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The Source for
Housing Solutions
January 26, 2017
Health Center and
Supportive Housing
Expansion
© All rights reserved. No utilization or reproduction of this material is allowed without the written permission of CSH.
Our Mission
Improve lives of vulnerable
people
Maximize public resources
Build strong, healthy
communities
Advancing housing solutions that:
GOALS:• Foster and expand
Health Center
collaboration with
other health system
stakeholders, and
supportive housing
• Improve healthcare
outcomes for extremely
low-income
individuals who
frequently use crisis
systems, have housing
instability, and lack a
connection to primary
and preventive care
services.
Webinar Series
Direct Technical Assistance
Online & In-Person Trainings
Peer to Peer networks
Resources
PARTNERS:Deep collaboration
with
Also partnering
with:
NACHC
CHPS
HRSA BPHC
CSH HRSA Frequent User T/TA
Visit us on the Web: www.csh.org/hrsaTA
Today’s Panelists
Jack Cheng, VP Health Care Services,
HealthRIGHT360, San Francisco CA
Michael Crawford, Chief of Staff, Unity
Healthcare, Washington DC
Jonathan Chapman, Director Advisory
Services, Capital Link
Jill Steen, Sr. Loan Officer, CSH
Jane Bilger, Senior Program Manager, CSH
Today’s Topic and Objectives
1.
Understand health and housing partnerships
2.
Effective planning for health and housing facility expansions
3.
Hear from health providers in the field partnering on locations with supportive housing
Housing = Health Care
• Social determinants of health are personal, social,
economic and environmental factors that affect a
wide range of health, functioning, and quality-of-
life outcomes and risks.*
• Studies demonstrate that stabilized housing with
services for vulnerable populations - those cycling
through our communities’ crisis care systems –
can positively impact health and quality of life
outcomes, and achieve cost savings (avoidance)
across the systems.**
*Healthy People 2020, Dept of Health and Human Services, 2010
**”Housing is the Best Medicine, CSH 2010. 2010
The Strongest Health Care Intervention
for Frequent Users is Housing
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Potential Reasons for Partnering
Identify potential clients through data sharing
Access to and funding for services
Understand target populations’ health and service needs
Access to potential engagement sites
Improve health outcomes through coordination
Advance resident stability and recovery
Developing partnerships
Stage I: Make the Case
Stage II: Make it Happen
Stage III: Make it Work
Stage IV: Make it Last
Types of Partnerships
Referrals
• Client referrals to preferred services
• Client initiated
• Partners retain autonomy and operations are independent; resources generally not shared
• Low collaboration
Care Coordination
•Client Centered joint care plans
•May include centralized intake
•Client initiated with strong transition supports
•Organizations operate independently but may share resources and funding
•Moderate to high collaboration, with cross-training and frequent communication
Co-Location
•Health center operates satellite or full center on-site at supportive housing or shelter
•Wrap-around care housed in a site that tenants access for various services
•Partners operate jointly, but may retain autonomy
•Can be incorporated into existing site, mobile services or new joint site
•High collaboration
Full Service Integration
•Single point of entry, integrated assessment
•Joint case planning/management
•Wrap-around care that may be brought to where it is most accessible to the client
•Partners may have independent or joint operations
•Very high collaboration, with integrated resources, service delivery and sometimes funding
New Market Tax Credit (NMTC)
Overview
$50.5 billion federal tax credit program administered by the
Department of Treasury’s CDFI Fund established 2000 (and
started in 2002).
Similar to the Low Income Housing Tax Credit, but targeted to
commercial, industrial, and community facility projects,
including community health centers. Can be used for mixed-use
rental housing projects where as least 20% of the income of the
building is from commercial.
Designed to stimulate private investment in underserved low-
income communities (targeted to eligible census tracts).
Awarded annually to Community Development Entities (CDEs),
like CSH, through a competitive application process who, in
turn, invests in projects that meet its investment criteria.
The sale of the tax credits to investors provides equity for the
construction and rehabilitation costs of projects to fill a 20% -
25% financing gap.
CSH Linking Healthcare and Housing
With NMTCs
To date, CSH has been awarded $130 million in NMTC allocation,
with $65 million award in 2016.
CSH invests its NMTCs in projects that:
Provide healthcare and/or other support services to homeless and high
health need/vulnerable populations, and
Are co-located with or have connections to permanent supportive
housing.
We target our NMTCs in low income communities that have a
high rate of homelessness or are Medically Underserved and will
provide services to help address these issues.
