Health Centers in the New Era of Emergency Preparedness

Health Centers in the New Era of Emergency Preparedness

Early 2020 ushered us into a new era of society, healthcare, and preparedness. Despite decades of pandemic planning, our reality was rapidly and drastically impacted by the spread of the novel SARS CoV-2 (COVID-19) virus. Health Centers have played a vital role in response to the ongoing Public Health Emergency (PHE) for over two years, and the lessons learned have been many and shared across the healthcare and public health sectors. Engaging Florida’s Community Health Centers in After-Action Reporting, FACHC has recognized how long-standing CHC characteristics, such as their mission-driven culture, adaptability, and system-based approaches, have been instrumental in overcoming significant challenges primarily related to shifting patient demands, staffing, and global supply chain issues.

Although working through the COVID pandemic was navigating a whole new territory, CHCs have significant experience responding to emergencies and disasters, having dealt with hurricanes, tornadoes, wildfires, infectious disease outbreaks, flooding, and even ice storms. The communication and coordination capabilities of CHCs have been demonstrated consistently, developing resilience and a unique perspective on the importance of emergency management and Whole Community Preparedness’

Now more than ever, CHCs are meeting the diverse and growing needs of vulnerable populations, individuals without healthcare coverage, and those seeking patient-centered care close to home. CHCs’ ability to address a wide range of primary care issues, from dental to behavioral health, makes them a crucial part of the nation’s healthcare infrastructure and pandemic recovery. Prompted by the pandemic’s restrictions and a focus on safety for all, CHCs launched expanded telehealth operations to enhance access to care. Another point of expansion has been seen in mobile health operations, with CHCs bringing testing and vaccination services into communities that would otherwise remain out of reach. With support from HRSA’s various supply programs, CHCs have distributed hundreds of thousands of at-home tests and N95 masks, and are positioned to play a significant role in the National Test-to-Treat program.

Looking ahead, the 2022 Hurricane Season is predicted to be above-average yet again. This annual focus on the tropics is now commonly paired with a discussion of the short- and long-term effects of climate change, especially across Florida.  Focusing on preventative measures, CHCs can take steps to fortify their facilities and adjust plans to address environmental risks and evacuation zones. Flood protection and emergency power supply options (including generators and solar options) can be explored and possibly funded through Mitigation grants and other partnership initiatives. Across all phases of Emergency Management (mitigation, preparedness, response, and recovery), the importance of integrating with local partners and regional Health Care Coalitions (HCCs) cannot be understated.  Ongoing HCC engagement supports effective communication and coordination and further defines CHC and partner roles at the local level.

The cycle of preparedness promotes continuous planning, organizing, training, equipping, exercising, evaluating, and taking corrective action (improving) to enhance capabilities in incident response. FACHC supports all CHCs in these efforts while maintaining situational awareness among various State, Federal, and NGO partners, providing training and deploying resources/equipment to support emergency operations statewide. Through robust communication and enhanced coordination, CHCs will continue to emerge as resilient leaders in the new era of healthcare emergency preparedness and response.  

Gianna Van Winkle, MBA
Director, Emergency Management Programs
Florida Association of Community Health Centers, Inc.

Health and Safety Risks Due to Environmental Factors

Health and Safety Risks Due to Environmental Factors

Environmental safety is something most of us take for granted. We assume the water we drink is safe, the air we breathe is clean, and the food we eat is free of contaminants. But unfortunately, that’s not always the case. Chemicals and biological pathogens such as bacteria, viruses, and parasites are everywhere and can easily migrate through the air, water, and soil. Most of the time, we’re unaware of the substances we’re inhaling, swallowing, or touching. And even when we are aware, the risks of exposure to these substances are often unknown. But in some instances, they can be hazardous to our health and safety, causing serious injury and illness.

