Healthcare Coalitions: Governance and Sustainability


Ladies and gentlemen, thank you for standing
by. Welcome to the Healthcare Coalitions Governance and Sustainability Webinar. During the presentation,
all participants will be in listen only mode. Afterwards, we’ll conduct a question and answer
session. At that time if you have a question, please press the 1 followed by the 4 on your
telephone. If you’d like to ask a question during the presentation, please use the chat
feature located in the lower left corner of your screen. If you need to reach an operator
at any time, please press * 0. As a reminder, this conference is being recorded Thursday,
September 4, 2014. I would now like to turn the conference over to Melissa Harvey, acting
deputy director, division of national healthcare preparedness programs at ASPR. Please go ahead,
ma’am. Thank you so much and good afternoon. Welcome
to the Healthcare Coalitions Governance and Sustainability Webinar and thanks so much
for your participation today. In speaking with many of our hospital preparedness program
awardees and coalitions this year, we repeatedly heard that coalitions want to learn from each
other, and that’s especially with regard to their governance models, some unique ideas
for financial sustainability, and coalitions’ roles during responses. So as a result, ASPR,
ASTHO, and NACCHO are thrilled to collaborate to bring this Webinar to you today. And we
all recognize that your communities are really, really different throughout the nation, and
we also know that your coalitions are also in various stages of development. So in considering speakers for today’s Webinar,
we looked for diversity with regard to governance models, as well as geography, and I have to
say that while we always thought that doing a Webinar like this would be a great idea,
we did have a practice session about two or three weeks ago, and after that I’ve been
even more excited about it because the information the speakers presented truly was phenomenal.
So regardless of whether you’re part of a coalition that is brand new or one that has
been in existence for over a decade, I really think that you’re gonna learn something from
our speakers today. But that said, we also know that many of you who are not speaking
have fantastic ideas and tremendous coalitions, so we want to also hear from you, and if you’re
willing, we’d love to facilitate an exchange between your coalition and others that have
already reached out to us for ideas and assistance. So please know you can always contact us at
[email protected] and we would love to hear from all of you. In addition to the information you’re gonna
hear in a few minutes and see during today’s Webinar, many of our speakers have agreed
to share their coalition’s foundational documents, things like their charters and their bylaws,
with you. ASTHO and NACCHO are gonna be hosting these on their websites, so please stay tuned
in the coming weeks for more information about where to find these helpful documents that
I think will probably help you translate some of the ideas you hear today into practice. On behalf of ASPR, I want to extend great
thanks to all of our speakers who have been willing and eager to share all of this information
with you, especially regarding their processes for building coalitions, and that includes
the hurdles and the barriers that they faced in order to do so. We know that each of our
speakers is tremendously busy and we thank you for all of your time and energy and dedication
to the HPP program. I’d also like to thank our colleagues at ASTHO and NACCHO who got
really creative and helped us dig deep to find these speakers and the great coalitions
models that are gonna be shared with you in a few minutes, and they also organized all
the logistics behind today’s presentation, so we greatly appreciate their help. And finally,
I’d like to extend a special thanks to Bobby Courtney from the MESH Coalition for moderating
today’s Webinar. So since we have a ton to get through in the
next two hours, I’m gonna turn this over to Bobby so we can get started. Thanks so much. Thank you, Melissa. I really appreciate being
here today. Thanks for the opportunity to moderate this Webinar. Before we get started,
I just want to, on behalf of myself and the presenters, and frankly, everyone on the call,
thank ASPR, ASTHO, and NACCHO for hosting this Webinar, for sponsoring this Webinar.
I’m excited to be here. I think it’s a great opportunity to share best practices around
governance, around programming, on sustainability, to really provide information on how to build
a successful healthcare coalition. So I’ll get right to it. Again, my name is Bobby Courtney.
I’m the chief operating officer and general counsel at the MESH Coalition in Indianapolis.
We’re a nonprofit public private coalition. Our mission is to enable healthcare providers
to respond effectively to emergency events and remain viable through recovery. We’re
also a founding member of the National Healthcare Coalition Resource Center. At this time, I want to take a couple seconds
just to introduce our speakers in the order they’ll be presenting. Feel free throughout
to submit questions and using the online portal. However, we’ll hold off until answering questions
until all presenters have finished. So with that, quickly, I want to introduce Onora Lien,
who is the executive director of the Northwest Healthcare Response Network in Seattle and
King County. Kevin McCulley, who�s the healthcare preparedness program manager at Bureau of
EMS and Preparedness at the Utah Department of Health. Linda Scott, who’s the hospital
preparedness section manager for the Michigan Department of Community Health. Ray Apodaca,
team lead, healthcare preparedness program, health systems branch at the Texas Department
of State Health Services. Jay Taylor, who’s the acting director of the Bureau of Public
Health Preparedness at Pennsylvania Department of Health. And finally, Mary Russell, who’s
emergency services department at Boca Raton Regional Hospital in Palm Beach County, Florida. So with that, I’ll turn it over to Onora first.
Onora, you ready? Yeah. So thanks. I want to thank ASPR, and
NACCHO, and ASTHO for inviting me to be a part of today’s presentation. I’m very happy
to share with everyone the story of the Northwest Healthcare Response Network, which is a coalition
serving in the sort of central and part of the south Puget Sound area in Washington State.
We are a coalition that has a history going back about, to about 2005 and is really one
that has emerged out of the work of two strong coalitions; the King County Healthcare Coalition
in the Seattle area and the Pierce County Coalition for Healthcare in Emergencies, which
is the county south of King County. In 2012, our coalitions actually merged to
create the Northwest Healthcare Response Network in an effort to better expand, streamline,
standardize, and kind of enhance our coalition to serve the medical providers, and the health
departments, and emergency response partners in the Puget Sound area. Our vision is really
about working with healthcare to create a resilient healthcare system and we’ve always
envisioned from the beginning of our work going back to the early days in 2005 that
our coalition has to be comprised, not only of work with health departments and hospitals,
but really, that our focus had to be across the continuum of care, and that we needed
to be engaging across all types of healthcare partners for us to really build and sustain
a resilient healthcare system. To give you a little bit more understanding
of our geography and who we serve, the population in King and Pierce Counties is roughly 2.7
million people right now. We have 2 local health jurisdictions, 2 counties, about 57
cities, and 3 tribal nations. From a healthcare service standpoint, we have 33 hospitals,
numerous community health clinics, numerous long-term care facilities, and certainly,
many folks also served in the home health environment. In terms of scale and what this
represents in Washington State, the hospital and long-term care footprint just in these
2 counties is roughly 50 percent of the state’s hospital and long-term care facility beds.
Although we are a heavily metropolitan area, within both of these counties there is also
a fair amount of rural geography, and included in our hospitals are two critical access hospitals.
We have the only level 1 trauma center and regional burn center for adult and pediatrics
in a four-state region. So there’s a very high concentration of specialized services,
as well as pediatric facilities, VA, military facilities that are served by our coalitions. What I really want to share with you today
is the transition that our organization has gone through to become a 501(c)(3). As I said,
our history goes back many years, and for both coalitions, and then, up until January
1st of 2014, the coalition was administered by Public Health Seattle, King County, and
after the merger and partnership with the Tacoma-Pierce County Health Department. And
we, like many of your coalitions around the country, had staff within the Public Health
Department that served to coordinate and to administer the coalition programs. In 2011, in early recognition that we wanted
to start thinking about longer term sustainability, we had the opportunity to partner with a local
501(c)(3) foundation to work with us to help start a healthcare sponsorship program that
enabled us to, back then, start receiving contributions from healthcare organizations
to give us a foundation that would help us think about building our coalition and financial
supporting our coalition beyond just using federal dollars, and that was an important
step for us and I’ll touch on this a little bit later because it gave us an important
base for us to work from when we decided to ultimately transition to our own nonprofit.
The transition for us was a two-year process and we have operated now independently of
the 501(c)(3) in partnership with both health departments, but as an independent organization
since January 1st of this year. The transition really made some significant
differences for us. Our coalition history was one with a very strong executive engagement
group. We had an executive council comprised of executive leaders from the health systems
and the two health departments. And in the transition to a nonprofit, we have transitioned
that group now to a formal governing board of directors. Our history for many years,
like many of you, was great coalition work done with no fees and just leveraging the
federal dollars that were available to our region. As a part of the transition to a nonprofit,
we have implemented a membership due structure. This is a work in progress. We still engage
with all healthcare organizations, but we recognize the importance in transitioning
to a nonprofit that we would have to look at additional ways to generate revenue and
offset other financial cuts we were receiving on the grant side. So we’ve implemented a
pretty expansive membership program that engages opportunities for healthcare organizations
and very recently is now expanding to other community and business partners to be more
formally a part of our coalition structure. In our early days, as I said, we received
historically almost 100 percent federal funding for our work. A few years ago, we started
receiving some contributions from healthcare to help us expand our work and build a foundation
that was important for us when we decided to make the transition to a nonprofit. Now,
as a nonprofit organization, we still do receive a significant proportion of our dollars from
the HPP funding. We contract directly with the Washington State Department of Health
as a recipient of those funds on behalf of our coalition. We also have membership dues.
We are structured to be able to receive charitable contributions as a charity in Washington State.
