by CEO Amy Behnke

Good morning and welcome to the Health Center Association of Nebraska 2021 Virtual Conference. I am Amy Behnke and I have had the honor of serving as HCAN’s CEO for the past six years. For those of you who may be new to your role, HCAN is Nebraska’s Primary Care Association and we conduct training, individualized technical assistance, and advocacy work for the seven health centers in our state. We are here to support you!

This year marks HCAN’s 10th Anniversary. Ten years ago, the health center patient population in Nebraska totaled just over 63,000. In 2020, that number was over 107,000. Since 2011, the health center footprint has grown to 7 health centers and over 70 service locations. Outreach and enrollment staff have educated nearly 500,000 Nebraskans on Marketplace and Medicaid coverage. You’ve expanded dental and behavioral health services, adopted telehealth, and brought health care directly to patients via mobile units. You employ over 1,000 Nebraskans and save the overall health care system $180 million a year. Nebraska health centers comprise one of the largest systems of primary health care in our state and deliver the highest quality health care among all health centers in the country. What you do is simply unrivaled.

As the COVID vaccine has become more readily available, you have once again answered the call; vaccinating nearly 50,000 Nebraskans, 68% of whom are of a racial or ethnic minority. You’ve taken vaccinations directly to the community and continue to be the trusted source to address vaccine hesitancy and misinformation.

And while COVID-19 is still with us for the foreseeable future, as you start to think about your work outside of COVID, we hope the lineup of speakers and exhibitors we have curated for you both reenergize you and spark new ideas.  Thank you for the gift of your time over the next two days and please don’t hesitate to let any member of the HCAN team know how we can continue to be of support.

Ten years ago we could have hardly imagined what would be endured by our patients, their families, and the health center family over the last 18 months. COVID-19 served as a stark reminder that there is a chasm when it comes to equitable access to health care in this country. The very foundation of this health center movement is rooted in civil rights and justice. And as we celebrate Pride month, recognize the 100th anniversary of the Tulsa Massacre, and are just days away from Juneteenth, we know there is work yet to do.

As we move through 2021, Nebraska health centers will continue to serve their patients with compassion and a commitment to equitable access to health care for all.



Alzheimer’s disease and dementia is a public health crisis which is only growing.

The Alzheimer’s Association annual Fact and Figures report was recently released and more than 6 million Americans are living with Alzheimer’s disease and by 2050, that number may grow to more than 12 million.

In Nebraska, there are currently 35,000 people living with the disease.

Alzheimer’s disease impacts more than just the person living with disease. In Nebraska, there are more than 61,000 family members and friends who provide unpaid care to a loved one with Alzheimer’s or other dementia. Women account for almost 60% of caregivers for those afflicted by Alzheimer’s disease. This impacts their long-term health and many times, their financial health. Nearly 19 percent of women Alzheimer’s caregivers had to leave the workforce either to become a caregiver or because their caregiving duties became too burdensome.

In addition, this year a special report, Race, Ethnicity and Alzheimer’s in America was included with Fact and Figures. It examines the perspectives and experiences of Asian, Black, Hispanic, Native and White Americans in regard to Alzheimer’s and dementia care. The report also examines the devastating impact the COVID-19 pandemic is having on people living with Alzheimer’s and their caregivers.

Some highlights from the report include:

  • Health and socioeconomic disparities and systemic racism contribute to increased Alzheimer’s and dementia risk in communities of color. According to the report, older Blacks and Hispanics are disproportionately more likely to have Alzheimer’s and other dementias. In addition, both groups are more likely to have missed diagnoses than older Whites.
  • Two-thirds of Black Americans (66%) believe it is harder for them to get excellent care for Alzheimer’s disease or other dementias. Likewise, 2 in 5 Native Americans (40%) and Hispanic Americans (39%) believe their own race or ethnicity makes it harder to get care, as do one-third of Asian Americans (34%).

However, there are ways we can make a difference.

