Primary Care Association Site Visit Report Template

TA Request Details

TA Request Number: TA002843

Grantee Information: Wyoming Primary Care Association (WYPCA) 118 Central Avenue Cheyenne, Wyoming 82001

Contact: Jan Cartwright jan@wypca.org 307-632-5743

Type of Visit: PCA Operational Site Visit

Date(s) of Visit: August 15-16, 2016

Consultants

(Ms.) Sip Mouden, Lead Consultant sbmouden@gmail.com

501-517-2591

Site Visit Participants Name Title Interviewed Entrance Exit

Jan Cartwright Executive Director YES YES YES

Brenda Burnett, MSN, RN

Mary Lynne Shickich

Clinical Quality Director

Health Policy/Community Integration Director

YES

YES

YES

YES

YES

YES

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Name Title Interviewed Entrance Exit

Hannah Wickey

Kathy Williams

Nathalia Drew

Stephanie Crist

Communications / O&E Manager and POC

Office Manager / Event Coordinator

Team Lead, State and Regional Partnerships Team

Project Officer

YES

YES

NO

NO

YES

YES

YES

REMOTE

YES

YES

YES

REMOTE

If an individual identified above participated by telephone instead of on-site, please state “phone” instead of “yes” in the appropriate box(es). N/A

If there is anyone with whom you requested an interview and the interview did not occur, please explain why the interview did not take place. N/A

Purpose of Visit

The PCA site visit process is used to verify whether and to what extent:

• The PCA is an organization that health centers can count on to provide the T/TA support they need.

• The statewide/regional T/TA activities conducted by the PCA are based on the identified T/TA needs of existing health centers.

• The PCA is conducting statewide/regional T/TA activities that have the potential to improve program compliance of existing health centers in the state/region.

• The PCA is conducting statewide/regional T/TA activities that can strengthen the clinical and financial performance and enhance the operations of existing health centers in the state/region.

• The PCA is conducting statewide/regional program assistance activities based on statewide/regional and/or national priorities (as defined in the most recent PCA Funding Opportunity Announcement (FOA) and approved work plan) for existing health centers and other interested organizations, where appropriate, regardless of PCA membership or grant status.

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Program Requirement Verification Review Summary

In circumstances where there is sensitive information (beyond a verification assessment) that must be conveyed to BPHC for a complete understanding and assessment of the PCA’s situation [or individual(s) within the grantee organization or Board], it should not be incorporated in the Site Visit Report, but rather conveyed to the PCA PO via a telephone call.

Program Requirement Verification Review

Verification Status

If Not Cite Issue(s)

Task Questions Used to Verify

1. T/TA activities based on identified T/TA needs

VERIFIED Pre-site/On-site Task 1

2. T/TA conducted to improve program compliance in at least 3 of 4 Program Requirement categories:

1. Need 2. Services 3. Management and Finance 4. Governance

VERIFIED Pre-site/On-site Task 2

3. T/TA conducted on Performance Improvement to strengthen clinical and financial performance

NOT VERIFIED

No specific T/TA provided to HCs for improving specific clinical and financial measures; all is generic training.

Pre-site/On-site Task 3

4. Information on Available Resources VERIFIED Onsite Task 4, Question 1

5. Special Populations VERIFIED Pre-Site Task 4, Question 3

On-site Task 4, Question 2

6. Collaboration/Partnerships VERIFIED On-site Task 4, Question 3

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Program Requirement Verification Review

Verification Status

If Not Cite Issue(s)

Task Questions Used to Verify

7. Emergency Preparedness NOT VERIFIED

No T/TA regarding Emergency Preparedness provided. No provisions for T/TA to HCs.

On-site Task 4, Question 4

8. Newly Funded Health Centers

If the PCA does not distinguish NAP and NF TA, please indicate this and provide a summary of NAP activities.

NOT VERIFIED

WYPCA had not provided, at the time of the Site Visit, specific implementation start-up T/TA in recruitment, billing #s, etc. to its NAP. Previous year, WYPCA did provide TA to communities developing NAP applications.

WYPCA did provide Board Development Training, UDS Training, and provided some information on Medicaid. No written details.

Pre-site Task 4, Question 1-2

On-site Task 4, Question 5

Program Requirement Verification Review Details When assessing PCA requirements, a requirement is either “Verified” or “Not Verified,” not “partially verified.” If any part of the requirement is not met, then the finding is “Not Verified.” Findings from the pre-site and/or on-site segments should be used to substantiate

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verification. Report should also address any innovations or promising practices identified, as well as areas for performance improvement. Finally, interview portion findings are summarized, though they do not contribute to verification status. Section 1. Verify that PCA T/TA activities are based on identified T/TA needs

Program Requirement #1 – Statewide/Regional Health Center T/TA Activities Conduct statewide/regional T/TA activities based on the identified T/TA needs of existing health centers in the following areas: (a) Program Requirements to improve program compliance of existing health centers in the state/region and (b) Performance Improvement to strengthen the clinical and financial performance and enhance the operations of existing health centers in the state/region. Verification Status: VERIFIED

Verification Review Findings: Review of 2015-2016 Written Needs Assessment Review of 2015 Work Plan Review of 2014 & 2015 Annual Conference Training Agenda Review of Evaluations of Trainings Offered During Annual Conferences & Webinars Use information placed in each “Response” section during pre-site and on-site segments process to substantiate fact-based findings. Explanation should address each question asked throughout the site visit process.

1.a) WYPCA’s process for identifying Annual T/TA needs in state/region included: • Working with CHAMPS in the development of the categories and questions to be

included in the Region 8 Needs Assessment • Participating with other Region 8 staff in determining new data elements • Identifying previous unsuccessful questions • Discussing refinement of Needs Assessment categories, and questions • Asking attendees of all Training Sessions and Webinars to state on the Evaluation

Forms what other needs the HC staff have/had for T/TA Training; • Asking HC CEOs/EDs and staff during “face to face” meetings to advise if they have

other T/TA needs • Verbal feedback regarding needs from WYPCA contract data needs consultant

1.b) WYPCA approach for on-going surveillance activities include, the following, but not all

inclusive sources: • Feedback from WYPCA Executive Director and Health Policy/Communication

Integration Director from attendance at, and Minutes from, Wyoming Joint Labor, Health, and Social Services Committee and Interim Committee

• Feedback from Consensus Revenue Estimating Group which looks at changes in Wyoming’s mineral industry & its impact on communities

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• Meetings with the Governor, Health Department, Medicaid, Office of Rural Health and the PCO, Medicaid Coalition members, Chambers of Commerce, Cancer Coalition, Heart Association and other state chapters of national organizations and associations; Medical Society, Hospital Association, Dental and Behavior Health

• Feedback from individual HC members, recommendations from WYPCA Board /Staff Committee regarding environmental changes and proposed policy and legislation that impact the FQHCs

• Feedback from CHAMPS, CCHN, other bordering states PCAs, HRSA/BPHC, NACHC, NRHA, and Integrated Work Solutions

Data sources for ongoing surveillance used include: Wyoming State Budget; Wyoming State Legislature Committee Minutes; Chamber Business Reports; BRFS; Data from Cancer Coalition; Heart Association; Department of Labor; Insurance Department; Region 8 Comparative Data Analysis Reports; Hospital Admissions and Discharge Data; UDS; HRSA/BPHC Conditions Report; NACHC, and NRHA. 2. WYPCA prioritizes its T/TA to be provided on a statewide basis based on:

• HC Top Challenges, as summarized in the Annual Needs Assessment. • SWOT Analysis from its Strategic Planning. • Those environment/public health and political issues that arise outside of the Strategic

Planning process and post the completion of the Needs Assessment. • WYPCA considers those needs that have the most probability of impacting the HCs’

viability and the patients and communities the Wyoming HCs serve when prioritizing its T/TA.

