North Country Healthcare Profile

Every so often at Healthcare Weekly, we highlight some influential industry players, putting their contributions to the healthcare sector at the center of our coverage. Today, we are cover North Country Healthcare, a small nonprofit health care organization based in Flagstaff, Arizona.

North Country HealthCare at a glance

Company Name: North Country HealthCare, Inc.

Year Founded: 1991

Location: Headquartered at 2920 N. 4th Street, Flagstaff, AZ 86004, with more than 14 locations in and around northern Arizona.

What They Do: North Country HealthCare, Inc. extends a broad range of high-quality, comprehensive, and affordable medical services, including dental care, physical therapy, behavioral health, pharmacy, family medicine, telemedicine, obstetrics & gynecology, chronic disease management.  The largest part of the practice is primary care to communities across northern Arizona.

Website: www.northcountryhealthcare.org

Company History

North Country HealthCare, Inc. traces its history back to 1991 when a clutch of local nurses, doctors, and other well-wishers alarmed by an influx of uninsured patients seeking ER care established the Flagstaff Community Free Clinic. The founders of the clinic noted that most of these people had no primary care physician and were predominantly from either rural or underserved communities in northern Arizona.

The non-profit healthcare institution also has some deep historical connections to the Northern Arizona Area Health Education Center (NAHEC) which was founded in 1987. The two organizations, Flagstaff Community Free Clinic and NAHEC merged to form North Country Healthcare (NCHC) in 1996, transforming the clinic from a volunteer-based facility into a federally- and state-funded community health center.

Over the years, NCHC has expanded from a single-location health center in Flagstaff to a multi-location 501(c)(3) non-profit organization with over 20 clinics and medical access points in more than 14 communities across northern Arizona.

After years of framing a Family Practice Residency Program, North Country HealthCare was granted approval by the Accreditation Council for Graduate Medical Education (ACGME) in October 2017. This allowed the health center to offer a highly versatile family care residency program beginning in July 2019.

The Current State of North Country HealthCare, Inc.

North Country HealthCare is currently a registered 501(c)3 non-profit that operates as an independent, federally qualified community health (FQHC) system with the following core mission: “to provide affordable, accessible, quality primary care in an atmosphere of dignity and respect where the health and well-being of patients and community are promoted through direct services, education, outreach, and advocacy.”

As part of its long-standing vision, the organization is focused on cultivating healthier communities by acting as the primary care facility of choice for people in the region, especially the uninsured and those without a primary care provider. At the moment, the system encompasses over 20 clinics and clinical access points across northern Arizona.

Currently, the healthcare company runs 14 locations, including two in its home community of Flagstaff, as well as Ash Fork, Bullhead City, Grand Canyon, Holbrook, Kingman, Lake Havasu City, Payson, Round Valley, Seligman, Show Low, Williams, and Winslow. Together, these health clinics receive well over 150,000 visits daily.

Like most non-profit organizations, North Country HealthCare, Inc. has numerous revenue streams, more than half (or, 53.7 percent to be precise) of which is patient revenue. Grants (~28%) and pharmacy sales (16%) are two other major income sources. In total, the company brings in about $51.5m, according to their Form 990 for FY 2018 – 2019.

Reimbursements from Arizona Health Care Cost Containment System (AHCCCS, Arizona’s Medicaid Agency) and Medicare account for nearly half (49%). The rest is derived from commercial payers (37%) and sliding scale fees from uninsured patients (14%).

The organization is structured so that every unit in the North Country HealthCare system is multifaceted, offering a diverse choice of medical services within the same facility. While primary health care is at the core of the organization’s business format, they also provide:

Acupuncture services: NCHC offers acupuncture at its largest health center, on 4th Street in Flagstaff. Its crew of licensed and qualified acupuncturists uses integrated therapies to treat a variety of conditions, from insomnia and back pain to anxiety and headaches.

Dental care: Dental services are offered to people of all ages at North Country’s Winslow, Flagstaff- 4th Street, and Ash Fork agencies. Their licensed dental professionals provide restorative care (e.g., bridges, fillings, crowns, etc.) and preventive services, (e.g., fluoride treatments, x-rays, cleanings, and oral exams.

