Sunday, December 11, 2016

Celebrating 20 years of Growth, Collaboration and Service!

By Scott Rollett, MBA, C.M.P.E.

1996 was literally twenty years ago.  But it sure doesn’t seem like that long ago to me.  In fact, it feels just likeyesterday.  Sometimes I scratch my head (where my hair used to be!) and wonder, can it really be 2016?  But, indeed, 20 years has passed and the reality is that the world looks just a little bit different today than it did back then. 

When I think back to what the world was like in 1996, I am in awe of how much things have changed in just 20 short years.  In 1996, no one had smart phones constantly in their hands or on their person.  In fact, lots of people didn’t even have a cell phone yet, and others had “car phones”.   The internet was in its infancy and the world was enthralled with America Online.  Facebook hadn’t even been dreamed up yet by then 12-year old Mark Zuckerberg.  The only way your car could be “self-driving” was if you put it on cruise control.  We loved our music back then just as much as we do today but we listened to it on our Sony Discman and lugged around our CD collections in large books with dozens of CD sleeves in them.  We were thrilled when Microsoft came out with the Encarta encyclopedia CD which rendered our parent’s hardbound encyclopedia collections suddenly obsolete.  The Google Guys had just graduated from Stanford so they were still a long way off from creating the world’s most prolific source of free, up-to-date information.  On Friday and Saturday nights, we still headed to the local Blockbuster to rent some videos of the movies we saw the summer before.  Gas was cheap, SUV’s were king, and life was good!    

But also in 1996, Windrose Health Network was just an idea that had yet to be born.  Johnson County, Indiana is located directly south of Indianapolis and Marion County, Indiana.  Although access to medical care was plentiful in northern Johnson County and extending down to Franklin, it was non-existent in the southern half of Johnson County.  In fact, the southern portion of Johnson County was (and still is) designated as a Medically-Underserved Area (MUA).  So a handful of citizens from the town of Trafalgar, working with Johnson Memorial Hospital, set out on a path to change that.

A former bar on the corner of State Road 135 and State Road 252 was purchased and renovated into a 3-exam room Rural Health Clinic (RHC).  Marc Hackett was hired as the Office Manager (Marc is now the Executive Director of Jane Pauley Community Health Center) and Judy Jacobs was hired as a Medical Assistant (Judy is now WHN’s Director of Outreach and Community Relations).  Marc and Judy worked feverishly over a period of about two weeks to get the new Trafalgar Family Health Center ready for Opening Day.  The TFHC had not yet hired any clinicians, but a rotation of physicians from Johnson Memorial Hospital were happy to staff the clinic in the early days.  In early December of 1996, on the TFHC’s first day of operations, the 3-person team of Judy, Marc, and Dr. Simon Feng saw a total of eight patients - - several of which are still patients today!  If you didn’t have health insurance, the cost of an Office Visit was $6.

The new clinic was a huge success and soon it hired its first full-time clinician - - Nurse Practitioner, Dena Barger.  Now many people in Trafalgar, Indiana had never heard of a Nurse Practitioner in 1997 and some people came to see her just to check her out and see what this was all about.  The clinic continued to grow and soon it expanded into the adjacent space and added more full-time clinicians - - Nurse Practitioner, Lisa Marrero, and Family Medicine physician, Dr. Hong Tang.  Nurse Practitioner, Kathy Hendershot had a full-time job at Methodist Hospital, but was willing to work Saturdays at the new clinic.  Just a few years later, Dr. Michael Chitwood joined the practice - - and continues to practice there today.

In 2002, the organization built a second RHC in Edinburgh, Indiana.  Nurse Practitioner, Glenda Wendling (Glenda continues to see patients at WHN’s Hope Center), and Family Medicine physician, Dr. Julio Sanchez, were hired to staff that clinic - - the Edinburgh Family Health Center - - which opened in July of that year.  With two clinics now, the organization changed its name to the Edinburgh / Trafalgar Family Health Centers (ETFHC) and it was off to the races!

