2022 Annual Report:
Meeting the Moment
MESSAGE FROM
PRESIDENT & CEO
Francisco J. Silva, Esq.
MESSAGE FROM
2021-2022 BOARD CHAIR,
David B. Vliet, MBA
CPCA BOARD / OFFICERS & MEMBERS
Chair
Britta Guerrero
Chief Executive Officer
Sacramento Native American Health Center
Chair-Elect
Paulo Soares
Chief Executive Officer
Camarena Health
Immediate Past Chair
David B. Vliet, MBA
Chief Executive Officer
LifeLong Medical Care
Secretary
Rakesh Patel, MD
Chief Executive Officer
Neighborhood Healthcare
Treasurer
David Lontok
Chief Executive Officer
Comprehensive Community Health Centers, Inc.
Speaker
Andrea Schwab-Galindo
Chief Executive Officer
Tiburcio Vasquez Health Center, Inc.
Vice Speaker
Christy Ward
Chief Executive Officer
Share Our Selves
Members at Large
Melissa Marshall, MD
Chief Executive Officer
CommuniCare Health Centers, Davis Community Clinic
Lucresha Renteria
Executive Director
Mendocino Coast Clinics, Inc.
Asa Satariano
Chief Executive Officer
South of Market Health Center
COMMITTEE MEMBERS
Doreen Bradshaw
Executive Director
Health Alliance of
Northern California
Warren J. Brodine
President & CEO
Eisner Health
Benjamin Flores, MPH
President & CEO
Ampla Health
Naomi Fuchs
Chief Executive Officer
Santa Rosa Community Health
Alvaro Fuentes
Chief Executive Director
Redwood Community Health Coalition
Jane Garcia
Chief Executive Officer
La Clinica de La Raza, Inc.
Franklin Gonzalez
Chief Administrative Officer
Via Care Community Health Center
Kerry Hydash
President & CEO
Family HealthCare Network
Julia Liou, MPH
Chief Executive Officer
Asian Health Services
Kevin Mattson
President & CEO
San Ysidro Health
Louise McCarthy
President & CEO
Community Clinic Association of Los Angeles County
Anitha Mullangi, MD
Chief Medical Officer
St. John’s Community Health
Danielle Myers, MD
Director of Health Informatics
Golden Valley Health Centers – Robertson Road
Jonathan Porteus
Chief Executive Officer
WellSpace Health
Tim Rine
Executive Director
North Coast Clinics Network
Corinne Sanchez
President & CEO
El Proyecto del Barrio, Inc
Ralph Silber
Executive Director
Alameda Health Consortium
Graciela Soto-Perez
Chief Executive Officer
Altura Centers for Health
Richard Veloz, MPH, JD
Chief Executive Officer
South Central Family Health Center
2022 Changes and Opportunities
Organizational Restructure
Under CPCA’s new leadership, the organization embarked on an organizational assessment that included internal staff interviews, member input and department-level evaluation. This assessment made it clear that we needed to restructure the way our organization was assembled in order to ensure our work was effective, efficient, and met members’ expectations. As such, CPCA embarked on a phased approach to implementing a new and improved organizational structure. The first phase took place in October of 2022 with the creation of an Operations Department, as well as the addition of Legal Affairs to our Health Center Operations (HCO) Department and the newly named Health Access and Quality Department (formerly the Care Transformation Department).
The Operations Department
The Operations Department was created to optimize CPCA’s member and staff experience and ensure we are all working toward the same goal. Even with the most competitive programs and services, and the most capable people, most organizations do not achieve their potential for greatness without strong operations. Under the leadership of Ginger Smith, CPCA’s Chief Operating Officer, the new dedicated Operations Department focuses on governance modernization, people operations, development of a customer management system, strategic planning, implementation of our hybrid technology initiatives, and membership services.
As part of the creation of this department, Christina Hicks moved into a newly created position of Vice President of Operations and Governance, where she leads and oversees organization-wide initiatives, large-scale change management efforts, and strategic plan implementation, and works to develop and manage key organizational performance metrics. Christina also supports membership engagement and governance activities, as well as overseeing the advancement of the customer management system and CPCA’s Training and Education team – which formerly lived within the Development and External Relations Department.
The Development and External Relations Department
The Development and External Relations Department was also revamped to ensure the team has the appropriate bandwidth to implement the amazing events CPCA is known for, support the organization’s ongoing marketing and communications needs, and grow our already robust development portfolio. Kearsten Shepherd, CPCA’s Vice President of Development and External Relations, oversees these extensive areas of work to ensure the organization can effectively support our members and our collective internal work. The Development and External Relations Department works closely with the Operations Department and under the Chief Operating Officer in supporting the organization.
Integration of Health Center Support
Utilizing the lessons learned from the agile transformation that CPCA and its members had to undertake because of the COVID-19 pandemic, CPCA continues to integrate the work of our policy, education, regulatory, and advocacy teams. CPCA has repositioned its Legal, HCO, and Care Transformation departments to further align our advocacy, education, training, and policy work with the present and future challenges that community health centers will confront to continue to provide high-quality, comprehensive, patient-led, community-based care. The goal is to encourage the continuous loop of collaboration among our departments by supporting and incentivizing cross-departmental, cross-functional, multidisciplinary, and self-organized teams working collectively to ensure health centers can operationalize regulator policies and programs; and that such work informs and supports our advocacy for community health centers and their patients.
New Health Quality & Access Department (formerly Care Transformation)
With the rapid growth of value-based programs, CPCA must be positioned to support and advocate for health centers and their patients through this transition. Cindy Keltner, Vice President of Health Access and Quality, leads the new Health Quality and Access Department that will focus on empowering health centers to thrive in the fast-changing health quality, delivery, and payment landscape. This is happening with the support and collaboration of Allie Budenz, Director of Population Health Management, who will focus on the policy implementation of several key Medi-Cal initiatives for health centers, including Alternative Payment Methodology (APM) and California Advancing and Innovating Medi-Cal (CalAIM) initiatives. In addition to these areas of work, CPCA’s robust data initiatives, behavioral health, PCMH, population health, and SDOH work will all live under this team.
The Department for Legal Affairs and Health Care Operations
The HCO Department and Legal team will now be combined to leverage the expertise of both to increase our legal capacity; broaden our educational and technical assistance for members as they operationalize the increasingly complex policy demands of regulators and payors; and use the data and information learned through providing such assistance to inform the policy agenda and advocacy of CPCA. In collaboration with the Government Affairs and Health Quality and Access teams, the Legal and HCO team will also advance regulatory priorities of CPCA and its members. General Counsel Joey Cachuela will lead the combined team in partnership with Nataly Diaz, CPCA’s Director of Health Center Operations, who is responsible for advancing programming and technical assistance efforts related to health center operations. This will include topic areas such as workforce, PPS, emergency management, licensing, compliance, and billing, among others.
CPCA’s Government Affairs Department and Finance Department will continue to operate under their current structures within the organization, led by Vice President of Government Affairs Dennis Cuevas-Romero and CFO Sonja Spowart reflectively.
Member Engagement
Connecting Community Health Centers with the tools and resources
they need to deliver quality care.
Ambassador Program
In 2021, CPCA developed the Ambassador Program to better connect member health centers with consistent, intentional, and comprehensive support through staff connection and technical assistance. This program assigns a CPCA staff member to serve as an ambassador to each health center member throughout the year.
Through the program, ambassadors work to connect with their assigned health centers for a formal check-in every six months with the goal of maintaining or improving member satisfaction and ensuring that all members continue to find value in CPCA membership. In 2022, 96 percent of member health centers received an email requesting to schedule a check-in and 24 percent of those health centers responded to the request, scheduling a call or visit.
Ambassadors will be reaching out to member organizations for a formal check-in throughout 2023. We look forward to learning more about our members’ accomplishments and how CPCA can better assist them in any challenges they are facing.
Member Satisfaction Survey
CPCA’s annual Membership Satisfaction Survey continues to be a valuable tool in evaluating the effectiveness of our work and engagement of our members. As consistent with our 2021 survey, our members continue to appreciate and remain highly engaged with our educational offerings and peer networks; 87 percent of respondents find CPCA membership to be of a high value and their top reasons for having a CPCA membership are educational offerings, access to member engagement forums, and policy and advocacy. Of note, some individual responses called out that CPCA’s “information is beneficial, up-to-date, and informative” and that the support from CPCA is “excellent.” In addition, respondents shared that This year’s survey has also provided us with member insight into how to improve our training offerings, increase member engagement, and better streamline communications.
CPCA's Connected Community Continues to Grow
Connected Community, the members-only online community that provides health center staff a means for connecting with peers across the state, continues to increase in value for members since it launched in 2019.
There are currently 38 active communities, driven by members and supported by CPCA staff. Within these communities, 109 individual discussion threads were posted in 2022. The most active conversations were regarding Credentialing Software, Patient Satisfaction Scores, Communication Platforms, Medi-Cal CHW, Promoting Staff Well-Being, and Patient Advisory Groups.
The most utilized feature of Connected Community is the resource library. In 2022, members uploaded 96 resources and more than 1,800 resources were downloaded. The top resource downloaded in 2022 was the California Department of Public Health’s Request for Application to assess and improve adult immunization levels in Community Health Centers.
More than 1,100 members completed tasks and earned badges during CPCA’s annual engagement contest, “The Road to the Annual Conference” in August. Each badge earned them a chance to win free registration to the 2022 Annual Conference. Vista Community Clinic was awarded this top prize!
More than 9,000 individuals have access to the Connected Community site. While only a fraction are using this free member benefit, more and more are learning about it each year, getting us closer to our goal of having all health center staff members join this amazing, peer-focused community.
Stay Connected
Encourage your colleagues to turn to CPCA’s Connected Community as their first source for information. Make sure you bookmark the community site – https://cpca.connectedcommunity.org/home – and watch for Daily Digest emails. Remember, you must be logged in to your CPCA account in order to access the community. If you have any questions regarding Connected Community, please contact training@cpca.org.
CPCA AS AN
ANTI-RACIST ORGANIZATION
January 2021 started off with many wondering if there would ever be a time when COVID-19 wasn’t impacting our lives.
How should CPCA continue to further its antiracism goals?
In response, CPCA leadership developed a four-prong approach to continue our justice, equity, diversity, and inclusion (JEDI) work and more deeply embed antiracism goals into the fabric of everyday work.
Leadership recognized that for an organization-wide effort toward antiracism to be successful, it needed to be fostered and supported at both the leadership and staff levels. To that end, CPCA developed an internal antiracism work group comprised of staff representation from across departments and inclusive of staff roles from administrative assistant to Vice President. The work group’s purpose was to move the organization further along the antiracism continuum. The work group began meeting in late Spring and continued through the calendar year to work on four specific objectives:
Defining shared anti-racism values to serve as the Association’s north star(see CPCA’s Statement on Being an Antiracist Organization).
Drafting processes and decision- making policies to help identify internal practices that will promote an anti-racist culture.
Defining shared anti-racism values to serve as the Association’s north star(see CPCA’s Statement on Being an Antiracist Organization).
Drafting processes and decision- making policies to help identify internal practices that will promote an anti-racist culture.
In addition to the work outlined above, staff were encouraged to bring additional antiracism ideas and requests to leadership. As a result, CPCA held several informal and impromptu Staff Townhalls that focused on issues such as racism and microaggression in the workplace and held space to reflect in real time on current events happening in the country, such as the Kyle Rittenhouse trial. While not new in 2021, and not specific to internal CPCA activities, it is also important to share that CPCA continued to facilitate antiracism conversations in member spaces, such as the Supporting Black Communities Work Group and the Health Equity Task Force.
CPCA is proud of the antiracism work prioritized in 2021 and is equally dedicated to continuing this important evolution in 2022 and beyond. Please contact Buddy Orange at borange@cpca.org if you have questions or would like to learn more about CPCA’s JEDI work.
Leadership Equity Program
Cohort 1
The Leadership Equity Program (LEP) was created to prepare the next generation of leaders with the capacity and skills to achieve and sustain health equity and community well-being in communities where community health centers (CHCs) are located, while also addressing racism, discrimination and other forms of oppression that sustain these inequities in Black, Indigenous and Populations of Color (BIPOC), as well as poor communities across California.
In Spring 2022, the LEP program’s inaugural cohort boasted a culturally diverse collective of professionals representing various CHCs from across the state. The 20 C-suite participants served in a variety of positions including managers, directors, and program leads.
