Community Wellness Centers Operations Manual
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Community Wellness Centers Operations Manual
18 Centers Delivering Comprehensive Care: Operational Blueprint
Budget Version: 3.1
Date: October 2025
Total Investment: $45M annually (when fully operational) | $90M over 3 years
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EXECUTIVE SUMMARY
Goal: 18 Community Wellness Centers across Louisville operational by end of Year 3
Model: Federally Qualified Health Center (FQHC) lookalike structure
- Primary care + mental health + substance abuse treatment + social services under one roof (8 core clinical staff, plus 17-22 administrative/support/outreach staff for full operations; 25-30 total per center)
- Sliding-scale fees based on ability to pay
- Accept Medicaid, Medicare, private insurance
- No one turned away for inability to pay
- Primary care (nurse practitioners for checkups, chronic disease, acute illness)
- Mental health counseling (therapists, psychiatrists)
- Substance abuse treatment (addiction counseling, medication-assisted treatment)
- Social services navigation (help accessing benefits, housing, jobs)
- Health education (nutrition, exercise, disease prevention)
- By health need: a need score built from CDC PLACES 2024 (frequent mental distress, depression, diabetes, fair or poor health, adults without health insurance, lack of transportation, food insecurity) and Census ACS 2024 poverty, for each of Jefferson County’s 33 residential ZIP codes (frequent mental distress: CDC PLACES 2024 release; poverty: U.S. Census Bureau, ACS 2024 5-year)
- At least one center in each LMPD division, so every part of the county has one
- Year 1 opens in the six ZIP codes with the highest need
- Exact sites are chosen with each community
- Annual physical exams
- Chronic disease management (diabetes, hypertension, asthma, COPD)
- Preventive care (vaccines, cancer screenings, wellness checks)
- Acute illness treatment (flu, infections, minor injuries)
- Women’s health (birth control, Pap smears, prenatal referrals)
- Pediatric care (well-child visits, vaccines, school physicals)
- On-site lab work (blood tests, urinalysis, rapid tests)
- Prescription assistance programs
- Care coordination with specialists
- 4 Nurse Practitioners (FT): $130K each = $520,000
- 1 Physician (PT, 20 hrs/week for complex cases): $120,000
- 3 Medical Assistants (FT): $45K each = $135,000
- 1 Lab Technician (FT): $50,000
- 1 Front Desk/Scheduler (FT): $40,000
- Supplies, equipment, lab costs: $35,000
- Individual therapy (depression, anxiety, trauma, PTSD)
- Substance abuse counseling (addiction assessment and treatment)
- Medication management (psychiatric medications)
- Group therapy (recovery support, grief, anger management)
- Crisis intervention (walk-in availability during hours)
- Family counseling (relationships, parenting, communication)
- Youth mental health (school stress, bullying, identity)
- Telehealth options (increase access, reduce stigma)
- 3 Licensed Clinical Social Workers (FT): $75K each = $225,000
- 2 Licensed Professional Counselors (FT): $70K each = $140,000
- 1 Psychiatrist (PT, 20 hrs/week): $150,000
- 1 Substance Abuse Counselor (FT): $65,000
- 1 Case Manager (FT): $55,000
- 1 Front Desk/Scheduler (PT): $25,000
- Supplies, telehealth tech: $40,000
- Benefits enrollment (Medicaid, SNAP, housing assistance, TANF)
- Job search assistance (resume help, interview prep, job postings)
- Housing support (homeless prevention, rental assistance applications)
- Transportation coordination (bus passes, ride sharing, medical transport)
- Legal aid referrals (family law, housing, benefits appeals)
- Childcare resources
- Utility assistance programs
- Food pantry coordination
- Education program connections (GED, ESL, job training)
- 2 Social Workers (FT): $70K each = $140,000
- 2 Community Health Workers (FT): $50K each = $100,000