We do fee for service work and we do generate some revenue from events that we host, and
this will be a growing part of our financial base as we expand the coalition and look for
additional ways to diversify our resources. One of the benefits to the transition for
the nonprofit for us as well was that for many years we operated with staff in three
different organizations, sometimes four different organizations. The opportunity we created
in becoming a consolidated independent organization was now the network actually employs all of
our staff directly. The process for us to make the decision to jump to a 501(c)(3) I
just want to reinforce was really a long process. It was at least two years in coming, but as
we made the decision that we wanted to think more concretely about how to do this, strategic
planning was really essential for us, and I want to reinforce, I think it’s one of the
most important things a coalition can do is to really think very hard about who you are
now, who you want to become, and what kind of expertise and resources is gonna be needed
in order for you to do that. As a part of our strategic process, we did
do a formal SWOT analysis looking at the strengths, weaknesses, opportunities, and threats of
our organization at the time. We recognize that some of the things that really were advantageous
for us in considering the move to a nonprofit was, one, we had a very strong history of
senior executive engagement from COOs, senior vice presidents, directors, CEOs of local
healthcare organizations, and their commitment and work with us for so many years really
enabled us to have effective collaboration and engagement with them to help with the
decision-making to transition to a nonprofit. We have strong relationships with the health
departments and other emergency response partners and we felt the scope and body of our work
was sufficient to translate into effective work even in a nonprofit structure. We had
to think hard about the limitations in terms of what staff expertise we had and would that
be sufficient to need, you know, to transition to a business, what other expertise would
we need to bring in, and we really had to think very hard and do some rigorous analysis
about what the finances of operating as a 501(c)(3) would be and really do sort of pros
and cons in terms of did we think if we did this we’d be able to sustain in that new business
environment and with all of those requirements in a way that would allow us to be successful
as a, as an independent organization? The transition for us, as I said, was about
24 months, and I want to just sort of highlight some of the steps that we had to go through.
Upon the decision that we wanted to kind of look for something beyond just working within
the health department, we did a comparison of three different potential business models.
One, what would it look like if we stayed and maybe we just restructured as a, in the
health department? Another was perhaps more formally aligning our coalition with another
501(c)(3) in a more formal way than we were currently. And then, the third was looking
at a 501(c)(3) option, which we decided if we went nonprofit would be the best structure
for us. Once our executive council of healthcare and
public health leaders approved the decision for us to look more formally at one of those
structures, and we opted to look more formally at the 501(c)(3) model, we then pursued a
fairly robust business planning process, and that included an extensive strategic planning
process where we really needed to revisit what was our mission, vision, what were our
values, and what would they be as a new organization, and really understand what our strategic priorities
and objectives would be in a new coalition structure as a nonprofit. We developed with
some expertise and advisors that we received on membership and financing a financial structure
for membership, really had to look at the governance structure, and that meant bringing
in the legal and business expertise to help us develop the appropriate legal documents,
board structure, and other business documents we would need to have to operate functionally
in Washington State as a nonprofit. We had to think about what our staffing model would
look like in the new business structure and what the financial requirements would be with
those and really do some modeling and projections on what our revenue options would be in this
structure. And I want to reinforce how important that was and it’s not something to underestimate
if you’re going, if you’re thinking of undertaking the business side of a coalition, it is so
important to really think about what your revenue beyond grant sources is gonna be and
how sustainable that will look for you. Once we had a final approval of our business
plan, we implemented a founding member campaign, which was a request to healthcare organizations
to make three-year financial commitments to our organization, which would help us ensure
that we had some stability in our financial base to get us started as an organization.
And once we had that approval and that process started, we fully went head full-on into implementing
the nonprofit transition, which included doing all the business licensing, implementing and
HR process, leasing new business base, and really focusing on the day-to-day operations
of opening a new business. Just, for example � excuse me, let me go
back one slide � I get a lot of questions about how do we, how do we staff our work,
and I just want to share, it was very important for us to think about all the different dimensions
of our business operations. So I’m providing an example of our staffing model where you
can see we have a number of folks working on the programmatic side, but we recognized
that the, how critical it was gonna be for us as a business that we ensure the staffing
of some of the other areas that would help us be successful both on the philanthropic
side, membership development side, and certainly, the administration of the nonprofit business.
All of our work is done with a great team, but we can’t do our work without ongoing consultation
and advisement from legal folks, both on the nonprofit and tax side, as well as employment
attorneys since we are an independent employer, we have information technology consultants
that help us just run and function as a business. And then, as a nonprofit, the bookkeeping,
accounting, and auditing process is quite essential, so we’ve made sure to bring in
the outside expertise that allows us to run all of those parts in an appropriate way,
particularly since we received both federal dollars, and then, also have other member
and other revenue dollars we need to effectively manage. I always want to acknowledge and thank
the contributions of our very important founding members who did make those three-year financial
contributions, and without their support, we wouldn’t have been able to make the transition
to a nonprofit. In conclusion, and I know this is a lot of
information, but I feel like as the executive director, I’m still learning on a day-to-day
basis the unique dimensions to what it really means to run our coalition and sustain the
great work that we’ve done in our community for so many years, but really think about
how that applies in the business context, and all I can say is my learning is there
are a lot of differences that you have to consider in what your coalitions looks like
once you become a business. You have to think differently about the scope of services that
you offer and what you can effectively finance and resource in a sustainable way and you
need to really think about as other organizations are starting to give you money, how you add
value to those organizations and what their expectations are gonna be for you. It’s important
to have a kind of ongoing dialogue with your community partners and to make sure that,
you know, the appropriate coalition voices are a part of that decision-making, but you
also have to be ready, I think, to make the hard decisions about what’s gonna be most
effective for your business, which may not always be the same thing that community partners
want to see. It’s really essential if you’re considering
a transition to really look hard at different business and governance models and consider
whether they are the right option for you. There are many great ways, I think, to do
coalition work that don’t necessarily require becoming a nonprofit and really understanding
the pros and cons of doing that and what’s gonna work most effectively for your community
is essential. I can’t underestimate or understate enough the importance of really, really looking
at the financial model and the revenue, having a strong revenue development plan before you
make the decision to transition. In our case in particular because we employ so many folks
it’s important for us to really know what are those dollars gonna look like and to be
able to think strategically about that, but I really encourage every coalition to do some
very hard modeling about what the long-term finances will look like before you make the
decision to go nonprofit if you’re considering that. I also want to share how important it
is to appreciate that unrestricted cash flow will be essential to being able to function
as a nonprofit. We all, or many of us at least, benefit from the HPP dollars and that’s so
critical to operating as a coalition as we have for many years. It’s really important
still to our budget. It’s just slightly more than 50 percent of my budget, but it is very
difficult to operate and almost impossible I would say to truly function as a totally
independent nonprofit without some source of unrestricted cash flow to cover expenses
that may not either be allowable by grant funds or that will be more readily and time,
available in a timely way to pay for what you need before you can be reimbursed by the
grant. Lastly, I’ll just reinforce the importance
of the legal and financial subject matter expertise. At every step, it was essential
to building our coalition at this point, and I rely on them on a regular basis in terms
of ongoing management of the coalition. And I think it’s really important for folks to
think in advance of what the expectation of those that are gonna contribute to your coalition
financially will be. As they give money, there is additional expectation of what they get
in return and knowing that going into the development of your coalition is absolutely
essential and I really encourage those dialogues to happen in advance before they make a financial
commitment or before you decide what direction you’re gonna go, so you can make sure you’re
aligning your business model with the appropriate expectations. And the work of, the business
of a coalition is always about demonstrating return on investment and continuing to demonstrate
value. That means we have to listen very carefully, but we also have to be very strategic in the
way that we organize and deliver our work. And I will wrap up my comments there. Thank you, Onora. Again, as I said before,
we’ll hold off questions till the end. So we’ll move right along to Kevin McCulley.