Here are testimonials from Cohort 1 members about their personal and professional journeys:
“I learned so much about how to connect the dots between patient experience and health outcomes...institutional racism, harmful policies that have limited BIPOC communities from getting to their full potential. The critical importance of walking alongside patients and engaging them in the decisions that impact them in our health centers. Helping them help us to develop interventions that could help us reach audacious goals to close those gaps and to improve health equity for all. It also provided us with practical strategies for building Justice, Equity, Diversity, and Inclusion teams that worked across departments and beyond our health center walls. I learned more about how health centers operate, how we can have a JEDI lens through operations, human resources, finances, the executive teams, HR, and even IT. There’s just so much more that the program offered that allowed me to see the tremendous opportunity in this California landscape that supports a throughline with equity patient outcomes and health center fiscal health. The most important thing that I found is my connection to my personal “why.” My commitment to this movement, to the community health center movement, is deepened because of this program. Now when I think about equity, the fuel that keeps me going in this line of work is thinking about those children...and those families who deserve to feel safe in their care systems and in their communities. And so now I invite you to nominate someone for the California Primary Care Association Leadership Equity Program. Thank You.”
“Coming into this program, to be honest, I was skeptical. I am a person of color. I was worried that this program was going to be more performative than action based. I decided to go for it, and I am very glad I did.”
The LEP Program covers four primary core curriculum areas:
Anti-racism &
Racial Equity
The curriculum included race equity theory and history, current trends and their impact on health care models and delivery, implications of implicit biases and structural racism, and implementation of anti-racist policies and practices that address the impact of racism on health outcomes and mitigate health disparities for BIPOC and poor communities.
Leadership
Development
The curriculum included core tenets of inclusive and adaptive leadership: examining personal biases, identifying key traits of an effective leader, and understanding the importance of engaging authentically and with purpose in order to drive change and create an organizational culture of inclusion and belonging.
Health Center Operations &
Facilities Mgmt.
Participants developed leadership skills in human resources, operations, health information technology, and finance and payment reform to advance innovation and person-centered, value-based, and population-based approaches to care delivery centered on the principles of justice, equity, diversity, and inclusion.
Community
Well-being
Participants developed a capstone project that addressed their unique organizational and community needs and leadership goals. They applied their learning and understanding of data, policies, and community voice for leadership decision-making and built a balanced strategy to address equity and advance well-being within their surrounding communities.
CPCA is working with two mission-driven and talented consulting teams,
The Leadership Equity Program is also supported by a committed Advisory Committee guiding the program team throughout the development and implementation of LEP, and is composed of the following individuals:
Alvaro Fuentes
Executive Director, Community Clinic Consortium
Andrea Schwab-Galindo, MPH
Chief Executive Officer, Tiburcio Vasquez Health Center
Anitha Mullangi, MD, MHCM
Chief Medical Officer, St John’s Well Child and Family Center
Britta Guerrero
Chief Executive Officer, Sacramento Native American Health Center, Inc
David B. Vliet, MBA
Chief Executive Officer, LifeLong Medical Care
Kimberly S.G. Chang, MD MPH
Family Physician, Director of Human Trafficking and Healthcare Policy, Asian Health Services
Melissa Marshall, MD
Chief Executive Officer, CommuniCare Health Centers
Naomi Fuchs
Chief Executive Officer, Santa Rosa Community Health
Sayeed Khan, MD
Chief Medical Officer, Molina Healthcare of California
Together, The Program is Aimed to:
achieve our vision
to collectively strengthen
Community Health Centers' Capacity to Achieve
just, healthy, & equitable
Communities Across California
THE APM ENTERS A NEW PHASE
After more than a decade of negotiations and implementation happening in fits and starts, the APM entered a new phase of operationalization.
In 2022, the effort to develop an alternative payment methodology (APM) for federally qualified health centers (FQHCs) continued in earnest with the Department of Health Care Services (DHCS).
A two-part application process initiated in Fall 2022, and the first round of APM health centers will be announced in March 2023 with a go-live date scheduled for January 1, 2024. This is the furthest we have ever made it in the APM development and CPCA is optimistic about the APM’s potential.
Part of the impetus for the APM is California’s commitment to a redesigned Medi-Cal program that offers the more than 14 million beneficiaries more equitable, coordinated, and person-centered care. The California Advancing and Innovating Medi-Cal (CalAIM) initiative moves Medi-Cal toward a population health approach that prioritizes prevention and whole person care. California’s community health centers (CHCs) share in CalAIM’s vision, but they need more resources and tools to accomplish it. Health centers often lament the inflexibility of the existing payment system to incentivize the types of non-traditional care management that patients need and expect. If California wishes to deliver on the promises of CalAIM – greater access to comprehensive, whole person care, enhanced quality outcomes, and reduced disparities – then DHCS needs to champion primary care and ensure reimbursement covers the full breadth and depth of non-traditional services needed to comprehensively care for patients.
This is where the APM comes in. The APM is a voluntary payment program for FQHCs that is intended to drive innovation by providing flexibility in how care is delivered while ensuring that the health center will receive the financial resources, they otherwise would have received under the current Prospective Payment System (PPS). Participating health centers will receive a PPS equivalent per member per month (PMPM) payment paid prospectively based on their historic utilization. This will allow FQHCs to shift up to 30 percent of their patient encounters away from traditionally billable providers to alternative care team members and interactions (like group visits or care management), while still receiving 100 percent of their capitated rate. If health centers go over their historic utilization, they will be made whole to PPS, no matter what. For many FQHCs the flexibility afforded in the new model will help to stabilize cash flow and position FQHCs for more innovative care delivery models.
DHCS will require that health centers maintain access and quality expectations and clinics will be required to report on specific measures through their managed care plans. Annual reconciliation will also be determined by counting PPS-eligible encounters submitted to Medi-Cal Managed Care (MCMC) Plans. To ensure health center reconciliation is accurate and health centers are protected, DHCS and their actuaries are evaluating health center MCMC Plan encounters and State wrap payment alignment through a data matching exercise. The results of this matching will be weighed as one criterion for acceptance in the APM.
NEXT STEPS
CPCA continues to negotiate the APM structure with DHCS to finalize a design that is practical and sustainable for FQHCs. Our most important priority is ensuring that health centers in the APM have a fair opportunity to undergo a change in scope process that reflects the care transformation activities necessary for population health management. To accomplish what DHCS is asking primary care providers to do in the APM and the Population Health Management Strategy1, clinics will need to have a different and robust care team and provide access to services in a new way than they would in a traditional volume-based model. This change from volume to value requires sustained investment in primary care that will achieve cost savings in other parts of the delivery system (like hospitals and specialty care) in years to come. The mechanism for health centers to true-up reimbursement to cost is through a change in scope. Health centers should have confidence that alternative services and staff will be allowed in the cost report and that they can reasonably access a triggering event to update their rate.
CPCA and the regional consortia are actively working with health centers on APM readiness assessments and preparedness activities. Regional consortia play a critical role in local APM readiness, especially in connecting early and often with payers to discuss payment flow (especially in delegated environments) and operationalization. For FQHCs interested in the APM, visit www.cpca.org/apm for tools and supports, including:
- Value-based Care course on the CPCA Learning Management System: This self-paced online training is available to all health centers free of charge until April 2023
- Financial readiness workbook: Supports health centers to articulate their rates, member months, and calculate the APM PMPM rate.
- Recorded trainings on APM overview, care redesign, finance and operations, and cultural leadership: These trainings are from Cohort 0 – a group of 16 health centers who piloted training and technical assistance needs for APM. These clinics received up to 16 hours of free, individualized technical assistance with subject matter experts.
Meeting the Moment
Moving Toward a Healthy Horizon
As the pandemic has highlighted, community health centers (CHCs) are uniquely positioned to address health disparities because they are rooted in the communities they serve and are a trusted source of care for anyone who walks through their doors. This year, CPCA honored and championed the cause of “healthcare for all”, something that is even more important in the wake of COVID-19.
We continued to focus our efforts on responding to and preparing for emergencies as well as developing a skilled and diverse workforce. We also continued our work in the domains of behavioral health and social determinants of health, and new partnerships will allow us to furthur our goal of moving toward a healthy horizon for all Californians.
Nearly simultaneous to the launch of the California Vaccine Program, the Health Resources and Services Administration (HRSA) began inviting health centers to participate in the federal Health Center Vaccine Program. CPCA supported HRSA and the health centers by conducting weekly outreach to health centers that experienced issues with program enrollment. One-on-one assistance was provided by CPCA to work through administrative barriers to accessing the CDC’s Vaccine Tracking System (VTrcks), and the Vtrcks Provider Order Portal (VPOP).
By early August 2021, the State of California had issued two Public Health Officer Orders that placed a vaccine requirement on all health care personnel and, if exempted, laid out requirements for health care work protections to be followed. CPCA immediately convened a member virtual meeting, where more than 350 attendees joined. CPCA continued support on the Orders through their compliance dates, holding two meetings with California Health and Human Services Secretary, Mark Ghaly, M.D. and his team. The California orders soon dovetailed into federal mandates, and support of both continued through the end of the year.
Public Health Emergencies
CHCs Remain Key Partners in Emergency Preparedness, Response and Recovery
California community health centers (CHCs) continued to be impacted this year by climate-related, public health and natural disaster emergencies, in addition to the ongoing COVID-19 pandemic and a surge in respiratory illnesses in late 2022.
The California Primary Care Association (CPCA) is committed to supporting CHCs’ emergency management programs by ensuring they have the necessary resources, regulatory flexibility, and representation on state agency and stakeholder groups to continue providing care to their patients and communities. Included below are the activities CPCA engaged in 2022 to position CHCs as key partners in statewide emergency preparedness, response, and recovery strategies.
Public Health Emergencies
CPCA Member Engagement & Support
The end of 2022 saw an increase in the spread of Respiratory Syncytial Virus (RSV), Influenza (Flu), and COVID-19, causing the Center for Disease Control and Prevention (CDC) to issue a Health Advisory warning that the spread of multiple infections could place stress on health care systems through winter. As part of a proactive response strategy, CPCA reached out to CHCs and consortia partners to better understand the challenges they were experiencing on the ground and to provide updates and resources to improve their readiness to respond to a surge of patients at their sites.CPCA engaged state, federal, and disaster relief partners to relay what was learned and ensure CHCs had the resources to support their communities. CPCA worked alongside the California Department of Public Health (CDPH) to present during CPCA’s Monthly Clinical Update Meeting on December 13, provide updates on the State’s response to the surge in respiratory illnesses, and share available resources to support CHC operations and patients, as well as listen to members’ experiences and needs and answer questions.
State Engagement to Influence Resource Allocation & PHE Extension
Informed by member feedback, CPCA met with CDPH leadership to position CHCs as key partners in the state’s response strategy and followed up with a formal letter outlining recommended strategies to support health centers. This included resource prioritization and extending the Public Health Emergency (PHE) that provides waiver flexibilities essential to increase CHC medical surge response capacity. Anticipating the potential of additional surges in RSV, Flu, and COVID-19 after 2022 holiday gatherings and travel, CPCA continued to engage with members to assess challenges and needs and advocate on behalf of CHCs to CDPH as needed.
Climate-Related Emergencies
CPCA Member Engagement & Support
Multiple Emergency Declarations were issued by Governor Newsom during this year’s wildfire season. California’s ongoing climate crisis led to a historic heat wave with record-breaking temperatures, major wildfires, poor air quality, and threats of widespread power outages throughout the state. CPCA, in partnership with consortia partners, reached out to CHCs in fire-impacted regions to learn how they, their staff, and their communities were impacted. In Northern California, evacuation orders affected both CHC sites and staff members’ homes. Even when staff were able to return safely, some sites remained closed due to loss of power. In Southern California, bad air quality forced some CHCs to reschedule patients and send staff home.Despite the challenge of facing multiple climate-related disasters, CHCs continued to meet the moment and upheld their mission to provide care to their communities. CHCs in fire-impacted regions alerted staff and were prepared to handle displaced patients who needed prescription refills while others leveraged telehealth capabilities to continue providing care to their patients. CPCA continued to support CHCs by providing resources to assist in managing, responding to, and recovering from emergency incidents and connected impacted CHCs with emergency relief partners who could provide additional support and resources.
