2021 Bi-State Primary Care Association 525 Clinton Street Bow, NH 03304 (603) 228-2830 www.bistatepca.org New Hampshire Primary Care Sourcebook TABLE OF CONTENTS Introduction to Bi-State Page 3 Ammonoosuc Community Health Services Page 25 Bi-State PCA NH Members Page 4 Amoskeag Health Page 26 Bi-State PCA NH Members (continued) Page 5 CHAN Page 27 2021 NH Public Policy Principles & Priorities Page 6 Charlestown Health Center Page 28 CHCs, FQHCs, FQHC LAL, and RHC Page 7 Coos County Family Health Services Page 29 Snapshot of Bi-State’s NH Members Page 8 Greater Seacoast Community Health Page 30 Investing in Primary Care Page 9 Harbor Care Page 31 CHC Data Page 10 Health Care for the Homeless Program Page 32 FQHC Data Page 11 HealthFirst Family Care Center Page 33 FQHCs Improve Access to Integrated Care Page 12 Indian Stream Health Center Page 34 A Growing Demand for FQHC Services Page 13 Lamprey Health Care Page 35 FQHC Clinical Quality Measures in 2019 Page 14 Mid-State Health Center Page 36 FQHC Funding Page 15 NH AHEC Page 37 Bi-State PCA NH Member Map Page 16 North Country Health Consortium Page 38 Bi-State’s Workforce Recruitment Center Page 17 Planned Parenthood of Northern New England Page 39 Supporting Communities in COVID-19 & Beyond Page 18 Weeks Medical Center Page 40 Strengthening Public Health During the Pandemic Page 19 White Mountain Community Health Center Page 41 Community Health Center Flu Clinics Page 20 Resources Page 42 Prioritizing Food Security as Part of Overall Health Page 21 FQHC Federal Requirements Page 43 Breaking Down Barriers to Care Amidst COVID-19 Page 22 FQHC Sliding Fee Scale Page 44 Telehealth: A Bright Spot During the Pandemic Page 23 Who’s My Legislator? Page 45 NH Member Profiles Page 24 Acknowledgements Page 46

2 What is a Primary Care Association? Each of the 50 states (or in Bi-State’s case, a pair of states) has one nonprofit Primary Care Association (PCA) to serve as the voice for Community Health Centers. These health centers were born out of the civil rights and social justice movements of the 1960s with a clear mission that prevails today: to provide health care to communities with a scarcity of providers and services. That includes bringing comprehensive services to rural regions of the country. Bi-State’s Mission Bi-State’s Vision Promote access to effective and affordable Healthy individuals and communities with quality primary care and preventive services for all, with health care for all. special emphasis on underserved populations in Vermont and New Hampshire.

Who We Are Bi-State Primary Care Association is a 501(c)3 nonprofit organization that was formed by two health and social service leaders in 1986 to expand access to health care in Vermont and New Hampshire. Today, Bi-State represents 31 member organizations across both states that provide comprehensive primary care services to over 300,000 patients at 142 locations. Our members include federally qualified health centers (FQHCs), clinics for the uninsured, rural health clinics, Area Health Education Center (AHEC) programs, and Planned Parenthood of Northern New England. We provide training and technical assistance for improving programmatic, clinical, and financial performance and operations. We provide workforce assistance and candidate referrals for providers including physicians, dentists, nurse practitioners, and physician assistants. We also work with federal, state, and regional policy organizations, foundations, and payers to develop strategies, policies, and programs that support community-based primary health care. NH Public Policy Workforce & Recruitment Bi-State is committed to improving the health status of Granite Bi-State’s Recruitment Center has sourced 1,490 candidates Staters and ensuring that all individuals have access to interested in practicing in VT and NH over the last year. We affordable and high-quality primary medical, mental health, helped recruit 32 providers to New Hampshire and Vermont substance use, and oral health care, regardless of insurance between July 2019 – June 2020 (FY20). status or ability to pay.

Annual Events In 2020, Bi-State hosted several annual conferences and trainings that provided important learning and networking opportunities for our colleagues from both states. The NH Public Policy team hosts our annual Legislative Breakfast to highlight the important roles our members play in their communities and the need for comprehensive health care and a robust health care workforce in NH. Our UDS Training in the fall discusses the new measures and requirements for Uniform Data System reporting and successful submission strategies. In December 2020, Bi-State held its first-ever multi-day, virtual Clinical Quality Symposium that focused on topics that were selected by NH and VT clinical teams in order to achieve better clinical outcomes and improve the health of patients. Bi-State also held our 2020-21 Leadership Development Program, tailored to training the next generation of community health center leaders. 3 Bi-State Primary Care Association’s New Hampshire Members

Ammonoosuc Community Health Services, Inc. Community Health Access Network Harbor Care (FQHC) (FQHC) Newmarket (Rockingham County) Nashua (Hillsborough County) Franconia, Littleton, Warren, Whitefield, Joan Tulk, Executive Director Peter Kelleher, Executive Director Woodsville (Coos and Grafton Counties) (603) 292-7205, (603) 292-7284 Jonathan Brown, Clinical Director Edward D. Shanshala II, Chief Executive Officer [email protected] (603) 821-7788 (main) (603) 444-8223, [email protected] 207A South Main Street, Newmarket, NH 03857 [email protected] 25 Mt. Eustis Road, Littleton, NH 03561 www.chan-nh.org (603) 816-7983, [email protected] www.ammonoosuc.org 45 High Street, Nashua, NH 03060 Coos County Family Health Services (FQHC) www.harborcarenh.org Amoskeag Health (FQHC) Berlin, Gorham (Coos County) Manchester (Hillsborough County) Ken Gordon, Chief Executive Officer Health Care for the Homeless Program Kris McCracken, President/Chief Executive (603) 752-3669 Ext. 4018, [email protected] (FQHC) Officer 54 Willow Street, Berlin, NH 03570 Manchester (Hillsborough County) (603) 935-5210, (603) 935-5229 www.coosfamilyhealth.org Amy Pratte, Director, External Affairs/ [email protected] Fiscal Manager HCH 145 Hollis Street, Manchester, NH 03101 Greater Seacoast Community Health (FQHC) (603) 663-8716, [email protected] www.amoskeaghealth.org Dover, Exeter, Hampton, Portsmouth, Rochester, 199 Manchester Street and Somersworth (Rockingham and Strafford Manchester, NH 03103 Charlestown Health Center (FQHC) Counties – includes Mobile Health Clinics) www.catholicmedicalcenter.org/Community-Health Charlestown (Sullivan County) Janet Laatsch, Chief Executive Officer Anila Hood, Director, Charlestown Health (603) 516-2550, [email protected] HealthFirst Family Care Center (FQHC) Center; www.GetCommunityHealth.org Franklin, Laconia (Belknap and Merrimack Josh R. Dufresne, Acting Chief Executive Counties) Officer, Families First Health and Support Center (FQHC) Russell G. Keene, President/Chief Executive Officer Springfield Medical Care Systems 100 Campus Drive, Suite 12, (603) 934-0177 Ext. 107 (603) 826-5711, [email protected]; Portsmouth, NH 03801 [email protected] (802) 885-7620,[email protected] www.familiesfirstseacoast.org 841 Central St, Ste 101, Franklin, NH 03235 250 CEDA Road, Charlestown, NH 03603 www.healthfirstfamily.org www.springfieldmed.org/charlestown-health- Goodwin Community Health (FQHC) center 311 Route 108, Somersworth, NH 03878 www.goodwinch.org

Lilac City Pediatrics 80 Farmington Rd, Rochester, NH 03867 www.lilaccity.goodwinch.org 4 Bi-State Primary Care Association’s New Hampshire Members

Indian Stream Health Center (FQHC) NH Area Health Education Center Weeks Medical Center (RHC) Colebrook (Coos County) Lebanon (Grafton County) Groveton, Lancaster, North Stratford, Sergio Zullich, Chief Executive Officer Kristina Fjeld-Sparks, Director Whitefield (Coos County) (603) 237-4170 (603) 653-3278 Michael Lee, President [email protected] [email protected] (603) 788-5026, (603) 788-4911 141 Corliss Lane, Colebrook, NH 03576 One Medical Center Drive, WTRB Level 5 [email protected] www.indianstream.org Lebanon, NH 03756 173 Middle Street, Lancaster, NH 03584 www.tdi.dartmouth.edu/education/professional- www.weeksmedical.org Lamprey Health Care (FQHC) education/new-hampshire-area-health- Nashua, Newmarket, Raymond education-center-ahec White Mountain Community Health (Hillsborough and Rockingham Center Counties) North Country Health Consortium (FQHC LOOK-ALIKE) Greg White, Chief Executive Officer Littleton (Grafton County) Conway (Carroll County) (603) 292-7214 Becky McEnany, Interim CEO Ken “JR” Porter, Executive Director [email protected] (603) 259-4785, (603) 259-3700 (603) 447-8900 Ext. 321, 207 South Main Street, Newmarket, [email protected] [email protected] NH 03857 262 Cottage St, Suite 230 298 White Mountain Highway, Conway, www.lampreyhealth.org Littleton, NH 03561 NH 03818 www.nchcnh.org www.whitemountainhealth.org Mid-State Health Center (FQHC) Bristol, Plymouth (Grafton County) Planned Parenthood of Northern New England Robert MacLeod, Chief Executive Claremont, Derry, Exeter, Keene, Manchester Officer (Cheshire, Hillsborough, Rockingham, and Sullivan (603) 238-3525 Counties) [email protected] Meagan Gallagher, Chief Executive Officer 101 Boulder Point Drive, Plymouth, (802) 448-9778 NH 03264 [email protected] www.midstatehealth.org 136 Pleasant Street Claremont, NH 03743 www.plannedparenthood.org/planned-parenthood- northern-new-england

5 2021 New Hampshire Public Policy Principles Bi-State is committed to improving the health of all New Hampshire residents. We work to ensure that Granite Staters have access to appropriate, high-quality, integrated primary and preventive health care, regardless of insurance status or ability to pay. Integrated primary and preventive care includes behavioral health, substance use disorder treatment, and oral health services. Bi-State strives to educate policymakers, non-profit leaders, and the business community on the value community health centers provide to the Granite State. We accomplish our goals by partnering with the state, health care providers, non- profit advocacy organizations, and business leaders.

