New and Noteworthy

2017 New Markets Tax Credit Program Allocation Round − Are You Ready?

Does your health center have a capital project on the horizon? With the Community Development Financial Institutions Fund (CDFI Fund) likely opening the 2017 application round for allocation at the end of this month (keep checking this link for updates), now is the time to act!

The NMTC program is highly competitive, with demand for credits for worthy projects vastly exceeding the supply. Health centers that want to obtain credits for their projects must carefully align their project planning cycles with the NMTC funding cycle. Capital Link has extensive knowledge of the NMTC financing process and can provide assistance with the complex process of obtaining a commitment of credits and completing a NMTC transaction. We are currently offering a NMTC-focused webinar and free technical assistance. To find out how Capital Link can help your health center capitalize on this invaluable financing option, please contact Jonathan Chapman, Director of Community Health Center Advisory Services at 970-833-8513 or This email address is being protected from spambots. You need JavaScript enabled to view it.. Or if you’re planning on attending the P&I later this month, Capital Link staff will be available throughout the conference to discuss how we can help you achieve your goals, including opportunities for expansion through New Markets Tax Credits. Click here to set up an appointment.

To help health centers understand NMTC, Capital Link has prepared a variety of resources, described below:

Spotlight on Capital Resources: New Markets Tax Credit Program Capital Link has published a series of three resources explaining what the NMTC Program is, how this type of financing works, and important updates on how health centers can qualify and the steps necessary to use NMTC for a capital project. These resources were developed with support from HRSA and can be accessed here. Save Millions by Using New Markets Tax Credits and/or Tax-Exempt Bonds to Finance Your Capital Project Wednesday, March 22, 2017, 2-3 p.m. ET Let’s be blunt: the use of New Markets Tax Credits (NMTC) and Tax-Exempt Bonds (TE Bonds) on a $5 million project can provide your health center with approximately $1,250,000 up front (NMTC) and save you $800,000 over the 25 years of your loan (TE Bonds). By beginning the financing process early enough to take advantage of these two incredible financing tools, your health center can literally save $2 million on a $5 million project. Simply put, this webinar shows you the benefits of these financing options and how to obtain them for your project. Register here. A recording will be posted here on our website if you miss it.

Why Should You Do a Market Assessment?

In times of change, success requires anticipation and preparation. It is imperative to identify and evaluate opportunities for growth, marketplace competition, projected market share, demand for services, unmet needs, and emerging trends. Whether your health center is expanding to a new site or evaluating changes in its existing service area, a market assessment provides essential information to guide your organization’s strategic direction.

1.Define Market Service Area

Using zip codes, a health center can focus on the general population or specific segments (e.g., children, women of childbearing age, etc.). Sources include:

• American FactFinder by the U.S. Census (http://factfinder2.census.gov),
• Fee-based sites such as DemographicsNow (http://www.demographicsnow.com/)

2. Determine Health Needs

State and county health departments are usually the most up-to-date source for accurate health indicators, such as immunization and mortality rates. The following resources also provide similar health indicators for all states:

• County Health Rankings (http://www.countyhealthrankings.org/)
• Community Health Status Indicators (www.cdc.gov/CommunityHealth)
  
• HealthLandscape (www.healthlandscape.org)

3. Assess Population Size by Payer Mix in Health Center Service Area

It is important to understand the potential payer mix in your service area and to understand which of the currently uninsured might enroll in Medicaid or the health insurance exchange. The following resources provide payer mix information:

• Medicaid – Enrollment data is available through the state offices of Medicaid
• Medicare – Enrollment by county (http://www.cms.hhs.gov/MedicareEnrpts/)
  
• Uninsured – US Census (https://www.census.gov/did/www/sahie/data)
  
• Exchange-Eligible – Uninsurance Explorer Tool (www.udsmapper.org)
  

4. Estimate Market Share

Compare your health center’s patient base to overall service area market size by payer to estimate its market share. For example, if there are 4,000 Medicaid enrollees in your service area and your health center has 800 Medicaid patients, your market share is 20%. Lower market share suggests greater market potential, while any market share of the Medicaid population that is over 60% merits a close analysis of other Medicaid providers as described below in number 5.

5. Review Competition/Similar Providers

Understanding the market environment in which your health center operates includes an analysis of similar providers. The UDS Mapper (www.udsmapper.org) provides detailed market data on the Federally Qualified Health Centers (FQHCs) and FQHC Look-Alikes providing care down to the zip code level. However, analysis should not stop there. Below are a few resources to help identify other providers in your area who are accepting Medicaid and the uninsured:

• State Medicaid websites often share phone numbers of providers (e.g. family practitioners, OBGYN, and pediatricians) that are accepting new Medicaid patients.
• For rural areas, market data on service site locations can be found via the Centers for Medicare and Medicaid (CMS) website (https://www.cms.gov/center/rural.asp). Note that Rural Health Clinics and Critical Access Hospitals are often the greatest source of primary care, although these entities are not required to serve the uninsured.

6. Estimate Unmet Need/Strategic Program Opportunities

This final step pulls the market information together and establishes the foundation for programmatic decision-making. Planners should answer the following questions:

• Based on the demographic data, health indicators, and insurance mix, what is the unmet need of the population segments?
• How should the health center address those opportunities via program changes/expansions/refocus?

For more information on Capital Link’s Market Assessment services, please click here to visit our website. You can also find a Market Assessment worksheet here on p. 33 of our publication, Creating a Dynamic and Useful Strategic Plan, A Toolkit for Health Centers, and a recording of our webinar, Planning in Uncertain Times: Market Assessment for Service Expansion to Respond to Community Needs, here.