By Lori Tremmel Freeman, BS, MBA
Chief Executive Officer, AMCHP
Looking back over my past 10 months with AMCHP, it has been a fulfilling and very rewarding experience working for this great organization. We've had our share of celebrations and our share of introspections around continuing the journey of continuous improvement. If you had a chance to attend the AMCHP business meeting just a few short weeks ago during the AMCHP 2015 conference, you'll recognize some of what is written here and I hope you'll revisit with me our journey. If this is the first time, please enjoy learning more about how AMCHP and I have grown together over the course of 2014.
AMCHP continues to have one of the best retention rates among nonprofits! With nearly 100 percent of members renewing, our ability to retain our vital constituent members shows that AMCHP continues to demonstrate value. The result? Critical support is retained for our programs because they make a difference to our members.
AMCHP has strong Association and Board Committee participation, with a robust and growing volunteer workforce of nearly 150 AMCHP members. With the board, we also are working to ensure we have sound practices and training in place for our volunteer workforce. All of our committees – Best Practices, Emerging Issues, Family and Youth Leadership, Governance, Legislative Affairs – are extraordinarily hard-working and produce non-stop results under the leadership of outstanding chairs and vice chairs. Please consider joining one today – e-mail me anytime with any level of interest!
Partnership and Collaboration
I have spent an extraordinary amount of time my first 10 months reaching out and getting to know existing and new partners. It has been one of the most amazing and overwhelming parts of my job. Everyone wants to touch or be touched by AMCHP! Although I've not counted the sheer number of meetings, personal conversations, and group discussions, my guess would place them in the hundreds. AMCHP is seen as a strong collaborator and we sit at many, many tables. I, along with our excellent staff, are committed to maintaining this role.
We have a strong, competent and growing staff with about 31 FTEs currently and three additional hires on the horizon. Staff growth is not ever a goal in and of itself under my leadership. But, adding staff does demonstrate adding support, always sustainable through our existing funding, to keep providing the caliber and breadth of programs, technical support, and resources to AMCHP members and partners.
With a staff this size, we hired a part time HR consultant who has been tremendously helpful in assisting with recruitment, hiring and separations; solidifying and implementing a consistent and well-documented onboarding process; and otherwise identifying and reviewing all AMCHP HR policies.
Let's face it, policies and procedures are necessary but sometimes organizations can't find the time to keep up with the myriad of laws, regulations, and organizational change spurred by sheer staff growth that precipitate the ongoing care and feeding of the policies and procedures. We've spent a lot of time these last months doing just that and we have plans in place that will facilitate ongoing review and modification as necessary. This past year, we did a full review of the AMCHP Employee Handbook and introduced revisions needed to ensure compliance with EEOC, FMLA, and other HR laws. Internal policies have been identified for the near time that need additional review and revision. Working with the Board and Governance Committees, we spent all of 2014 reviewing EVERY board policy and making revisions to those. And, we completed a rather extensive revision to the AMCHP By-Laws in order to bring us in compliance with new DC nonprofit laws and regulations.
We also began work with the Center for Public Health Quality to launch quality improvement (QI) initiative. We chose to undertake three intensive QI efforts around best practices, virtual engagement, and emerging issues. We hope this work will improve your experience while also improving our internal processes.
As soon as I touched down at AMCHP, it was apparent to me that gaining control of the finances was a top priority. To do this effectively, it was important to restructure the senior leadership team that I rely on heavily and to immediately elevate our senior accountant to the leadership team. This has helped our senior staff to learn more about the importance of one another to their own priority areas, as well as integrate financial discussions into all that we do throughout the organization.
Throughout the year, we've taken every opportunity to educate staff at all levels on the crucial nature of good budget practices and accountability for our own audit findings. We have taken time to fully explain the purpose of the financial audit and the responsibility of the organization and its staff to addressing audit findings and eliminating them. Period.
Implementing specific education and policy adjustments to address the 2013 audit findings was an absolute priority. Our audit is looked at by every funder who is considering granting work to AMCHP. Changes included adjustments to our contract review and approval processes; implementing a stronger Executive Committee review and approval process for contracts above certain thresholds; and assembling approved policies for ease of employee access to name a short few.
I am so proud that we have effectively addressed and eliminated all prior audit findings except the one related to the budgeted deficit. This year, we fully intend to work to address this last finding by reversing multiyear extensive deficits. We have budgeted for a modest net income for 2015.
How did we turn the situation around quickly? We've implemented stronger budget planning using zero-based budgeting and justification of all revenue and expense projections.
Recognizing that we have an equal role to play in propelling AMCHP toward its first budgeted net income in several years, we knew it was not fair to simply rely on dues increase. We worked hard to trim expenses and challenge all staff to find efficiencies in their work that lead to cost containment.
Lastly, we did get some unexpected news that had potentially significant impact on our finances. We learned that AMCHP's building in DC was being purchased and that we would lose our existing lease, which had about five years remaining on it. We negotiated a very strong early lease termination agreement that will allow AMCHP to move its offices in September 2016 without having ANY FINANCIAL IMPACT on its capital reserves. Since office moves are extraordinarily costly, this is a major accomplishment. If we are fiscally conservative, we have negotiated a strong enough agreement now that we should be able to ADD to our reserves through this lease end negotiation.
Under the very capable leadership of Lacy Fehrenbach and her talented staff, we worked hard in 2014 to to identify appropriate grant opportunities for AMCHP. We applied for 26 grant proposals worth $11.6M and were awarded 22 of those grants worth $9.6M (a pretty astounding 83 percent success)! Again, this work will NEVER be accomplished without all hands on deck. If I haven't said it enough, we have a pretty amazing staff at AMCHP who work tirelessly to achieve these results. Please join me in thanking them always for their dedication, support, and can do attitudes.
