Annual Report 2012 -2013

2

A Letter From Linda Muller & Charlie Milich 4

Going Beyond Health Care by Dr. Avi Silber6

Reinventing the Exam Roomby Jesse Sarubbi 8

Going Where There is a Need18Making a Better Place to Work & Live 19

15Improving Grant Funding 16

Demonstrating Our Growth & Progress23

Forming Partnerships that Work by Robert S. Ross10

Offering Alternatives to Emergency Care 22

Improving Clinical Care20

3

Being a Leading Community Health Center by Kathy Davey

12Building Community Support &Giving Back to the Community

Linda S. MullerPresident & CEO

Charlie Milich Chairman

There is a story behind every improvement, every achievement, and every success of The Greater Hudson Valley Family Health Center; revealing the reason for everything that we do and giving meaning to what we stand for. This report illustrates how, through growth, we improved, achieved, and succeeded in 2012-2013. Growth is not about the level of success that we experience, it is about our ability to positively influence our patients each day. Our goal is to create a place where our physicians are more than medical providers and our health care organization is not just a facility; it is a health home for thousands of patients.

To do this, we address our patients’ significant need for care coordination, a relatively new concept of care that helps patients manage their health more easily. Involving care coordinators in delivery of care ensures that patients overcome circumstances that otherwise cause barriers to health care. Investing in the resources necessary to eliminate these barriers creates better health outcomes for our patients and allows them to concentrate more of their efforts on maintaining good health.

We also develop programs that serve as an extension to medical care. Through health education, we can further our patients’ understanding of the importance of healthy living. We offer programs ranging from chronic disease management to wellness initiatives. Focusing on our childhood weight-control program—the only one of its kind in Orange County—is a vital outlet for pediatric patients who are suffering from obesity and

their families to learn about healthy eating and exercise.

Without collaboration we would not be able to make such monumental advancements as a patient-centered health care organization. By partnering with local hospitals, like St. Luke’s Cornwall Hospital, we are able to move toward implementing a HIPAA compliant medical records exchange that will improve access to care for patients locally and eventually statewide. With better capabilities for sharing patient information, physicians will be able to work together to ensure continuity of care is successfully maintained.

Another aspect of growth comes from our expansion efforts to areas where the need is greatest. Our service areas now include bringing care to those who may not be able to seek medical attention because they are homeless or at risk of homelessness. We also offer family medicine services to residents of Highland Falls who face geographical barriers that impact access to quality health care.

We invite you to experience the health center’s extraordinary transformation over the past year. This period of growth would not be possible without our patients, our partners, and our commitment to providing high quality, comprehensive care to the individuals and families who call our health center their medical home. Thank you to those who have helped us along the way.

&

4

5

Chairman

Vice Chair

Treasurer

Secretary

Charlie MilichRAL Supply Group

Debra JohnsonWilliam A. Smith & Son, Inc.

Wayne DayDay Seckler, LLP

David DendyFine & Associates Engineering

Immediate Past ChairPaul Broadie II

Orange County Community College

Rev. Nelson McAllisterRetired

Arif Muslim, MDPremier Medical Group

Marianna KennedyDrake, Loeb, Heller, Kennedy,

Gogerty, Gaba & Rodd

Maryjean ValigorskyFidelis Care New York

Floyd JohnsonEngineer

Mirta RivasPapeleria Services, Inc.

Daisy ValeRetired

Rhonda GreenYouth Advocate Programs, Inc.

Marcel MartinoInspire

Our Board of Directors:

CARE COORDINATIONGrowth Means Going Beyond Health Care

By Avi Silber, MD, FAAP Medical Director & Pediatrician

6

Care Coordinators pictured above (L to R):Crystal Marr, Celia Herrera, & Emma McAdams

Physicians of an underserved population often detect that an overwhelming amount of patients that they serve neglect their health because they do not have the means to manage it. Finding a place to sleep, being able to feed their family, looking for employment, or even struggling addiction overpower the decision to maintain good health. Nevertheless, it is a physician’s responsibility to cure the sick and heal the wounded. Because of the everyday barriers impacting patients, it is becoming increasingly more difficult to uphold this credo and to guarantee patients are receiving proper medical care.

