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The Source for

Housing Solutions

January 26, 2017

Health Center and

Supportive Housing

Expansion

© All rights reserved. No utilization or reproduction of this material is allowed without the written permission of CSH.

Our Mission

Improve lives of vulnerable

people

Maximize public resources

Build strong, healthy

communities

Advancing housing solutions that:

GOALS:• Foster and expand

Health Center

collaboration with

other health system

stakeholders, and

supportive housing

• Improve healthcare

outcomes for extremely

low-income

individuals who

frequently use crisis

systems, have housing

instability, and lack a

connection to primary

and preventive care

services.

Webinar Series

Direct Technical Assistance

Online & In-Person Trainings

Peer to Peer networks

Resources

PARTNERS:Deep collaboration

with

Also partnering

with:

NACHC

CHPS

HRSA BPHC

CSH HRSA Frequent User T/TA

Visit us on the Web: www.csh.org/hrsaTA

http://www.csh.org/hrsaTA

Today’s Panelists

Jack Cheng, VP Health Care Services,

HealthRIGHT360, San Francisco CA

Michael Crawford, Chief of Staff, Unity

Healthcare, Washington DC

Jonathan Chapman, Director Advisory

Services, Capital Link

Jill Steen, Sr. Loan Officer, CSH

Jane Bilger, Senior Program Manager, CSH

Today’s Topic and Objectives

1.

Understand health and housing partnerships

2.

Effective planning for health and housing facility expansions

3.

Hear from health providers in the field partnering on locations with supportive housing

Housing = Health Care

• Social determinants of health are personal, social,

economic and environmental factors that affect a

wide range of health, functioning, and quality-of-

life outcomes and risks.*

• Studies demonstrate that stabilized housing with

services for vulnerable populations - those cycling

through our communities’ crisis care systems –

can positively impact health and quality of life

outcomes, and achieve cost savings (avoidance)

across the systems.**

*Healthy People 2020, Dept of Health and Human Services, 2010

**”Housing is the Best Medicine, CSH 2010. 2010

The Strongest Health Care Intervention

for Frequent Users is Housing

XXXXXXXXXXX

XXXXXXXXX

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Potential Reasons for Partnering

Identify potential clients through data sharing

Access to and funding for services

Understand target populations’ health and service needs

Access to potential engagement sites

Improve health outcomes through coordination

Advance resident stability and recovery

Developing partnerships

Stage I: Make the Case

Stage II: Make it Happen

Stage III: Make it Work

Stage IV: Make it Last

Types of Partnerships

Referrals

• Client referrals to preferred services

• Client initiated

• Partners retain autonomy and operations are independent; resources generally not shared

• Low collaboration

Care Coordination

•Client Centered joint care plans

•May include centralized intake

•Client initiated with strong transition supports

•Organizations operate independently but may share resources and funding

•Moderate to high collaboration, with cross-training and frequent communication

Co-Location

•Health center operates satellite or full center on-site at supportive housing or shelter

•Wrap-around care housed in a site that tenants access for various services

•Partners operate jointly, but may retain autonomy

•Can be incorporated into existing site, mobile services or new joint site

•High collaboration

Full Service Integration

•Single point of entry, integrated assessment

•Joint case planning/management

•Wrap-around care that may be brought to where it is most accessible to the client

•Partners may have independent or joint operations

•Very high collaboration, with integrated resources, service delivery and sometimes funding

New Market Tax Credit (NMTC)

Overview

$50.5 billion federal tax credit program administered by the

Department of Treasury’s CDFI Fund established 2000 (and

started in 2002).

Similar to the Low Income Housing Tax Credit, but targeted to

commercial, industrial, and community facility projects,

including community health centers. Can be used for mixed-use

rental housing projects where as least 20% of the income of the

building is from commercial.

Designed to stimulate private investment in underserved low-

income communities (targeted to eligible census tracts).

Awarded annually to Community Development Entities (CDEs),

like CSH, through a competitive application process who, in

turn, invests in projects that meet its investment criteria.

The sale of the tax credits to investors provides equity for the

construction and rehabilitation costs of projects to fill a 20% -

25% financing gap.

CSH Linking Healthcare and Housing

With NMTCs

To date, CSH has been awarded $130 million in NMTC allocation,

with $65 million award in 2016.

CSH invests its NMTCs in projects that:

Provide healthcare and/or other support services to homeless and high

health need/vulnerable populations, and

Are co-located with or have connections to permanent supportive

housing.

We target our NMTCs in low income communities that have a

high rate of homelessness or are Medically Underserved and will

provide services to help address these issues.