The Alzheimer’s Association exists to eliminate Alzheimer’s disease and other dementias through the advancement of research; to provide and enhance care and support for all those impacted on the Alzheimer’s journey; and to reduce the risk of dementia through the promotion of brain health.

What can you do?

For providers, the Association has tools and training to learn more about diagnosis and care planning. The no-cost Approaching Alzheimer’s training is a great place to start.

The Alzheimer’s Association also offers a variety of support services – some available 24/7!  The first and most important service we provide is a 24 hour/7 days a week, 365 days a year helpline.  Master’s level clinicians are available to answer any questions you may have and offer support services to those affected by Alzheimer’s and their caregivers. The number is 1-800-272-3900.

In addition, we offer a variety of educational programs that are available anytime online at as well as live Zoom sessions. Topics include warning signs, responding to behaviors, how to reduce your risk for dementia and more.  We also offer support groups for caregivers as they navigate the sometimes difficult waters of caring for someone living with Alzheimer’s. Other support services are available at

Want to make sure you know the warning signs of Alzheimer’s?

Join us for The 10 Warning Signs on April 26th at 10:00 am CST for a FREE live session.

One of our most important roles is raising awareness and increasing knowledge of Alzheimer’s and dementia. The more people understand about Alzheimer’s and dementia, the more likely they will take action when there are signs and symptoms and we can work to break the stigma associated with this disease.

written by Julie Chytil


Julie Chytil | Director of Programs
Alzheimer’s Association, Nebraska Chapter

24/7 Helpline: 800.272.3900 |





Written by: Mutual of America Financial Group

A leading provider of investment and retirement services, Mutual of America Financial Group is no stranger to Nebraska. The Company opened its Omaha office a year ago, and as a result, growing closer to the local community has gone hand in hand with increasing our exposure to causes that are important to the organizations we serve—including healthcare.

The idea of actively promoting the welfare of others is close to our heart. Mutual of America Financial Group (then known as the National Health & Welfare Retirement Association) was founded on October 1, 1945, by an exceptional group of leaders who were dedicated to supporting the nonprofit sector and believed that every worker deserves a financially secure and dignified retirement. Integrity, prudence and reliability are the values that have guided us since our inception and that continue to serve us well.

In 2019, Mutual of America invested in new and innovative capabilities to accelerate our growth in the retirement savings and investments markets that promise to be even more dynamic in the years ahead. This included investments in advanced technologies, such as the implementation of Salesforce’s customer relationship management system and the introduction of our Payroll Integration service, which will enhance the customer experience while providing new ways to streamline our business processes through artificial-intelligence-driven data analytics. We also partnered with FIS—a global leader in retirement technology solutions—to integrate their leading-edge, online OMNI recordkeeping platform solution into our operations.

Our future will include a new array of products and services, such as providing 403(b) and 401(k) Thrift plans through a mutual fund trust platform, as well as investment advice and wealth management services, and guaranteed income streams for those already retired. “Since our founding, we have been dedicated to helping our customers stay focused on achieving their retirement and investment goals,” said John R. Greed, Mutual of America Chairman, President and Chief Executive Officer. “This commitment helps us make an even more meaningful impact in the communities where we all live and work.”

We are readily available to provide plan sponsors with the tools they need to review the retirement plans they offer their employees. As always, participant education is paramount for Mutual of America. Through one-on-one attention and tailored service from our representatives, we aim to engage employees, help them better understand their benefits and make smart financial decisions. The quality of our investment offerings, outstanding personal service and history of financial strength is evident in client feedback.