During this pandemic, our State has opportunities to bolster its response to COVID-19. The ability of our health care system to respond to COVID-19 is dependent on a powerful health care workforce, adequate Medicaid reimbursement rates, a robust safety-net provider system, and Granite Staters practicing public health safety measures to prevent the spread of COVID-19. Bi-State’s 2021 New Hampshire Public Policy Principles and Priorities reflect the fact that stabilizing our Granite State’s public health and safety-net system while increasing access to integrated health care services is critical in stopping the spread of COVID-19. 2021 New Hampshire Public Policy Priorities ➢ Support local and statewide policies designed to stop the spread of COVID-19, with a focus on the disproportionate impact to racial-ethnic minority populations and other high-risk populations; ➢ Increase investments in health care workforce development and recruitment, particularly those that target medically underserved areas; ➢ Adequate funding of the adult Medicaid dental health benefit to include educational, preventive, and restorative services; ➢ Ensure the success of the Granite Advantage Health Care Program as a reliable source of health insurance for low- income Granite Staters; ➢ Increase state support for integrated primary and preventive care, and reproductive health care services for our underserved populations; ➢ Support access to telehealth and reimbursement parity for services provided via telehealth; and ➢ Support policy changes that eliminate racial injustice, poverty, and discrimination to ensure inclusiveness, diversity, and health equity for all.

6 Community-based primary and preventive health care

Comprehensive means primary and preventive medical, dental, oral, Enabling services are non-clinical services designed to increase access to mental health, and enabling services. health care and improve health outcomes. Examples include: translation and interpretation, help accessing transportation, and assistance navigating financial issues. Community Health Centers Federally Qualified Health Centers Community Health Centers (CHCs) provide comprehensive and Federally Qualified Health Centers (FQHCs) are non- enabling services in medically underserved regions. CHCs offer In 2019, 14 CHCs: In 2019, 11 FQHCs: profit, community-based health care organizations services to all residents in their service areas, determining charges that provide comprehensive and enabling services based upon the resident’s ability to pay. Every CHC is unique, • Served 119,735 in medically underserved areas throughout the • Served 94,776 patients tailoring programs and services to the needs of their communities. patients in NH. country. FQHCs are supported by the federal in NH. Collaborations with community partners allow CHCs to go above and • Conducted 511,103 government through a competitive grant process to • Conducted 417,265 beyond in delivering high quality of primary care. In many patient visits. provide health care services to the un- and patient visits. communities, CHCs are the only comprehensive, patient-centered • Offered services in underinsured in rural and urban areas. FQHCs are • Offered services in 8 medical home open to all patients without restrictions, especially every NH county, governed by a board of directors, of whom a underinsured and Medicaid patients. NH counties, across 47 across 57 sites. majority of the members receive care at the FQHCs. sites. FQHCs accept patients regardless of ability to pay, Bi-State’s Community Health Centers in New Hampshire include: offer a sliding fee scale to persons with incomes - 11 Federally Qualified Health Centers below 200% of the federal poverty level, and work - Planned Parenthood of Northern New England with their communities to address a range of - Weeks Medical Center, a Rural Health Clinic barriers to health. - White Mountain Community Health Center, an FQHC LAL

Rural Health Clinics Federally Qualified Health Center Look-Alikes The Rural Health Clinic Services Act of 1977 (Public Law 95-210) was enacted to address an inadequate supply of physicians serving In 2019, 4 RHCs: Federally Qualified Health Center Look-Alikes (FQHC Medicare patients in rural areas and to increase the use of non- LALs) are Community Health Centers that meet the In 2019, 1 FQHC LAL: physician practitioners such as nurse practitioners and physician • Served 9,375 requirements to be FQHCs (including having a assistants in rural areas. Rural Health Clinics (RHCs) can be public, patients in NH. patient-majority board), but do not receive grant • Served over nonprofit, or for-profit heath care facilities. They must be located in • Conducted 65,322 funding from HRSA. They provide services in 2,498 patients in NH. rural, underserved areas. They are required to use a team approach patient visits. medically underserved areas, provide care on a • Conducted over 10,000 of physicians working with non-physician practitioners such as • Offered services in sliding fee scale, and operate under a governing patient visits. board that includes patients. nurse practitioners, physician assistants, and certified nurse mid- Coos county across • Offered services in wives to provide services. RHCs are required to provide outpatient 4 sites. Carroll county. primary care services and basic laboratory services. Bi-State’s member, White Mountain Community Health Center, is an FQHC LAL with a site in Carroll Bi-State’s member, Weeks Medical Center, is an RHC with 4 sites in county. 7 Coos county. Snapshot of Our New Hampshire Members

➢ Community Health Centers include: Bi-State’s 14 Community Health ➢ Federally Qualified Health Centers (FQHCs): Centers and clinics 11 New Hampshire FQHCs encompassing 47 serve 119,735 patients sites in 8 counties – includes mobile health at 57 locations across clinic sites every county in New Hampshire. ➢ Planned Parenthood of Northern New England: 5 locations

➢ Weeks Medical Center (RHC): 4 Rural Health Clinics 1 in 5 uninsured Granite Staters, as well ➢ White Mountain Community Health Center: as 1 in 5 Granite A Federally Qualified Health Center Look-Alike Staters enrolled in (FQHC LAL) Medicaid, receives care at a New Hampshire ➢ Community Health Access Network (CHAN) Community Health Center. ➢ NH Area Health Education Center Program (AHEC)

➢ North Country Health Consortium (NCHC) 8 Investments in primary and preventive care help to contain the growth of the total cost of care in New Hampshire.

CHCs serve about 20% of (1 in 5) Investing in primary and Community health centers are NH Medicaid enrollees and 1 in 5 preventive care is the most economic engines in their uninsured Granite Staters. effective way to reduce the communities, often serving as the growing costs of care in our largest local employer. CHCs CHCs ensure that Medicaid enrollees state – keeping people well employ over 1,440 employees in the receive cost-effective, comprehensive instead of paying to fix Granite State, while creating jobs in primary care. problems after they occur. other industries.

(2019 NH UDS data and self-reported data (2019 NH UDS data, self-reported in BSPCA member surveys) data in BSPCA member surveys, and statewide data from Kaiser Family Foundation)

CHCs are part of the solution in A landmark study found that in 13 Our members offer sliding fee tackling vaccine hesitancy. They states, CHCs save, on average, scales, including free care, to have a long and solid history of $2,371 (or 24%) per Medicaid ensure that everyone can afford optimizing immunization coverage in patient when compared to other their services. at-risk populations, and partner providers. closely with public health, pharmacists, dental providers, and (NACHC Blog, "Health Centers Serving other community partners. More Medicaid Patients Than Ever," 2019) (NACHC, “Community Health Centers and the COVID-19 Vaccination Effort,” 2020.)

9 New Hampshire’s Community Health Centers serve 119,735 Granite Staters

➢ 14 New Hampshire community health enters – including 11 FQHCs, Planned Parenthood of Northern New England, Weeks Medical Center, and Community Health Center White Mountain Community Health Center - serve as Payer Mix the medical home for approximately 120,000 Granite Staters who made over 511,000 visits in 2019.

➢ In the past 5 years, New Hampshire’s CHCs have Uninsured experienced a growing demand for services: 15% 29% in Medicare patients served Medicaid 19% increase in total patient visits 30% 8% increase in total patients served Medicare ➢ 1 in 11 Granite Staters receives care at a New 20% Hampshire CHC.

➢ 1 in 5 uninsured Granite Staters receives care at a Commercially New Hampshire CHC. insured 35% ➢ 1 in 5 Granite Staters enrolled in Medicaid receives care at a New Hampshire CHC.

➢ 1 in 10 Granite Staters enrolled in Medicare receives care at a New Hampshire CHC.

2019 NH UDS Data and Self-Reported data in BSPCA member surveys NH Statewide Data from Kaiser Family Foundation This CHC data does not include Springfield Medical Care Systems’ NH Site: Charlestown Health Center. 10 New Hampshire’s Federally Qualified Health Centers serve 94,776 Granite Staters

➢ 11 New Hampshire federally qualified health Federally Qualified Health Center centers (FQHCs) serve as the medical home for approximately 95,000 Granite Staters who made Patient Mix over 417,000 visits in 2019.

➢ In the past 5 years, New Hampshire’s FQHCs have Uninsured experienced a growing demand for services: 14% 25% increase in total patient visits Medicaid patients 15% in Medicare patients served 32% 13% increase in total patients served Medicare 19% ➢ 1 in 14 Granite Staters receives care at a New Hampshire FQHC.

➢ 1 in 6 Granite Staters enrolled in Medicaid Commercially insured receives care at a New Hampshire FQHC. 35%

➢ 1 in 6 uninsured Granite Staters receives care at a New Hampshire FQHC.

➢ FQHCs are a subset of community health centers.

2019 NH UDS Data and Self-Reported data in BSPCA member surveys 2019 NH Statewide Data from Kaiser Family Foundation This FQHC data does not include Springfield Medical Care Systems’ NH Site: Charlestown Health Center. 11 FQHCs improve access to integrated primary care services

Percent of NH Population Served by FQHCs

8.00%

7.00%

6.00%

5.00%

4.00%

3.00%

2.00%

1.00%

0.00% 2009 2014 2019 12 Demand for FQHC services continues to grow in New Hampshire. Integrated primary and preventive care includes mental health, substance use disorder treatment, oral health, and vision services.

