The Freeport / Roosevelt The Freeport / Roosevelt Community Health CenterCommunity Health CenterPresented by: The Nassau Health Care Corporation

Overview

• What is the Nassau Health Care Corporation?• Health Care Disparities in Nassau County• The Current Freeport-Roosevelt Community

Health Center• The “New” Freeport-Roosevelt Community

Health Center– The Importance of 380 Nassau Road– The Health Center– The Institute for Healthcare Disparities– The Community Imaging Center

What is the Nassau Health Care Corporation?

The Nassau Health Care Corporation• Created in 1999; purchased health care assets from Nassau County• Consists of four components:

– Nassau University Medical Center (NUMC)– A. Holly Patterson (AHP) Extended Care Facility– Six Community Health Centers– One School Based Clinic in Roosevelt

• Budget in excess of $500 million; 3,400 employees• Safety net health care facility in Nassau County• Important statistics:

– 22,000 discharges– 77,000 emergency department visits– 68,000 visits to community health centers– Over 200,000 ambulatory visits at NUMC– Census at AHP of approximately 580

NHCC’s Past• Troubled financial history.• Turmoil and turnover in governance and

administration.• Decline in outpatient services, particularly in

community health centers.• Lack of investment in facilities.• Lack of focus on ambulatory care.• A “closed shop” – not open to broad relationships

with advocacy organizations or community physicians.

• Absence of clear focus on its mission.

NHCC’s Present and Future• Significant financial gains.• Stability of administration and governance.• Increase in outpatient visits and services.• Considerable investment in facilities, including

community health centers.• Major focus on upgrading clinical quality and

improving and diversifying ambulatory care.• An “open shop” – reaching out to community leaders

and voluntary physicians.• Clear focus on mission and on concretely

addressing health care disparities.

Financial Improvements at the Corporation

RECURRING OPERATING BUDGET IMPROVEMENTS

ITEM AMOUNTFull share of federal DSH payments at NUMC 15,000,000$ Opening of 72 additional psychiatric beds 5,000,000 Hospital based status for AHP 5,000,000 Bedhold reimbursement at AHP 1,200,000 Improved case mix at AHP 1,200,000

TOTAL 27,400,000$

CAPITAL AND DEBT RETIREMENT FUNDS

ITEM AMOUNTHEAL II funds (ED, health center improvements) 24,000,000$ HEAL IV funds (Debt retirement, shell floors) 37,000,000 County tobacco funds 80,000,000 New market tax credits (for health center improvements) n/a

TOTAL 141,000,000$

GRANTS, FUNDRAISING, AND EARMARKS

ITEM AMOUNTInstitute for Healthcare Disparities 6,000,000$ Federal earmark for Institute's outreach 200,000 *Federal earmark for chemical dependency / WTC program 200,000 *NCIDA grant for equipment purchase for Freeport 250,000 *2007 gala funds for disparities intervention 80,000 *

TOTAL 6,730,000$

*These items have not yet been received and therefore are subject to change

June 2006 through today

FINANCIAL IMPROVEMENTS ATTHE NASSAU HEALTH CARE CORPORATION

Other Important Improvements• Quality of Care

– Reversed conditional accreditation and secured full accreditation, with no citations, through 2009

– Recruited eight new clinical chairs– Established Corporate quality goals; material improvements

observed

• Facility Modernization– Commenced comprehensive modernization program

exceeding $240 million– Opened three new psychiatric units; new Burn Center and

Center for Hypertension, Diabetes and Vascular Medicine will open in early 2008

– Emergency department planning nearly complete; expect late 2008 groundbreaking

– CON filed for replacement nursing home; expect early 2009 groundbreaking

Health Care Disparities in Nassau County

Health Disparities in Nassau County

• Black and Latino residents of Nassau County:– Report less favorable health status – Are more likely to be overweight or obese.– Have higher rates of infant mortality, – Are much more likely to be living with HIV/AIDS – Are far more likely to be diagnosed with Tuberculosis.– Are more likely to die of diabetes, septicemia and cirrhosis. – Have significantly less access to healthcare

• Black residents of Nassau County in particular:– Are less likely to access adequate prenatal care.– Have higher cancer mortality rates.– Are 2x more likely to have diabetes and high blood pressure

A Snapshot of Health Disparities: Heart Disease

Age-Adjusted Death Rates from Heart Disease per 100,000 in Population

The Medically Underserved Areas in Nassau County

Elmont Health CenterElmont Health CenterElmont Health CenterElmont Health CenterElmont Health CenterElmont Health CenterElmont Health CenterElmont Health CenterElmont Health Center