At the health center, we are pushing beyond these barriers so our patients have access to the quality and affordable health care that they deserve. Through care coordination, patients are able to work directly with care coordinators to better manage their health. These efforts address patient needs, like securing transportation to and from the health center; following-up with appointments; completing necessary medical documents; as well as coordinating with insurance carriers, other departments in the health center, and various health care providers and community organizations.

With physicians and care coordinators working together to help patients overcome obstacles to care, more patients are making their appointments and the number of new chronic disease cases is decreasing. Patients already diagnosed also are learning how to live better with their conditions. Since beginning the program in 2012, over 200 patients have overcome many access barriers to health care.

This new approach to health care delivery creates a system that is continuously going above and beyond traditional means of providing medical services. To be a part of this movement means that this health center will be able to bring care to more patients and make a considerable difference in the lives of those who have forgotten that access to quality, affordable health care is a right, not a privilege.

Care Coordination

Simplified

Step One:Introduce patients to a

team of coordinators who ensure access to care.

Step Three:Implement tools needed for patients to maintain a

happy, healthy life.

Since beginning the

program in 2012, over 200 patients have

overcome many access

barriers to health care.

“

”

Dr. Avi Silber

7

Step Two:Work one-on-one with patients to understand

their specific needs.

HEALTH EDUCATIONThe percentage of patients with controlled hypertension has increased.

The percentage of children with high BMIs enrolled in Fit for Life programming has increased.

The percentage of smoking patients introduced to our Tobacco Cessation program has increased steadily.

30%

60

Different health education programs

offered

20

Community organi-zation partnerships

1,500

Participated in educational

programming

111

Graduated from Smoking Cessation

classes

54

Took our Fit for Life program

65

Learned to manage their diabetes

100

Joined us for Wellness Mondays

By The Numbers

8

Since beginning our Health Education program in 2011:

There are no boundaries to learning, even in health care. Education is a fundamental aspect of growth that allows patients to further their knowledge of what it means to be healthy. Through health education, the health center reinforces the importance of continued learning by providing opportunities that help patients gain understanding of improved physical, social, and mental health. These programs serve as tools to strengthen the level of care already given by physicians.

The health center offers learning experiences designed to assist patients with health concerns like chronic disease, tobacco use, substance abuse, mental health, domestic violence, eating disorders, and sexually transmitted infections. With the development of health education, patients receive guidance from their physician while participating in programs that also meet their specific health care needs.

To help pediatric patients who are overweight or at risk of obesity, the health center offers a program that reduces obesity in children and adolescents living in Orange County. These sessions help young patients and their parents or caregivers learn about healthy diet and exercise. Physicians, health educators, and registered dietitians, monitor patients’ height and weight during each class while educating them in a fun and interactive environment. Participation in Fit for Life has tripled over the past two years. As a result, the health center is working with the Community Health Care Association of New York State and the Department of Health to expand the program to children across the state.

Improving the livelihood of patients as they gain more insight into good health is important to the health center. For that reason, we will continue to provide educational opportunities and improve health awareness for every patient visiting the health center each day. Participation in Fit for

Life has tripled over the past two years.“

”

Growth Means Reinventing the Exam Room

by Jesse Sarubbi, Director of Care Management & Health Education

9

by Robert S. RossPresident of St. Luke’s Cornwall Hospital

10

One of the first things I learned when I joined the team of St. Luke’s Cornwall Hospital (SLCH) was its deep roots and connections to the people and communities of the mid-Hudson Valley. The partnership with and support for the Greater Hudson Valley Family Health Center goes back several decades to the establishment of the Family Health Center in Newburgh. SLCH is proud to work with the Family Health Center to meet the health care needs of those who have the most difficulty in accessing medical care.