Vision Patients Vision Office Visits Dental Patients Dental Office Visits

2000 2500 12000 30000 2000 10000 25000 1500 1500 8000 20000 1000 6000 15000 1000 4000 10000 500 500 2000 5000 0 0 0 0 2014 2019 2014 2019 2014 2019 2014 2019 376% increase in NH patients 479% increase in office visits 43% increase in NH patients 46% increase in office visits receiving vision services provided for vision services receiving oral health services provided for dental services

Substance Use Disorder Substance Use Disorder Mental Health Patients Mental Health Patients Office Visits Office Visits

10000 1200 14000 70000 12000 60000 1000 8000 10000 50000 800 6000 8000 40000 600 4000 6000 30000 400 4000 20000 2000 200 2000 10000 0 0 0 0 2014 2019 2014 2019 2014 2019 2014 2019 98% increase in NH patients 388% increase in office visits 130% increase in NH patients 234% increase in office visits treated for substance use provided for substance use disorder receiving treatment for mental provided for mental health disorder treatment health treatment 13 New Hampshire’s FQHCs exceeded national FQHC average for many clinical quality measures in 2019

Diabetes Poor Control Rate Hypertension Control Rate Tobacco Use Assessment & Cessation Counseling 2019 US: 32%; NH: 23% 2019 US: 65%; NH: 72% 2019 US: 87%; NH: 91% LOWER=BETTER

Kids Immunization Rate Cervical Cancer Screening Rate Colorectal Cancer Screening Rate 2019 US: 40%; NH: 54% 2019 US: 56%; NH: 65% 2019: US: 46%; NH: 60%

14 FQHC Funding

FQHCs are eligible to receive federal 2019 Sources of Revenue for appropriations to support services that are not New Hampshire FQHCs reimbursed by Medicaid, Medicare, commercial Other payers, and patient self-pay. Some of these Foundation/Private Revenue Grants/Contracts Self-Pay Patients services may include care provided to uninsured 3% 4% 5% and underinsured low-income patients, and State Contracts Medicare enabling services, outreach, transportation, and 6% interpretation. 15% • Federal FQHC grants are awarded based upon a very competitive national application process. • When FQHCs are awarded federal funds, they must meet strict program, performance, and Federal accountability standards. Almost 100 24% additional regulations are connected to FQHC status. Medicaid • Federal FQHC appropriations are not 24% transferable to any other entity. • Medicare and Medicaid FQHC reimbursement is a prospective encounter rate. Commercial • FQHCs bill commercial insurers just like any 19% other primary care practice. • No payer reimburses FQHCs for the full costs 2019 UDS Data of providing services. 15 Our members serve Granite Staters in every corner of the state. Our goal is for geography to never be a barrier to accessing comprehensive, quality services in New Hampshire. Our members operate in 57 sites across the state, in every county. Our members also look for creative ways to extend their coverage, such as mobile clinics, school visits, and expanding use of telehealth connections. Our members had more than 511,000 visits in 2019. Ammonoosuc Community Health Services, Inc. (FQHC)

Amoskeag Health (FQHC)

Coos County Family Health Services (FQHC) Greater Seacoast Community Health (FQHC) Harbor Care (FQHC)

Health Care for the Homeless Program of Manchester (FQHC)

HealthFirst Family Care Center (FQHC) Indian Stream Health Center (FQHC)* Lamprey Health Care (FQHC) Mid-State Health Center (FQHC) Springfield Medical Care Systems (FQHC) Weeks Medical Center (RHC)

White Mountain Community Health Center (FQHC Look-Alike)

Planned Parenthood of Northern New England (CHC)

Community Health Access Network North Country Health Consortium

Area Health Education Center (AHEC) Regions Shaded by County Northern New Hampshire 16 Southern New Hampshire *Indian Stream Health Center has a location in Canaan, Vermont. Bi-State’s Recruitment Center & Workforce Development

Bi-State’s Recruitment Center combines local outreach with national strategic marketing campaigns to recruit clinicians in primary care, oral health, mental health, and substance use disorder treatment. This workforce program was established in 1994. Since then, we have worked with more than 100 sites and our work has helped recruit 592 providers to practice in Vermont and New Hampshire communities. BiStateRecruitmentCenter.org 25+ Years of Recruitment Experience Workforce Development and Adaptability

Our recruitment advisors identify physicians, nurse practitioners, The COVID-19 pandemic created unique challenges for the health care physician assistants, dentists, and mental health and substance use workforce, fundamentally changing the way care is delivered. Providers disorder treatment providers who will thrive in our rural and patients alike are adapting to our new reality through the use of communities. In FY20 alone we identified 1,490 providers with audio and video telehealth platforms to deliver and receive care. interest in our two states. Adaptability has been key for the Recruitment Center as we seek to We monitor national and regional recruitment and retention trends in attract and recruit clinicians for our two states. The Recruitment Center order to advise practices on ways to be innovative and competitive in expanded our virtual promotional efforts this year, allowing us to hiring and retaining clinicians. continue to connect with candidates across the country to promote openings in VT and NH while supporting our clients in a way that best We are a resource for information on State and Federal Loan meets their needs. Repayment programs and the J1 Visa Waiver program, and we connect eligible providers with qualifying health care facilities. Throughout the year Bi-State engages with staff and clinicians working in health centers in our region to support retention and professional development. We do this by facilitating peer-to-peer groups in areas Comprehensive Workforce such as clinical quality improvement, billing and coding, and care Planning Workforce coordination; as well as through interprofessional trainings such as our development and planning for health care organizations is more Clinical Quality Symposium and our Leadership Development Program. important now than ever before. The Recruitment Center recently initiated a 3-year project with community health centers across NH and VT to develop comprehensive recruitment and retention plans. Bi-State’s Recruitment Center serves all interested NH and VT health care organizations, placing special emphasis on rural and We are helping health centers to develop sound strategies for long underserved areas. In 2020, we were actively recruiting for an range workforce planning so they can continue to provide average of 48 vacancies in NH and 61 vacancies in VT. For more comprehensive medical, dental, mental health and substance use information, contact Stephanie Pagliuca, Director of Workforce disorder treatment services in their communities. The plans are Development and Recruitment, [email protected]. based on recognized best practices in recruitment, hiring, and onboarding, that are designed to facilitate from the start of the recruitment process. 17 Supporting Communities in COVID- 19 and Beyond

18 Expanding capacity for community testing & strengthening public health during the pandemic

Community health centers remain open! NH community health centers remain open throughout the emergency, expanding hours, ramping up telehealth visits to meet patient needs, and doing outreach to make sure families do not forego routine care (i.e. child immunizations, treatment of chronic diseases, dental care, and well-child visits). Some health centers have on-call clinicians who provide patients 24-hour advice by phone.

Car-side screening & testing for COVID-19 NH’s community health centers offer outdoor and drive-thru COVID-19 testing for Amoskeag Health offers pediatric care at four community members, health care workers, and first responders as part of a sites. Here is a young patient having a little fun statewide strategy to expand capacity. Some also offer transportation vouchers to during her well-child visit. patients.

Community health centers have conducted over 15K COVID-19 tests NH’s community health centers have conducted over 15,500 COVID-19 tests to Granite Staters. As of January 1, 2021, they are testing about a thousand Granite Staters each week.

Providing health care outside their four walls Many NH health centers have mobile health vans to take immunizations, COVID-19 testing, and other services including behavioral health out into the community.

“We understand better now that we have an opportunity to get out into the community to deliver our services outside our four walls – and I think we have Ammonoosuc Community Health Services photos of proven we can do that.” – Greg White, CEO of Lamprey Health Care caring for staff throughout the Public Health Emergency. 19 Community Health Center Flu Clinics

Convergence of the flu and COVID-19 Getting a flu vaccine during 2020-2021 is more important than ever, to reduce the burden of flu illnesses, hospitalizations, and deaths on the health care system and conserve scarce medical resources for the care of patients with COVID-19.

Health centers vaccinated over 17K Granite Staters in 2020 NH’s community health centers host flu shot clinics to make it as easy as possible for Granite Staters to get Indian Stream Health Center and Upper Connecticut Valley vaccinated! Health centers provided over 17,700 flu Hospital partnered to offer drive-thru flu shot clinics. vaccinations to their patients and community members of all ages in 2020. Flu clinics for the whole family NH’s community health centers have outdoor curbside and drive-thru flu clinics. Many partner with schools to provide school-based flu clinics and make vaccinations available to patients who come in for their regular health and wellness visits.

New patients welcome! Flu shot clinics are open to patients of all ages. Community health centers welcome new patients who Lamprey Health Care's Free Drive-Up Adult Flu Clinic in are looking for a new primary care provider. Newmarket, NH 20 Prioritizing food security as part of overall health

Maintaining food pantries Community health centers mitigate the impact of food insecurity on children and families, maintaining pantries and delivering food to people experiencing homelessness.

Community efforts and ingenuity Health centers work with the NH Food Bank, food pantries, co- ops, grocery stores, and farmers’ markets to bring delicious and nutritious recipes and meals to the community. They host cooking classes and use donations from their neighbors to provide meals for essential workers in need – in NH and Mid-State Health Center partnered with the NH Food Bank beyond. They participate in initiatives like the Essential Meals to host a Fresh Food Pantry. Initiative to donate prepared meals to health care workers in New York City, demonstrating that “kindness has no Mid-State has a boundaries.” – Ammonoosuc Community Services Community drop- off location for Relations Director, Jill Kimball dry goods and cans at Market Basket to collect donations for Many health centers have buttons on their websites for food their food security donations and food drop-off locations at their local grocery program. They have a “Help us Feed the stores. They also work with restaurants and businesses to offer Need” page on their donated treats for staff who are putting their lives on the line website for food every day! donations.

“The response was overwhelming: Over 200 community members received healthy fresh food for their families. For our health center, this event brought to light the need for to do more to help those we serve who are food insecure.” – Mid-State Health Center staff speaking about their Fresh Food Pantry. 21 Breaking down barriers to care during the pandemic

In the Spring of 2020 when COVID-19 turned our world upside down, Bi-State’s NH-based staff transitioned from its typical public policy agenda to strategizing alongside members of the NH Health Care Consumers and Providers COVID-19 Coalition, comprised of over 50 health care and social service advocates and providers, to address the challenges the public health emergency created for the health care sector and for Granite Staters in general. The Coalition identified telehealth as the #1 tool that must be utilized to mitigate the barriers to accessing health care that the pandemic created, and to ensure people continue to receive the services they need. In response, a bipartisan group of legislators developed a bill that made permanent the interim guidance from an emergency order established by Governor Sununu at the outset of the pandemic, to ensure that telehealth continues to be available to Granite Staters. The bill, HB 1623, includes the following provisions and more:

I. Ensures coverage and reimbursement parity, expands site of service, and enables all providers to deliver services through telehealth for Medicaid and commercial health coverage. II. Enables access to medication assisted treatment (MAT) in specific settings by means of telehealth services. III. Amends the Physicians and Surgeons Practice Act to expand the definition of telemedicine. IV. Amends the Nurse Practice Act to expand the definition of telemedicine. V. Enables the use of telehealth services to deliver Medicaid reimbursed services to schools.

The hard work and ability of community health center staff to so quickly change over to telehealth - a whole new model of care - is a testament to their dedication to their patients and their fellow NH citizens.

Pictured right: Dr. Joann Buonomano, chief medical officer for Greater Seacoast Community Health, was interviewed by Seacoast Online, and said televisits by phone or video will be one enduring benefit of the pandemic. “Telemedicine has been on the edge for the past five years. This pandemic has turned it into a mainstay reality.”

22 Throughout the public health emergency, health center patients can access a variety of services from the comfort of their own homes via telemedicine.

