Greater New Bedford Community Health Center BPCHC Condition of Participation

Board Composition

Consumer Board Members

The Greater New Bedford Community Health Center (GNBCHC) governing board is comprised of individuals who volunteer their time and energy to create a fiscally and managerially strong organization for the purpose of improving the health status to the Greater New Bedford community. A majority of the members of the board must be people who are served by the health center and who as a group, represent the individuals being served.

Since the intent is for consumer board members to give substantive input into the health center's strategic direction and policy, these members should utilize the health center. A consumer member should have used the health center services within the last two years. A legal guardian of a consumer who is a dependent child or adult, or a legal sponsor of an immigrant, may also be considered a consumer for purposes of board representation

Other

Since the GNBCHC is a complex organization working in dynamic environments, the board should be comprised of members with a broad range of skills and expertise. Finance, legal affairs, business, health, managed care, social services, labor relations and government are some examples of the areas of expertise needed by the board to fulfill its responsibilities. The health center strives for diversity of expertise and perspective among their board members.

Number of Members

The number of board members must be specified in the bylaws of the organization. The bylaws may define a specific number or provide a limited range if there are reasons for not maintaining a specific number of members. The size should be related to the complexity of the organization and the diversity of the community served.

Regulations for community health centers specify boards must have at least 9 and no more than 25 members. These size parameters are designed to ensure a large enough board to achieve diverse representation across the consumer groups and expertise while maintaining a size that effectively functions and makes decisions.

Selection of Board Members

The organization's bylaws or other internal governing rules must specify the process for board member selection. The bylaws should specify the number of terms a member may serve and provide for regular election of officers and periodic changes in board leadership.

Conflict of Interest

The GNBCHC prohibits conflict of interest or the appearance of conflict of interest by board members, employees, consultants and those who furnish goods or services to the health center. No board members shall be an employee of the health center or an immediate family member of an employee. The Chief Executive serves as ex-officio member of the board.

Governing Board Functions and Responsibilities

The governing board of the health center provides leadership and guidance in support of the health center's mission. The board is legally responsible for ensuring that the health center is operating in accordance with applicable federal, state and local laws and regulations and is financially viable. Day-to-day leadership and management responsibility rests with staff under the direction of the chief executive and designees.

Responsibilities

A governing board is responsible for assuring that the health center survives in its marketplace while it pursues its mission. This is a massive challenge in an extremely dynamic health care environment which is placing increasing financial and service delivery pressures on all providers. Boards must be knowledgeable about marketplace trends and be willing to adapt their policies and position to reflect these trends. In addition to approving annual grant applications, plans, and budgets, boards should work with health center management and community leaders to actively engage in long-term strategic planning to position the health center for the future.

Success is dependent on the health center's ability to effectively adapt to marketplace trends while remaining financially viable. Boards must not only plan effectively but also measure and evaluate the health center's progress in meeting its annual and long-term programmatic and financial goals. The health center's mission, goals, and plans should be revised as appropriate to the feedback gained through the evaluation process. The governing board must select the services provided by the health center. While certain services are mandated by law, health center boards have a great deal of latitude in deciding which additional services should be offered by the health center and whether the services should be offered directly or through referral and collaboration with other service providers. Resources are always limited and a major challenge confronting health center boards is deciding which services should be supported with available resources. Effective needs assessment and planning processes are essential for making informed decisions about service configuration.

The governing board must determine the hours during which services are provided at health center. The health centers is expected to schedule hours that are appropriate for the community. Generally this means some early morning, evening and/or weekend hours should be offered to accommodate people who cannot easily access services during normal business hours.

The board must approve the annual budget and grant application. The intent is not that the board simply sign-off on documents but that it understands the substance and implications of the budget and application. Ensuring the financial health of the organization and aligning the goals of the project application with the strategic direction of the health center are critical functions for the board. In order to effectively fulfill these functions, the board must be involved in health center planning throughout the year.

The board must approve the selection and dismissal of the chief executive. Because the chief executive is the primary connection between board established policy and health center operations, the board must evaluate the performance of the chief executive and hold him or her accountable for the performance of the health center. Together, the board, the chief executive and other members of the management team comprise the leadership for the health center. To succeed, they must work together to ensure a strong organization and move forward into the future.

