- Good afternoon. Welcome to the Bloomington Rotary Club's weekly celebration of service. I'm Steve Wicks,
- and I'm honored to serve as your president this year. Please silence your electronic devices. On this
- day in history, February 24th, 1977, US President Jimmy Carter announced that US foreign aid would consider
- human rights. Changing our lineup or our
- Order of events a little bit this morning. Lynn Schwartzberg will introduce our guests today. Well,
- it's just noon, so I can't say good morning or good afternoon. So welcome. I have several guests to
- introduce today. When I read your name, if you will please stand so we can recognize you in attendance.
- We have a guest of Shelley Saleh. We have Michelle Gilchrist.
- from the Bloomington Hospital Foundation. We have two guests of our dear Ellen Strohman. We have Melissa
- Van Buskirk and we have Brianna Featherston. And Steve Engel has two guests. He has Brad Meyer, maybe?
- It's hard to read this stuff. And Becky Wan, please welcome Lynn. Are there any guests online? Lynn,
- we do not have any guests online. Well, thank you, Joy. If you have any questions about our club or
- interest in Rotary, please speak with someone at your table. Thank you, Lynn. Sarah Loughlin.
- is going to deliver today's reflection. And since she'll be already up in front of the group, she'll
- provide us with an update of the district grant process. Which will actually be kind of one and the
- same, God willing. Tyler's bringing up the PowerPoint.
- But I'll just get started by saying that I think I've been involved with the district grant process
- since right after I joined the club. The first pictures I have are from 2012. And so that's 13 years
- of district grants. And what I wanted to talk about is, you know, our club vision says that this club
- will create significant positive impact in our community.
- So in 2012, we... I wrote the first grant that I had written, and it was before the Rotary Toast, so
- we were always concerned about having... Not so close. We were always concerned about having enough
- money to match. This was a $2,000 grant, a thousand from us, a thousand from the district, to buy cheese
- for the Hoosier Hills Food Bank, something that was high protein and hard for them
- to get. In 2013, we replaced the sun screens, the sunshades, at Mills Pool. And I don't have a picture
- of that. But in 2014, we supported the Education Matters project in the Democratic Republic of Congo.
- Many of you will remember we worked on that project for several years. We bought bookshelves. We put
- a fence around it and some
- watering stuff around a garden they had. We actually wrote a book about the project and sold it to benefit
- them, produced it in French as well. In 2015, we supported RYLA, the Rotary Youth Leadership Retreat,
- which is every fall we were able to send twice as many students and they had a reunion halfway around
- the year. In 2016, we rebuilt
- the fence around pals. Some of you will remember we took down the fence, which was not an easy thing
- to do because they had drainage problems in their outside exercise area for the horses. And then after
- the drainage was fixed, we rebuilt the fence. And you wouldn't believe how hard it is to make a fence
- post straight, you know, straight up and down and straight in a line. The next year, we funded the
- the sunshade at Fairview Elementary School. And our part, our volunteer role there was we host, we,
- we helped the kids play during the dedication of the sunshade. We helped the kids play non-competitive
- games on the playground. Oops. Oh, did I do that? Oh, I'm back though.
- The following year, we painted the inside of Amethyst House. I think some of us, for us, some of us,
- it was the very first time we'd ever painted a wall. It looked pretty good, though, by the end.
- Despite that, we didn't spill anything, even though some people tried to carry the rolling pan up to
- the top of the ladder. Not a good idea. The next year, we
- paid for and helped out at the dedication of Wonder Lab's sprouts space for little kids who, you know,
- a special place for the little toddlers and crawlers to be not overwhelmed by the bigger kids. The following
- year we, this is the pandemic, you'll recognize Owen Johnson there with his mask on. Nevertheless, we
- packed backpack buddies
- books, bags full of books and other school kinds of learning things for kids who are stuck at home,
- literacy backpacks. The following year, still a little bit pandemic-y, as I remember, we sponsored the,
- or we helped out at the Lotus Blossoms Bazaar, which is a two-day event. The first day, I think, is
- third grade kids, fourth grade kids from every school come
- for a day of international, you know, world music. And the next day it's open to the kids and the community.
- So the kids and their parents, we helped out for that and had so much fun. The following year we did
- a farm to school program. MCCSE takes every third grader to a farm to see what that, to see things growing.
- This is the, this is a third grade group at Sobra Mesa Farm.
- And our job was to help the teachers keep them under control while they were there. The following year,
- we helped out the Lake Monroe Water Fund. We did some beach trash pickup. We hosted their Lake Monroe
- Day events at the farmers market and at the upland afterwards. And last year, of course, you remember
- my sister's closet.
- probably the world's most incredible bike rack. It's not up yet because they're moving, as you know.
- And they didn't want to put it up and then have to move it, take it down and move it. So it'll be up.
- It's stored safely. And we look forward to dedication number two when the move is over. But here you
- see Bill Brown and Caleb Poor using their artistic skills to help out.
- And this year we supported Meals on Wheels. We bought three of these refrigerators that you see on the
- left. One, they can be all refrigerator or they can be all freezer or they can be half and half, which
- dramatically expanded their ability to have fresh food for their groceries to go program. And we also
- bought 500 of these bags. It's a little bit, I realized my photographs may be a little over cropped.