According to the Office of Disease Prevention and Health Promotion, preventable environmental factors lead to a quarter of deaths worldwide and 26% of deaths in children under the age of 5. Staying informed about these risks and how to protect yourself and your family are important to maintaining your overall health.

These risks include but are not limited to:

According to data collected by the World Health Organization, water contamination is the leading cause of death and disease across the globe. Potential sources include agricultural runoff, septic tanks, improperly constructed or maintained wells, and urban runoff. 
Pollution impacts all of us, with chronic exposure to air pollution being linked to cancer, long-term damage to the respiratory and cardiovascular systems, and early death. Indoor pollutants include mold, asbestos, and tobacco. 
That being said, it is still possible to reduce pollution and repair some of the damage caused by consumers to the environment. We've created an infographic with 25 Ways You Can Reduce Pollution!

If you're interested in learning more, please visit

Michelle Llamas
Senior Editor
Consumer Notice

Key Strategies that Make the Workforce Roller Coaster a Less Scary Ride

Key Strategies to Make the Workforce Roller Coaster Ride Less Scary

Lately, the nation's jobs marketplace appears to be on a roller coaster ride, especially within healthcare. With record resignations and work separations, many feel as though they are headed up to the first big climb on a roller coaster. The anticipation of who may leave next feels daunting; however, that churn means there are lots of qualified candidates looking for jobs, and employers have the opportunity to acquire truly talented individuals (similar to the thrill of that first big drop on the roller coaster). Like any scary ride, the ups and downs don't stop there. The seemingly insurmountable wage war represents the twists and turns; an organization's obligation to diversity, equity, and inclusion (DEI) in the workforce, and the effort that this obligation requires, can feel like a big loop that turns you upside down before setting you straight again. In the end, the roller coaster returns you to level ground. But any ride worth its merit gives its riders a badge of honor, having experienced profound elements that leave one with a new perspective. In many ways, the current jobs marketplace can do the same for Community Health Centers.

So, what should CHCs be focusing on to navigate the current jobs marketplace?

Know Your Data: We all collect data; it's the nature of a Community Health Center. Data collection is generally established for external reporting or internal purposes. From a workforce development perspective, the fundamental strategy is using this data. To use the data, a CHC must know its data. Simply put, what is the story that your data is telling you?

For the workforce, data collection should focus on every aspect of your employees' engagement: from pipeline development to recruitment, to sourcing and selection, to workplace engagement, to retention, to advancement, and finally to separation. Within each of those phases, the data has a story to tell. For example, patterns from pipeline development to recruitment can help gauge how effective an organization's outreach is; further, separation data will help tell why someone is leaving to define trends. Suppose a significant number of mid-level employees are leaving. In that case, the “Great Resignation” is hitting an organization hard, or if a substantial number of first-year employees are leaving, there's a perfect opportunity for a mentorship program. Understanding the story behind your data is often the first step in understanding your workforce development strategy.

Leverage Existing Infrastructure: For the most part, CHCs have an expansive workforce development infrastructure. The professionalization of these efforts has taken hold in organizations of all types over the last couple of decades, helping organizations transition from a transactional nature to one focused on relationships and engagement. That's the good news. The even better news is that CHCs don't have to recreate the proverbial 'wheel' to respond to today's workforce challenges. Instead, leveraging your existing infrastructure to adapt to your organization's needs and the workforce is far more effective.

Take, for example, the ever-growing commitment to substantive DEI efforts. Most organizations now know that DEI efforts require far more effort than simply putting together a blue-ribbon committee. Accordingly, the challenge for meaningful changes within an organization related to DEI relies on the actions. Those actions can (and should) be embedded within an organization's existing infrastructure, like training opportunities for hiring managers, utilizing data to understand wage inequity, or utilizing professional development opportunities that lead to advancement. While these strategies require an affirmative commitment, the infrastructure to make these changes already exists and creates significant momentum toward positive change.

