MetropolitanFamily Health Network

2017Annual Report

Compassionate, Quality Care ... Close to Home

Tabl

e of

Con

tent

s1 Overview of Metropolitan Family Health Network, Inc.

2 Message from President/Chief Executive Officer

2 Message from Chairman of the Board of Trustees

3 Mission/Vision/Values

4 Executive Team

5 Programs and Services

7 Highlights of 2017

12 Patient Demographics

13 Visits Type

14 Visit by Payor Type

15 Late Hour Visits Report

What’s Inside

Metropolitan Family Health Network (MFHN) is a Federally Qualified Health Center with three (3) centers in Hudson County, New Jersey – two in Jersey City, and one in West New York. All are easily accessed using public transportation. MFHN provides primary care for adults and children, as well as dental services, podiatry, and behavioral health. Certified Affordable Care Coordinators are available for insurance verification.

MFHN began as an independent operation in 2006. At that time there were two centers – the present headquarters at 935 Garfield Avenue in Jersey City and the West New York center at 5300 Bergenline Avenue. In 2009, Metropolitan created a third center on Bergen Avenue in Jersey City, which is dedicated to serving the medical and social services needs of the community’s homeless population. Metropolitan has shared this location in partnership with the United Way of Hudson County.

In 2010, Metropolitan received its gold seal of accreditation from the Joint Commission, an independent organization that accredits and certifies health care organizations. (MFHN has earned that accreditation three times since.) In 2013 MFHN received Patient Centered Medical Home (PCMH) designation from the National Committee for Quality Assurance (NCQA).

In a long-standing relationship with Jersey City Medical Center/RWJBarnabas Health, Metropolitan has been the home for Adult Care and OB/GYN Resident Rotation since 2013. In addition, Metropolitan has an agreement with Lutheran Health Center in Brooklyn, New York for a Dental Residency Rotation. Uniquely, MFHN shares a relationship with Jersey City Medical Center/RWJ Barnabas Health which positions staff members in the Medical Center’s Emergency Room to educate, and to channel patients to Metropolitan for care.

Overview of Metropolitan Family Health Network, Inc.

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As a Federally Qualified Health Center, Metropolitan Family Health Network Trustees act as represen-tatives of our community. We are responsible for ensuring that ev-erything at MFHN is in compliance with federal, state and local laws and regulations. We must make sure that our programs are respon-sive to the needs of our community, and that our policies support the

MFHN mission. We are also responsible for making certain that our organization is financially stable.

The Board of Trustees works with Metropolitan Fam-ily Health Network’s Administrators, and we are proud of the accomplishments achieved in 2017 and the fact that

MFHN continues to be a model FQHC. Our sincere thanks to Joan Dublin and the entire Metropolitan Family Health Network staff for their commitment to excellence and their diligence in seeking and obtaining the resources our com-munity needs. Special thanks to our community partners for their assistance in helping us grow.

Our promise to the community we represent: We are dedi-cated to continuing to make high-quality, affordable, pri-mary care service and programs accessible for everyone in our community.

Jeff HertzChairman

Just as health care is ever-changing, so is Metropolitan Family Health Network. We are constantly working to improve and inno-vate so our community has the finest health care available.

During 2017, we became more patient-cen-tered and community-involved than ever. Thanks to a grant from The Nicholson Foun-dation, we began an innovative program of integrated behavioral health that helps

achieve the most positive outcomes by treating body and mind.

We also continue to work with our partners to reach more members of our community and provide them with the quality, affordable health and dental care they need and deserve. In 2017 we began offering free dental screenings to children in the Jersey City Public Schools, and we intend to broaden the scope of these efforts to include more schools and senior citizens as well.

This Annual Report highlights just some of the many ways we have achieved becoming a very integral part of our community. Our suc-cess is due in large part to the efforts of our providers and staff mem-bers and to our partners – elected officials, foundations, other health care organizations, schools, community organizations and vendors – who work with us in serving our community. Sincere thanks to you all!

Joan Dublin, RN, MPA, ACHEPresident & Chief Executive Officer

From the President/Chief Executive Officer

From the Board of Trustees Chairman

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Our MissionThe mission of the Metropolitan Family Health Network is to provide high quality, accessible health care to the under-served population in our community, regardless of their ability to pay.

Vision Statement To marshall the forces within Metropolitan Family Health Network – employees, physicians, services and technology – to-ward the single objective of ensuring the best possible health outcome for every patient.