At that point in time, the ETFHC was still under the guidance and control of Johnson Memorial Hospital.  But that began to change in late 2003 when the ETFHC was awarded a New Access Point grant by the Bureau of Primary Health Care (BPHC) and officially became a Federally-Qualified Health Center (FQHC).  Now becoming an FQHC has its own set of rules and regulations and one of those rules is that the FQHC must be fully independent and directed by a Board of Directors made up of a minimum of 51% patients.  Further, of the remaining non-patient Board Members, no more than 10% can be employed in the field of health care.  So it was at this juncture that the ETFHC had to formally separate from Johnson Memorial Hospital to become a fully, independent organization.  On December 1, 2003, the ETFHC hired Dr. Michael Kolenda to be its new CEO - - a role which he still fulfills today. 

Dr. Kolenda brought with him a new vision for the ETFHC of growth and expansion.  While some thought the ETFHC’s mission was complete with (2) Health Centers in the southern part of Johnson County, Dr. Kolenda encouraged others to envision taking the mission of healthcare to the medically-underserved to any community that needed it.   This was bold thinking back in 2004 for the fledgling organization.  Although it had, by this time, been around for eight years, it had been heavily dependent upon the support of Johnson Memorial Hospital to sustain its operations.  When the ETFHC became fully independent in 2004, it brought with it a fresh set of challenges.

But the staff met the new challenges with creativity, ingenuity, and a steely resolve.  Soon opportunity knocked again.  The town of Hope had not had a physician in its community since the mid-1980’s.  Town leaders approached the ETFHC about the possibility of opening up a Health Center to help take care of the town’s population.  Partnering with the Community Center of Hope, the ETFHC was able to open a small, (2) Exam Room clinic in a 900 square foot space within the Community Center in September 2006.  At first the clinic was only able to be open on a part-time basis with a myriad of part-time medical providers.  But soon, it became clear that patient demand warranted more hours of service and a steady clinician.  At that point, Dr. Cindi Yantz joined the Hope Family Health Center as its first full-time medical provider.  That clinic continued to grow and in 2010, with the help of President Obama’s Stimulus Package, the ETFHC purchased some land south of town just off of State Road 9 and constructed a new Health Center that was nearly 9,000 square feet in size - - 10 times bigger than the original space!  That expansion allowed the ETFHC to hire Nurse Practitioner, Julie Snyder, and also add (2) Family Medicine physicians and a pediatrician, as Dr. Yantz went on to become the full-time Medical Director.

But before that expansion happened in Hope, opportunity was also knocking on the South Side of Indy.  With financial support from Adult and Child, Inc. and Community Health Network, the ETFHC opened an (8) Exam Room Health Center near the corner of Madison Avenue and Stop 12 Road in October 2008.  Initially, that clinic opened with pediatrician Dr. Lourdes Geise, a nurse practitioner, and a physician on-loan from Community Health Network.  Patient demand there exploded and soon the Countyline Family Health Center took over the entire 2nd floor of the building it was in.  Along the way, Drs. Margarita Wiersema, Aileen Puno, Praveen Rajanahalli, and Aris Abeleda joined the practice along with some Prenatal Care providers from the IU Family Medicine Residency Program.  Within only a few years, Countyline quickly became  the ETFHC’s busiest Health Center.  This was largely due to both the population density of the Indianapolis area as well as the large number of Burmese refugees which began settling in the area in 2008, 2009, and 2010.  As a whole, the medical community on the South Side of Indy was unprepared to treat these large numbers of non-English-speaking patients.  With its mission to provide healthcare services to the poor, the working poor, and the medically disenfranchised, these patients quickly felt at home at Countyline Family Health Center.    

Now by 2009, with (4) Health Centers in operation, it no longer made any sense for the organization to be called the Edinburgh / Trafalgar Family Health Centers.  The ETFHC’s management team and Board set out to find a new name that better-suited the growing organization.  Several names were proposed but none fit as well as Windrose Health Network.  WHN - - as the organization came to be called - - was looking for a name that both better-defined it geographically and also connoted its mission of creating a better life for its patients through the provision of affordable, high-quality health care services.  Thus, the ETFHC officially became Windrose Health Network that year and the tagline “Leading You to Better Health” was adopted.

By the end of 2010, after only 6 years as an independent organization, WHN had officially doubled in size in nearly every way.  Its two Health Centers became four.  The 5,500 patients receiving 18,797 outpatient visits became 12,333 patients receiving 37,046 outpatient visits.   Its staff had grown from approximately 32 people to 71 people.  But the growth didn’t stop there.  Demand for its services remained strong at each of its Health Centers and WHN continued to try to meet that demand to the best of its ability.

