Low-Income Pool Primary Care Application: Community Health ...

Low-Income Pool Primary Care Application: Community Health of South Florida Inc

1. Applicant:

Community Health of South Florida Inc

2. Medicaid Provider Number: 02957800

3. Provider Type: Private nonprofit Federally-Qualified Primary Health Care Provider

4. Amount applying for: $850,000

5. Identify as a new or enhanced program: Enhanced program

6. Description of the delivery system and affiliations with other health care service providers

The Community Health of South Florida Inc (CHI) health care delivery system is a comprehensive integrated model that is driven by a local community's identified health care needs and barriers; barriers include racial, cultural and linguistic diversity; fear of deportation; adverse health attitudes and beliefs; untreated chronic disease; mental health conditions; poverty; and lack of insurance. Services in CHI health centers, all of which are located in medically underserved and health professional shortage areas in Miami-Dade and Monroe counties, include ? Well care, such as routine check-ups, physicals, screenings, and immunizations ? Emergency and sick visit care for illnesses such as colds and flu ? Treatment and management of chronic and acute conditions such as arthritis,

asthma, diabetes and hypertension ? Diagnostic procedures, including x-rays ? OB/GYN services, including pre-natal and post-partum care ? Dental and oral health services ? Ancillary services such as pharmacy, radiology, and laboratory; for moderate and

complex lab work, centers use contracted commercial laboratories ? Free delivery of low cost medication ? Transportation: If requested, CHI provides transportation for patients from their

homes to the nearest health center for their appointments. For specialized services that the center staff cannot provide, for example in areas such as cardiology and neurology, CHI refers patients to area specialists

Key components of CHI's delivery system are ? Integration of primary and behavioral health care services: Mental health counselors are embedded in primary care units and screen all patients for depression, anxiety, schizophrenia, alcohol and substance abuse. Cross-referrals are made between primary care and mental health providers.

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Low-Income Pool Primary Care Application: Community Health of South Florida Inc

? Case management: A highly effective case management system provides an additional level of supportive care. A nurse and social worker provide patients with referrals, advocacy linkages, networking and monitoring of preventive services, perinatal care, PEPW application, connection to Woman Infant Children (WIC), and healthy start services.

? Community Health Workers Program: Outreach workers go neighborhood by neighborhood to help children and families gain access to CHI health centers, enroll in programs such as Florida KidCare and Medicaid, and generally increase their contact with primary care services. Many live in the neighborhoods where they work, serving as ambassadors for CHI while raising increasing awareness of community needs

CHI has several partnerships and linkages with public and private community health care service providers that will enable the future West Kendall Health Center (WKHC) to efficiently utilize federal, state and local resources to meet the target population's health care needs. Among them are:

? Baptist Hospital (newly opened in West Kendall): hospitalization and specialty care

? Jackson Memorial Hospital: hospitalization and specialty care ? Miami Children's Hospital: referrals for pediatric patients with special needs ? South Florida AIDS Network: diagnosis, primary care, case management,

medication and social services to HIV/AIDS patients ? Miami-Dade Health Department: WIC, Healthy Start, STD and TB testing and

treatment ? RCMA: child development and care services for Migrant Seasonal Farm Worker

children ? Florida Department of Children and Families: facilitating insurance coverage for

uninsured pregnant women and children.

7. Service Area

The West Kendall Health Center service area includes the neighborhoods within the zip codes of 33176, 33177, 33186, 33187 and 33196. West Kendall is located in the southwest corner of Miami-Dade County; it runs from Krome Avenue (SW 177th Ave) to SW 107th Avenue and from Kendall Drive (SW 88th St) to Coral Reef Drive (SW 152nd St).

8. Service Area characteristics

West Kendall is a racially, culturally and linguistically diverse community. It is one of the fastest growing and most densely populated communities in Florida (Kendall Federation of Homeowners). It is home to many undocumented immigrants, including Haitian families who fled to the U.S. following the 2010 earthquake. Total population

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Low-Income Pool Primary Care Application: Community Health of South Florida Inc

in the service area zip codes is 230,433 (2010 UDS Report). Demographic breakdown for West Kendall is not available since, for census purposes, West Kendall is counted within the suburb of Kendall. The service area zip codes lie in Florida congressional districts 18, 21, and 25. Demographic breakdown for these districts is Hispanic 67 percent, 72 percent and 76 percent respectively; and Black 7 percent, 10 percent, and 9 percent respectively.

West Kendall has a substantial low-income population, with nearly a quarter of the population classified as low-income (UDS Report). Of the service area target population, 50 percent lives below 100 percent of the poverty level; for a family of four, this translates to living on less than $23,050 per year.

West Kendall has a low penetration rate by community health centers. In 2010, only 23 percent of the low-income population accessed primary health care services through community health centers (UDS Report). In 2011, Community Health of South Florida served 60,700 patients in South Miami-Dade and Monroe counties; 15 percent of patients resided in the proposed service area zip codes. Of total patients served, 54 percent were Hispanic, 31 percent were Black, and 9 percent were White non-Hispanic. Among patients 14,215 were homeless and 4,762 migrant and seasonal farm workers (UDS Report). Although homeless and migrant workers do not reside in significant numbers in West Kendall, CHI estimates that many immigrant families live in the area with extended families and friends with no permanent address, thus meeting the definition of homeless.

