CHAD Connection - August 6

August 9-15 is National Health Center Week, and health centers in North Dakota and South Dakota are taking this moment to celebrate. The Dakotas’ network of nine community health center organizations will be using this opportunity to thank their patients and the communities they serve, and to highlight the important contributions health centers make to the health care system in both urban and rural communities. It is also an excellent opportunity for health centers to recognize their outstanding staff for all they do and to give back to the communities they call home.

Both Governor Doug Burgum of North Dakota and Governor Kristi Noem of South Dakota declared next week as Community Health Center week in their respective states with official proclamations. With the opportunity for in-person events limited this year, health centers are using social media to draw attention to different aspects of health center services and the people who make our work possible – our staff, patients, and community board members. Check out CHAD’s Facebook page and Twitter account to see (and share!) these public health messages. Focus days for the week include:

Sunday, August 9 – Whole Person Day, bringing attention to the social and economic factors that impact our health;
Monday, August 10 – Health Care for the Homeless Day, honoring the work being done at community health centers to provide high-quality, comprehensive primary care, behavioral health care, case management, outreach, and other services to meet the needs of the unhoused;
Tuesday, August 11 – Economic Impact Day, highlighting the combined economic impact of health centers across North Dakota and South Dakota of over $160,000,000 in 2019;
Wednesday, August 12 – Patient Appreciation Day, celebrating patients and board members who keep health centers accountable and abreast of community needs;
Thursday, August 13 – Legislative Day, thanking local partners and government officials at the local, state, and national level for their support and collaboration;
Friday, August 14 – Staff Appreciation Day, spotlighting the diligent work of health center staff and volunteers; and,
Saturday, August 15 – Children’s Health Day, celebrating the more than 42,500 children in the Dakotas get their primary health care from a community health center.

CHAD will be publishing weekly data representing the number of positive COVID-19 tests for the current week as compared to the previous week, the cumulative number of cases diagnosed, current and cumulative hospitalizations, the percent of health center visits compared to the determined baseline, and the percent of visits that are being done virtually. This data will be compiled for North Dakota and South Dakota each week. This week’s data covers the week beginning Thursday, July 30 to Wednesday, August 5.

The Senate introduced its fourth legislation package in late July. The Health, Economic Assistance, Liability and Protection, and Schools (HEALS) Act provides $7.6 billion in supplemental funding to community health centers but does not include long-term funding. The bill also preserves the ability of Federally Qualified Health Centers (FQHCs) to provide telehealth services in Medicare for five years following the end of the public health emergency. The bill is expected to reach the Senate floor this week. The House of Representatives passed their fourth COVID-19 relief bill, the HEROES Act, on May 15.

There are currently several pieces of legislation being considered by Congress that address telehealth. Four main changes would help health centers provide telehealth care include: continuing to bill as distant sites under Medicare for telehealth visits; continuing to allow telehealth reimbursement for patients who are at home; removing geographic restrictions on telehealth sites; and requiring Medicare to pay health centers their usual prospective payment system (PPS) rate. CHAD members should have received an email last week asking everyone to contact their members of Congress. There is still time to take action on this important issue. If needed, please contact Jessica Gilbertson to be added to the CHAD advocacy email list.

The North Dakota State Emergency Commission met on Monday, August 3, and unanimously approved $319.7 million in federal Coronavirus Aid, Relief, and Economic Security (CARES) Act funding to support the state’s COVID-19 response. North Dakota received a total of $1.25 billion from the CARES Act. Previous allocations included $524.2 million in May and $406.1 million in June. The six members of the Emergency Commission are House Majority Leader Chet Pollert, Senate Majority Leader Rich Wardner, House Appropriations Chairman Jeff Delzer, Senate Appropriations Chairman Ray Holmberg, Secretary of State Al Jaeger and Governor Doug Burgum.

The current allocation includes:

$59 million for cities and counties for law enforcement payroll;
$20 million for local public health units;
$100 million for the unemployment trust fund;
$96.6 million for the North Dakota Department of Health, which includes an enhanced testing campaign for K-12 education and the North Dakota University System;
$23.3 million for the Office of the Adjutant General for statewide testing sites;
$17.4 million for the North Dakota University System, including $13.6 million for HVAC modifications to improve air quality in campus buildings;
$13.3 million for the North Dakota Department of Human Services, including $12 million for the childcare emergency operations grant through December;
$5 million for tribal colleges, trade schools, and private colleges; and,
$5.2 million for other state agencies.