Inwood-Lawrence Health CenterInwood-Lawrence Health CenterInwood-Lawrence Health CenterInwood-Lawrence Health CenterInwood-Lawrence Health CenterInwood-Lawrence Health CenterInwood-Lawrence Health CenterInwood-Lawrence Health CenterInwood-Lawrence Health Center

New Cassel/Westbury Health CenterNew Cassel/Westbury Health CenterNew Cassel/Westbury Health CenterNew Cassel/Westbury Health CenterNew Cassel/Westbury Health CenterNew Cassel/Westbury Health CenterNew Cassel/Westbury Health CenterNew Cassel/Westbury Health CenterNew Cassel/Westbury Health Center

Hempstead Health CenterHempstead Health CenterHempstead Health CenterHempstead Health CenterHempstead Health CenterHempstead Health CenterHempstead Health CenterHempstead Health CenterHempstead Health Center

Roosevelt Jr/Sr High SchoolRoosevelt Jr/Sr High SchoolRoosevelt Jr/Sr High SchoolRoosevelt Jr/Sr High SchoolRoosevelt Jr/Sr High SchoolRoosevelt Jr/Sr High SchoolRoosevelt Jr/Sr High SchoolRoosevelt Jr/Sr High SchoolRoosevelt Jr/Sr High School

Freeport/Roosevelt Health CenterFreeport/Roosevelt Health CenterFreeport/Roosevelt Health CenterFreeport/Roosevelt Health CenterFreeport/Roosevelt Health CenterFreeport/Roosevelt Health CenterFreeport/Roosevelt Health CenterFreeport/Roosevelt Health CenterFreeport/Roosevelt Health Center

Satellite Center at Long BeachSatellite Center at Long BeachSatellite Center at Long BeachSatellite Center at Long BeachSatellite Center at Long BeachSatellite Center at Long BeachSatellite Center at Long BeachSatellite Center at Long BeachSatellite Center at Long Beach

NUMCNUMCNUMCNUMCNUMCNUMCNUMCNUMCNUMC

Medically Underserved Areas (MUAs)

NUMC

Areas of high Preventable Quality Indicator (PQI)

Community Health Centers

Key

Sources: MUAs: US Department of Health and Human Services – Heath Resources and Services Administration (HRSA) http://muafind.hrsa.gov/index.aspx; Preventable Quality Indicators (PQI): SPARCS ver02.06.03.22.07adj/jm; NUMC Community Heath Centers (http://www.numc.edu/index.php?id=99).Map prepared by North Shore-LIJ Health System Office of Strategic Planning and Program Development/jpl

Medically Underserved Areas in Nassau CountyNUMC’s Community Health Centers

There are 33 federally

designated medically

underserved areas in Nassau County, including the communities of Freeport and

Roosevelt.

A Demographic Profile of NHCC’sPrimary Service Area NHCC

Service Area

Total Population 226,182 1,334,544 18,976,457

Race% Hispanic 23.90% 10.00% 15.10%% White Alone Not Hispanic 35.00% 73.90% 62.00%% Black Alone Not Hispanic 35.60% 9.70% 14.70%% Asian Alone Not Hispanic 3.00% 4.70% 5.50%% Other or Multiple Races Not Hispanic 2.50% 1.70% 2.70%

Gender% Male 48.10% 48.10% 48.10%

Age% < 5 yrs 7.10% 6.40% 6.50%% < 18 yrs 25.90% 24.60% 24.60%% 18-64 yrs 62.80% 60.40% 62.50%% 65+ 11.30% 15.00% 12.90%

Primary Language, Pop Age 5+% Speak English At Home 66.70% 76.80% 72.00%% Speak Spanish At Home 22.50% 9.20% 13.60%% Speak Asian/PI Languages At Home 1.80% 2.90% 3.80%% Speak Other Indo-European Languages At 8.50% 10.00% 9.30%% Speak Other Languages At Home 0.50% 1.10% 1.20%

Nation of Origin% Foreign Born 28.30% 17.90% 20.40%

Education% 25+ High School Grad 74.80% 82.10% 79.10%% 25 + Some College 46.40% 59.90% 51.30%% 25+ BA 22.10% 35.40% 27.40%% 25 + Grad Degree 9.30% 15.60% 11.80%

Labor Force Participation% 16+ in labor force 62.70% 63.00% 61.10%% Individuals Age 5+: Disabled 20.20% 15.80% 20.60%

Income and Poverty% Below 50% FPL 5.20% 2.50% 7.40%% Below 100% FPL 10.70% 5.20% 14.60%% Below 200% FPL 26.70% 14.00% 30.50%

Nassau County

New York State

The Current Operations at the Freeport-Roosevelt Health Center

The Current Freeport / Roosevelt Health Center

Though Freeport residents constitute a larger percentage of patient encounters at the current health center, patient encounters as a

percentage of overall population are greater for Roosevelt (24.3%) than for Freeport (15.4%).