During COVID-19, telehealth helps keep patients and staff safe and allows health centers to reserve their personal protective equipment (PPE) for testing patients who may be COVID-positive. Telehealth has resulted in expansion of behavioral health services: Several health centers, for the first time, are seeing a 0% no-show rate for behavioral health. Patients who come in every week or month, like cancer patients or those receiving Medication-Assisted Treatment, have shared that telehealth means they do not miss as much time from work. For these reasons and many more, health care providers including the health centers are making changes in their offices to accommodate for telehealth as the way of the future.

Community health center staff telehealth stories:

23 NH Member Profiles

24 Ammonoosuc Community Health Services, Inc. Edward D Shanshala II, MSHSA, MSEd, Executive Director/Chief Executive Officer 603-444-2464 • www.amoskeag.org ACHS SERVICES 25 Mt. Eustis Road, Littleton, NH 202 Cottage Street, Littleton, NH ➢ Integrated Primary Medical Care 333 Route 25, Main Street, Warren, NH ➢ Prenatal Care 79 Swiftwater Road, Woodsville, NH ➢ Women’s Health: Birth Control, 14 King’s Square, Whitefield, NH STD Checks, Pap/Pelvic Exams, 1095 Profile Rd, Suite B., Franconia, NH HIGHLIGHTS IN ACHS HISTORY Long-Term Contraceptives ABOUT OUR CLIENTS ➢Behavioral Health: Counseling, Where They Live: ACHS patients come from 1975: Established to provide family planning, WIC, prenatal, Drug and Alcohol Treatment, 40 communities in Grafton and Coos and child health care in northern NH Medication- Assisted Treatment Counties, as well as neighboring towns in 1995: Designated as a Federally Qualified Health Center for Substance Use Vermont - a service area of approximately providing comprehensive primary care services ➢Oral and Dental Health Services 68,000. 1998: Received initial JCAHO accreditation (recertified in 2001) ➢Health and Nutritional Education, Socioeconomic status: 12% of residents in 2002: Added fifth health center site in Franconia, NH the county of Grafton, and 10% of residents Promotion, and Counseling 2007: Woodsville Expanded Medical Capacity grant and ➢ Chronic Disease Management in Coos County have household incomes at implementation ➢Prescription Drug Program or below 200% of the federal poverty level. 2015: Added Dental and Oral Health Center in Littleton, NH Insurance Status (2019): 2016: In partnership with area optometrists, offers an ➢Cancer Screening 9% were uninsured affordable Vision Program ➢Hospice and Palliative Care 18% were covered by Medicaid 2019: ACHS Collaborative with RIT on Repetition Rebellion, ➢Medical Legal Partnership 28% were covered by Medicare HRSA Funded Collaborative on AI/Behavioral Health ➢Patient Navigation 45% were covered by private insurance ➢Vision Services FINANCIAL INFORMATION ➢Support Programs NUMBERS OF PATIENTS SERVED Agency Revenue (2019): $11,305,606 ➢Breast and Cervical Cancer Total Medical Patients: 10,781 Employees (2019): 105 FTEs Screenings Total Visits (includes all services): 43,327 ➢Text 4 baby: Free Educational Total Dental Patients: 1,492 VALUE OF DISCOUNTED SERVICES PROVIDED TO PATIENTS Medicaid Dental Patients: 231 Program of the National Healthy Total: $644,540 Mothers, Healthy Babies Coalition Commercially Insured Dental Patients: 218 Medical: $219,057 ➢HIV/STD Counseling and Testing Uninsured Dental Patients: 355 Dental: $339,338 Total Dental Visits: 4,532 Behavioral Health: $41,725 Total Mental Health Visits: 5,279 Pharmacy: $44,420

A GROWING DEMAND FOR SERVICES (2015-2019): 12% increase in total patients 48% increase in dental patients 25 45% increase in mental health patients AMOSKEAG HEALTH SERVICES

• Primary Medical Care Highlights in Amoskeag Health History Healthcare for adults and children of all 1981: Dr. Selma Deitch establishes Child Health Services ages, regardless of insurance status Kris McCracken, President/Chief Executive Officer (CHS) to provide family-oriented primary health care • Prenatal Care 145 Hollis Street Manchester, NH to the uninsured, underinsured or to those lacking Care through pregnancy and childbirth in 184 Tarrytown Road Manchester, NH access to quality health care. collaboration with Bedford Commons OB/GYN 1245 Elm Street Manchester, NH 1993: Manchester Community Health Center (MCHC) opens for high-risk patients 1555 Elm Street Manchester, NH ProHealth as a joint endeavor of Elliot Hospital and Catholic • Specialty Care 88 McGregor Street Manchester, NH Medical Center (CMC) with the support of many local Podiatry services, dental referral services, and non-profit leaders, including Dr. Deitch. www.amoskeaghealth.org • 603-626-9500 other special medical programs such as care 1999: CHS achieves Joint Commission on the Accreditation coordination, developmental screenings and About Our Patients of Healthcare Organizations and Primary Care nutritional care Where They Live: 85% in Manchester and Effectiveness Review accreditation, the first facility of • Chronic Disease Care neighboring towns; 15% are from various other its kind in the nation to achieve this joint recognition. Services such as diabetic eye care, chronic counties. 2004: Citizens Bank and WMUR name MCHC the disease self- management courses and high ‘Community Champion in Healthcare’. blood pressure program Socioeconomic Status: Approximately 94% of 2008: MCHC moves from its original Elm St. location to the • Behavioral Health Services Amoskeag Health patients are known to be at current Hollis St. location. CMC and Dartmouth Services such as mental health therapy, 200% of the Federal poverty level or below Hitchcock create West Side Neighborhood Health substance misuse counseling, medication located in the CMC Medical Building on McGregor St. assisted therapy and perinatal substance use Outpatient Insurance Status 2013: MCHC adds a second location at Tarrytown Rd. disorder (SUD) care 24% were uninsured; 6% were covered by 2014: MCHC and CHS combine operations. • Optometry Care Medicare; 50% were covered by Medicaid. 2015: MCHC assumes management of the West Side Vision care for patients ages five and older, 20% were covered by private insurance. Neighborhood Health Center on McGregor Street. including routine eye care for diabetic patients, 2018: MCHC opens first FQHC-based Optometry Clinic in NH and free glasses for children who qualify for eye health and vision services. • Preventive Care Languages Spoken 2019: MCHC, CHS, West Side Neighborhood Health Center, Lifestyle changes programs, nutritional 44% (over 6,500 Amoskeag and Tarrytown are brought together under one name: counseling, breast feeding education, Health patients) do not use Amoskeag Health. screening for breast, cervical and colorectal English as their primary 2019: ProHealth, co-located physical and mental health cancer language. The predominant services with the Mental Health Center of Greater • Social Services and Support non-English languages are Manchester, opens its doors. – Please add any Case management, transportation, language Spanish, Arabic, Nepali, accomplishments if applicable. ☺ interpretation, food pantries, teen clinic, French, Portuguese and medical/legal partnership, ACERT & Family Kiswahili. Financial Information Justice Center collaborations Agency Revenue: $17,936,317, ; Employees: 195 FTEs Number of Adult and Children Served Last Year Total Patients: 14,686 Total Visits: 73,052 26 Community Health Access Network (CHAN) CHAN SERVICES Joan Tulk, Executive Director Electronic Health Record 207A South Main Street Electronic health record system that enables Newmarket, NH 03857-1843 clinicians and staff to document patient visits, 603-292-7274  www.chan-nh.org streamline clinical workflow and securely exchange data; a patient portal and integration with patient engagement and telehealth systems ABOUT US HIGHLIGHTS IN CHAN HISTORY Practice Management CHAN is the only Health Center Controlled Network 1995: Five community health care centers Patient scheduling, registration and revenue (HCCN) in NH. CHAN has developed and supports an with a collective history of over 75 years of cycle management provides all the tools integrated clinical and administrative system experience in providing primary care needed to manage the specific needs of infrastructure that affords innovative opportunities for services to the uninsured, underinsured, practices and boost efficiency its Federally Qualified Health Center (FQHC) members, and Medicaid populations formed an Data Warehouse which include 2 Healthcare for the Homeless programs. Integrated Services Network (ISN), called CHAN. Updated daily with clinical, operational and CHAN’s endeavors, particularly in the Health 1996: A NH Health Care Transition Fund financial data. Supporting quality management Information Technology arena, enable the provision of Grant helped to expand the HCCN and & measurement, operational and financial enriched patient experiences and quality care. develop shared services. reports, analysis; member-generated ad hoc 1997: Two additional community healthcare reports and data visualization tools. OUR MEMBERS centers joined the network, and CHAN was Clinical Standards • Amoskeag Health awarded our first Bureau of Primary Health Supporting clinical operations and providing • Greater Seacoast Community Health Care grant. support for chronic disease management and • Health Care for the Homeless Program, Catholic 2008: CHAN was awarded the HIMSS prevention. Medical Center Nicholas E. Davies award for improving • Health First Family Care Center healthcare through the use of HIT. IT Services • Lamprey Health Care, Inc. 2010: CHAN expanded across state lines Services such as systems maintenance, • Shackelford County Community Resource Center, and welcomed a health center from Texas upgrades, disaster recovery, electronic dba Resource Care (TX) into the network reports and custom data entry screens/forms 2016: CHAN began hosting the IT development. Data submissions to regulatory • Ammonoosuc Community Health Services, infrastructure for a VT health center agencies & payers • Coos County Family Health Services, 2020: Expanded data visualization • Indian Stream Health Center and capabilities & welcomed our tenth member Quality Improvement technical assistance, • The Health Center (VT) training and audits

27 Charlestown Health Center Anila Hood, Director 250 CEDA Road, Charlestown, NH 03603 603-826-5711 www.springfieldmed.org/charlestown-health- center/ CHARLESTOWN HEALTH CENTER SERVICES

INSURANCE STATUS ➢ Integrated Primary Medical Care 10.3% Uninsured 19.8 %Medicaid ➢ Walk-in Access 7 days a week 24.7% Medicare 45.1 %Commercial Insurance ➢ Preventive Health Screenings