- But the bags are branded Meals on Wheels and Rotary. And we delivered those to, we rode along with their
- daily Meals on Wheels delivery and delivered them to 118 households in Bloomington over a week. And
- probably the
- positive, long-term impact of this project is that we've adopted Meals on Wheels now as an ongoing club
- project. So we'll get to help pack more groceries to go. And a couple of our members have signed up
- to volunteer. So sometimes that happens. So what's next? That's really
- Yeah, we've been busy, haven't we? As a club, I'm so proud of this club. So you can probably tell from
- the pictures that in addition to the significant positive impact, is it fun? Yes, it is quite fun. So
- what's up next is up to you. So how many of you work for a nonprofit? Raise your hand if you work for
- a nonprofit and keep your hand up. How many of you are on the board of a nonprofit? More hands go up.
- How many of you are a passionate supporter of at least one non-profit? Keep your hands up, all. Because
- what we see is everyone in the room, right, is involved in this town, one of this town's 700-plus nonprofits.
- So would that organization that you're thinking about, that you're involved with, would they be excited
- about $6,000?
- The ones that I know, that's a big amount of money. We work hard to raise money and that would be a
- significant gift. And what about a day of Rotarians volunteering to do something that you have had a
- hard time getting around to doing? So that's our, our next, you know, we just sent in our 2025 report
- and now we're ready to start working on the 2627 project. So on your table,
- and it'll also be in the roundabout, a link to the proposal form. What you have to do to be chosen as
- a project for the Bloomington Rotary Club is you have to be sponsored by one of our members and you
- have to submit this proposal. And we ask that it be two pages. So it's not a killer proposal. No audit
- required, no 990 to send in, no board signatures, you know,
- a simple proposal. And so what we count on you to do is to distribute this proposal opportunity to those
- nonprofits that you're involved with. Give them a call, say we have this opportunity at the Rotary Club.
- Here's the proposal. I'd be happy to sign up as the person sponsoring you and send them to me if they
- need any help in writing the proposal. The deadline for receiving the proposals is, it says on the slide,
- March 28th, but I think it's actually March 27th. It's Friday, March 27th, I'm pretty sure. And then
- the Community Service Committee reviews all the proposals. We have a rubric that we use, and you can
- see it along in the proposal, because we want the proposers to know what they're going to be judged
- against when it comes back to us. And we'll let them know by April the 10th. And then the next step
- is we have to send it on to the district.
- I'll be working on the application with the successful proposer between April 10th and May 1st. We have
- to submit it to the district by May 1st. Then we have a bit of a wait, because not only does the district
- approve it, but it has to go all the way to RI for approval there. And so usually it's about the 1st
- of August when we get the approval back, and we have to be finished by the end of March.
- Project timeline is August to March. Doesn't include the summer, notably. So trail repair projects are
- a little problematic. August to March. All right, that's it. I hope you'll realize that we
- have an opportunity to make a significant positive impact and have some fun.
- Thank you, Sarah. Your fingerprints are all over all the successful projects this club has done in the
- last 12 or 13 years. Birthdays. We have one birthday to observe. Eric Coyne on the 1st. And then rotary
- anniversaries. On the 28th, Amy Garst and Carlos Laverde, both three years. On the 1st, Chas Mottinger,
- three years. Club treasurer John Zoti, five years in this stint, eight years with the club total.
- And also on the first, John Hobson, who is here somewhere, 41 years with Rotary. Only a few announcements
- today. Rotary District Conference registration is open, scheduled for May 8th and 9th at the Galt House
- in Louisville. I think there's going to be a lot of fun scheduled Friday night. Saturday will be filled
- with productive programming.
- You can learn more and register at RotaryAllStars.com. Those of you who have any connections with Bedford,
- their rotary toast will be held this Friday evening, February 27th. If you have any interest in attending,
- please see me for the details. Next Rotary Club book meeting, save the date, April 15th. And a regular
- scheduled meeting on the 17th will be our club assembly and annual meeting.
- And then finally, Sarah made mention to this, we have a mini project scheduled now for March 4th, 10
- to noon with Meals on Wheels, be packing groceries to go. We need up to four people. If you're interested
- or you wanna learn more, see Diana Hoffman in the back there or Mandy or me for more details. Now we
- have some membership time.
- Celebration of Service, this was not a Rotary project, but the Hoosier Hills Food Bank had their annual
- soup fundraiser this weekend and lots of Rotarians in attendance. And Alan Barker was called out by
- name for his contributions and also Charlotte Zitlow was mentioned for everything that she had done
- for that event. So it's proud to see so many Rotarians in the audience helping Hoosier Hills Food Bank.
- And we're going to do the mystery rotarian today. It's been a few weeks since we've done this.
- Once again, I will provide a clue. If you know the answer, put up your hand. Don't shout it out. Those
- of you online, if you know the answer, put up your hand electronically. And here's the first clue. Born
- and raised in Woodstock, New York, this rotarian was exposed to peace, love, and music at an early age.