• Crisis intervention also impacts the WYPCA priority decisions for the provision of T/TA.

• HCs’ mission to provide equal access to quality primary and preventive health care to all underserved residents of the communities they each serve is paramount in that prioritization process.

WYPCA’s decision to provide T/TA statewide to all HC staff in one location/venue is very problematic as travel distance is as much as 6 ½ hours one way for several HCs, and the terrain and mountains between HCs and the PCA are sometimes not passable. Examples of WYPCA’s provision of statewide T/TA that reflect their system of prioritization include: Annual Conference Training on HC Board Roles and Responsibilities; Financial Considerations in Operating a Health Center; Strengthening Management Skills; Using Data and Leading With Data; Medicaid Updates and PPS; 340 B; Building a Strong QI Plan, and Preparing for Your HC OSV. All training provided was in response to the Statewide Needs Assessment. WYPCA assessed that providing Outreach and Enrollment Statewide Training and TA was critical, not only to help the HCs meet one of the identified Needs, as reported in the Statewide HCs’ Needs Assessment, but also to help the HCs in their readiness for Open Enrollment. The timing of when the Statewide training was held and the importance of assuring that all HC OEWs, Navigators, and Counselors heard the same message, directions, and guidance at the

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same time from Enroll America, Enroll Wyoming, and other Marketplace experts prior to Open Enrollment, were critical factors that impacted WYPCA’s decision to provide O & E Training and TA when it did. WYPCA also offered Webinars on Governance, ICD 10, and HPAA Webinars, which were also provided in response to the Wyoming HCs Statewide Needs Assessment. 3. WYPCA’s strategies used to meet the three identified T/TA needs of HC include:

• Host T/TA where most HC staff can come together to learn, network, and benefit from hearing each other’s questions and answers

• Offer T/TA via Webinars which can be “replayed” when HC staff have time to view if the time offered is not convenient for them and taking care of HC patients and administration

• Offer T/TA via WYPCA Bi-Weekly and Quarterly Communications • Offer T/TA to HC on a one on one basis

WYPCA offers Training within Annual Conferences and Regional Trainings; develops and hosts Webinars; provides or makes provisions for Technical Assistance in Governance, Needs Assessment/Data Collection, Clinical Quality and HC Financial Management; offers TA through its Bi Weekly and Quarterly Electronic Communications, and TA through links on its Web Sites. 4. WYPCA identified the following circumstances, issues, and innovations driving

state/regional priorities: • Recent major cuts in the state budget • No Medicaid expansion • Withdrawal of all insurance companies in the Exchange except BCBS • Elimination of the Oral Health Office • Decline in the mineral industry • Turnover in HCs’ EDs/CEOs • New Starts and other states HCs wanting to move into Wyoming to establish a NAP • HCs needing TA in Credentialing, QI/QA Plans, and Referral Agreements

WYPCA’s Needs Assessment does identify those areas of need that HCs need T/TA in to help them meet Program Requirements and improve their Clinical and Financial measures. If Not Verified- Steps/Actions Recommended for Improvement: Section 2. Determine whether PCA is conducting T/TA activities that improve program compliance

Program Requirement #1A. – Program Requirements T/TA Focus Areas PCAs are expected to assist existing health center grantees and Look-Alikes in the state/region meet Health Center Program Requirements. PCAs must provide T/TA in at least three of the following focus areas 1. Need, 2. Service, 3. Management and Finance, 4. Governance. The selected T/TA focus areas must align with the identified needs from the state/region.

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Verification Status: VERIFIED

Verification Review Findings: 1. T/TA Program Requirement from Need, Service, Finance, and Management and

Governance: The first of the three selected Focus Areas is Finance: The PCA Corresponding Goal is: Provide T/TA on workforce recruitment and retention of health center staff (e.g., health center managers, providers/staff, and board members).

a. WYPCA Goal targeted Recruitment of Providers, the 2nd Top Challenge out of 8 Top

Challenges, identified by WY HCs in the 2015-2016 Annual Needs Assessment. WYPCA did not use the BPHC State Conditions Report to determine this need for HC T/TA, but they did review the HCs’ Service Areas, the # of patients served, the unmet need, the capacity of the HCs to recruit providers, and the limited pipeline of primary care providers and clinical staff interested in working in Wyoming Health Centers.

b. T/TA activities provided by the WYPCA include:

• Developed and strengthened relationships with state, regional, and national organizations to secure recruitment and retention knowledge, information and tools to share with the HCs

• Facilitated trainings regarding effective recruitment and retention strategies • Developed a Resource Directory for each County that included recruitment

information in the Bi-Weekly and Quarterly Communications Bulletins: i. WYPCA collaborated with the Wyoming Department of Rural Health, the

Primary Care Office, Wyoming Resource Services, “Transition Assistance” Program Manager at F.E Warren Air Force Base, the Veterans Steering Committee, National Health Service Corp, CHAMPS, UW, and Wyoming Workforce Services, and with NHSC Ambassadors, local hospitals, medical society, nurses association, and the University of Wyoming Nurse Practitioner Program to acquire access to provider data bases as well as recruitment tools, resources and successful strategies and techniques. WYPCA uses its website, social media account, and Indeed.com. WYPCA facilitated training and technical assistance regarding best practices in recruitment and retention, tools and tracking processes, contract development and negotiation, and incentives.

ii. WYPCA shared that a contributing factor was its hiring of the

Communications/O & E Manager, who also is certified as a NHSC Ambassador, and the Clinical Quality Director, who is a MSN with many nursing and physician contacts through previous work experiences, and the hiring of its Health Policy/Community Integration Director whose experiences include working with hospitals and their providers and referring providers.

iii. WYPCA shared that a restricting factor to assisting the HC with meeting

their needs in Provider Recruitment is the needed financial resources to

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travel around the state and out of state to talk with and recruit potential providers to Wyoming and to the locations of the HCs.

c. WYPCA plans to continue their efforts of providing T/TA to the Wyoming HCs

regarding the tools needed, contracts, and incentive plans; outreach to Veterans and NHSC providers; develop a HC Provider Position Openings link on the WYPCA web site, as well as connect with other State PCAs to learn of their successful recruitment strategies and build those into the WYPCA planned recruitment and retention activities.