To seek opportunities to expand the continuum of health services provided to our patients and the community, and enhance the quality of services rendered through superior health care offerings.

To be the preeminent provider of services in the region, and to be distinguished for the high quality of health care services provided by competent and compassionate staff.

To create a workplace environment that recognizes and rewards the importance of each employee to the delivery of health care and to foster opportunities for career development, teamwork and respect for each individual employed by Metropolitan Family Health Network.

To maintain a position of financial stability, efficiency and sound management practices.

Values Statement Respect - Showing consideration and appreciation for not only our patients but for each other as co-workers.

Excellence - To continuously strive to achieve quality through growth, creativity, and a positive approach to change.

Service - We are dedicated to serving everyone in need of health care regardless of race, creed, sex, religion, national origin, sexual orientation, gender, disability, age or ability to pay.

Participation - We will strive to have a share in the work so we can all share in accomplishments.

Empathy - We will strive to identify with and understand our patients’ needs and feelings because only then can we serve them with compassion. Community - We will foster a sense of community among ourselves, with our patients and with the community itself.

Teamwork - Even the impossible becomes possible when a group works together. Teamwork is our means to excellence.

Executive Team

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Joan Dublin, RN, MPA, ACHE President & Chief Executive Officer

Patrick Beaty, MD Chief Medical Officer

Scott Carey Chief Operating Officer

Programs and Services

Pediatric Care for Infants and Children to age 18 • Asthma and Diabetes Care and Education• Immunizations • Lab Tests • Nutrition Counseling and Education • Medicaid and Family Care Eligibility and Enrollment • Screening Tests • Sick Visits • Well-child and School/Sports Exams

Dental Care for Children and Adults• Basic Restorative Care (Fillings) • Brightening/Whitening • Checkups and X-Rays • Cleanings and Deep Cleanings • Crowns • Dentures (Partial and Full) • Extractions • Gum Treatments and Care • Oral Hygiene Instructions • Oral Cancer Screenings • Root Canals • Smoking Cessation

Adult Care/Internal Medicine for ages 18 and up • Adult Asthma Care • Behavioral Health • Physical Exams • Diabetes Management Program • Diabetes Testing • Geriatric Care• Health Education and Outreach • Healthcare for the Homeless • Immunizations and Flu Shots • Lab Tests • Medicaid and Family Care Eligibility and Enrollment • Nutrition Counseling and Education • Podiatry (Foot Care) • Social Services and Case Management

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• Breast Exams • Breast Cancer Prevention and Education

Programs (including self-exam follow-ups) • Contraceptive Counseling • Family Planning • Gynecologic Screenings

• Lab Tests • Pap Smears • Prenatal Testing • Pregnancy Care and Delivery • Menopause Services • Ultrasound Monitoring

Obstetrics/Gynecology and Post-Partum Care for Women

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Pharmacy • Onsite Pharmacy at 935 Garfield Avenue (Jersey City)• Participates in the 340B Drug Discount Program • Provides up to 50% Discounts on Certain Medications for Eligible Patients

Patient Centered Medical Home • MFHN is Certified by National Committee for Quality Assurance as a Level 3

Patient Centered Medical Home• MFHN Achieved Designation by Focusing on Supporting Patients and Families,

Coordinating Care, and Ensuring Services are Accessible.• Model Program Coordinates Care Through One’s Primary Care Physician• Operates as a Health Care Team with the Patient• Utilizes Electronic Health Records

Wealth From Health • Funded by the Horizon Foundation • Dedicated to improving patients’ health and reducing overall costs • Provides proactive, preventive care to reduce the number of Emergency Room visits • Assists patients in navigating the healthcare system • Established a foundation for patient-centered chronic disease management • Health coaches work directly with patients and connect them to outside resources

Affordable Care Act (ACA) • MFHN has been a Certified ACA Healthcare Center since 2013• Offers insurance benefits regardless of pre-existing conditions, sex or age• Certified ACA application counselors assist patients in determining eligibility for

Medicaid, CHIP, tax credits, and cost-sharing reductions for insurance

Programs and Services (cont.)

Highlights of 2017

The MFHN Dental Program celebrated its 5th Anniversary in 2017. The state-of-the-art dental suite at Metropolitan’s 935 Garfield Avenue center includes a reception area, laboratory and four operatories, and offers digital x-ray technology and electronic dental records. Complete services are offered for children and adults.

