For this feature, we interviewed Carolyn Witherspoon, Executive Director of Coalition of Health Services in Amarillo, Texas.  Carolyn has served on the NCHN Board for seven years and served as President from 2011 through 2012. This year, Carolyn was recognized as NCHN's Outstanding Network Leader of the Year.

Q: The Coalition of Health Services has been around since 1996. Can you talk a little about its beginning and its growth into an organization that provides many valuable services to the Texas Panhandle? Throughout the process, how has the vision evolved?

The Coalition of Health Services was organized in February 1996 and incorporated as a 501(c)(3) not for profit organization in October 1997. There are currently 14 hospital affiliates, serving twenty-six counties. These hospitals are geographically located from Dalhart in the northwest Texas Panhandle to Childress, Texas in the southeast. The administrative office of the organization is located in Amarillo, Texas.

The purpose of the Coalition of Health Services is to enhance rural health through coordinated and collaborative efforts of the member rural health care facilities, their partners and to support ongoing rural health initiatives in individual communities. This effort includes preventive and public health endeavors, as well as, primary health care delivery through the establishment of comprehensive medical homes for every resident. Opportunities have arisen to provide basic public and preventive health services, the institution of services that were new to specific sites (such as prenatal care), and the simultaneous infrastructure development and modeling of a successful network of rural health entities. These entities now serve over 400,000 people living over a sparsely populated 26,000 square miles.

COHS' vision is, “Strengthening healthcare providers to build healthier communities.” The vision continues to evolve as we explore opportunities which will benefit providers and communities of the Panhandle of Texas.

One of the forces which drew the Coalition together originally in 1996 was the Title V program. It was determined this project would better serve the communities and health care facilities if the dollars were administered thru one agency rather than each provider or clinic requesting the funds individually. This grant served 41 counties of Public Health Region 1 and 1 county in Region 2, over the years as programs have decreased so have the number of counties. The Coalition currently employs 14 fulltime and 2 part time employees.

Q: COHS’ coverage area is quite large. Did the network form with the intention of covering the 32 counties that you now serve or did the network’s coverage area expand over time? How do you coordinate services for 32 counties and overcome the transportation barriers that are inherently involved in doing so?

We administer or subcontract the following services in 26-32 counties:

• PRIMARY HEALTH CARE
  The PHC program provides prevention-oriented, education-based primary health care to Texas residents who otherwise could not receive such care.  Eligibility is limited to those residents whose gross family income is at or below 150% of the Federal Poverty Income Guidelines (FPIG) and who do not qualify for any other programs or benefits that provides the same services.
• BREAST AND CERVICAL CANCER SERVICES
  The BCCS program targets women 50 – 64 who are at or below 200% of poverty. It enables women to access quality screening and diagnostic services for breast and cervical cancer and assistance with accessing treatment for qualifying breast or cervical diagnoses. This is accomplished through an extensive network of contractors and private and public stakeholders. BCCS funds provide for early detection for women at highest risk of dying from breast and cervical cancer.
• TEXAS HOME VISITING PROGRAM       
  The purpose of this program is to support the development and implementation of home visiting programs in at risk communities in Texas; and contributes to the development of a comprehensive early childhood system that promotes maternal, infant, and early childhood health, safety, and development, and strong parent-child relationships in these communities. Potter County was one of the selected communities and the Coalition has partnered with three agencies for these services.
• CARE for KIDS
  This program offers outreach and education for children’s Medicaid in 26 counties. Contact is made to each new or recertified client thru telephone, mail or in person to assure the client knows the resources available to them.   Though we do not determine eligibility for this program, we do offer assistance with the application process as well as information about the program.
• UNITING PARENTS 
  This program is a parent case management program for families of children with chronic illnesses and/or disabilities. Uniting Parents offers a network of support to families caring for children with chronic illnesses and/or disabilities.  Staffed by a program director, administrative assistant and trained parents, Uniting Parents provides families in the upper 32 counties of the Texas Panhandle the resources they need to help their children. The program is designed to empower families and enhance their children's quality of life providing information, education, training, referrals, networking and support.
• CSCHN RESPITE
  This program provides opportunities for families of Children with Special Health Care Needs enrolled in the Uniting Parents program to participate and receive access to short –term respite.  Respite assists parents to keep their child at home, preserve and strengthen the family, provide care during short term emergencies, rebuild marital relationships, reduce stress, provides opportunities to participate in other activities and more. The mission of CSCHN Respite is to strengthen the family unit by providing respite and resources while allowing the child to be a part of his community not apart from his community.