The second area of Focus is Need. The corresponding PCA Goal is: Provide T/TA in the development and implementation of periodic community and/or population needs assessments focusing on overcoming access issues, minimizing barriers to care and maximizing community collaboration.

a. WYPCA assessed the importance of the existing health centers and those communities interested in developing access to primary and preventive health care, to having a better understanding of how and where to collect population health data as well as how to interpret and use that data to further identify the unmet population health needs. The Health Centers identified during the Needs Assessment and during their Strategic Planning that they needed tools for data collection that will inform their decisions and quantify the unmet needs in their service areas.

b. WYPCA T/TA activities included:

• Provision of technical assistance to the health centers and communities through contracting with consultants who helped them understand UDS Data Mapper as well as components to a comprehensive Population Health Needs Assessment

• Offering how data factors into the comprehensive Population Health Needs Assessments during its 2016 Annual Conference Training on Social Determinants of Health

• Offered training of Leading with Data and Using Data to Drive Performance during its 2015 Annual Conference:

i. WYPCA collaborated with Utah Primary Care Association, NACHC, and

Department of Rural Health and the PCO in helping them determine the best resources for accessing available consultants who are experts in the field to provide the training, offer tools, and where and how to access the needed Population Health Data for their service area and state.

ii. WYPCA identified that a Contributing Factor was that their Annual

Conference was a successful venue for providing the HCs and community members with training and TA on data, data sources, and how to use and interpret that data, as evidenced by completed evaluations of the training sessions. WYPCA also identified that the number of communities requesting help with identifying Population Health Data has increased, as well as additional requests from existing HCs for more tools on data collection, analysis, and extrapolation were being received.

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iii. WYPCA identified that a Restricting Factor was the reticence of HCs to

share data.

c. WYPCA plans to continue to offer T/TA in Needs Assessment to the Wyoming communities wanting to increase access to affordable primary and preventive health care, as well as, to the Wyoming HCs, which are continually needing data to determine where the unmet needs lie to help them determine where they should expand services.

The third Area of Focus is Governance. The corresponding PCA Goal is: Provide T/TA on governance requirements for health centers (board authority, functions/responsibilities, composition, training, recruitment, and evaluation tools).

a. WYPCA determined Governance would be a major focus for it to provide, or make provisions for, training in this area, which was a result of the previous State Conditions Report citing Board Authority as an area that some HCs were not compliant as well as from the 2015-2016 Needs Assessment.

b. WYPCA T/TA included:

• Provided Introduction to Health Center Governance: Ensuring a Highly Effective and Efficient Board, and Preparing for your On-Site Visit (OSV) trainings during its May 2015 Annual Conference

• Developed and offered a webinar on Board Governance Training in April 2016 • Conducted Board Development Training in January 2015 • Conducted Board Development Training in November 2015

i. WYPCA used its previous collaborations with NACHC, CHAMPS, Feldsman Tucker, and other experts in the development of the WYPCA training in Board Governance Training.

ii. WYPCA’s contributing factor was that HCs were requesting assistance in

order to ensure that their conditions were met, as well as a desire for a higher functioning Board of Directors. Another contributing factor the WYPCA stated was that Wyoming has increased the number of HCs and that the need for initial and refresher Board Governance Training was included in the Needs Assessment.

iii. WYPCA notes that the distance some HCs are from Cheyenne is as much as

6 ½ hours, and that for others, the terrain that HC board members must drive often times prohibits them coming to Cheyenne for training, thus the decision to develop a Board Governance webinar.

c. WYPCA does have plans to continue to offer Board Governance Training to not only

include Board Authority, but also Roles and Responsibilities, and Preparing for the HCs OSV.

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2. State Performance Profiles: No, the Program Requirements Goals listed on the HRSA/BPHC State Performance Profile are not reasonable, given the fact that there have been two of the now eight HCs experiencing turnover of senior leadership, specifically the CEO; the addition of a New Start, and three of the eight FQHCs are Special Populations with two of those CEOs also serving as CEOs of larger organizations. In addition, provider longevity ranges from two months to four years, with two of the HCs providing primary and preventive health care with “locum” providers, and three of the HC providers have been there for one year. Many of the providers were not working with the HCs when previous T/TAs were provided regarding clinical measures, MU, PCHM, QI/QA, and other clinical quality initiatives, and few HCs CEOs and financial staff were in attendance at the Financial Management trainings offered by the WYPCA. While the HCs aspire to reach The Healthy People 2020 Goals, the attainment of those goals in less than three years is not realistic based on the HRSA/BPHC Wyoming Performance Profile as follows:

• Four of the then six HCs met or exceeded one or more Healthy People 2020 performance measures:

o Two of those HCs that met or exceeded one or more of the Healthy People 2020 performance measures had only 33.3% of the children immunized; the goal is 80%.

o One of those HC’s diabetic patients had HbA1c less than or equal to 9%; the goals is 83.9%.

o None of those HCs’ cervical cancer screenings is 93% or higher. o None of those HCs’ hypertensive patients had blood pressures of 140/90 or

less; the goal is 61.2% or higher. o Two HCs’ percentage of low birth weight babies was 7.8% or lower. o Two HCs served prenatal patients in the 1st trimester; the goal is 70.5% or

higher. o None of the HCs conducted colorectal cancer screenings; the goal is 70.5%.

• Two of the then reported six Wyoming HCs attained PCMH • Three of the six HCs have on-going financial concerns. • Two of the six have cost increases less than the national average.

3. WYPCA Methods and Frequency for Evaluating T/TA include written evaluations after

each training and webinar as well as verbal comments shared with the WYPCA. Evaluation of TA provided by contract consultants is currently determined by the contract completion per the terms of the contract deliverables and time frames. Additional evaluations are verbally expressed by HCs to the WYPCA Executive Director. Currently, the method for evaluating the value of the WYPCA provision of TA has been via verbal assessments from the HC and their request(s) for additional TA from the WYPCA.

