Grant Partners

 To hire a consultant for strategic planning and evaluation purposes.

 To purchase and implement a computer-based documentation system, SNAP.

Harbor Health Services will participate in off-site joint outreach sessions at social service agencies, supermarket chains, ethnic markets, Councils on Aging, Veterans Agencies, sites serving behavioral health and developmental delayed persons, subsidized housing, state employment and job training sites, schools, food pantries, WIC program sites, health fairs, and via social media. It will create a health insurance literacy community assessment, and develop user-friendly materials that educate clients on how to use health insurance benefits. Finally, it will dedicate a phone number and webpage for residents to reach staff for enrollment assistance, and execute a social media campaign.

Family Health Center of Worcester (FHCW) will partner with community organizations to receive referrals for individuals needing enrollment assistance. They will provide one-on-one sessions and events about minimizing the risk of losing coverage, review all eligibility determination letters, utilize its EMR to record pending expiration dates, and use automated call center software to reach uninsured patients in multiple languages. The organization will conduct quarterly “health insurance 101” trainings, provide regular patient orientation sessions, and make health insurance literacy information and resources available through patient computer kiosks.

To hire a consultant.

To purchase an autoclave sterilizer. 

The League will continue monitoring changes in the health care environment, sharing information with health centers, coalition partners, and state entities.  The organization will engage community health center board members to foster active advocacy and policy work to advance adult dental coverage, grow health center pharmacy programs, support the certification of community health workers, and improve health care for homeless people, veterans, and individuals recently released from correctional institutions.

To purchase a colposcope and related instrumentation for its Martha’s Vineyard Family Planning clinic.

Project Directors: Robin Clark, PhD, Director of Research and Evaluation (Principal Investigator) and Deborah Gurewich, PhD, Associate Director of Research and Evaluation“Identification of Effective Community-Based Models for Coordinating Care for Persons with Substance Use Disorders” will analyze community-based approaches for coordinating care for patients with substance use disorders (SUD) and identify those models that appear most effective in accomplishing care coordination. Through their work, which will be based on assessing different care coordination models employed at three sites serving the Worcester area, the team will provide insight into the relative efficacy of different community-based approaches for engaging and coordinating services for patients with SUDs. Efficacy will measured based on a comparison of selected cost and quality metrics as well as self-reported patient experience.   

 To hire a consultant nurse educator to train members’ agencies in standard clinical protocols and outcome evaluation practices.  

Lynn Community Health Center (LCHC) has developed and implemented a fully integrated primary care and behavioral health program with (a) the co-location of services, (b) co-management of patients by the medical and behavioral health providers through a ‘shared care’ model, and (c) utilization of a shared EHR. There are five integrated health teams, each with five to nine primary care providers of various types (i.e. family medicine, internists, nurse practitioners, etc.), two to three licensed behavioral health therapists, a psychiatrist or advanced practice psychiatric nurse practitioner to work with the PCPs in prescribing psychotropic medications, and clinical assistants and nurse case managers for care coordination and management of complex patients with multiple co-morbidities and high ED utilization. The health center has a fully integrated EHR with complete patient information available to all providers involved in a patient’s care. Screening tools, including PHQ-2, PHQ-9 and SF-36 are templates in the system. This allows for tracking a patient’s screening scores, and data reporting for quality improvement and evaluation. LCHC utilizes the Quality Improvement (QI) process to identify issues and opportunity for improvements, which are presented and discussed at Integration Team meetings. A team is then designated to undertake a QI project to clarify the problem, utilize the available data to measure the impact of proposed changes, and test the changes using Plan-Do-Study-Act (PDSA) cycles. Successful solutions are then spread throughout the other Integration Teams for adoption as a best practice. This model allows patients to access behavioral health services through their primary care team, effectively reducing the barrier of stigma and ensuring timely access to appropriate care.

Community Health Connections will conduct intensive street and shelter outreach to individuals who are homeless, providing eligibility determinations and application assistance.  They will hold “office hours” at local organizations to answer questions regarding programs, eligibility requirements, and sources of care in the community.  A “Community Collaborations” group consisting of health and human services organizations will be convened, serving the region’s homeless, to share information about the Affordable Care Act.  

Community Action of the Franklin, Hampshire and North Quabbin Regions will assist eligible consumers with applications, offer education about health access services over the phone, and provide financial assistance assessments.  Referral linkages with area providers will also be enhanced.  

Health Law Advocates will continue its advocacy work in five areas:  health care reform implementation, medical debt advocacy, children’s mental health access, access to oral health care, and pro-bono legal support.  Additionally, the organization will provide individual representation for residents who have been denied access to health care or have received unaffordable medical bills.  

 To hire a grantwriting coach.