Engagement: "Employee engagement" can feel cliched at times. The rhetoric behind employee engagement is self-evident, but the concept is a truism for that very reason: it simply works. We know that individuals often say they leave because of pay. Still, when you look at the data surrounding separations (see the strategy above), engagement (or lack thereof) is often the culprit.

I've said it forever: people take a new job agreeing to a salary or hourly rate; they leave a job because of a lack of engagement. Certainly, this isn't true for all, but it's true enough that we must pay attention to what is truly happening when people leave. Being unhappy with your salary is often a proxy for lack of engagement. If we think about a typical salary complaint, it might start like "I'm not paid enough to deal with…" or "I didn't sign on to have to do…". Is this a complaint about one's salary, or are there other underlying issues?

Employee engagement is how individuals develop agency within their job; no longer simply exchanging time for money, they are contributing to a greater cause (and what greater cause can an individual find than contributing to the health and well-being of our community's most vulnerable populations). Engagement, when authentic, doesn't have to be expensive or time-consuming. When we use data to understand the needs of the workforce better, engagement can be as simple as job shadowing or job sharing, participation on an organization-wide committee, or mentoring (as a mentor or mentee), all of which are needs of an organization as well. When we help meet the holistic aspirations, engagement becomes powerful for the CHC and the workforce.

Beyond this silly roller coaster metaphor, the state of workforce development is genuinely in a transformational phase. Even though we don't yet know how this will play out, many truisms remain: career pathways for your employees are a tried-and-true strategy; "grow your own" approaches are as effective as ever, and a substantive commitment to DEI will transform your organization.

Steven Bennett, MA, SHRM-SCP
Director, Workforce Programs
Florida Association of Community Health Centers, Inc.

340B: Why Do We Take A Hard Line?

340B: Why Do We Take A Hard Line?

Since 1992 there has been a recognition by the federal government that discounting pharmaceuticals for underserved, uninsured people are paramount to helping safety net providers design treatment plans for their patients. The 340B program provides that discount and for the past 27 years our community health centers (CHCs) have used this program in the way it was intended - helping safety net patients by passing along savings to them and providing the necessary services.

In the following years, covered entities (such as hospitals, community health centers, Ryan White programs, etc.) continued to utilize the program to provide more services to those in need. Unfortunately, some covered entities began abusing the program by purchasing pharmacies to place under their existing umbrella, thereby increasing their footprint for 340B, costing the program millions. At this time, there are over 28,000 hospital facilities using the 340B program. This has tainted the program, threatening its value.

A few years ago, Medicaid managed care organizations (MCOs) started to look at the discounts to those covered entities, and, as the contracting entity, began reducing those discounts, charging the providers more for their contracts. Pharmacy Benefit Managers (PBMs) began a program to increase the costs for drugs to these covered entities, including CHCs, at an alarming rate. Today, we are staring at a potential loss estimated at over $100M at CHCs here in Florida if the PBMs are allowed to continue their discriminatory and predatory practices.

What makes this problem different from the myriad of issues that impact our health centers nearly every day? And, why are we so focused on our attempts to fight this?

PBMs have found a niche market for themselves that has been made at the expense of not only the CHCs, but the patient as well; and those expenses are direct. The intent to do good in this program has been allowed to take a back seat to profit motives for the PBMs and MCOs. And so, the first reason to take the hard line on this is to protect the patients from price gouging. There is only one rationale for PBMs to take these funds: increase shareholder value/profits. Those profits are paid for by increased prices to the patients. If the covered entities are even passing along the discounts in the first place. I am more than hopeful that all of our community health centers do that.

The second reason for taking the hard line is that PBM actions can wreak havoc on a health centers bottom line. CHCs generally live on a low margin of between 2%-5%. Those dollars go right back into the operations of the center. They don’t increase stock value. In many cases, a CHC’s margin may BE the savings from 340B. It is a mandate that the Florida Association of Community Health Centers does everything possible to protect the solvency of our community health centers.