Village / City Zip Code# of

Encounters% of

EncountersFreeport 11520 6,781 43.2%Roosevelt 11575 3,890 24.8%Hempstead 11550 1,446 9.2%Uniondale 11553 1,403 8.9%Baldwin 11510 556 3.5%Rest 1,606 10.2%PATIENT ENCOUNTERS 15,682

FREEPORT CHCFREEPORT / ROOSEVELT CHC

Current Patient and Community Demographics

RACE # %WHITE HISPANIC 8,796 75%BLACK 1,854 16%OTHER 557 5%WHITE / NON-HISPANIC 427 4%BLACK HISPANIC 56 0%ORIENTAL / ASIAN 16 0%AMER INDIAN / ALASKAN 5 0%Grand Total 11,711 100%

AGE RANGE # %LESS THAN 1 YEAR OLD 1,359 12%1 TO 9 YEARS OLD 1,603 14%10 TO 19 YEARS OLD 1,027 9%20 TO 29 YEARS OLD 3,815 33%30 TO 39 YEARS OLD 2,027 17%40 TO 49 YEARS OLD 946 8%50 TO 59 YEARS OLD 499 4%60 TO 69 YEARS OLD 291 2%70 TO 79 YEARS OLD 118 1%80 TO 89 YEARS OLD 20 0%90 TO 99 YEARS OLD 6 0%Grand Total 11,711 100%

Number Percentage

Total Population 15,975Median Age 31.7

Ethnicity

White 1,313 8.2Black 12,585 78.8Latino (any race) 2,585 16.2

Number Percentage

Total Population 44,026Median Age 34.6

Ethnicity

White 18,774 42.6Black 14,496 32.9Latino (any race) 14,660 33.3

ROOSEVELT

FREEPORT

41.3% of all hospital discharges in Roosevelt occur at NUMC.

41.3% of all hospital discharges in Roosevelt occur at NUMC.

20.4% of all hospital discharges in Freeport occur at NUMC.

20.4% of all hospital discharges in Freeport occur at NUMC.

Type of Patient Encounters at Freeport / Roosevelt CHC

Patient encounters have steadily increased since 2004, and are projected to be up 9.8% between 2006 and 2007.

Discipline 2004 2005 2006 2007* Grand Total % of ActivityGrowth '04 >

'07 Pediatrics 2,988 4,001 4,449 4,067 15,505 27.2% 36% Medicine 2,183 2,936 2,825 3,293 11,237 19.7% 51% Family Planning 2,059 2,522 2,297 2,922 9,800 17.2% 42% OB 2,091 2,225 2,572 2,705 9,593 16.8% 29% STD 787 662 575 720 2,744 4.8% -9% Tuberculosis 660 822 655 566 2,703 4.7% -14% Gynecology 162 215 330 864 1,571 2.8% 434% YAS - OB 302 336 280 291 1,209 2.1% -4% HIV 248 295 277 372 1,192 2.1% 50% YAS – Fam Plan 202 239 241 166 848 1.5% -18% Mammography 212 46 1 259 0.5% -100% YAS – OB 52 78 87 39 256 0.4% -25% YAS – Medicine 8 5 10 23 0.0% -100% No Charge Lab 17 17 0.0% 0% Nutrition 1 1 0.0% -100%Grand Total 11,955 14,382 14,599 16,024 56,960 100% 34%

* - Projected volumes for 2007

Patient Satisfaction at the Freeport –Roosevelt Community Health Center

The mean patient satisfaction at the

Freeport – Roosevelt community health center

is– strong but a little short of our benchmark. This is an area for even

more focus and improvement in the

future.

The mean patient satisfaction at the

Freeport – Roosevelt community health center

is– strong but a little short of our benchmark. This is an area for even

more focus and improvement in the

future.