Data from the 2010 Miami-Dade Community Health Report indicates that West Kendall residents have among the county's highest rates of preventable hospital admissions for conditions that indicate poor health maintenance and lack of access to primary health care. Among these are asthma, pneumonia, diabetes complications, hypertension, and urinary track infections. Rates of obesity, sexually transmitted diseases and HIV are on the rise, while fewer women received mammograms and fewer adults had regular dental care.

Among patients served in 2011 by CHI, 69 percent carried no medical insurance (UDS Report). Patient payment sources consisted of Medicaid 23 percent; Medicare 4 percent; private insurance 4 percent. CHI anticipates a similar payment source trend for WKHC. Although in 2009 income in the service area was estimated to be 28 percent uninsured, the West Kendall area has many small businesses that employ local residents. In the past two years many have stopped offering employees health insurance as a result of spiraling premium costs. This leads CHI to anticipate a higher number of uncovered patients.

9. Organizational Chart and point of contact:

Mr. Brodes Hartley Jr., President and CEO Tel: 305-252-4853 Organizational chart (attached ? see p.5 of the Organizational Chart)

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Low-Income Pool Primary Care Application: Community Health of South Florida Inc

10. Proposed budget for funding detailing the request:

Through this proposal, CHI requests $850,000. The budget is attached and follows the narrative.

11. Provide a brief summary of your proposed project:

Community Health of South Florida Inc proposes to establish a community health care center in the West Kendall neighborhood of Miami-Dade County. The ultimate goal of the West Kendall Health Care Center (WKHC) is to improve the health status of the local underserved population. WKHC will provide culturally and linguistically appropriate primary and mental health care services to users at all stages of life, from infants through the elderly, regardless of ability to pay. It will replicate the comprehensive integrated health care delivery system in place at CHI's seven other community health centers in Miami-Dade and Monroe counties.

CHI anticipates that after the first year, the WKHC will serve an estimated 6,000 unduplicated users with 16,500 patient visits. The majority will be Hispanic and Black, including African American, Haitian, and other Caribbean immigrants. The center will target the very low and low-income populations.

This request will fund hiring of a medical team at West Kendall that includes 1.0 FTE Family Practitioner, 0.8 FTE Pediatrician, 1.0 FTE Licensed Practical Nurse, 3.0 FTE Patient Care Technicians and 2.0 FTE patient financial services specialists. Following successful implementation, CHI will seek to hire additional staff to provide obstetrics, mental health and oral health care services on site; these services will be available immediately upon startup at CHI's other locations. The center will utilize the Electronic Health Record to ensure staff works with the most accurate and updated patient information. WKCH will be open Tuesday through Friday, with evening hours on at least two days, and on Saturday morning. A health care provider will be on 24-hour call for consultation on after-hour emergencies.

The West Kendall Center will be located at a long-term leased property which is easily accessible by public transportation. The proposed 3,000 square foot building will be zoned for commercial use. It will be fully equipped to provide state-of-the-art primary and mental health care services with expansion capability. Space will include six exam rooms (to be shared among health care services); lab/phlebotomy room; bio-hazardous materials room; and storage room. There will be a reception area and waiting room for 30 people; a nurse's station and two offices.

12. Describe plan for identification of participants for inclusion in the population to be served in the project

The proposal to expand services in the West Kendall area is the result of CHI's ongoing strategic planning. As part of this process, CHI reviews trends in local health care needs, identifying gaps in services and, strategically plans to provide health care

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Low-Income Pool Primary Care Application: Community Health of South Florida Inc

services to meet community needs. CHI began plans to expand services to West Kendall in 2007, completing a full needs assessment of the organizational service area including the target community in 2009. For the past three years, two West Kendall residents have served on the CHI board, bringing with them unique insights into local needs.

CHI is an active part of the communities it serves, partnering with other social service providers, local schools, and faith-based organizations to ensure that all members of the community in need of health services are identified. CHI also maintains excellent relations with local elected officials, working closely with them to identify needy constituents. To identify and serve eligible school-age children, CHI provides health care services in maintaining health teams in 31 Miami-Dade County public school sites; CHI was recently awarded four additional school based sites, some of which are located in the West Kendall area. Through the Healthy Body/Healthy Soul Program, CHI partners with clergy and members of the faith-based community in health promotion and outreach activities. CHI will bring these types of initiatives to the West Kendall community.

As noted earlier, the Community Health Worker Program is a key aspect of CHI's health outreach and delivery system. These trusted and well-trained members of the community go block-by-block in neighborhoods to identify and recruit hard-to-reach populations who are not using primary health care services. For the West Kendall service area, CHI plans to utilize existing Community Health Workers (CHW), of which CHI has 12; to identify community residents who can take advantage of the new health care services. The existing CHWs work alongside a Health Navigator (HN) to assist patients navigate the health care system, link to resources and enroll in health insurance plans.

13. How will access to primary care access system services be enhanced by this project?

This project will enhance access to primary care services by ? Creating a medical home for residents and reduce ER useage ? Providing services on a sliding fee scale ? Accepting all Medicaid and Medicare patients ? Providing evening and Saturday morning hours, same day emergency appointments,

and access to health providers outside of health center hours ? Providing transportation to and from the health center for patients who lack access

to public or private transportation ? Employing culturally diverse individuals, many of whom reside in the service area,

to bring hard-to-reach populations into the primary health care system

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