Along with its NMTCs, CSH provides free TA and training to

sponsors to help strengthen connections between housing and

supportive services.

To date, CSH has invested in 7 projects, all of which have a

healthcare component planned, and will invest in another 6

projects in the next year.

HealthRIGHT 360 (“HR360”)

1563 Mission Project-San Francisco, CA(Closed & Under Construction)

Type of Organization:

Federally Qualified Health Center

Project Basics:

Acquisition and renovation of 50,000 SF building in South of Market/Tenderloin Neighborhood for relocation and expansion of services.

Modern medical campus providing comprehensive and integrated medical, dental, mental health, and other enabling services, including benefits enrollment and Housing Resource Center.

Health/Housing Partnership:

Critical need: 70%-80% of patients are homeless or in unstable housing situations.

Extensive housing referral services provided through partnerships with 12 core housing providers (to hopefully continue to expand).

CSH provided TA to help expand and strengthen connections with housing providers.

Partnerships have evolved and HR360 is providing on-site serves to nearby housing developments.

Total Project Cost- $52,000,000

CSH NMTC Financing - $9,000,000

Projected Community Impact: 16 new FTE permanent jobs/79 retained

183 construction jobs

8,100 patients to be served per year, of

which 5,300 will be new

LEED-Gold Certified

Community Demographics: 11.79% Poverty Rate

Family Income: 69.83% of AMI

Unemployment Rate 2.3%

District 6: 58% of City’s Homeless

The Women’s Home (“TWH”)

WholeLife Service Center-Houston, TX(Closed & Under Construction)


Behavioral Health and Housing Provider

Project Basics:

30,000 SF shared use medical and social service facility:

6,400 SF leased to Spring Branch Community Health Center to provide medical & behavioral health services.

Partnerships with YMCA, DePelchinChildren’s Center, & Memorial Assistance Ministries to provide after school programs, counseling, and adult education/workforce development programs.

Adjacent to 87-unit supportive housing project with 25 units for homeless individuals & within two blocks of an 84-unit supportive housing project for families, with 40 units dedicated to homeless families.


Same target service area with established referral relationship.

Partnership grew from a comprehensive community needs assessment completed by TWH.


CSH NMTC Financing - $9,000,000

Projected Community Impact: 44 new permanent jobs/23 retained

46 construction jobs paying Davis

Bacon wages

2,600 people to be served per year

LEED-Silver Certified




Medically Underserved Area

Central City Concern (“CCC”)

Eastside Health Center-Portland, OR(Potential CSH NMTC Investment)


Fully Integrated FQHC, Behavioral Health, & Housing Provider

Project Basics:

New 40,000 FQHC providing primary and acute medical care, mental health services, substance use recovery programs.

51 respite care beds to serve those that are homeless and exhibit acute medical conditions.

Co-located with 124 substance use disorder units, of which 90 units will be fully subsidized, and 34 will be affordable at or below 30% of AMI, with lengths of stay up to two years.


CCC owns and manages 1,700 units of housing and several medical clinics.

Extensive partnership and programs with area hospitals and managed care organizations to help finance capital cost and operations.

Part of CORE (Center for Outcomes Research and Education) study of effect of housing on cost and access to services.


Potential CSH NMTC Financing- $14,000,000

Projected Community Impact: 65 new FTE permanent jobs/22 retained

100 construction jobs

3,000 patients to be served per year, all

of which are new




Located in Enterprise Zone &

Neighborhood Stabilization Target Area

2016 Capital Link www.caplink.org

Capital Link - Overview

• Launched in 1995, nonprofit, HRSA national cooperative partner

• Offices in MA, CA, CO, ME, MO, SC, and WV

• Over $1 billion in financing for over 218 capital projects (about 10% of current health center facility space)

- Direct assistance to health centers and complementary nonprofit organizations in planning for and financing operational growth and capital needs

- Industry vision and leadership in the development of strategies for organizational, facilities, operational, and financial improvements

- Metrics and analytical services for measuring health center impact, evaluating financial and operating trends and promoting performance improvement


Outline

• Key performance metrics to examine

• Key market metrics to examine

• Access point opportunities and considerations

• Aligning resources and funding


Key Performance Metrics

Metric Why This Is Important

1 Operating MarginMeasuring stick of your business model; margins typically small but need to be positive

2 Bottom Line MarginIs performance dependent upon large capital grants and/or other sources of non-operating revenue?

3 Personnel-Related Expense Consumes 70-75% of budget; key driver of financial performance

4 Days Net Patient A/R Financial management starts with collecting your money efficiently

5 Days Cash on Hand Is there enough liquidity to keep operations running smoothly?

6 Physician Productivity (visits) Productivity is the basis for revenue generation

7 Mid-Level Productivity (visits) Productivity is the basis for revenue generation

8 Dental Provider Productivity (visits) Productivity is the basis for revenue generation

*Capital Link Performance Benchmarking Toolkit


• Patient Origin

• Total Market (general population, low income, etc)