Kevin, are you all set? I am all set. Hopefully you’re hearing me
loud and clear. Yep. We hear you. Great. Well, thanks again to all the hosters
and planners for this meeting. I’m gonna present the model that Utah has chosen to follow for
development of regional medical surge coalitions, and that is a local health department-hosted
model. A little bit about background for Utah, this is a bit of a busy map, but what you
can see is that we have 29 counties in the state, about 3 million people. Actually the
four urban counties that are in the red outlined area, that’s about 75 percent of Utah’s population
and that’s called the Wasatch Front. There are also 12 rural counties and we actually
have 13 frontier counties, which are less than 7 people per square mile. Also, in terms
of putting all our eggs in one basket, for the hospital density, in our northern 3 regions,
and you’ll see on the map that’s northern, SST, and Utah Wasatch, about 87 percent of
the beds in the state are in these regions, and 86 percent of our population. Now to show
that we are in a, certainly have some vulnerabilities in this area, there’s a yellow line going
north to south, that is actually the major fault line for the Wasatch Front area, and
it extends from Idaho all the way down to the center of the state. So not only do we
have the bulk of the population, the majority of the hospital beds, but we also have one
of the greatest infrastructure threats that exists right in our Wasatch front area. What I wanted to do in this, in this presentation
is just do a bit of a comparison because although we have 25 rural and frontier counties, we
are actually the 6th most urbanized state in the nation, and with that in mind, let’s
take the first example of SST, which stands for Salt Lake, Summit, and Tooele Counties
regional coalition. There are over 107 members on that, including each of the health departments
in that region, 17 hospitals, 37 long-term care centers, and many others, including emergency
management associations, outpatient, and other partners. And let’s contrast that with our
southeast region where they have about 12 members. That includes the four hospitals,
a handful of FQHC, CHC clinics, a strong presence of DEMS agencies, and as a wise person who
I heard on prior conference tell me, it really follows the STP method, which is the same
ten people that are involved in most of the activities. So if we look at some of the key elements
of the coalition, as I noted, our model for both of these is a local health department-hosted
model. However, for the SST, which includes three health districts, one, the Salt Lake
County Health District is serving as the host. In the other case, for southeast, it is one
host and one health district that covers four separate counties. Each of these groups are
funded completely through HPP funds for staffing, training, equipment, and exercises. One of
the big differences in the staffing is that for an area like SST with its high number
of members and lots of activity, it does require near to full FTE plus administrative support
to manage the affairs of the coalition, whereas in the southeast area, it’s more rural and
frontier. Our rural and frontier ones use about a 0.5 to 0.6 FTE person who is employed
by the health department. And just by way of numbers, for example, in addition to the
funding for administrative costs, we provide a shared coalition, equipment, training, and
exercise fund. And so, just for comparison, you can see that the SST, for example, gets
about $45,000 to be able to do equipping, training, and exercising activities for its
members, contrasted with southeast, which gets about $12,000. For meetings, the SST is a bit more formalized,
where every other month there is a full coalition meeting, and then, on the off months there
is an executive committee meeting. The southeast, by comparison, they have a full coalition
meeting that occurs quarterly, but monthly we actually have the coordinator do outreach
and attend local emergency planning committees, EMS meetings, hospital emergency management
meetings. And so, as I’ll describe a bit later, one of the key issues for us with just the
amount of space in some of our more rural areas is it really takes a coordinator who
is willing to go out to the facilities and work with them individually because it can
often be challenging just by way of mileage, but also by way, by way, of times of the year
when travel from the remote parts of the state is not as easy as it normally is. In terms of some key documents, the SST for
one example has bylaws and an MOU that’s been signed by participating members and they have
a base response plan with very important section, including a resource management plan and a
communications plan. By contrast, the southeast not quite as formalized, but still formal
documentation would be a charter that everyone agrees to the purpose of the functions of
the coalition. They develop a base response plan, but the communication piece is as much
as tree or a protocol as it is a detailed plan. And then, something that’s key for us
that we’ve always encouraged our regions to do is that, you know, we recognize that there
are some significant state level threats that are identified through JRA or through the
THIRA, or a state hazards assessment. But we really want these regions to be most sensitive
to preparing for those events that are most likely in their area. And so, you can look
at some of the priorities for our urban area, includes a pandemic, an earthquake, evacuation,
or falling down of a hospital, a large MCI, and certainly a utilities interruption that
would impact the healthcare system’s abilities to provide care, and contrast that with our
rural and frontier primary threats, include things like an MCI bus crash, certainly receiving
earthquake evacuees that may come out of the Wasatch Front during an event and present
into these healthcare systems, pandemic novel event, and there are many concerns about gas
and oil extraction events that may take place in those areas, and then, certainly severe
weather and fire can not only cause infrastructure impacts, but most importantly, can cause,
can cause damage, or can cause impassable roads ’cause in many of our rural areas, there’s
really only one way to get in our out of these communities. So in terms of the some of the factors we
considered when pursuing the local health department-hosted model, we first looked at
historic factors, and that includes within the Salt Lake Valley, many of our Salt Lake
City area hospitals participated in CSPP, which is the Chemical Stockpile Preparedness
Program where we had a munitions disposal facility that was, that was within plume range
of Salt Lake Valley. So there was an opportunity for hospitals to begin to work together many,
many years ago. We also had the 2002 Winter Games that took place in Salt Lake. This became
another opportunity for the Salt Lake area hospitals to work together. And then, finally,
the city’s readiness initiative. The three counties that are in the SST region were also
the three counties that were part of the CRI. We did an assessment of existing regions,
including the historic Homeland Security regions, the HRSA bioterrorism regions from the prior
iteration of the grant, and the existing boundaries of local health departments. We compared some
of the existing regions against assessments of hospital catchment areas, which included
normal patient access and transfer patterns with and between EMS and hospitals, and then,
looked at some significant geographic barriers that we experience in our state, including
many mountain ranges and lack of roads into some areas. So local health departments and local health
districts came as the host. We found that the local health districts actually approximately
matched patient movement patterns as they stood. We also saw that local health departments
were developing increased roles to fulfill ESF8 functions in jurisdictions and not just
for traditional public health events. We actually saw that an opportunity presented itself for
our local health department emergency response coordinators, which are our PHEP funded folks
to assist with not only public health functions, but to assist with medical facility and EMS
functions in jurisdictional ESF8 roles and in command centers. We also had a long history
of success through the PHEP program with working with our local health departments and ongoing
excellent relations, that also from our perspective, from the state perspective, it certainly eased
the processing, budgeting, work plans, and other, and other, you know, crossed Is and
dotted, or crossed Ts and dotted Is for the activities or the grant. And one of the things
that we were most concerned with is that, you know, this really, a big piece of coalition
is developing trust that the coalition itself and the coalition coordinator is there to
support the local healthcare entities. And so, our take was to use local people to serve
local agencies and take advantage of those existing relationships. Now we certainly can’t go through all this
and have everything worked perfectly. We have run into some barriers or challenges that
I’d like to briefly review. The first one is a communication gap that historically existed
between some entities. For example, between local health departments, hospitals, long-term
care. There was a lot of planning going on in silos. There was a little bit of overlap
with some public health preparedness and response, but really, one of the ways that we started
to get past that barrier is many of our regions will actually now rotate their meetings between
coalition member sites, and then, include a tour and a presentation by the meeting hosting
entity so that that they can get to understand the capabilities of the different entities
that are a part of this group. We certainly have rural challenges, including
up to 150 miles between some facilities, and also, the fact that the response is county-based.
So as I mentioned before, many of our rural coalition coordinators, we encourage them
to travel to sites and do one-to-one meetings if you have challenges getting everyone to
a full group meeting, and then, also encourage the coordinators to attend any ESF8, LAPC,
or any other relevant meeting that’s going on in within a county or within those communities
and just try and get about five minutes at that meeting to say, “Hey, we’re the healthcare
coalition. We’re helping the jurisdiction to ensure that health and medical is supported,”
and that way others who have concerns can understand that we’re support, not to take
over or not to try and be infinite command over healthcare. Related to that was some impression initially
that the coalition was walking over some of these existing groups, like LAPC or existing
ESF8 work groups. So we provide the direction to our folks to ensure that clarity is offered
to all of the response partners in these communities that the coalition is an asset. We’re building
caches, we’re building communication systems, and we’re building plans to support impacted
facilities. We can actually take some of the burden off jurisdictional emergency managers
by having a coordinated system for health and medical. We did find that recruitment to these coalitions
was often much easier than retention. So we ensure that the meeting content and goals
are system-based. It’s about the healthcare system as all of you who work in this now
realize and that all participants can benefit from shared coalition funds. More recently,
the introduction of the CMS proposed rule for emergency management has really been an
opportunity for us to ensure that these coalition leads develop themselves as not only a technical
assistance expert to entities that are just coming, such as home health and Hospice, but
that they can, they can help these entities fulfill some of the conditions of participation
that are gonna be required of any entity that bills Medicare or Medicaid when those goals
are finalized. And then, finally, we have seen some difficulty in completing some of
the grant targets or resource elements, particularly the planning ones or the written ones because
often what we saw is there was a lot of deferral to the coalition to try and make progress
and written plans, and in some cases it even resulted in sitting through a meeting with
a document up on the screen trying to wordsmith, trying to get the language right, and it really
put a crimp in the ability to just get these things out. So instead, what we’ve done is
empowered the coordinators to go ahead and develop, borrow, steal, re-appropriate existing
content, get it out as drafts, and then, seek edits, and that’s been a big, a big benefit
to us in developing our written plan response planning targets. So in terms of short- and long-term sustainability,
you know, we may not be one of those states who is in a position to develop a model that
is fee-based or to independently move into a 501(c)(3). We are still dependent on the
HPP funds. However, we believe that investing in this process and in the people that make
it happen, that it’s gonna succeed. So currently about 40 percent of our Utah of HPP grant
goes to coalitions. We believe that sustainability also results from sustaining a regional cache
training and exercise fund. This is an opportunity for all members to express what their needs
are and to ensure that they’re met in a way that is shared across the region and not held
by any individual facility or held tight for some later time. It’s meant to be spent based
on the needs of the coalition. We work across all levels of responder agencies
to define the value of the coalition. Working with EMS agencies, fire agencies, traditional
emergency management to show that there is value in having a coordinated system of medical
search, management, and response. And then, we take whatever opportunity we can to leverage
the existing champions in our communities, and this is especially true in our rural areas.
There is often one or two, or three or four individuals that have really taken this emergency
management under their wing and really feel that they are a critical piece, and we need
to take advantage of that just to make sure that this thing continues to go. In terms of longer term sustainability, we
do anticipate that we will still have a reliance on the HPP grants. However, as we develop
program targets, one, for example, includes a yearly exercise in each region in which
any member can play. So we know that the HPP grant only requires once every five years,
but as we start to see these CMS rules come rolling out, you know, there is required yearly
exercises within that CMS rule. There are required yearly exercises within those entities
that seek accreditation, whether it’s joint commission, DNV, or any other accrediting
agency. As I mentioned before, we see the region to
be a primary point person on technical assistance to assist healthcare facilities with meeting
the CMS EMS, the CMS EM rules. We increased our interregional and interstate coordination.
