The RCHN Community Health Foundation’s signature Population Health Initiative was developed to help health center organizations implement comprehensive and community-centered population-focused health improvement strategies. Working on local priority issues, our health center and primary care association grantees have developed replicable approaches to build capacity, and strengthen care delivery, systems, and outcomes.

The projects initiated in 2017-2018 are nearing completion, providing an opportunity to showcase the effective strategies and interventions deployed by each organization over the two-year project period. Mariposa Community Health Center (MCHC) in Nogales, AZ focused on addressing food insecurity and its related health outcomes, a widespread problem in their predominantly low-income, Mexican-American border community. MCHC launched the “Comer Bien” (Eat Well) Initiative to increase access to nutritious food and improve health outcomes and blood sugar control for a pilot group of patients with uncontrolled diabetes. The health center created a comprehensive program, offering cooking classes, transportation to farmer’s markets, community health worker home assessments and care coordination, tailored healthy food boxes and prescriptions for fruits and vegetables through the FVRx Fruit and Vegetables Prescription Program. At the end of the second project year, and through sustained community-based partnerships, collaborations with grocers and markets, and provider engagement to support the effort, participants achieved an average reduction from their baseline HbA1c ranging from 17-19%.

In South Los Angeles, St. John’s Well Child and Family Center (SJWCFC) developed the Healthy Homes Healthy Kids (HHHK) program to intentionally address housing-related asthma triggers common in the area, integrating in-home outreach by community health workers and comprehensive case management with team-based primary care. SJWCFC aimed to improve participants’ asthma control and to decrease emergency room (ER) visits and hospitalizations by improving care-giver knowledge, providing in-home asthma education, assessment and remediation of asthma triggers, and offering comprehensive case management services. The health center partnered with Strategic Actions for a Just Economy (SAJE), a community-based organization focused on tenant rights, healthy housing, and equitable development, to address housing conditions and provide legal aid. Additional strategic collaborations focused on care coordination as well advocacy for sustainability, with Asthma Coalition of Los Angeles, Regional Asthma Management and Prevention (RAMP), Californians for Clean Air (CFCA), and Esperanza Community Housing Corporation. By the end of the project period, 100% of the 168 patients who completed the program showed an improvement in asthma symptoms as measured by the Asthma Control Test (ACT) and Core Caregiver Survey. In addition, 77% of participants were able to reduce their use of the emergency room; the remaining 23% of participants did not increase their ER use.

Stay tuned for updates about our population health grantees, and meanwhile read more about our population health initiative.


Participants of MCHC’s ‘Comer Bien’ (Eat Well) program take part in an exercise demonstration, (Nogales, AZ).


RCHN CHF and SJWCFC staff visit project partner, Strategic Actions for a Just Economy (SAJE), in Los Angeles, CA.


Updated – Population Health Resources
As part of the Foundation’s signature Population Health initiative, RCHN CHF collaborated with project grantees and partners to share information and resources to deepen and strengthen health center operational and clinical capacity, develop partnerships, and enhance the potential for sustainability. Our updated repository of population health resources, including materials covering environmental drivers, steps to population health management, and process outcomes relevant to all health centers undertaking population health improvement projects, is available on our website.
View population health resources.


COVID 19 Data Note Series – New Update
Our weekly update tracking the state-specific experience and impact of COVID-19 on the nation’s community health centers continues. The latest is Update #7, “Despite a Drop in the Number and Percentage of Patients Testing Positive for COVID-19, the Percentage of Those Testing Positive Continued to Exceed National Percentages,” which analyzes survey data collected by HRSA through May 15. These weekly updates, which underscore both essential, front-line health center activity, and the toll the pandemic is taking, are produced by the Geiger Gibson/RCHN CHF Research Collaborative.
Read Data Note: Key Updates from the Health Center COVID-19 Survey (Update #7)



NHIT Community Transformation Webinar – Food Supply Impact
The National Health IT Collaborative for the Underserved (NHIT) is hosting a new webinar, part of their NHIT- Community Transformation Forum webinar series, focused on the COVID-19 pandemic. RCHN CHF is proud to support this NHIT series as a Community Transformation Partner.

Topic: COVID19: The Impact of a Disrupted Food Supply Chain in Underserved Communities.
Date: Tuesday June 2, 3PM EDT

Speakers include Jon Jackson, Former U.S. Army Ranger, Founder of Comfort Farms and Executive Director, STAG VETs, Inc., Sylvia Partida, Chief Executive Officer, National Center for Farmworker Health, and Joyce Hunter, Former Deputy CIO for Policy & Planning, US Department of Agriculture.

To register for the upcoming webinar and view recordings of past sessions, please visit


CHroniCles Spring 2020 Raffle
CHroniCles documents the unique story of each community health center and the diverse dimensions of the health center movement as a whole, and makes this living history accessible to visitors everywhere. Tell your community health center story and enter to win our July raffle! Prizes include $150 AMEX gift card, $100 AMEX gift card, and a $50 AMEX gift card or a copy of Out in the Rural by Dr. Thomas J. Ward, Jr.

How to enter:

  • First, sign up using this form: or email our project manager, so we know who is responsible for updating the health center profile.
  • Then upload a main narrative and profile image to your CHroniCles profile by June 30, 2020. Full instructions on adding materials to the site are available here:
  • Add more material for more chances to win. Each additional item – document, photo album, or video upload – will get you an additional entry into the raffle.
  • Already have a profile on the site? Your organization can still participate by adding to the main narrative, or adding content to the profile. Please be sure to fill out the raffle form.


In Case You Missed It
CHroniCles Video: Agents of Hope, Centers of Change.