Wednesday, November 5, 2014

New Resource Explores How Health Centers Can Measure and Improve Performance

“If you can’t measure it, you can’t manage it.” There is a great deal of truth to this adage, especially in today’s health care environment where health centers have an even greater need to employ efficient and effective management techniques. To achieve improved performance, health centers need to assess what they do and measure how well they do it. But what should be measured? How do they interpret the data? And, how can this information be transformed into decision-making? 

High-Performance Community Health Centers: Learning, Measuring, and Achieving helps answer these questions by exploring the transition from data to information to knowledge to action with the goal of achieving a high level of performance. This guide, developed specifically for health center staff and boards, discusses the difference between calculating outputs and measuring outcomes, and reviews the basics of “change management,” explaining how to identify what’s important and how to transform limited resources into significant improvements. It also describes the importance of measuring, benchmarking, and evaluating all organizational activities, providing an introduction to the tools needed to attain “high performance.”

Health centers and PCAs can access this resource, which was developed with support from the Health Resources and Services Administration, on our website at

Tuesday, October 14, 2014

New Report Analyzes the Factors that May Contribute to Health Center Failure

The Federally Qualified Health Center (FQHC) business model is complex but for the majority, it has proven to be sound when competently implemented. Not all FQHCs have implemented it successfully, however, and the result is that some have failed outright while others were forced into mergers. It is clear that while all health centers share a similar basic business plan structure, enough to collectively call them an “industry,” many factors conspire to make operating one center very different from the next. In order to identify which factors may contribute to health center demise, Capital Link and Community Health Center Capital Fund (Capital Fund) issued a report examining the differences between failed or failing health centers and their more successful counterparts.

Based on an analysis of the financial and operational performance of 29 health centers over a four-year period leading up to the centers’ demise, this analysis is the third topic in the Citi Foundation-sponsored series Community Health Center Financial Perspectives. The report contains two issues to address different audiences: Identifying the Risks of Health Center Failure: A Guide for Health Centers and Identifying the Risks of Health Center Lending: A Guide for Lenders.

The health center guide (Issue 5) offers health centers a better understanding of what operational and financial issues have resulted in financial stress for other centers and impacted their ability to stay in business. The lender guide (Issue 6) provides lenders and investors with the insight necessary to determine potential early warning signs of future financial distress when underwriting health center loan requests—whether for capital project financing, working capital, or growth capital.

The following infographic illustrates key findings and the complete report is available at

Monday, August 11, 2014

Despite Aggressive Growth, Health Centers Challenged to Meet Capital Needs

Capital Link announces the release of Capital Plans and Needs of Health Centers: A National Perspective, a biennial study conducted to determine the current capital plans of health centers across the United States and whether those plans, if funded and implemented, would be sufficient to provide the facilities necessary to accommodate patient growth expected as a result of Affordable Care Act implementation. This study was supported by the Health Resources and Services Administration, Bureau of Primary Health Care.

The dramatic increase in patient demand over the past several years has necessitated rapid growth in health center facilities. The number of patients served by health centers grew 50% between 2005 and 2012, and this trend will only continue in an era of health reform. Capital Link conducted this study to determine capital project plans, investment needs, sources of capital, projected funding gaps, and growth readiness to expand facilities to meet the projected market need. Data was requested  from 1,200 health centers, resulting in a 33% response rate.

Three-fourths of the responding health centers indicated that they had specific plans to initiate capital projects within the next five years, which Capital Link estimates will total approximately $5.1 billion for owned facilities and $2.6 billion for leased space. This facilities investment should accommodate an additional 5.9 million patients for a total capacity of 30 million patients and 31,000 providers by 2018. With 32 million patients annually projected, however, a total capital investment of $10.3 billion in physical infrastructure, including leased space of $3.4 billion, will be needed. Funding for health center-owned projects has been identified and secured for only 37% of planned projects, leaving a $3 billion gap to accommodate 30 million patients and at least $4.8 billion to reach the 32 million patient goal.

Key findings are illustrated in the following infographic.

For detailed results, access the complete report online at

Tuesday, August 5, 2014

The Community Impact of Health Centers Nationally Continues to Rise

Using an integrated economic modeling and planning tool and the latest Uniform Data System data (2012), Capital Link captured the economic effects of health centers across the nation. Health centers collectively generated more than $26.5 billion in total economic activity for their local communities in 2012 – a 33% increase since 2009 and a 13% increase since 2011. Employment grew from approximately 189,000 jobs in 2009 to just over 230,500 jobs in 2012, a 22% increase since 2009 and an 8% increase since 2011.
Download a PDF copy of the infographic here.

In the past, health centers have used this information to educate policymakers, seek community support, and pursue funding opportunities. For more information on economic impact analyses, visit our website or contact Steve Rubman, Manager of Data Resources & Analysis, at

Thursday, June 5, 2014

Low-Cost Financing Opportunity for California Clinics and Health Centers

The California Endowment (TCE) has just released a request for application for a new round of low-cost financing to qualifying California community clinics and health centers with capital expansion plans.