Pediatric care: North Country hires board-certified pediatric experts with over three decades of combined experience to take care of children of all ages, from infants to adolescents. Pediatric services are varied and available in all 14 locations.  They include: well-child exams, lactation support, newborn through adolescent care, immunizations, and management of chronic conditions ranging from obesity and ADHD to asthma and allergies.

Behavioral Health: Counselors offer ongoing and short-term behavioral health counseling in-person and via telemedicine to both families and individuals. Counseling is available for depression, anxiety, smoking cessation, addiction, and stress.

Family medicine: Family-oriented services include long-term care for chronic conditions such as diabetes, as well as disease diagnosis, treatment, and prevention.  Patients have access to nurses, medical assistants, physician assistants, nurse practitioners, and doctors. Patients can choose a primary family doctor and preferred location from a choice of 14 clinics throughout Arizona.

Telemedicine: Having boomed in the last few years, telemedicine has become part and parcel of the North Country Healthcare portfolio. Telemedicine solutions include digital stethoscopes, multi-way video conferencing, and super-tech cameras.

Pain management, behavioral health, Hepatitis C & HIV/AIDS management, and primary care are some of the services that have been partially shipped to the telemedicine platform. NCHC is partners with American Telemedicine Association, Southwest Regional Telehealth Resource Center, and the Arizona Telemedicine Program to ramp up their telemedicine offerings.

Pharmacy: NCHC offers on-site pharmacy services at the Grand Canyon, Kingman, and Flagstaff locations. By request, a pharmacist can be part of the patient-clinician consultation. Pharmaceuticals can be shipped from one of the several in-network and affiliated pharmacies to a location nearer to the patient.

Women’s Health Care: NCHC boasts board-certified nurse-midwives and OB-GYNs who offer tailored and comprehensive women’s care and health programs such as hormone balancing, birth control methods, delivery care, labor care, prenatal care, well-woman exams, and much more.

Physiotherapy: Grand Canyon and Williams locations provide patients with comprehensive physical therapy by physiotherapists who work in conjunction with primary healthcare providers.

North Country HealthCare is also pushing multiple community-focused programs and initiatives. For example, for the past several years, their nutritionists and clinicians have run the seven-week Eating for Life Nutrition Workshop for people with chronic lifestyle conditions such as high cholesterol, diabetes, high blood pressure, and obesity. Those who are at a higher risk of developing these conditions, but who have not yet been diagnosed, are also welcome.

The Well Woman HealthCheck, is a wonderful initiative tailored to underinsured, uninsured, and low-income women to help them get free access to cervical and breast cancer screening. It also integrates diagnostic services such as pelvic exams, HPV & Pap tests, mammograms, and clinical breast exams.

North Country HealthCare’s Radiation Exposure Screening & Education Program (RESEP) has recently put the nonprofit on the map. Arizona’s only RESEP initiative, it offers early detection diagnostics and treatment of cancer and a variety of other complications linked to exposure to uranium radiation at no cost to the patient. The program is especially focused on people who were affected by the Nevada nuclear test site radioactivity during the ‘50s through the early ‘60s.

Other community initiatives championed by North Country HealthCare include Girls on the Run (a 10-week program for third graders through eighth-graders); Health Partners; HealthStart (designed for new moms & expectant women); HealthySteps (geared towards parents who want to bring up healthy, responsible kids).

In the education arena, the company is advancing several educational and research initiatives that include:

• Community Health Education
• Health Professionals Continuing Medical Education
• Health Professional Student Education & Training
• Medical Education at A.T. Still University of Health Sciences Campus
• Residency
• Pharmacy Residency Program
• Youth Academic Preparedness, College Readiness & Health Professions Exploration

North Country HealthCare, Inc. has a three-tiered organizational system. The first leadership tier is the policy-making Board of Directors, of which at least 50 percent must be patients.

As of writing, Aaron Secakuku is the President and the head of the Board of Directors which include: Cheryl Blume (Former President), Chris Fetzer (NACOG’s current Executive Director), David Chavez (Secretary), Denise Burley (Director of Mohave County Department of Public Health), and George Glen.

Anne Newland, MD, MPH, has been the CEO of North Country HealthCare since she joined the organization in 2013 from Indian Health Service on the Navajo Reservation. She represents the second tier of the organizational structure by answering directly to the Board of Directors.

