Cooney is the CEO ofCommunity Health Partners(CHP), a federally qualified health center (FQHC) in
Montana that provides integrated medical, dental,
behavioral health, pharmacy services and educational
programming in rural Southwest Montana. Prior to that,
she served as Clinic Director at CHP's Livingston site
for five years.
Cooney holds a B.A. degree in Biology from The
Colorado College and a M.S. in Science Education from
Montana State University. Before joining CHP, she was a
teacher and program director forThe Traveling
School, a study abroad semester program in South
America, where she lived and taught in small communities
in Ecuador, Peru, and Bolivia. After that, she taught
middle school Spanish in the public school system in
Montana for a year.
Cooney grew up in Kansas, but regularly visited the
West with her family to go hiking and skiing, and always
wanted to live there. When not working, or reading books
on leadership, Cooney enjoys the mountains and rivers
around Bozeman, skiing, kayaking, and biking, with her
husband, daughter, and golden retriever.
You have said that your experiences living and working in
less developed countries opened your eyes to disparities
in health, wealth and education, and drove you to work on
disparities in your own country. How did that lead
you to CHP? And have you seen disparities in Montana that
compare to what you saw in South America?
I spent three to four months a year in South America with
The Traveling School. Before that I had done mission
trips there—it was something I was interested
in. It was unique and interesting traveling with
teenagers because they see things adults don't see. They
ask questions, like “why are these people
living in poverty and I don't?” Questions like
this are powerful when they come from kids. It's not an
easy answer to explain why some countries are less
developed than others.
That became the defining feature of my life. When I was
no longer traveling and I was working in the public
school system, I began to see what poverty looks like in
the U.S. What's different about poverty in the U.S. and
Bolivia is that we hide it better. It's relative poverty
we're talking about. In the U.S., we desperately believe
in the American Dream, we don't want to believe class
exists. But working in a public school system you can see
poverty in a way that other people can't see.
I only spent one year teaching in a public school, so
when I reflect on it, it's through the lens of how I
understand public health now. The kids who were
struggling in school didn't have dental
care—they had cavities and dental pain. They
didn't eat well. They couldn't concentrate because they
were hungry and in pain. I think about those kids who
were in sixth grade then and don't know where they are
now—if they've even graduated from high school.
I can only believe that those kids are going to have
significant barriers in their lives, from what I was
seeing in public school.
I'd love to see all our schools equipped with health
centers on-site, so that kids won't have barriers to
learning and can graduate from high school and have lots
of opportunities in their lives. What you see in public
school is that if kids don't have all the tools, they're
not prepared for success. Seeing that from where I sit
now, with a broader understanding of the social
determinants of health, I understand that we can predict
which kids will grow up to live long healthy lives and
which ones will have significant barriers to achieving
that. We later end up catching it in the jail system or
in emergency medicine (when they get treatment for heart
attacks, instead of getting care for chronic conditions),
or in the Medicaid system. We ought to be making low-cost
health interventions at the elementary school level. And
make sure they get good elementary education, good
preschool education. It's less expensive than living in
jail, than treating a heart attack. Our approach in this
country is backwards.
For me at this point it's hard to pull education and
health apart. I feel like I ended up at CHP because I was
in the right place at the right time. It offered me an
amazing opportunity to work directly on some of the
things that bother me about our country.
One of your clinic's goals is to help its clients earn
their high school degrees. Why is this important to you?
It's not about me—it's about our mission to
enhance community health and well-being. When we look at
determinants of health, chronic disease and life span, we
tend to believe that going to a doc makes you
healthy—but that's not what the research says.
It says it's your health behaviors and social
circumstances, outside of genetics, that influences how
healthy you are long term. When we look at health
behaviors, they are intertwined with social
circumstances, neighborhoods, transportation ability,
access to healthy foods, education. If you live in
a neighborhood where it's hard to access fresh produce,
you don't develop behaviors around eating vegetables. Or
if it's unsafe to play outside, you don't develop healthy
physical activities. These are strong predictors of
whether people develop chronic disease, and how long they
live. Our mission is to help people become healthier, but
if we don't address social circumstances, if we aren't
helping people change social circumstances in some way,
we are going to have a hard time helping people meet
their health goals.
Do you have community volunteers teach the classes or CHP
The Livingston clinic site has a broad array of
educational classes, not just high school equivalency.
Partners (part of CHP) is funded by philanthropy and
grants. A part-time classroom teacher helps students take
assessment tests, connects them with community
volunteers, assigns them to a tutor, and helps them get
to a level where they pass the high school equivalency
test. There they might also learn computer skills,
improve their English and take online college classes.
We also have a parenting support program, which offers
weekly parenting classes, parenting support groups, and
Parents As Teachers Home Visits, where we send a trained
home visitor out to the home to meet with parents and
children to share information about developmental
milestones, safety, and to talk about whatever the parent
wants to talk about, addressing their needs. The idea is
addressing those root causes of poor health.
Do you know of any other FQHCs that do this or do you
think yours is unique?