For example, we have a multi-region vigilant guard National Guard exercise coming up in
the fall and we’re gonna ensure that we work between regions in the state to see how they
can work together to support each other. And also, we have worked with some of our collar
states. For example, our northern region recently had a meeting with the southeast Idaho region
to talk about shared activities and ways to support each other in an event. We do hope
to see in the near future, and this may not be new to many states, but the development
of regional resource hospitals. For example, our only burn center and our only pediatric
specialty hospital are located in the Wasatch Front. And so, if one or two of those is down
or inaccessible, we may have to rely on hospitals that are not accustomed to receiving and holding
burn or pediatric patients to have the resources and training to accommodate those patients
until we can get the system back up. And then, finally, we believe longer term sustainability
will be found through continued coordination with state and local EMS agencies for mass
casualty planning. So in terms of materials and resources, I
won’t read the whole list, but we have quite a bit, including resource element assessments,
checklists, shared regional equipment budgets, and you can see the lists there. You are welcome
to either contact me individually or through the hosting group for this call and we’ll
make sure you guys get what you need. So that is all for me. Thanks to everyone and I’ll
pass the ball onto the next. Great. Thanks so much, Kevin. That’s great
information. We’ll move on next to Linda Scott from the Michigan Department of Community
Health. Linda, are you all set? I am. I am. Thank you for the opportunity
to present on behalf of the Michigan Department of Community Health, office of public health
preparedness, and our eight regional healthcare coalitions, and I have to say, including our
leadership teams and the partners that really do the heavy lifting that make our program
so successful. As with the other presenters, this slide shows
the geographic boundaries and the number of healthcare organizations and partners, which
have remained pretty stable since they were formed in 2002, and really, we have a pretty
solid core of partner composition within our coalitions. Each coalition has additional
members based on their regional resources. The early HRSA grant asked that states or
awardees, and I quote, develop, implement, and intensify regional terrorism plans and
protocols for hospitals, outpatient facilities, EMS systems, and poison control centers in
collaborative statewide or regional models. So Michigan established our healthcare coalition
structure to align with the established emergency management districts, thus maximizing a framework
that had already been established for planning and response to emergencies. And in addition,
our state regional trauma system is being established, utilize these same boundaries,
which really strengthens the relationship of emergency preparedness planning and response
to day-to-day operations. These eight regional healthcare coalition partner serve Michigan’s
10 million population. So I’m going to discuss the med control authority
in more detail shortly, but I want to just outline as well the infrastructure of our
healthcare coalitions. Each healthcare coalition has established a contract for a part-time
medical director who’s an emergency department physician with excellent knowledge of our
EMS and growing trauma system. Each coalitions has a full-time regional coordinator and over
time, each region has added an assistant coordinator due to the human resources needed to complete
the deliverables to the federal cooperative agreement, and probably more importantly,
provide the extensive logistical support required for healthcare coalition activities, including
robust education, training, and exercise programs, and of course, their role and response. Each coalition maintains bylaws originally
established in 2002, but recently updated to ensure that all coalitions have the same
consistent components to the bylaws, which really contribute to that consistent statewide
planning effort. Identified in the bylaws are two required meeting structures and these
structures have been in place since the beginning of our coalition formation. The first is the
regional planning board, which is responsible for voting on the prioritization of program
initiatives and the allocation of funding linked to those priorities. This board has
voting members based on organization type and discipline representation, but is not
linked to the size of the organization, so it’s one for one. Decisions are through consensus
and developed by the coalition based on identified gaps after action reports and each budget
period priority initiatives established collaboratively with our office, which is the awardee. Each
coalition also has an advisory committee, which is compromised, which is comprised of
subcommittee and/or groups. Again, these are established from within the coalition. So
what does the coalition need to accomplish their tasks? And then, our eight coalition
leadership team actually meets monthly as a group with our state staff, so that we not
only have the planning that goes on within the coalition, but the planning that goes
on across coalitions and some of those statewide coordinated activities. So this Webinar is focusing on the governance
model, so it’s important to understand the structure we have in Michigan, which really
has enabled strong healthcare coalitions, not only during planning, but during response.
So when we established our regional structure in 2002, it became clear that we wanted to
develop a framework that would not appear to place any one healthcare organization as
the primary sub-awardee for receipt of the federal funds and assume the responsibility
to coordinate activities for all healthcare organizations that fell within that jurisdictional
boundary. So after careful review, we decided to use something that is probably somewhat
unique to Michigan, which we call a quasi-governmental structure called a medical control authority,
which actually is designated under Part 209 of the Michigan Public Health Code. So a med control authority is administered
by the participating hospitals and is designated by the state department of licensing and regulation
to supervise and coordinate emergency medical services for a specific geographic region.
In 2002, there were 65 med control authorities in the state. So we convened a meeting of
this group and they self-identified the one med control authority within each of those
emergency management districts, which are now our emergency preparedness regions and
our trauma regions to service the fiduciary for the HRSA, now ASPR cooperative agreement.
This agency really has continued to be a proven mechanism to ensure that hospital and pre-hospital
partners, as well as the diverse membership of long-term care, local public health, and
emergency management to name a few are really well-served by our coalition. So like many on this Webinar, in the early
days of establishing the regional healthcare structure, we worked to implement the tiered
structure outlined in the Department of Health and Human Services publication Medical Surge
Capacity and Capabilities. We know all response is local or tier 1, but for the purpose of
this discussion today talking about healthcare coalitions, I will focus on the oval structure,
which is on this slide, which indicates the healthcare coalition medical coordinator center.
So in Michigan, this is our tier 2 multi-agency coordination system or MAC in NIMS terminology,
which coordinates activities above the field or hospital level through the prioritization
of the incident command for critical or competing resources, and � very important and � serves
as an important resource to both local and state emergency operation centers. You will
note that the MDCH CHECC, which we call our check, stands for the Community Health Emergency
Coordination Center, which is responsible for ESF8 and works directly with local public
health and our healthcare coalition medical coordinating center during response. The MCC
is established and available 24/7, 365 in Michigan and has both a fixed location within
each healthcare coalition, but can also be virtual or relocated to support operations
as needed. So our MCC has proven invaluable to streamline communication and information
requests, as well as has demonstrated efficient use of available resources. So many of you may be thinking, “Under what
authority does the MCC function?” because I know we all hear what is the authority of
our healthcare coalitions. So there are actually several ways that this entity does have authority
since both the healthcare coalition and the medical coordinating center are part of our
Michigan emergency management plan, which has been signed by the governor, giving them
a clear role in incident response. In addition, EMS agencies are guided by protocols. These
protocols must be at least as comprehensive as a state model protocol developed by our
state EMS office in conjunction with their state level advisory committee. In 2009, the regional medical coordinating
center was written into our state’s mass casualty incident protocol. So essentially, all med
control authorities and all EMS follow this protocol. Now, I understand that you can’t
read this slide, but essentially verifies that the medical coordinating center acts
an extension of the med control authority, again, which is defined in the public health
code, it highlights normal activities that would include maintaining communication with
involved entities, such as EMS incident command physicians, hospitals, local ELCs, our CHECC,
which is Community Health Emergency Coordination Center, and other med control authorities.
It also recognizes a role in casualty transport mechanisms, coordination and distribution
of resources and other tasks for an effective regional medical response. And, of course,
importantly it ramp forces the immunity for liability for the med, medical coordinating
center and those personnel staffing and performing the functions, unless the usual act or omission,
which is the result of gross negligence or willful misconduct. So as we talk about authority, as we talk
about staffing these MACs or this tier 2 medical coordination center, this has been very important
in helping us to establish our three deep roles, which would be needed to fill the medical
coordinating center during an incident. This slide is just really for the purposes of review
after this presentation that talks a little bit, kind of highlights the key points that
I just discussed through our state model protocol and our medical coordinating center. So now we’ll kind of flip, so that told you
a little bit about our state, a little bit of our structure, what our authority is, and
so, we have pretty mature healthcare coalitions with staff infrastructure. So during budget
period 2 last year, last grant year, we started the process to pursue becoming 501(c)(3).
So this really started consistent with the January 2012 healthcare preparedness capabilities
documents distributed by ASPR, where in capability 1, healthcare system preparedness, you know,
it tells you that needs to focus on developing, refining, and importantly, sustaining healthcare
coalition. It specifically states to develop strategies to empower and sustain the healthcare
coalition as an entity. So as I stated during the previous budget period, each of our eight
healthcare coalitions began to lay the groundwork with their advisory committee and planning
board of the need to become a 501(c)(3). As Onora noted, this is a complex process, which
requires careful explanation, and planning, and assurances that the healthcare coalition
system as it is currently established will still be able to support their partners. Our
healthcare coalition leadership have communicated that fact and doing so will provide the opportunity
for coalitions to seek additional funds that can maintain their infrastructure and continue
to move emergency preparedness forward for healthcare organizations and the community
they serve in light of diminishing federal emergency preparedness funds. So we see this as an important path to financial
sustainability and stability of our eight regional healthcare coalitions. So this is
a diagram that really lays out kind of those major milestones to complete this initiative.
So although we started almost a year ago, we thought we would be farther along in this
process, but I think Onora gave us a great presentation that just talks about what they
went through to establish it for one coalition. We’re doing this for our eight coalitions,
but due to the hard work completed thus far, we feel confident that we will be able to
accomplish this goal by the end of budget period 3, or pretty close to June of 2015.
That’s our goal. Now, if you’re thinking that this cannot be
accomplished for the many reasons we struggle with, our healthcare coalition is too rural,
ours is too large, or it’s under-resourced, I’m really happy and proud to be able to provide
an update of where our eight healthcare coalitions are in this process. So I know that these
numbers don’t mean anything to you, but these are how we signify our eight regional healthcare
coalitions. So as you can see, each healthcare coalition has taken a slightly different path
and some are working together to utilize the resources available, like regions 2 north
and 2 south, whose medical control authority is already a 501(c)(3) corporation, and they
are integrating each healthcare coalition as a limited liability corporation as part
of their med control authority. That’s really our southeast Michigan highly populated area;
shares an international border. You’ll note that region 6 is noted twice on this slide
as their med control authority serves both region 6 and 7. So they are working in several
directions to support this project. Now, region 8 is our Upper Peninsula region, very rural,
but actually the first region to get their application paperwork submitted to the IRS
and the State of Michigan. So you can see that, as Onora stated, you have to look at
what’s gonna work for that region, and then, establish the structure that meets that region’s
need. So anybody liking more information can certainly get a hold of me and we can talk
a little bit more in-depth. So the most important message for Michigan
today is that our regional healthcare coalitions continue to demonstrate value to their partners,
not just medical and public health, but also emergency management, law enforcement, non-governmental
organizations, and other participating entities. You may have heard that Michigan recently
had significant flooding in southeast Michigan, some of our highest populated areas with many
healthcare organizations. Two of our healthcare coalition medical coordinating centers support
their organizations continuously through this response with continuous communications and
the identification of resources, which might be needed to continue several hospital emergency
department operations that had to temporarily modify their operations due to the impact
of the flooding and the space. Using this structure, this medical coordinating center,
that tier 2 MAC, three healthcare coalitions through their medical coordination center
put a query out to their coalition members and within an hour had identified requested
equipment of supplies should they be needed. This really demonstrates continued value to
coalition members, that it should be ongoing, and it’s critical steps like this towards
continued participation, again, not just planning, but also, for response, and I think that’s
really the take home message is that it doesn’t have to be a catastrophic incident. When you
have flooding in a highly populated area, that’s pretty catastrophic to that community.
