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?