Please don’t hesitate to reach out:

Justin Grimm
Regional Manager

Field Consulting Services
Aksarben Village

2111 South 67th Street

Suite 300

Omaha, NE 68106
w: 402.378.7280

For more information, visit


Submitted by

Jennifer A. Collins, PhD, F-ABFT
VP Operations/Discipline Director Forensic Toxicology—LabCorp

What Was
As most everyone knows, the U.S. is in the midst of an opioid epidemic. In 2017 the Department of Health and Human Services (HHS) declared the opioid epidemic a public health emergency, but the roots of the problem go back much further. The issues began in the late 1990s with changes in the way that chronic pain was treated. Between 1999 and 2012 there was a substantial increase in prescription rates for opioids before it became clear that these medications could be highly addictive and dangerous. Along with this increase in prescription rates came dramatic increases in opiate overdoses. Between 1999 and 2018 almost 450,000 people died from overdoses that involved either prescription or illicit opioids. The Centers for Disease Control and Prevention (CDC) has characterized the epidemic into three distinct phases.

• The first phase began in the late 1990s and was dominated by prescription opioids that were natural or semi-synthetic such as methadone, hydrocodone, and oxycodone.
• The second phase began around 2010 and was marked by an increase in overdoses involving heroin.
• The third phase began in 2013 where the country saw the impacts from synthetic opioids, especially illicitly manufactured fentanyl.

What Is
Even though the prescription rates are dropping, our communities across the nation are still flooded with opioid prescriptions. The CDC reported that over 168 million opioids were still prescribed in 2018. To complicate matters, we are currently at the crossroads of two separate health crises. The COVID-19 pandemic raises new risks and creates additional challenges for patients with substance use disorder (SUD), and data indicates that drug overdoses are spiking during this new pandemic. In response, Substance Abuse and Mental Health Services Administration (SAMHSA) and the U.S. Drug Enforcement Administration (DEA) have increased flexibility for providing buprenorphine and methadone to patients with opioid use disorder. The CDC has developed a resource page for patients and healthcare providers who are navigating treatment of SUD during the current COVID-19 environment.

Even before the current COVID-19 pandemic, multiple organizations recognized the need to balance the risk and benefits of opioid therapy especially in patients suffering from chronic, painful conditions. In response, Opioid Prescribing Guidelines issued by the CDC and the American Academy of Pain Medicine recommend that healthcare providers perform a benefit-to harm assessment for the individual patient. Several screening tools have been developed to assess patient risk with chronic opioid therapy (COT). For consumers, public service awareness campaigns strive to educate Americans about the risks of opioids and encourage patients to talk to their doctors about opioid alternatives.

What Can Be
Since declaring the opioid epidemic a public health emergency, HHS launched a 5-point strategy to combat the health crisis. At the top of the list is the need to expand access to treatment and recovery services such as Medication Assisted Treatment (MAT). In 2016, at least 2.1 million people were living with an opioid dependency, while only 374,000 individuals sought treatment. There is a significant need to empower more physicians with the ability to provide MAT in order to improve outcomes for opioid-dependent patients. Research has shown that SUD is a chronic condition. Now, more than ever before, programs and policies are being implemented so that SUD can be treated like other chronic conditions.

Medical schools in the United States are beginning to integrate courses covering pain-related incidents and SUD. Major insurance plans are taking leadership roles in promoting and covering holistic and collaborative care of patients with SUD. Technology companies are developing software to connect each part of the care team ecosystem.

Like most large problems, there is no single solution to conquering the opioid crisis. Collaboration among physicians, counselors, laboratories, pharmacies, policy makers, insurance companies, and many others will be required to overcome this crisis. Cultural changes in the way society treats people with substance use disorders will also be necessary. This is perhaps the best news of all—that we can each play a part in reducing the impact of the opioid crisis in our country.

In an effort to address the opioid crisis, LabCorp has developed several test options to help manage Suboxone® MAT for SUD. Click here to learn more. LabCorp also offers a comprehensive test menu to help meet the drug testing and clinical testing needs of different patient populations.

written by: Omaha Integrative Care

These are unprecedented times. Never before have we experienced such a far-reaching event as that of the COVID-19 pandemic. It has changed so many aspects of our lives: Who we see. What we do. Where we work. Where we go. How we interact. Our entire reality has shifted, and it is no wonder that we are all reeling, staggering to catch our footing, wondering why we feel so strange, so rattled. If you, too, are wondering why you’re feeling so “off,” know that there are several processes at play in this, our collective experience.