- This individual began playing the piano at age eight, learned transcendental meditation at age 14, and
- spent a summer at the Tanglewood Music Institute at age 17. Okay, I see a few hands up in the room.
- Okay. Second clue. This Rotarian previously worked as director of social services at Meadowood,
- and executive director for Bell Trace. For the past five years, this rotaria has owned and operated
- anchored passages, providing competent and compassionate non-medical guidance and support to individuals
- and their families during the difficult passages of life. We have quite a few here. Yeah, okay. Final clue.
- In the local community, this Rotarian has served as the Area 10 Agency on Aging board president, currently
- serves as board president for Limestone Post. Club member for just under 20 years, this Rotarian has
- served in multiple roles, including club president, chair of the Youth Services Committee, assistant
- governor, and frequent Zoom host, including today, Joy Harder.
- Rex, I think you were the first one to put up your hand. Did you have it right? Good job, Rex, Hillary.
- And Joy, besides you, did anyone online have it right? I'm pretty sure Raj had his hand up, and I think
- Sandy Keller was hip to the program, and Marcy was, so yeah. All right, excellent. Joy obtained her
- bachelor's degree in psychology from Kenyon College, her master's degree in counseling from IU,
- She is a certified death doula and conscious dying coach or end of life specialist. She has completed
- her Reiki three master practitioner training and Joy recently began offering community sound baths.
- And here's a picture of a sound bath. I've been to one of them. It was really cool. Very restful, very
- relaxing. Joy does a great job. If you have an interest, contact her.
- And then here's a picture of Joy doing one of her rotary voluntary activities. This is from Ryla this
- past fall. She spent an entire afternoon there registering students, so they came in the door. Joy is
- kind of interesting in the sense, as club president, she was the one who introduced the fifth part of
- the rotary four-way test. Is it fun? But I'll also say, in her professional role,
- with her personality for a family, dealing with the death of a loved one, I can only just be sure that
- she would be really great in that role. So it was wonderful having Joy as a member of our club.
- Thank you, Steve. Thank you, everyone. Rotary International Seven Areas of Focus.
- This is the last week for Peacebuilding and Conflict Prevention Month. And then we're just gonna spend,
- well, just a reminder, we're not doing Happy Dollars today, but the proceeds in Jan and Feb will be
- given to Teachers Warehouse. Club members were especially generous last week. And now, Tyler, if you
- wanna pull up, we're gonna just spend a minute or two going through my Rotary website.
- So for those of you, myrotary.org is the Rotary International website. And if there's a up there, I
- can't see it from this angle, but if you wanted to register for Rotary, it's really easy to do. You
- put in the email, the same email that you use when you became a club member, and then they'll help you
- create a password.
- But what we're going to do today, Tyler, if you'll work your way down the page, is just look. I'll keep
- going. All right. I missed it. Get involved. Sorry about that. Go ahead, and if you'd click on that.
- So this is something you can do without logging in. You can see different ways to get involved.
- And one of the ways that we're going to focus on today is a rotary action group. You go ahead and click
- on that, Tyler. And here is a very short video.
- the sound may be off.
- Rotary action groups are a great resource because they have the expertise in their various subject matters
- to support clubs and districts with project implementation and execution. Across the world, there's
- so many different action groups. There's one for environmental sustainability. We've got disaster response.
- We have water and sanitation. If somebody wants to know how to build a toilet, drill a borehole, implement
- rainwater harvesting, for example, action groups have the expertise to enable the club
- to achieve its humanitarian goals. They are not just Rotarians or Rotoractors. They could be, you know,
- partners. They could be alumni. A Rotarian doesn't have to be an expert because they're all at hand.
- And when a club wants help, we link them with sources of funding, usually another club, but also to
- private donors and other foundations. When you've got this group that has members from around the world
- in one particular focus, you can have an impact that is huge.
- could close that out, Tyler. We're just going to look at one group very quickly. So here's just a list.
- You can see a list of different ones. Let's go to Peace. It's the top one, because this is Peace Building
- Month. And you can see here's a site if you're interested, and you're going to learn more. So anyway,
- this is Rotary for us locally, but Rotary is international as well. If you have a particular interest,
- You can go on this, like I said, it's real easy to get to and you can find it. So just keep it in mind,
- log on to myrodery.org and just explore. Okay, Shelly Salee will introduce our speaker.
- Good afternoon, everyone. Today, I am delighted to introduce your fellow Rotarian, Cindy Brumbarger.
- Cindy has been a part of HealthNet for nearly 17 years, was named Chief Branding and Engagement Officer
- in December of 2025, after serving as a Chief External Affairs Officer. She's had some mighty good titles.
- She leads brand identity, outreach, marketing,
- patient experience initiatives, outreach enrollment, and acts as board liaison. Cindy also serves as
- the executive director of Health Net Foundation. She does quite a bit. Cindy brings more than 15 years
- of nonprofit leadership experience, as well as a clinical background, having worked as a critical care
- nurse with a focus on bone marrow transplant at IU Health early in her career.