NUMBER OF PATIENTS SERVED ➢ Chronic Disease Management and Total Patients (2019): 4,601 Diabetes Education Total Visits (2019): 16,238 ➢ Support programs for Breast and ABOUT OUR CLIENTS GENERAL INFORMATION Cervical Cancer screenings Where they live: Patients served reside in Employees: 22 New facility opened in July, 2017 Charlestown, NH and surrounding communities in ➢ Nutrition Counseling Sullivan County, portions of Cheshire County, NH, as A GROWING DEMAND FOR SERVICES ➢ Smoking Cessation Counseling well as some residents of adjacent Vermont ➢ Patient count grew 13.8% from communities. 12/31/18 to 12/31/19. ➢ Discount Pharmaceuticals Socio-economic Status: Sullivan County, population ➢ Patient visits grew by 32.8 from 43,742, is rural with the second least populous county 12/31/18 to 12/31/19. ➢ Behavioral Health and Substance Use Disorder Counseling in the state. The unemployment rate is 2.0. 2014-2018 median household income is $60,780. ➢ On-site Lab and X-ray services Per capita income in past 12 months, 2014-2018 is $31,668. ➢ SMCS In-Network Dental and Percent in poverty is 11.2% Vision Care Access Persons without health insurance, under age 65 years, 7.2%. Persons with disability, under age 65, 2015-2018, 9.4%

Source: www.census.gov/quickfacts/sullivancounty 28 Coos County Family Health Services Ken Gordon, Chief Executive Officer www.coosfamilyhealth.org 133 Pleasant Street Berlin, NH 03570  603-752-2040 CCFHS SERVICES 2 Broadway Avenue Gorham, NH 03581 603-466-2741 73 Main Street Berlin, NH 03570  603-752-2424 ➢ Primary Medical Care/Family Medicine 59 Page Hill Road Berlin, NH 03570  603-752-2900 ➢ Prenatal Care & Obstetrics: In 54 Willow Street Berlin, NH 03570  603-752-3669 Partnership with Androscoggin Valley Hospital ➢ Family Planning: Reproductive Health Services ➢ Breast & Cervical Cancer Screenings ➢ HIV Testing & Counseling ➢ Diabetes Education & Support ➢ Chronic Disease Management HIGHLIGHTS IN CCFHS HISTORY ➢ Behavioral Health Services ➢ Substance Use Treatment WHO WE PROVIDE CARE FOR 1974: Started as a Title X Family Planning Agency. 1980: Merged with Family Health Programs to provide ➢ Reduced-Cost Prescription Drugs Where They Live: Patients come from over 13 prenatal and infant care and added WIC and RESPONSE. ➢ Women, Infant and Children (WIC) communities of Coos County and neighboring 1993: Designated as a Federally Qualified Health Center Nutrition/Health Services towns in Maine, which are federally-designated (FQHC), providing comprehensive primary care services. ➢ Dental/Oral Health Services Medically Underserved Population (MUP) areas, 2004: Expanded to an additional site in Berlin and one in ➢ Health Promotion and Education and both Medical and Dental Health Professional Gorham, adding an additional 10,000 patients. ➢ Nutrition Counseling Services Shortage Areas (HPSAs). 2016: Coos County Family Dental Clinic established. ➢ On-site Laboratory Services Socioeconomic Status: Approximately 62% of 2018: Medication Assisted Treatment program began ➢ Medical Social Work CCFHS patients have household incomes below operations. ➢ Podiatry 200% of the federal poverty level. 2020: CCFHS becomes an accredited Diabetes Self- ➢ Telehealth: in Partnership with the Management Education and Support Provider Organization. Dartmouth Hitchcock Medical Center ➢ Medical Appointment Offered 7 Days Insurance Status (2019) 9% were uninsured. FINANCIAL INFORMATION per Week 22% were covered by Medicaid. Agency Revenue (2020): $14,430,536 ➢ RESPONSE: Advocacy and counseling 29% were covered by Medicare. program for survivors of domestic 40% were covered by private insurance Employees: 105 FTEs violence and sexual assault, shelter for Annual Savings to health care system (2015-2019): battered women and their children, NUMBERS OF CHILDREN and transitional housing AND ADULTS SERVED (2019) A GROWING DEMAND FOR SERVICES (2015-2019) Total Patients: 12,678 20% increase in patient visits Total Visits: 58,200 30% increase in mental health patients 1,177% increase in dental patients 29 GREATER SEACOAST SERVICES

PRIMARY & PRENATAL CARE 2019 Data • Primary care for adults • • Total Patients Served: 15,933 Pediatric care • Prenatal care • Medical: 13,106 patients, 45,254 visits • Mobile health care for people experiencing • Dental: 4,725 patients, 10,540 visits homelessness and others with low incomes • Mental Health: 1,371 patients, 7,749 visits • Child-development screenings Greater Seacoast Community Health • Substance Use: 186 patients, 1,621 visits • Breast and cervical cancer screenings Janet Laatsch, CEO  GetCommunityHealth.org • Home Visits, Parent Education: • Nutrition education and counseling 1,645 children and parents, 9,541 visits • Chronic-illness education and support Mission: To deliver innovative, compassionate, • Health Center patients with incomes below 200% • Acupuncture integrated health services and support that are of the federal poverty level: 83% DENTAL CARE accessible to all in our community, regardless of • Insurance status: 16% uninsured, 41% Medicaid • Patients experiencing homelessness: 735 • On-site hygiene, treatment and urgent care ability to pay. • School-based education, screening, cleaning, sealants Health Center Locations 2019-2020 Accomplishments • Mobile dental clinics • Families First Health & Support Center • Quickly adapted to demands of the COVID-19 100 Campus Dr, Portsmouth pandemic, including adding patient and staff BEHAVIORAL HEALTH SERVICES • Goodwin Community Health screening and other safety measures at our sites; • Behavioral health counseling 311 Route 108, Somersworth offering telehealth medical, behavioral and dental • Psychiatric care • Lilac City Pediatrics visits; opening a learning center for staff children • Substance Use Disorder counseling • 80 Farmington Rd, Rochester doing remote schooling; and moving many Medication-assisted SUD treatment • Intensive Outpatient Program • Mobile Health Clinics Rochester, Dover, services to online, phone or curbside (including parent and family programs, SOS Recovery Portsmouth, Hampton and Exeter PARENT & FAMILY PROGRAMS services, pharmacy pickup, and the WIC and CSFP • Parenting classes and groups, with child care Program Partner Locations nutrition programs). • Playgroups and family programs • SOS Recovery Community Organization • Became the first Community Health Center in • Individual support for families under stress, Office: 311 Route 108, Somersworth New Hampshire to serve as a professional including families with a chronically ill child Service sites: Dover, Rochester, Hampton outpatient home for a physician residency • Support for grandparents raising grandchildren • Strafford County Public Health Network program as part of Portsmouth Regional 311 Route 108, Somersworth Hospital’s new Graduate Medical Education … AND MORE • Women, Infants, and Children Nutrition program (affiliated with Tufts University School of • Social work services and care coordination • Insurance and benefits enrollment Program 311 Route 108, Somersworth Medicine) • Renewed highest-level Patient-Centered Medical • Prescription assistance Home recognition (Somersworth and Portsmouth • In-house pharmacy and 340B drug discount 2019 Budget and Staffing program locations) • Agency Operating Budget: $19.7 million • On-site lab services • Employees: 300 30 Peter Kelleher, President and CEO 45 High Street Nashua, NH 03060 HARBOR CARE SERVICES 615 Amherst Street Nashua, NH 03063 Mobile Health Van, Hillsborough County 603-882-3616 Access to a comprehensive set of services www.harborcarenh.org designed to address social determinants of health and end or prevent homeless Highlights in 2019/2020: ABOUT US Harbor Care, formerly known as the Partnership for Successful ➢ Housing (Permanent, Temporary, Harbor Care Health and Wellness Center Living (PSL) recently rebranded with a focus to more effectively Veteran) (HCHWC) is the Federally Qualified Health Center integrate community and patient-centered social and health care ➢ Primary and Acute Medical Care, services to Greater Nashua’s most vulnerable. (FQHC) of Harbor Care. Harbor Care the new including Same Day Visits shared name and brand of Harbor Homes, In the midst of the COVID-19 Pandemic, Harbor Care’s Federally ➢ Women’s Health and Pediatrics Keystone Hall, Healthy at Home and Southern NH Qualified Health Center (FQHC), Harbor Care Health and ➢ Behavioral Health Care, including Mental HIV/AIDS Task Force. We have built success Wellness Center (HCHWC), quickly pivoted to Telehealth Medical Health Medication Management, Mental through innovation, collaboration and an and Behavioral Health services without shutting off services for a Health Counseling unwavering commitment to our most vulnerable single day during the transition. Additionally, Harbor Care ➢ Medication Assisted Treatment community members. Over the next months, we provides curbside COVID Testing, Flu Vaccinations, and rapid (MAT) including Substance Use COVID-19 Antigen Tests. will continue our journey and become Harbor Disorder Treatment and Withdrawal Care, a recognition of our roots, and a glimpse of HCHWC’s dental program is reopening with start-of-the-art Management Services where we are heading. COVID safe protocols and we have expanded dental services to ➢ Substance Use Disorder Outpatient provide a greater range of care. Services including Intensive Outpatient As one of only three Health Centers in NH Program (IOP) designated as a Health Care for the Homeless HCHWC integrated with several Harbor Care programs to deliver ➢ Pharmacy: 340B Low-Cost Prescription Health Center, HCHWC serves approximately more effective and seamless patient-centered care. The Program Homeless Outreach Program (HOP), using the “Housing First” ➢ Homeless Outreach Program (HOP) 3,200 unique patients through 25,000+ visits and Harm Reduction evidence-based approaches to care, HOP annually with primary care, MAT, mental health, offers ongoing, intensive case management for adults and young ➢ Motivating and Empowering Recovery and SUD services. adults in Hillsborough County who are struggling with through Integrated Treatment (MERIT) homelessness and substance abuse. MERIT, which stands for ➢ Employment Supportive Services Socioeconomic Status “Motivating and Empowering Recovery through Integrated ➢ Case Management Approximately 50% of NH’s homeless live in our Treatment,” offers treatment and recovery services for adults in ➢ Early Invention Services including PrEP Service Area. 75% of the patients we serve are Hillsborough County who are struggling with methamphetamine ➢ Patient Navigation and Insurance use. homeless. 93% of the patients we serve are Enrollment below 200% of the Federal Poverty Level. FINANCIAL INFORMATION (2019) ➢ Sliding Fee Scale, Payment Plans and 48% of our total visits were substance misuse or Full-Time Equivalents: 66.82 Discounted Services mental health related. Total Uncompensated Care: $2,648,530 24x7x365 After-Hours Coverage NUMBERS OF PATIENTS SERVED (2019) A GROWING DEMAND FOR SERVICES (2015-2019) Unique Patients: 3,194 61% increase in Medicaid patients; 48% increase in Total Visits: 25,491 Behavioral Health; 21% increase in Substance Use Disorder 31 Dental Visits: 1,582 patients; 46% increase in Homeless patients; 134% increase in Behavioral Health & Substance Misuse Visits: 12,330Total Visits; 46% increase in Total Patients served Health Care for the Homeless (HCH) A Program of the Manchester Health Department based at Catholic Medical Center