State Engagement to Influence Wildfire Insurance Regulations
Recognizing the growing concern among members regarding insurer-initiated non-renewals and increased premiums of commercial property insurance due to perceived wildfire risk, CPCA submitted written comment to the Department of Insurance (DOI) on the California Insurance Commissioner’s proposed wildfire insurance regulation. We are excited to share that the concerns regarding financial sustainability and continued access to care we raised during open comment were successfully addressed in the final language of the regulation, which went into effect on October 17, 2022. CPCA, in partnership with regional consortia, also met with the Commissioner’s staff and led a discussion regarding concerns of the long-term implications non-renewals would have on access to care for CHC patients, shared feedback on opportunities to improve the California FAIR Plan, and discussed how we can be a partner with DOI and the Commissioner’s office on activities to ensure equitable and sustainable access to wildfire insurance in California. CPCA staff compiled a resource library to support facility hardening and mitigation efforts and is working to develop training and technical assistance on the wildfire insurance enacted regulation.
Natural Disasters
Like an earthquake itself, its impact on CHC operations is unpredictable. Humboldt County experienced a 4.6 earthquake in December that left over 71,000 people without power, caused damage to roads, bridges, and homes, and prompted Governor Newsom to proclaim a State of Emergency. Multiple CHC sites were forced to remain closed until power was restored and suffered minor damage to office items but remained structurally stable. CPCA reached out to consortia partners and CHCs in the impacted area to offer resources and support, and to remind them of additional support available to them through our emergency relief partners.
Emergency Management Programmatic Support
While emergency incidents can happen without warning, there are steps CHCs can take to prepare for, mitigate the impact from, and respond appropriately to such events. CPCA held multiple training opportunities, including the annual Emergency Preparedness Symposium and Emergency Management Peer Network (previously Clinic Emergency Preparedness Peer Network) meetings, that showcased training sessions by CHC peers and other subject matter experts on topics such as: challenges experienced during summer wildfires followed by heavy winter snow; wellness at work for healthcare workers; the Centers for Medicare & Medicaid Services’ Emergency Preparedness Rule surveys; preparing for and responding during an active shooter situation; mitigating cybersecurity threats; how to operationalize a CMS compliant emergency preparedness program; the importance of partnership agreements and healthcare coalitions; and simple, cost-effective actions staff can implement to retrofit their sites and increase safety during an earthquake.
CPCA also developed educational materials, operational tools, and other resources to support, improve, and strengthen CHC emergency management. In collaboration with consulting partners, an expert review and update of existing resources – the Continuity of Operations Plan toolkit, Crisis Communications Plan template, and Emergency Operations Plan template – was completed in addition to the development of a Backup Power Resiliency Plan template and a Hospital Incident Command System webcast series, all of which are available on CPCA’s Online Store or OnDemand Library.
Partnerships Building Climate-Resilient Communities
2022 saw CPCA expanding its work in the areas of environmental health, climate change, and health center sustainability.
As part of CPCA’s commitment to this issue, and the broader issue of sustainability and continuity of operations, we have developed a partnership with Collective Energy Company, a social and mission-driven business focused on helping CHCs access cleaner, more affordable, and more reliable power through education, design, installation, and financing of projects.
CPCA’s Amanda Carbajal, Associate Director of Health Center Operations, serves on the Advisory Board of Collective Energy to represent CHCs across California. CPCA also partners with Collective Energy on educational sessions and disseminating information and funding opportunities to members when they become available. This collaboration further strengthens CPCA’s commitment to sustainability, climate change, environmental justice, health center operations, and long-term financials.
We also partner with these disaster relief organizations, connecting them with CHCs who need crucial relief and direct assistance:
- Direct Relief is an international humanitarian aid organization with a mission to improve the health and lives of people affected by poverty or emergencies. Assistance is free and is targeted to help safety net providers prepare for and respond to emergencies, including incident-specific supplies, medical products, prescription pharmaceuticals, over-the-counter items, and funding opportunities.
- Americares is a health-focused relief and development organization that saves lives and improves health for people affected by poverty or disaster. It supports a network of more than 4,000 health centers worldwide with health programs, medicine, and medical supplies. Additionally, grants are available to CHCs who need supplies or support that are not available in Americare’s warehouse.
If you would like additional information or have questions about CPCA’s Emergency Management programmatic, advocacy and regulatory efforts, please reach out to our Emergency Management team:
Ivan Prado, Program Coordinator of Health Center Operations and Emergency Management: iprado@cpca.org Amanda Carbajal, Associate Director of Health Center Operations: acarbajal@cpca.org
workforce
The California Primary Care Association (CPCA) is committed to growing and diversifying the health care workforce, inclusive of the variety of disciplines and professional levels.
Our cross-department and cross-disciplinary team of staff worked on several different initiatives and projects to ensure that community health centers (CHCs) were well represented and had access to a variety of resources that met their needs.
This work includes both policy and programmatic efforts and spans the range of workforce development activities – from health professions education and training to recruitment and retention.
Recruitment and Retention
Supporting CHC Implementation of Clinic Workforce Retention Payments
CPCA is working closely with clinics and partners on the implementation of the Clinic Workforce Stabilization Retention Payments (CWSRP). We hosted three educational meetings for clinics and created a FAQ and communication toolkit for health centers. CPCA also met with the Department of Health Care Services (DHCS) several times over the past four months to provide answers to critical program questions posed by CHCs. We continue to deliver direct technical assistance to health centers via email and phone calls. Our collective efforts showed positive results: Approximately 250 clinic organizations successfully registered by the December 28th deadline. We were pleased with the results and the training and technical assistance our team has provided. Contact Nataly Diaz, Director of Health Center Operations, at ndiaz@cpca.org with questions.Influencing Grant Distribution for Dental Student Rotations
CPCA is working with the California Dental Association (CDA) Foundation on a Dental Student Grant Advisory Committee to influence the dissemination of $10 million to create new and enhanced community-based dental student rotations. This funding can enhance the dental student rotation capacity of CHCs and leverage these student rotations as a workforce recruitment strategy. These funds are the result of a one-time investment in the 2022-23 state budget. Through our participation on the advisory committee, CPCA successfully educated committee members and state regulators on how health centers are uniquely positioned to be prime candidates for this grant opportunity given the communities they serve and their Health Professional Shortage Area designation. As a result, the California State Dental Director of the California Department of Public Health (CDPH) Office of Oral Health (OOH), reached out to CPCA staff to strategize and partner on recruitment efforts of health center dental program applicants. CPCA is excited to continue partnering with the CDA Foundation and the State Dental Director on outreach efforts to ensure the grant funding is allocated to health centers. Grant applications are expected to open mid-2023. If you would like to learn more about the funding opportunity, contact CPCA’s Associate Director of Health Center Operations, Amanda Carbajal, at acarbajal@cpca.org.Collecting Data to Inform Workforce Policy & Programming Decisions
Each year, CPCA conducts an annual compensation and benefits survey and produces a report to provide unique data that allows clinics to benchmark compensation and benefits offerings against other health care employers, including hospitals. The 2022 Compensation & Benefits urvey was enhanced to capture greater insights on inflation implications on compensation and provide recruitment and retention data to support CHCs with competing in the current labor market. The data captured through CPCA’s 2022 Compensation & Benefits Survey is reflective of compensation data from 30,084 employees that work for CHCs throughout California. The full results are comprised of three connected reports and access to an online compensation customization tool. All four resources were made available to participating clinics and a copy of the statewide results is available for purchase through the CPCA store. Contact Isa Iñiguez, Associate Director of Workforce Development and Special Populations, at iiniguez@cpca.org with questions.Providing Training to Promote Dental Assistant Retention
At the height of the COVID-19 pandemic, many health centers lost their dental assistants as dental services were shut down or significantly reduced. Recognizing the growing need to provide health centers with strategies to expand their dental care team recruitment and retention efforts, CPCA hosted a webinar in May, in partnership with the National Network for Oral Health Access (NNOHA), on Recruiting Dental Assistants: Best Practices and Considerations. The training kicked off with CPCA’s Associate Director of Workforce Development and Special Populations, Isa Iñiguez, highlighting how to leverage results from CPCA’s annual Workforce Development Survey to identify recruiting and retaining incentives for dental assistants. Next, subject matter experts from NNOAH walked attendees through findings from NNOHA’s 2021 workforce survey, including an overview of the health center dental assistant national landscape as well as recruitment and retention recommendations and career ladder opportunities that health center dental programs can implement at their organization. This training was recorded and can be accessed through CPCA’s on-demand library, or you can contact CPCA’s Oral Health lead, Amanda Carbajal, at acarbajal@cpca.org and CPCA’s Associate Director of Workforce Development and Special Populations, Isa Iñiguez, at iiniguez@cpca.org for more information.Convening CHCs and Experts on Strategic Workforce Planning
CPCA convened the second virtual cohort of our Strategic Workforce Planning (SWP) program in the CPCA Online Training Portal. The curriculum, based on the Human Capital Institute’s eight-step strategic planning model, was further refined by stakeholder interviews with health center leaders and iterative design based on feedback from the first cohort. Twenty-eight health centers registered for the program, which was delivered virtually in four phases. At the end of the course, several health centers submitted fully formed strategic workforce plans for their organization and were awarded certificates of completion. This work furthers CPCA’s commitment to developing the health center workforce and fulfills the Health Resources and Services Administration’s goal of having health centers develop comprehensive workforce plans. Applications for a third cohort will open in Spring 2023. Contact Kokaale Amissah-Aidoo, Assistant Director of Education and Training, at kaidoo@cpca.org with questions.
Health Professions Education & Training
Expanding Access to Clinical Social Workers and Marriage & Family Therapists
CPCA is committed to expanding access to and increasing health professions education and training efforts for behavioral health providers in health centers. Please check out the Behavioral Health section (link) for more information on our efforts around behavioral health workforce, including SB 966 implementation and a resource for field training partnerships.Advocating for Funding of Nurse Practitioner and Physician Assistant Postgraduate Training
CPCA, alongside our affiliate, CaliforniaHealth+ Advocates, championed new state investments in nurse practitioner (NP) and physician assistant(PA) postgraduate training, which were secured through the budget process and AB 204. CPCA is now working with the Department of Health Care Access and Information (HCAI) on implementation. CPCA will engage existing NP and PA postgraduate programs in CHCs to obtain their feedback and shape discussions with HCAI on the application, which is expected to be released between July and August 2023. Contact Nataly Diaz, Director of Health Center Operations, at ndiaz@cpca.org with questions.Shaping Workforce Development Discussions with State Entities
The California Budget for 2021-22 included a historic $4.4 billion investment and five-year plan to transform the behavioral health system for children and youth. As part of that funding and plan, HCAI received $360 million to design and build a new behavioral health workforce of wellness coaches. Please see the Behavioral Health section for more on the new Wellness Coach designation.HCAI convenes the California Health Workforce Education and Training Council that is responsible for helping to coordinate California’s health workforce education and training initiatives. CPCA has been an active partner with HCAI during these meetings by providing public comment based on feedback collected from health centers. CPCA also played a role in supporting two appointments of health center leaders on the council which is composed of 18 members who, together, represent various graduate medical education and training programs and health professions, including specialties for primary care and behavioral health, and consumer representatives.
Additionally, CPCA has been working with HCAI to help influence their work in creating a certification program and training curriculum for community health workers (CHWs). More specifically, CPCA provided feedback to HCAI in a one-on-one interview as part of HCAI’s stakeholder interview process. This created an opportunity for CPCA to educate HCAI on ways that CHWs have been helping patients at CHCs for years.
CPCA was also appointed to and an active participant in the DHCS CHW advisory workgroup that helped to create the State Plan Amendment (SPA) that added CHWs as a Medi-Cal reimbursable service. CPCA worked to ensure that services CHWs provide today at CHCs were included in the final SPA. We are happy to report that, through our advocacy efforts, we were successful in adding CHW services conducted at CHCs. We were also successful in influencing the educational requirements to ensure CHWs have lived experience and stay true to their roots in representing the communities they are serving while making certification requirements less stringent. CPCA continues to work with the California Pan-Ethnic Health Network and other partners to influence the implementation of this benefit. To learn more about the CHW benefit and how it impacts CHCs, including FQHCs, please see the FAQs that CPCA drafted or contact Liz Oseguera, Assistant Director of Policy, at loseguera@cpca.org.