So the healthcare coalition really serves a role in day-to-day operations. Finally, this slide lists some of the tools
and/or resources that Michigan has developed with, which may be of interested to those
of you on this Webinar. Please don’t hesitate to contact me, and it sounds like we’re gonna
be able to put this information up on our website so you will have access to it, but
again, we’d be willing to share our coalition bylaws template. Each of our regions have
operational guidelines, which are all setup consistent with the CPG 101, so it’s got a
base plan with annexes and appendices. We’ve developed a statewide electronic patient tracking
algorithm. We developed an essential elements of information template that we use and have
utilize during exercises. You can get access to our ethical guidelines on the website that’s
listed on that slide. We have a pretty robust mass casualty incident burn surge plan, and
we have a lot of resources for long-term care on our website. So with that and that very
quick overview, I’m gonna turn it over to our next speaker and I thank you. Thank you so much, Linda. Great practical
information on a lot of great resources for folks. I just want to remind our remaining
speakers, keeping to our times that we discussed just so we can save a little bit of time at
the end for questions, and with that, I’ll go onto Ray Apodaca. You ready, Ray? Yes. Thank you for the opportunity to present
and share our information today, and for the sake of time, I will attempt to quickly go
through the overview of the process that we use in Texas for governance and sustainability
of our healthcare coalitions. First of all, just wanted to share with everybody that our
coalitions include 22 that cover the entire State of Texas. Us, as the state awardee have
entered into a contractual relationship with a lead agency for each of the healthcare coalitions
that facilitate and administer all the day-to-day activities of the coalition in order to meet
the grant requirements and to meet the state preparedness or healthcare preparedness expectations. Our 22 healthcare coalitions vary considerably
in size by population and geographic area. They include small rural coalitions, mid-sized
urban, and very large metropolitan coalitions. Our smallest coalition includes two acute
care hospitals and our two largest coalitions each have well over 100 hospitals and all
of our coalitions also include many other health and medical partners. Our coalitions
have a minimum of three counties that make up their geographic boundary and each has,
as a minimum, at least a level 3 trauma hospital or greater. Also, our healthcare coalitions,
not only hospitals, but include health and medical partners, EMS, public health, emergency
management, and first responders. Present day, the way our coalitions look because
they have changed over the years since year one of the HPP program, but present day, we
have 20 of our 22 coalitions that function as 501(c)(3) nonprofit organizations, and
that’s based on the structure that our lead agency for the coalition has in place. So
they function as part of their governance under a charter and/or bylaws. Most of these,
since they are nonprofit 501(c)(3) organizations already had a governance system in place before
the HPP program. Because we used the existing EMS and trauma structure, most of these organizations
already had that in place as part of the state EMS and trauma system. Most of the, those existing nonprofits, as
I mentioned, use their existing governance structure and in most cases just amended it
and included HPP as a subgroup or a subcommittee of their existing structure for their regional
healthcare coalition. Two of our twenty-two healthcare coalitions present day are local
health departments, and actually I believe in this case there was some challenges initially
when they were selected as the lead agencies partly because they’re accustomed to being
governmental organizations and not necessarily used to functioning under bylaws or charters,
and also, they usually function under a political jurisdictional boundary where our healthcare
coalitions involve multiple counties and a larger regional area, but they have been able
to overcome some of those challenges since they were selected to be a lead agency. Our healthcare coalition since year one of
the HPP program has been funded by us, the state awardee. We traditionally have pushed
out 70 to 80 percent of our total grant award awarded to the State of Texas, we pushed that
out to the local regional level through our healthcare coalitions and we do that through
the existing contractual sub-award agreement that we have with the lead agencies. Over
the years, the funding formula and methodology has changed partly due to the changes that
we have experienced over the years with the HPP program, but we have always had open discussions
with our healthcare coalitions to receive input and recommendations on how we should
model our funding allocation formulas. Over the years, we have also conducted competitive
RFPs to select the regional lead or host agency for each of our healthcare coalitions. The reason we chose the model that we have
in place for Texas was partly due to the state legislature that limits the staffing that
we can have as a state agency, and in order for us to be able to properly implement and
administer a statewide program that includes well over 600 hospitals, we did not feel that
we had the staff in place to properly administer and manage that. So we very much took the
regional approach and elected to initially implement 22 regional contracts and have them
be the conduit to all the health and medical partners in the region. We initially, in year
one, attempted to partner with the state hospital association, like many other states have done,
but in this case it did not work and actually the hospital association declined the opportunity
to do that for many reasons that I won’t get into right now for the sake of time. But they
have always since day one to present remained a very important partner in our statewide
hospital preparedness program. When we elected to implement the statewide
regional structure, we initially in year one did that with 22 nonprofit organizations.
So we tapped into the existing EMS and trauma system that we already had contracts in place
with those entities, but as I mentioned a little while ago, at about the five-year mark,
our agency decided that we needed to re-evaluate what we were doing statewide and open it up
to a competitive RFP process to allow anyone, including nonprofits to compete for the lead
role of our healthcare coalitions, and that is when our program started changing somewhat
over the years, and we did end up getting some agencies that serve as the lead healthcare
coalition agency that are not nonprofits. For example, the two health departments. Initially, in year one we had 22 contractors
to oversee the 22 healthcare coalitions, but over the years because of the reduction in
funding and some of the changes that we made in the expectations we had in our RFP to reduce
some of the administrative costs, we have been able to reduce the number of contractors
to where we now presently have 14 contactors that oversee 22 healthcare coalitions. So
some of our contracts administer and oversee more than one healthcare coalition and there
have been significant benefits to that. Some of the difficulties and challenges that
we have experienced over the years. Several years ago, particularly in year 10 through
12 of the HPP program, we started realizing that as we tried to move our program forward,
and make it more mature, and establish the level of preparedness that we had hoped for
in each of our coalitions, it was difficult because of the difference in sizes, the difference
in resources, the difference in funding that each of the coalitions receive that we were
really encountering some problems, and through the advice of some of the coalition members,
what we did is we took a step back and what we did is developed a very detailed three-year
strategic plan and we broke down every one of the HPP capabilities or back then, the,
they weren’t called capabilities, but I can’t remember the word right now off the top of
my head, but what we did is we took each one of those and we established a minimal level
of preparedness that we were shooting for to accomplish in a three-year program, and
that way, depending on the size, the number of resources, and the number of funding that
they receive, they were able to do it in an incremental process, depending on the capabilities
of their healthcare coalition, and that seemed to work real well for us and move the program
forward. The other thing that has been a struggle initially,
there was a lot of pushback nationwide with the coalitions taking on a response role.
Some state awardees have really embraced that and some have not. In Texas, we very much
embrace that and we could not be successful as we have had real life responses without
the coalition members that we have. They play a very important role in our statewide response
and the contracts that we execute with the lead agency with the healthcare coalitions,
there is an expectation in the contract language that they will respond. And because there
have been challenges, particularly from emergency management in the early years and resistance
saying that particularly nonprofits, that they did not have a authority to respond,
and the way we’ve done that is through our contractual relationship, and also, we issue
some written mission taskings through our state medical operation center when we deploy
them as a state resource, and we believe that that has worked well for giving them the response
authority and in some cases additional funding for the response. As far as short-term or long-term sustainability
challenges that we have been dealing with, it was actually our coalition members that
came forward in about year 2010, and we, as we started seeing the funds being reduced
from year to year, we quickly realized that we needed to take a step back and try to determine
what was it that we wanted to have in place for when this federal funding went away whenever
that day comes, what did we want to have in place. And one of the things that our coalitions
really brought forward was the idea of developing eight emergency medical task force teams that
are made up of multiple coalitions and cover the entire State of Texas, and that’s what
we did, and that’s what we’ve been sustaining and building on since 2010, but each of those
emergency medical task force teams include ambulance strike teams, mobile medical units,
or mobile hospitals, nurse strike teams, and ambulance buses that have really played an
important role for mass casualty incidents and for hospital evacuations. The program
has actually been a great success and has been a great best practice that we have shared
with others nationally. And we usually, while we have those resources in place at the local
and regional level and they very much function day to day as a local and regional resource,
but we have the ability and expectation to also deploy them as a state resource on a
state mission. The other challenge that we have same as everyone
else is with reaching of the funding. We are very much concerned on our ability to sustain
the 22 healthcare coalitions that we have. We feel that if the funding gets reduced further
than it has in the last year, particularly since we allocate 70 to 80 percent of our
federal award to the healthcare coalitions, we really have some concerns about our ability
to sustain each of the 22 healthcare coalitions and we hope that we do not reach the point
with the reduction in funding that will cause us to lower that number below 22 and have
to consolidate and make our regions even larger than they already area. Our coalitions have
largely been successful because of the full-time staff that our coalitions have that are able
to manage the day-to-day activities that the coalitions need to have in place for them
to be able to accomplish what we think the federal grant expects, but more importantly,
what we expect as far as healthcare preparedness for the State of Texas. And I won’t read the
list. You can see it on the list, but these are some examples of some of the resources
that we can share, but before I conclude my presentation, the one thing I wanted to share
is that the reason our program has been successful in the State of Texas is very much due to
the passion and commitment that our healthcare coalition lead agencies and our healthcare
coalition members have. We meet every month together in a statewide meeting in Austin
and have been doing that for many years. That is where we provide guidance, we share lessons
learned, and we really try to identify some challenges and barriers that we’re all dealing
with and really feed off of each other to try to keep our program moving forward. So
that concludes my presentation. Thank you so much, Ray. That was great. We’ll
move right along. Jay Taylor from the Pennsylvania Department of Health. You ready, Jay? Jay?