Wilson Street Integrated Health New Horizons for NH The Family Place Practice Practice Practice 293 Wilson Street, Suite 102 199 Manchester Street 177 Lake Avenue Manchester, NH Anna Thomas, Executive Director (Health Dept.) Manchester, NH Manchester, NH 603-665-7450 [email protected]; 603-657-2700 603-663-8718 603-782-7414 Amy Pratte, Director of External Affairs/Fiscal Manager (CMC) [email protected]; 603-663-8716 HEALTH CARE FOR THE About Our Patients HCH History HOMELESS SERVICES

Who They Are: Men, women, 1980s: Manchester Health Department (MHD) is ➢ Primary Medical Care, Medical teens, and children in the City of awarded a federal grant to provide Case Management, Chronic Manchester, NH, who do not have homeless healthcare services. MHD Disease Management a regular or adequate place to call contracts with Catholic Medical Center home. (CMC) to implement program operations. ➢ Integrated Behavioral Health Clinic opens at New Horizons Shelter. Services, Counseling and Where They Live: Individuals and Medication Assisted Treatment for families live in transitional 1990s: Program expands to include clinic hours Substance Use Disorders housing, temporary shelters, or at Families in Transition with medical team “couch surf,” doubled up with and substance use disorder support in place. ➢ Easily Accessible Clinics, Outreach, other families, friends or and Street Medicine acquaintances. Some sleep in 2000s: Team expands to include support staff, a places not intended for human psychiatric prescriber, behavioral health ➢ Testing and Treatment for STD/HIV habitation, such as in cars, counselors, and a health educator. abandoned buildings, and in tents 2010s: HCH is designated an FQHC. An increase in ➢ Health Screenings and Phlebotomy along the river or in the woods. the number of patients served and enhanced Socioeconomic Status: grant and third party revenues support the ➢ Prescription Medication Assistance Close to 100% of patients have doubling of HCH staff. A third integrated primary incomes below 200% of the care clinic is opened. Medication Assisted ➢ Telehealth Federal Poverty Level. Treatment, Telehealth, Phlebotomy, and Street Medicine services are added. Community ➢ Transportation Coordination Insurance Status: partnerships are enhanced in response to the ~ 25% are uninsured; ~ 57% are ➢ Referrals to Specialty Care opioid epidemic and the COVID pandemic. covered by Medicaid, including Medicaid Expansion products; ➢ Social Work/Case Management All people experiencing homelessness in the ~ 10% are covered by Medicare; ~ 8% have private insurance. City of Manchester are welcome to our practices. 32 No one is turned away due to an inability to pay. HEALTHFIRST FAMILY CARE CENTER PROVIDES

➢ Primary Health care for Men, Women and HealthFirst Family Care Center Children of All Ages, Regardless of Ability Russell G. Keene, Chief Executive Officer to Pay or Insurance Status 841 Central Street, Franklin, NH  603-934-1464 22 Strafford Street #1, Laconia, NH  603-366-1070 ➢ Women’s Health Care Including, but not www.healthfirstfamily.org Limited to, Free Breast and Cervical Cancer Screenings for Eligible Women

HIGHLIGHTS IN HEALTHFIRST HISTORY ➢ Disease Management and Education on 1995: Established with funding from the NH DHHS Managing Chronic Diseases such as 1997: Received designation as a Federally Qualified Look-Alike Diabetes, Asthma, Hypertension 2002: Designated as a Federally Qualified Health Center ABOUT OUR CLIENTS 2006: Opened second primary care site in Laconia ➢ Same Day Appointments Where They Live: Our clients come from 23 rural 2012: Integrated behavioral health within primary care HealthFirst Participates in the Federal townships within the Twin Rivers and Lakes Region 2019: MAT program offered ➢ Health Disparities Collaborative for of New Hampshire (i.e. Belknap, Carroll, Merrimack 2020: MAT program expanded into Tilton and Grafton counties), a population of approximately Diabetes 81,000 people. 2020 Specific Highlights: ➢ Onsite Certified Application Counselor to • Responding to an increased need for food that was Assist Clients with Accessing Health Socio-Economic Status: 76% of HealthFirst clients identified for some of HealthFirst’s most vulnerable clients Insurance and Medicaid are at 200% of the federal poverty level or below. with the onset of the COVID-19 pandemic, HealthFirst's Community Care Coordinators worked closely with the ➢ Health and Wellness Promotion and Insurance Status: Greater Tilton Area Family Resource Center food pantry to Education • 14% were uninsured collect weekly food donations and personally deliver food • 20% were covered by Medicare to patients and others in the greater Laconia and Franklin ➢ Screenings and Treatments for Chronic • 24% were covered by private insurance region. Illnesses • 42% were covered by Medicaid • HealthFirst received a grant that allowed for the purchase ➢ Minor Procedures of a 12’ x 20’ outdoor shed which is placed at the far end Numbers of Children & Adults Served of the HealthFirst Franklin campus parking lot. The project ➢ Nutrition Counseling Total Patients: 5,135 known as “Sharing Spaces” houses essential furniture and Total Visits: 25,530 household items for clients who are moving into an ➢ Behavioral Health Services Integrated in apartment (often for the first time) and need furnishings Primary Care, Substance Misuse Financial Information for basic daily living such as dressers, dishes, lamps, Counseling and Addiction Treatment Agency Revenue: $7,450,000 beds, and more. Employees: 62 • HealthFirst has responded to the growing demand for ➢ Medication Assisted Treatment (MAT) Total Uncompensated Care: $402,400 behavioral health, substance use disorder, and medication ➢ Hepatitis C Treatment Uninsured Clients Served: 550 assisted treatment services by growing its team of providers, increasing access to services and adding ➢ COVID-19 Testing treatment locations for patient convenience. 33 INDIAN STREAM SERVICES

Primary Medical Care For men, women and children of all ages regardless of insurance status Sergio Zullich, CEO Locations: Pediatric primary care 141 Corliss Lane, Colebrook, NH 03576  603-237-8336 Developmental screenings, preventive care 253 Gale Street, Canaan, VT 05903  802-266-3340 and treatment of acute illnesses www.indianstream.org Behavioral Health Services HIGHLIGHTS IN INDIAN STREAM HISTORY Family therapy, substance misuse treatment 1979: Practice established as Indian Stream Professional and counseling, behavioral health counseling Association for issues such as depression and anxiety by the husband and wife team, Dr. Gifford ABOUT OUR CLIENTS & Dr. Parsons In House Pharmacy Where They Live: Patients come from 850 1993: Received Rural Health Clinic designation Providing reduced cost medications; available square miles encompassing the northern most 2001: Clinic purchased by Dartmouth-Hitchcock Clinic to patients and the community regions of New Hampshire, Vermont and 2003: Established as Indian Stream Health Center, Inc., Maine. School Nurse Program a 501(c)(3) not-for-profit corporation Socioeconomic Status: 62% of Indian Stream On-site nursing care and services at schools 2006: Designated as a Federally Qualified Health Center patients have household incomes at or below in SAU 58 (FQHC) 200% of the federal poverty level, Care Management: FINANCIAL INFORMATION Insurance Status Patient advocates for prevention, continuity of Agency Revenue (2019): $6,100,503 10% were uninsured. care and enhancing coordination of care to Employees: 50 FTEs 22% were covered by Medicaid. meet health goals and improve outcomes. Annual Savings to health care system (2016): 32% were covered by Medicare. 24% lower costs for ISHC Medicaid Patients; 36% were covered by private insurance Outreach Services: $2 million in savings to Medicaid – Please update if Patient assistance with Advance Directives, applicable or feel free to remove. NUMBERS OF CHILDREN AND Insurance enrollment (Marketplace, VT Health Connect, Medicaid, Medicare), Transportation, ADULTS SERVED Medication Assistance Programs, and other Total Patients: 3,573 area resources. Total Visits: 13,781