In addition to the above services we work closely with the Benefit Bank of Texas to assure residents are receiving benefits they are potentially eligible to receive. We continually look for opportunities to implement other programs or projects in addition to partnering and collaborating with other organizations.

Q: In your time as Executive Director – and from your perspective – what are your greatest accomplishments?

The fact the organization has been in existence for 17 years and maintained the majority of the original members is a major accomplishment. Three of the original programs have also been in existence since the Coalition was formed. I recently celebrated my 15th year having first started as Quality Assurance Coordinator and moving 2 years later into the role as Executive Director. The collaborations and the partnerships we have been able to establish have been very beneficial both personally and professionally. The challenges have and continue to be funding.

Q: You are just ending a seven year term on the NCHN Board of Directors. That included serving as NCHN President from 2011 through 2012. What is the biggest change you have seen in NCHN over the years you have served on the NCHN board?

I joined NCHN a couple of years after I became ED. This has been one of the best organizations I have ever been associated with. At the time I became a member I was learning (and still am) what it was to be an Executive Director of a nonprofit organization. The synergy in the room at my first meeting was unbelievable and when I saw the “bullwhip” being passed to the new president I knew I wanted to learn more and become involved. I have always enjoyed the networking which occurs at meetings, learning of other networks programs and models which have been shared all across the country.

One of the biggest changes I have seen over the years has been in the NCHN leadership from the involvement of the Board of Directors, to the members to the phenomenal leadership of our current Executive Director Rebecca Davis. When I was serving as your President it was Rebecca who kept everything on track and made my job easy. Having just completed my Board term and as I reflect back on the years of my service it is difficult to think what my life is going to be like. NCHN is doing great things through the partnerships and programs which have been implemented and I know it is only going to get better. It has been a privilege and honor to serve and work with such great people. A Big Thank you to all of you, it takes each one being involved to sustain and continue the work of NCHN.

The future success of NCHN is going to be upon each of the members including myself. I challenge each of you to get involved, serve on a committee, participate in the quarterly calls, attend the leadership summit AND the annual conference. NCHN is YOUR support center!

And a personal note from Carolyn:

Dear NCHN Board of Directors, Awards Committee and Members,

Words cannot begin to express my appreciation for being selected as the 2013 Network Leader of the year. I am humbled and honored to be joining the previous recipients whom I have looked up to since the inception of this award.

It has also been an honor to have served on the Board of Directors for seven years. This has been a remarkable group of people whom I have had the privilege to work with and serve.

My prayer is for God to Bless each of you Abundantly during this coming year as you serve your communities.

I look forward to seeing all of you at the Leadership Conference in the fall and the annual conference next year.

Sincerely,

Carolyn

 

For this feature, we interviewed Carolyn Bruce, Executive Director of Western Healthcare Alliance in Grand Junction, Colorado. In 2011, Carolyn was recognized as NCHN's Outstanding Network Leader of the Year. Under her leadership, WHA has grown to become a profitable, multi-million dollar network with four separate limited liability companies and a staff of over 75 employees. WHA is comprised of 26 full members and 39 affiliate members. In addition, WHA is a founding member of NCHN!

 

Q: WHA is one of the founding members of NCHN.  How much has WHA grown in the last 18 years and, if you had to pinpoint one factor that facilitated WHA’s success, what would it be?
A: First, we are so proud to have been a part of NCHN and see how much it has grown as an organization.  What began as a small forum for network directors to come together and collaboratively discuss issues has developed into a comprehensive resource for new and established networks across the country.  Props to Executive Director Rebecca Davis for her strong leadership and providing direction for a very dynamic group of organizations.

We like to think about our success as a three-legged stool with each prong working together for a solid foundation that allows WHA to deliver top return on investment for the dues and time members put into the organization.  The prongs are financial strength through revenue generation, metrics for value-based outcomes , and utilizing effective leadership through our board governance.  You could say the top of the stool is that we never wait for 100% consensus before moving forward on a program that will benefit a significant portion of our membership – we implement.