To ensure that kids 6-months of age and up have strong baby- and permanent-teeth and healthy gums, MFHN continued its Seal the Deal program. Since tooth decay is the most common chronic childhood disease, staff taught parents – and children – how to properly care for teeth and gums. This included instructions on brushing, flossing—when a child can manage it—eating healthy foods, and limiting sugary foods and beverages. When necessary, the team provided fluoride varnish for baby teeth and dental sealants for permanent teeth. Both are safe, pain-free ways of protecting teeth from decay. The staff also stressed the importance of regular oral and dental screenings.

MFHN’s Dental Program Celebrates its Fifth Year

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On February 3, MFHN hosted Give Kids a Smile Day, which offered free dental services for kids 17 and younger. The team provided 40 children with free dental exams, cleanings, and fluoride treat-ments, and offered referrals and appointments for follow-up care. Educational games helped attendees learn about food choices that will help keep their teeth healthy. There was also instruction on proper brushing and flossing.

MFHN Celebrated “Give Kids a Smile” Day with FREE Dental Exams

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On August 14, MFHN welcomed elected officials, dignitar-ies, other healthcare organizations, and community mem-bers for the annual statewide kick-off ceremony of National Health Center Week. The event was held in conjunction with New Jersey Primary Care Association (NJPCA).

National Health Center Week celebrates New Jersey’s health centers—the keys to healthier communities. One in fifteen people in America depends on these services. These health centers deliver high quality, cost effective, accessible care while serving as economic engines that help power local economies. They accomplish this through partnerships with local, state and federal governmental entities.

Serving as mistress of ceremonies, MFHN President and CEO Joan Dublin, along with NJPCA President and CEO Jillian Hudspeth, introduced influential officials in government and health care. Honored guests included: John Bardis, Assistant Secretary for Administration of the U.S. Department of Health and Human Services; Cathleen Bennett, the Commissioner of Health for the State of New Jersey; Dennis Gonzalez, the Act-ing Regional Director and Executive Officer of the U.S. De-partment of Health and Human Services Region II; Jersey City Mayor Steven Fulop; U.S. Congressman Donald M. Payne, Jr.; Carissa Lawson, the award-winning anchor on News 12 New

Jersey; and Jim McGreevey, former Governor and the Execu-tive Director of Jersey City Employment and Training program (JCETP). Representatives of U.S. Senators Robert Menendez and Cory Booker were there.

Mr. Bardis addressed Department of Health and Human Ser-vices priorities: opioid addiction, solutions for mental illness, and childhood obesity. Commissioner Bennett praised the work of health centers and how their success comes from knowing their communities. Congressman Payne stated that federally qualified health centers are vital resources and May-or Fulop said that Jersey City was addressing some key issues being targeted by the federal government such as homeless-ness and affordable housing for seniors and veterans. Ms. Lawson spoke about her work promoting good health habits, and Governor McGreevey concluded by relating how MFHN helped a JCETP client improve his health so he could enter the workforce.

Several organizations volunteered their services for free health screenings and offered giveaways, refreshments, and more. Among them: Aetna, Amerigroup, CarePoint, Horizon NJ Health, United Healthcare, Madeline Fiadini LoRe Foun-dation, and Women Rising.

MFHN Hosted Statewide Annual Kickoff

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MFHN’s satellite health center locations in Jersey City and West New York were formally recognized by the National Committee for Quality Assurance (NCQA) as Patient-Centered Medical Homes (PCMH). The Program is the most widely adopted PCMH evaluation program in the U.S. More than 12,000 practices (with more than 60,000 clinicians) are recog-nized, and more than 100 payers support NCQA recognition through financial in-centives or coaching. Achieving NCQA recognition means a healthcare facility has committed to quality improvement and a patient-centered approach to care. The PCMH puts patients at the forefront. This results in better relationships between patients and their clinical care teams. Research shows that

PCMHs improve quality, patient experi-ence, and staff satisfaction while reduc-ing health care costs. MFHN has achieved PCMH recognition at all locations – 935 Garfield Ave. and 857 Bergen Avenue in Jersey City, and 5800 Bergenline Avenue in West New York. To achieve this, staff mem-bers dedicated a tremendous amount of time and effort to meet six rigorous PCMH care standards that validate our organiza-tion’s commitment to high-quality care.

In other relevant news, MFHN achieved PCMH Level 3 Accreditation. There are three

levels of accreditation, and Level 3 signifies that MFHN dem-onstrated strong performances in better patient experience and health, and lower per capita cost.