Program-related Investments (PRI) from TCE combined with capital from Community Health Center Capital Fund (Capital Fund) and Capital Impact Partners will provide loans of up to $5 million. Preference will be given to health centers located within one of the 14 California communities that are part of TCE's 10-year Building Healthy Communities plan, but others may also apply. Acceptable uses of funds include land and building acquisition, new construction or renovation, leasehold improvements, and equipment purchases. Applicants must be California-based, non-profit, and tax-exempt community clinics and health centers.

The application deadline is July 31, 2014. An applicant conference call will be scheduled for mid-June. Click here to access the online application and specific details, including eligibility requirements, investment criteria, and financing terms.

Capital Link provides assistance with several of the requirements for this application such as financial projections, business planning and finance packaging, capital project planning, and market and impact analyses. For more information on how we may be able to help, please visit our website or contact Mark Lurtz, Senior Director of Marketing and Project Consulting at 636-244-3082 or

Monday, May 19, 2014

10 Disruptive Forces Plaguing the Healthcare Industry

A list of the 10 most disruptive forces in healthcare was released last week by Insigniam, an international management consulting firm. Based upon a literature review and interviews with experts across the healthcare industry, the disruptive forces include projected provider shortages, the transition to value-based care, and challenges accessing capital. While community health center leaders know most of these forces all too well, the list serves as a helpful recap of the state of primary care, and can be particularly useful for health center boards as they complete the Environmental Scan phase of their strategic planning process.  

Access the original article or review Becker Hospital Review’s chart for a brief summary.

Below is a list of resources available on Capital Link’s website designed to help community health centers prepare for these trends.


Wednesday, April 9, 2014

New Resource Examines the Impact of Capital Projects on Health Center Operations and Financial Performance

Currently the largest network of primary care providers nationally, federally qualified health centers doubled the number of patients served over the past decade, creating the need for facilities expansion. Health centers added approximately $11.1 billion in leased and owned buildings, property, and equipment, from 2008-2012, a growth trajectory that will continue with Affordable Care Act (ACA) implementation. To determine the effect of this growth on health center operations and financial performance, Capital Link and Community Health Center Capital Fund (Capital Fund) completed a study of 118 health centers over a five year period. 

Impact of Capital Projects on Heath Centers: Growth, Financial Trends, and Operational Transformation, is the second topic in a series of resources sponsored by Citi Foundation called Community Health Center Financial Perspectives. The study provides insights such as: How fast do health centers grow after a capital project? What are the potential pitfalls? How large should cash reserves be to mitigate possible losses as a new facility ramps up? How fast do other health centers add staff and how does that affect the bottom line? How much debt do other health centers support when they take on a capital project and how much equity do they usually raise? The analysis also addressed the issue of project size, and how this factor may affect health center finances and operations.

Two reports were produced to discuss findings relevant to different audiences: (1) community health center leaders and (2) lenders and investors.

The health center guide (issue 3) offers information to assist health centers with capital planning and financing processes. A lender guide (issue 4) will be released soon which offers a data-informed analysis for lenders as they underwrite health center capital projects.

Key findings are illustrated in our infographic.  The complete resource document with detailed financial and operational metrics and trends is available at

Thursday, March 27, 2014

New Analysis on a Growing Sector: Community Health Center Financial Perspectives

by Allison Coleman, Chief Executive Officer, Capital Link
Kristen Scheyder, Senior Program Officer, Citi Foundation

Federally qualified health centers have experienced unprecedented growth over the past decade, doubling the number of patients served to 22 million and reporting operating revenues of $14 billion in 2011. In today’s environment of health reform, this growth will climb even further, as health centers are expected to serve upwards of 40 million people in the coming years. Key to these growth efforts are lenders and investors, such as Community Development Financial Institutions (CDFIs). However, there remains a data gap about the financial and operational profile of health centers on a consistent basis that limits the financing of these crucial urban and rural anchors.

To fill the information gap, Capital Link and Community Health Center Capital Fund (Capital Fund) recently completed Community Health Center Financial Perspectives, Financial and Operational Ratios and Trends, 2008-2011: A Guide for Lenders, a new resource funded by the Citi Foundation. This report provides insight into multi-year financial trends for community health centers on a national basis, information that helps lenders and investors understand the industry and climate in which they operate.

Using Capital Link’s database of audited financial statements from nearly 4,000 health centers and the Health Resources and Services Administration’s Uniform Data System (UDS) data, the analysis is a starting point to create more transparency in the field. The new findings provide metrics not previously available on the financial and operational performance of health centers. The Citi Foundation supported this effort to help educate the field of Community Development Finance about the financial needs and complexity of community health centers to promote financing to these vital community resources in a way that improves financial outcomes for low-income residents.  

Key findings are illustrated in our infographic.