The third tier is the management team steered by the CEO. Together, the combined team members are responsible for daily activities at the organization. Gregory Kuzma is the current CFO, a position he assumed in 2014 after serving in various posts since joining NCHC in 1992.

The title of Chief Information Officer is currently occupied by Flagstaff native and long-time member of the US Marine Corp, Jon Smith. Marti Neff is NCHC’s COO, and April Alvarez-Corona is the Chief Medical Officer.

The management team includes directors of various departments: Amanda Guay (Community Health Programs & Services), Bruce Wilcox (Dental Services), Marica Martinic (Northern Arizona Area Health Education Center), Ed Paul (Family Medicine Residency Program), David Bianco (HR), Tammy Howell (Marketing), and Kim Chen (Pharmacy).

Where North Country HealthCare Has Made Headlines

As a primary community health care provider for more than 55,000 residents throughout northern Arizona, North Country HealthCare is bound to make it into the news headlines from time to time. Here we feature four prominent news stories that have involved the organization within the last few years.

North Country HealthCare launches virtual visits to support patients with flu-like symptoms during the COVID-19 crisis

In mid-April, North Country HealthCare launched virtual appointments especially for patients having flu-like symptoms. Patients are urged to self-evaluate what they’re experiencing via an online symptom checker tool embedded in the official website. Once done, the patient can choose to make a quick 15-minute virtual visit with a selected healthcare provider through the hotline number provided.

According to the nonprofit’s officials, this easy and hassle-free process will ensure no-contact consultations to protect frontline providers while helping patients get access to proper medical care and advice. As with most telehealth technologies and solutions during this pandemic, NCHC’s virtual visits will be billed like any other conventional in-person appointment.

This isn’t the first time North Country Healthcare is getting its feet wet in the world of telemedicine. Before the COVID-19 pandemic hit, patients could readily complete virtual Zoom appointments for behavioral health, routine follow-up, RX refills, test/lab results, illness evaluation, chronic pain assessment, and chronic condition management (including asthma, high blood pressure, diabetes, etc.)

Arizona senators set aside $750,000 for North Country HealthCare in its budget for 2019/2020 fiscal year

As first reported by Arizona Daily Sun, state senators have agreed to fund the recently approved family medicine residency program at North Country HealthCare to the tune of $750,000. The money was earmarked in the state budget for 2019/2020.

The inaugural class will commence their residency program as soon as July 2020 in rotation across several NCHC locations in Apache, Navajo, Mohave, and Coconino counties, as well as rural regions such as Whiteriver, Polacca, and Tuba City.

North Country HealthCare helps Flagstaff Shelter Services after 20+ people test positive for COVID-19

At the end of the first week of May, NCHC’s partner Flagstaff Shelter Services was hit by an outbreak of COVID-19. After conducting several tests in conjunction with North Country HealthCare officials, the facility reported that no fewer than 20 individuals, including 2 staff members, had tested positive for the novel coronavirus.

Most of those who tested positive were asymptomatic, which prompted the two organizations to transfer residents from the shelter into local hotels willing to accept them. This was a bold attempt to implement more aggressive social distancing measures. The rest of the clients were moved into hotels on May 12.

Arizona senior lawmaker Kyrsten Sinema secures a federal grant worth $5.4m for North Country Healthcare

Arizona long-time Senator Kyrsten Sinema announced in mid-January 2020 that she had secured $5.4 million in federal grants from the U.S. Health Resources and Services. The grant money would help establish the new family medicine residency program at the community health center in northern Arizona.

Earlier in May 2019, the outspoken senator wrote a letter in support of the grant application by the NCHC to raise funds for a dental facility that would serve the communities in Show Low and vicinity.

The newly approved grant is a result of ongoing efforts by Senator Sinema to convince the USHRS of the great work being done by North Country HealthCare for communities in northern Arizona. After visiting the main health center in Flagstaff, she noted numerous opportunities and challenges being faced by the patients and healthcare professionals in the region.

Where North Country HealthCare Is Going

With over 20 clinics and clinical access points, plus strong leadership and technical teams, the future of North Country HealthCare is brighter than ever. This is in part thanks to its solid reputation, which is clearly reflected by the number of grants and collaborations it has secured in the past two or so years.