4. Evaluation of T/TA information is used by the WYPCA in:

• Determining the usefulness of the training in helping the HCs meet their needs • Revising/refining the training objectives to ensure the needed information is conveyed by

the speaker the next time the content/topic is requested • Determining if WYPCA wants to bring the speaker/presenter to provide additional

training /technical assistance

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• Validating that WYPCA is meeting its HRSA/BPHC Cooperative Agreement requirements of providing T/TA to its HC members and other non-member WYPCA HCs in the state

5. WYPCA used BPHC resources to leverage other resources, such as, state funding and

contracting with professional consultants to provide T/TA. WYPCA also uses BPHC resources for: • Acquiring information, tools, and data • Developing partnerships and collaborations focused on protecting the health center

mission • Conducting outreach and in-reach and enrollment in Medicaid and the Exchange • Enhancing primary and preventive health care the health centers provide • Providing assistance to health centers in serving special populations • Working on arrangements for specialty care access for the health center patients • Supporting the continuum of care • Facilitating data collection, aggregation, and analysis • Facilitating health centers working together • Assisting with workforce development • Conducting surveillance of the state political landscape • Raising the awareness and educating businesses, communities, state leaders about HCs

and the public health policies needed for the health centers to be the safety net providers as well as the provider of choice and employer of choice

Use information placed in each “Response” section during site visit process to substantiate fact-based findings. Explanation should address each question asked throughout the site visit process. If Not Verified- Steps/Actions Recommended for Improvement:

Section 3. Assess whether PCA is conducting T/TA activities that improve health centers’ clinical and financial performance measures

Task 3 – Program Requirements T/TA Focus Areas PCAs must annually conduct statewide/regional Performance Improvement T/TA activities relating to both clinical and financial performance. The selected T/TA activities must align with the identified needs of the state/region and enhance the operations and clinical and financial performance of existing health centers in their state/region. Verification Status: NOT VERIFIED

Verification Review Findings: 1. WYPCA provides, or makes provisions for, T/TA in performance improvement of the HCs

clinical and financial measures. The selected Focus Area is Clinical. The WYPCA corresponding goal of the Focus Area is: Clinical Measures-Provide T/TA to Health Center

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Program grantees on how to improve clinical performance on one or more clinical performance measures (e.g., Outreach/quality of care and health outcomes/disparities).

a. T/TA activities PCA provided to achieve its goal - NONE i. PCA did not indicate in its Work Plan that it would collaborate with state

and regional organizations to achieve the goal of helping the HCs improve clinical performances on one or more clinical measures. WYPCA did not identify which specific clinical measures it would help HCs achieve and/or improve. • WYPCA Work Plan states that “QI Staff and consultants would work

with quality improvement to ensure that all HCs have tools to continue their work on quality outcomes”. WYPCA did not state specifically what tools would be used, nor did it state what the HCs quality outcomes are and would be after T/TA. WYPCA Work Plan stated that the HCs reportable outcomes will show improvement in number and scale. WYPCA did not state what specific reportable outcomes of which clinical measures would show improvement in number and scale. WYPCA used vague terms “numbers and scales” and did not define.

• WYPCA Work Plan states that it will engage and provide tools to several newer HCs to begin the conversation about PCMH designation and the importance of monitoring quality improvement measures. WYPCA does not state specific quality improvement outcomes or improvement in any specific clinical measures. WYPCA did not stipulate what tools it will provide.

• WYPCA Work Plan states it would work with HC leaders on data sharing and aggregation to allow for quality best practices and benchmarking. WYPCA did not state best practices in“what”, nor did WYPCA provide clarification as to what would be “benchmarked” much less state at what level. WYPCA did not indicate what data it wanted the HCs to share. WYPCA did not produce any evidence that it addressed data sharing with the HCs, what best practices they wanted to develop, and what measures the HCs wanted to Benchmark. WYPCA does not have signed DATA SHARING Agreements with the HCs.

ii. Contributing Factors: NONE

iii. Restricting Factors:

• WYPCA did not identify specifically from the State Performance Profile which clinical measures it would assist the HCs in improving.

• WYPCA did not extract from the 2015-2016 Needs Assessment which clinical measures the HCs indicated they needed T/TA to help improve.

• WYPCA did not identify specific clinical measures it would help the HCs improve. WYPCA did not employ a Clinical Quality Director until two months ago.

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• WYPCA did not engage a Clinical Consultant to provide T/TA to help the HCs develop strategies and processes that would help them improve specific clinical measures

• WYPCA did not consult CHAMPS or other PCAs regarding how they are/would provide T/TA to the HCs to help improve their HCs Clinical Measures

• WYPCA does not have signed DATA SHARING Agreements with the HCs.

2. The WYPCA develops a set of questions for each participant to evaluate the trainer and the

content of the training. Each conference/training attendee is requested to complete the evaluation after each training session, regardless if the trainer is a volunteer, the WYPCA Clinical Quality Director, a HC provider or nurse, an invited health care partner, or a paid contract expert/consultant.

3. The results of the training evaluations are used:

• By the WYPCA in determining if the topic was of value to the HCs in meeting their T/TA needs as previously identified in the Annual Needs Assessment

• To determine if WYPCA would want to invite back that presenter/trainer or recommend that trainer/presenter to other PCAs to provide training

• In the WYPCA Strategic Planning • To validate that it is implementing its strategies and activities as outlined in the Work

Plan • To validate that the training was useful to the HCs in meeting their training needs for

improving their clinical and financial measures

4. WYPCA uses BPHC resources to leverage other resources to help health centers improve clinical and financial measures by contracting with Clinical Experts as well as negotiating with other entities and organizations to support Conferences and Individual Trainings provided to help the HCs with understanding how to improve their processes that would impact the HCs in improving their clinical and financial measures.

Use information placed in each “Response” section during site visit process to substantiate fact-based findings. Explanation should address each question asked throughout the site visit process.

If Not Verified- Steps/Actions Recommended for Improvement: 1. Recommend that WYPCA develop Data Sharing Agreements and secure the written

signatures on those agreements from each HC. 2. Recommend that WYPCA revise its Work Plan to include specific quality improvement

processes and activities that the Clinical Quality Director will implement and/or facilitate the implementation of those activities that will help the HCs increase (or decrease) each of the clinical measures identified by the Wyoming HCs in the 2015-2016 Needs Assessment and

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in the BPHC Wyoming Performance Profile. The outcomes must be quantifiable, measurable, and also reasonable so that the HCs will achieve/realize them by a specific date.

3. Recommend that WYPCA revise its Work Plan to include specific quality improvement

processes and activities that WYPCA will implement and/or facilitate their implementation. Those activities will help the HCs increase (or decrease) specific financial measures identified by Wyoming HCs in the 2015-2016 Needs Assessment in which they wanted T/TA to help them increase (or decrease). In addition, the activities should also specifically address each of the BPHC Wyoming Performance Profile financial measures. The outcomes must be quantifiable, measurable, and also reasonable so that the HCs will achieve/realize them by a specific date.

4. Recommend that WYPCA develop a system for prioritizing the TA that WYPCA will

provide, or make provisions for contract consultants to provide the needed TA. 5. Recommend that WYPCA develop a system for tracking, monitoring, evaluating, “re-group,”

and cancelling, if necessary, any TA activity that it directly provides, or make provisions for contract consultants to provide.

6. Recommend that WYPCA develop a system for “closing the loop” after training or TA is

provided, as well as determining when to follow up with a HC to learn if it implemented any of the processes and strategies offered during the TA and/or if the HC noted any improvement.

