The State of New Hampshire, with its population of approximately 1.3 million, includes a relatively even mix of smaller urban, suburban and rural settings for the delivery of safety net health care. Although the State lacks significant county-level public health resources, it supports a substantial public health care system. New Hampshire also has seven Federally-funded Section 330 ambulatory care health centers. Five southern New Hampshire health centers make up the membership of CHAN, a not-for-profit organization that relies primarily on grants from the BPHC and other funders to operate. CHAN’s primary purpose is to support the mission of the health centers themselves. To do this, CHAN provides technical assistance and develops standard policies related to clinical, administrative, financial and technical aspects of health center operations. In recent years, the network has developed its own IS infrastructure and launched use of shared applications for EMR and practice management among member health centers.
Four of CHAN’s member health centers are community health centers (CHCs) and the fifth is a 330-funded Health Care for the Homeless center. Collectively, the CHAN members, all of whom provide comprehensive primary health care as well as some specialty services, have more than 136,000 patient encounters per year. Some centers provide health care to nearly 15 percent of their local population. Although patient and payor mix vary by health center, approximately 45 percent of CHAN patients are below 200 percent FPL and pay either on a sliding scale or through Medicaid; 7 percent are Medicare enrollees; 30 percent are commercially insured; and 15 percent self-pay the full cost of their care. Only one center, Nashua Area Health, serves a large minority (predominantly Hispanic) population.
The site visit, which took place on May 11, 2004, involved initial telephone and email contacts followed with in-person interviews with 15 respondents representing 5 institutions involved in the State’s primary health care safety net. Table 1 below lists all health centers and other stakeholders interviewed as part of the site visit and follow-up telephone calls.
Consolidated HealthCenter Respondents
|Lamprey Health Care||Lamprey is NH’s oldest and largest community health center (CHC), and one of CHAN’s founding members. Located in Raymond, NH, it operates 3 sites and serves 16,500 patients per year.|
|Manchester Community Health Center||MCHC is a CHC and CHAN partner located in Manchester, NH. It currently has one site and sees over 7,000 patients per year.|
|Health First Family Care Center||Health First is a CHC and CHAN member based in Franklin, New Hampshire. The center operates one site and serves 3,000 patients annually.|
|Community Health Access Network (CHAN)||CHAN is a not-for-profit network of health centers in southern New Hampshire. It provides shared information systems, IT infrastructure, training, clinical programs and other integrated services to its five members.|
|New Hampshire Department of Health and Human Services, Office of Community and Public Health (OCHP)||OCPH supports the state’s public health entities through grants, policy decisionmaking, technical assistance and education, and quality assurance activities. It works in collaboration with CHAN on various initiatives.|
Telephone and in-person interviews with respondents were conducted using open-ended discussion guides, designed to support a consistent structure for exchange while allowing sufficient flexibility to capture all relevant information. In addition, a table shell was emailed to information systems staff at respondent health centers prior to the site visit to facilitate collection of standard information relating to infrastructure and technical capacity. For each scheduled site visit interview, the NORC team prepared materials that outlined our preliminary knowledge of the respondent and highlighted outstanding questions to address during the interview. Examples of the discussion guides and other materials can be found in previous site visit reports.