Overall Quarterly Patient Satisfaction Data by Community Health CenterJanuary 2007 – October 19, 2007

0

10

20

30

40

50

60

70

80

90

100

HempsteadElmont F/R Inwood

New Cassel

Q1 '07 Q2 '07 Q3 '07

The AMA Regional Performance Benchmark

The AMA Regional Performance Benchmark

The “New” Freeport-Roosevelt Community Health Center

The Centerpiece of NHCC’s Efforts to Address Disparities: 380 Nassau Rd

Some Details• Why:

– Inspired by Rev. Reggie Tuggle’s vision to provide high quality health care in a dignified setting to the residents of the communities of Freeport and Roosevelt.

• Status:– NHCC has executed a lease for 380 Nassau Road.

• Cost: – Expected to involve approximately $11 million to build

out the building.• Funding:

– County tobacco proceeds, State/ other grant funds, Sec. 108 loan, NHCC equity.

– Other sources of funding may include New Market Tax Credits.

Some More Details• Construction Information:

– 12-18 months from the date of CON approval by the State.

– Approximately 35 construction jobs will be created by this project.

– M/WBE program will be in place for this project.• Taxes and Economic Development:

– NHCC intends to pay taxes or a PILOT as appropriate. In fact, the Corporation pledged to do so in its lease agreement.

– NHCC also wants to participate in and support any economic revitalization efforts that occur in downtown Roosevelt.

The Intended M/WBE Program for the Build-Out of 380 Nassau Road

• Local Law 14 highlighted in all construction documents.• Monthly meetings held with Nassau County’s Office of

Minority Affairs.• Right-size construction contracts – create opportunities

for SBEs.• Community business outreach during design phase.• M/WBE outreach during design phase – Job Fairs.• Conduct pre-bid conferences:

– Emphasize M/WBE goals & program– Encourage W/MBE & local workforce participation– Introduction of bidders to M/WBE candidates

• Document & manage “best faith efforts”.

Plans for Use of the Space at 380 Nassau Road

NHCC plans to more than double the

square footage being used for

clinical and other services

for the community.

NHCC plans to more than double the

square footage being used for

clinical and other services

for the community.

PROGRAM CURRENT PROPOSED

EXISTING PROGRAMSCOMMUNITY HEALTH CENTER 8,670 6,900WOMEN AND INFANT CHILDREN (WIC) 855 2,000

9,525 8,900NEW PROGRAMS

CHC DENTAL SUITE 0 550COMMUNITY FITNESS CENTER 0 1,600IMAGING CENTER 0 4,300INSTITUTE FOR MINORITY HEALTH 0 1,700HEALTH FIRST OFFICES 100 200MEMORIAL ECON DEV CORP (MEDC) 0 1,100

100 9,450OTHER FACILITIES

STAFF LOCKER ROOM / LOUNGE 0 450CENTRAL CONFERENCE ROOM 0 400

0 850

GROSS SQUARE FOOT TOTAL 9,625 19,200

SQUARE FOOTAGE

The Community Health Center

NHCC’s Plans Call for Expanded Hours and Increased Clinical Services

The “new” Center will offer dentistry, adolescent medicine, physical medicine & rehabilitation in a therapy/rehabilitation gym, podiatry, and optometry.

The Center will also offer a “Cooking for Health Classroom” as well as health-related topic workshops and lectures for our patients and community members in the Center’s new conference rooms.

The “new” Center will offer dentistry, adolescent medicine, physical medicine & rehabilitation in a therapy/rehabilitation gym, podiatry, and optometry.

The Center will also offer a “Cooking for Health Classroom” as well as health-related topic workshops and lectures for our patients and community members in the Center’s new conference rooms.

DISCIPLINE CURRENT PROPOSED % Increase

PRIMARY CAREPEDIATRICS 10.0 14.0 40%MEDICINE 10.0 15.0 50%FAMILY PLANNING 7.0 8.0 14%OB 6.0 9.0 50%YAS 1.0 2.0 100%MED/FP 4.0 12.0 200%

SUBTOTAL 38.0 60.0 58%

SPECIALIZED CAREPM&R 0.0 0.5DENTISTRY 0.0 5.0PODIATRY 0.0 0.5

SUBTOTAL 0.0 6.0

TOTAL 38.0 66.0 74%

# OF WEEKLY SESSIONS

The Future Direction of the Health Center

• In next 12-18 months:– Expanded services– Educational programs– Reduced wait and cycling times– Improved patient satisfaction and

feeling that health center is a “medical home”

– Adoption and execution of ambulatory care quality improvement goals

– On-site physician leader, physician practice development, and full time on-site physicians, which will foster better continuity of care and effective doctor-patient partnerships

– Connections with not-for-profit organizations and community physicians

• Beyond 18 months:– FQHC status– 340 B pharmaceutical program

FQHC status provides certain patients access to low-cost prescription drugs

The Community Imaging Center

Imaging Center Will Be the First of Its Kind in Freeport / Roosevelt

There is no freestanding imaging center anywhere within almost three square miles of 380 Nassau Road.