I think we may have a little bit of a glitch. Maybe what we’ll do is we’ll move on. Mary,
are you ready? And then, if Jay comes on, we’ll have him close. This is Mary and yes, I’m ready. Mary Russell from Boca Raton. Actually, I’m a representative of a local
acute care hospital, but I am serving as a representative also for healthcare emergency
response coalition, which is in Palm Beach County, Florida. It’s kind of interesting.
We’re located in South Florida. Florida has 67 counties, 7 regions, and 15 healthcare
coalitions. So what’s kind of interesting about where we’re located is it’s population
dense. So we have 1.3 million residents, lots of tourists, a big geographic area, and you
can see the density. I kind of thought it was interesting with Utah, seven people per
square mile. We’ve got, like, 670 people per square mile, and definitely vulnerable populations.
You can see our elderly population. Out of all the older adults in Florida, one-third
of them live in South Florida. So we have to consider that with, you know, all sorts
of issues that occur. In terms of hazards, clearly weather-related
concerns top our hazard vulnerability analysis. Wildfires, infectious diseases, and manmade
disasters. Infectious diseases is kind of interesting because being an international
destination, we’re only a plane flight or a boat ride away from any kind of potential
transmission of diseases. So we’re, we’ve endured things like weaponized anthrax attacks,
you know, obviously influenza, but more recently, things like dengue, chikungunya, you know,
are on our list of things that we have to be concerned about, and certainly Ebola as
well. And in terms of the governance model, we have
kind of a different one than the rest of the speakers. We have, the health, our healthcare
emergency response coalition is a program of Palm Beach County Medical Society services.
Our Palm Beach Medical Society is a 501(c)(6), but has a nonprofit 501(c)(3) under which
it has our healthcare emergency response coalition, medical reserve corps, project access, and
some others, and our mission is definitely aligned with theirs in terms of promoting
quality healthcare. Whoops. Thought I went too quick there. They were established in
2001. We formalized our coalition in 2003. So we
are probably one of the older coalition models. We have a representative on their board and
they are a member of our coalition as well. Definitely aligned with our mission. They
offered initially a centralized geographical meeting location because being such a large
geographic area that was certainly helpful. They got a consultant to help us get started.
They provide a shared administrative coordinator, so it’s someone who is in charge of disaster
services with the Palm Beach Medical Society, but helps MRC, helps our coalition, helps
other disaster-related functions. They provide the accounting and audit support for us so
that doesn’t become a burden to us and a financial type of issue where, that really definitely
is helpful to us, and they provide a link to physicians, and I think that’s important.
They have 1,400 physicians within their medical society and that’s in addition to all of our
acute medical care staff offices. So during H1N1, it was certainly helpful to have that
link when that was a threat that, you know, you saw such a surge at the private provider
level. Ten percent of healthcare coalitions nationally are linked with medical societies.
It’ just another option if you need the additional support and don’t have the financial structure
to support a 501(c)(3) all by yourself. We did explore that doing an independent 501(c)(3)
and really didn’t see the value, and actually felt we would lose the support of being linked
with such a strong organization. In terms of factors to pursue our model, we
have actually been enduring things for a long time. We had a category 5 hurricane back in
1992 where patients were evacuated by the busloads to other counties, and the whole
state actually mobilized, and I think that kind of really jumpstarted a lot of agreements
within our state that led to coalitions. We had an anthrax in 2001 and that was a weaponized
anthrax attack with the first fatality occurring. So that was our first kind of venue into real
bioterrorism needs in terms of preparation. We have strong working relationships with
our health department and emergency management. They’re at every meeting. They certainly advise
us with threats and give us credible information, which is really, really important. And let’s
see. And we’ve been recognized as a special focus in terms of critical infrastructure
and I think that is, you know, a strength. In terms of � this was our initial venue.
This was back actually in 2001, but, you know, definitely woke us all up, and also, with
the mobilization factor for emergency response agencies to say, “Hey, you know, we’re in
this all together.” White powder incidents numbered in the thousands, and there was a
need for equipment, training to manage any kind of contaminated incidents and casualties,
and a need for coordinated public messaging for rumor control and education. So we saw
the value of working together way back and organized back then. We have 27 voting members. These are our member
organizations. It includes all of our acute care hospitals. We have 14 acute care hospitals
and they are part of systems, corporate, not for profit, for profit. We even have a VA
thrown in there that comes to the meetings as well. Specialty hospitals, over 190 long-term
care facilities. We have a representative representing long-term care on our steering
committee and also voting members. You can see Florida Health is our department of health
and you can see all the other agencies that you all have serving on your coalitions as
well. And then, we have trusted partners. Now these are not voting members, but certainly
invited members because they provide value with all the other emergency response entities
that we need. You’ll see universities on there, veterinary care. We also invite students from
the universities, MD, MVH, like University of Miami students. They have at least six
students come to every single one of our meetings on a rotating basis to understand, you know,
public health support for coalitions, behavioral health, and it goes on and on, as you can
see. We are � our kind of philosophy is that
everybody needs to play together in the sandbox and I think that’s an important piece of this
in terms of that, you know, that everybody needs to kind of work together when there
is a threat, and we saw this especially during the Haiti earthquake in 2010; kind of an interesting
type of issue. Our coalitions in Florida work together to basically coordinate the transport
and transfer of over 700 trauma patients from Haiti, but we also recognized with the coalitions
too that there was a tremendous workforce issue that at least 15 percent of our workforce
in South Florida was from Haiti, and there was a behavioral health concern that, you
know, some of these people lost entire families over there. So that was kind of interesting
on the responder side within the coalitions of how do we support that, how do support
each other, and there were a lot of lessons learned. Mass fatality; I mean, we didn’t
want to do it like this. You know, so that kind of jumpstarted a lot of our processes
to say, “Hey, we could do a lot more.” But that all went, not only from the transport
and treatment, but into recovery as well for these patients in repatriation. In terms of barriers or challenges, CEO support
definitely. We kind of managed that by actually hand carrying our memorandum of agreement
to every organization. Initially this was just acute care hospitals, but we felt one
common document kind of stressed how we’re all in this together and that kind of worked
to get everybody onboard. Our healthcare coalition membership definitely eases accreditation
visits. Everybody values that and we also share lessons learned at every meeting for,
you know, those who are undergoing visits to say, what are they stressing, what do we
need to worry about, how can we work together. We find that turnover can be a big issue for
strong hospital and for the command system in that you kind of have rotating people and
you get people new to the area, new to our hazards, so, you know, it’s kind of unusual
to have people that have never even been through a hurricane, which for us is a concern and
we have to educate them. In terms of another barrier is or challenge
is membership turnover. We use a 3D _____ command system concept to support attendance.
We have designated two alternate persons from each organization. These are designated by
the CEO. One of them has to be an infection control practitioner just because of the concern
of infectious diseases. Our Palm Beach County epidemiology comes to every meeting and they
brief us in terms of current threats. Attendance is tracked. Calls are made to non-attendees.
We want to make sure that everybody does attend meetings and if there’s a concern of, you
know, turnover, you know, that we make sure that somebody else is assigned to roles. Another
challenge is always communication. Number one thing to fail in disasters. We try to
prevent that by having weekly radio roll calls using communications equipment, and track,
that and report that, and that’s important. You need everyday communication to make sure
that, you know, you can respond in an event. And, you know, attendants get struck by lightning,
all sorts of different things that, you know, we have to make sure everybody’s equipment’s
always working. We have email distribution lists, mass notification
drills to overcome that, conference calls during incidents. It’s kind of interesting
during major threats like Haiti earthquakes, we actually had to resort to phone conference
calls and everybody wanted that because of the support there to be able to talk to each
other. So it’s kind of interesting even with technology support, you know, that sometimes
the lowest common denominator works in a disaster. In terms of sustainability, we poll our members.
We find that the biggest reason people come to coalition meetings is they want the situational
awareness. They want to know what’s going on. They want to know about threats. They
want to know about what’s coming up with trainings or exercises and all these different things.