As community-based organizations, we care for the same patient community. Our partnerships are structured around improving medical

services. The Family Health Center and SLCH

are developing connections across our medical record systems to share information to enhance our patients’ health care. This interconnectivity will enable the Family Health Center and St. Luke’s Cornwall to provide the right care, at the right place, at the right time for our patients.

Both organizations face changes in the way we deliver health care. This combined with the need to reduce costs while improving quality increases the opportunity to work together. I look forward to further collaboration with the Greater Hudson Valley Family Health Center. Together we will improve the quality of life of the community we serve.

GROWTH MEANS FORMING PARTNERSHIPS

THAT WORK

Together we will improve the quality of life of the community we serve.“

”

Action Toward IndependenceAHRCCatholic Charities Community ServicesCrystal Run Village, Inc.Emergency Housing Group, Inc.Independent Living, Inc.Inspire, CP Center

Jewish Family Services of Orange CountyMaternal Infant Services of Orange, Sullivan and UlsterMental Health Association of Orange CountyOccupations, Inc.Orange County United Way

Regional Economic Community Action Program, Inc.Rehabilitation Support Services, Inc.Restorative Management Corp.Safe Homes of Orange CountyYouth Advocate Programs, Inc.

GHVFHC is Proud of our Work With Many of the Members of the Joint Membership of Health and Community Agencies (JMHCA):

11

”

Pictured above: Vince Bosco, PA

Without the support of our generous donors, the health center would not be able to maintain and develop such a strong organization. In this past year alone, donations supported access to quality, affordable primary and specialty health care to over 20,000 patients.

Pillars of The Community Awards GalaEach year, over 400 community members join the health center to honor distinguished individuals and organizations who share our vision of improving the community. This celebration helps fund an array of programs offered at the health center. Baile Latino Dinner DanceThis cultural event, hosted by the caring employees and friends of the Family Health Center is an elegant, relaxed, and fun event that celebrates the Latino culture in our community.

Cosmos & Cupcakes for CausesThis “sweet” event benefits three great charities; The Family Health Center, The Miles of Hope Breast Cancer Foundation, and The Littman Cancer Center at St. Luke’s Cornwall Hospital.

Moroney’s Toy RunAn annual event for over a decade, Moroney’s Harley Davidson of New Windsor has collected, wrapped, donated, and delivered toys to hundreds of the health center’s pediatric patients. The New Windsor Fire Department and Moroney’s riders and volunteers, allow our young patients to experience all that the holiday season has to offer.

GROWTH MEANS BUILDING COMMUNITY SUPPORT

Development

12

114

Volunteers helped the health center

in 2012

2,213

Volunteer hourscompleted

450

Children received a gift, pajamas, and a

toothbrush during our toy run

2,700

Gently used books donated for children of

all age

4,000

Books “prescribed” to pediatric patients since January 2012

600

Consignors registered at Encore

since its 2011 opening

5,000

Reusable water bottles, snack boxes, and sun

screen donated

In February 2013, the health center opened a Reach Out & Read reading nook for children to use.

GROWTH MEANS GIVING BACK TO THE COMMUNITY

As a community-based organization, a core aspect of development includes building relationships and participating in ongoing initiatives that help the communities that we serve.

Encore Inc., Consign for a CauseDonate and shop at our Encore store. Over 700 area residents consign and donate to us on a regular basis to benefit our health

center. The consignment shop has been an economic engine and a positive presence in the community welcoming friends, staff, volunteers, students, and the community at large. Visit us online at http://www.consign4acause.org/

Reach Out & ReadSince joining Reach Out & Read of Greater New York in 2011, the Family Health Center’s Pediatric Department has “prescribed” over 4,000 books to help young patients gain

literacy skills that positively impact their health. This program encourages children and their families to read together.