Along with its NMTCs, CSH provides free TA and training to
sponsors to help strengthen connections between housing and
supportive services.
To date, CSH has invested in 7 projects, all of which have a
healthcare component planned, and will invest in another 6
projects in the next year.
HealthRIGHT 360 (“HR360”)
1563 Mission Project-San Francisco, CA(Closed & Under Construction)
Type of Organization:
Federally Qualified Health Center
Project Basics:
Acquisition and renovation of 50,000 SF building in South of Market/Tenderloin Neighborhood for relocation and expansion of services.
Modern medical campus providing comprehensive and integrated medical, dental, mental health, and other enabling services, including benefits enrollment and Housing Resource Center.
Health/Housing Partnership:
Critical need: 70%-80% of patients are homeless or in unstable housing situations.
Extensive housing referral services provided through partnerships with 12 core housing providers (to hopefully continue to expand).
CSH provided TA to help expand and strengthen connections with housing providers.
Partnerships have evolved and HR360 is providing on-site serves to nearby housing developments.
Total Project Cost- $52,000,000
CSH NMTC Financing - $9,000,000
Projected Community Impact: 16 new FTE permanent jobs/79 retained
183 construction jobs
8,100 patients to be served per year, of
which 5,300 will be new
LEED-Gold Certified
Community Demographics: 11.79% Poverty Rate
Family Income: 69.83% of AMI
Unemployment Rate 2.3%
District 6: 58% of City’s Homeless
The Women’s Home (“TWH”)
WholeLife Service Center-Houston, TX(Closed & Under Construction)
Type of Organization:
Behavioral Health and Housing Provider
Project Basics:
30,000 SF shared use medical and social service facility:
6,400 SF leased to Spring Branch Community Health Center to provide medical & behavioral health services.
Partnerships with YMCA, DePelchinChildren’s Center, & Memorial Assistance Ministries to provide after school programs, counseling, and adult education/workforce development programs.
Adjacent to 87-unit supportive housing project with 25 units for homeless individuals & within two blocks of an 84-unit supportive housing project for families, with 40 units dedicated to homeless families.
Health/Housing Partnership:
Same target service area with established referral relationship.
Partnership grew from a comprehensive community needs assessment completed by TWH.
Total Project Cost- $10,700,000
CSH NMTC Financing - $9,000,000
Projected Community Impact: 44 new permanent jobs/23 retained
46 construction jobs paying Davis
Bacon wages
2,600 people to be served per year
LEED-Silver Certified
Community Demographics: 43.2% Poverty Rate
Family Income: 46.48% of AMI
Unemployment Rate 7.0%
Medically Underserved Area
Central City Concern (“CCC”)
Eastside Health Center-Portland, OR(Potential CSH NMTC Investment)
Type of Organization:
Fully Integrated FQHC, Behavioral Health, & Housing Provider
Project Basics:
New 40,000 FQHC providing primary and acute medical care, mental health services, substance use recovery programs.
51 respite care beds to serve those that are homeless and exhibit acute medical conditions.
Co-located with 124 substance use disorder units, of which 90 units will be fully subsidized, and 34 will be affordable at or below 30% of AMI, with lengths of stay up to two years.
Health/Housing Partnership:
CCC owns and manages 1,700 units of housing and several medical clinics.
Extensive partnership and programs with area hospitals and managed care organizations to help finance capital cost and operations.
Part of CORE (Center for Outcomes Research and Education) study of effect of housing on cost and access to services.
Total Project Cost- $23,000,000
Potential CSH NMTC Financing- $14,000,000
Projected Community Impact: 65 new FTE permanent jobs/22 retained
100 construction jobs
3,000 patients to be served per year, all
of which are new
Community Demographics: 17.0% Poverty Rate
Family Income: 64.56% of AMI
Unemployment Rate 7.4%
Located in Enterprise Zone &
Neighborhood Stabilization Target Area
2016 Capital Link www.caplink.org
Capital Link - Overview
• Launched in 1995, nonprofit, HRSA national cooperative partner
• Offices in MA, CA, CO, ME, MO, SC, and WV
• Over $1 billion in financing for over 218 capital projects (about 10% of current health center facility space)
- Direct assistance to health centers and complementary nonprofit organizations in planning for and financing operational growth and capital needs
- Industry vision and leadership in the development of strategies for organizational, facilities, operational, and financial improvements
- Metrics and analytical services for measuring health center impact, evaluating financial and operating trends and promoting performance improvement
