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The Health Care Collaborative of Rural Missouri (HCC) got its start in 2004 to create momentum among Lafayette County, MO, organizations and residents to address health concerns in the rural county. HCC incorporated as a 501(c)3 in 2006 and became a rural health network, serving as a hub and catalyst for pulling in resources and partners to meet residents’ health and human services needs.
Lafayette County was ripe for this work, said Toniann Richard, HCC’s CEO. County residents ranked low in general awareness of health issues and knowledge of chronic diseases and how to manage these conditions, as well as importance of regular medical visits to reduce the need for emergency care.
Working with a strong board of directors and community leaders and health, social services and other partners, as well as with state and federal rural health agencies and regional foundations, HCC’s early work led to the establishment of HCC-managed rural, federally qualified health centers in Buckner, Concordia and Waverly, and in Carrollton in neighboring Carroll County. These Live Well Community Health Centers provide dental, behavioral health, primary care and social support services.
The county seat of Lexington, population 4,500, had a Federally Qualified Health Center operated by Samuel U. Rodgers Health Center in Kansas City, MO. Over the years, Rodgers Health, which operates several clinic locations in the Kansas City metro area, worked collaboratively with HCC and other county health leaders to build a complement of services at the Lexington clinic. Richard said HCC was a ready partner, but as HCC developed its Live Well Clinics and improved continuity and coordination of care, it was natural for HCC and the local community to look at the possibility of transitioning the Lexington clinic into HCC’s network.
Samuel U. Rodgers Health Center has a history of leadership in health care delivery that began when Dr. Samuel Rodgers, the first Board-certified Black Obstetrician/Gynecologist in the Kansas City area, established a health center in downtown Kansas City in 1968. With four clinic sites, Rodgers Health has long provided comprehensive adult, senior, and well-woman and pediatric care, behavioral health and dental care for Kansas City’s most medically and socially vulnerable families. Many of the health center’s patients are non- and/or limited English-speaking, and represent more than 60 nationalities.
While Rodgers’ clinics and leadership team were located in the Kansas City metro area, the Lexington clinic was situated nearly an hour away from its main location. Recruiting for the Lexington location and maintaining continuity of staff was at times a challenge, Richard said.
“In my experience building a rural health network, I learned early on that relationships in our county matter most,” said Richard. “It’s important to really spend time cultivating and understanding what our community members need and want from their health care providers. There are differences in a rural versus urban-based model – and that’s where we got our start.”
Exploration of a possible transition of ownership of the clinic had begun 10 years ago, but it wasn’t until early 2019 that discussions gained momentum. Faisal Khan, CEO of Rodgers Health, is a medical epidemiologist with a background in public health management. Khan brought his patient-centered and community-focused mindset to Rodgers Health. Khan and Richard and members of their teams began talking about what a transition of the Lexington clinic might entail, and how to make that transition sustainable for both organizations.
“Serving the community requires that you know your community and that you reside in the community and have strong well-established relationships with individuals and organizations,” said Khan. “Since Samuel U. Rodgers Health Center is located in urban Kansas City, it was difficult for us to maintain strong links with the Lexington community. That added impetus to the need to transition the site to HCC.”
Khan said he and Richard established a high level of trust based on their shared commitment to transparency and open communication. “We empowered our respective teams to work together towards a mutually beneficial process for this transition with the active support of the REACH and Health Forward Foundations.”
Quality, accessible safety net health care has been a grantmaking priority of the REACH Foundation since its start. The foundation has supported both organizations as core operating partners, funded through the Strong Safety Net outcome investment area, and has funded other projects, including expansion of behavioral health and dental care, and other organizational needs.
Over the prior four years, REACH has awarded $9.8 million in grants within the Strong Safety Net outcome area.
The leaders of HCC and Rodgers Health discussed their proposed transition plan with state and federal health officials to understand the challenges and federal requirements of such a move. They also reached out to the CEOs of REACH and the Health Forward Foundation as funding partners and advocates for their organizations for input.
There was a long list of to-dos to tackle for the federal Health Resources and Services Administration (HRSA): financial review; analysis and planning for ensuring continuity of patient care; management of patient records and information; communications protocols and community engagement, and more. Richard said that working through all of these issues was “really tough, and seemed almost impossible” at times. She said this is where external guidance and support from the foundations helped.
The two organizations asked the foundations for financial support to conduct the business and clinical assessments. In 2019, the REACH Foundation and Health Forward each awarded grants to support the two organizations in their analyses and planning. REACH awarded HCC a $15,000 grant to support a comprehensive assessment of clinical and operational expenses and administrative requirements, and to document the intent and responsibilities of both health centers. The study included a revenue analysis, review of clinical personnel needs; cost of supplies and operations; and examination of patient demographics and the payer mix. The study also included projections of revenue potential to determine sustainability.
When there was demonstration of HRSA approval and agreement from the two health organizations that they were equipped to proceed, REACH awarded a 36-month, $300,000 grant to Samuel U. Rodgers Health Center to support costs associated with the transition of the approximately 2,300 patients served at the Lexington Clinic to HCC, and to support Rodgers’ staffing needs aligned with refocusing their resources on health services in Kansas City. HCC similarly was awarded a $300,000 grant in 2020 to support their transition costs, including general operations, administrative and staffing needs.
“The biggest lessons learned were patience. We had to go back to the table a few times, but we didn’t lose ground. I’m grateful to Rodgers Health because we were both committed to figuring it out—and not letting little things bog us down so we could get to a solution.” – Toniann Richard, CEO, HCC
Richard said the CEOs of REACH and Health Forward not only gave encouragement but also provided policy-level direction and context as the two health organizations worked through their individual organization’s concerns. “Our (REACH) program officer kept us on task, and encouraged us to integrate some of HCC’s innovative programs like Project Connect and the Community Health Worker program into this new project from the start.”
As 2020 opened, HCC and Rodgers Health were working on community engagement and other aspects of their implementation plans. These included a communications plan for how and when to announce the transition; final logistical and staffing details; and action plans leading up to transition of ownership. That transition was scheduled to become public on June 1, 2020, with an HCC open house at the Live Well Community Health Center – Lexington on June 23.