- Cindy earned a BS in nursing from Indiana University, master of education from Western Governors University
- and completed UCLA Anderson's healthcare executive program. She currently serves on the boards of Heart
- and Soul Free Clinic, Southeast Community Services and Edna Martin Christian Center. She is a passionate
- advocate for sound health policy and ensuring that access to care is addressed on a daily basis. Today,
- She will share more about the role of community health centers nationwide and the warning signs that
- we all need to be paying attention to today. Thank you, Cindy. Well, good afternoon, everybody. Thrilled
- to be here. Thank you for that, Shelley. I appreciate it.
- Some of you are aware of Health Net, and hold on just a minute, I'm trying to get my notes to work here,
- there we go. How many of you are familiar with Health Net here in Bloomington? Awesome, that's exactly
- what I want to see. I'm gonna speak a little bit to the nature of Health Net, but I really want to expand
- our conversation to talk about community health centers in general. Community health centers are both
- a lifeline
- for the patients and the communities that they serve, but they also serve as the proverbial canary.
- They are that early warning system as to what's going on in the healthcare landscape. As community health
- centers, we are the first to see trends, often trends that are concerning, and that includes
- access to health care, the expense of health care, and the efficacy of the health care that we're providing.
- So let me start by talking about what a community health center is. A community health center is a federally
- qualified health center. What that means is that we as a health center meet distinct
- criteria as it relates to the federal definition. That's very specific to how we provide care. It's
- very specific to the removable barriers to access that care and making certain that healthcare is always
- accessible. When I speak to those barriers, I'm talking about those non-traditional barriers that some
- providers of healthcare don't always consider. We are community-based, which means that within a community,
- we're engaged in that community.
- Health Net is here in Bloomington. We also have eight locations in Indianapolis. And one of the things
- I adore about the community nature of our particular health system is that each community health center
- has its own personality, its own flavor. It looks like the neighborhood and the zip code where it lives.
- It's one of the things that makes community health centers so incredibly special.
- The other element that I truly appreciate about not only Health Net but every community health center
- in the nation is that they are required to have a board composition that is majority patient. I want
- you to think about that for just a moment. That governing authority must be made up of individuals who
- are seeking care, the majority of such. So that's a really unique element when it comes to a board governance
- in a nonprofit space.
- We provide care in underserved communities. Those are the communities where a lot of individuals don't
- want to plant their flag and provide care. Community health centers, we're kind of the antithesis of
- that. We're like, let's do it. That's where we want to be. When we look at establishing a health center,
- we look at the data. We look at the access. We want to make certain that if we're going to be present
- in a location, that there's the potential for impact there.
- Generally those trends when we look at a location for a health center tend to see a community that's
- disproportionately struggling with things like poverty and access. They've just been a population that
- may have been overlooked for time. We're happy to be part of their community and look to change things
- for their betterment. We do see everyone regardless of their ability to pay. Often when I make that
- statement people just assume that means anybody who doesn't have
- access. I like to really expand that idea of regardless of ability to pay. If you are commercially insured,
- if you are on the marketplace, if you have Medicaid, if you have Medicare, emergency Medicaid, no money
- to pay at all, we will see you. Your health care coverage status does not matter to us. We not only
- want to see you, but we have a federal obligation and are required by law to see you.
- walk into another primary care practice and tell me that that's consistent. You won't find that, but
- that is the heart and soul of community health centers. So what is a community health center not? So
- we're not a free clinic. I always like to make that distinction.
- Obviously, if an individual walks in, we are going to see them regardless of their ability to pay. But
- the care isn't free. We will navigate that with that individual to put them on a sliding fee discount
- program. That's also a federal requirement for all community health centers. We are not reimbursed when
- we provide care to somebody who doesn't have insurance. There's a myth out there that community health
- centers get all kinds of money if they see patients who aren't insured.
- Not true. Most of the time, if we see someone who is not insured, we work to put them into a health
- care coverage program that fits them. If it doesn't fit them, we put them on a sliding fee discount
- program scale and hope for the best. The nuance there is we're not reimbursed, but we still see them.
- Anyway, we're going to talk about that here in just a moment. And then finally, we are not a temporary
- safety net. We are an essential part of communities across the country. Health net, for example, has
- been around for 58 years. Community health centers take their roots all the way back to the Johnson
- administration and his war on poverty. We are not just a stop gap. We are the bridge for communities
- that are in need of health care.
- The other thing that I really like to highlight is the comprehensiveness of our care. So not only do
- we provide primary care, but we also provide access to behavioral health services, dental services in
- many of the locations. Some community health centers are now opening up pharmacy access because we know
- that there are food deserts,
- There are health care deserts and there are pharmacy deserts. So that is one of the things we see growing
- in that community health space. And then in some instances, community health centers are in a position
- to offer additional services. For Health Net, that includes an eye care center, podiatry, chiropractic
- care. We have nutritionists on staff. We've also opened up in the past year access to rheumatology and
- dermatology.
- It's hard enough for you and I to get a dermatology appointment. Imagine being a patient at a community
- health center and trying to get access to a dermatologist. Good luck with that. We're trying to change
- that. I guess the bottom line is this, that we are a permanent and critical part of the health system
- in both urban and rural America. And when I say we, I am truly speaking to community health centers,
- not just Health Net. So let's take a look at that national impact.