I'm not sure if others have exactly what we have. We were
featured in a
study funded by the Kresge Foundation and the
Institute for Alternative Futures that presented 10 case
studies of health centers ”leveraging the
social determinants” of health.
One example was a health center in the South that was
seeing children with intestinal bugs, coming from their
water source. They decided, we can treat them every two
months for diarrhea, but the problem is clean water. So
they drilled wells, which helped a significant number of
families in their area. You don't think this is a problem
in the U.S., but community health centers (CHCs) are
places where they see this type of thing. Another example
was a CHC in Boston that saw local kids there had a low
high school graduation rate—so they started
their own high school at the health center. They are
creating a pipeline of kids who go on to college. They
offer them behavioral health counseling and internships
in the center so they can see what a nurse or doctor
does, and see more opportunities in this world.
Around 40 people last year got their GED through our
program. The local high school graduated 110 students
that year. You'd think, given that, that everyone here
would eventually get their high school degrees, but we
always have people traveling through, in transit
situations, with more people still coming in.
How many patients does CHP see each year? And what are
they coming in for?
We have four CHC sites, two dental clinics and four
medical clinics that see 45,000 visits a year. We serve
over 12,000 patients in a two-county service area that is
the size of Connecticut. We rent space to folks who do
WIC, housing support and energy assistance at our
Livingston Clinic. There folks can get their medical,
dental, pharmacy, housing support, WIC and counseling all
in one place. We like to think of it as a warm hand off
to another professional. It's amazing how significant a
barrier it is to arrange a ride to another facility.
There's also a significant barrier between medical and
dental. We've reduced ER visits by giving injectable
antibiotics to patients who are swollen and infected. In
most dental offices that would be an ER visit, but we
have a nurse give the injection.
People will wait so long for dental because they don't
have access—and will wait until it's an
emergency. We end up extracting teeth. We pull over 200
teeth a month in our dental clinics—we can't do
root canals because of the cost (a root canal can cost up
to $2,000). That is a clear indication of a health
disparity in our country. So that's their only option.
But when we take out a front tooth, it's hard to get a
job as a waitress or cashier, where you're working with
You display graphs on your clinic walls. What do they
show? And how does that help in your effort to improve
efficiency and quality at CHP?
Sharing data in a timely, transparent manner assists us
in maintaining focus and making forward progress on
quality improvement initiatives. For example, are
patients with diabetes getting better? What we've done is
to use data to engage all of our employees in quality
improvement (QI) efforts, to be constantly looking at
systems and processes. So by sharing data transparency
regularly, we can engage people at the front desk, and
elsewhere, on how the processes are working.
All of our patients are organized in panels, so they see
the same team (provider, nurse, medical assistant and
administrative support) every visit. We can give that
team info about those patients. We show each team a list
of their patients with a certain diagnosis, like high
blood pressure, and whether each patient's blood pressure
is in control. With that data they might decide to call
in those whose blood pressure wasn't in control. They can
provide proactive care from a population perspective, so
they provide patient care before the patients come in.
We use data in our education programs, pharmacies and HR
department to make sure that people doing the work have
the tools to make a change and are being successful. I
have a couple of graphs on my window; other people have
specific data outside their offices. Each clinic has
specific measures that we rotate. We want patients to see
it too, to show that we're trying to improve.
How does CHP promote health literacy?
We're constantly talking in the clinic about health
literacy. Patients may be able to read, but for health
literacy, you need to process a lot of words and
numerical info at once—many people have been
shown to walk out of their doctor's office without
understanding what was said. To help, we print out
instructions, use plain language in talking with patients
(like “high blood pressure” vs.
hypertension), and have patients ”teach
back” instructions. Medical professionals
aren't necessarily trained in school to communicate with
health literacy in mind. We use so many medical terms as
common language, and we know that patients aren't
understanding us. Changing those behaviors is hard.
How is your clinic funded?
As a FQHC, all of our services are available on a sliding
fee scale to those who demonstrate that their income is
200 percent of the federal poverty level or below.
Federal funding provides about 40 percent of our revenue,
the remainder comes from patient fees—we charge
$10 for a medical visit and $35 for a dental visit.
Revenue from these self-pay encounters is a significant
revenue source for us. We also bill Medicaid, Medicare
and private insurance. We do some fundraising for our
educational programs. Our state is not one that
funds CHCs in any significant way, and it doesn't have a
robust Medicaid program. Over half of our patients are
Is being a CEO like being a teacher in any way?
I think that as a teacher, I was a facilitator. I
helped students gain skills and do their best work. And
that's my job here. That's how we achieve our mission,
through employee engagement. I see lots of
similarities—or I wouldn't be here.
What's your favorite part of your job?
Hands down, we have incredibly mission-driven employees.
I get to come to work with people who are smart,
patient-centered, who work very hard, and are dedicated.
It's incredibly fulfilling.
Opinions expressed are those of the interviewee
and do not necessarily reflect the views of the Rural
Health Information Hub.