Stress is a normal and inevitable part of being alive. And like all living things, we humans have developed a natural response to stress that is meant to keep us safe and help us survive. You might know it as “Fight, flight, or freeze.” Over the course of human history, the stressors we face have shifted from evading predators and surviving the elements to juggling packed schedules and tackling unending obligations at work and at home. But while our stressors have changed, our stress response has stayed more or less the same: Fight, flight, or freeze. When the stress response is activated, the body prepares to take action by pumping adrenaline and thereby increasing our heart rate, blood pressure, and respiratory rate. It also diverts energy away from digestion — deemed nonessential in a moment of survival. What this means for us now is that we may be feeling restless, on edge, unable to focus, and may be experiencing digestive problems.

The stress of COVID-19 is also different from our day-to-day stressors in that it is chronic rather than acute. While our everyday stressors are distinct, like specific notes or instruments in a song, the stress of COVID-19 is more like a low and ever-present hum. This puts us in a perpetual state of stress, which can have long lasting negative effects on our minds and bodies.


Whenever we experience a significant change or loss, we experience grief. Consider all the things that have changed or been lost in the wake of COVID-19. Daily interactions with coworkers, friends, even strangers. Celebrations like birthdays, graduations, weddings, baby showers. Handshakes, hugs, and even smiles, which might now be obscured behind masks. We no longer have access to these things in the same way we did before, and we are grieving the loss. Grief takes many forms and might show up as anger, denial, bargaining, or depression, until eventually shifting into acceptance and meaning. Acknowledging this grief can be a first step toward processing it and making peace with all that has changed or been put on hold.


The global experience of COVID-19 is one of collective trauma. The circumstances that we are experiencing — as individuals and as members of the global community — are overwhelming, distressing, and threatening. We are in the midst of a crisis, and our minds and bodies are responding accordingly. Trauma impacts our ability to function in many ways: Cognitively, it can impair our memory, learning, concentration, and decision-making abilities. Emotionally, it can reduce our impulse control and regulation. Physically, it can increase our risk for many ailments, including heart disease, diabetes, and substance abuse. Relationally, it can alter our concepts of ourselves and of others, perhaps viewing ourselves as weak or responsible, or viewing others as dangerous or not to be trusted.


While COVID-19 has increased our stress, elicited grief, and exposed us to collective trauma, it has also impacted our access to resources that normally help us cope: exercising at the gym, attending spiritual or religious services, going out to bars and restaurants, attending concerts or events. (Add these losses to the list of things we are grieving.) Many of us may have noticed that because of this, we are turning to other forms of coping. As humans, we have a limited amount of energy — physical, mental, emotional. When our energy is depleted, we turn to the coping strategies that require the least amount of energy, like snacking, pouring a drink, or retreating into a cozy cocoon of procrastination or avoidance. While these strategies make sense and provide some comfort or relief in the short term, they often are not very effective in the long term. Intentionally cultivating productive coping and regulation strategies can help replenish our stores of physical, emotional, and mental energy. Here are just a few options:

  1. Relaxation: The counterpart to stress is relaxation. We can achieve this through specific relaxation techniques, such as meditation or progressive muscle relaxation, or through enjoyable activities that boost feelings of relaxation, such as reading, crafting, or cooking.
  2. Physical movement: Physical movement helps us release some of our built-up stress energy (the “flight” in “fight, flight, or freeze”). This movement can be as simple as going for a walk or doing gentle stretching.
  3. Seeking support: Our relationships and connections with others have been shown to increase our ability to handle stress. Seeking support can look like reaching out to friends or loved ones (whether in person or virtually). It can also look like talking to a therapist, receiving medical care, or finding a connection to a community, such as a faith group, hobby club, or other organization.