Under the excellent direction of Erin Bonzon, associate director of our women's and infant health team, the team's 2014 accomplishments follow.
- We welcomed a second cohort of six states to the Merck for Mothers-funded Every Mother Initiative which helps states translate data from their maternal mortality reviews to programmatic and policy actions
- With support from the W.K. Kellogg Foundation, we began a project to improve post-partum systems of care to improve women's health and birth outcomes
- AMCHP continues to work with National Institute for Children's Health Quality (NICHQ), March of Dimes, Association of State and Territorial Health Officials (ASTHO), and other partners to support roll out of the Infant Mortality Collaborative Improvement & Innovation Network (CoIIN)
- We also recently received funding from the Robert Wood Johnson Foundation to provide additional technical assistance and support related to birth outcomes in the southeastern states in Regions IV and VI, especially as related to health equity, QI, and demonstrating value of birth outcomes work
Under the excellent direction of Treeby Brown, associate director of our child and adolescent health team, the team's 2014 accomplishments follow.
- With support from the Lucille Packard Foundation for Children's Health and the Maternal and Child Health Bureau (MCHB), AMCHP has been providing significant support to help states implement the Standards for Systems of Care for CYSHCN through an action learning collaborative
- We have been working with MCHB and the Centers for Disease Control and Prevention (CDC) to improve early childhood health, especially in the area of developmental screening
- AMCHP is very fortunate to be co-leading the newly funded Adolescent and Young Adult Health Resource Center, which will provide resources, training, and technical assistance to state to improve access, quality, and equity in preventive care for adolescents and young adults
Under the excellent direction of Caroline Stampfel, associate director of our epidemiology and evaluation team, the team's 2014 accomplishments follow.
- AMCHP has supported a community of practice to help states complete return on investment calculations and other economic analyses
- With support from CDC and the W.K. Kellogg Foundation, AMCHP is providing states and jurisdictions with tools to help use the Life Course Indicators to measure implementation of life course approach. For example a group of states is developing communications tools for some of the complicated measures such as concentrated disadvantage. There also are tip sheets on the Life Course Indicators for some of the more challenging calculations
- We have built a sustainable epidemiology and evaluation function within AMCHP for the very first time that will continue to evolve and provide new and different kinds of resources and technical assistance to states
Under the excellent direction of Stacy Collins, associate director of the health reform implementation team, the team's 2014 accomplishments follow.
- AMCHP has updated several resources related to Women's Access to Care and leads the Access to Care and Systems Integrations Core in the National MCH Workforce Development Center
- We received funding for a new project: Alliance for Innovation in MCH, which seeks to help states increase continuity of coverage for pregnant women and children, improve systems of care for CYSHCN, and support implementation of Bright Futures in states. The work will be done in partnership with the National Governors Association, National Conference of State Legislatures, ASTHO, the American Academy of Pediatrics (AAP), and National Academy of State Health Policy
- We built a sustainable health reform implementation function within AMCHP that will continue to evolve and provide new and different kinds of resources and technical assistance to states
Under the excellent direction of Sharron Corle, associate director of workforce and leadership development, the team's 2014 accomplishments follow.
- AMCHP has worked with committee leadership to make improvements to the best practice submission/review process and improve how we track, identify, and address emerging issues
- The team is working with the CYSHCN staff, with support from MCHB and the Lucille Packard Foundation for Children's Health, in leading a project to better understand how CYSHCN And MCH programs partner with families, where there are strengths, and what needs and gaps exist
- We provided development opportunities for several new leaders through the New Director Mentor Program and Family Scholars Program and began developing programs for next generation leaders
- AMCHP contributed to the very successful launch and first year of the National MCH Workforce Development Center and led activities related to family leader development
Policy and Government Affairs
We all know that working in the current congressional climate in Washington, DC can be challenging in the best of times. The ongoing gridlock and partisan divide that the country has faced in recent years can make progress especially difficult for a bi-partisan organization like AMCHP. Under the excellent direction of Brent Ewig, director of policy and government affairs, and Amy Haddad, associate director for government affairs, this small (but mighty) team's select 2014 accomplishments follow.
- In a very austere environment, AMCHP led advocacy efforts resulting in a $3 million increase for the Title V MCH Services Block Grant and we are looking to build on that momentum in the year to come
- In the Spring, AMCHP played a key leadership role in a broad coalition that successfully secured a one year extension and additional $400 million for the Maternal, Infant and Early Childhood Home Visiting (MIECHV) program
- AMCHP worked with many key partners to secure congressional reauthorization and funding for the Personal Responsibility Education Teen Pregnancy Prevention Program (PREP), the Family to Family Health Information Centers, the Autism Cares Act and the Newborn Screening Saves Lives Act
In closing, as we look forward to the coming year, we realize we cannot let up. We can pause occasionally to celebrate our success as we are doing now. Yet, there's much more work to do, more ways to serve you, our members and constituents and partners. Our plans also include continuing our work to improve operations, find efficiencies in our work, and evolve our policies, procedures and practices to align with the growth of AMCHP.
We also are delighted to look ahead to focusing and aligning our grant and other work to our mission, vision and new strategic plan. Please join us as we set forth on a new and exciting journey in 2015 as we embark on this work together and begin our visioning process for the future. Don't forget to ENGAGE with us! We cannot accomplish these amazing things and further improve without your feedback, input and guidance.