Partnering to Offer Comprehensive Behavioral Health Training for Primary Care Providers
CPCA has continued to partner with the University of California, Irvine School of Medicine that offers the Train New Trainers Primary Care Psychiatry (TNT PCP) Fellowship and Train New Trainers Primary Care – Training and Education in Addiction Medicine (PC-TEAM), a new program starting March 2023. TNT PCP is a year-long clinical education program for primary care-oriented trainees and providers who wish to receive advanced training in primary care psychiatry. PC-TEAM is a one-year fellowship comprising innovative and targeted training to optimize the treatment of substance use disorders.Thanks to advocacy efforts, which CPCA has been a partner in, HCAI offers scholarships for providers that work at qualifying sites like Federally Qualified Health Centers and Look-A-Likes to participate in both training programs. The next application cycle for TNT PCP will be in April 2023 and the application cycle for PC-TEAM closed in January 2023.
Sharing Promising Practices for Health Professions Education and Training
CPCA created two promising practices and three program highlights that showcase innovative opportunities for CHCs to “grow their own” workforce and build strategic partnerships. The two promising practice resources focused on preceptor training and affiliation agreements developed through in-depth interviewing and feedback from CHCs across California. The three programs highlighted include innovative dental assistant and behavioral health programs that CHCs have developed as a result of the workforce shortages. These resources are free and available on the CPCA store. For questions, contact Araceli Valencia, Program Coordinator of Health Professions Education, at avalencia@cpca.org.
Health Quality & Access
As value-based programs continue to grow rapidly, CPCA saw the need for support and advocacy for health centers and their patients.
The new Health Quality and Access Department focuses on empowering health centers to thrive in the fast-changing health quality, delivery, and payment landscape.
A district court order vacating the rule is now final, meaning that the long-standing 1999 “field guidance” (the policy that was in place before the 2019 Rule) remains in place, making it safe for immigrants and their families to use health, nutrition, and housing programs for which they qualify.
Included under the new Health Quality and Access banner are CPCA’s initiatives in the spheres of behavioral health, population health, and social determinants of health (SDOH).
Social Determinants of Health
Health outcomes of populations are more often determined by social factors than by medical care. According to Healthy People 2030, social determinants of health (SDOH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks; and while the estimated impact of clinical care on health outcomes is 20 percent, SDOH can affect as much as 50 percent, making it a huge focus for overall population health.
Community health centers (CHCs) have a history of, and commitment to, addressing community health needs and have a unique opportunity to delve into assessing and understanding the root causes of poor health such as education, poverty, housing, violence, and other SDOH issues. Strong partnerships across sectors help engage key stakeholders and pool efforts and resources to address SDOH.
CPCA is committed to helping CHCs address the SDOH affecting patients. This past year, we assisted CHCs in understanding the screening tools available, collecting patient-level data with the necessary workflows, building partnerships, and understanding the resources in their community through the following:
California Social Health Network
CPCA met with individual members of the SDOH statewide convenings to revise the network’s name, mission, and vision to best meet the goals of cross-sectoral collaborators. The newly named California Social Health Network (CSHN) met in May and November of 2022 to uplift shared goals and interests in SDOH advocacy and data collection. In October 2022, CPCA created a poster highlighting the origins and emerging partnerships of the CSHN to a national audience at The Root Cause Coalition’s 2022 National Summit, held in Minneapolis, Minnesota.Z Codes
To support the CalAIM Population Health Management initiative and overcome challenges of collecting SDOH data, the California Department of Health Care Services (DHCS) issued a list of 25 priority SDOH codes (Z codes) for managed care plans and providers to use when coding for SDOH. CPCA, in partnership with Blue Shield of California and various electronic health records (EHR) vendors, worked to increase the utilization of Z codes for tracking SDOH at California CHCs. As part of this endeavor, CPCA staff ensured EHR vendors were integrating Z codes with existing SDOH screening, capturing the 25 priority codes within their systems, and providing access to and guidance for CHC users.SDOH Screening Learning Cohort
The SDOH screening learning cohorts were a series of webinar offerings aimed toward engaging stakeholders in the Protocol for Responding to & Assessing Patients’ Assets, Risks & Experiences (PRAPARE). PRAPARE presentations focused on training CHC staff in the basics of SDOH data collection using PRAPARE, gathering feedback, and identifying project champions. CPCA connected CHC staff to regional resources as well as provided a shared learning environment for staff. Participant feedback and analysis of engagement and the learning cohort led to a revision of the learning structure to create webcasts in an interactive online platform. This revision allowed for ease of access, a wider audience, and flexible engagement for users on their schedule. In 2022, small group discussions on lessons learned aligned with the PRAPARE toolkit were facilitated by CPCA and CHC staff in the SDOH Peer Network, a peer learning space committed to supporting CHCs to learn from each other on how they have been developing SDOH components into clinical workflows and work environments.
Behavioral Health
The burden of untreated behavioral health conditions, which includes mental health and substance use disorders (SUD), continues to be a major public health problem and a delivery system challenge. In 2022, CPCA remained committed to helping community health centers meet the increasing demand for behavioral health care by providing training and technical assistance, as well as engaging in advocacy and forging partnerships that accelerate behavioral health care improvement and integration through policy and practice change.
Behavioral Health Workforce
The COVID-19 pandemic and recovery highlighted the lack of an available behavioral health workforce, especially one that is representative of the populations served at community health centers. CPCA has prioritized our efforts to expand the behavioral health workforce in community health centers with the successful passage of SB 966, which will allow patients to be treated by Associate Clinical Social Workers (ACSWs) and Associate Marriage & Family Therapists (AMFTs).
The bill also implements a permanent billing and Prospective Payment System policy for ACSWs and AMFTs. CPCA confirmed with the Department of Health Care Services (DHCS) that a Change in Scope-Of-Service Request will not be required to begin billing and using these providers. We continue to work with DHCS on how to implement the SB 966 policy after the declared federal COVID-19 Public Health Emergency ends. We also regularly update CPCA’s FAQ with the latest guidance.
CPCA also published a with the California Social Work Education Center, which outlines everything a health center needs to know when developing or enhancing field training and internship partnerships with accredited Master of Social Work (MSW) programs. Offering training to MSW students within a health center will: 1) expand the number of MSWs trained to practice in health centers, 2) create a sustainable retention and workforce development pipeline for clinical social workers within health centers, and 3) broaden and enhance the quality of care that health centers are able to provide. You can download the report, titled Developing MSW Field Education Partnerships: A Guide for Community Health Centers, for free at CPCA’s store. If you have any questions, contact Peter Dy, Associate Director of Care Transformation, at pdy@cpca.org.
Children and Youth Behavioral Health Initiative
The Children and Youth Behavioral Health Initiative (CYBI) was announced in July 2021 with a $4.4 billion investment to enhance, expand, and redesign the systems that support behavioral health for children and youth. In August 2022, Governor Newsom announced California’s Master Plan for Kids’ Mental Health, an integrated multi-year effort uniting historic investments across disciplines to more holistically serve the state’s diverse children and families. In 2023 and 2024, we look forward to working with the Department of Health Care Services (DHCS) to expand access and quality of behavioral health services, through CYBHI. This includes launching dyadic services – an enhanced Medi-Cal benefit that offers preventative behavioral health services to young people and their caregivers. CPCA assessed health centers to identify current capacity and technical assistance needs.
As part of that funding and plan, the Department of Health Care Access and Information (HCAI) received $360 million to expand the behavioral health workforce through the new Wellness Coach designation The Wellness Coach Workforce is designed to increase overall capacity to support growing youth behavioral health needs, build a diverse behavioral health workforce with lived experience, and fill some of the workforce gaps that exist today, especially given that there are few existing behavioral health roles that require one to four years of education. CPCA has been integrally involved in the development of the Wellness Coach Workforce by participating in stakeholder interviews and workshops. Training of wellness coaches is expected to begin in 2024 with coaches in the field in 2025.
We anticipate more funding and initiatives from HCAI to expand the behavioral health workforce, like grants to expand the culturally and linguistically competent behavioral health workforce. We also anticipate the 2024 launch of the State’s behavioral health virtual services platform, which will provide virtual behavioral health services and educational content to all California children, youth, and families, regardless of payer. CPCA actively participates in this important initiative.
Behavioral Health Integration Efforts
CPCA staff are committed to supporting systemic and site-specific integration of primary and behavioral health at community health centers through policy change, training, and technical assistance. In 2022, CPCA staff were among other California-based experts in behavioral health integration implementation, care delivery, quality measurement, and policy to participate in the National Committee for Quality Assurance’s Delphi Panel for Behavioral Health Integration. The key objective of this project is to develop consensus, aligned across levels of the delivery system, on priority quality measures and concepts in the context of behavioral health integration in primary care settings by employing the modified Delphi panel method and the Behavioral Health Quality Framework.
CPCA continued to collaborate with colleagues across seven statewide associations to participate on the Delta Center California’s State Policy & Partnership Roundtable. Delta Center California is a 2.5-year initiative supported by the California Health Care Foundation and the Robert Wood Johnson Foundation that brings together behavioral health and primary care leaders to accelerate care improvement and integration through policy and practice change. CPCA staff also serve on Delta Center’s Advisory Group and Co-Design Team for local learning labs.
Additionally, CPCA continues to track the statewide adoption of Certified Community Behavioral Health Clinics (CCBHC). In the past two years, 24 organizations in California were awarded CCBHC grants from the Substance Abuse and Mental Health Services Administration (SAMHSA). For the state’s dual FQHC/CCBHCs, this designation is a means to offer expanded mental health and substance use disorder services typically not included in their FQHC scope. The carve out of specialty mental health and SUD from managed care continues to be a financial and operational challenge for dual FQHC/CCBHCs. President Biden signed the Bipartisan Safer Communities Act on June 26, 2022, which includes $8.6 billion to be made available over 10 years to expand CCBHCs. The legislation calls for 10 states to be added to the CCBHC Demonstration Program every two years. In 2022, DHCS did not apply for a state demonstration, which would require the State to create a license/certification and payment methodology for CCBHCs.
CPCA members currently participating in SAMHSA’s CCBHC Program:
- Chinatown Service Center
- HealthRight360
- Hill Country Community Clinic
- JWCH Institute
- Mission City Community Network
- San Ysidro Health
- Santa Barbara Neighborhood Clinics
- School Health Clinics of Santa Clara County
- South Central Family Health Centers
- Tarzana Treatment Centers
- Wellspace Health
partnerships
California Endowment Continues Support of CPCA and Regional Consortia Collaboration
In 2022, CPCA and the Regional Associations of California (RAC) were invited to apply for funding from The California Endowment to strengthen the longstanding partnership between our organizations in support of California’s community health centers (CHCs).
CPCA worked with the RAC, as well as the Southside Coalition, Planned Parenthood, and the California Rural Indian Health Board to develop a proposal that support our respective organizations over the next five years.
The California Endowment Board approved our funding proposal last summer with work beginning in October of 2022 and going through September of 2027. The grant to CPCA will provide ongoing support for policy, advocacy, and workforce efforts, along with the Alternative Payment Methodology (APM) work and community engagement by all organizations. The total funding amount for the proposal is $13 million over five years, with CPCA serving as the fiscal agent, and funds being distributed to the 16 consortia according to their individual grant agreements.
Population Health Management Initiative
Kaiser Permanente has partnered with the State of California and CHCs to develop population health management (PHM) solutions to meet the needs of the Medi-Cal population.
The goals of the program are:
Think Boldly:
To transform care for Medi-Cal enrollees, eliminate health disparities, improve outcomes and move interventions upstream
Integrate Initiatives:
For synergy between CalAIM, APM 2.0, and encounter data projects
Establish Critical Partnerships:
By leveraging Kaiser Permanente’s skills and experience to support PHM solutions for CHCs
Special focus
to achieve the long view on health and wellness for Californians on Children’s Health, Maternal Health, and Behavioral Health
CPCA has partnered with Kaiser, the State of California, regional consortia based in Kaiser-specified regions, and 32 CHCs to work toward the overall program goals. Over 2022, planning grants were given to CHCs and a total of 38 Plan-Do-Study-Acts (PDSAs) were conducted in 30 CHCs throughout September. CHCs tested the recommended tools and workflows with support from their PDSA Practice Coach. After a comprehensive evaluation process involving subject matter experts from Kaiser Permanente and CHCs, a population health management technology platform was selected for proof-of-concept testing.
Additionally, the PHMI Core Measurement Set was developed and is aligned with the APM 2.0 Pilot, as well as Department of Health Care Services (DHCS) bold goal measures. These PHMI Quality Measures were developed and endorsed by DHCS to fulfill the expectation that the PHMI will prepare CHCs for the APM 2.0 Pilot and CalAIM by improving their population health management capabilities and achieving key Medi-Cal program metrics and outcomes.