Section 4. Verify PCA is conducting program assistance activities based on set priorities

Task 4 – Program Requirements T/TA Focus Areas PCAs must annually conduct activities under ALL statewide/regional Program Assistance T/TA focus areas: information on available resources, special populations, collaboration, emergency preparedness, newly funded health centers. Verification Status: VERIFIED 1. Information of Available Resources

a. WYPCA ensures that all interested health centers, regardless of PCA membership or grant status, receive resources and information through WYPCA Quarterly Communications Bulletins, web site access, notices of training topics/dates/times/locations, notices of webinar topics/dates/times, and O & E activities.

b. WYPCA reaches out to non-member HCs and look-a-likes through phone calls, e-mails,

WYPCA Quarterly Communications Bulletins, and visiting with those non-member HCs and look-a-likes.

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c. WYPCA uses its web site, radio, e-mails, Facebook, Quarterly Communications Bulletins

and announcements in partnership meetings, community meetings, fairs, church meetings, and events.

d. Viewed several online platforms WYPCA uses to communicate with HCs.

2. Special Populations

a. WYPCA designated its Communications/O & E Manager to serve as the point of contact

(POC) for special populations. The POC integrated special populations work into outreach and enrollment.

b. WYPCA coordinates with special/vulnerable populations NCAs by creating a work plan

that placed a focus on Native populations: 1. Assisting health centers near reservations with finding a qualified certified

application counselor 2. Assisting Migrant Health Center with getting their assister program up and

running 3. Updating its current outreach and enrollment handbook with enrollment factors

that are specific to Native Americans

c. WYPCA co-hosted a webinar on collecting SO/GI data for LGBT patients with 11 states and CHAMPS, the Region 8 PCA.

d. WYPCA built relationships with organizations that can help WYPCA learn more about the needs of the migrant communities, the need for access to affordable quality health care, and how WYPCA can help meet their unique needs.

e. WYPCA also co-planned and executed a health fair targeting possible migrant and Spanish-speaking individuals in the communities to ensure that they are knowledgeable where they can access affordable quality and culturally sensitive primary and preventive health care.

f. WYPCA featured Wind River Reservation during its Annual Training Conference in 2016. Former IHS Director presented the unique needs of the Tribal populations as well as provided updates about the Wind River Reservation.

3. Collaboration-Partnerships with state agencies, PCO, Medicaid

a. Successful collaborations and resulting T/TA: i. Medicaid- Jim Bush, Medicaid Medical Director provided Updates in

Medicaid to HC attendees at the WYPCA Annual Conference May 2016.

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ii. Wyoming Department of Health –PCO and Office of Rural Health work with WYPCA on HPSA scoring and workforce development with NHSC.

b. WYPCA uses the identified needs of its HCs to establish collaborative partners,

priorities, and activities: i. “Recruitment of Providers” was identified by the HCs who completed the

2015-2016 Needs Assessment Survey as its #2 Top Challenge. WYPCA developed a collaborative partnership with University of Wyoming Department of Nurse Practitioners to work with WYPCA of recruiting ANPs. Ann Maria Hart, PhD, FNP-BC, presented during the WYPCA Annual Conference May 18, 2016 an overview of the ANP practice, licensure law regarding scope of practice and prescription writing, clinical rotations, and recruitment issues.

ii. WYPCA’s collaborations and partnerships with the NHSC, Wyoming

Health Resources, and the Wyoming Department of Health enabled WYPCA to bring representatives in from each to present “Everything You Want to Know About Recruiting” during the WYPCA May 2015 Annual Conference.

c. “Continuous Quality Improvement”. One hundred percent of the Wyoming HCs that

completed the 2015-2016 Annual Needs Assessment Survey rated the need for T/TA in Continuous QI as “high,” and 100% of the HCs rated “credentialing” as the #4 Top Challenge HCs face. WYPCA contracted with Julie Vlasis Consulting Services to present “Building a Strong QI Program” during the May 2016 Annual Conference.

d. As a result of the numerous partnerships developed by WYPCA staff with local hospitals,

WYPCA facilitated the HC staff to work with the credentialing departments of the local hospitals for TA on credentialing processes.

4. Emergency Preparedness:

a. How HC emergency preparedness needs are assessed before, during, after an emergency WYPCA is not assessing the needs before, during or after an emergency.

b. How WYPCA coordinates at the regional, state, and community level before, during, and

after an emergency. WYPCA is not coordinating at the regional, state or community level before, during and after an emergency.

c. How PCA demonstrate emergency processes/tools used to engage HCs before, during, and after an emergency. WYPCA did not demonstrate emergency processes or tools it used to engage HCs before, during, and after an emergency.

Recommend that WYPCA develop an Emergency Preparedness and Response Plan that they will follow before, during and after an emergency or disaster.

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Recommend that WYPCA do the following, which is NOT an all inclusive list, (but a start to brainstorming on what must be done) PRIOR to developing the WYPCA Emergency Plan and PRIOR to implementing that Plan in offering T/TA to HCs:

• Talk with CHAMPS and other PCAs and request a copy of their respective Emergency Preparedness and Response Plans to use as a guide in developing WYPCA’s Plan

• Develop a list of emergency contacts and phone numbers • Develop relationships with State Emergency Preparedness and Response staff with the

state and governor’s office • Learn roles and scope of responsibilities of state, regional, and local communities

Emergency Preparedness and Response staff as well as the governor’s office • Learn what supplies and other resources will be available to whom and how to secure

same • Learn what medications are “stockpiled,” the location(s) of those meds, and how to

access same • Learn how state and governor’s office communicate with command centers • Learn where each of the command centers are located and their range of coverage. • Learn how command centers communicate with each other as well as with the state and

local governments (consider all barriers, such as no electricity, cell towers, and/or satellites)

• Learn how WYPCA and the HCs can communicate with each other and the closest command centers

• Learn what is expected of Primary Health Care Providers, hospitals, VA, and other health care providers

• Learn what FQHC providers can do within Scope of Practice and their FTCA coverage • Learn how the “Good Samaritan” Law impacts the FQHCs • Learn what law enforcement, Army, Air Force, National Guard, and others who protect

do as well as how and when they are dispatched, and by whom • Learn what HRSA, NACHC, Direct Relief and other national organizations do/provide • Learn what agencies and organizations offer trainings in how to respond to shootings,

chemical spills, bomb threats, flooding, and other life threatening events • Learn what agencies and organizations teach self defense, safety, and other proactive

approaches in the event of an emergency or disaster. • Discuss what HCs will need during an emergency or disaster. Such items may include

bottled water, blankets, pillows, canned food, canned openers, OTC medications, first aid kits, clothing, personal items like soap, deodorant, toilet paper, and other supplies