Find more information about the Emergency Commission’s allocations here.

Last week, the Governor announced the formation of the Burleigh-Morton COVID-19 Task Force to address the growing number of COVID-19 cases in the Bismarck/Mandan area. The goal of the task force is to prevent and mitigate the spread of COVID-19 in the two counties where cases are rising at a higher rate than the rest of the state. As of July 28, the rolling average positive test rate in Burleigh County was 4.12%, compared to the state rolling average of 2.77%. The task force will be following a model similar to the Red River Valley Task Force, which brought the average in Cass County down from 9.6% in May, to 2.73% in July. The task force will be made up of city and county officials, local public health units, representatives from the education, medical and business sectors, and the North Dakota Department of Health. To read Governor Burgum’s press release on the event, click here.

In July, Horizon Health Care and Horizon Health Foundation offered several "first look" tours of Yankton Community Health Center and Dental Services in their new location at 920 Broadway Avenue in Yankton. Horizon staff showed around small, masked groups, including community partners, state legislators, stakeholders, and members of the media.

The building was completely renovated and will provide the community of Yankton with expanded access to medical, dental, and behavioral health services. Horizon Health Care began seeing medical patients with a soft launch on Monday, August 3 and will follow with dental patients in September.

Earlier this week, CHAD hosted a workshop designed for health center leaders across a range of disciplines to explore the highs and lows of the last four months, and how to apply hard-won new knowledge to be more prepared for what lies ahead. Speakers from Coleman Associates helped health centers assess readiness for future pandemic waves, do some scenario planning, and shared tools that to help health centers prepare for an uncertain fall.

Based on information from The New York Times, CHAD is adding a new data point to the COVID-19 dashboard: the top five counties in both North Dakota and South Dakota, with the most cases per 100,000 residents in the last seven days. With COVID-19 numbers climbing in both states, we feel that it is critical for health centers to track emerging hotspots (those with the most cases over the last seven days) in order to respond effectively. Over the past week, there have been an average of 84 cases per day in South Dakota, an increase of 31% from the average two weeks earlier. In the same period, there have been an average of 113 cases per day in North Dakota, an increase of 11% from the average two weeks earlier.

Being prepared to launch different aspects of a health centers’ emergency plan is the ability to foresee potential COVID-19 hot spots or recognize emerging virus trends. Reduced primary care visits this spring, lagging vaccination rates, and the upcoming flu season coupled with a potential COVID-19 surge means health centers must be primed for multiple scenarios. CHAD plans to continue publishing these data points to aid health centers in watching for issues in surrounding communities.

Each week, the Health Resources and Services Administration (HRSA) requests information from community health centers across the country to track the impact of COVID-19 on capacity, operations, patients, and staff. The data is used to plan for training and technical assistance, funding, and additional resources. A few highlights from the latest report, dated July 24, include:

Patient Testing

COVID-19 testing capacity is 100% of health centers for both North Dakota and South Dakota.
ND reported 33% of COVID-19 test results are returned in 2-3 days with the balance returned in 4-5 days. SD reported half of the test results are returned in 2-3 days, with the balance returned in 4-5 days.
Both states reported an increase in the total number of tests performed. Since reporting began on April 3, ND reported a total of 2,384 patients tested with SD reporting 3,073 patients tested for COVID-19.
Of the patients tested, 25% were racial/ethnic minority in ND (16.4% of the population were racial/ethnic minorities), and 32.2% in SD (18.6% of the statewide population are racial/ethnic minorities). ND health centers reported 41% of the total positive cases identified as being of racial and/or ethnic minority, with SD reporting 50%.

Operations

Weekly visits compared to pre-COVID-19 visits in ND increased to 71.67%. SD also saw an increase and is reporting 80%.
ND reported an increase in the number of visits conducted virtually with an increase from 22.5% to 30.0%. SD decreased from 8.33% to 5.0%.