PHMI Core Measures Include:
Pediatric Prevention
- Child Immunization Status
- Well Child Visits in first 30 months of life
Behavioral Health
Depression Screening & Follow-Up for Adolescents and Adults
Maternity Care
Prenatal & Postpartum Care
Adult Prevention & Management
- Colorectal Cancer Screening
- Comprehensive Diabetes Care: HbA1c Poor Control
- Controlling High Blood Pressure
Health Professions Education & Training Initiative
Dr. Luis Padilla, MD, FAAFP
Associate Administrator, Bureau Health Workforce, Health Resources and Services Administration (HRSA)
“We know that providers who receive training in community and underserved settings are more likely to practice in similar settings, such as health centers. This is even more evident when the physician has a connection to a practice location – perhaps because they are part of a minority group or grew up in a rural area. We are moving away from funding traditional institutional curriculum development and focusing on more “training in place” efforts to meet workforce needs.”
— January 2021 CPCA blog interviewThis statement shows that CHCs can increase the likelihood that those trained at a CHC will develop a deeper connection to the mission and culture of CHCs by playing a part in the education of these learners. As a result, learners may be more likely to pursue employment with CHCs. Providing educational opportunities to existing staff also strengthens the workforce and improves existing staff morale. Having visible career paths for all staff and providers helps employees see that there is a future for them to move forward in a familiar place, serving their community.
For this reason, CPCA is also working with HRSA on a second initiative to “grow our own” robust and diverse CHC workforce, the Health Professions Education and Training (HP-ET) Initiative. Our goal is to enhance health centers’ capabilities to recruit, develop, and retain their workforce by exposing health and allied health professions students, trainees, and residents to education and training programs conducted at health centers. Over the course of a year and a half, CPCA has created significant learning opportunities to support CHCs in HPET.
Readiness to Train Assessment Tool (RTAT)
Assists health centers in assessing and improving their readiness to engage in health professions training programs. CPCA encouraged CHCs to participate between September 2020 and February 2021. Community Health Center, Inc sent the RTAT results to participating CHCs in November 2021. Statewide and national reports are expected in March 2022.HP-ET Workgroup
Creates a space for members and CPCA staff to strategize the development of training and technical assistance (T/TA) that supports health center health professions training. The group meets bimonthly to also strategize the development of partnerships with academic institutions to recruit and retain students from our communities who have a strong desire to pursue a career in a CHC.HP-ET Template for Assessment and Action
Provides a road map and series of action items to develop health professions training programs aligned with organizational workforce goals and strategies. It walks health centers through how to lay the foundation for health professions training, assess current and future needs, plan and act, and adjust.Medical Assistant Development Toolkit for Clinical Managers and Supervisors
Highlights practical tools, examples, and resources from California community health centers that help clinical managers and supervisors foster a strong medical assistant team. Topics covered include recruitment, training, career development, finances, and return on investment.HP-ET Resource Library
Offers a one stop shop of toolkits, reports, templates, and previously recorded trainings available to health centers to assist with developing or enhancing training programs and partnerships.HP-ET Webinar Series
Showcases a variety of training programs and models leveraged by CHCs across California. New webinars are being added frequently.
Care Transformation
Adverse Childhood Experiences (ACEs) Aware
Adverse childhood experiences (ACEs) are potentially traumatic events that occur in childhood (0-17 years). Examples of ACEs such as experiencing/witnessing violence and mental health problems are categorized into three groups: abuse, neglect, and household challenges.
ACEs are common and the economic and social costs to families, communities, and society totals hundreds of billions of dollars each year. However, ACEs are preventable. There are several factors that may increase or decrease the risk of perpetrating and/or experiencing violence. To prevent ACEs, we must understand and address the factors that put people at risk for or protect them from violence.
The ACEs Aware initiative is a first-in-the nation effort to screen patients for ACEs to help improve and save lives. ACEs Aware strives to create a better world for our children, families, and communities by working together across sectors to prevent and address the impact of ACEs and toxic stress. CPCA was contracted by Aurrera Health Group in three ACEs Aware grant activities: Network of Care, Peer to Peer Learning, and Communications. These grants helped organizations offer additional opportunities for providers and other stakeholders to share lessons learned and best practices tailored to specific geographic areas, patient populations, providers, and practice settings.
Communications
CPCA coordinated a statewide communications project that leveraged CPCA’s robust communications structure of networks and partner organizations, to reach staff of the over 1,300 community health centers (CHCs) in California, from CEOs and providers to front line staff. In addition to engaging with CPCA health center members, CPCA partnered with other organizations, including the Regional Associations of California (RAC), and coalitions to support and strengthen CHCs and will utilize these partnerships for this work. Close partnerships with the RAC allowed CPCA to leverage our collective statewide and regional strengths and reduce duplication of efforts for this ACEs Aware Initiative.Communications grant objectives that were met included monthly social media content calendars for subgrantees, Tweets, Facebook posts, LinkedIn posts, CPCA Weekly Update blurbs, an ACEs Aware informational page with links to resources, and an ad retargeting campaign to promote ACEs Aware advertisements to all CPCA website traffic and linked back to acesaware.org. Although CPCA does not directly interact with the communities our members serve and support, our efforts in messaging “Become ACEs Aware” to clinicians made an impact on the number of providers who took part in the training. The ad retargeting campaign, even running for a few weeks, resulted in a reach of over 5,000 – all which were presented with ACEs imagery and directed back to acesaware.org. CPCA’s social media and communications efforts are run internally, and therefore ACEs information/trainings/updates will continue to be disseminated via social channels and throughout our various member communications.
Network of Care
To screen Medi-Cal beneficiaries for ACEs, there are two approved screening tools: the Centers for Disease Control and Prevention (CDC) ACE Assessment Tool and the Pediatric ACEs and Related Life Events Screener (PEARLS). CPCA identified a need among health center providers to build systems and capacities to meaningfully engage with ACEs/PEARLS screening results data for clinical practice and trauma-informed and resilience-oriented (TIRO) systems. The ability to use the screening tools is based on the ability of CHCs to enter screening data into the electronic health record (EHR) and pull reports from data analytics platforms. However, there is a gap in functionality in EHRs and data analytics platforms in using screening results and data to advance clinical practice and care transformation.Ongoing efforts in Network of Care include the integration of ACEs and PEARLS screening tools into most common EHR and data analytic platforms used by CHC’s. CPCA is partnering with EHR/data software vendors to ensure that the ACEs and PEARLS screening tools (pursuant to licensing availability) are incorporated into these EHR and data software systems. CPCA’s continued work in this area includes the development of EHR templates that include the ACEs/PEARLs screening questions and coordinating with data software vendors to ensure that screening results can be pulled from the EHR for reporting and analytic purposes. To effectively test the modifications to EHR templates and data software systems within CHC sites, CPCA is partnering with three Regional Associations of California (RAC) to leverage expertise working directly with member CHCs on projects related to health information technology.
- EPIC OCHIN – Alameda Health Consortium
- eClinicalWorks – Redwood Community Health Coalition
- Relevant – Redwood Community Health Coalition
- NextGen – CPCA
Peer to Peer
CPCA partnered with six RAC organizations to each lead regionally focused peer networks focused on strategies and promising workflow practices for screening patients for ACEs and toxic stress. In the first two quarters, all RAC subgrantees began assessment of providers and their familiarity with the ACEs/PEARLS screening tools. Buy-in from providers and stakeholders was collected to identify existing knowledge of ACEs and potential to screen in various health care settings (e.g., perinatal care, behavioral health, primary care, etc.) and expansion of trauma-informed care across the health center’s care ecosystem. The RAC organizations developed action plans and conducted 18 ACEs peer-to-peer learning meetings.CPCA supported subgrantees with agenda setting and presentations for peer-to-peer meetings, hosted bi-monthly RAC and CHC ACEs Aware coordination calls, and answered technical assistance questions from RAC subgrantees and CHC staff on the ACEs Aware initiative throughout the grant period. On September 21, 2021, CPCA hosted a convening for all RAC subgrantees and other health center ACEs Aware grantees to attend and participate in a peer-to-peer discussion reflecting on lessons learned, challenges, and recommendations of ACEs Aware work sustainability beyond grant funding. Post convening materials include a summary of lessons learned that was shared with all subgrantees and various forms of access to the didactic convening recording. In open-ended responses, participants indicated that the most valuable piece of the virtual convening was hearing from other attendees and speakers on their experiences with ACEs work and focusing on actionable steps to take when thinking about the sustainability of ACEs Aware work beyond grant funding.
Next Steps
CPCA has used the lessons learned to network with other ACEs Aware grantees during ACEs Aware Regional Meetings hosted by Aurrera. Throughout the summer of 2021, these Regional Convenings helped CPCA staff identify partners throughout California to share and learn from each other and participate in discussions on challenges and highlights of our work. Internally, CPCA staff continue to coordinate efforts on available funds that overlap with ACEs work such as activities around Trauma Informed Care, Resiliency and Recovery (TICRR), SDOH networks, and advocacy efforts.
CPCA is creating new opportunities to educate providers and non-providers on ACEs screening and continues to highlight ACEs in peer network settings (e.g., CPCA SDOH peer network) and CPCA online resources available to statewide members at both RAC and CHCs.
Based on feedback from RAC subgrantees, CPCA plans to inform strategic planning of the commitment to standardized training in the area of ACEs, seeking new and strengthening existing cross-sector partnerships to learn about and share workflows and processes, and identify ACEs-focused advocacy opportunities; CPCA is actively working on integrating ACEs and Pediatric ACEs and Related Life-events Screener (PEARLS) tools into the most common EHR and data analytic platforms used by CHCs through our parallel work in the ACEs Aware Network of Care grant. Following integration and testing, CPCA plans to include educational materials on use of the tools along with all other proposed ACEs-related educational opportunities.
Social Determinants of Health (SDOH)
Health outcomes of populations are more often determined by social factors than by medical care. According to Healthy People 2020, Social Determinants of Health (SDOH) are conditions in the places where people live, learn, work, and play affect a wide range of health risks and outcomes. About 40% of a person's health is attributed to SDOH.
Community health centers (CHCs) have a history of and commitment to addressing community health needs and have a unique opportunity to delve into assessing and understanding the root causes of poor health such as education, poverty, housing, violence, and other SDOH issues. Strong partnerships across sectors helps engage key stakeholders and pool efforts and resources to address SDOH.
CPCA is committed to helping CHCs understand the screening tools available, collecting patient level data with the necessary workflows, building partnerships, and understanding the resources in their community to address the SDOH affecting patients. Beginning in the summer of 2020, CPCA [in partnership with Blue Shield of California (BSC)] supported the Regional Associations of California (RAC) and CHCs through learning cohorts to: (1) develop rapid community health needs assessment (CHNAs) using the MySidewalk’s Neighborhood Dashboard (NHD) digital intelligence tool, and (2) explore strategies to leverage aggregated SDOH data from the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) assessment tool.
NHD generator
BSC engaged CPCA to develop knowledge and proficiency in the newly developed NHD generator for MySidewalk and deliver two train-the-trainer learning cohorts in Blue Shield target counties. Target audiences included RAC and/or primary care providers to discuss the availability and use of NHD in their communities to develop CHNAs and identify and align on priority community health issues. CPCA provided a platform for discussion and technical assistance support to develop rapid CHNA and prioritization working sessions using the MySidewalk digital intelligence tool, NHD.CPCA worked with BSC and MySidewalk to coordinate and develop train the trainer virtual learning cohorts. The NHD generator training offered skills for CHCs and RAC staff to assess their communities, develop cross-sector partnerships, and engage in advocacy work. Training materials were made available to California health care staff and providers. The first training (hosted on March 2, 2021) was co-led by all three partners—CPCA, BSC and MySidewalk. The second training (hosted on June 29, 2021) was led by CPCA staff, engaging participants, and sharing best practices and lessons learned. Both virtual training sessions were attended by a total of 58 organizations from across the state. The evaluation of both trainings indicated high satisfaction from attendees and interest in future opportunities to share best practices in SDOH including partnerships and workflows.