MFHN Achieved Special Recognition as a Patient Centered Medical Home

On October 22, members of MFHN’s team donned signature sweatshirts that read: “Faith, Love, Hope, Believe ... Together, Commitment, Support, Strength, Awareness, Cause, Cure, Fight.” They joined more than 5,000 people who united to sup-port the American Cancer Society’s “Making Strides Against Breast Cancer” walk in Jersey City. The event raised $329,000.

MFHN Staff Participated in Annual ‘Making Strides Against Breast Cancer’ Walk

MFHN Awarded Grants for New and Increased Services

MFHN successfully applied for and received funding to help increase community services and care. These include: • The Nicholson Foundation - Integrated Behavioral Health, which provides a program of integrated care in primary

care settings. -$225,000 • New Jersey Department of Health - Heart Disease & Stroke Prevention Program for preventing and managing

heart disease and strokes. - $90,000 • U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA) - Access

Increases in Mental Health and Substance Abuse Services (AIMS) for the expansion of services. - $175,700 • U.S. Department of Health and Human Services HRSA - Health Center Quality Improvement FY 2017 Grant

Award for Clinical Quality Improvers and Achieving PCMH Recognition - $44,583 • Madeline Fiadini LoRe Foundation for Cancer Prevention for supporting access to cancer screenings, and more;

ongoing since 2012. Total 2012 – 2016: $33,570. Total year-to-date in 2017: $5,160

Year-round Open Houses and Events

National statistics show major disparities exist between the general population and the most vulnerable and underserved populations in terms of the access to comprehensive medical and dental care. MFHN is committed to providing ongoing patient-centered and community-oriented activities to help facilitate the availability of much-needed health services and to address the needs of the community it serves.

Throughout the year MFHN organizes and holds several Open Houses and other special events, including education-al sessions on nutrition, exercise, childbirth, diabetes, dental care, and women’s and men’s health issues. MFHN also pro-vides health care and dental screenings at events held in Jer-sey City, West New York, and Union City, and we hold food drives to make the holidays a bit brighter for those in need.

Straight TalkOn the third Monday of each month, members of our outreach and marketing teams conduct informal one-on-one interviews with 15 to 20 patients selected at random. These sessions help us understand why and how patients came to choose MFHN for their health care, as well as whether or not they are satisfied with services and hours. It also helps us gauge patients’ awareness of new initiatives. Straight Talk also provides opportunities to inform patients about services and programs that they may find beneficial and invite them to participate in upcoming events and programs.

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Partners:

Advanced Medical Billing Systems, Inc.Aetna Better Health of NJAmerican Cancer SocietyAmerican Dental Association Foundation AmerigroupAmerigroup RealSolutionsASL Interpreter Referral Service, Inc. Bergen-Hudson Chronic Disease CoalitionCarePoint Health Clover Health CohnReznickDaniel H. & Sandra KrivitHorizonHorizon NJ HealthJersey City Medical Center - RWJBarnabas HealthJersey Elevator

Jones & Associates CommunicationsKeyCare, Inc.Kluger Healey, LLCLabCorpLindo Consulting, Inc. Madeline Fiadini LoRe FoundationNational Healthcare ConsultingNew Jersey Department of Health and Human ServicesNJ Cancer Education and Early Detection (CEED)NJ Primary Care Association NJ Supplemental Nutrition Assistance Program (SNAP)Novo NordiskNYU Lutheran Family Health CentersRSC ArchitectsThe Horizon FoundationUnited Healthcare

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Patient Demographics

65%35%

Female

Male54,620Annual Visits

16,670Patients Served

3,402Dental Visits

1,259Homeless Visits

2,294Dental Patients

Served

476Homeless Patients

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2017 Visit Type

Family PractitionerPediatricianPodiatrist

InternistPsychiatristNurse Midwife

Social WorkerDentistOB/GYN

20,000

18,000

16,000

14,000

12,000

10,000

8,000

6,000

4,000

2,000

0 0

17,082

1,062

12,942

0

4,178

240

3,402

11,934

Payor Type

2016 2017Uninsured 2,665 2,609Medicaid 11,111 10,809Medicare 802 778Private Insurance 1,988 2,474

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2016 2017

2,665

1,988802

2,609

778

2,474

11,11110,809

12,000

10,000

8,000

6,000

4,000

2,000

0

3,920 Late Hours Visits for 2017