34 LAMPREY HEALTH CARE SERVICES

➢ Primary Medical Care: For adults and children of all ages, regardless of ability to pay ➢ Behavioral Health: Provided services to 1,048 patients Greg White, Chief Executive Officer ➢ Prenatal Care: Includes care management and Newmarket Center: 603-659-3106 nutritional counseling for 428 patients 207 South Main Street Newmarket, NH HIGHLIGHTS IN LAMPREY HEALTH CARE HISTORY ➢ Certified Diabetes Educator: Diabetes Raymond Center: 603-895-3351 2021: Adding a mobile health unit (van) in early 2021 education and treatment for 1,576 patients 128 State Route 27 Raymond, NH 2020: Continued integrated clinic at Greater Nashua ➢ Asthma Care Management: Asthma education Nashua Center: 603-883-1626 Mental Health; developed another integrated clinic – and treatment for approximately 565 patients 22 Prospect Street Nashua, NH Healthy Together at Center for Life Management in Derry; ➢ Breast & Cervical Cancer Program: Enrolled InteGreat Health: 603-402-1501 implemented a Hepatitis C clinic; distributed food during and screened 237 women age 50+ 7 Prospect Street, Nashua, NH the pandemic shutdown; developing partnership for ➢ Medication Assisted Treatment Program: Providing care and resources to patients Nashua Soup Kitchen: 603-889-7770 primary care to residents at a local assisted living facility; 2 Quincy Street, Nashua, NH 03060 struggling with opioid use and alcohol use Diabetes Self-Management Education and Support disorder. Center for Life Management: (DSMES) accreditation; renewal of PCMH certification at ➢ Case Management & Community Education 603-434-1577 all health centers; established a new location of care at 1,812 patient visits 10 Tisienneto Road, Derry, NH 03038 the Nashua Soup Kitchen & Shelter. ➢ Interpretation: Interpretation services provided www.lampreyhealth.org 2018: Launched InteGreat Health Program for 4,151 patients non-English speaking ABOUT OUR PATIENTS 2017: Launched Nurse Practitioner Fellowship Program (mostly Spanish and Portuguese) Where They Live: Our patients come from over 2015: Integrated Behavioral Health Services ➢ Preventive Dental Health: School-based dental 40 communities within Rockingham, Hillsborough 2015: Added Seacoast Public Health Network program in 10 schools screened 1,852 and parts of Strafford Counties. 2013: Recognized as NCQA Level III Patient Centered children Socioeconomic Status: Approximately 87% of Medical Home ➢ Telehealth: Implemented Telehealth during the Lamprey Health Care patients are at or below 2011: Expansion of the Nashua Center COVID-19 pandemic. 200% of the Federal poverty level. 2005: Expansion of the Newmarket Center ➢ Reach Out & Read: Provided over 1,900 Insurance Status: In 2019, aggregating figures 2000: Implemented an Electronic Medical Records (EMR) books to pediatric patients ages 6 months – 5 from all three centers showed 17% were system; Third Center established in Nashua years to promote early literacy & a lifetime uninsured; 27% were covered by Medicaid; 16% 1996: Expansion of the Raymond Center love of books were covered by Medicare; and 40% had 1995: Developed School-Based Dental Program ➢ Health Care for the Homeless: Provided health private insurance. However, in the Nashua Center, 1981: Second Center established in Raymond & care management services to 1,191 32% of patients are uninsured. 1973: First Center established in Newmarket homeless patients NUMBERS SERVED (2019) 1972: Created Transportation Program to improve access ➢ Health Care for Veterans: Provided health & Total Patients: 15,594; Patient Visits: 58,110 to health & community services for Seniors & Individuals care management services to 424 Veterans with disabilities. FINANCIAL INFORMATION 1971: Founded by a group of citizens to bring medical, Agency Revenue: $15 million; Employees: 182 health and supportive services to communities in 35 FTEs: 143 Rockingham & Strafford Counties. MID-STATE SERVICES ➢ Primary Medical Care; Chronic Disease Education, Care Management and Supports for Illnesses Such as Asthma, Diabetes, and Hypertension HIGHLIGHTS IN MID-STATE HISTORY 1998: Established as a separate, nonprofit corporation ➢ Same-Day Program – Open to Walk-ins Robert MacLeod, Chief Executive Officer 2005: Changed name to Mid-State Health Center ➢ 24-Hour Clinical On-Call Service 101 Boulder Point Drive 2005: Designated a Federally Qualified Health Center for Registered Patients Plymouth, NH 03264 • 603-536-4000 Look-Alike 100 Robie Road 2013: Designated as a funded Federally-Qualified Health ➢ Behavioral/Mental Health Counseling/Tele- Psychiatry; Substance Use Disorder Recovery Bristol, NH 03222 • 603-744-6200 Center Supports including Outpatient Medication www.midstatehealth.org 2014: Built a new health center facility in Bristol, NH 2015: Added oral health preventive and restorative Assisted Treatment and Intensive Outpatient services Treatment 2016: Expanded services to include Medication Assisted ➢ Dental Services including Exams, Cleanings, Treatment Fillings, Crowns, Bridges, Extractions, 2018: On-site Pharmacy partnership with Genoa Health Periodontal Evaluations, Dental Appliances, and ABOUT OUR CLIENTS 2019: Behavioral Health Workforce Education & Training Standby Hours for Emergencies Where They Live: Patients come from 19 Program collaboration with Plymouth State ➢ On-site Laboratories geographically isolated, rural communities University within Grafton, Belknap and Merrimack 2019: Feed the Need Initiative launched to address food ➢ Prescription Services Counties. All of the towns are designated as insecurity ➢ Infusion Services Medically-Underserved Populations. 2020: Onsite visiting specialist program Socioeconomic Status: 32% of our service area 2020: Intensive Outpatient Treatment Program for ➢ Marketplace Education and Outreach residents are 200% of the Federal Poverty Level Substance Use Disorder added to Recovery ➢ Language Interpretation Services or below. Program 2020: Opened RISE Recovery Program located at Whole ➢ Nutrition Consults and Education Insurance Status: Village Family Ctr. ➢ School-Based Oral Health Outreach Program 7% were uninsured. 2020: Onsite diagnostic Imaging 17% were covered by Medicaid. 2020: Telehealth - Remote Visits ➢ Transportation Services 28% were covered by Medicare. 2020: Psychiatry added to its services via telehealth 48% had private insurance, including ➢ Food Security Program – Feed the Need Initiative Marketplace options and Medicaid Expansion FINANCIAL INFORMATION (2019) products. Agency Revenue: $11 million ➢ On-site Diagnostic Imaging (digital x-ray, Employees: 151 individuals; Full-Time Employees: 118 NUMBERS OF CHILDREN ultrasound) AND ADULTS SERVED (2019) A GROWING DEMAND FOR SERVICES (2015-2019) ➢ Onsite Specialty Services Available including Total Patients: 11,786 12% increase in total patients Orthopaedics; ENT/Otolaryngology; Total Visits: 44,715 (includes medical, mental 99% increase in dental patients Dermatology health, oral health, substance use disorder 31% increase in mental health patients 36 treatment & enabling service visits) 12% increase in total patient visits Kristina Fjeld-Sparks, MPH, Director One Medical Center Drive; WTRB Level 5 Lebanon, NH 03756 Email: [email protected] Website: www.tdi.dartmouth.edu/education/professional- education/new-hampshire-area-health-education- center-ahec

HIGHLIGHTS IN NH AHEC HISTORY ABOUT US The national AHEC program began in 1972 to help prepare primary The New Hampshire Area Health Education Center (NH AHEC) focuses on the care physicians for community practice at a time when cost training health care pipeline/workforce in New Hampshire. NH AHEC is one of a national occurred in the hospital setting. Its establishment coincided with network of programs that provide educational support to current and future the establishment of community health centers and the National members of the health care workforce and collaborate with community Health Service Corps - supporting education, clinical care and organizations to improve population health. The NH AHEC operates as a partnership workforce. NH AHEC began in 1997. between Geisel School of Medicine at Dartmouth and Regional centers in Littleton and Raymond to serve the entire state. NH AHEC SERVICES ➢ Connecting students to health careers The structure of AHEC in NH is one program office and two center offices: ➢ Promoting health career awareness and recruitment for young Program office: Dartmouth Institute for Health Policy & Clinical Practice people, including activities such as health career day and (Lebanon, NH) residential camps Center office: Northern NH AHEC at North Country Health Consortium ➢ Improving care and access to care (Littleton, NH) ➢ COVID-19-related workforce trainings and services Center office: Southern NH AHEC at Lamprey Health Care (Raymond, NH) ➢ Facilitating Community Placements for health professions students In addition to the statewide AHEC network, AHECs are part of an active National ➢ Team training for health professions students from multiple AHEC Organization, representing over 85% of the counties in the the United States. disciplines MISSION ➢ New Hampshire AHEC Health Service Scholars NH AHEC strives to improve care and access to care, particularly in rural and ➢ Wellness activities underserved areas by enhancing the health and public health workforce in New ➢ Continuing education provided to health and public health Hampshire. providers throughout NH lunch and learn workshops

37 Leading innovative collaboration to improve the health status of northern New Hampshire We are a private, public health non-profit and rural health network, created in 1997 as a vehicle for addressing common issues through collaboration.