- I'm a data geek. I love the numbers. I think the numbers come together to tell the story, and then you
- use that passion to weave those numbers together into something really meaningful. So if you look at
- the 2024 data, this was just released in early January, community health centers served 52 million unique
- patients nationwide. Those are unique patients, not collective appointments. That's one in seven Americans
- have received care at a community health center.
- All in total, 145 million visits. So when we think about the impact of community health centers, this
- isn't just a one-off and they're not just here or there. We're talking about being an anchor thread
- in the tapestry of our healthcare system in this country.
- CHCs deliver high quality primary care at a lower cost. This piece always fascinates me, especially
- when you get into the politics of the reds position and the blues position. At the end of the day, whether
- it's access or fiscal responsibility,
- When you look at the outcomes with CHCs, we perform better. I'll give you one statistic to kind of frame
- that and put that in context. If you look at a Medicaid patient in the state of Indiana receiving care
- in a community health center, the cost to the state is 24% less than a patient who doesn't receive access
- or care at a community health center. And moreover, the outcomes beat the industry average. I think
- that's pretty impressive.
- CHCs offer those comprehensive care pieces like I talked about. We operate under a patient-centered
- medical home. Again, this isn't just Health Net. This is CHCs across the entire country.
- We know that if you have one home for your care, not just your primary care physician, or not just a
- behavioral health therapist over here, or maybe care for your dental and the other zip code, when you
- bring that together collectively, you get such cohesive care. And that's what a patient-centered home
- is all about. We are the go-to player in community health. If you look at the impact that CHCs had during
- COVID, we were on the ground making certain that vaccines
- delivered to those zip codes that may have not had access. We were the experts in making certain that
- care was delivered when there were barrier after barrier after barrier that needed to be overcome. Here's
- the truth. It's what we do. It's why CHCs are so incredible and so important. And there's a couple of them.
- As I mentioned, there's quite a few of them here. That's just kind of a distribution map here in the
- country. I think what's really interesting, and I didn't bring this for the presentation, but I will
- tell you, if you took an overlay of this map and you looked at income, what you would find
- is the distribution of community health centers kind of mirrors those areas that have higher poverty
- level rates. It's really, really interesting to look at.
- So let's talk about that Hoosier Impact. We are here for thousands of Hoosiers. That's a distribution
- here in Indiana. There are 41 FQHCs in the state with more than 400 delivery sites, 436 to be specific.
- 29% of FQHCs here in Indiana are in rural settings. They are the lifeblood, and they are essential to
- those areas that we are now watching lose access to care. It seems like every time I open up my feed,
- I see another headline about services being cut in a rural community. I know we just saw that
- big announcement with Johnson County. They're closing down their maternal provisions in the hospital.
- Those things are heartbreaking and heart-wrenching to me.
- ready to stand in the gap whenever we can. As for patients, 820,000 Hoosiers received care, with 273
- of those patients being children. I think it's a really impressive number. Here's where we're different,
- though. If you look at community health center care in Indiana, you will note that 39% of our patients
- sit at or below the poverty level. If you extract that to the entire population, that's only about 12%
- of the population of Indiana.
- So 39% of our patients fit a demographic that really only compromises 12% of the general population.
- When we look at Medicaid patients, the same holds true. 41% of our patients are Medicaid patients. General
- population is about 17% across the state. Now I will tell you that while that data may raise some eyebrows,
- it's old. What we are seeing, and I'm going to speak to this in just a moment, this is that canary,
- its feathers are pretty ruffled and it's struggling right now. The reality of it is that Medicaid number
- is dropping
- It's plummeting and our uninsured is skyrocketing. And that's really, really concerning for us. We are
- an essential support to making certain that healthcare is accessible. 14% of patients seen by CHCs in
- Indiana have been uninsured. That is old data. That number is approaching 20%. And some of our industry
- experts believe that we'll hit 25% in early 2027. It's not a great picture there.
- As for my friends in southern Indiana, here's just a couple little nuggets for you. I just pulled the
- data specific to the second district. Here in southern Indiana, six FQHCs including Health Net 27 service
- sites serving 220,000 patients in 2020.
- In an age where we continue to hear about the loss of services, as I alluded to, especially in rural
- locations, you can see why it's so important that we have CHCs available in the state. Moreover, what
- we know is that by using community health centers, we're able to help patients avoid things like going
- to the ED for their care. That's so much more cost effective. The outcomes are better. But as we begin
- to see stresses on the CHC system, that becomes a rising
- concern. So let's talk about what happens when CHCs fall out of the picture. Here's the thing, the care
- and the need for care doesn't go away. That never changes. No matter what is happening in the healthcare
- landscape, the care is needed and we start to see that care divert just a little bit. We do see preventative
- care decline. So we are in the business, or we would like to stay in the business, of healthcare.