2016 Capital Link www.caplink.org
Outline
• Key performance metrics to examine
• Key market metrics to examine
• Access point opportunities and considerations
• Aligning resources and funding
2016 Capital Link www.caplink.org
Key Performance Metrics
Metric Why This Is Important
1 Operating MarginMeasuring stick of your business model; margins typically small but need to be positive
2 Bottom Line MarginIs performance dependent upon large capital grants and/or other sources of non-operating revenue?
3 Personnel-Related Expense Consumes 70-75% of budget; key driver of financial performance
4 Days Net Patient A/R Financial management starts with collecting your money efficiently
5 Days Cash on Hand Is there enough liquidity to keep operations running smoothly?
6 Physician Productivity (visits) Productivity is the basis for revenue generation
7 Mid-Level Productivity (visits) Productivity is the basis for revenue generation
8 Dental Provider Productivity (visits) Productivity is the basis for revenue generation
*Capital Link Performance Benchmarking Toolkit
2016 Capital Link www.caplink.org
• Patient Origin
• Total Market (general population, low income, etc)
• Market Percentages
• Other Services/Providers
• Patient Characteristics
• Projections
Key Market Metrics
2016 Capital Link www.caplink.org
Access Point Opportunities and Considerations
• HRSA Applications
• 19 Key Requirements
• Scope of Work
• Partnerships
• Competing Interests
• Timelines
2016 Capital Link www.caplink.org
Aligning Resources and Funding
• Foundations: Grants, Program Related Investments (PRI)
• Community Development Financial Institutions (CDFI)
• Tax Credits: New Markets, Housing, Low Income, etc.
• Commercial Loans/Lines of Credit
• Tax-Exempt Bonds
• Partnerships
• Grants
• Government Programs
2016 Capital Link www.caplink.org
Resources
• FQHC: • https://bphc.hrsa.gov/about/• http://www.nchph.org
• Financial Audits/Form 990
• Uniform Data System (UDS) Reports• www.udsmapper.org• https://bphc.hrsa.gov/uds/datacenter.aspx?q=d&year=2015
• www.CapLink.org• Capital Planning, Strategic Planning Toolkit, Benchmarks, etc
2016 Capital Link www.caplink.org
Main Office
Massachusetts
Allison Coleman
Chief Executive Officer
Susan Petrie
Chief Operating Officer
Tel: 617-988-2248
Steve Rubman
Director of Data & Information Systems
Tel: 617-988-2299
Regional Offices
California
Tony Skapinsky
Project Consultant
Tel: 805-544-2355
Colorado
Jonathan Chapman
Director of CHC Advisory Services
970-833-8513
Missouri
Mark Lurtz
Director of Partnership Development
Tel: 636-244-3082
Maine
Dan Woodman
Project Consultant
Tel: 978-201-8973
South Carolina
Terry Glasscock
Senior Project Consultant
Tel: 781-789-684
West Virginia
Cindy Barr
Operations & Facilities Planner
Tel: 304-876-6996
Contact Us
Our Mission:
• HealthRIGHT 360 gives hope, builds health, and changes lives for people in need. We do this by providing compassionate, integrated care that includes primary medical, mental health, substance use disorder treatment and re-entryservices.
Our Values:
• HealthRIGHT 360 is a non-profit organization providing a wide array of primary care, behavioral health and substance abuse treatment services
• Prioritizing underserved and special populations, we build communities that heal, promote change, and foster emotional and physical safety
• We treat all individuals with dignity and respect, we celebrate diversity, individuality and each person’s cultural contribution to the community
• We are guided by a belief in the transformative power of community and family
Family of Programs
• Walden House
• Haight Ashbury Free Clinics• Asian American Recovery Services
• North County Serenity House
• Women’s Recovery Association
• Rock Medicine
• Lyon-Martin Health Services
• Tenderloin Health Services
• Prototypes
• 4 Federally Qualified Health Centers
• Substance Use Disorder Treatment
• Primary Care/Psychiatry/Infectious Disease
• Mental Health Services
• Youth Services
• Case Management, Re- Entry and Social Support
• Post-Release Re-Entry Service
• In Custody Substance Use Disorder Treatment
• Medication Assisted Treatment
Who are we and what do we do?
HealthRIGHT 360 providers a full continuum of integrated services, including:
HealthRIGHT 360 has programs in over 10 counties, including:
San Francisco, San Mateo, Santa Clara, San Diego, Los Angeles, Imperial, Orange, Solano, Ventura, San Joaquin, Sacramento, Contra Costa, Amador
Housing Partnerships
• In-house Resource Center which provides job & skills training and social work assistance to housing (shelter, low income, short-term, sober living).