The complete resource document with detailed financial and operational metrics and trends is available at The findings were also published as part of the special report series of the Center for Community Investments, Federal Reserve Bank of San Francisco, available at

Tuesday, February 11, 2014

Health Center Funding Opportunity: Patient Centered Medical Home Facility Improvement Grant

Early last week, the Health Resources and Services Administration (HRSA) announced that it is accepting applications for the Patient Centered Medical Home (PCMH) Facility Improvement (P-FI) Grant Program, as authorized by the Affordable Care Act. This grant program addresses the facility modifications needed to improve or enhance a health center’s capacity to deliver care using the PCMH model. 
HRSA anticipates awarding approximately $35 million in fiscal year 2014 through competitive one-time capital development awards to 150-175 existing section 330 health centers for a two-year project period. Applications are due March 14, 2014. 
Successful applicants must address PCMH-related capital needs at an active service delivery site and demonstrate:
  • how the existing facility directly poses a barrier to improving or enhancing service delivery using the PCMH model of care;
  • how the proposed project will respond to the current facility barriers;
  • how the project will create immediate and tangible benefits upon completion; and
  • how the health center has the appropriate knowledge, resources, and capabilities to successfully complete the proposed project.

For a complete description of this grant opportunity and the eligibility requirements, you can access the funding announcement here.   
HRSA will be conducting a call to provide detailed information about the P-FI grant opportunity and answer specific questions about application requirements. Participation information is as follows:
HRSA P-FI Briefing Session
Tuesday, February 18 from 3:00-4:30 p.m. ET
Dial-in number: 1-888-950-5921
Participant passcode: 8957252

Friday, February 7, 2014

Behavioral Health Integration Grant Opportunity for Health Centers

The Health Resources and Services Administration (HRSA) is currently soliciting applications for the FY 2014 Mental Health Service Expansion-Behavioral Health Integration (BHI) funding opportunity. This is a competitive grant process with $50 million available for approximately 200 health centers, with awards of up to $250,000. Applications are due March 3, 2014.

According to the announcement, the goal of the fiscal year (FY) 2014 BHI funding is to increase the coordination, collaboration, and integration of primary and behavioral health care services at existing health centers funded under Section 330. Specifically, this funding opportunity will increase access to behavioral health services, and increase the number of health centers with integrated primary care and behavioral health models of care. For the purpose of this funding opportunity, behavioral health includes both substance use and mental health disorders.

Applicants must demonstrate a high level of need for behavioral health services in their community/target population, a sound proposal to meet this need, and readiness to rapidly implement the proposal. In addition, applicants must show that BHI grant funds will increase access to comprehensive, culturally competent, collaborative, and integrated behavioral health services. Applicants are expected to explain how services will be made available to all individuals in the service area while maximizing collaboration with existing behavioral health providers in the community.

Click here for more details about this opportunity including the funding announcement, information on how to apply, and frequently asked questions.

HRSA will be conducting a call this Monday to provide detailed information about the BHI grant and answer specific questions about application requirements. Participation information is as follows:

HRSA BHI Grantee Briefing Session

Monday, February 10 from 3:00-4:30 p.m. ET

Click here to access the call

Dial-in number: 1-888-949-2798

Participant passcode: 78893

Monday, January 13, 2014

Capital Link to Provide Training for CDFIs to Advance Lending to Health Centers

Community health centers constitute the largest network of primary care providers in the United States, serving more than 22 million patients at almost 9,200 sites across the country. As a result of the Affordable Care Act (ACA), health centers are poised to grow to serve 30 to 40 million patients on an annual basis over the next several years.

With many of the provisions of the ACA going into effect in 2014, health centers need to expand their operations now in order to provide their comprehensive model of care to a growing patient base. Community Development Financial Institutions (CDFIs) are stepping forward to help by participating in a new Capacity Building Initiative supported by the U.S. Dept. of the Treasury’s CDFI Fund.

Through this effort, CDFIs will develop the skills to successfully finance community health centers in medically underserved markets. The Opportunity Finance Network (OFN) partnered with leading industry experts—Capital Link, Primary Care Development Corporation, and Capital Impact Partners—to develop a new training and technical assistance program for CDFIs.

Foundations in Financing CHCs Trainings

Six, free two-day training workshops will be offered to provide CDFIs with a comprehensive overview of the CHC landscape and how CDFIs can provide financial services to CHCs. The Foundations training workshops will be held from January through June 2014. See a list of the trainings here. CDFIs can apply to attend here.

Technical Assistance

Comprehensive individual and group technical assistance will be available to CDFIs that attend one of the Foundations trainings. There will also be a schedule of technical assistance webinars open to everyone.

Advanced Financing CHC Forum

In addition, OFN and the National Association of Community Health Centers (NACHC) are co-convening an Advanced Forum on financing CHCs that brings together CDFIs and other stakeholders to share best practices and to interpret the fluid CHC operating environment. This network of CDFIs with experience lending to CHCs is meeting regularly in person and by phone to evaluate innovations and provide up-to-date analysis of the rapidly evolving health care environment. Capital Link is pleased to be involved in this initiative. Visit our website at for more information.