For the first ten years of our coalition, we charged nothing and we actually only got
HPP funding this year. So, you know, we have no direct funding from the Hospital Preparedness
Program for coalitions. We did start charging membership dues I want to say at least six
years ago. They were initially $250.00. Now they’re $500.00 for voting members. What’s
kind of interesting about that is for members that can’t afford it, like our fire rescue,
law enforcement, that kind of thing, our county commissioners have agreed to support the governmental
emergency response member fees and also they will pay membership fees for our newest members,
like we want to get more members from, you know, different agencies just to kind of fill
gaps that we have. Oh no. My thing just closed. Well, that’s interesting. Okay. We also have vendor presentations. You might
have to advance my slides for me. All of a sudden, it kind of got weird online. Nicole,
can you advance my slide? Keep it to short- and long-term sustainability. We do vendor
presentations. We do exhibits at monthly meetings. We give the first ten minutes of each meeting
just to go over anything new that’s out there that people might be interested in and we
have a list of sponsors that, you know, examples that we can use for vendor funding. We do
recognition events. We do breakfasts for our members. We do dinners for our members recognizing
their support. Also, foundation support; we have a local foundation that gives a matching
grant, a healthcare foundation, and they’ve been wonderful to us in terms of getting us
initial equipment and support for healthcare organizations and they’re also interested
in expanding membership and helping us that way. The, and the last slide is the sponsors. You
can see that there is definitely a range of them. You can advance to the next slide. We
feel it’s important to document and celebrate progress, so we definitely encourage any other
coalitions to document your progress in an annual community report. We find that’s really
helpful for potential new partners, even for students that are attending the meetings that
this is what our coalition’s all about. It’s also good for local state and federal contacts
who come to our area. Details coalition purpose, member organization, our activities and accomplishments
during, you know, during the year, including training exercises, equipment purchased by
the coalition, and acknowledgement of sponsors. And if anybody has any questions, our coalition’s
happy to assist anybody across the U.S. We have all sorts of information that we can
help you with and maybe ___ _____ _____. Wonderful. Thanks so much, Mary. You’re welcome. And I’ve been told that Jay Taylor is back
on the call. Jay from the Pennsylvania Department of Health, are you ready to go? Yes. We’re ready. Okay. Let’s see if, make sure we can get you
back to your slide deck. There we go. Apologize for the inconvenience. One of those
technical barriers that occurred just as you, right as you turned it over to us, so we apologize
for that, but thank you for having us anyways. You know, Pennsylvania, we’re kind of fortunate
here in our healthcare coalition. We, the commonwealth established by legislated, legislation,
the, our boundaries, if you will, for our coalitions, and they’re created in the form
of tax forces, which are ______ _____ counties across the commonwealth and we have nine of
them here in Pennsylvania. In each one of these task forces, the operating project that
we have is subcommittees. We use subcommittee alliance with the emergency support functions,
ESF1, ESF2, and of course, we have an ESF8 ____ coalitions. So we’re able to easily create
the transition over for coalitions here for us. We still have some more hurdles to get
through as far as funding goes, but some of the things we have been able to do, I’m gonna
turn it over to Melissa Robin, she’s my manager here, who is our HPP coordinator for our healthcare
coalitions across the commonwealth. Melissa. Thank you, Jay. As Jay was saying, here in
Pennsylvania, we have nine regional healthcare coalitions and they actually were borne out
of legislation that created them back in 1998. They’ve been around and they’ve been working
through what they call a regional task force model. They are comprised of healthcare facilities,
EMS, public health agencies, long-term care, community behavioral health. We’ve got emergency
management agencies in there and we have several other response partners, like the Red Cross
and some other community groups as well. They vary in size, much like many of our other
states that we’ve heard from. Our coalitions are not really cookie cutter. Some coalitions
are bigger than others. Some have more populations. Some are more rural. Some are more urban.
They are, they do vary quite a bit. In addition, they vary in the activities that they do and
they perform. As far as governance, much like I just said
before, here in Pennsylvania, we don�t really have a cookie cutter model and I’m really
glad to hear other states have seen the exact same thing. You have to work with what’s gonna
work best within your region and that’s what we’ve done here in Pennsylvania as well. As
I said, our coalitions have been around since 1998, so they’ve got quite a history with
working together, and yes, some of the partners and some of the members come and go ’cause
there’s always turnover. However, their mission has really stayed the same. One of the great
things that we have done is within our coalition, we’ve actually, we are working on a statewide
MOU with all of our coalitions that will be, that can be broken down by coalition if need
be, but really, what we were looking to do was to make it so that it could be cross-regional,
so that we weren’t just having it one little coalition in and of itself sharing stuff,
and then, the boundary comes between another coalition and they can’t share things. Well,
we saw that as a real problem a while back and thought, “You know what? Let’s move towards
more of a statewide focus.” In addition, we are looking down the line to extend that out
to out of state, our border states as well, facilities, who are just right on the border
who work every day with our facilities and our agencies within Pennsylvania to ensure
that they’ll also include it so that we can have a seamless response. ‘Cause as you know,
disasters do not have borders. They have, some have adopted bylaws as well.
Some have not. They are working through that. Some have charters. Some do not. Really, our
coalitions here in Pennsylvania are kind of grass roots. I mean, they are volunteer. Not
only do they not have to pay to be part of the coalition, but, you know, they are volunteers
and they come because they truly believe that the work and the effort positively impact
a community with which they’re in. So they really do go through, go through the volunteer
beginning. Again, they do not have to pay fees. There are no membership dues to belong
to our coalition. Some of the challenges that we are currently
facing is that Pennsylvania right now, still we fund individual healthcare facilities.
We are going still on our individual healthcare facility model. However, we are moving away
from it. We are currently in the transition to transition into a regional coalition funding
model, and I was really encouraged to hear how some other states today have done that
and I’d be interested to get into more information on how we can do that. We have several options
that we are looking into. So we are currently transitioning into that. That’s probably one
of our biggest challenges currently right now is our funding away from individual facilities
going more towards regional coalition funding, even though it will still be maintained as
a volunteer model, it will still be, more than likely, will not require dues to belong
to the coalition. We want to try to get them funding so that they can do exercises and
do some big events within the regional coalition. What we do offer currently right now, as I
just said, we don’t, we don’t offer our coalitions funding. They are still volunteers. However,
we do offer them resources. One of the large resources that we offer them is we have our
regional preparedness managers throughout the state, they are contracted through the
hospital association of Pennsylvania here, and they work with our healthcare coalitions
on preparedness, on exercises, on planning and response. So that is one of the resources
that we offer, the state offers our coalitions to assist them with their work, and their
planning, and their preparedness. In addition, we have a web-based emergency management system
that we provide to all of our coalitions, all of our individual healthcare facilities,
our EMS partners, and our public health partners, and it’s called knowledge center. And within
that system, as I said it’s web-based, within that system we do all of our bed tracking,
we do all of our, we can do our patient tracking. We do situational awareness information sharing
and they can manage all their incidents and even their exercises free of charge. It is
their system. They can log in, have their uses from either their local healthcare facility
all the way up to our state users, and they can use that to manage incidents and even
manage exercises, and that is free, excuse me, free as well. We also have equipment and
supplies available to them, so you can ____ do a resource request process and we have
several other plans and response capabilities that we offer them, of course, free of charge. Again, these are just examples of some of
the resources that we have. I mentioned our field staff for planning and responses. We
actually had 18 of them. They are broken into our regional coalitions. Some cover more than
1, but we have 18, and I had, Jay had mentioned that we really are focused on ESF8 if you
are familiar with the federal ESF, our focus is on ESF8. So that is our healthcare, our
public health, and EMS. And so, we have our 18 managers our in our field who assist with
these types of programs surrounding ESF8. We also have three state medical assistance
teams that are available statewide for deployment either for local, for a local facilities response
or a coalition response or a statewide response, and our EMS strike team, we have communication
equipment, and again, I mentioned the caches, we also have pharmaceutical caches and PPE
caches as well that we offer our coalitions. For us right now for sustainability that is
what we are working on as we move out of individual healthcare facility funding and into regional
coalition funding. So right now we are working on our sustainability plan, but we are, again,
we are transitioning. And that’s about it from me. It’s short and sweet. Any questions,
there’s my contact information and again, I apologize for our delay. It was technical
difficulties on my part, so I apologize for that, but that’s it for us. No worries. Thank you so much, Jay and Melissa.
I really appreciate it. It’s great information. I think we’ll take the, we’ve got about 19
minutes left on the call, so hopefully enough time to get some questions. I’ll sort of pitch
to the ready talk representative to take any questions over the phone first. Thank you. Ladies and gentlemen, if you’d
like to register for a question, please press the 1 followed by the 4 on your telephone.
You will a three-tone prompt to acknowledge your request. If your question has been answered
and you’d like to withdraw your registration, please press the 1 followed by the 3. So once
again, it’s the 1-4 to queue up for a question on the audio side. And for now, I’ll turn
it back over to our presenters for indeed chat questions. Great. So I’ll just go through a couple questions
and if you have a voice question, just let me know. First and foremost, a quick question,
just a housekeeping question, someone had asked online if the slides would be made available
after the Webinar. Yes, they will. I believe they’ll be on the NACCHO YouTube page. Someone
will have to correct me if I’m wrong on that, but I believe that’s the case, and then, if
there are questions after the fact, you can email those to Nicole Dunifon at NACCHO. Her
email address is [email protected] So just to get that out of the way. One of the questions
that someone asked and we hear this a lot, what are some of your revenue sources beyond
federal and state grant opportunities? So I know that Onora spoke initially during her
presentation about some development work and looking to identify potential donors, philanthropic
donors, that sort of thing. What have other folks still on the call, other presenters
identified as far as additional revenue sources beyond the grant opportunities? I think I
would just say whoever wants to chime in, go for it. This is Mary Russell. We, the membership dues
is one avenue. Vendor presentations or exhibits, we ask that they give us $500.00 to be able
to present in front of the coalition members, keep it short and sweet, and make it generic,
and they actually get a return on investment. They’ll setup a booth and it’s amazing how
many people are interested in the common types of subjects. Look for your local foundations.
Make sure, you know, you have a presentation and you give ’em a copy of your community
report, who you are, what you’d like to do. Check with your county commissioners is one
other issue that � and in-kind support is always valued. Great points. Anyone else? Yeah. Hey, this is Michigan. Currently we
are, our coalitions are 100 percent funded with HPP funds, but I think that your comment
about the in-kind contribution of our healthcare organizations really can’t be underplayed
because really there’s a lot of work that gets done by our coalition healthcare organization
members, but we are working really hard. That’s why we’re moving towards the 501(c)(3). We’ve
got lots of thoughts in our minds about what will do once we establish that structure.