13

The Greater Hudson ValleyFamily Health Center

NEWBURGH NEW WINDSOR

HIGHLAND FALLS

For 46 years, we have been dedicated to growing our health center because we believe

everyone has a right to quality, affordable health care. It is our responsibility to provide

excellent care to you. We will continue to grow well into the future in both number of

locations and quality of service to fit the needs of our patients and the community. The

Greater Hudson Valley Family Health Center has grown significantly in the last year -

we hope that you will follow us as we continue to experience such great changes.

Pictured below is the beautiful Hudson Valley which we are proud to call home.

14

JOINTCOMMISSIONExceeding expectations is a paramount objective of our community health center. We are designated as the highest level Patient Centered Medical Home; we successfully meet Meaningful Use requirements by implementing Electronic Health Record technology; and most recently, we became accredited by The Joint Commission for our exemplary approach to medical care. Reaching these accomplishments places the health center among the top of all other federally-qualified health centers in the country.

In August 2013, all of our locations received accreditation from The Joint Commission after extensive preparations to ensure that we are meeting higher standards of care established for our patients by the Commission. Completing the voluntary accreditation process distinguishes the health center from other health care providers in the Newburgh area. We now join just 300 other health centers nationwide as a Joint Commission-accredited practice.

With a challenging on-site review, Joint Commission surveyors measured the health center’s everyday routine, as well as our employees’ understanding and ability to fulfill their job responsibilities. To attain accreditation standards, we are held more accountable for successfully protecting patient information, ensuring patient safety, offering more health education opportunities, providing improved medication-safety measures, and reducing the risk of health care-associated infections or emergencies by refining our administrative and clinical policies.

Constantly testing our abilities and setting new benchmarks allows the health center to take the necessary steps to maintain high levels of care for patients and to offer exceptional health experiences to those who seek our services.

Growth Means Being a Leading Community Health Center

Center for Recovery received Joint Commission

accreditation2008

All GHVFHC Services received Joint Commission

accreditation2013

by Kathy DaveyDirector of

Organizational Transformation

15

GROWTH MEANS IMPROVING GRANT FUNDING

14

Federal and StateHRSA Section 330 Grant Supports daily health center operations, allowing us to provide high-quality, comprehensive primary and preventive health care services to a medically underserved population.

New Access PointsProvides funding to support two new sites of service in Orange County: 127 Main Street in Highland Falls and Harper Health at 290 Broadway in Newburgh. The Highland Falls location offers primary and preventive care for patients of all ages. Harper Health provides essential health care services to those who are homeless or at risk of homelessness.

Supplemental Funding for Quality ImprovementSupports the salary of a Preventive Screenings Care Manager who helps coordinate care for patients in need of preventive screenings, including tests for cervical, breast, and colon cancer. Funding also supports our effort to maintain and expand our designation as a Level 3 Patient Centered Medical Home.

Doctors Across New YorkImproves access to obstetrics and gynecology services by supporting the salary of a bilingual OB/GYN physician in Newburgh, a designated “critical access area.”

Safe NYSupports efforts to distribute free child passenger safety seats to patients. Through this grant, trained technicians will be available at health center sites to install safety seats and educate parents about child passenger safety.

Medicaid Health HomesFunds an effort to improve health outcomes while reducing the cost of care as a system of managing the care of New York State’s most complex Medicaid patients that involves the coordination of services from multiple providers – including primary care providers, mental health services, and specialty care.

Outreach and Enrollment Supplemental Funding Provides funding to support the hiring of outreach staff to assist patients with health insurance enrollment through the New York State Health Benefits Exchange.

RegionalSNAPProvides staff and resources to assist patients with enrollment in the Supplemental Nutrition Assistance Program (SNAP, formerly known as the Food Stamp Program).

16

Indigent CareOffsets the impact of providing primary and preventive health care services to uninsured patients on a sliding-fee scale.