In 2013, the Franciscan Alliance very generously donated a facility in Franklin, Indiana to WHN.  The donation was very timely and helped WHN meet not only a growing shortage of primary care physicians in Franklin, itself, but it also helped WHN solve its need for more administrative space for its ever-expanding staff.  After completely renovating that facility, WHN moved its Edinburgh Family Health Center to Franklin in March of 2014 and repurposed the Edinburgh facility as an Administrative Center.  In November of 2015, WHN opened a Convenient Care Center in the other half of the Franklin facility to be able to offer Same Day, Walk-In services for its patients.

In the meantime, patient demand on the South Side of Indianapolis continued to grow and it became clear that the Countyline Family Health Center practice would need to relocate.  Soon, a decision was reached to split the practice into two separate practices which would allow both to continue to grow.  After a hectic summer, WHN opened a new Countyline practice in October 2015 and followed that with a new Epler Parke practice in December of 2015. 

At this writing, on December 4, 2016 - - almost exactly 20 years after WHN saw its first patients in Trafalgar - - WHN continues to grow.  By the end of this year, WHN’s clinicians will have delivered more than 70,000 outpatient visits to over 20,000 patients and there is no sign of slowing down.  Although the future is perhaps unknowable, one thing is absolutely clear:  for the past 20 years, WHN has fulfilled unmet healthcare needs in the communities that it serves.  God willing, WHN will be here for the next 20 years, still meeting the needs of the medically-underserved.

In conclusion, let us simply say thank you to all who have been a part of Windrose Health Network for the past 20 years.  To our staff, thank you for your daily hard work and dedication which has both carried us through hard times and also allowed us to grow and flourish.  To our Board Members, both past and present - - thank you for your faithful service and for believing in an idea and a vision that, through the hard work of many, has become a reality.  But most of all, thank you to our patients for allowing us the privilege to care for you and your families - - it is the greatest honor of all.      


Tuesday, November 29, 2016

Flu Vaccines: Get Yours Today!

By Laura Pryor, RN, MSN

The Centers for Disease Control and Prevention, also known as the CDC, reports that the single best way to protect against influenza (flu) is to get vaccinated each year.

Many people believe the flu is no more serious than a cold; however, influenza is a serious viral disease that can lead to hospitalization and sometimes even death. This is especially true for the very young, those over the age of 65 years, as well as people with other chronic health issues. Even healthy people can get very sick from the flu and spread it to others. Several years ago, I skipped the flu vaccine, thinking I was a young mom that had a healthy immune system. I got the flu that season and was very ill. I had to have my young daughter phone her grandmother to come over because I was too sick to care for myself or my two young children. That experience made me seriously re-think the importance of the flu vaccine! I have not missed a vaccine since that year.

Flu season can begin as early as October and can last as late as May. During this time, flu viruses are circulating at higher levels in the U.S. population. Flu is usually at it’s peak in January or February each year. Because it can take 2 weeks for your body to develop flu antibodies, it’s best to get your flu vaccine as early in the season as it is available (usually around September or October). For those who didn’t get their vaccine yet, it is still a good idea to get one. Vaccines can be given throughout the flu season.

Everyone 6 months of age and older should get a flu vaccine every season. This recommendation has been in place since February 24, 2010 when CDC’s Advisory Committee on Immunization Practices (ACIP) voted for “universal” flu vaccination in the United States to expand protection against the flu to more people.

Vaccination to prevent influenza is particularly important for people who are at high risk of serious complications from influenza. More information is available at Who Should Get Vaccinated Against Influenza.

I’ve heard many people say that the flu vaccine “gave them the flu”. It is quite common for a person to have a mild fever, feel tired, and even have some muscle aches or headache as part of the natural process the body goes through while developing antibodies from a vaccine. Experiencing this does not mean a person got the flu from their vaccine.

There are different forms of flu vaccine available. The following link will take you to the CDC website, where you can learn more about the different types of flu vaccine:

The CDC recommends use of injectable influenza vaccines (including inactivated influenza vaccines and recombinant influenza vaccines) during 2016-2017. The nasal spray flu vaccine (live attenuated influenza vaccine or LAIV) should not be used during 2016-2017.

Both trivalent (three-component) and quadrivalent (four-component) flu vaccines will be available.