• Discuss what HCs will need after an emergency or disaster • Develop a contact list with key emergency phone numbers • Learn which state, regional and local organizations conduct “Emergency Desktop Drills”

and their availability to train the HC staff • Learn which state, regional, and local organizations conduct “Simulated Drills” and their

availability to train the HC staff Recommend that PRIOR to developing and implementing the WYPCA Emergency Preparedness and Response Plan that WYPCA:

• Ask the HCs if they have a written Emergency Preparedness and Response Plan

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• Request copies of the HCs’ Emergency Preparedness and Response Plans • Ask each HC what T/TA they need:

o Before an emergency or disaster o During an emergency or disaster o After an emergency or disaster

Recommend WYPCA incorporate and link its Emergency Preparedness and Response Plans to the Wyoming HCs Emergency Preparedness and Response Plans. 5. Newly Funded TA:

a. One of the currently eight grantees in the state/region was funded during the last three

months. Three of the HCs were funded within the last one to two years of the project period.

b. How WYPCA reached out to the newly funded grantee(s). WYPCA did not reach out to

each of the HCs to provide TA in New Start Development; WYPCA did provide Governance: Board Roles and Responsibilities training and webinars. WYPCA also provided UDS training and ICD-10 training, and information on Medicaid.

Recommend that WYPCA develop a “Health Center Start-Up Tool Kit” that contains the following, but not all inclusive information, documents, resources, samples, acronyms and key contact information:

• HC Financial, Human Resource, Clinical and Operations Policies and Procedures • Steps to follow in acquiring a Medicare Provider # and Medicaid Provider # • Recruitment Tools • HC Position Descriptions • HRSA/BPHC Reporting • O & E In-reach and Outreach • Board Governance Training • 19 HRSA Program Requirements • PINS and PALS • QI/QA Plan –Template • Credentialing and Privileging • FTCA • NHSC • Samples: Patient Satisfaction Survey • Services Provided By WYPCA and How to Access • WYPCA Member Application

Verification Review Findings: Use information placed in each “Response” section during site visit process to substantiate fact-

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based findings. Explanation should address each question asked throughout the site visit process. If Not Verified- Steps/Actions Recommended for Improvement

Section 5. Innovative/Promising Practices

Indicate any of the PCA’s promising practices or innovations that were noted at any point throughout the site visit process. Areas of promising practice could include data sampling techniques, organizational culture, an effective initiative with their health centers, or leveraging HRSA funds. WYPCA Communications/O & E Manager: 1. Developed and made available to all Navigators, CACs, and In-Person Assisters an Outreach

& Enrollment Resource Manual. 2. Partnered with the Department of Corrections to be part of the Re-entry Program for

incarcerated adults to help with education about and enrollment in coverage. 3. Used earned media through radio spots to educate public about Marketplace Health Care

Coverage and encourage enrollment. 4. Partnered with the Boys and Girls Club and elementary schools to increase enrollment in

health care coverage. 5. Purchased and placed in strategic locations around the various towns drop boxes to

encourage consumers to make an appointment with In-Person Assisters. 6. Partnered with organizations that would help connect Assisters with consumers. 7. Surveyed all Assisters about their experiences during open enrollment and shared the results

with all Assisters, Navigators, and CACs during debrief meeting. 8. Integrated special populations to include Native populations, LGBT, migrant, Spanish

speaking individuals into Outreach & Enrollment Strategies and Action Plans. 9. Refined WYPCA web site to be “mobile friendly” with links and popups related to O & E. 10. Facilitated training conferences and arranged Enroll America, Enroll Wyoming, CMS,

Medicaid, CHIP, CHAMPS, Department of Insurance, Exchange Insurance Companies (now down to one), the Institute for Population Health, HHS HRSA Region 8, Center of Budget and Policy Priorities, Office of Multicultural Health, Wyoming Health Council, St. Johns Hospital, Teto Co. Public Library, CAPN, and experienced Navigators, Assisters and Counselors to address the attendees and answer questions.

11. Hosted numerous O & E conference calls with HCs O & E leads. 12. Added O & E as “Hot Topics” in the Bi-Weekly and Quarterly Communications Bulletins. 13. Created and ensured the development of several O & E webinars, which included, but are not

limited to: • Streamline Applications for Medicaid and CHIP • State Specific Plan Selection

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Section 6. Targeted TA Recommendations This section addresses areas that were identified as verified and meet BPHC funding requirements, but the consultant identifies as having room for potential performance improvement. Consultant should indicate both specific reasons this area was identified for improvement and methods to address improvement. WYPCA does not have written contract procedures that the WYPCA must follow when procuring services, technical assistance, training, and consultation, etc. from a consultant or consulting Firm. WYPCA does not have written procedures regarding the evaluation of all trainings offered to its HCs. WYPCA does, however, conduct written evaluations of every training and webinar offered. WYPCA does not have written procedures regarding the monitoring and evaluation of TA provided to its HC members. WYPCA conducts only verbal feedback from a HC on TA provided by its staff and by a contract consultant, but that feedback is not consistently acquired for each TA provided. WYPCA does not have specific criteria that must be included in a WYPCA consultant contract and memorandum of agreement (MOA). Recommend that WYPCA develop written policies and procedures for procuring services, goods, trainings, technical assistance, grant development, etc. from consultants. Recommend that WYPCA develop written policies and procedures regarding the monitoring and evaluation of TA provided to HCs and evaluation of trainings and webinars provided to the HCs. Recommend that WYPCA develop a list of specific criteria and safe guards that it should include in any consultant contract and in any MOA. Such criteria may include, but not be limited to, the following:

• Overall purpose of the contract/MOA o Training o Technical assistance o Assessment o Resources o Grant review and edit o Grant development o Policy and procedure development

• Desired qualifications of consultant, trainer, grant writer, etc. • Specific objectives (what is the consultant supposed to do-action oriented, measurable) • Time frames • Expected outcomes-deliverables

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o Report (includes the action taken to achieve the objectives, resources provided and to whom, results of the TA, recommendations, etc., follow up required)

o Training presentation outline o PowerPoint o Handouts

• Time frames for drafts (if applicable), final deliverables • Terms for payment • Penalties if consultant does not meet deliverables and time frames

WYPCA provision of T/TA for helping the HC meet Performance Requirements was verified. However, WYPCA does not have a system for prioritizing what T/TA should be provided when where, and how. WYPCA does not have a written system in place for identifying and tracking what TA is provided when and to which HC or by which WYPCA staff person, much less have a mechanism in place that stipulates what topic/issue that generated the TA, or a mechanism for all WYPCA staff to know what was said or done as TA. Recommend that WYPCA develop a system that tracks what TA is provided to which HC, the topic/issue, the date, and by which WYPCA staff. Ensure that all WYPCA staff have access to the system to enter information and view what other WYPCA staff have done. Recommend that WYPCA develop criteria and a system for prioritizing what T/TA should be followed when providing T/TA to HC members and nonmembers. Follow up by PCAs in this area is optional and will be discussed with PCA PO during ongoing monitoring. PCAs may consider using their targeted TA days to address identified improvement areas. Section 7. Budget Review Provide a summary budget review based on Pre-Site Analysis Task I. Questions 3-5. Pre-Site Analysis Task 1 Question 3. WYPCA Budget Details and Narrative a. Budget reasonable in relation to the PCA’s planned activities and staffing plan for the

Budget Period:

WYPCA Budget Line Item “Travel” includes a grand total of $106,000 for in-state and out of state travel for WYPCA staff, consultants, Board Chair, Board members and staff of HCs. Specifically, four round trips for the PCA Board Chair to attend four conferences at a budgeted amount of $2,300 for each trip plus support for newer HC staff on an “as needed basis” totaling $35,000. A total of $6,500 budgeted for Board in-state travel of ten round trips. In-state and out of state travel totals $12,700.