- As we see access erode, now we have sick care. The health outcomes when you focus on sick care are not
- great. We really want to be in the business of health care. Preventative care begins to decline and
- we all know that with the decline of preventative care, the outcomes begin to look less rosy. We certainly
- see those poor outcomes already
- in some of the underserved communities where community health centers are, we don't need to make that
- more complicated. And then finally, we have this rise in cost. The rise in cost hits our state budget,
- it hits our insurance premiums because that cost has to be collected elsewhere, the healthcare ecosystem
- begins to get stressed and phrased, and then suddenly the community is dealing with a healthcare concern.
- So let's talk about our canary. When CHCs see a problem,
- the community is already at risk. So I want to go back to some of those principles that make CHCs really
- unique. Remember, we are the first line of defense for a lot of people. We see everyone regardless of
- their ability to pay. If they walk in the door, we see them. So we often see those warning signs a little
- bit earlier. Our comprehensive approach has merit. It works. But when you don't walk through that door,
- We're not able to provide that. For us right now, the things that are bringing us pain include the rising
- uninsured. You've no doubt seen some of those headlines about the number of people who are no longer
- on Medicaid. I think the one number that was really championed by some in Indianapolis was 300,000 people
- have been removed from Medicaid.
- You can champion fiscal responsibility, but there has to be a conversation about the consequence of
- people losing their health care coverage. And that is very, very real. When the demands exceed capacity,
- things begin to really fall apart. So the crisis that community health centers are seeing today, not
- just in the state of Indiana, but nationwide, are multi-fold. We are watching the uninsured climb. We
- are watching patient visits,
- drop. Is there a relationship? Probably. Good chance that there is. And other sources of funding are
- now coming under incredible scrutiny and some of them even being removed. As the demand for care and
- care coverage climbs, the people visits stop and we start to see sickness increase. At some point, people
- who are sick who don't have care coverage are going to have to see someone. And where are they going to go?
- They're going to the emergency rooms. They're going to the ED. Number one, that's incredibly expensive.
- Number two, by the time you get there, your care is so complex when you could have been able to see
- a primary care provider on a routine basis at a much more cost-effective position and control your disease
- early on. I want to get really down to the basics here. How many of you own a car, have driven a car,
- have had a car?
- Not hard, not hard. Many, many years ago, many years ago, I had a sweet young cousin whom we gifted
- a car. It was a beater car. Don't get too impressed. I wasn't that wealthy. Still I'm not. But he was
- in college and he needed some wheels. And so we gave him a car. He never got the oil changed, didn't
- get those tires rotating balanced, didn't think about coolant flush, taking it in for that preventative
- maintenance. Anybody see where this is going?
- And to nobody's shock, the car just didn't quite make it not for long. We're the same way. You can replace
- the entire engine block at incredible cost, or you can change the oil on a routine basis. You can go
- see your primary care provider. You can have educated decisions. You can discuss whether immunization
- and vaccination is right for you. Run the screens, catch things early. Get this. Did you know that stage
- one breast cancer
- If you are diagnosed with that today, 99% survivability. 99% survivability. That's stage one. If you
- don't have health care and you're not going in for your preventative screenings, are you going to catch
- that at stage one? Think about that. I saw a fascinating statistic that said, if Americans had their
- well visits annually, we could be saving at least 100,000 lives a year.
- That's just by going to the doctor on a routine basis. And if it's every 18 months, I'm still happy
- as a client. I don't care if it's every 12 or 18. Go regularly. Needless to say, when people aren't
- going in for their primary care visits and they're getting sick and they're going to the ED, it becomes
- very expensive. Here's the thing that maybe we don't talk about enough. I want you to think a little
- bit about what happens to our economy and what happens to our state a couple years out.
- Forecast this. Now we have individuals who aren't seeking care. We are now seeing poorer health outcomes.
- Our maternal fetal health statistics, they're not attractive. We're watching chronic disease climb.
- We're watching cost of managing chronic disease climb because it's out of control.
- I'm an employer looking to relocate my headquarters to the state of Indiana. I'm bringing a lot of jobs,
- high-tech jobs, people with professional smarts into the state, and I'm going to flood it with dollars.
- But when I see the health outcomes in your state, do I have pause? And do I get concerned when I see
- a state that has some of the most expensive health care in the nation with some of the most horrible
- health outcomes and a crazy uninsured population
- Why would I relocate to Indiana? If health policy doesn't get your attention, I would think that the
- fiscal picture would. And that matters to every single one of us because we're not only taxpayers, but
- we're residents of communities that are being impacted. When systems are undermined, these are some
- of the outcomes that we're concerned with. As CHCs look to continue to fulfill their mission and live
- out health care policy, the deck is beginning to seem stacked against us.
- Policy is driving an absolutely unsustainable model for community health centers. Remember, we're required
- by law to see everyone regardless of ability to pay. That includes the uninsured. When one in five quickly
- approaching one in four patients is uninsured, that business math doesn't work. The rate of uninsured
- is probably one of our most concerning elements, not only because of the health outcomes, but because
- of our ability to stay open and do business. And then finally, the biggest concern we have in the state
- of Indiana currently is regarding something called 340B. I'm not going to get into it. It's messy. It's
- complicated.
