Community Impact FY 17 BOOKS DISTRIBUTED VIA REACH OUT & READ

19,881 HEALTH SCREENINGS AT COMMUNITY EVENTS

7,800

3,891 APPLICATIONS FOR ENROLLMENT INTO SPECIAL PROGRAMS*

104 FAMILIES, INCLUDING 260 CHILDREN, SUPPORTED THROUGH THE ANITA FUND

8,172 KINDER CARE ORAL HEALTH SCREENINGS

73,636

PEOPLE EDUCATED THROUGH OUTREACH

687,341

FITCLUBS CREATED IN: Farmersville (1) Woodlake (2) Tulare (3) Ivanhoe (2) Visalia (3) Cutler-Orosi (1)

*Special Programs include: Covered CA, Medi-Cal, M-CAPRepHi, Cal Fresh, Medicare, Social Security, VEA Apps, etc.

Community Impact FY 18 BOOKS DISTRIBUTED VIA REACH OUT & READ

33,166 HEALTH SCREENINGS IN COMMUNITIES

9,311

4,293 APPLICATIONS FOR ENROLLMENT INTO SPECIAL PROGRAMS*

108 FAMILIES, INCLUDING 256 CHILDREN, SUPPORTED THROUGH THE ANITA FUND

7,019 KINDER CARE ORAL HEALTH SCREENINGS

121,356 PEOPLE EDUCATED THROUGH OUTREACH

FITCLUBS CREATED IN: Cutler-Orosi (2) Tulare (1) Visalia (3) Woodlake (1)

*Special Programs include: Covered CA, Medi-Cal, M-CAPRepHi, Cal Fresh, Medicare, Social Security, VEA Apps, etc.

Here’s to Another 40 years!