Finally, CHCs must not be considered an easy target for organizations to come after. They are recognized as the primary care safety net for Florida. Without community health centers, over 1.5M people would go without health care or would flock to hospital ERs across the State. There are consequences to the PBM approach to ripping these savings away from our centers. The cost is huge increases in the Medicaid bill as patients have nowhere to go but the ER. How does this make sense? Community health centers must remain a viable part of the safety net. FACHC will do everything we can to assure the integrity of Florida’s community health centers – Florida’s primary care safety net.

Best Regards-

Andy Behrman
President & CEO
Florida Association of Community Health Centers, Inc.

Hard work by Community Health Centers and Innovation lead Recovery Operations in Hurricane Michael Impact Areas

Hard work by Community Health Centers and Innovation lead Recovery Operations in Hurricane Michael Impact Areas

Hurricane Michael arrived and left in a day but the challenges of a recovering region are certainly still there. PanCare and North Florida facilities felt the brunt of Michael in locations up and down the panhandle coast, including communities they serve on the Georgia and Alabama lines. Both members temporarily lost several medical facilities during the first two weeks after landfall. Unfortunately, PanCare's admin and main dental site in Panama City along with its primary care and dental site in Marianna suffered serious enough damage to knock them out of operation for months to come.

Both overcame issues ranging from lack of electric, water, sewer, excessive debris, damaged/closed main roads, and dusk to dawn curfews just to open services again.  North Florida’s Wewahitchka site was temporarily utilized by the national guard and then suffered a large diesel fuel spill (since cleaned up by the private vendor).

Additional issues include disruption of staff due to widespread damages to their homes and apartments and shutdown of area infrastructure.  For the first week post-storm, there were no operating gas stations, grocery stores, banks, etc. open for miles and of course, basic municipal electric, water, sewer and gas services were gone.  Again, many staff members were dealing with unexpected homelessness and displaced family members.

For the last few weeks, PanCare has rolled out and positioned mobile units at locations in Panama City, Mexico beach, Marianna and several other high-need areas. With the shut-down of hospitals and many doctor offices due to damage, PanCare is one of the few primary care providers available to the stricken communities they serve.

All of these challenges were met with huge efforts by both CHC’s leadership and staff and plentiful assistance from our members and several NGO Aid organizations! 

Here is a short list of some of the actions taken to help stand-up medical services:

  • CHC members donating Hurricane Packs and other medical supplies and the use of mobile units for deployment.
  • PanCare staffed and rolled out all its mobile units to needed locations just a few days after storm impact; it consolidated its 15th street administrative site to its diesel generated 11th street site and also continued with primary care at this location.
  • PanCare began arranging for temporary housing for impacted staff, and was able to provide gas to staff through a private vendor from Texas along with gas cards from Direct Relief.
  • Bond CHC loaned its Mobile unit to N. Florida CHC so services in Havana FL could continue until that Health Center was operational.
  • The damaged PanCare sites in PC and Marianna now have field grade Medical tents being placed there by the International Medical Corps allowing them to offer regular services until the main buildings are fixed.
  • FACHC has worked with Direct relief and Americares on several donations of materials, including 3500 hygiene kits, two 15,000 watt portable gas generators, and cash donations to assist members.
  • County Emergency Management provided requested water, portable sinks, security, and portlets at our sites to help make them and mobile units operational.
  • We recently received EM priority service designations by ATT for PanCare’s new wireless hotspots to ensure adequate IP throughput.

There are many other small successes like the ones listed above and there is much more to be accomplished before we reach full recovery. We do need to recognize our helpers!  We sincerely appreciate the volunteer efforts by other members of FACHC, our NGO partners, and State ESF-8 community.  It has allowed the recovery efforts to proceed at a quickening pace while keeping a focus on service to the community and safety and well-being of staff. Thank you again for your efforts!  Other updates will follow.

Thomas J. Knox Jr., MPA
Director Emergency Preparedness &
Education Programs