Right now, our coalitions often help with a lot of community events, you know, the international
auto show, some of the marathons, and our coalitions are going to be looking towards
those partners that they help now, but seeking some additional funding to offset some of
that, those costs. Great. Anyone else have any comments on that
question on additional revenue strategies? One thing that I can say, at least from our
perspective here in Indianapolis as a coalition, we’ve developed several fee for service programs,
so leveraging our expertise in the healthcare emergency management space to provide emergency
management services for some of our local hospitals under a managed services arrangement,
working basically to provide expert consultation on CMS and in joint commission requirements,
which someone else I believe mentioned in their presentation. And one other comment
I’ll make too on your ability to receive funding, you’re gonna want to keep in mind the organizational
model that you have. Some organizational models may limit the type of funding that you can
receive. So, for example, if you’re embedded in a public health department, that may limit
your ability to accept foundation funds, so on and so forth. So just to point out that
some of these things may be organizationally dependent. Next question, someone had asked whether or
not there are other coalitions in Washington and are they also nonprofit? I’ll have to
defer that question to Onora and we can make sure she gets that offline, but I believe
there are at least
I want to say two, well, there are eight other coalitions in Washington. I think at least
two are administered by trauma councils, which are nonprofits. I’m not sure about the remaining
though, so we’ll make sure that Onora Lien gets that to follow-up on. Another question
was what percentage of each of the presenter’s fundings come from 501(c)(3) and it is more
targeted towards equipment or other target areas? I think what that question is asking
is sort of your revenue mix for your organization. So are you 100 percent HPP, which I think
Linda had just noted, but moving to a little bit of a different model, what are the other
organizations as far as your mix of revenue? Well, I can’t speak toward the 501(c)(3) angle,
but for the local health department model that we use in Utah, it’s about 75 percent
of the funds support admin and about 25 support equipment training and exercises. Kevin, are you still on from � or wait,
was that Kevin? That was me. Yeah. Sorry. Ray, are you on? Yes, this is Ray from Texas, and it’s kind
of interesting listening to those that do use membership dues because our coalitions
are for the most part funded 100 percent with HPP funds and we have had our coalitions ask
about the use of membership dues, and we actually prohibit them because of the guidance that
we got from our federal regs subject matter experts from our stage agency. The way they
interpret the federal regs, they indicate that if the, if the members are required to
pay dues or membership fees in order to be benefactors of the HPP federal funds, that
would be considered an allowable reimbursable expense. So if hospital X is required to pay
a membership fee in order to bee a benefactor of the federal HPP funds, they can request
reimbursement for that fee, that membership fee. So it kind of defeats the purpose of
the membership fee because they’re gonna get reimbursed. So because of that and because
of the guidance that our federal subject matter, or federal reg subject matter experts have
given us, we have prohibited those type of membership fees or that type of revenue. Because
of our emergency medical task force response teams, since they do serve as a local and
regional resource in addition to a federal resource, there are situations where they
can be deployed. That’s not through a governmental mission that could generate income and we
follow the federal regs with regard to that, and it has to be incorporated and brought
back into the program as program income as spelled out in the federal regs. Great. Thanks, Ray. Can you speak to, while
I’ve got you, can you speak to the mix of sort of administrative versus equipment when
you look at your expenses for the coalitions in Texas? Well, we do fund staffing for each of our
coalition and it varies depending on the size and number of coalition members on how much
we allow for administrative costs. We have implemented some guidelines fro trying to
determine that. The last several years we have pretty much tried to hold the line on
that because of the reduction of funding. The big transition we made was years ago when
ASPR starting pushing the whole community healthcare approach and not preparing individual
hospitals, but preparing the community or preparing the region, and that was a difficult
transition that we implemented years ago, so now they more fund larger region-wide projects
or projects that benefit multiple hospitals within their region. So we have seen some
transition over the years on how those funds are allocated. We also, in my presentation
I mentioned that we carve out 70 to 80 percent of our total federal award to push our to
our coalitions. In collaboration with our coalitions, sometimes we set aside dollars
for statewide projects, like we have a statewide have bed reporting system that we pay upfront
as the state agency on behalf of the coalitions because there’s some cost savings for us doing
it as a state awardee, and we do other statewide projects that we carve out money in cooperation
with our coalitions because of cost saving opportunities. Great. Thank you so much. Anyone else want
to speak to the revenue generating strategies question before I move on? Okay. Hearing none,
the next question we have up is how common is the use of volunteers by coalitions, for
example, a medical reserve corps, and how are they managed? Does anyone want to take
that question? Sure. I’ll take a jump in first. This is Kevin
from Utah. You know, the MRCs in our state, for example, are hosted by local health departments
and again, because we have a local health department HPP model, what we’ve done is provided
opportunities for MRCs to investigate medical response. Traditionally they have conducted
a lot of public health response, which is probably follows that they’re hosted by health
departments, but now they have an opportunity to pursue medical response as well, and through
the coalition, we’ve been able to include them as members, get them engaged in training
and exercises, and several of our hospitals have actually gone to the point of hosting
MRC days at their facilities just to get the MRC teams into the building to understand
some of the roles that they could do, and to get ’em familiar with the facility. So
it’s really a developing success story from our perspective. That’s all. Great. Thanks so much. Anyone else? Yeah. Hi, this is Linda from Michigan. We’re
very fortunate that our state MRC coordinator is also our state EMAC coordinator. So we
married the, those two themes of volunteers for medical and public health together several
years ago. So we have great MRC coordinators. Some of them, our MRCs are managed at local
public health. Some are affiliated with the coalition. Some are affiliated with faith-based
organizations, but we coordinate the activities here in our office of public health preparedness
working through both programs and we hope that we’re supporting them the way that they
need to be supported, and they are definitely important. We just did a big statewide exercise
with our mobile medical field team and they ran the show for volunteer management and
did an excellent job. Wonderful. This is Mary from Florida. Medical reserve
corps, the way we’ve used them at least in our coalitions is they man call centers at
our emergency operation centers under an ESF8 mission. So, for example, during H1N1, they
could answer questions from the community, in terms of linking them up with information.
They help us with immunization campaigns, again, another mission, help us with neighborhood
preparedness since we have so many older dense communities. It helps to make sure that neighborhoods
are prepared, including points of distribution for, you know, CRI and that kind of thing. Great. Thank you so much. There’s a bunch
of good questions in here, so I’m just gonna try and go through a couple real quick in
our last few minutes. For all of the presenters, have you found that any healthcare entities,
such as FQHCs, federally qualified health centers, are locked out of participating in
the coalition because of dues requirements? For those coalitions that have member dues
and whatnot, has that been a barrier to entry or participation? This is Mary in Florida. Absolutely not. We
would encourage their participation whether they can pay or not. Anyone else? I can say from our perspective
we are a subscriber-based organization. The hospitals in Indianapolis here have really
made a commitment and really understand that supporting the broader healthcare infrastructure
ultimately supports them. So, you know, for those organizations that we work with who
do not technically subscribe or pay dues to the organization, it’s certainly not a barrier
to us working with them. Another question, actually there’s two questions here along
the same line. The attendee asks, you know, we’ve heard a lot about HPP funding. How are
PHEP funds being used? Do any coalitions on the call receive any PHEP funding to do the
coalition work that they’re doing? PHEP being the Public Health Emergency Preparedness program. In Florida, our public health, our county
health departments receive funding for, you know, equipment and supplies and all that
kind of thing. Our coalition does not. Yeah. Hi. In Michigan, PHEP funds certainly
contribute to our coalitions at the state level because they support much of the infrastructure
that is used by all of our preparedness partners, not just the coalitions, but public health
and many of the other disciplines. So, you know, there are certainly shared resources
that happen between PHEP and HPP, and then, at the coalition level, I think again, it’s
more of that in-kind of shared exercises leveraging resources to support coalition activities.
All of our public, local public health are very involved in our coalition activities. For example, for both of you, do those PHEP
funds help foster collaboration across the various entities? Absolutely. And this is Ray from Texas � I think someone else, I accidentally cut someone
off. This is Ray from Texas and very similar to
Linda from Michigan, we look for opportunities to do cost sharing with HPP and PHEP funds,
particularly at the state level, whether it’s funding systems that benefit both programs,
but whenever we have an opportunity where we have particularly carry forward funds from
the PHEP side, we allow our healthcare coalitions to submit proposals just like anyone else
from the public health side to submit proposals to try to find specifically identified projects
that are not recurring costs, but we’re very thorough in making sure that the funds are
being used to fund activities that are compatible with the capabilities of the funding source. And we’ve seen the same here in Indiana as
well, Ray. I think, I think several states have taken that approach, which is great.
Really quickly, we have two minute left if someone wants to chime in on this last question.
Any tips on facilitating the MOU process? We got bogged down in legal review between
entities, and even though MOUs have limited legal expectations, that does create barriers.
Any tips on the MOU process? This is Mary in Florida. For some of the corporate
systems, actually getting an MOU signed enabled through one of the organizations usually opens
the door for agreements to be signed through all of the system partners. So that’s kind
of interesting. Getting the VA agreement is almost impossible, but, you know, they basically
have locally said, you know, they’d rather ask forgiveness than permission to support,
you know, local disasters. So that’s my take on that. Great. Well, I want to thank everyone. We’ve
got a minute left. So I’ll close this up here. Thanks to our sponsors, ASPR, ASTHO, and NACCHO
for hosting the Webinar. Thanks to our speakers, our presenters, and all of you attendees for
calling in and listening. This has been great information. Clearly demonstrates along the
lines of, in the context of governance that it’s not a one size fits all model as you’ve
seen. Any remaining questions will be documented and distributed after feedback from the presenters.
I know someone had asked on the chat whether or not specific contact information will be
provided for presenters. I believe all of that is in the presentations themselves, which
again, will be hosted online and sent out again by NACCHO. And if there are any additional
questions, please email those to [email protected], and then, last but not least, I’ll give a
quick plug for the National Healthcare Coalition Preparedness Conference this year, which is
December 10th through the 12th and it’s in Denver, Colorado. You can register at healthcarecoalitions.org.
With that, I think we’ve hit 5:00 on the button and if, unless anyone has anything they need
to add, I think we’ll thank you and say have a nice afternoon. [End of Audio]

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