The Community Health Association of Mountain/Plains States (CHAMPS) and the Northwest Regional Primary Care Association (NWRPCA) are committed to the wellbeing of our members, partners, and staff. After much consideration, they have made the difficult decision to host the fall 2020 Primary Care Conference virtually due to the ongoing COVID-19 pandemic. Their goal is to provide an engaging event while also protecting the health and safety of all attendees. CHAMPS organizational member health centers are entitled to reimbursement for up to two conference registration fees. For more information, click here. To register, click here.

This flu season, the Sioux Falls Area Immunization Coalition (SFAIC), is partnering with Families Fighting Flu, a nonprofit organization dedicated to preventing children, families, and communities from the devastating effects of influenza. Together, they are working to increase flu vaccination rates through text message reminders. To receive an individualized reminder to get an annual flu vaccine this season, text SDFLU to 47177. Once signed up, participants will receive personalized texts encouraging them to help protect themselves and loved ones against the flu. Please feel free to share this opportunity with friends and family, colleagues, and email groups.

Rural health care facilities face unique challenges in the fight against COVID-19. Developed by the Rural Surge Readiness team COVID-19 health care resilience working group, a partnership between the U.S. Department of Health and Human Services and the U.S. Department of Homeland Security and other federal agencies, the Rural Health Surge Readiness web portal provides essential resources, tools, and trainings for rural health care systems preparing for and responding to a COVID-19 surge. The material is appropriate for executives, managers, and providers at a wide range of health care settings, and it covers topics including behavioral health, operations, and telehealth.

The American Cancer Society (ACS) has updated its guidelines for cervical cancer screening. The new guidelines are for people with a cervix with an average risk of cervical cancer. For people aged 25 to 65 years, the preferred screening recommendation is to get a primary human papillomavirus (HPV) test every 5 years. A primary HPV test is an HPV test that is done by itself for screening. The US Food and Drug Administration (FDA) has approved certain tests to be primary tests. Because these HPV tests may not be widely available in the US yet, the guidelines include these two other acceptable screening methods and schedules.

A co-test every five years that combines an HPV test with a Pap test; or,
A Pap test alone every three years.

The 2020 guidelines also recommend that people older than age 65 with a cervix stop being screened as long as they’ve had ten years of regular screening with normal results. Otherwise, they should continue to be screened until they do. Those who have had their cervix removed, such as from a hysterectomy, don’t need screening as long as the surgery was done for reasons not related to cervical cancer or serious pre-cancer. People who have gotten the HPV vaccine should still follow the screening guidelines as listed above. The full, updated guideline was published online on July 30, 2020, in CA: Cancer Journal for Clinicians. The journal also has a patient page.

The National Association of Community Health Centers (NACHC) is partnering with nonprofit VotER to build this capacity within the health center movement. Every community health center (CHC) will receive two window clings with QR and text codes that will direct patients, staff, vendors, and supporters to a link to register to vote. NACHC hopes that health centers will post these clings to encourage patients and staff to participate in the democratic process. NACHC will be encouraging participation by holding a state-by-state competition.

For additional resources:

Sign up for Healthy Democracy Kits. There is a free digital option, and a paid option for a physical version - both come with monthly reporting of how many patients have registered.
Sign up for free voter registration posters, and patient handouts in English and Spanish branded uniquely for each health center.

NACHC Advocacy 101 Summer Training Series: Leveraging Social Media

In the last installment of the National Association of Community Health Centers (NACHC) grassroots advocacy team’s Advocacy 101 Summer Training Series, speakers will discuss how to leverage social media to elevate advocacy messages and best practices for advocacy on social media. This session will provide tools and ideas for health center advocates to engage social media influencers and build a larger audience platform for their messages. Attendees will learn how to reach broader audiences through compelling narrative storytelling.

Thursday, August 6
2:00 pm MT/ 3:00 pm CT
Register here.

Health Center School-Based Dental Programs and COVID-19

As school districts develop plans for the upcoming school year, the ability of health center school-based dental programs to deliver care is unknown. Health centers must be ready to respond to new local requirements and develop new policies and protocols to be able to resume their school-based dental programs. Presented by the National Network for Oral Health Access (NNOHA), this listening session will provide a forum for health centers to listen and discuss strategies on resuming school-based dental services and share challenges and barriers. This session will be an open discussion that will also identify future training and technical assistance opportunities for NNOHA to help health centers restart their school-based dental programs during COVID-19.

Monday, August 10
11:30 am MT/ 12:30 pm CT
Register here.