- 1 Benefits Specialist (FT): $55,000
- 1 Job Placement Coordinator (FT): $55,000
- Office supplies, technology: $50,000
- Nutrition classes (healthy eating on a budget, cooking demos)
- Exercise programs (walking groups, yoga, fitness classes)
- Disease prevention workshops (diabetes, heart disease, cancer screening)
- Parenting classes (infant care, child development, positive discipline)
- Chronic disease support groups
- Health screenings (blood pressure, glucose, cholesterol)
- Community health fairs
- School partnerships (health education in schools)
- 1 Health Educator (FT): $60,000
- 1 Nutritionist (PT): $40,000
- 1 Community Outreach Coordinator (FT): $55,000
- Program supplies, materials: $50,000
- Community event costs: $45,000
- 1 Center Director: $90,000
- 1 Office Manager: $55,000
- 1 Billing/Insurance Specialist: $50,000
- 1 Receptionist/Scheduler: $35,000
- IT support: $20,000
- Rent (10,000 sq ft @ $20/sq ft): Included in capital
- Utilities: Included in capital
- Insurance: Included in capital
- Maintenance: Included in capital
- Comfortable seating for 25-30 people
- Children’s play area
- Health education materials
- ADA accessible
- 8 exam rooms
- Procedure room
- On-site lab
- Medication room
- Nurse station
- 6 private therapy offices
- 2 group therapy rooms
- Quiet room (crisis intervention)
- Psychiatrist office
- 4 private consultation offices
- Computer lab (4 stations for job search, benefits applications)
- Resource library
- Multi-purpose space for classes, support groups
- Kitchenette for cooking demos
- AV equipment
- Staff break room
- Conference room
- Staff restrooms
- Storage
- Director office
- Billing office
- IT closet
- Medical records room
- Medical supply storage
- Janitorial closet
- Public restrooms (2)
- Primary care staff
- Mental health staff
- Social services staff
- Health education
- Administration
- Rent/lease (10,000 sq ft @ $25/sq ft): $250K
- Utilities: $30K
- Property insurance: $15K
- Maintenance: $5K
- Medical supplies: $100K
- Pharmaceuticals (sample medications): $50K
- Lab supplies: $40K
- Office supplies: $20K
- IT/technology: $40K
- Program materials: $50K
- Electronic health records (EHR): $40K
- Telehealth platform: $20K
- IT support: $20K
- Software licenses: $10K
- Equipment maintenance: $10K
- Credentialing/licensing: $20K
- Legal/compliance: $25K
- Accounting: $20K
- Malpractice insurance: $25K
- Consulting: $10K
- Community events: $30K
- Marketing/outreach: $25K
- Staff training/development: $25K
- Emergency fund: $20K
- Many patients will be Medicaid-eligible
- Center bills Medicaid for services
- Reimbursement rates apply
- Senior patients covered
- Standard Medicare reimbursement
- Patients with employer insurance
- In-network contracts negotiated
- Patients with income pay reduced fees
- Based on federal poverty guidelines
- Federal health center grants
- State health department funding
- Foundation grants
- Corporate partnerships
- Income level
- Insurance status
- Employment status
- Housing status
- 100% of Federal Poverty Level: FREE
- 100-200% FPL: $10-25 per visit
- 200%+ FPL: $40-60 per visit (still affordable)
- Specialist referrals
- Complex case coordination
- Training site for medical residents
- Emergency backup
- Specialist network access
- Diagnostic imaging referrals
- Inpatient care coordination
- Similar partnerships
- Geographic coverage
- Prescription discount programs
- Medication delivery for homebound
- Chronic disease medication management
- School nurse coordination
- Student health services
- Parent education programs
- Athletic physicals
- Outreach locations
- Health ministry partnerships
- Space for support groups
- Co-locate programs
- Shared resources
- Cross-referrals
- Housing organizations
- Food pantries
- Job training programs
- Legal aid
- Exercise programs
- Wellness classes
- Community events
