CityMatCH January 17, 2008 Collaboration between Community Health Centers and Local Health Departments

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Lyon County Health Department dba Flint Hills Community Health Center (LCHD/FHCHC) The ultimate collaboration

Demographics Population of Lyon County: 35,560 Principal city population (Emporia): 26,780 Population of 4-county catchment area for community health center: 63,627 Majority of services provided to Lyon County residents, and maximum distance would not exceed 20 miles. Outlying counties: maximum travel distance, 50 miles

Responding to community need As Lyon County Health Department meeting two essential services: community assessment and assurance led the organization to pursue community health center funding.

Community Needs Lack of access to personal health care services was a significant unmet need leading to the initiative to secure funding and resulting in the collaboration. Local hospital was a key partner in the process. Lack of access to oral health services resulted in addition of dental clinic in 2000 Capacity shortage for mental health services resulted in addition of behavioral health services in 2002

Historical Context Great unmet need for primary health care both for uninsured and Medicaid recipients in Lyon and surrounding counties County hospital provided funding to establish a small primary care clinic staffed by Advanced Registered Nurse Practitioner County health department secured Federally Qualified Health Center Look-alike status Community Health Center funding (Section 330) secured in 1997

Organizational structure Lyon County Health Department was the grantee and thus the CHC functioned as a public entity 501(c)3 corporation established with a consumer majority board Organization continued as a unit of county government until December 31, 2003

August, 2001: The Question Can LCHD/FHCHC be a totally independent entity?

July, 2002: The Answer NO Must maintain a connection to Lyon County as an instrumentality of government. This became a key issue. Instrumentality is a legal construct under Kansas law.

The Charge Lyon County Commission authorized Flint Hills Community Health Center Board of Directors to move forward with an implementation plan to begin functioning as an instrumentality of government

The Administrative Challenges of Functioning as a Public Entity Dual governance: County Board of commissioners and Community Health Center Board Duplication of work efforts in human resource and financial responsibilities More limited ability to be responsive to work force needs in the health care environment

A new model for governance LCHD/FHCHC began functioning as an instrumentality of government effective January 1, 2004 Employees were transferred from Lyon County government to FHCHC Lyon County Health Department remains the grantee for Section 330 funds FHCHC Board of Directors has a contract with Lyon County Commission by which grants and their requisite responsibilities are assigned to FHCHC Contract also includes assignment of responsibility for public health functions

Challenges Maintaining level funding from county to sustain public health functions Some loss of revenue for public health functions as state Medicaid agency does not allow the agency to bill both as a local health department and an FQHC

Benefits Collaboration with public health at its best CHC has been easily incorporated into Public Health Preparedness Planning One-stop for health care for low-income, underserved residents of catchment area (population-based health services, primary care, dental, and behavioral health Cost effective with shared administration and infrastructure Administrative challenges and duplication of work effort reduced or eliminated Organization able to be more responsive to changes in health care environment

Questions/Comments? For more information, contact: Lougene Marsh, MPA Executive Director 420 W. 15 th Avenue Emporia, KS , x261