• Market Percentages

• Other Services/Providers

• Patient Characteristics

• Projections

Key Market Metrics


Access Point Opportunities and Considerations

• HRSA Applications

• 19 Key Requirements

• Scope of Work

• Partnerships

• Competing Interests

• Timelines


Aligning Resources and Funding

• Foundations: Grants, Program Related Investments (PRI)

• Community Development Financial Institutions (CDFI)

• Tax Credits: New Markets, Housing, Low Income, etc.

• Commercial Loans/Lines of Credit

• Tax-Exempt Bonds

• Partnerships

• Grants

• Government Programs


Resources

• FQHC: • https://bphc.hrsa.gov/about/• http://www.nchph.org

• Financial Audits/Form 990

• Uniform Data System (UDS) Reports• www.udsmapper.org• https://bphc.hrsa.gov/uds/datacenter.aspx?q=d&year=2015

• www.CapLink.org• Capital Planning, Strategic Planning Toolkit, Benchmarks, etc

https://bphc.hrsa.gov/about/

http://www.nchph.org/

http://www.udsmapper.org/

https://bphc.hrsa.gov/uds/datacenter.aspx?q=d&year=2015

http://www.caplink.org/


Main Office

Massachusetts

Allison Coleman

Chief Executive Officer

[email protected]

Susan Petrie

Chief Operating Officer

Tel: 617-988-2248

[email protected]

Steve Rubman

Director of Data & Information Systems

Tel: 617-988-2299

[email protected]

Regional Offices

California

Tony Skapinsky

Project Consultant

Tel: 805-544-2355

[email protected]

Colorado

Jonathan Chapman

Director of CHC Advisory Services

970-833-8513

[email protected]

Missouri

Mark Lurtz

Director of Partnership Development

Tel: 636-244-3082

[email protected]

Maine

Dan Woodman

Project Consultant

Tel: 978-201-8973

[email protected]

South Carolina

Terry Glasscock

Senior Project Consultant

Tel: 781-789-684

[email protected]

West Virginia

Cindy Barr

Operations & Facilities Planner

Tel: 304-876-6996

[email protected]

Contact Us

mailto:[email protected]









Get Better. Do Better. Be Better.

Our Mission:

• HealthRIGHT 360 gives hope, builds health, and changes lives for people in need. We do this by providing compassionate, integrated care that includes primary medical, mental health, substance use disorder treatment and re-entryservices.

Our Values:

• HealthRIGHT 360 is a non-profit organization providing a wide array of primary care, behavioral health and substance abuse treatment services

• Prioritizing underserved and special populations, we build communities that heal, promote change, and foster emotional and physical safety

• We treat all individuals with dignity and respect, we celebrate diversity, individuality and each person’s cultural contribution to the community

• We are guided by a belief in the transformative power of community and family

Family of Programs

• Walden House

• Haight Ashbury Free Clinics• Asian American Recovery Services

• North County Serenity House

• Women’s Recovery Association

• Rock Medicine

• Lyon-Martin Health Services

• Tenderloin Health Services

• Prototypes

• 4 Federally Qualified Health Centers

• Substance Use Disorder Treatment

• Primary Care/Psychiatry/Infectious Disease

• Mental Health Services

• Youth Services

• Case Management, Re- Entry and Social Support

• Post-Release Re-Entry Service

• In Custody Substance Use Disorder Treatment

• Medication Assisted Treatment

Who are we and what do we do?

HealthRIGHT 360 providers a full continuum of integrated services, including:

HealthRIGHT 360 has programs in over 10 counties, including:

San Francisco, San Mateo, Santa Clara, San Diego, Los Angeles, Imperial, Orange, Solano, Ventura, San Joaquin, Sacramento, Contra Costa, Amador

Housing Partnerships

• In-house Resource Center which provides job & skills training and social work assistance to housing (shelter, low income, short-term, sober living).

• Formal referrals and MOUs to approximately 75+ housing agencies across SF Bay area (East Bay, Oakland, San Jose)

• Established partnerships with residential housing programs (SF Mayor’s office, Community Housing Partnership, Glide Community Housing) by providing on-site medical services to low-income housing programs in SF.

• Creating bi-directional referrals and the ability to prioritize patients w/ high utilization in short to long term housing.