SDOH Learning Cohort
CPCA leveraged relationships with the RAC to recruit CHCs from across the state and worked with RAC to disseminate the PRAPARE assessment tool and explore potential strategies to leverage aggregated SDOH data for integration with the Unite Us platform. A total of 44 health center organizations participated in the SDOH learning cohort. The PRAPARE Learning Cohorts, organized via virtual platform, were made up of CPCA members and BSC stakeholders in target counties divided into four regions:
- Southern California
- Greater Sacramento
- Inland Empire
- Bay Area Coastal
PRAPARE Learning Cohorts followed a nationally established training program with a three-pronged approach to SDOH by working with clinics and other stakeholders to (1) understand what and how to use PRAPARE to collect data, (2) analyze and use data collected through PRAPARE, and (3) develop either clinic resources or community partnerships to address the social needs identified through the data collected via the screening tool. The virtual training sessions also include an overview of SDOH, integration of social needs into health care delivery, and CHC and other Medi-Cal provider requirements. CHCs were also offered one-on-one coaching support. During the one-on-one meetings with health center staff, CPCA worked with the staff to understand the training and technical assistance needs not identified during the live webinars. Evaluation reports across all learning cohorts indicated that participants highly rated the webinars where they were able to hear specific referral options for their region and introductory information to explore leveraging SDOH data.
Next Steps
Health equity and the reduction of health disparities are at the center CPCA’s mission and the work we do. To increase participation in future cohort sessions and improve the quality of information, CPCA plans to expand access and quality of future learning cohort sessions on the topic of SDOH through streamlined processes for ease of access to information, in addition to restructuring content to better highlight well-received areas. The partnership with BSC and MySidewalk allowed CPCA the opportunity for facilitating robust discussions about using the NHD generator and PRAPARE screening tool within existing clinic workflows. This helps address a wide array of health issues, their prevalence, severity, and the ability to evaluate outcomes on issues beyond clinical diagnoses of patients and the communities they exist in. Based on participant feedback of both the NHD generator and PRAPARE screening tool learning sessions, CPCA will continue to engage stakeholders on all aspects of understanding the importance of assessing for unmet social needs and strategizing the implementation process of collecting and analyzing SDOH data.
CalAIM Moves from Ideas into Implementation
After being sidelined by the pandemic, the Department of Health Care Services (DHCS) used much of 2021 to reacclimate stakeholders to their ambitious proposals aimed at reforming Medi-Cal. California Advancing and Innovating Medi-Cal (CalAIM) is a multiyear, layered approach to transform California’s Medi-Cal program, with a special attention to social services and support for the millions of Californians with the most complex needs. CalAIM marks an incredible opportunity to align systems, integrate wholistic care and focus more intentionally on prevention, early intervention, and wrap-around support.
CPCA is focusing our attention and efforts on the following CalAIM programs and services:
- Establish new programs focusing on Enhanced Care Management and Community Supports (In-Lieu-of Services);
- Reform current county specialty mental health and substance use disorder systems;
- Establish a data-driven population health management strategy that assess beneficiaries whole-person needs; and
- Create a new health plan model that fully integrates physical, behavioral, and oral health under one contracted entity.
DHCS postponed the planned implementation of the CalAIM initiative, originally scheduled for January 1, 2021 so that both DHCS and all of their partners could focus their limited resources on the needs arising from the public health emergency due to COVID-19. They picked back up with a clear vision and plan for how to accomplish their goals. CPCA has tracked the implementation since the Department first put forth their policy proposals in 2019. Staff sat on various CalAIM workgroups and also supported health center representatives. Much of CPCA’s communication to health centers about the proposed changes came through the CalAIM Task Force, which is where we vetted the proposals and formulated feedback to the Department.
As the proposals move into implementation, we continue to offer the health center perspective through the state’s implementation workgroup. CPCA is highlighting the need for funding (including transition support, reimbursement, and incentive dollars) to community-based providers, like CHCs, to plan and provide this robust complement of services. Reimbursement rates need to be sufficient for providers to cover the cost of these services for patients at the top tier of complexity and risk. The state also needs to be focusing on ensuring that the care team of the future is diverse, representative of their patient population, and trained to meet demands.
CPCA is using the Managed Care Task Force as a forum to share updates, dialogue about the impact, and provide implementation trainings. We welcome everyone to join and augment our understanding of how CalAIM will impact health centers.
Data Sharing for Achieving Health Equity
To help in the advancement toward health equity, CPCA knows that patient data is at the center of creating impactful stories of community health centers (CHCs) and the patients they serve. These stories play a key role when sharing with state officials, funders, and the many other organizations that support health center patients.
CPCA, in partnership with two California Health Center Controlled Networks (HCCN), are further developing a data aggregation pilot to collect state level data on a quarterly basis. The data aggregation platform is an extension of a platform already in place for social determinants of health (SDOH) data. The goal of the pilot is to identify a roadmap for HCCNs, Regional Associations of California (RAC), and health centers for uploading data to the platform. The pilot is focused on identifying the most efficient way to upload data and will also test a subset of data with an intention to further expand the amount of data that is shared at the state level. This will help CPCA collect data in real-time, in addition to standardizing a modality for effective data sharing, regardless of EHR type – allowing CPCA to be preventative in our healthcare vision and better predict treads across the state.
One of the organizations that has shown interest in data sharing and our pilot program is Redwood Community Health Coalition (RCHC). RCHC is a network of 16 members, 15 community health centers and wellness education site, and a total of 74 sites in Marin, Napa, Sonoma and Yolo Counties. Formed in 1994, their mission is to improve access to, and the quality of care provided for under-served and uninsured people in their four counties. RCHC’s major focus is to strengthen the capacity of member health centers to act as a regional network of comprehensive primary care that provides access to consistently high-quality clinical care, effective care coordination and reduce health disparities. Another organization that has also shown interest in data sharing is the Coalition of Orange County Community Health Centers (the Coalition) which serves over 340,000 patients annually throughout their many facilities. The Coalition was founded in 1974 as a 501(c)3 not for profit organization designed to support and strengthen Orange County’s network of licensed community clinics. For 47 years, the Coalition has served as a membership organization for freestanding, mobile community based non-profit clinics offering a forum in which clinic leaders can share ideas and concerns, as well as to advocate for the clinics and their patients. The overall vision of the Coalition is to be the “voice” of the uninsured and vulnerable population in their area. They have established a safety net providers and key partners which allows them to create quality healthcare for vulnerable and underserved communities.
Behavioral Health
The immediate impacts of loss, isolation, and longer term needs due to the economic fallout highlighted an increased societal interest in behavioral health.
COVID-19 has unfortunately exacerbated mental health and substance use conditions for the general population.
Behavioral Health Workforce (BHWF)
The pandemic (and recovery) highlighted the lack of available behavioral health workforce, especially one that is representative of the populations served at community health centers.
CPCA has prioritized investments to expand the BHWF, including working with the Department of Health Care Services on implementing Licensed Marriage and Family Therapist (LMFT) and looking at post-public health emergency policies to keep the current flexibilities that allows health centers to bill Associate Clinical Social Workers (ASWs) and Associate Marriage and Family Therapists (AMFTs). Specific examples include engaging behavioral health statewide associations, partnering with the National Association of Social Work California Chapter (NASW-CA) and California Association of Marriage and Family Therapists (CAMFT), forming relationships with the California Board of Behavioral Sciences (BBS), and holding informational briefings for legislative and capitol staff members to educate key decision makers of the role community health centers play in California’s behavioral health delivery system.
CPCA has also been partnering with UC Berkely’s California Social Work Education Center (CalSWEC) to create a toolkit for community health centers to prepare, build and implement Masters of Social Work Internship Field Placement Programs, which looks at developing the BHWF pipeline at community health centers for ASWs and LCSWs.
Our goal with an increased focus on behavioral health workforce is to ensure that health centers have the human resources to meet the demand for services and that the diversity of patients’ identities are reflected the workforce composition.
CPCA Staff are committed to supporting systemic and site-specific integration of primary and behavioral health at community health centers through policy change and training/technical assistance.
Behavioral Health Integration Efforts
In 2021, CPCA staff joined colleagues across seven statewide associations to participate on the Delta Center California’s State Policy & Partnership Roundtable. The Delta Center of California is a 2.5-year initiative supported by the California Health Care Foundation and the Robert Wood Johnson Foundation that brings together behavioral health and primary care leaders to accelerate care improvement and integration through policy and practice change. CPCA staff also serve on the Delta Center’s Co-Design team for local learning labs. Each learning lab team consists of representatives from the specialty behavioral health and primary care delivery system. Teams will work together towards shared policy priorities, diving into areas such as financial sustainability for integrated care, best practices in telehealth, building up their workforce capacity, and integrating the disparate systems of primary care with specialty and mild/moderate mental health care. All teams are working to center racial equity and lived experience in their project work to ultimately reduce disparities in care.
Additionally, CPCA continues to support community health centers who expand behavioral health integration by implementing services under the Certified Community Behavioral Health Clinic (CCBHC) model of care. CCBHCs provide integrated, evidence-based, trauma-informed, recovery-oriented, and person-and-family-centered care by offering mental health, substance use disorder (SUD) and primary care services, while having to have established collaborative relationships with other providers and health care systems to ensure coordination of care. The first round of SAMHSA funding for California CCBHCs were awarded in 2020, and since the beginning, CPCA hosts monthly peer-to-peer sharing forums for CCBHCs as they begin to plan, prepare, implement, and improve services under this model of care. Additionally, CPCA uses this forum to connect CA CCBHC grantees to state and federal advocacy.
California community health centers participating in SAMHSA’s CCBHC Program:
Chinatown Service Center
HealthRight360
Korean Community Services
La Maestra Community Health Centers
San Ysidro Health
Santa Barbara Neighborhood Clinics
School Health Clinics of Santa Clara County
South Central Family Health Centers
CPCA continues to offer meaningful and high-quality training and technical assistance to health centers’ integrated health teams. One example is our Diabetes and Depression Learning Cohort focused on integrating primary and behavioral health care to treat co-occurring conditions in health center patients. The learning cohort focused on evidence-based behavioral health practices regarding diabetes and co-occurring depression and understanding how to incorporate these practices in clinic’s workflows and processes.
In looking forward to 2022, we project a substantial year for behavioral health. The state will launch several of their CalAIM policy proposals aimed at integrating and standardizing the specialty behavioral health delivery system. CPCA was intimately involved in the state’s vetting of these proposals before the pandemic, and we are excited to offer the health center perspective as the state seeks to implement.
Training & Techinical Assistance
Assisting health centers in the delivery of culturally appropriate, high quality, primary and preventive health services
In 2022, CPCA continued to provide timely, informative, and high-quality training and technical assistance (T/TA) to the community health centers of California. Still primarily virtual, CPCA hosted 94 learning opportunities, exclusive of conferences and symposiums, that were attended by nearly 5,000 registrants.
Staff also provided 1,348 instances of phone, email, and in-person technical assistance to members. Topics T/TA covered in 2022 included workforce, value-based care, data, and social determinants of health, to name a few. CPCA looks forward to returning to in-person trainings as well as offering hybrid learning opportunities in 2023.
In 2021 CPCA expanded this partnership, and in collaboration with Direct Relief and Macro-Eyes, partnered to advance emergency readiness for the increasing threats that have been posed by wildfires and power outages using AI that would help predict infrastructure readiness for every federally qualified health center (FQHC) in California.
Over time, California’s power outages have forced the cancellation of thousands of patient visits at CHCs due to closure. CHCs that lost power, but were still able to open, found themselves crippled by the loss of power, forced to slash services, close sites like dental clinics, and attempt to operate without the computer systems that are the backbone of modern healthcare. Even if a CHC stays in operation without power, without electronic health records, the doctors can’t access lab results, records of current prescriptions, schedules for screening tests like mammograms, records of blood pressure and cholesterol level, or reports from specialists. California’s widespread power shutdowns have revealed a hidden weakness in our health care safety net, and Public Safety Power Shutoff (PSPS) events are likely to become more commonplace as California’s utility companies seek to prevent destructive wildfires during periods of extreme risk.
In January 2021, Direct Relief and the CPCA initiated an engagement with Macro-Eyes to apply machine learning to understand individual health facility and health safety network capacity and readiness for managing Covid-19 vaccinations for the communities they serve. The first phase of this project was a rapid two-month deployment of the Macro-Eyes health readiness product, Striata, which uses artificial intelligence (AI) to machine learn the current state of infrastructure at each FQHC while generating data on the catchment population. Striata learns about health infrastructure from publicly available data and data derived through a set of proprietary
In 2022, CPCA continued to provide timely, informative, and high-quality training and technical assistance (T/TA) to the community health centers of California. Still primarily virtual, CPCA hosted 94 learning opportunities, exclusive of conferences and symposiums, that were attended by nearly 5,000 registrants.