If you are looking for further support, Omaha Integrative Care can provide treatment and care to support your wellness in mind and body. We recognize that our patients are more than just their symptoms, and we strive to approach each person as a unique and complex individual, shaped by the many facets of their lives, relationships, resources, and identities.

We provide primary medical care, integrative mental health therapy, psychiatric medication management, yoga and meditation classes, and body-focused healing modalities, including massage, acupuncture, reiki, and sound bath healing. Our integrative team of providers collaborates to provide patients with the most comprehensive care possible. For more information, visit or call 402-934-1617.

By Dr Laura Leone, DSW, MSSW, LMSW
Integrated Health Consultant for Practice Improvement, National Council for Behavioral Health

Suicide prevention can seem like a daunting undertaking for any health center, but as the number of deaths by suicide keep increasing, it becomes a necessary public health issue to be addressed within primary care. If your health center is overwhelmed with how to proceed, the following eight steps are a framework to give you the guidance on what to do.

  • Step 1: Identify Leadership, Champions and Task Force: It’s important to get many people involved in suicide-prevention efforts, supporting it both from the “bottom up” and from the “top-down.” It is most effective to find staff in several disciplines and roles that are not just from behavioral health, as well as to consider how to include the voice and choice of patients.


  • Step 2: Educate and Inspire Change: When people understand why change, new workflows or asking the hard questions is necessary, they are more likely to engage in doing it, and doing so well. Educate people on suicidality, including national and local statistics; on the various opportunities during work to ask people about suicide; and on ways to intervene when necessary.


  • Step 3: Gauge the Current Organizational Landscape: Understand the baseline metrics around suicide for your organization, such as when people are most “at risk,” how many deaths by suicide, how many suicide attempts, how many safety-planning interventions are used with patient expressing suicidality, etc.


  • Step 4: Practice Improvement: Take education a step further with understanding best practices around suicide inquiry, screening and evidence-based interventions. There are opportunities to assist clients in their outpatient setting rather than them visiting a hospital emergency department.


  • Step 5: Imbed Throughout Organization: Consider how to optimize your electronic health record around suicide-prevention efforts, including the use of decision supports, problem lists, and other features. Effectively communicating around patients who are “at risk” in real time could save a life. Likewise, find multiple ways to discuss suicide prevention efforts with staff, such as at staff meetings and during huddles; creating a continual feedback loop using the data collected.


  • Step 6: Ongoing Mining of Resources and Supports: There are constantly new resources, trainings and support around suicide prevention for both patients and staff. Take the time to periodically check in on what’s new, from organizations such as the National Council for Behavioral Health, Suicide Prevention Resource Center, Zero Suicide, Now Matters Now and more.


  • Step 7: Collaborate with Patients, Community, External Organizations, and Stakeholders: Consider how to best share information and support patients in the community around their suicidality, and to help create opportunities for wellness. Efforts and success will be greater and stronger when people and organizations collaborate, as well as share information and resources.


  • Step 8: Wash, Rinse, then Repeat! Don’t get comfortable in going through these steps once. Instead, run through them again and again to keep your continual quality improvement going for suicide prevention. Continue to use your metrics to gauge improvement opportunities and successes.

Remember that the Health Center Association of Nebraska and the National Council for Behavioral Health are available to provide support around building internal and external capacity for suicide prevention. You can make a difference by preventing deaths by suicides and the negative impact that every death has on the surviving 135+ lives that the person leaves behind.