Health and Housing Capital Expansion

January 26, 2017

Our Mission Comes First

Promoting healthier communities through

compassion and comprehensive health and human

services, regardless of the ability to pay.

promoting healthier communities

through compassion and comprehensive

health and human services

Background

• Founded in 1985 as Health Care for the Homeless

Project

• Became a Federally Qualified Health Center in 1996

• Began providing health care in the DC Jail in 2006

• Currently operate over 20 traditional and non-

traditional sites and a mobile medical outreach

vehicle throughout the District







Unity Sites

• 10 Community Health

Centers

• 10 Medical Sites in

Homeless Shelters

• 3 School-Based Health

Centers

• 1 Mobile Van

• Health Services in DC Jail




Who We Serve2015

• Total of 106,469 patients served, 504,006 visits

– 11,422 patients experiencing homelessness

– 6,796 patients who are incarcerated

• 74% are African American

• 18% are Hispanic

• 69% of patients have income

below the 100% federal poverty

level




Who We Serve2015 Insurance Coverage

• 63% of our patients have

Medicaid

• Unity has Enrollment Specialists

at various sites to help

individuals sign-up for health

insurance through DC Health

LinkMedicare

MedicaidAlliance

Private

Self-Pay




Health and Human Services• Primary Care

– Family Medicine, Pediatrics,

Internal Medicine

• Obstetrics/Gynecology

• Dental

• Psychiatry and Counseling

• Infectious Disease

• Family Planning

• Case Management

• Other Specialty Medical

Services




Programs and Initiatives• Convenient Care: Open until 10 pm weekdays and 8am- 2pm

weekends to increase access to care

• Patient Portal & Unity App: Increases patient engagement

and participation in their own health care

• WeCan! Program: Helps overweight and obese children and

adults maintain a healthy weight through nutrition and physical

activity




Unity & SOME Partnership• Partnership Rationale

• Project Overview

• Future Co-location Initiatives

http://capitalcampaign.some.org/2016/09/13/progress-at-the-conway-center/

http://capitalcampaign.some.org/2016/09/13/progress-at-the-conway-center/




Contact Information

• Michael Crawford, MBA, Chief of Staff

• [email protected]

PANELIST FACILITATED DISCUSSION

Creating Partnerships

What were the key decisions that pushed you to

your partnership(s)?

Linking to Housing

What do you want to know about the housing

market and demand in your community?

What hurdles did you need to

overcome?

Challenges

Flexibility is Important

What assumptions needed to be adapted?

Resources & Support

What are some of the resources to access?

• building the facility

• supporting coordination activities

Q/A

DiscussionHave a question?

Type into the Chat box.

Enable Chat by clicking the icon in the

top right corner.

Q/A Discussion

Next Steps

• As soon as the recording is available, we will send you the slide deck and a link to the recording.

Today’s Recording & Slide Deck

• When you log out of today’s event, a pop-up window should appear displaying a survey about this webinar. We value your input!

Survey

Resources & More Info on Upcoming Webinars:

www.csh.org/hrsaTA

http://www.csh.org/hrsaTA

www.csh.org/summit17

Community Investment/Supportive Housing Development

Housing & Criminal Justice Reforms

Healthcare & Housing Integration & Partnerships

One Roof Families & Children Thriving in Supportive Housing

Supportive Housing Onboarding Track/Introduction to the Field

Maximizing Services

Pay for Success Financing, Contracts & Contacts

Systems Transformations for the Aging, Chronic Homeless,

ID/DD, and Veterans Populations

Effective Housing Models for Youth

Receive up-to-date perspectives, predictions, trends and innovations

focused on crucial and timely issues:

Join Us in Denver!

May 24-26, 2017

About HRSA NCAs

National Cooperative Agreements(NCAs) are national organizations that receive HRSA funds to help

health centers and look-alikes meet program requirements and

improve performance. They also support Health Center Program

development and conduct national analyses around one of the

following target audiences:

Vulnerable populations, including those who frequently and

inappropriately utilize health system resources

Underserved Communities/Populations, such as the homeless,

public housing residents, and migratory workers

“This project was supported by the Health Resources and Services Administration (HRSA) of the U.S.

Department of Health and Human Services (HHS) under cooperative agreement # U30CS26935, Training

and Technical Assistance National Cooperative Agreement (NCA) for $325,000 with 0% of the total NCA

project financed with non-federal sources, if any. This information or content and conclusions are those

of the author and should not be construed as the official position or policy of, nor should any

endorsements be inferred by HRSA, HHS or the U.S. Government.”

http://bphc.hrsa.gov/technicalassistance/partnerlinks/natlagreement.html

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