Healthy WorksitesProvides employees with opportunities and incentives for exercise, tobacco cessation, and healthy eating while at work.

FoundationsUnited Way: Women’s LeadershipFunds the Orange County Women’s Enrichment Program, which is delivered in conjunction with the Orange County District Attorney’s Office and provides education and resources to at-risk women in Orange County.

United Way: Crisis InterventionFunds help offset transportation and prescription drug costs for homeless patients and patients at risk of homelessness.

United Way: Community ImpactSupports the expansion of our Fit for Life program, which provides education and opportunities for physical activity in an effort to prevent childhood obesity. Funding will help offer the program at new venues in Newburgh, including: The Newburgh Armory, Newburgh YMCA, and Newburgh Enlarged City School District.

Delta Dental FoundationProvides discounts of up to 50 percent off the cost of dentures and dental implants to patients who earn an income that is below 150 percent of the Federal Poverty Level.

NYS Health FoundationSupports a study of unmet health care needs in the Southern Tier Region of New York State and the feasibility of establishing a health center site in the region.

Dyson FoundationProvides care management services to patients age 55 and older who are suffering multiple chronic health conditions.

Stewart’s Holiday MatchHelps offset the costs associated with offering our Fit for Life childhood obesity-prevention program.

Reach Out & ReadProvides new books that are “prescribed” to every child who visits the health center for a well-child visit between the ages of six months to five years. Our pediatricians engage the children and encourage a love of reading.

2009 201220112010Annual Grant Funding

2009 201220112010Annual Grants Received

FederalStateCountyFoundation

2012 Grant Sources

17

GROWTH MEANS GOING WHERE THERE IS A NEED

Expansion in 2013

2010DecemberNew Access

Point Grant submitted

New Access Point Grant awarded

2012June

2012AugustGround

breaking for future site

Highland Falls

2012NovemberConstruction

began

2013JanuaryBegan service

with Mobile Health Van

2013MarchConstruction

ended and use began

2013AprilDoors

officially opened

Harper Health2010

December New Access Point Grant submitted

New Access Point Grant awarded

Construction began

Began service with Mobile Health Van

Construction ended and use began

Doorsofficiallyopened

2012June

2012November

2013January

2013February

2013March

18

Over the past three years, the health center has grown to over 300 employees and staff, with 130 jobs being created within the last year. Of those employees, many live in the same communities

as the patients that we serve, bringing more jobs as well as quality health care to the Greater Newburgh area.

We hire individuals who understand our mission and who have the drive to meet the needs of our patients. Whether an employee is a patient services representative, a member of senior staff, or anything else there is always room for personal and professional growth within this organization.

It is our goal to create an environment that will help our employees and the health center succeed during this transformative time in medicine.

Growth Means Making a Better Place to Work & Live

FACESof GHVFHC

Health center staff pictured above (L to R): Denise Suarez, Dr. Mukai Jaravaza, Violet Bruno, Monica Francis, and Dr. Avi Silber

19

INSIDE THEEXAM ROOM

Growth Means Improving Clinical Care

When patients enter an exam room they see those staple objects that are in every doctor’s office—the exam table, the scale, the blood pressure meter, gloves, antibacterial soap. The list goes on. As patients recognize these distinct markers, what they don’t realize is that while the exam room looks the same, there are subtle changes that allow health care professionals to provide higher quality, more innovative medical services. This is done by incorporating clinical development with patient needs and experience.

These changes have transformed our delivery of care, making our organization one of the leading community health centers in the area. Testimony from our department leaders emphasizes how modifying our scope of practice has positively impacted the health center’s ability to bring the best care possible to our patients.

HARPER HEALTH

Jody-Ann Buckle, FNP, CDE

“We opened a site for individuals and families who are in transition or homeless to help those who may have neglected their health by providing care that is tailored to their specific needs.”

HIGHLAND FALLS

Rocco Russo, MD

“With this newly established department, we brought health care for all ages to communities previously having little to no access to medical care.”