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The budgeted expenses for Board travel and new HC staff travel do not tie back to the WYPCA Work Plan activities described and who is responsible for implementing those activities.

The description of several contracts in the last three years of the WYPCA budgets do not tie back to the Work Plan activities and who is responsible for implementing those activities, which include $22,850 to “Revenew” (Health Center Marketing) and $31,267 and $33,000 to “SigmaMed” (Lean Principles).

b. Budget within the targeted funding level? YES

Recommend that WYPCA create a system of checks and balances when developing its Work Plan to include, but not be limited to: identifying the targeted areas for T/TA from the Needs Assessment, State Performance Profile, and the State HC Conditions Report when developing the WYPCA Work Plan activities, and when developing the WYPCA Budget to include in the line item justification how each line item will enable WYPCA to accomplish the Work Plan activities and who is responsible for those activities.

Question 4. T/TA Contracts and Agreements Obtained with BPHC funding

a. Purpose and scope of contracts and agreements accomplish PCA FOA requirements.

WYPCA provided the list of all 2014, 2015, and 2016 contracts and agreements. The list included the name of the contractor, the purpose, and the amount of each. All contracts and agreements relate to the WYPCA activities and FOA requirements with the exception of three. The description of those three contracts do not reflect the Work Plan activities. Those three contracts were for Health Center Marketing ($22,850) and for Lean Principles TA ($31,267 and $33,000).

b. Timeframe for contract(s) agreements correlate with BPHC funding project period.

Dates of the WYPCA contracts and agreements included in the lists were for a one time only specific date, one year date, and two to three years, such as with the lease and auditor. Consulting agreements for ICD-10 training, Board Governance Training, Data Support for New Access, and WYPCA Financial Consultant are for three years and two years.

Question 5. Key Management Positions-Changed Since Last PCA Application

Executive Director – 5/2014 (With WYPCA since 9/2009) 100% time Reviewed resume

Discussed onsite roles and responsibilities

Clinical Quality Improvement Director – 5/2016 100% Time Reviewed resume

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WYPCA did not send position description (PD) Discussed onsite roles and responsibilities Reviewed Work Plan, which addresses functions in T/TA in Clinical Quality Measures, PCMH, Emergency Preparedness, Telehealth, ECHO, HIV, Cancer Screenings, and other chronic diseases

Outreach & Enrollment/Communications Manager – 8/2014 100% time Reviewed resume Did not review PD Discussed onsite roles and responsibilities Reviewed O & E Work Plan presented on site Health Policy/Community Integration Director – 2014 65% time Reviewed resume Reviewed PD Roles and responsibilities included in PD Qualifications included in PD Reviewed T/TA to HC Document Health Policy/CI Director provided onsite Office Manager/Event Coordinator – 2013 100% time Reviewed resume Did not review PD Discussed onsite roles and responsibilities Section 8. Health Center Interviews PCA: Wyoming Primary Care Association Dates Interviews Conducted: Tuesday, July 26 – Friday, July 29, 2016 Interviewees: 1. Cheyenne Health & Wellness

a. CEO b. Clinical Operations Manager c. Business Office Director

2. Community Health Center of Central Wyoming

a. Program Director b. Case Manager/Outreach c. COO

3. Powell Health Center

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a. CEO b. OE Specialist

4. Community Action of Laramie

a. Program Director b. Case Manager/Outreach

5. Sweetwater County Community Health Center a. Interim CEO

Question Average Rating & Summary of Ratings

Response Summary

Have you accessed PCA T/TA or other program assistance activities in the past 3 years?

1. If no, why not 2. If yes, on a 1-5 scale

how accessible are PCA T/TA or program assistance activities

Does the PCA T/TA address key issues your health center has encountered by assisting with: 1. Meeting or maintaining compliance with program requirements 2. Improving Clinical and/or financial performance? As a result of the PCA’s T/TA are you: 1. Experiencing fewer HC program requirement compliance findings 2. Experiencing more ease in maintaining compliance 3. Better able to achieve your

If “yes” 1=very inaccessible 2 3=somewhat accessible 4 5=very accessible 5 = 3 HCs 4 = 2 HCs 1: Y/ N Y = 5 HCs N = 0 HCs 2: Y/N Y = 4 N = 1 1: Y/N Y = 4 HCs Not sure = 1 HC 2: Y/N Y = 4 HCs Not sure =1 HC

Several of the HC interviewees wanted to share what activities they have participated in. To highlight a few mentioned: Annual Conference, Multi-Cultural Training, Assister Training, BOD Training, UDS and ICD-10 Trainings, NCHCW, Webinars, Bi-Weekly Communications, Quarterly Board Meetings, and 19 Program Requirements. WYPCA sat in on OSV and appreciated being there. WYPCA provided 19 PR Training prior to the OSV. Brenda is the new Clinical Director who is helping with clinical performance. WYPCA needs a financial person to work with us on financial performance measures. Consultants help. We will wait and see how we do with our OSV. Now that WYPCA has a Clinical Director, we will be able to work together on QI processes for improving clinical measures.

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Question Average Rating & Summary of Ratings

Response Summary

HC clinical or financial goals 4. Experiencing more ease in achieving clinical or financial performance goals Has the PCA supported your health centers PCMH accreditation process Have you been contacted for/participated in a T/TA needs assessment by the PCA Have you been asked by the PCA about emerging issues affecting your health center?

3: Y/N Y =3 Not sure = 2 HCs 4: Y/N Y = 3 HCs Not sure =2 HCs Y/N Y = 5 Y/N Y = 5 Y/N Y = 5

WYPCA needs to hire a financial staff person to work with HCs on financial measures. Consultants give the broad brush overview, which is very helpful, but need more. WYPCA is very supportive of the HC achieving PCMH status, although the state of Wyoming has not placed a great deal of emphasis on its importance; FQHC Look-A-Like has attained PCMH status. WYPCA works with CHAMPS to conduct an Annual Needs Assessment. Prior to sending out the NA, WYPCA calls and asks us what questions we think should be on the Survey. WYPCA staff asks us whenever we talk with them, what do our HCs need and how can they help? WYPCA asks in the evaluations of each training session and webinar what other T/TA do we need? They ask us what needs we have after we have been meeting with them and others on different projects or issues. WYPCA asked how state budget cuts would impact the HC and the patients we serve. WYPCA shared that Medicaid was not being expanded and that the state eliminated oral health funding and asked what impact that would have on our HCs and our patients’ access to oral health. Jan contacts us frequently. She called to ask how merging providers and partners might impact us. Hannah worked with us to get ready for Open Enrollment.