Staff also provided 1,348 instances of phone, email, and in-person technical assistance to members. Topics T/TA covered in 2022 included workforce, value-based care, data, and social determinants of health, to name a few. CPCA looks forward to returning to in-person trainings as well as offering hybrid learning opportunities in 2023.
Striata found that out of 2059 sites, 1258 (61%) were without any form of back-up power, while 212 (10%) were without refrigeration. 721 sites (35%) had both refrigeration and some form of back-up power.
This level of insight from Striata can support strategic targeted investment in the health safety net and identify sites ready to deliver essential services dependent on reliable refrigeration (such as a mass vaccination campaign), as well as sites able to continue to deliver care services during power outages or times of restricted access. This is especially significant in regions where natural disasters are an annual occurrence.
With these statistics in mind, Striata quickly became a resource mapping and investment planning tool where you can see in real-time which facilities have a higher proportion of population at risk of not being able to access health services, and which sites currently have a low resiliency to power outages where investment may improve their ranking. Striata helped pinpoint populations most at risk of wildfires and power outages alongside the existing user interface. This provides insight into whether the health center is fire ready, what are the capacities that need to be built, and whether they have that capacity to improve resilience.
Through this partnership, Striata has the potential to empower regional associations to have a more influential role in the allocation of resources and decision-making power, positioning visibility as an advocacy tool.
Regional Associations of California (RAC)
California is a large and regionally diverse state
with a complex health care market, and as such has a long history of statewide and regional clinic consortia supporting community health centers in our state.
Over the past decades, CPCA and clinic consortia have developed and refined an innovative partnership model and infrastructure to effectively partner and execute coordinated projects, through collaborative programs and resource sharing. In 2021, CPCA embarked on a number of unique partnership opportunities with the clinic consortia and continued, as well as closed out, a number of projects that were started in 2020.
Working with the regional consortia partners, we were able to offer regional training, education and outreach efforts in order to increase knowledge around COVID-19 safety, vaccination efforts and combat vaccine hesitancy.
The consortia continue to be integral thought partners around statewide strategic planning and funding opportunities. As such, CPCA and the regional consortia participate in regular meetings with statewide philanthropic funders to discuss ongoing and time-sensitive issues facing California’s community health centers. Through this work, funders have provided additional support for health centers around COVID-19 vaccine equity, contact tracing efforts, and emergency preparedness.
CONFERENCES & EVENTS
CPCA’s 2022 Conferences and Events Were a Great Success!
Each year, CPCA hosts four conferences to provide learning opportunities for our members and a chance to share how California’s health centers are meeting the moment, innovating, and doing incredible work in their communities to achieve the mission of health for all. In addition, we offer issue-specific symposiums to highlight important and emerging issues. Here is a recap of our 2022 conferences and events.
Virtual Events
CPCA continued to host some events virtually in 2022 to comply with local COVID-19 guidelines and keep our attendees safe. These events were hosted in our Online Training PortalWorkforce Symposium
The second annual Virtual Workforce Symposium on January 19-21, hosted over 100 participants! Through six educational sessions, we explored HRSA Workforce Initiatives, Strengthening Compensation through Pay Equity, policy updates impacting the workforce space, and of course the ever-popular attorney-led session on 2022 labor and employment law updates. We are thankful for our sponsors who supported the event and provided additional value to our members through their products and services.
Quality & Technology Conference
Nearly 150 individuals participated in the Virtual Quality & Technology Conference February 24-25. This event featured educational sessions on important topics such as patient engagement, quality assurance, quality improvement, data collection and analytics, and the strategic use of technology at health centers. The conference even included a virtual tradeshow component where attendees were able to attend live exhibitor presentations and schedule one-on-one meetings to learn more about the health center-tailored services and products that our sponsors and exhibitors offer.
Emergency Preparedness Symposium
The virtual Emergency Preparedness Symposium was hosted March 29-31, 2022. This event was an excellent forum for those responsible for emergency preparedness (EP) and response in community health centers to learn best practices, emerging trends, and the latest news and strategies to stay prepared. The theme this year was “diversifying our preparedness,” and educational sessions included an active shooter response training, mitigating cybersecurity threats, and an explanation of EP surveys and compliance with the Center for Medicare and Medicaid Services’ EP rule. The Chair of CPCA’s 2022 Clinic Emergency Preparedness Peer Network provided closing remarks after three days of learning.
In-Person Events
As we emerged from the pandemic and entered a period of recovery, we were excited to be back in person at the following events.
Day at the Capitol
Day at the Capitol, California Health+ Advocates’ signature annual event, was back in person on April 20, with 140 advocates and leaders from across the state convening at the State Capitol to engage in dialogue with legislators and legislative staff about budget and legislative priorities impacting community health centers (CHCs). Day at the Capitol is critical to CaliforniaHealth+ Advocates as a forum in which the voice of CHCs can unite and be heard. Participants attended legislative visits with their respective representatives to emphasize the importance of clinics in the current year’s budget and legislative session, in addition to expressing the vital need for administrative streamlining.
Financial Conference for Billing Managers and Chief Financial Officers
CPCA hosted the 2022 Financial Conference for Billing Managers and CFOs on May 17-20 at the Hyatt Regency La Jolla Aventine in sunny San Diego, CA. Nearly 350 participants convened to learn about topics related to the financial health and growth of health centers. Session topics included how to create a “learning organization” to achieve long-term success, envisioning the future of telehealth, preparing for Alternative Payment Methodology, and more. Attendees also networked with our valued sponsors and exhibitors and played Exhibitor Bingo for an entry to win awesome prizes. We are looking forward to seeing everyone again at our 2023 Financial Conference for Billing Managers and CFOs!
Region IX Clinical Excellence Conference
CPCA and the Western Clinicians Network partner each year to host the Region IX Clinical Excellence and Leadership Conference, which draws a variety of attendees from throughout the region including clinicians, chief medical officers, medical directors, dental directors, executive directors, board members, and state and regional partners. The 2022 conference was held on June 26-28 in Las Vegas, NV at the Green Valley Ranch Resort. Nearly 250 attendees gathered to network and learn about topics important to health center clinical and management teams, such as leadership development and improving overall efficiency and effectiveness in care delivery. Invited speakers from the National Association of Community Health Centers and HRSA presented timely information on the national landscape and updates impacting health centers in Region IX.
The Western Clinicians Network presented its Clinical Excellence Award and announced the changing of the Board of Directors. Immediate past-president Anitha Mullangi, M.D., MHCM, CPE, FAAFP was presented with a certificate of appreciation by incoming Board President Javier Luna, Ph.D, Director of Integrated Health Services at Winters Healthcare.
In addition to the rich content and peer learning sessions, conference attendees had the opportunity to network with their peers, visit with sponsors and exhibitors, and play Exhibitor Bingo during the conference reception. This conference is always a wonderful opportunity to connect with our regional partners and learn from each other!
Annual Conference
CPCA hosted our 2022 Annual Conference, Meeting the Moment: Moving Toward a Healthy Horizon, on October 27-28 in Sacramento, at the SAFE Credit Union Convention Center. Nearly 700 attendees spent two days learning about topics tailored to California’s community health centers and the diverse communities they serve.
CPCA hosted a pre-conference event, Meeting the Moment: Addressing Climate Change Now, to discuss the impact of climate change on the health of underserved communities and the urgent need to address climate change as an environmental justice and health equity issue.The two-day 2022 Annual Conference began the following day with a beautiful and moving land acknowledgment ceremony by members of the Wilton Band of Miwok Indians, followed by a warm welcome by CPCA’s President and CEO, Francisco J Silva.The event offered an array of sessions that focused on educational tracks important to community health centers on topics including Policy and Advocacy, Clinical and Care Innovations, Business Innovations, and Strategic Leadership.
We also honored our Hero and Legacy Awardees for their service and commitment to the mission of community health. Their work to advance our movement is truly inspirational! While honoring our legacy leaders for their outstanding careers, CPCA was also excited to welcome 20 emerging leaders through our new Health Center Scholars program. Scholarship awardees, including current health center medical residents, early career and frontline staff, and students, are aspiring to make an impact in their community through careers at community health centers. CPCA is proud to offer this program that covers the costs of attending our annual conference and provides ongoing peer learning and connection for the Scholars through an online community.
It was an absolute honor to hear from California’s Surgeon General, Dr. Diana Ramos, MD, MPH, MBA, FACOG, who provided important and timely state updates. We look forward to partnering with Dr. Ramos and the state to continue the work of achieving health equity!
Another highlight was hearing from our closing Keynote Speaker, Dr. Esther Choo, Professor of Emergency Medicine at the Center for Policy & Research at Oregon Health & Science University, who spoke of the importance of equity in the workplace. Dr. Choo provided sobering data while also providing examples of how to build a culture of both equity and organizational excellence.
In between educational sessions, attendees visited the “Wellness Spa Oasis” tradeshow to relax, renew, and network with their peers. Our sponsors and exhibitors truly embraced the tradeshow theme and gave away some awesome swag and prizes, in addition to the plethora of prizes that CPCA raffled off as part of the Exhibitor Bingo game!
It was wonderful to see everyone at our 2022 Annual Conference, which was our first in-person conference since 2019. Thank you to everyone who participated!
Join us in 2023!
We are so pleased with the outcome of our 2022 conferences. CPCA and our staff look forward to hosting these events each year as they provide a wonderful opportunity to connect with our members and create a sense of community. We are excited to see you in 2023! Information regarding our 2023 conferences can be found at: cpca.org
CPCA MEMBERSHIP
CPCA welcomed four new member organizations in 2021 – Elica Health Centers, Celebrating Life Community Health Center, St. Vincent de Paul Village Family Health Center, and Tender Care Community Clinic Inc. All new member organizations are participating in a comprehensive on-boarding process during their first year of membership to increase their engagement with CPCA and provide a proper introduction to the benefits of their membership.
In Fall 2021, CPCA launched a new CPCA Membership Ambassador Program. The program, that is on-going, proactive, and an intentional connection with members, was developed to increase engagement with as many members as possible for the purposes of maintaining and/or improving member retention, satisfaction, and ensuring all members see the value in participating with CPCA.
CPCA strives to be a strong Association, one that is built on staff and member partnership, developed through engaged members giving constructive feedback to staff to make informed decisions about the Association’s priorities. The program creates meaningful, rewarding, and insightful connections that promotes trust, increases the value of a membership, and enhances the member’s experience with CPCA.
Looking ahead to 2022,
CPCA Ambassadors will be reaching out to member organizations for a formal check-in and look forward to learning more about our member accomplishments and how CPCA can better assist members in any challenges they are facing.
CONSORTIA
Alameda Health Consortium
California Consortium for Urban Indian Health
Central Valley Health Network
Coalition of Orange County Community Clinics
Community Clinic Association of Los Angeles County
Community Clinic Consortium
Community Health Association Inland Southern Region
Community Health Partnership
Essential Access Health
Health Alliance of Northern California
Health Center Partners of Southern California
North Coast Clinics Network
Planned Parenthood Affiliates of California
Redwood Community Health Coalition
San Francisco Community Clinic Consortium
Southside Coalition of Community Health Centers
COMMUNITY HEALTH CENTERS
Alexander Valley Healthcare
Alliance Medical Center, Inc.
AltaMed Health Services Corporation
Altura Centers for Health
American Indian Health & Services
Ampla Health
Anderson Valley Health Center, Inc.
APLA Health & Wellness
Arroyo Vista Family Health Center
Asian Americans for Community Involvement
Asian Health Services
Asian Pacific Health Care Venture, Inc
Avenal Community Health Center
Axis Community Health
BAART Community Healthcare
Bartz-Altadonna Community Health Center
Bay Area Community Health
Big Sur Health Center
Borrego Community Health Foundation
Camarena Health
Camino Health Center
Celebrating Life Community Health Center
Center for Comprehensive Care Diagnosis of Inherited Blood Disorders
Central City Community Health Center, Inc.
Central Neighborhood Health Foundation
Chapa-De Indian Health Program – Corporate Office
ChapCare
Chinatown Service Center Family Health Clinic
Clinica De Salud Del Valle De Salinas
Clinica Monsenor Oscar A. Romero
Clinica Sierra Vista – Corporate Headquarters Office
Clinicas de Salud del Pueblo
Clinicas del Camino Real, Incorporated
CommuniCare Health Centers, Davis Community Clinic
Community Health Centers of the Central Coast, Inc.
Community Health Systems, Inc.
Community Medical Centers, Inc.
Comprehensive Community Health Centers, Inc.