Trivalent flu vaccines include:

  • Standard-dose trivalent shots (IIV3) that are manufactured using virus grown in eggs. Different flu shots are approved for different age groups. Most flu shots are given in the arm (muscle) with a needle. One trivalent vaccine formulation can be given with a jet injector, for persons aged 18 through 64 years. 
  • A high-dose trivalent shot, approved for people 65 and older. 
  • A recombinant trivalent shot that is egg-free, approved for people 18 years and older. 
  • A trivalent flu shot made with adjuvant (an ingredient of a vaccine that helps create a stronger immune response in the patient’s body), approved for people 65 years of age and older (new this season). 

Quadrivalent flu vaccines include:

  • Quadrivalent flu shots approved for use in different age groups. 
  • An intradermal quadrivalent flu shot, which is injected into the skin instead of the muscle and uses a much smaller needle than the regular flu shot. It is approved for people 18 through 64 years of age.
  • A quadrivalent flu shot containing virus grown in cell culture, which is approved for people 4 years of age and older (new this season). 

If you have questions about which vaccine is best for you, talk to your doctor or other health care professional.

Sources: Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases (NCIRD)

Monday, November 14, 2016

"Steady As She Goes"

By Scott Rollett, MBA, C.M.P.E.

If you were like me, you went to bed late Tuesday night simply stunned by the election results.  Being a healthcare administrator who has worked for a Community Health Center for more than twelve years, my first initial thought was one of panic:  the GOP finally has the power to repeal the Affordable Care Act (ACA) - - an act the GOP-led Congress brought to a vote more than 60 times since the ACA was signed into law but each were defeated either by Congressional Democrats or vetoed by President Obama.    

My thoughts turned immediately to the possible impact on Windrose Health Network, its patients, and its employees if that were to occur.  Regardless of what anyone thinks about the overall impact of the legislation, the fact of the matter is that Windrose Health Network has grown significantly as the result of the ACA.  Below is a brief comparison of some common statistics for WHN in 2010 (the year the ACA was signed into law) and projected figures for 2016.    
# of Patients Served
70% ↑
# of Patient Visits
92% ↑
% of Uninsured Pts.
21% ↓
# of Employees
96% ↑
WHN Annual Budget   
142% ↑

Additionally, WHN was poised for even more growth in 2017, with as many as (3) new Health Centers planned to come online throughout the year.  With these facts in mind, one can understand my initial, fearful  reaction.  Simply repealing the ACA - - without a replacement plan - - would do significant damage to WHN and the people and the communities that it serves.  Further, the GOP has already identified this as Priority #1 for the Trump Administration and the 115th Congress.

However, as the days and hours after the election passed, my outlook began to change.  The more that I thought about things and the more that I began to talk with other healthcare leaders and read thoughtful analysis by industry experts, the more that I realized that simply overturning / reversing the ACA  is likely not possible.  The healthcare environment has shifted significantly in the past six years and - - like it or not - - the ACA is already well-entrenched into society.  Below are a few thoughts that give me solace, even in the midst of an uncertain future.

Popular Components of the ACA:
Most critics of the ACA focus on some of the unpopular components of the ACA, like the Individual Mandate, the economic impact on Small Businesses, or the overall lack of affordability for Marketplace Exchange products.  But critics rarely focus on the positive components of the ACA which consumers have already begun to appreciate and use.  Some of these things are:
·       Free preventative care - - especially for pricey items like colonoscopies and mammograms
·       Continued coverage for adult children up to Age 26 (regardless of college status)
·       The removal of Annual or Lifetime Coverage Limits
·       No denial of coverage for pre-existing conditions
·       The establishment of Marketplace Exchanges and Medicaid Expansion to create additional access to coverage for early retirees, the self-employed, the unemployed, or those whose employers do not offer affordable coverage (through which an additional 20M people now have coverage)    
·       Healthcare premium subsidies based on Household Income and Size

These are all popular components of the ACA and ones which will be difficult to "walk back" without having serious implications for the 2018 Mid-Term Elections. 

 The Impact on the Economy:
One of the strongest arguments against a swift repeal of the ACA is the overall negative impact it would have on the economy.  To start with, states who have already expanded Medicaid have seen an influx of Federal Dollars that they would not otherwise have access to.  These Federal Dollars have bolstered state budgets and created tens of thousands of new jobs in government, in healthcare, and in healthcare-related industries like Pharmaceuticals and Medical Device Manufacturers.  A January 20, 2017 rollback would instantly imperil those jobs and I do not think any of our elected officials are eager to let that happen. 