In the wake of the COVID-19 pandemic, for example, the nonprofit organization has received an overwhelming number of donations for everything from hand sanitizers and isopropyl alcohol to toilet rolls and masks/PPEs. The donors include local breweries like Grand Canyon Brewing & Distillery and Lumberyard Brewing Company, as well as personal connections, grocery stores, radio broadcasters, El Capitan Fresh Mexican Grill, ChemStation of Arizona, and more.

On its part, North Country HealthCare officials want to push patients to continue seeking important preventive evaluations and screenings. One specific type of screening being championed by the NCHC’s CEO, Dr. Anne Newland, is the fecal immunochemical test (FIT). This is a crucial at-home test that helps detect colon cancer in its early stages.

Recent grants include $5.4 million from the Health Resources and Services Administration’s Teaching Health Center Graduate Medical Education (THCGME) Program for its family medicine residency program and another $35,000 from Delta Dental of Arizona Foundation.

North Country HealthCare has several educational programs and initiatives through its Northern Arizona Area Health Education Center, and K-12 programs like Future Health Leaders, Girls on the Run, In-A-Box, and JUMP, a collaboration with Northern Arizona University.

Looking into the future, NCHC will likely see more patients, especially the under-insured and uninsured, walk through their doors in all locations in the aftermath of the COVID-19 pandemic.

As more people continue to lose their jobs or fall behind in their policy payments, the number of uninsured patients in northern Arizona will probably rise. And the vast majority will turn to community health centers such as those in the North Country HealthCare system.

Three Big Questions for North Country HealthCare

1- How would an overhaul of Medicare or the healthcare system impact North Country HealthCare?

The community health centers that make up the North Country HealthCare business play a crucial role in care delivery to high-need communities across northern Arizona. There’s no doubt about that, which is why they received more funding through the Affordable Care Act (ACA) to extend their capacity.

Before ACA was passed, at least two out of every 5 patients served at community health centers (CHCs) were either uninsured or underinsured. Thankfully, the Affordable Care Act expanded Medicaid coverage in 2014, reducing the proportion of uninsured patients walking into CHCs from around 38% to 22%.

Meanwhile, patients under 65 covered by Medicaid spiked to approximately 45% from 34%. That has always been sweet music to the ears of the NCHC management team and the Board of Governors.

What happens if the ACA or Medicare is overhauled?

If the ACA is scrapped altogether as some lawmakers have suggested, it would be devastating for millions of Americans, including high-need communities in northern Arizona. By extension, North Country HealthCare will see a drastic decline in federal and state funding.

This would be particularly disparaging because charity care among private hospitals, clinics, and private practitioners has been dwindling over the years. That means the uninsured and underinsured will likely have fewer options for primary care, and therefore flock to community health centers in huge numbers.

2- How equipped is North Country HealthCare to handle any big-picture technological shifts that impact their business?

North Country HealthCare has shown forward-thinking leadership and willingness to embrace new technology to improve care delivery and access. More specifically, the organization has launched a robust Telemedicine Program that allows patients in rural and isolated communities in northern Arizona to seek virtual appointments with physicians, community health educators, and other clinicians.

With virtual visits covering a myriad of services – from behavioral health to pharmacy, the nonprofit has demonstrated its readiness to handle any massive technological shifts. This has been apparent during the COVID-19 pandemic, in which virtual appointments have been instrumental in facilitating no-touch health care and social distancing.

3- What are the next best opportunities for growth for the company?

As a federally qualified health care system, North Country HealthCare depends heavily on state and federal funding through Medicaid and Medicare. As such, the room for improvement in terms of revenue rests almost squarely on donor funding.

The nonprofit runs 20+ clinics, but only a few offer the full range of services under NCHC’s portfolio. Perhaps this presents significant opportunities for growth. For instance, Ash Fork, Holbrook, Payson, and Winslow locations may benefit from offering on-site pharmacy services, while others may stand to bring in more revenue by adding dental care to their service list.

Conclusion

Focusing initially on primary care, before expanding across a range of medical care services such as behavioral health, family medicine, OB-GYN, dental, and chronic disease management, North Country HealthCare is a federally qualified system and a healthcare pillar in northern Arizona. With credible public support and a strong reputation, it will continue to expand its medical services and build healthier communities.

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