• Formal referrals and MOUs to approximately 75+ housing agencies across SF Bay area (East Bay, Oakland, San Jose)
• Established partnerships with residential housing programs (SF Mayor’s office, Community Housing Partnership, Glide Community Housing) by providing on-site medical services to low-income housing programs in SF.
• Creating bi-directional referrals and the ability to prioritize patients w/ high utilization in short to long term housing.
Our Mission Comes First
Promoting healthier communities through
compassion and comprehensive health and human
services, regardless of the ability to pay.
promoting healthier communities
through compassion and comprehensive
health and human services
Background
• Founded in 1985 as Health Care for the Homeless
Project
• Became a Federally Qualified Health Center in 1996
• Began providing health care in the DC Jail in 2006
• Currently operate over 20 traditional and non-
traditional sites and a mobile medical outreach
vehicle throughout the District
promoting healthier communities
through compassion and comprehensive
health and human services
promoting healthier communities
through compassion and comprehensive
health and human services
Unity Sites
• 10 Community Health
Centers
• 10 Medical Sites in
Homeless Shelters
• 3 School-Based Health
Centers
• 1 Mobile Van
• Health Services in DC Jail
promoting healthier communities
through compassion and comprehensive
health and human services
Who We Serve2015
• Total of 106,469 patients served, 504,006 visits
– 11,422 patients experiencing homelessness
– 6,796 patients who are incarcerated
• 74% are African American
• 18% are Hispanic
• 69% of patients have income
below the 100% federal poverty
level
promoting healthier communities
through compassion and comprehensive
health and human services
Who We Serve2015 Insurance Coverage
• 63% of our patients have
Medicaid
• Unity has Enrollment Specialists
at various sites to help
individuals sign-up for health
insurance through DC Health
LinkMedicare
MedicaidAlliance
Private
Self-Pay
promoting healthier communities
through compassion and comprehensive
health and human services
Health and Human Services• Primary Care
– Family Medicine, Pediatrics,
Internal Medicine
• Obstetrics/Gynecology
• Dental
• Psychiatry and Counseling
• Infectious Disease
• Family Planning
• Case Management
• Other Specialty Medical
Services
promoting healthier communities
through compassion and comprehensive
health and human services
Programs and Initiatives• Convenient Care: Open until 10 pm weekdays and 8am- 2pm
weekends to increase access to care
• Patient Portal & Unity App: Increases patient engagement
and participation in their own health care
• WeCan! Program: Helps overweight and obese children and
adults maintain a healthy weight through nutrition and physical
activity
promoting healthier communities
through compassion and comprehensive
health and human services
Unity & SOME Partnership• Partnership Rationale
• Project Overview
• Future Co-location Initiatives
promoting healthier communities
through compassion and comprehensive
health and human services
Contact Information
• Michael Crawford, MBA, Chief of Staff
Resources & Support
What are some of the resources to access?
• building the facility
• supporting coordination activities
Q/A
DiscussionHave a question?
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Resources & More Info on Upcoming Webinars:
www.csh.org/hrsaTA
www.csh.org/summit17
Community Investment/Supportive Housing Development
Housing & Criminal Justice Reforms
Healthcare & Housing Integration & Partnerships
One Roof Families & Children Thriving in Supportive Housing
Supportive Housing Onboarding Track/Introduction to the Field
Maximizing Services
Pay for Success Financing, Contracts & Contacts
Systems Transformations for the Aging, Chronic Homeless,
ID/DD, and Veterans Populations
Effective Housing Models for Youth
Receive up-to-date perspectives, predictions, trends and innovations
focused on crucial and timely issues:
Join Us in Denver!
May 24-26, 2017
About HRSA NCAs
National Cooperative Agreements(NCAs) are national organizations that receive HRSA funds to help
health centers and look-alikes meet program requirements and
improve performance. They also support Health Center Program
development and conduct national analyses around one of the
following target audiences:
Vulnerable populations, including those who frequently and
inappropriately utilize health system resources
Underserved Communities/Populations, such as the homeless,
public housing residents, and migratory workers
“This project was supported by the Health Resources and Services Administration (HRSA) of the U.S.
Department of Health and Human Services (HHS) under cooperative agreement # U30CS26935, Training
and Technical Assistance National Cooperative Agreement (NCA) for $325,000 with 0% of the total NCA
project financed with non-federal sources, if any. This information or content and conclusions are those
of the author and should not be construed as the official position or policy of, nor should any
endorsements be inferred by HRSA, HHS or the U.S. Government.”
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