20

PEDIATRICS

Tracy Lucas, FNP

“Our Fit for Life program, which is exclusive to this area, partnered with CHCANYS and the Department of Health’s statewide childhood obesity initiative.”

WOMEN’SHEALTH

Daniel Pagnani, MD

“In addition to increasing awareness about pap smear testing and cervical cancer screenings, our providers also delivered nearly 600 babies at St. Luke’s Cornwall Hospital.”

DENTAL

Richard Herman, DDS

“Through outreach to local schools, we raised awareness about dental health to over 500 school-aged children.”

INTERNALMEDICINE

Chanchal Singh, MD

“Our practice managers started a pilot program that targets issues concerning patient needs, like reducing wait-time for patients visiting the Internal Medicine Department.”

URGENT CARE

Vincent Bosco, PA

“We extended office hours and opened a radiology department right next door to Urgent Care so that our patients can receive fast x-ray results during each visit.”

CENTER FOR RECOVERY

Peter Saetta, LMSW, LCSW, CASAC, MA

“Our department moved to electronic medical records, making communication between providers and access to health care for our most vulnerable patients easier.”

WIC

Monica Bernard -Thompson, RD,

CDN, CLC

“Our WIC Department is not just for mothers and infants. To make sure that the entire family is healthy we began offering more health education programs.”

BEHAVIORAL HEALTH

Denise Morales, LCSW

“With a growing number of staff and additional resources, we met the needs of more than 100 new patients in 2012.”

21

GROWTH THROUGHURGENT CAREOFFERING ALTERNATIVES TO EMERGENCY CARE

In 2012, the health center’s Urgent Care

extended their hours and began providing radiology

services at the Kaplan Family Pavilion, leading to more immediate care and faster x-ray results. These added benefits

contribute to the already increasing amount of patient encounters at

the health center. There were over 13,000 patient visits just at Urgent Care last year. With enhanced Urgent Care services and

availability of primary care components,

patients have access to high quality, affordable

alternatives to Emergency Room care.

2,200 new patients visited Urgent Care in 2012. Of these patients, 3/4 chose to receive additional services

offered at the health center. Our Urgent Care is a portal to all of

our services, successfully allowing staff to address the medical needs

of more patients and increasing awareness of our comprehensive

approach to health care.

70%of Urgent Care patients

returned two or more times

2010 2011 2012

Total Urgent Care VisitsI have used other

URGENT CARE centers in the past, but the care delivered is far

superior at The Greater Hudson Valley Family

Health Center.

“

”

Services Used By Returning Urgent Care Patients

Center for Recovery

Specialties

Internal Medicine

Women’s Health Dental Pediatrics

Urgent Care

22 - Lindsay Suchow, Patient

2008 2009 2010 2011 2012

Total Patients

2008 2009 2010 2011 2012

Total Visits

Center for Recovery

Positive Choices Center

Internal MedicinePediatrics

Women’s Health

Dental

Behavioral Health

Enabling ServicesUrgent Care

2012 Visits

2012-2013 Statement of Health Center OperationsDemonstrating our Growth and Progress

2009 2010 2011 2012 2013

Health Center Sites

2010 2011 2012 2013

110161

244

311

Employee Growth13

,495

13,1

88

13,7

33

16,1

43

18,3

03

78,4

74

107,

417

113,

549

138,

450

163,

474

23

NewburghNew Windsor

Highland Falls

Kaplan Family Pavilion147 Lake Street Newburgh, NY845-563-8000

Center for Recovery3 Commercial Place Newburgh, NY845-220-2146

Lipman Family Dental100 Broadway Newburgh, NY845-569-8412

Harper Health290 Broadway Newburgh, NY845-561-3759

New Windsor91 Blooming Grove Tpke New Windsor, NY845-561-2257

Highland Falls127 Main Street Highland Falls, NY845-446-4076

OU

R LOCA

TION

S