• Solving common problems and facilitating regional solutions • Creating and facilitating services and programs to improve population health status • Providing health professional training, continuing education, and management services to encourage sustainability of the healthcare and workforce infrastructure • Increasing capacity for local public health essential services Becky McEnany, • Increasing access to healthcare and other Interim CEO 262 Cottage St., resources for underserved and uninsured residents of Suite 230 Northern NH Littleton, NH 03561 NCHCNH.org 603-259-3700 603-259-3700 38 PLANNED PARENTHOOD SERVICES – Meagan Gallagher, Chief Executive Officer Health Centers in New Hampshire: Primary Medical Care Claremont Health Center of Claremont, NH: 136 Pleasant Street Claremont, NH 03743  603-542-4568 Care for all, regardless of health Derry Health Center of Derry, NH: 4 Birch Street Derry, NH 03038  603-434-1354 insurance status. Services Exeter Health Center of Exeter, NH: 108 High Street Exeter, NH 03833  603-772-9315 include: well person visits; Flu, Keene Health Center of Keene, NH: 8 Middle Street Keene, NH 03431  603-352-6898 Tdap, HPV, and Hepatitis A & B Manchester Health Center of Manchester, NH: 24 Pennacook Street Manchester, NH 03104  603-669-7321 immunizations; cervical, breast, www.plannedparenthood.org colorectal and testicular cancer screenings; Pap tests; high blood ABOUT OUR NH PATIENTS HIGHLIGHTS IN PPNNE HISTORY pressure, thyroid, cholesterol and Where They Live: Our patients live across 1965: Planned Parenthood of Vermont (PPV) formed diabetes screenings; PrEP and the New England States. 1966: Planned Parenthood Association of the Upper PEP, vasectomies and trans- PPNNE serves NH patients in Manchester, Valley (PPAUV) formed inclusive health care Derry, Exeter, Keene and Claremont. 1984: PPV/PPAUV merge to form PPNNE including hormone therapy Socioeconomic Status: Approximately 66% of our 1986: PPNNE merges with Family Planning Services patients are at or below 200% FPL ($24,980 for a of Southwestern New Hampshire (Keene), Health Care Education household of one). Health Options (Manchester), Southern Coastal Family Peer sexuality education for high Planning, and Rockingham County Family Planning school students and community- Insurance Status: 2015: PPNNE Celebrates 50 years based sexuality education 14% NH Family Medical Assistance Program 20% Government (includes Medicaid, Medicare, Family Planning Services NH Healthy Families and others) Services such as contraception, 44% Private Insurance NUMBER OF TOTAL PATIENTS SERVED ACROSS ME, NH STD/HIV testing and treatment, 21% Self Pay AND VT IN 2019 emergency contraception 1% Access Plan Medical care users: 44,673 patients 13% are men; 87% are women. Total NH patients: 13,086 Medical care visits: 65,877 Total NH visits: 18,400 88,916 STD screenings 11,797 pregnancy tests FINANCIAL INFORMATION 4,915 pap tests Agency Budget: $25 Million 5,822 breast exams Employees: 239 $8 million in discounted and free health care provided 39 Weeks Medical Center Michael Lee, President 173 Middle Street, Lancaster, NH 603-788-4911 1-800-750-2366 (In NH only) www.weeksmedical.org HIGHLIGHTS IN WEEKS HISTORY 1996: Weeks Names Lars Nielson, MD New Chief Medical Officer 2006: Weeks Auxiliary Raises $22,000 for Artery Disease Test WEEKS SERVICES Equipment 2007: Weeks installs Baby Abduction Protection System 2008: Weeks Auxiliary donates $26,795.00 for the purchase of a ➢ Primary Medical Care Glidescope for the Emergency Dept., Recumbent bike for Rehab, and a ➢ Women’s Health Care: portable ventilator for Respiratory. Free breast and cervical cancer 2009: Weeks Auxiliary donates $ $47, 797.00 for the purchase of a screenings for income-eligible women, Bladder Scanner for Nursing, 2 Echocardiology beds, Small Joint STD screening and treatment Locations: Arthroplasty Equipment for OR and two transport monitors for Med- ➢ Pediatric Care: Groveton Physicians Office: 47 Church St. Surg. Pediatric eye and ear screenings on site Lancaster Physicians Office: 173 Middle St. 2010: Weeks Auxiliary donates $16,547.00 for the purchase of 4 CADD Parenting education, developmental Pumps for Med-surg. North Stratford Physicians Office: 43 Main St. screenings, and child development 2011: Weeks Auxiliary donates $19,335.00 for the purchase of a services for learning disabilities Whitefield Physicians Office: 8 Clover Lane Spirometry for the Whitefield Physician Office, Renovated the Quiet ➢ Disease and Case Management: ABOUT OUR CLIENTS room at the hospital and helped the Gift Shop purchase a Point of Sale System. Education on managing chronic diseases Where They Live: Patients come from 2012: Weeks Auxiliary donates $19,695.00 for the purchase of 3 Ceiling such as asthma, diabetes and North Country towns of New Hampshire Lifts for Med-surg. hypertension and Vermont. 2013: Weeks Auxiliary donates $14,598.00 for the purchase of ➢ Health and Nutritional Education, Insurance Status: Volunteer Smocks, Blanket Warmer Oncology, Ceiling lift for Med-surg. Promotion and Counseling 3% were uninsured. 2014: Weeks Auxiliary donates $26,000.00 for the hospital parking lot ➢ Podiatry and Wound Care 13% were covered by Medicaid. renovation project. ➢ Behavioral Health, Substance Use, 59% were covered by Medicare. 2015: Weeks Auxiliary donates $15,000 for hospital cafeteria and Medication Assistance Therapy 25% had private insurance. renovations. Sliding fee scale available 2016 Weeks Names New CEO Mike Lee ➢ 24-Hour Call Service 2016: Weeks Auxiliary donates $21,600.00 for the purchase of a NUMBERS OF CHILDREN ➢ Rehabilitation Services AND ADULTS SERVED Glidescope for the Emergency Department and 10 Elevated Chairs for the Physician Offices and Hospital Lobby. physical, occupational, and orthopedic Total Patients: 9,375 2017: Weeks Auxiliary donates $5,150.00 for the purchase of therapy Total Visits: 65,322 communication white boards for patient rooms and $7,500.00 for a ➢ On Site CLIA Laboratory GROWING DEMAND (2019-2020) ceiling lift for med-surg. They also gave the Gift Shop $10,000 to ➢ Coordinate Transportation Services upgrade their Point of Sale System. 2% increase in insured patients ➢ Language Interpretation Services 2018 & 2019: Weeks Auxiliary donates a total of $60,000 to the new 12% increase in patient encounters Lancaster Patient Care Center Building (45,000square feet) completed in 9% decrease in patients December 2019. 31% increase in Medicare patients 2019: The new Lancaster Patient Care Center opened. 40 12% decrease in Medicaid patients 2020: Weeks Names Dr. Mark Morgan New Chief Medical Officer WHITE MOUNTAIN SERVICES

➢ Primary Medical Care ➢ Dental Services: Children’s full-service program and adult hygiene ➢ Prenatal Care: Comprehensive care with two certified nurse midwifes and White Mountain Community Health Center NUMBERS OF CHILDREN AND ADULTS SERVED deliveries at Memorial Hospital Kenneth “JR” Porter, Executive Director Health care users: 2,498 ➢ Family Planning Services 298 White Mountain Highway, Conway, NH 03818 Patient care visits: 10,116 ➢ Teen Walk-in Clinic: A safe and 603-447-8900 confidential www.whitemountainhealth.org place for teens, with a teen educator on HIGHLIGHTS IN WMCHC HISTORY staff ABOUT OUR CLIENTS 2000: White Mountain Community Health Center ➢ HIV/STD Testing Where They Live: Patients come from nine rural is established (Children’s Health Center, ➢ Nutrition Counseling New Hampshire communities in northern Carroll established in 1968, and Family Health ➢ Social Services and Case County, as well as from neighboring Maine towns. Center, established in 1981, merge) Management: Socioeconomic Status: 83% of White Mountain 2005: Began offering dental hygiene services, Assistance with obtaining fuel, food, or Community Health Center patients are at or below both on site and through a school-based program housing assistance, care coordination 200% of the federal poverty level. 2017: Medication-assisted treatment for and case management, with social substance abuse disorder added workers and a community Insurance Status (2019): 2018: Designated a Federally Qualified Health health worker on staff. 7% were covered by Medicare. Center Look-Alike ➢ Mental Health Services: Short-term 23% were uninsured. mental health counseling 27% had private insurance. CHANGING WITH THE COMMUNITY NEEDS ➢ Substance Misuse Treatment: 43% were covered by Medicaid. White Mountain Community Health Center screens Medication-assisted treatment with all patients age 12 and older for depression and integrated social work substance misuse annually. Families of children ➢ Affordable Healthcare Assister: FINANCIAL INFORMATION with mild to moderate iron deficiency anemia Free one-on-one help enrolling in the Full-Time Employees: 21 are not only educated about nutritional changes, Health Insurance Marketplace and Charity care provided (2019): $88,454 they are also provided with a Lucky Iron Fish to accessing other programs to make assist with iron supplementation. Using a daily healthcare affordable, including the supply of drinking water that has been prepared Medication Bridge Program using the Iron Fish can help raise iron levels ➢ Private Assistance Funds: To help without the uncomfortable side effects sometimes reduce other barriers to care, such as seen with iron supplements. Hepatitis C treatment diabetes supplies and transportation is available through telemedicine appointments with a specialist at Dartmouth-Hitchcock. 41 Resources

42 FQHC Federal Requirements Federally Qualified Health Centers (FQHCs) are health care practices that have a mission to provide high quality, comprehensive primary care and preventive services regardless of their patients' ability to pay or insurance coverage. FQHCs must successfully compete in a national competition for FQHC designation and funding. Additionally, they must be located in federally-designated medically underserved areas and/or serve federally-designated medically underserved populations. FQHCs submit extensive financial and clinical quality data to their federal regulators annually, the Health Resources and Services Administration (HRSA) in a submission called UDS. HRSA regulators audit each FQHC with a multi-day onsite visit every three years.

Per Federal Regulations, FQHCs must comply with 90+ requirements. In summary, they must: • Provide all required primary, preventive, enabling health services (either • Exercise appropriate oversight and authority over all contracted directly or through established referrals). services. • Ensure a majority of board members for each health center are patients • Make efforts to establish and maintain collaborative relationships with of the health center. The board, as a whole, must represent the other health care providers. individuals being served by the health center in terms of demographic • Maintain accounting and internal control systems to safeguard assets factors such as race, ethnicity, and sex. and maintain financial stability. • Provide services at times and locations that assure accessibility and • Have systems in place to maximize collections and reimbursement for meet the needs of the population to be served. costs in providing health services. • Have a system in place to determine eligibility for patient discounts • Develop annual budgets that reflect the cost of operations, expenses, adjusted on the basis of the patient’s ability to pay. No patient will be and revenues necessary to accomplish the service delivery plans. denied services based on inability to pay. • Have systems which accurately collect and organize data for reporting • Maintain a core staff as necessary to carry out all required primary, and which support management decision-making. preventive, enabling, and additional health services. Staff must be • Ensure governing boards maintain appropriate authority to oversee appropriately credentialed and licensed. operations. • Document the needs of their target populations. • Ensure bylaws and/or policies are in place that prohibit conflict of • Provide professional coverage during hours when the health center is interest by board members, employees, consultants, and those who closed. furnish goods or services to the health center. • Ensure their physicians have admitting privileges at one or more referral hospitals to ensure continuity of care. Health centers must firmly establish arrangements for hospitalization, discharge planning, and patient tracking. • Have an ongoing Quality Improvement/Quality Assurance program.

Summary of Health Center Program Compliance Manual Requirements. (November 2018) from Bureau of Primary Health Care, Health Resources and Services Administration, https://bphc.hrsa.gov/programrequirements/index.html 43 FQHC Sliding Fee Scale

NH FQHCs discounted over Example of Sliding Fee Schedule $12 million in 2019.

2019 NH UDS Data

➢ FQHCs must provide the patients in their service area access to services regardless of their ability to pay and must develop a schedule of fees or payments, called a sliding fee scale, for the services they provide to ensure that the cost for services not covered by insurance are discounted on the basis of the patient's ability to pay, for those with incomes below 200% of the Federal Poverty Level

(FPL). For each additional ➢ Ability to pay is determined by a patient's person, add annual income and household size NHSC Sliding Fee Discount Schedule Information Package, Revised June 2019 according to the most recent U.S. Poverty level is based on ASPE 2019 Federal Poverty Guidelines. Department of Health & Human Services Federal Poverty Guidelines. 44 Who’s My NH Legislator?

Discover a city or town’s state representative here.

Find your NH state senator here.

Hearings during the 2021 NH legislative session are conducted remotely due to the COVID-19 pandemic. Click here to watch House hearings and here to watch Senate hearings.

Visit the NH General Court website here for more information about legislative activities in NH.

45 Acknowledgements

Special thanks to our New Hampshire Bi-State Members for providing high quality health care in their communities and valuable data for the Primary Care Sourcebook.

For more information, please contact:

Kristine E. Stoddard, Esq., Director, NH Public Policy 603-228-2830 Ext. 113 [email protected]

Colleen Dowling, Project Coordinator, NH Public Policy 603-228-2830 Ext. 127 [email protected]

Bi-State Primary Care Association, 525 Clinton Street Bow, New Hampshire 03304 www.bistatepca.org  www.facebook.com/BiStatePrimaryCareAssociation/  www.twitter.com/bistatepca

Information and data in the print version of the Sourcebook is updated as of January 2021. For online version visit www.bistatepca.org.

46