This promising practice is shared by
Bluestem Health in Lincoln, NE
In July 2018, Bluestem Health applied for the Safety Net Solution In-Kind Dental Program Technical Assistance. This opportunity was first brought to our attention by Jenna Thomsen, Director of Training and Technical Assistance at HCAN. Bluestem Health’s dental clinic was one of ten programs selected to receive this technical assistance. The process included:
  1. Practice Analysis (practice management data survey, key practice data, site visit)
  2. Findings and Discussions (presentation, discussion, strategy)
  3. Improvement Plan (action steps, road map, timelines)
  4. Supported Implementation (coaching, guidance, motivation, accountability)
Beforehand, we were required to submit key practice data. The whole process was run very efficiently. Dr. Russell and Caroline from Dentaquest served as project managers. They came for a site visit and met with dental staff, billing staff, and the leadership team. Bluestem is currently in the ‘Improvement Plan’ stage, with some action steps completed and some in progress. This technical assistance will end February 15th, 2021. The advice that I would give other dental programs considering this process is to apply. We received helpful guidance from Dr. Russell and Caroline and gained access to resources such as templates, advice, reminders, and otherwise. Getting your dental program evaluated from an outside perspective is helpful and can result in a cascading effect of other positive outcomes similar to what Bluestem experienced, such as the HRSA grant and revenue cycle analysis technical assistance from HCAN.
Name something unique about the work completed:
Sometimes we do not think outside the box because we just keep on working and doing the same things over and over again. Bluestem Health Dental clinic was constantly looking to expand the dental program outside the main location thinking that we do not have space for expansion at the main clinic. Dr. Russell revealed to us during the site visit that we can indeed expand here by moving our dental front desk and dental waiting area to the large medical side lobby and build two dental operatories in that space. As soon as the HRSA Oral Health Infrastructure grant came along we were ready to act on this renovation project and were awarded the grant.
List lessons learned:
1. We were not collecting co-pays upfront for restorative visits for commercial insurance patients before the site visit. Now we are collecting all the co-pays upfront for restorative visits.
2. We were offering up to 3 dental appointments per patient which caused lot of back log in our scheduling and increased our no-shows. Per Dr. Russell’s recommendation we started giving only one appointment at a time and once the patient showed up for that appointment we give another one. This unclogged our scheduling and opened up lot of slots for other patients.
3. Staffing issues: We were short staffed at the dental front desk and sterilization. As per Dr. Russel’s recommendations we were able to add these two new positions for this year’s budget.
4. We were seeing too many new patients and were not able to complete their treatment plans in a timely manner. Now we are tracking the treatment plan completing rate.
5. Billing and Revenue cycle analysis weakness were identified at the site visit. We got TA assistance from HCAN to get Coding and Compliance Initiatives, Inc to do Revenue Cycle analysis and give us recommendations on improving our program.
Please list clinical outcomes/results from this project:
1. We got a HRSA grant to add two new dental operatories which was directly related to the recommendations from site visit.
2. Revenue cycle analysis was done from Coding and Compliance Initiative which came about because Jenna from HCAN was present during the final presentation of site visit and offered TA from HCAN.
3. We are tracking Treatment completion rate from the guidelines Dentaquest gave us.
4. We are focusing more on medical-dental integration and prioritizing children, pregnant patients, patients with diabetes, etc
Please list any future plans:
1. Follow Revenue cycle analysis site visit recommendations
2. Medical-dental integration
3. To increase treatment completion rate up to 80%
Submitted by:
Dr. Reddy
Bluestem Health

At this time of year, many of us are looking back at 2019 and looking forward to 2020.  As far as the 340B Program goes, although there was a lot of sabre rattling there were very few changes heading into 2020.

2019 Year in Review

Legislative Activity

Specific to FQHC’s, although 340B was mentioned in numerous pieces of legislation throughout the year no major 340B legislation materialized.  Because drug pricing is such a high priority, the program remains a talking point however the legislative focus has shifted from 340B to the PBM’s

Price compression

One of the biggest threats to 340B was not government related at all but rather the Pharmacy Benefit Industry (PBM) who has seen 340B as a threat to their rebate revenue stream. In late 2018, CVS Caremark, one of the country’s largest PBMs, sent notices to 340B providers and contract pharmacies notifying them of significant reductions in reimbursement rates. In essence they were attempting to recharacterize 340B pharmacy as non-retail pharmacies, which would allow CVS to reimburse these pharmacies at a much lower rate.  After a considerable outcry from a large number of 340B stakeholders and court rulings related to the reduce Medicare payments to 340B Hospitals, CVS Caremark backtracked and announced that it was reversing its decision.