- difficult at best, but let me give you the Cliff Notes version. In 1992, Congress wisely recognized
- the need to provide financial support for essential services like community health centers. In the Veterans
- Health Care Act, they instituted the 340B program. This is a congressionally approved program whose
- purpose is, and I quote, to enable essential entities
- like community health centers, to stretch federal resources so that eligible patients can be provided
- with more comprehensive care. We continue to see growing restrictions on this particular program, mostly
- because of the heavy lobbying from pharmaceutical manufacturers. And this includes increasing administrative
- burden for us to access the same funds. This year, the state of Indiana has filed a state plan amendment
- with the Office of CMS
- that would allow the state of Indiana to take those funds, and instead of those funds going directly
- to community health centers across the state, they would go directly to the state of Indiana. We are
- talking millions and millions of dollars that community health centers will no longer have access to.
- The consequences are dire. We have a loss of insurance, we have an escalating uninsured rate, and now
- the state of Indiana is looking to carve out critical dollars that will allow us to continue to provide care.
- You can connect the dots. You're smart people, I have no doubt. But I think it's important that you
- know what's going on here in the United States, what's going on in Indiana, and what's going
- on in Bloomington. So how can you help? Be educated. Understand the role of community health centers
- in your community. If you have questions, I know a girl who would love to talk to you. There are some
- great resources I can make available to you. Happy to see you afterwards. Get your info and get you
- connected.
- Sign up for the Health Net Advocacy Alerts, that way you know what's going on on any given day, but
- more importantly, advocate. Support the policies that strengthen, not weaken, primary care, including
- funding for community health centers. Be a voice for health access and stability, and raise awareness
- about your concerns regarding 340B.
- I want to thank you for your time. You've been delightful. You've let me be a little bit passionate
- and ramble on about this topic. I am happy to take any and every question you want to toss at me. Thanks
- for the presentation, Cindy. You talked to us about veteran care. So looking at the map,
- I'm just curious how VA centers, if you're trying to get a VA clinic in your city, if you see a veteran
- who needs care, do you treat them or do you coordinate with the VA? How do veterans interact with community
- health centers?
- We do treat them. I don't have the data at my fingertips, but it's a significant number of veterans
- that we treat. Usually when that happens is because there's not a veteran access point readily available.
- What we will do is treat them, take care of their issue, and then if there's a referral that needs to happen,
- work with them. One of the things I think is great about community health centers as it relates to referrals
- is that we have things like social workers and resources to connect people to that type of care, a better
- fit for their care. And so that's different than what you see in most primary care practices, but that's
- certainly what happens. Yes. Oh, sorry. I'm a retired ER physician. God bless you.
- worked everywhere from Richmond, to Lowesport, to Evansville. And I guarantee you at least 50 to 60%
- of all the patients I saw were under-insured or Medicaid, Medicaid-eligible, whatever. When one has
- an emergency, what they could perceive as an emergency, they run to the UDAR. They don't run to the
- community health centers
- And just because we have to see everybody that comes. It continues to be an issue. It's been that way
- for 50 years. It has never changed, not in Indiana.
- Yeah, and I think you bring up a great point. It's really one of the reasons that currently Health Net
- is looking to open a Health Net Now opportunity. So we're trying to really promote same-day care and
- even have walk-in hours for individuals to come in that same day for those visits that aren't ED appropriate.
- If you're feeling sick, we definitely want to take care of you. Maybe going to the ED for an earache
- isn't the best fit, but coming to see primary care and being able to walk in and get that care is something
- that we can encourage among our patients.
- It's a patient education issue, and as you well know, it is ongoing and may never be completely satisfied.
- Thank you again for your time in the ED. That's a valiant heroic position to take on. So do we have
- a question online from Sandy Keller? If she's not.
- I didn't know my audio wasn't on. Is there dental care available and to what extent is that available
- for low-income residents? Yes, so dental is a requirement. It's a required service for CHCs. If dental
- is not available at a particular location, then that community health center is required to have a referral
- agreement with a partner in that community to pass on things like that sliding fee discount
- fee that's that's required by federal law. So for Health Net, we are lucky enough to have dental available
- in Indianapolis. We would love to find a dentist and reopen it here in Bloomington. There's a national
- dental shortage that we're just huge fans of. So whenever we're not able to provide a service, then
- we find a partner who is willing to provide those discounts that as we are at the health center. Great question.
- not to put you on the spot on this, this question, if you want to get back to me later, I know you've
- got your folks know how to do it, but what can community leaders give you that we're not currently giving
- you to support your mission? Yeah, that's a fabulous question at a really high level. I think the biggest
- concern that we have is the advocacy piece. So much of what we're seeing in the drop in the end and
- drop and ensure that the
- jump in uninsured is related to a couple things. And some of those things are outside of our control.
- Some of those things can be modified with legislation.