Except in the case of public entities funded under section 330(e), the board must establish general policies for the health center. These include personnel, health care, fiscal, and quality assurance/improvement policies. These policies provide the framework under which health center staff conduct the day-to-day operations of the organization.

Board Meetings

The health center governing board must meet at least monthly.

The board must keep minutes of each meeting which are approved at a subsequent meeting. The board should also maintain a systematic tracking system of approval/disapproval of board policies and procedures as well as other records to verify and document its functioning.

Board training and development

It is expected that governing board members have sufficient knowledge and information to make informed decisions about the health center's strategic direction, policies and financial position. Board members should be provided with opportunities for training and development, as well as conducting self evaluations. The board is responsible for identifying and assuring it meets its educational and training needs including orientation and training of new board members.

Committees

The board should have a committee structure which facilitates carrying out its responsibilities. Appropriate committees include executive, finance, quality improvement, personnel, audit and planning. However, only the executive committee is authorized to act for the Board.

Affiliations

In some organizational affiliations, the selection, composition and/or responsibilities of the health center governing board may be altered. This may happen through formation of a new board for an integrated delivery system or through the participation of affiliate representatives on health center boards. There may also be various arrangements where a portion of the scope of the project is being provided by an entity other than the grantee. With any such arrangement the governing board must retain its full authorities, meet selection and compositional requirements and exercise all responsibilities and functions prescribed in legislation and regulations.

Collaboration and Affiliation

Health centers must collaborate appropriately with other health care and social service providers in the area. Such collaboration is critical to ensuring the effective use of limited health center resources, providing a comprehensive array of services for clients, and gaining access to critical assistance and support (e.g. housing, food, jobs). In many instances, health centers may consider more formal affiliation opportunities such as contractual relationships, certain types of joint ventures or mergers. Affiliations are desirable when they lead to integrated systems of care which strengthen the safety net for underserved clients.

Health centers may join other organizations such as other health centers, hospitals, specialty groups and social service providers to form integrated delivery systems. An integrated system may be formed through contractual relationships or memoranda of agreement. In these situations, each partner in the affiliation retains its organizational autonomy and integrity and the health center governing board continues to meet expectations.

In other situations, a new organization may be formed.

While health centers are encouraged to collaborate with other entities, they must ensure that all the laws, regulations and expectations regarding the health center governing board member selection, composition, functions and responsibilities are protected if the health center wants to retain eligibility for federal funding. The resulting delivery system must contribute to the desired outcomes of availability, accessibility, quality, comprehensiveness, and coordination.

Cost-effectiveness/cost-competitiveness

Many decisions in the health care arena are driven by economic considerations, and it is imperative that health centers strive to be cost-competitive. All health centers must be as efficient as possible, understand the costs of the services they provide, and bring costs in line with other providers in the marketplace providing comparable services. Health centers should be able to document the value, i.e., cost and quality, of the services they provide and demonstrate the impact of their services on the health and well-being of the communities they serve.

As part of becoming cost effective, health centers are expected to evaluate their management and delivery systems in order to be able to increase efficiency and to maintain operations in the competitive, cost conscious marketplace. Health centers need to manage the care of their patients in accordance with their pay for performance care arrangements and be able to monitor opportunity costs related to contracting requirements.

. The resulting delivery system must contribute to the desired outcomes of availability, accessibility, quality, comprehensiveness, and coordination.

c. Cost-effectiveness/cost-competitiveness

Many decisions in the health care arena are being driven by economic considerations, and it is imperative that health centers strive to be cost-competitive. All health centers must be as efficient as possible, understand the costs of the services they provide, and bring costs in line with other providers in the marketplace providing comparable services. Health centers should be able to document the value, i.e., cost and quality, of the services they provide and demonstrate the impact of their services on the health and well-being of the communities they serve.

As part of becoming cost effective, health centers are expected to evaluate their management and delivery systems in order to be able to increase efficiency and to maintain operations in the competitive, cost conscious marketplace. Health centers will need to manage the care of their patients in accordance with their managed care risk arrangements and be able to monitor their financial risk related to managed care contracting requirements.