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Question Average Rating & Summary of Ratings

Response Summary

On a 1-5 scale, do you feel the PCA has supported coordination and collaboration among existing health center and/or safety net providers? Has the PCA assisted in emergency preparedness If applicable, on a 1-5 scale, has the T/TA provided by the PCA been helpful in meeting your HC’s unique special populations needs? For newly funded health centers only. a What TA was provided? b On a 1-5 scale, how helpful has the T/TA provided by the PCA been for your newly funded health center? PCA QUESTIONS: Have the recent Annual Training Conferences met your training needs of your Health Center?

1=not at all 2= 3=somewhat 4= 5=very much supported 5 = 2 HCs 4 = 3 HCs 3= 1 HC Y/N Y = 2 HCs Don’t Know =3 1=not at all 2 3=somewhat 4 5=very much 4 = 4 HCs 3 = 1 HC 1=not helpful 2 3=somewhat helpful 4 5=very helpful 3 = 2 HCs No Response = 3 HCs 1=not all 2= 3=somewhat 4 5=very

Time constraints. WYPCA could do a better job of planning ahead—not last minute. Sometimes, there is no direction. CHCs need to share what they have learned. WYPCA does a great job networking the CHCs with other providers and state agencies. Medicaid Expansion is a great example. Difficult to do as some HCs are 6 1/2 hours away from others. Don’t know that WYPCA has done anything. Maybe they should develop a Webinar on HIPAA and one on ER. Did send out an email about being cyber prepared. Very helpful in working with the migrant population, learning about native Americans, the homeless, and veterans. Wyoming doesn’t have a very good count on the number of homeless, however. WYPCA was a strong advocate for Sweetwater. WYPCA worked with another PCA to get help on data. Each HC has unique special population needs. Board Development Training, UDS Training, draw down issues, Medicaid, where to go for answers regarding outreach and enrollment. If they don’t know the answers, they research and get the answers or connect you to someone who does. Great Job. Appreciate all the work the WYPCA does. Did not attend. Speaker at Annual Conference used a California model. NOT possible for Wyoming. WYPCA should have briefed the speaker on Wyoming.

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Question Average Rating & Summary of Ratings

Response Summary

Does the WYPCA provide training and support for Health Center OEW efforts?

4 = 3 HCs 3 = 1 HC 2 = 1 HC 1=not all 2= 3=somewhat 4 5=very 4 = 3 HCs 3 = 2 HCs

Don’t be like NACHC. Make content more relevant to Wyoming. WYPCA needs to understand HC staff. HC Board members attended and got “nothing” out of the Conference. If Hannah doesn’t know the answer, she will find the answer for us. Great getting us all together to learn processes and rules and the “how to.”

Documents Reviewed Prior to the Site Visit, and to a limited extent during the Site Visit if necessary, the Lead consultant and secondary consultant review a variety of PCA documents. This review and analysis is primarily preparation for the Site Visit, to get as much of an understanding of the PCA as feasible from the materials and a thorough grasp of exactly what additional information would be needed on-site to complete the verification process. The Lead consultant will identify the documents needed from the PCA and PCA Project Officer (PO) to facilitate the review and achieve the Site Visit’s purpose (e.g., the approved work plan, activities, and performance measures Please put a bolded “X” by each of the BPHC and PCA documents in the list below that were reviewed prior to and/or during this Site Visit: BPHC Documents PCA Documents Original grant application ____

Three Work plans __2__

State performance profiles X

Clinical performance measures: past and present __X__

Financial performance measures: past and present __X__

Most recent progress report __X__

1. PCA website for reviewing any TA offerings, including members only access __X__

2. PCA Strategic Plan __X__ 3. Most recent organization chart and staffing plan ____ 4. Compliance and clinical/financial performance data ____ 5. Needs assessments documents, including a summary _X___ 6. Sample minutes from selected peer networks, if any _N/A 7. T/TA tools for two T/TA activities for each of the following areas

(total 4-6 sample TA activities): a. Program requirements __X__ b. Identified performance improvement measure ____ c. Newly funded health center* TA (if applicable) ____ d. T/TA tools submitted should include:

i. Evaluations _X___ ii. Attendance __X__

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State conditions report _X___ iii. All materials shared with participants ____

*Newly funded health center (NF)- received H80 funding for the first time during the project period. If the PCA does not distinguish New Access Point (NAP) and NF TA, please indicate this and provide a summary of NAP activities.

Provide a list of any additional documents reviewed prior to and/or during the Site Visit:

Document Title Web Site Link (if applicable) Date Document Purpose Review

Purpose WYPCA Annual Conference Agenda WYPCA Annual Conference Agenda WYPCA Annual Conference Agenda Summary of TA provided by Policy/Community Integration Director to

May 17-18, 2016 May 5-7, 2015 May 6-8, 2014 8/2016

Agenda Topics and Speakers For the WYPCA Annual Conferences Agenda Topics and Speakers For the WYPCA Annual Conferences Agenda Topics and Speakers For the WYPCA Annual Conferences Showcase TA regarding 5 of the 19 HRSA Program Requirements provided by WYPCA

Match up topics to Needs Assessment, Work Plan, and HRSA State Performance Profile Same as above Same as above Validate that the WYPCA is providing more TA,

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Document Title Web Site Link (if applicable) Date Document Purpose Review

Purpose HCs relevant to HRSA 19 HC Performance Requirements Written explanation of how WYPCA creates Needs Assessment with CHAMPS and Member Input List of all WYPCA contracts, with whom, amount, date, and purpose Outreach & Enrollment Work Plan and Activities T/TA Fiscal & Program Management Work Plan Goal WYPCA By-Laws

8/2106 8/2016 7/ to 8/15 2016 8/15-8/16 1/21/2105

not in Work Plan Explanation of Needs Assessment Development Accounting of all WYPCA contracts Detailed Plan of O&E /Communications Work Plan that describes T/TA; WYPCA will provide in the development and implementation of QI/QA systems to include risk management, FTCA, credentialing, patient satisfaction, and quality care reporting WYPCA By-Laws which are the policies of the Board of Directors

valuable TA than what is in the Work Plan Answer how the Annual Needs Assessment is created Part of Budget Review and matching up expenses to Work Plan Showcase all the O & E activities planned & implemented Showcase all the planned and implemented QI/QA activities Review of the Executive Director’s Authority

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