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Community Wellness Centers Operations Manual

18 Centers Delivering Comprehensive Care: Operational Blueprint

Budget Version: 3.1
Date: October 12, 2025
Total Investment: $45M annually (when fully operational) | $135M 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
• Sliding-scale fees based on ability to pay
• Accept Medicaid, Medicare, private insurance
• No one turned away for inability to pay

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:

• 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)

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. West End: Russell (40203) – PRIORITY high-need area
2. South Louisville: Okolona (40219)
3. Southwest: Shively (40216)
4. East End: St. Matthews area (40207)
5. Central: Old Louisville (40208)
6. Northeast: Fern Creek (40291)

Why These Locations:

• Geographic distribution across Louisville
• High unmet health needs
• Proximity to target populations
• Community support strong
• Available real estate

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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. West End: Portland (40212)
8. South: Newburg (40218)
9. Southwest: Pleasure Ridge Park (40258)
10. East: Middletown (40243)
11. Central: Highlands (40204)
12. Northeast: Buechel (40220)

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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. West End: Shawnee (40211)
14. South: Valley Station (40272)
15. Southwest: Fairdale (40118)
16. East: Jeffersontown (40299)
17. Central: Clifton (40206)
18. Northeast: Highview (40228)

Result: Every Louisville resident within 15-20 minutes of a wellness center.

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SERVICES OFFERED

PRIMARY CARE ($900K per center annually)

Hours: Monday-Friday 8am-6pm, Saturday 9am-2pm

Services:

• 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

Staffing:

• 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

Capacity: 80-100 patients daily, 20,000+ visits annually per center

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MENTAL HEALTH SERVICES ($700K per center annually)

Hours: Monday-Friday 9am-7pm (extended evening hours), Saturday 9am-2pm

Services:

• 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)

Staffing:

• 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

Capacity: 50-60 therapy sessions daily, 12,000+ sessions annually

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SOCIAL SERVICES NAVIGATION ($400K per center annually)

Hours: Monday-Friday 8am-5pm

Services:

• 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)

Staffing:

• 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

Capacity: 30-40 clients assisted daily, 8,000+ annually

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HEALTH EDUCATION & COMMUNITY PROGRAMS ($250K per center annually)

Services:

• 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)

Staffing:

• 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

Participation: 200+ community members monthly in programs

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ADMINISTRATION & OPERATIONS ($250K per center annually)

Staffing:

• 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

Facility Costs:

• Rent (10,000 sq ft @ $20/sq ft): Included in capital
• Utilities: Included in capital
• Insurance: Included in capital
• Maintenance: Included in capital

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FACILITY SPECIFICATIONS

PHYSICAL SPACE

Size: 10,000 square feet per center

Layout:

Waiting Area (800 sq ft):

• Comfortable seating for 25-30 people
• Children’s play area
• Health education materials
• ADA accessible

Primary Care Clinic (3,000 sq ft):

• 8 exam rooms
• Procedure room
• On-site lab
• Medication room
• Nurse station

Mental Health Wing (2,500 sq ft):

• 6 private therapy offices
• 2 group therapy rooms
• Quiet room (crisis intervention)
• Psychiatrist office

Social Services Area (1,500 sq ft):

• 4 private consultation offices
• Computer lab (4 stations for job search, benefits applications)
• Resource library

Community Room (1,200 sq ft):

• Multi-purpose space for classes, support groups
• Kitchenette for cooking demos
• AV equipment

Staff Areas (800 sq ft):

• Staff break room
• Conference room
• Staff restrooms
• Storage

Administrative (400 sq ft):

• Director office
• Billing office
• IT closet

Support Spaces (800 sq ft):

• Medical records room
• Medical supply storage
• Janitorial closet
• Public restrooms (2)

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OPERATING COSTS PER CENTER

Total Annual Cost: $2.5 Million

Personnel: $1.6M

• Primary care staff: $900K
• Mental health staff: $700K
• Social services staff: $400K
• Health education: $160K
• Administration: $280K

Facility: $300K

• Rent/lease (10,000 sq ft @ $25/sq ft): $250K
• Utilities: $30K
• Property insurance: $15K
• Maintenance: $5K

Supplies & Equipment: $300K

• Medical supplies: $100K
• Pharmaceuticals (sample medications): $50K
• Lab supplies: $40K
• Office supplies: $20K
• IT/technology: $40K
• Program materials: $50K

Technology & IT: $100K

• Electronic health records (EHR): $40K
• Telehealth platform: $20K
• IT support: $20K
• Software licenses: $10K
• Equipment maintenance: $10K

Professional Services: $100K

• Credentialing/licensing: $20K
• Legal/compliance: $25K
• Accounting: $20K
• Malpractice insurance: $25K
• Consulting: $10K

Miscellaneous: $100K

• Community events: $30K
• Marketing/outreach: $25K
• Staff training/development: $25K
• Emergency fund: $20K

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

• 40-50% of patients Medicaid-eligible
• Center bills Medicaid for services
• Reimbursement rates apply