- So that advocacy piece comes into play. The biggest hurdle we have for 340B, quite candidly, is that
- we aren't able to make any kind of movement at the state. We have plenty of people who are trying to
- advocate for that. We actually just had an amendment that was put into some legislation that was going
- to be out to save and pull back our 340B dollars. And unfortunately, the state intervened and extracted
- that, and it was never even heard. We lost that opportunity. So for that particular issue, and we can
- talk about other things later, for 340B, it's
- Our last stopgap effort here is going to convince our federal representatives, both the House and the
- Senate, to go to the Office of CMS on our behalf and say, look, the state is asking to pull these funds
- back to the state, but the intent of the legislative language that was approved by Congress is X. It's
- to really support what we're doing. I might add, because it's a state plan budget amendment that goes
- to CMS, there's no opportunity for public input.
- It's an administrative maneuver. So as taxpayers, you have not had an opportunity to comment on that
- particular administrative maneuver. So really, if anything, maybe it's just reaching out to your federal
- representation and say, hey, I learned about this. Email me. I'll give you some resources. I'm worried
- about what this is going to do to 820,000 Hoosiers, because it really could have impact. I'm interested
- in what the CHC
- interaction is or there's a plan for universal nonprofit health care that goes up before Congress and
- hopefully we'll get it voted through. But is CHC's part of that plan and how would that plug and play?
- I know the CHCs have been mentioned multiple times in some different agendas related to making America
- healthy. Again, to that specific one, I'm not sure. What I will tell you is that the history and the
- model of the CHCs has produced the data that shows that it works, and they have been referenced many
- times when we're thinking about a more universal model. So we'll kind of wait and see what that looks
- like. We've got one more question online. Yes, thank you Cindy for visiting with us.
- I appreciate your presentations. We need more of you than if you were. The program you present to us,
- it seemed to me a beautiful map for the country to follow and move forward with it. To be more specific,
- in our community of Bloomington, I would like to see your thought or your
- information about a pregnant woman who is uninsured and walk into the clinic. How do you manage that
- particular one? Another issue is an insured individual who come to the clinic and they have high blood
- pressure or diabetes, et cetera, and you send them out where he or she
- received a medication to help him be after the visit you provide.
- Okay, two great questions, Raj. I'm so glad to hear your voice. You're on the screen behind me here.
- I'll speak to the prenatal first when it comes to fetal maternal health. If they walk into the health
- center, obviously we will see them. We do not have an OB on staff in Bloomington, so they're going to
- be referred out depending on where they are in their pregnancy and get connected with the correct resources
- so we can follow up with that prenatal care. I think Bloomington's really unique. I will make this plug
- really quickly.
- in that we have a lot of individuals who are showing up at the health center who have maybe emergency
- Medicaid or they don't have any coverage at all. If that's the case, their care is not covered by insurance,
- their prenatal care. Emergency Medicaid is pretty much delivery
- only in really simple terms. You have a very generous community here, an incredibly generous community.
- That goes all the way back to the volunteers and medicine days. And so we do have a small patient assistance
- fund where we try to make certain that prenatal care is covered for those women so they don't stop pursuing
- that prenatal care. This is where partnership comes into play. It's important that we have relationships
- with larger hospital systems and other community entities. If there's a service that needs to be provided,
- prenatal care is a required
- service for all community health centers. If we can't provide it at that point in time, we have to have
- a partner that we refer patients out to. To your other point, Raj, when it comes to education, that
- is one of the things that we try to follow up on. Obviously, if they have to be referred out, we may
- lose that patient. We would rather bring them back in and have them become a patient under our primary
- care umbrella where we can do that patient education. That is something that for the community, that's
- one of the things that I get to champion is community education through community outreach.
- But we do have the opportunity to possibly lose them if they leave our community health center, so we
- try to keep them close at hand so we can make sure they have the resources they need. And our last question
- from Markeit. Thank you so much for this information. I'm curious to learn a little bit more about the
- landscape of CHCs in public education across the country as well as in the state of Indiana. What's
- currently happening and what is the potential likelihood of something like that
- of being expanded into public schools.
- point, a lot of CHCs have presence in schools. They provide the health care. When we talk about all
- those delivery sites, they are often in schools providing that care. There's usually a nurse practitioner
- who's there. They can not only provide the care that you think of the typical school nurse. My mother
- was a typical school nurse, so I'm using those quotes really, really carefully. They do great work.
- But because they are nurse practitioners, they can go a little bit further in their care. In Indianapolis,
- we have a presence in two large high schools that have multiple team members that are on
- site in the high school where they can provide care. Indianapolis specifically, Raphael, Shalom, there
- are a number of FQHCs that that's kind of their bread and butter. They do it. They do it really,
- really well. It's a micro community health center within the school to take care of those students and
- the staff and families too. Thank you.
- your credit to our club. In honor of your talk, a donation we made this quarter to Amethyst House. We're
- running short on time, so I'm not going to mention today's volunteers by name, but thank you. Our next
- regular meeting will be on March 3rd. We'll be downstairs in the French Panty Room. IU Student Foundation
- Race Director Peter Schultz will speak to us about the life of the Little 500. Tyler, if you would please
- share the graphic for the four-way test.
- Please stand if you are able and join me. Of the things we think, say, or do, first, is it the truth?
- Second, is it fair to all concern? Third, will it build goodwill and better friendships? Fourth, will
- it be beneficial to all concern? And fifth, is it fun?