There is no freestanding imaging center anywhere within almost three square miles of 380 Nassau Road.

Google Earth Image

of Area Surrounding 380 Nassau

Road

Why Does This Matter?• NHCC will utilize the Community Imaging Center to

screen residents for a variety of coronary conditions, offering further outpatient or inpatient services as necessary to address any conditions that are identified.

• Such conditions are prevalent in minority communities and contribute to disparities in health outcomes.

• NHCC also intends for the Community Imaging Center to serve as a resource for voluntary physicians in the surrounding area, since these physicians often have a difficult time getting timely access to high-end imaging equipment.

Equipment Proposed for the Community Imaging Center

• CT Scanner: Either a dual source 64 slice CT scanner, 128 slice CT Scanner, or a 256 slice CT scanner.

• MRI: 1.5t short bore.• Ultrasound• X-ray

• CT Scanner: Either a dual source 64 slice CT scanner, 128 slice CT Scanner, or a 256 slice CT scanner.

• MRI: 1.5t short bore.• Ultrasound• X-ray

Equipment for the Imaging Center will be purchased using County tobacco proceeds, HEAL NY awards, and grant funds.

The Institute for Healthcare Disparities

What is the Mission of the Institute for Healthcare Disparities?

The Purposes of the Institute• To offer programs dedicated to the prevention, detection,

screening, and management (treatment and aftercare) of diseases that have disproportionate impact on minority communities.

• To implement outreach and educational (viz: lectures, workshops, forums) interventions.

• To promote improved access and culturally compatible “patient-provider matches”.

• To conduct research on health care disparities.• To seek grants and/or funding opportunities.• To develop financial approaches and resources within the

evolving healthcare reimbursement system, and through other sources, to support these purposes.

• To serve as a local repository and clearinghouse for sharing of experiences, strategies, and best practices

Models

• Chronic disease care management.• Bridges to health (CMS).• Internet access.• Collaborative website and clearinghouse• Electronic personal health records.• Cultural competence (CLAS standards).• Creative and innovative interventions.

The Institute’s Partners and Alliances

Forging Community Relationships• In anticipation of its official “roll-out”, scheduled for

November 15th, representatives of the Institute have met and are meeting with:

State, County, Town and Village OfficialsNassau EOC

Family and Children’s AssociationHempstead CAP

FEGS LINassau Head Start

Hispanic Counseling CenterNassau Board of Health

St. Brigid’s Parish OutreachCoalition Against Domestic Violence

African American Health Education ProjectCoalition Against Child Abuse

EACLI Immigrant Alliance

Planned Parenthood of LIWork Place Project

Health and Welfare CouncilHofstra Center for Suburban Studies

Downstate Healthy Start ProgramErase Racism

The Structure of the Institute• The Institute is a component

of a 501c3 established by NHCC.

• Funding comes initially from a grant of tobacco proceeds provided by the County.

• The Chair of the Institute is Al Cuyjet, MD, NHCC’s Vice President for Clinical Effectiveness and Minority Health.

• An executive director will be announced soon. Other staff consist of a deputy, outreach workers, grant writers, and clerical support.

NHCC Board of Directors

Meadowbrook Medical Education and

Research Foundation

Institute for Healthcare Disparities

Advisory BoardAl Cuyjet, MD - Chair

Staff

Accomplishments to Date• Co-sponsored “Vital Signs” study with Adelphi

University and NSLIJ to analyze access to care in Nassau and Suffolk Counties.

• Applied for federal grants and earmarks (the earmark has been introduced by Rep. McCarthy).

• Established vital relationship with the National Association of Public Hospitals, a representative from which will serve on the Advisory Board of the Institute.

• Begun forming strong community alliances, populating Advisory Board, and appinting staff.

• Developed initial disparities interventions which will be funded by proceeds from 2007 NHCC Gala and will be officially put forward on November 15th.

Conclusion