Also, in late 2018, a federal district judge struck down HHS’ proposed cuts of almost 30% to Medicare Part B reimbursements for 340B providers stating CMS overreached its legal authority. This decision, however, was appealed and cuts remain in place.

A final hearing was held on November 8th with a decision expected soon. If the government prevails, we may see Caremark (and other PBM’s) attempt to lower reimbursement for 340B providers.

340B Drug Pricing Website

April 1st, HRSA finally launched its 340B Drug Pricing website, which provides additional transparency and assists safety-net providers in determining the maximum price manufacturers can charge under the program.  This implementation was driven by a 2010 law authorizing civil penalties for manufacturers who “knowingly and intentionally” overcharge covered entities. This should be accessible through the Covered Entity’s 340B PVP account.

On the audit front, HRSA suspended uploads of audit outcomes to its website during 2019.  The audits continued but between June 21st and October 10th no audit outcomes were posted on HRSA’s website.  HRSA states that it was reevaluating its level of authority and oversight of the program.

Looking Ahead to 2020

Focus of Attention

Drug pricing remains a focus of the Trump Administration as we enter the new year and most presidential candidates. This will keep a focus on the entire industry including 340B.

Rebates and Duplicate Discounts

The definition of “Medicaid” as it relates to 340B remains murky. At this time, HRSA only regulates Medicaid Fee-for-Service claims through the Medicaid Exclusion File located on the OPAIS. That said, it remains the covered entities responsibility to coordinate rebates/discounts with the state (which many states have not shown interest in doing).

Apexus provides a Medicaid profiles per State tool to assist entities in accurately billing Medicaid Fee-For-Service.  The tool can be found at

Individual states have recently begun to get explore various forms of 340B legislation. Some of these initiatives are advantageous to covered entities while others have the potential to be very detrimental.  Examples of these bills include:

  • Prohibition of discriminatory 340B reimbursements while others are considering the adoption of
  • Enhanced Medicaid billing procedures
  • Mandatory 340B reporting regulations

Changes to HRSA policy and areas of focus can affect a covered entity’s policies and procedures, contracts, and many other areas of program oversight.  RPh Innovations strives to keep up to date with what is happening with 340B, legislative and/or state involvement, HRSA changes, and other governmental and non-governmental organizations, to ensure covered entities are too. We suggest covered entities keep up to date on what is happening with proposed 340B legislation and sharing information gained with peers.

About RPHI

RPh Innovations offers many services to both its clients and to organizations such as HCAN and other state primary care associations such as:

  • 340B Program support
  • Independent, external audits
  • Contract pharmacy processing services
  • Consulting
  • Summit and other educational presentations

Please feel free to contact Myself, Lyn Mikesell at or Anita Miller, RPHI’s Nebraska dedicated Account Manager at or call 630-963-0024.

This promising practice is shared by OneWorld Community Health Centers, in Omaha, NE


Please give an overview of your work completed:

HCAN offered a unique opportunity to work with a 340B consultant Judy Lapinski.  OneWorld’s Pharmacy Director and CEO met with Judy via phone and email several times in 2019.  HRSA offers best practice suggestions for entities to follow and one of them is having an external review of the program.  OneWorld decided this would be a great opportunity to work with Judy to perform this external review. During the initial meetings we identified areas we would like to focus on as an external 340B review  Those area’s included a review of:  policy and procedures, operational agreement for Contract Pharmacies, internal review procedures for both in-house and contract pharmacies and discussion around USP 800.

HRSA offers a check list that includes essential elements that should be discussed with in our policy and procedures.  Judy also provided us with 12 essential elements on monthly reviews.  We reviewed our audit procedures and audit templates with these elements to ensure we are looking at all compliance elements.