- Hire Director of Wellness Centers (oversees all 18)
- Hire 6 Center Directors
- Establish HR processes
- Recruit physicians, nurse practitioners
- Hire mental health professionals
- Recruit social workers
- Medical assistants
- Front desk staff
- Community health workers
- Billing specialists
- Staff training
- Practice workflows
- Soft opening
- Grand opening
- Medical Assistant: $40-50K
- Community Health Worker: $45-55K
- Front Desk: $35-45K
- Nurse Practitioner: $110-140K
- Social Worker: $65-80K
- Counselor: $65-80K
- Physician: $180-220K (PT)
- Psychiatrist: $200-250K (PT)
- Center Director: $90-110K
- Health insurance
- Retirement (city plan)
- Student loan assistance (for hard-to-fill positions)
- Professional development
- Flexible schedules
- Diabetes control (HbA1c levels)
- Blood pressure control
- Depression/anxiety improvement (PHQ-9, GAD-7 scores)
- Substance abuse recovery rates
- Patient satisfaction scores
- Wait time for appointments
- Same-day availability
- Insurance coverage rates
- Sliding scale utilization
- Language access
- Patient visits per month
- Services per patient
- ER visits by center patients (should decrease)
- Hospital admissions (should decrease)
- Medication adherence rates
- Cost per patient
- Revenue capture rate
- Medicaid enrollment assistance
- Charity care provided
- Health education participants
- Community satisfaction surveys
- Referral network effectiveness
- 120,000 patient visits
- 30,000 unique patients served
- 20% reduction in ER visits by center patients
- 70%+ patient satisfaction
- Medicaid enrollment increases in coverage areas
- 240,000 patient visits
- 60,000 unique patients served
- 30% reduction in ER visits
- Measurable chronic disease improvement
- Mental health wait times reduced citywide
- 360,000 patient visits
- 90,000 unique patients served
- 35% reduction in ER visits
- Significant health disparities reduction
- $5.60 saved for every $1 spent
- Every $1 spent saves $5.60 in healthcare costs
- $45M investment = $252M in savings
- Net positive: $207M annually
- Healthier population
- Reduced suffering
- Economic productivity
- Crime reduction (health and crime are linked)
- 63 mini substations across Louisville (4-year deployment)
- Officers living and working in communities they serve
- Preventative community policing model
- Year 1: 12 substations in highest-need areas
- I will place 18 Community Wellness Centers by health need (CDC PLACES 2024 plus Census poverty data)
- Mental health counseling, addiction support
- Youth programs, family services
- At least one center in every LMPD division
- After-school programs at all substations
- Job training and mentorship
- Arts, sports, and STEM programs
- Youth advisory councils
- Summer employment pathways
- Small business incubators at substations
- Local hiring requirements for city contracts
- Neighborhood-based economic zones
- Affordable housing protection
- Living wage standards
- Expanded affordable housing trust fund
- Strong tenant protections
- Community land trusts
- Rent stabilization measures
- Anti-displacement policies for existing residents
- Real-time budget dashboard
- Public data portal for all city metrics
- Community advisory boards with veto power
- Open contracting process
- Regular town halls in all neighborhoods
Investment: $2.5M per center annually = $45M total when fully operational
Return on Investment: $5.60 saved for every $1 spent (documented in multiple studies)
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WHAT IS A COMMUNITY WELLNESS CENTER?
Not a hospital. A neighborhood health hub providing:
One-Stop Care: Everything in one accessible location. No more bouncing between providers.
Affordable: Sliding scale based on income. Medicaid/Medicare accepted. No one turned away.
Evidence-Based: Proven to reduce ER visits by 35%, improve chronic disease outcomes, and save money long-term.