Q: How would you summarize WHA’s primary functions or focus and in what tangible ways does it affect rural health in Colorado?
A: We strengthen the financial operations of healthcare organizations so they can better serve the health needs of their individual communities.  We do this by providing programs and services that generate not just cost savings, but actually cost transformation.  We work with corporate partners who understand the need for facilities to make decisions at the local level while remaining committed to providing the highest level of care regionally.

Q: WHA is a relatively large network. How many members do you have? What are the challenges and benefits of  your composition?
A: At present, our membership includes 26 full members in Colorado and 39 affiliate members in California and New Mexico.  Members are primarily acute-care hospitals in community and rural settings, along with mental health providers, independent physician associations, health technology organizations and a health plan.  Providing services for a large and diverse membership gives us the ability to work with a wide range of programs through our corporate partners as well as build our own services.

Q: WHA also manages Healthcare Management, which is a NCHN Business Partner. What is the connection between the two organizations?
A: Western Healthcare Alliance has been a self-sustained organization for over 15 years due to our unique business model:  WHA members formed a Limited Liability Corporation (LLC) to house for-profit activities and called it Healthcare Management.  The company was created when members identified a need in the early nineties to provide their own centralized revenue cycle services and chose to build their own where they could have management input in a company uniquely tailored to the needs of health providers. Once exclusive for members, Healthcare Management now provides services to over 200 clients across the country and features a share-back fee to help fund other newly founded and established health networks.

Q: One question that we’ve been asking on Coffee/Tea Chats and will be asking prior to the Conference is, “What keeps you up at night?” What are you currently working on or facing that sticks in your mind?
A: We are concerned about two major challenges facing our members and the best ways we can provide assistance.  First, we are monitoring closely the potential impacts of state health insurance exchanges on reimbursement levels.  Secondly, we’re working closely with members on the future of managed care contracts and how changes will influence their bottom lines.  We are thinking a lot about how we can bridge the environment between cost, reimbursement, and quality outcomes. 

 

Q: What advice do you have for other networks who are working toward a sustainable business model?
A: Begin immediately thinking about potential revenue streams.  Even if your network is devoted solely to clinical programs, give thought to how you can diversify and build a multifaceted portfolio of services that serve your members.  NCHN provides a excellent forum for reaching out to other directors who have generated a phenomenal amount of success within their networks, so don’t be afraid to ask others about their strategies.  The most successful networks we’ve seen over the last 18 years are those that nurture their flagship program while always being innovative and providing relevant new programs.

CHEERS: A Tennessee Rural Partnership Program

For a number of years, the Tennessee Primary Care Association (TPCA) was the recipient of a federally funded SEARCH grant (student/resident experiences and rotations in community health) to support rural/underserved rotations for health professions students and medical residents. The SEARCH program was terminated in September 2012. However, due to the successes of the administration of the SEARCH program by TCPA and the Tennessee Rural Partnership’s (TRP) rural rotation program, a consensus was reached by the leadership of these groups that a joint program would be developed to focus on the most efficient and useful strategies and resources of each organization and their partners.

Funding for the program’s continuation will be provided by TRP. The goal of the new program will be to encourage rural practice rotations to provide better access to primary care in the state of Tennessee. The new program, to be called CHEERS (community health educational experiences for residents and students), will focus on the pipeline approach of reaching out to students and residents to cultivate an interest in practicing in rural or underserved areas. The organizations also will help provide a seamless transition from student/trainee status into the practice of medicine, which is consistent with the mission of both organizations.

CHEERS will utilize social media to attract and track participants as they continue their education and enter practice. For additional information about the program, contact Mary Ann Watson, Network Director, at maryann.watson@tnrp.org.

This week, we interviewed NCHN's President, Heather Fuller, Executive Director of the 2011 NCHN Network of the Year, Sunflower Health Network. We asked some questions about her membership with NCHN and experience on the Board, as well as what has made SHN so successful. Heather has been a member of NCHN for over 7 years and has served as President since April 2012.

Q: You have led the Board as the 2012 – 2013 NCHN President. That gives you a unique perspective on both the organization and its members. How do you see NCHN growing and in what direction would you like to see the services move toward?