Name something unique about this work completed:

This was an excellent, unique opportunity to work with a knowledgeable consultant regarding 340B.  Valuable insight and feedback was given on the area’s we focused on.  Internal process changes were made based upon feedback given.  Our work is not completed as Judy will be making an on-site visit to our location in January.  This is also a unique and excellent opportunity to look at process and procedures at an in-depth level outside of an actual HRSA 340B audit.

Please list lessons learned/process improvements:

Working with Judy created an excellent opportunity to review operations of our 340B program.  This allowed us to collaborate on process improvement in numerous areas.  Policy and procedures:  when reviewing our policy and procedures and evaluating them against the HRSA check list we discovered there were several area’s that needed to be updated and redefined.  Material breach is an example of one of those areas.  We needed to provide a clear understanding of our limits on material breach and process regarding that if something were to happen.  Another area needing updated was to include statements with regards to patient freedom of choice.

Prescription capture rate was something we looked at as well.  We were able to create detailed reports from our EHR to determine our in-house pharmacy capture rate of prescriptions.  The results of our capture rate was lower than we anticipated.  There have been good conversations and collaboration around how to increase that number.  During these conversations challenges were also discussed regarding how to maximize capture rate, physical space, staffing, patient wait time, patient satisfaction and patient perception.  This will continue to be an area that we look at and follow in the upcoming year.

Please list clinical outcomes/results from project:

Clinical outcomes and results from this project are not complete.  We are looking forward to Judy’s on-site visit in January 2020.  At that time, we will be taking a closer look at maximizing prescription capture rates, maximizing workflow opportunities, patient wait time, staffing models, billing procedures, sliding fee schedules, reducing duplicate processing and review of the OPA database.  This has been a unique opportunity to collaborate with a 340B expert and come up with creative solutions and ideas for operational improvement and compliance.

USP 800 was an area that is still very vague and not a lot of guidance has been issued surrounding this topic.  USP800 enforcement body is still undetermined as this went into effect on December 1, 2019.  Ideas on how to create the policy and procedure and implementation was minimally discussed with Judy.  Due to vague national guidance this became an internal research project.  OneWorld pharmacy did create a policy and procedure, perform risk assessments on high risk medications listed on NIOSH list and implemented employee safety procedures.

Submitted by Coleen Schrage

Director of Pharmacy

OneWorld Community Health Centers, Inc.


Today, September 25th, we celebrate National Voter Registration Day. National Voter Registration Day is a day of action before state deadlines begin in October. Last year, millions of Americans didn’t vote because they missed a registration deadline or didn’t know how to register.

This upcoming Midterm elections are especially important for Nebraska. On November 6th, Nebraskans will be asked to vote on Initiative 427, which can expand Medicaid to an estimated 90,000 low-income Nebraskans and provide health coverage to those that desperately need it.

Medicaid Expansion will have a profound effect on thousands of hard-working Nebraskans who are working desperately to pull themselves out of poverty.  Patients with chronic disease such as diabetes are much more likely to have their conditions under control if they have health insurance.   Moreover, they are more likely to have serious diseases diagnosed earlier so treatment can begin sooner.  Expanding Medicaid will ensure families get access to preventative care, leading to overall improved well-being and avoiding costly trips to the emergency room.  A recent study of Medicaid Expansion in Ohio, conducted by The Ohio Department of Medicaid, found that emergency room utilization decreased 17%, 37% of smokers enrolled in the expansion program were able to quit, and 97% of those with an opioid addiction received treatment.

So, this National Voter Registration Day, I encourage you to get registered to vote. If you recently moved, turned 18, changed your name, or haven’t voted in recent elections, you need to update your voter registration!  All it takes is 30 seconds to register to vote online at

And when it comes time to vote on November 6th, I encourage you to vote FOR Initiative 427. Everyone deserves the peace of mind that comes with having access to health insurance.


By: Angela Lindstrom

Integrated Marketing Director