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DEPLOYMENT SCHEDULE
YEAR 1: 6 CENTERS (One Per Geographic Area)
Launch: Months 4-12 of first year
Annual Cost: $15M
Goal: Demonstrate model, establish operations
Locations:
1. California, Park Hill & Algonquin (40210) – health-need rank 1 of 33; 21.7% of adults with frequent mental distress, 37.8% in poverty; LMPD 2nd Division
2. Chickasaw, Shawnee, Parkland & Park DuValle (40211) – health-need rank 2 of 33; 20.9% of adults with frequent mental distress, 38.0% in poverty; LMPD 2nd Division
3. Portland & Shawnee (40212) – health-need rank 3 of 33; 21.0% of adults with frequent mental distress, 32.2% in poverty; LMPD 1st Division
4. Downtown & Phoenix Hill (40202) – health-need rank 4 of 33; 21.4% of adults with frequent mental distress, 34.9% in poverty; LMPD 1st Division
5. Jacobs, Taylor Berry, Beechmont & Hazelwood (40215) – health-need rank 5 of 33; 21.4% of adults with frequent mental distress, 27.7% in poverty; LMPD 4th Division
6. Russell, Old Louisville & Shelby Park (40203) – health-need rank 6 of 33; 20.7% of adults with frequent mental distress, 43.3% in poverty; LMPD 1st / 4th Division
How these locations were chosen:
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YEAR 2: 6 MORE CENTERS (12 Total)
Launch: Months 7-12 of second year
Annual Cost: $30M total
Goal: Expand coverage, refine model
Additional Locations:
7. Old Louisville (south), University & Algonquin (40208) – health-need rank 7 of 33; 24.6% of adults with frequent mental distress, 32.0% in poverty; LMPD 4th Division
8. Fairdale (40118) – health-need rank 8 of 33; 19.4% of adults with frequent mental distress, 21.6% in poverty; LMPD 3rd Division
9. Shively (40216) – health-need rank 9 of 33; 18.4% of adults with frequent mental distress, 16.8% in poverty; LMPD 2nd / 3rd Division
10. South End: Iroquois, Beechmont & Southland Park (40214) – health-need rank 10 of 33; 18.2% of adults with frequent mental distress, 18.8% in poverty; LMPD 3rd / 4th Division
11. Okolona (40219) – health-need rank 11 of 33; 17.9% of adults with frequent mental distress, 18.0% in poverty; LMPD 7th Division
12. Poplar Level, Audubon Park & Watterson Park (40213) – health-need rank 12 of 33; 17.9% of adults with frequent mental distress, 17.7% in poverty; LMPD 6th Division
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YEAR 3: 6 FINAL CENTERS (18 Total – COMPLETE)
Launch: Months 7-12 of third year
Annual Cost: $45M total
Goal: Full citywide coverage
Final Locations:
13. Valley Station (40272) – health-need rank 13 of 33; 17.7% of adults with frequent mental distress, 12.7% in poverty; LMPD 3rd Division
14. Pleasure Ridge Park (40258) – health-need rank 14 of 33; 18.1% of adults with frequent mental distress, 13.8% in poverty; LMPD 3rd Division
15. Bashford Manor, Buechel & Watterson Park (40218) – health-need rank 15 of 33; 17.3% of adults with frequent mental distress, 14.0% in poverty; LMPD 6th Division
16. Okolona (south) & Hillview area (40229) – health-need rank 16 of 33; 17.7% of adults with frequent mental distress, 11.8% in poverty; LMPD 7th Division
17. Crescent Hill, Butchertown & Clifton (40206) – health-need rank 20 of 33; 15.1% of adults with frequent mental distress, 11.4% in poverty; LMPD 5th Division
18. Lyndon, Plantation & Rolling Hills (40242) – health-need rank 22 of 33; 14.8% of adults with frequent mental distress, 8.6% in poverty; LMPD 8th Division
Result: 18 centers, at least one in every LMPD division, the first six in the county’s highest-need ZIP codes.
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SERVICES OFFERED
PRIMARY CARE
Hours: Monday-Friday 8am-6pm, Saturday 9am-2pm
Services:
Staffing:
Capacity: 80-100 patients daily, 20,000+ visits annually per center
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MENTAL HEALTH SERVICES
Hours: Monday-Friday 9am-7pm (extended evening hours), Saturday 9am-2pm
Services:
Staffing:
Capacity: 50-60 therapy sessions daily, 12,000+ sessions annually
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SOCIAL SERVICES NAVIGATION
Hours: Monday-Friday 8am-5pm
Services:
Staffing:
Capacity: 30-40 clients assisted daily, 8,000+ annually
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HEALTH EDUCATION & COMMUNITY PROGRAMS ($250K per center annually)
Services:
Staffing:
Participation: 200+ community members monthly in programs
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ADMINISTRATION & OPERATIONS ($250K per center annually)
Staffing:
Facility Costs:
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FACILITY SPECIFICATIONS
PHYSICAL SPACE
Size: 10,000 square feet per center (Note: Platform documents cite 5,000 sq ft as minimum baseline; the full operations model requires 10,000 sq ft for comprehensive service delivery)
Layout:
Waiting Area (800 sq ft):
Primary Care Clinic (3,000 sq ft):
Mental Health Wing (2,500 sq ft):
Social Services Area (1,500 sq ft):
Community Room (1,200 sq ft):
Staff Areas (800 sq ft):
Administrative (400 sq ft):
Support Spaces (800 sq ft):
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OPERATING COSTS PER CENTER
Total Annual Cost: $2.5 Million
Personnel: $1.6M
Facility: $300K
Supplies & Equipment: $300K
Technology & IT: $100K
Professional Services: $100K
Miscellaneous: $100K
TOTAL: $2.5M per center annually
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REVENUE MODEL
While services are free/sliding scale to patients, centers pursue all available revenue:
REVENUE SOURCES (Estimated $800K-1.2M per center annually)
Medicaid Reimbursement: $400K-600K
Medicare: $150K-200K
Private Insurance: $100K-150K
Sliding Scale Payments: $50K-100K
Grants: $100K-150K
Net Operating Cost to City: $1.3M-1.7M per center (after revenue)
For budgeting, we conservatively estimate $2.5M per center total city investment.