DAP Health
Davis Street Primary Care Clinic
Dientes Community Dental Care
East Valley Community Health Center, Inc.
Eisner Health
El Dorado Community Health Center
El Proyecto del Barrio, Inc.
Elica Health Centers
Families Together of Orange County
Family Health Care Centers of Greater Los Angeles
Family Health Centers of San Diego
Family Health Matters Community Health Center
Family HealthCare Network – Corporate Office
Friends of Family Health Center
Gardner Family Health Network, Inc.
Golden Valley Health Centers
Harbor Community Clinic
Harmony Health Medical Clinic and Family Resource Center
Health and Life Organization, Inc. – Sacramento Community Clinic – Explorer
Hurtt Family Health Clinic – Orange County Rescue
Imperial Beach Community Clinic
Indian Health Center Of Santa Clara Valley, Inc.
Indian Health Council, Inc.
Inland Behavioral & Health Services, Inc.
Jewish Community Free Clinic
JWCH Institute
Kings Winery Medical Clinic / Greater Fresno Health Organization
La Clinica de La Raza, Inc.
La Maestra Community Health Centers – City Heights
LifeLong Medical Care
Livingston Community Health
Livingstone Community Health Clinic
Long Valley Health Center
Los Angeles Christian Health Centers
Los Angeles LGBT Center
MACT Health Board, Inc.-Corporate Office
Marin Community Clinic – Corporate Office
Mendocino Coast Clinics, Inc.
Mendocino Community Health Clinic, Inc.
Mission City Community Network, Inc.
Mission Neighborhood Health Center
Mountain Valleys Health Centers
Native American Health Center – Corporate
Neighborhood Healthcare
North East Medical Services
Northeast Community Clinic – Corporate Office
Northeast Valley Health Corporation
Northeastern Rural Health Clinics
OLE Health – Corporate Office
Omni Family Health – Corporate Office
One Community Health
Open Door Community Health Centers
Parktree Community Health Center – Village
Peach Tree Healthcare
Petaluma Health Center
QueensCare Health Centers
Ravenswood Family Health Network
Redwood Coast Medical Services, Inc.
Redwoods Rural Health Center
Ritter Health Center
ROADS Community Care Clinic
Saban Community Clinic
SAC Health System
Sacramento Native American Health Center
Saint John’s Well Child & Family Center
Saint Vincent De Paul Village Family Health Center
Samahan Health Centers
Samuel Dixon Family Health Center
San Benito Health Foundation
San Fernando Community Health Center
San Francisco Community Health Center Formerly Asian and Pacific Islander
San Ysidro Health
Santa Barbara Neighborhood Clinics
Santa Cruz Community Health Centers
Santa Rosa Community Health
School Health Clinics of Santa Clara County
Share Our Selves
Shasta Cascade Health Center
Shasta Community Health Center
Shingletown Medical Center
Sierra Family Medical Clinic
Sonoma Valley Community Health Center
South Central Family Health Center – Corporate Office
South of Market Health Center
Southern Trinity Health Services
St. Jude Neighborhood Health Center
T.H.E. Health & Wellness Center
Tarzana Treatment Center
The Children’s Clinic, Serving Children & Families
Tiburcio Vasquez Health Center, Inc.
TrueCare
Unicare Community Health Center
United Health Centers of the San Joaquin Valley, Inc.
Universal Community Health Center
University Muslim Medical Association (UMMA) Community Clinic
Valley Community Healthcare
Valley Health Team, Inc.
Venice Family Clinic
Via Care Community Health Center
Vista Community Clinic
Watts Healthcare Corporation
WellSpace Health
West County Health Centers, Inc.
West Oakland Health Council, Inc.
Westside Family Health Center
White Memorial Community Health Center
Wilmington Community Clinic
Winters Healthcare Foundation
EMERITUS MEMBERS
Carl Coan
Irma Cota
Susan Fleischman, MD
Harry Foster
Cathy Frey, MHA
Jose Joel Garcia, JD
C. Dean Germano
John Gressman
Nik Gupta
Ray Hamby
Mike Kirkpatrick
Marty Lynch
Tracy Ream
Gladys Sandlin
Stephen Schilling
Mike Sullivan
Sophie Wong
Peer Networks
CPCA understands the power of peer-to-peer learning, which is why we offered 23 different peer networks in 2022 for members to connect with peers who work in health centers throughout the state. These peer networks provide an opportunity to exchange valuable information, share best practices and templates, and provide feedback on state association activities, policies, and training programs.
340B Peer Network
Behavioral Health Peer Network
Billing Managers Peer Network
Chief Executive Officer (CEO) Peer Network
Chief Financial Officer (CFO) Peer Network
Compliance Officer Peer Network (COPN)
Consortia Policy Group (CPG)
Dental Directors Peer Network
Emergency Management Peer Network
Health Information Technology Peer Network
Health Professions Education & Training (HPET) Peer Network
HIV Prevention Peer Network
Human Resources Peer Network
Immigration Peer Network
IPA/Clinically Integrated Networks Peer Network
Justice, Equity, Diversity and Inclusion (JEDI) Peer Network
Marketing & Development Peer Network
Outreach & Enrollment Peer Network
Primary Care Peer Network
Public Affairs Peer Network
Residency Peer Network
Social Determinants of Health Peer Network
Statewide Quality Improvement Committee (SQIC) Peer Network
CPCA STAFF
Executive Leadership
Francisco Silva
President & Chief Executive Officer
Robert Beaudry
Executive Vice President & Chief Strategy Officer
Val Gotingco Sheehan
Senior Vice President & Chief Program Officer
Andie Martinez Patterson
Senior Vice President of Strategy, Integraion and System Impact
Dr. Michael Witte
Vice President & Chief Medical Officer
Leadership Equity
Buddy Orange
Senior Vice President of Justice, Equity, Diversity & Inclusion
Lizbeth Bayardo Cardenas
Assistant Director of Leadership Equity
Health Access & Quality
Cynthia Keltner
Vice President of Health Access & Quality
Allie Budenz
Director of Population Health Management
Takhmina Amin-Rahbar
Associate Director of Data Science
Peter Dy
Associate Director of Care Transformation
Yarin Gomez
Senior Program Coordinator of Care Transformation
Jeanita Harris
Associate Director of Data Science
Charlotte Labbe
Senior Administrative Coordinator
Deirdre McCallin
Director of Health Information Technology
Ekeoma Nwadibia
Senior Coordinator of Quality Improvement
Lucy Saenz
Deputy Director of Data Informatics
Jesus Torres
Program Coordinator of Data Science
Development & External Relations
Kearsten Shepherd
Vice President of Development & External Relations
Kokaale Amissah-Aidoo
Deputy Director of Events & Continuing Education
Kelly Cimino
Deputy Director of Marketing & Communications
Abby Nuño
Sponsorship & Tradeshow Coordinator
Ashley Owens
Assistant Director of Development
Courtney Rodseth
Marketing & Communications Coordinator
Tiffany Ruvalcaba
Assistant Director of Learning & Innovation
Ayo Taylor
Associate Director of Strategic Communications & Public Affairs
Rachel Tyberg
Event Coordinator
Finance & Operations
Ginger Smith
Chief Operationg Officer
Sonja Spowart
Chief Financial Officer
Christina Hicks
Vice President of Operations & Governance
Eva Avila
Finance Coordinator
Heather Barclay
Executive Assistant and Board Liaison
Glenna Davido
Senior Member Services Representative
Rosie Gilb
Director of People Operations
Victoria Gomez-Camacho
Executive Assistant
Jeanette Hernandez
Finance Coordinator
Shadi Kanaan
Assistant Director of Operations
Lydia Ossentjuk
Assistant Director of Finance
Becky Paplanus
Executive Assistant to the CEO
Erin Perry
Deputy Director Education & Training
Daniel Sanchez-Cruz
People Operations Specialist
Kimberly Yost
Deputy Director of Finance
Government Affairs
Beth Malinowski
Director of Government Affairs
Kelley Aldrich
Associate Director Legislative Affairs
Victor Christy
Deputy Director of Political Engagement
Dennis Cuevas-Romero
Vice President of Government Affairs
Marisa Melendez
Senior Administrative Assistant
Liz Oseguera
Assistant Director of Policy
Eric Paredes
Associate Director of Grassroots Advocacy
Laura Sheckler
Deputy Director of Policy & Regulatory Affairs
Marissa Vismara
Senior Policy Coordinator
Health Center Operations & Legal Affairs
Nataly Diaz
Director of Health Center Operations
Joseph Cachuela
General Counsel
Denise Alfaro
Senior Administrative Assistant
Amanda Carbajal
Associate Director of Health Center Operations
Michelle (Elle) Grant
Senior Program Coordinator of Licensing & Enrollment
Isaias Iniguez
Associate Director of Workforce Development & Special Populations
Mahnoor Khan
Associate Director of Legal & Regulatory Affairs
Mariselle Moscoco
Senior Program Coordinator Health Center Operations
Ivan Prado
Program Coordinator Health Center Operations
Emily Shipman
Deputy Director of Health Center Operations
Aracei Valencia
Program Coordinator of Health Professions Education
CPCA FINANCIAL STATEMENT
Summary of 2020 - 2021
(April 1, 2020 – March 31, 2021)
Consolidated Statements of Activities
CPCA and AFFILIATES
NET ASSETS WITHOUT DONOR RESTRICTIONS REVENUES:
| Grants and Contributions | $4,238,136 |
| Membership dues | $3,088,768 |
| Clinic support services | $1,259,836 |
| Contribution from acquisition of CalHIPSO | $1,244,725 |
| Paycheck Protection Program loan forgiveness | $892,100 |
| Conferences | $542,127 |
| Training and workshops | $355,680 |
| Interest income from loans | $164,783 |
| Interest and investment incomes | $7,011 |
| Other income | $127,091 |
| Net assets released from restrictions | $3,405,063 |
| Total revenues | $15,325,320 |
NET ASSETS WITHOUT DONOR RESTRICTIONS REVENUES:
Program Services:
| Clinic Operations Support | $9,707,406 |
| Legislative | $770,728 |
| Information systems and loan program | $800,149 |
| Total program services | $11,278,283 |
| Management and General | $1,817,920 |
| Total expenses | $13,096,203 |
| INCREASE (DECREASE) IN NET ASSETS WITHOUT DONOR RESTRICTIONS | $2,229,117 |
| NET ASSETS WITH DONOR RESTRICTIONS: Grants and contributions | $8,721,443 |
| Net assets released from restrictions | ($3,405,063) |
| INCREASE (DECREASE) IN NET ASSETS WITH DONOR RESTRICTIONS | $5,316,380 |
| INCREASE (DECREASE) IN NET ASSETS | $7,545,497 |
| NET ASSETS, Beginning of Year | $15,284,238 |
| NET ASSETS, End of Year | $22,829,735 |
ASSETS
| CURRENT ASSETS: Cash and equivalents | $13,179,519 |
| Grants receivable | $1,501,415 |
| Dues and accounts receivable | $564,239 |
| Current portion of loans receivable | $2,366,398 |
| Prepaid expenses | $141,814 |
| Total current assets | $17,753,385 |
| NONCURRENT ASSETS: Long-term certificates of deposit | $715,855 |
| Loans Receivable, Net | $10,182,482 |
| Property and Equipment, Net | $3,934,160 |
| Total Assets | $32,585,882 |
LIABILITIES AND NET ASSETS
| CURRENT LIABILITIES: Accounts payable | $488,821 |
| Accrued expenses | $441,376 |
| Deferred revenues | $77,926 |
| Current portion of loans payable | $340,150 |
| Total current liabilities | $1,348,273 |
| LOANS PAYABLE, NET | $8,407,874 |
| Total liabilities | $9,756,147 |
| NET ASSETS: Without Donor Restrictions | $15,801,153 |
| With Donor Restrictions | $7,028,582 |
| Total net assets | $22,829,735 |
| TOTAL LIABILITIES AND NET ASSETS | $32,585,882 |
2021 FUNDERS
Bureau of Primary Health Care
Blue Shield of California
California Health Care Foundation
California Food Policy Advocates
Sunlight Giving
California Department of Healthcare
Aurrera Health Group
John Snow, Inc.
Kaiser Permanente
Public Health Institute
Sierra Health Foundation
Health Net
University of California, San Francisco
University of California, Davis
The California Endowment
2021 ANNUAL SPONSORS
EXCLUSIVE
PREMIER
ELITE
TRIFECTA