CCHN/ CHAMPS Health Equity Learning Series

The four-part 2020 Health Equity Learning Series hosted by the Colorado Community Health Network (CCHN)/ Community Health Association of Mountain/Plains States (CHAMPS) is designed to introduce all levels of staff to the community health center movement’s position and continued efforts in the journey towards a more equitable and just health system. Participants will come away from the series with a greater understanding of organizational and personal positions in this work, as well as a few strategies to assist in moving the work forward. This series is free for all Region VIII health centers.

Tuesday, August 11, September 1, September 22, and October 13
12:00-1:15 pm MT/ 1:00-2:15 pm CT
For more information and to register, click here.

Summer School with the School-Based Health Alliance

The School-Based Health Alliance (SBHA) is hosting a multiple-part virtual learning series—Summer School with the School-Based Health Alliance to help meet the needs in the current landscape. Please find a description and registration link for all webinars below.

Hearing Hoof Beats from a Distance: Primary Care and Telehealth
As school-based telehealth care becomes more critical to maintaining students’ access to care, many clinicians are venturing into a virtual approach to primary care. This webinar offers an opportunity to learn from presenters who deliver primary care via school-based telehealth. Presenters will use a "rounds-style" collaborative discussion of evaluating, diagnosing, and treating patients remotely based on clinical cases.

Wednesday, August 12

10:00 am – 11:00 am MT/ 11:00 am – 12:00 pm CT

Developing and Implementing Tele-behavioral Health in SBHCs
School-based health centers are rapidly adopting and accelerating tele-behavioral health services. In this webinar, behavioral health care providers and administrators will describe their experiences implementing or adapting tele-behavioral health programs, identify challenges and opportunities discovered through this process, and discuss strategies and best practices for others moving forward.

Wednesday, August 19

10:00 am – 11:00 am MT/ 11:00 am – 12:00 pm CT

Join Jim Macrae for updates on COVID-19 and other topics, such as the multi-year transformation effort to advance community health. Missed recent Today with Macrae calls? Recordings and transcripts are posted on the Bureau of Primary Health Care’s Emergency Preparedness and Recovery Resources for Health Centers webpage as soon as possible after each call. Save the dates for future Today with Macrae updates on September 29 and October 29.

Thursday, August 20
12:00 pm MT/ 1:00 pm CT
Join the webinar on the day of the session.

Preparing for Value-Based Care through Sustainable Telehealth Workflows

Telehealth has been an effective tool for treating patients remotely and ensuring any on-premise patients and staff stay safe. Some health centers are treating telehealth as a crisis management tool rather than a tool to improve the health of their patients in a cost-efficient and outcome-driven way. Presenters from the Health Information Technology, Evaluation, and Quality Center (HITEQ) will cover sustainable telehealth services that are often underutilized and example workflows that have worked for other health centers during this session.

Thursday, August 27
12:00 pm MT/ 1:00 pm CT
Register here.

UDS Mapper Webinars

The UDS Mapper is a collaboration between the Health Resources and Services Administration (HRSA) and the American Academy of Family Physicians (AAFP) and is part of the HealthLandscape online mapping platform. These webinars are open to the public and free of charge.

Introduction to the UDS Mapper
This webinar is a general introduction to the UDS Mapper, a mapping and decision-support tool-driven primarily from health center patient location data within the Uniform Data System (UDS). This webinar will go over the basics of using the UDS Mapper and is geared toward users who are new to the UDS Mapper or in need of a refresher.

Wednesday, September 2

12:00 pm MT/ 1:00 pm CT

UDS Mapper Advanced Topics: New Features in the UDS Mapper
Attend this session to learn about recent updates to the UDS Mapper, including new data and enhanced functionalities. The webinar is geared toward users who are familiar with the UDS Mapper.

Thursday, September 17

12:00 pm MT/ 1:00 pm CT

UDS Mapper Special Topics: Food Insecurity and Opportunities for Health Centers
This special topic webinar will focus on examining the relationship between health center service areas and food insecurity. During this session, speakers will highlight how to use the UDS Mapper, including a new functionality allowing users to add area-level data to analyze food insecurity in a community. The webinar is geared toward users who are familiar with the UDS Mapper.

Wednesday, September 23

12:00 pm MT/ 1:00 pm CT