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PATIENT ELIGIBILITY
Who Can Use Wellness Centers?
EVERYONE. Services open to all Louisville residents who are here lawfully, regardless of:
Payment Structure:
No Insurance: Sliding scale based on income
Medicaid/Medicare: Standard coverage, no copays for most
Private Insurance: In-network rates, standard copays
No one turned away for inability to pay. Ever.
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PARTNERSHIPS
HEALTHCARE SYSTEM INTEGRATION
University of Louisville Hospital:
Norton Healthcare:
Baptist Health:
Local Pharmacies:
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COMMUNITY PARTNERSHIPS
Schools:
Churches/Faith Communities:
Community Centers:
Nonprofits:
Parks & Recreation:
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STAFFING & HIRING
YEAR 1 HIRING TIMELINE
Months 1-3: Leadership
Months 4-6: Clinical Staff
Months 7-9: Support Staff
Months 10-12: Launch Prep
CAREER PATHS
Entry Level:
Mid-Level:
Senior Level:
Benefits:
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QUALITY METRICS
WHAT WE MEASURE
Patient Outcomes:
Access Metrics:
Utilization:
Financial:
Community Impact:
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EXPECTED OUTCOMES
YEAR 1 (6 Centers)
YEAR 2 (12 Centers)
YEAR 3 (18 Centers – Complete)
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BUDGET SUMMARY
3-YEAR INVESTMENT:
Year 1: $15M (6 centers + startup costs)
Year 2: $30M (12 centers total)
Year 3: $45M (18 centers total)
Total 3-Year Investment: $90M
Ongoing Annual Cost (Year 3+): $45M
Return on Investment:
Plus immeasurable benefits:
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RISK MITIGATION
Challenge: Finding qualified staff
Mitigation: Competitive salaries, loan repayment, partnerships with UofL medical/nursing schools
Challenge: Community skepticism
Mitigation: Early engagement, advisory boards, cultural competency training
Challenge: Sustaining funding
Mitigation: Revenue capture, grant applications, demonstrated ROI
Challenge: Integration with existing healthcare
Mitigation: Partnership agreements, care coordination protocols
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WHAT THIS BUILDS ON
Community health centers that put primary care, mental health care and social services under one roof already operate in cities across the country. The return this plan is built on, $5.60 saved for every $1 spent, is documented in the Research Bibliography.
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CONCLUSION
18 Community Wellness Centers represent a fundamental transformation in how Louisville delivers healthcare.
One-stop access: Primary care + mental health + social services under one roof
Affordable: Sliding scale, no one turned away
Effective: 35% ER reduction, better health outcomes, $5.60 ROI per dollar
This is how we address the root causes of crime (untreated mental illness, addiction)
This is how we reduce healthcare costs (prevention cheaper than crisis)
This is how we build a healthier Louisville for everyone
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For Implementation Questions:
Email: dave@rundaverun.org
Website: rundaverun.org/wellness-centers
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WELLNESS CENTERS OPERATIONS MANUAL
Budget Version 3.1 | Updated October 2025
Comprehensive Care. Accessible. Affordable. Evidence-Based.
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