Secondly, the ACA was signed into law in March 2010 and while some of its components took effect immediately, other parts of it took years to be implemented as State Governments and Insurance Companies worked to incorporate the changes into their business models.  Yes, there has been a lot of negative publicity in the past six months about some large insurance companies dropping out of specific Marketplace Exchange networks.  But they are not telling the whole story.  The ACA has many positive attributes to it that Insurance Companies have incorporated into their conglomerate organizations.  For example, Medicaid Expansion has been a boon to many private insurance companies because they manage risk for many Medicaid Members on behalf of state governments.  In fact, United Health Care, of which a lot of focus was put on this past summer as they announced they were dropping out of many Marketplace Exchanges was one of several insurance companies that submitted a bid to try to get INTO Medicaid Expansion / HIP 2.0 in Indiana in 2017.  Clearly, their leaders saw this part of the ACA as a business opportunity, even as they were abandoning the less-profitable Marketplace Exchange market.  Additionally, the creation of Accountable Care Organizations and Shared Savings Plans put Medicare and private insurers on a pathway that already has created hundreds of millions of dollars in cost savings and fraud prevention.  Last but not least, the taxpayer premium subsidies have been incorporated into the revenue streams of nearly every major health insurance company in America.  Ending those on January 20, 2017 would throw the insurance industry into immediate turmoil.  I do not think any of our elected officials would be eager to let that happen either.         

HIP 2.0:
Initially, the Healthy Indiana Plan (HIP 2.0) - - Indiana's version of Medicaid Expansion - - was highly political.  Governor (and Vice-President Elect) Mike Pence's Administration negotiated with President Obama's Administration and Health and Human Services (HHS)to develop a plan that both sides could live with.  The result of HIP 2.0, more than a year and a half after its implementation, is that it not only works, it is also widely seen by conservative leaders as a successful model that can be duplicated in other states that have yet to implement Medicaid Expansion.  Furthermore, specific components of  HIP 2.0, like Presumptive Eligibility, have been not only a financial "shot-in-the-arm" for hospitals, specialty physicians, pharmacies, and other healthcare providers, it has also been a blessing to many previously-uninsured patients who need healthcare services NOW and not in 45-60 days when their applications can be approved.  The fact that Indiana - - a fiscally-conservative state - - has implemented such a program to great success gives me hope that President-Elect Trump's campaign promise to "repeal and replace the ACA" with something that "covers everyone" might be legitimate.       
We Still Have a Voice:
Last but not least, as advocates of the poor, the working poor, the medically-underserved, and the middle class, we still have a voice.  The elections are over, and our newly-elected Senators and House Reps have a job to do - - to serve the people that elected them.  Lobbyists will soon begin their descent on Washington and will be making their case for their clients' best interests.  We must continue to do the same and we must not become complacent.  Americans everywhere must continue to let their government reps know how their decisions will impact their lives, the lives of their family members, and the communities in which they live.  The good news is that the Health Center Program enjoys bipartisan support and as Tom Van Coverden, President & CEO of the National Association of Community Health Centers (NACHC), said in a statement issued last Thursday, Congress and Presidential Administrations on both sides of the aisle have made investments in Health Center expansion over the last 16 years.  WHN has seen this bipartisan support demonstrated at a local level.  In 2015, House Representative (and Senator-elect) Todd Young visited our Countyline Health Center.  He was both supportive of our mission and inquisitive as to the people that we serve.  Finally, last summer, when WHN put in an application to serve the community of Bloomington with a new Health Center, both Mr. Young and Democratic Senator Joe Donnelly gave us a Letter of Support towards that endeavor.            

In conclusion, at this point in time, there are likely more questions than answers about what  a Donald J. Trump Presidency and a GOP-controlled Congress will mean for the healthcare industry.  The reality is that none of us can predict exactly what will happen after January 20.  So as we look down towards this unknown path and ponder the journey that we are all about to embark on, the words that Captain James T. Kirk ended many Star Trek episodes with echo in my head, "Steady as she goes, Mr. Sulu.  Steady as she goes."