A: NCHN has grown so much over the past 7+ years that I have been involved- due in large part to NCHN’s executive director, Rebecca Davis, and dedicated staff.  NCHN has become more involved on the national level with partner organizations such as NRHA and ORHP.  I look forward to more and even stronger partnerships and collaborations on projects that will benefit our members. 

Q: What do you most value about your experience on the Board?

A: From my 3 years on the board, I absolutely treasure the contacts and friendships I have made.  I can pick up the phone and call any of them if I have a question or need advice on an issue.  Being on the board has also made me aware of all of the benefits and opportunities that NCHN has to offer.

Q: What is/are the most valuable aspects of your membership in NCHN?

A: I think I might need more space to answer this question!  There are so many valuable aspects of NCHN.  Obviously, the people are the biggest value.  NCHN members are always so willing to share resources and help a friend.  I also think the annual conference is a huge value.  I look forward to it each year to learn new ideas, see friends, and hear what is going on at the national level.  I also appreciate the membership calls, list serve, coffee chats, and leadership learning calls. 

Q: Sunflower Health Network was the recipient of Outstanding Health Network of the Year in 2011. What factors have made SHN successful and sustainable?

A: I think what has made the Sunflower Health Network sustainable over the last 20 years is our board of directors.  There is such a high level of trust among the members and a commitment to making sure healthcare in the region is as effective and efficient as possible.

Q: What advice do you have for newer or newly forming networks and network leader?

A: My advice would be to get involved: attend the NCHN conference, join a committee, network with other leaders-anything you can!  The more involved you are, the more you will learn and gain from the organization. 

Q: What do you most look forward to at the NCHN Conference next month?

A: I am looking forward to the NCHN annual conference next month to see old friends, meet new network directors, and learn new ideas from the great sessions that have been planned by the conference planning committee!  I’m also looking forward to a little warmer weather!

Q: What are SHN's main areas of focus? What new projects are you considering?

A: The purpose of the SHN is to improve the effectiveness and efficiency of healthcare in our region.  We offer many programs and services including physician recruitment, group purchasing, group health insurance, equipment maintenance, department director education (radiology, lab, materials, nursing, quality, IT, CFO, clinic managers, etc.).

Over the next year, we plan to offer LEAN training for members; explore palliative care; and education on physician-hospital relationships and what we can do as a network that we can’t do individually.  We also plan to partner with one of our members to work on drug/alcohol detox in the region and evaluate the need to offer a credentialing service to our members.

For this feature, we interviewed the 2012 New and Emerging Network Leader of the Year, Toniann Richard, Executive Director of the Healthcare Collaborative (HCC) of Rural Missouri. We asked her questions about her current work and impact, as well as future plans and, of course, her thoughts on being a 2012 Award recipient. In her time with HCC, Toniann has worked to grow her network significantly as well as support other networks. In addition to serving on the NCHN Board of Directors, she is involved in numerous other community initiatives. She is a mother, network director, community builder, and wellness promoter. Her energy is contagious. (On a side note, we recently spotted her (via Facebook) waking up at 3:15 AM to go to the gym.)

 

Q: What is your #1 leadership guideline?
A: Regardless of your position in the network I believe every person has an equal voice. Those collective voices, along with hard work daily, build success. Our programs are owned by the employees. They are the ones doing the work in the community and with the network partners. If they don't own it it would be difficult to grow and sustain it.

 

Q: In what ways do you see HCC tangibly affecting your region?
A: HCC has added 9 FTE jobs in the last 8 years with 7 of those being since November 2010. The economic impact of HCC in rural Missouri is powerful. We are very proud of our financial balance and plan to continue that stability.

Q: In what areas do you want to have a larger impact? Are you/HCC considering undertaking any new initiatives? If so, what are your next steps?
A: HCC has been growing over the last five years. We are now at a point that sustainable programming is the key. Determining our areas of impact took several years. Working hand in hand with our board of directors to ensure that the Network stayed within areas they could support financially and from a leadership standpoint was critical. We believe that our clinic project will be our largest area of impact from a care delivery standpoint.