Medicare: $150K-200K

• Senior patients covered
• Standard Medicare reimbursement

Private Insurance: $100K-150K

• Patients with employer insurance
• In-network contracts negotiated

Sliding Scale Payments: $50K-100K

• Patients with income pay reduced fees
• Based on federal poverty guidelines

Grants: $100K-150K

• Federal health center grants
• State health department funding
• Foundation grants
• Corporate partnerships

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 regardless of:

• Income level
• Insurance status
• Immigration status
• Employment status
• Housing status

Payment Structure:

No Insurance: Sliding scale based on income

• 100% of Federal Poverty Level: FREE
• 100-200% FPL: $10-25 per visit
• 200%+ FPL: $40-60 per visit (still affordable)

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:

• Specialist referrals
• Complex case coordination
• Training site for medical residents
• Emergency backup

Norton Healthcare:

• Specialist network access
• Diagnostic imaging referrals
• Inpatient care coordination

Baptist Health:

• Similar partnerships
• Geographic coverage

Local Pharmacies:

• Prescription discount programs
• Medication delivery for homebound
• Chronic disease medication management

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COMMUNITY PARTNERSHIPS

Schools:

• School nurse coordination
• Student health services
• Parent education programs
• Athletic physicals

Churches/Faith Communities:

• Outreach locations
• Health ministry partnerships
• Space for support groups

Community Centers:

• Co-locate programs
• Shared resources
• Cross-referrals

Nonprofits:

• Housing organizations
• Food pantries
• Job training programs
• Legal aid

Parks & Recreation:

• Exercise programs
• Wellness classes
• Community events

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STAFFING & HIRING

YEAR 1 HIRING TIMELINE

Months 1-3: Leadership

• Hire Director of Wellness Centers (oversees all 18)
• Hire 6 Center Directors
• Establish HR processes

Months 4-6: Clinical Staff

• Recruit physicians, nurse practitioners
• Hire mental health professionals
• Recruit social workers

Months 7-9: Support Staff

• Medical assistants
• Front desk staff
• Community health workers
• Billing specialists

Months 10-12: Launch Prep

• Staff training
• Practice workflows
• Soft opening
• Grand opening

CAREER PATHS

Entry Level:

• Medical Assistant: $40-50K
• Community Health Worker: $45-55K
• Front Desk: $35-45K

Mid-Level:

• Nurse Practitioner: $110-140K
• Social Worker: $65-80K
• Counselor: $65-80K

Senior Level:

• Physician: $180-220K (PT)
• Psychiatrist: $200-250K (PT)
• Center Director: $90-110K

Benefits:

• Health insurance
• Retirement (city plan)
• Student loan assistance (for hard-to-fill positions)
• Professional development
• Flexible schedules

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QUALITY METRICS

WHAT WE MEASURE

Patient Outcomes:

• Diabetes control (HbA1c levels)
• Blood pressure control
• Depression/anxiety improvement (PHQ-9, GAD-7 scores)
• Substance abuse recovery rates
• Patient satisfaction scores

Access Metrics:

• Wait time for appointments
• Same-day availability
• Insurance coverage rates
• Sliding scale utilization
• Language access

Utilization:

• Patient visits per month
• Services per patient
• ER visits by center patients (should decrease)
• Hospital admissions (should decrease)
• Medication adherence rates

Financial:

• Cost per patient
• Revenue capture rate
• Medicaid enrollment assistance
• Charity care provided

Community Impact:

• Health education participants
• Community satisfaction surveys
• Referral network effectiveness

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EXPECTED OUTCOMES

YEAR 1 (6 Centers)

• 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

YEAR 2 (12 Centers)

• 240,000 patient visits
• 60,000 unique patients served
• 30% reduction in ER visits
• Measurable chronic disease improvement
• Mental health wait times reduced citywide

YEAR 3 (18 Centers – Complete)

• 360,000 patient visits
• 90,000 unique patients served
• 35% reduction in ER visits
• Significant health disparities reduction
• $80M+ saved in avoided ER/hospital costs

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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:

• Every $1 spent saves $5.60 in healthcare costs
• $45M investment = $81M in savings
• Net positive: $36M annually

Plus immeasurable benefits:

• Healthier population
• Reduced suffering
• Economic productivity
• Crime reduction (health and crime are linked)

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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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COMPARISON WITH OTHER CITIES

Cities with Similar Models:

Denver, CO:

• 12 community health centers
• 250,000 patients served annually
• 40% reduction in ER visits by patients
• $150M saved in healthcare costs

San Francisco, CA:

• 15 primary care clinics + mental health integration
• Universal healthcare access
• Significant health disparity reduction

Baltimore, MD:

• Community health centers in underserved areas
• 35% improvement in chronic disease outcomes
• Strong Medicaid enrollment

Portland, OR:

• Integrated behavioral health model
• Mental health + primary care co-location
• Proven cost savings

Louisville will build on these proven models.

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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: implementation@rundaverun.org
Website: rundaverun.org/wellness-centers

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WELLNESS CENTERS OPERATIONS MANUAL
Budget Version 3.1 | Updated October 12, 2025

Comprehensive Care. Accessible. Affordable. Evidence-Based.