Q: What are your biggest challenges and how have you overcome them?
A: There is so much work to be done in rural healthcare. Trying to figure out the balance of action on that work continues to be a challenge. Our team does our best to look at the healthcare spectrum as a whole and determine how best to address the issue through collective impact style programs. The more collaboration we have on programs the more successful they tend to be. Without our partners we would struggle to meet the needs of the community and network partners.

Q: What are HCC’s major areas of focus?
A: HCC is focused on access to care. We have recently broken our network into five key areas: Care Coordination, HIT/Telehealth, Advocacy, Workforce, and Clinic Management. The diversifying nature of the network will allow us to address access to care issues across the spectrum.

Q: What do you most look forward to at the NCHN Conference next month?
A: Seeing all my Network friends!! I am also very interested in the evaluation pre proposal session. We have been focusing on evaluation over the last few years and it is wonderful to see it all come together!

Q: Last year you were recognized as the New & Emerging Network Leader of the Year? Were you surprised? How did your staff react?
A: Yes I was very surprised!! To me, one of the highest honors is to be recognized by my peers. To know that someone took the time to nominate me was humbling! My staff were happy, they are a phenomenal team and it is because of the HCC staff and board I am able to work on growing the network. Without their leadership I would not be able to spend time building the capacity within our network.

 

To find our more about HCC of Rural Missouri, go to www.hccnetwork.org

In October 2012, we welcomed Katharine Terrie, formerly with North Country Health Consortium, as an associate member. Find out more about NCHN's newest member in the interview below.

 

You have spent much of your career working with health networks. In your career with health networks, what lessons stand out for you the most and what have you learned about health networks that you would like to share?
KT: For the past 30 years, I have worked with organizations dedicated to improving access to health care in rural areas, first in Southern West Virginia and more recently in Northern New Hampshire. I have learned that in rural areas, which in most cases are synonymous with under-served areas, the most cost effective and cost efficient way to provide health care is for health care providers, including rural health clinics, community health centers, critical access hospitals, home health agencies and other providers of care to work in a collaborative fashion to serve their patients. Only when providers share resources within a network, can access be improved and health status indicators improve.

What are some of the qualities of health networks that are invaluable/irreplaceable?
KT: As stated above, the bulk of my experience is with rural health networks composed of safety net providers serving under-served populations. Safety network providers, specifically community health centers (whether FQHC or look alike) and critical access hospitals, have put the profit motive aside to concentrate on their patients – a trait not usually seen in a for-profit, private practice environment. Moreover, these for-profit providers are not usually interested in becoming part of health networks. Community health centers, and critical access hospitals whether in a formal network on simply dedicated to working together have the best chance of reaching the unserved and under-served populations residing in their service areas.

How did you come to work with health networks and what were some of the unique challenges your network/s faced?
KT: In 1978 I moved back to my home state of West Virginia from 15 years in Washington, D. C., to help implement the National Health Planning and Resource Development law which created state Certificate of Need programs, state health planning agencies and health systems agencies. Part of the intent of the National Health Planning law was to address improving access to health care through a collaborative effort dedicated to planning and allocating health care resources based on demonstrated need and a focus on improving access to health care through collaboration. Such collaboration was demonstrated through the strict requirements imbedded in federal law that all appropriate providers be represented on the boards advising the state health planning agencies and the health systems agencies operating within each state. In addition, Certificate of Need decisions made at the local level were required to be made by a cross-section of providers and consumers. In fact consumers were a part of the decision making process at all levels of state and local health planning carried out under the auspices of the National Health Planning law.

I spent ten years working for the state health planning agency and the health systems agency in West Virginia and then in a health system agency in Ohio until President Reagan repealed the law in 1986. One only has to look at the dramatic increases in the costs of health care after that time to understand that planning and allocating of health care resources in a collaborative environment worked. I have taken the many lessons learned during that time and have applied them to work as a private consultant to safety network providers in both West Virginia and New Hampshire and in ten years as the Director of Development for the North Country Health Consortium serving consumers and providers in Northern New Hampshire. Upon my retirement from the Consortium two years ago, I went back into the consulting business to write grants and provide management services to rural, not-for-profit health care and human service providers.

 

In what ways would you like to support health networks and in what ways can NCHN support you?
As an associate member of NCHN, I would like to share the expertise and experience with other rural health networks. I would also like to participate in the RHNR Consulting Program.

Connect with Katharine Terrie