board of managers meeting - central health...5.4.2011 – board minutes - 1 minutes of meeting –...

Board of Managers meeting

May 18th, 2011

AGENDA ITEM C1

Approve minutes for the following meetings of the Central Health Board of Managers:

a. May 4, 2011

5.4.2011 – Board Minutes - 1

MINUTES OF MEETING – MAY 4, 2011

CENTRAL HEALTH BOARD OF MANAGERS MEETING

On Wednesday, May 4th, 2011, a meeting of the Central Health Board of Managers convened in open session at 5:35 pm in the Board Room of the Central Health Administrative Offices located at 1111 E. Cesar Chavez St., Austin, TX 78702. Clerk for the meeting was Shanna Willner.

Board Members present: Chairperson Coopwood, Vice-Chairperson Mendoza, Treasurer Rodriguez, Manager Hudson, Manager Lightsey, Manager Heidrick, and Manager Haley.

CITIZENS’ COMMUNICATION

Clerk’s Notes: Dr. Tom Coopwood spoke about the Central Health employee lunch on April 28th, 2011 and the Board Retreat on April 30th, 2011. Ms. Barbara Grove spoke in support of providing services to the Dove Springs neighborhood. Ms. Eliza Galahan spoke in support of providing services to the Dove Spring neighborhood. Mr. Alfred Krebs spoke in support of providing services to the Dove Spring neighborhood. Ms. Ofelia Zapata spoke in support of providing services to the Dove Spring neighborhood. Ms. Nidia Oprta spoke in support of providing services to the Dove Spring neighborhood. Ms. Haria Peia spoke in support of providing services to the Dove Spring neighborhood. Ms. Roxanne [unknown last name] spoke in support of providing services to the Dove Spring neighborhood. Ms. Maria Cachola spoke in support of providing services to the Dove Spring neighborhood. Ms. Leonor Varga spoke in support of providing services to the Dove Spring neighborhood. Mr. Bruce Bower spoke in support of providing services to the Dove Spring neighborhood. Ms. Cathy Cranston spoke in support of People’s Community Clinic becoming a look-alike FQHC. Mr. Eric Holloway spoke in support of providing services to the Dove Spring neighborhood. Mr. Jeff Kohoe spoke in support of People’s Community Clinic. Ms. Donna Hagey spoke in support of providing services to the Dove Spring neighborhood. Mr. Frank Campus spoke in support of providing services to the Dove Spring neighborhood. Manager Daniel arrive at 6:20pm.


REGULAR AGENDA 4. Discuss and take appropriate action on a request to build a multi-purpose facility in the Dove

Springs neighborhood. Clerk’s Notes: This item was taken out of order. Chairperson Coopwood reviewed Central Health’s history of response to the Dove Springs community and listed action taken by Central Health in the last two years, including the building of the William Canon Health Clinic and the current service expansion that is under construction. Manager Rodriguez made a motion to postpone consideration on item 4. Manager Hudson made an Amendment to the motion to look at actual community needs and assets in Dove Springs in the interim. Manager Haley seconded the motion. Vice-Chairperson Mendoza spoke stating she wanted to be clear to the people in the community that purchase of land or a building in Southeast Austin would in no way preclude services being provided to Dove Springs. Chairperson Coopwood expressed his belief that it was not the role or the business of Central Health to build multi-purpose facility centers. He indicated that the business of Central Health was adding clinical space to meet healthcare needs and that this other request was not within the mission of the organization. Manager Rodriguez commented that social wellness was a large contributing factor to health. Other Board members wanted to further explore and define what was meant by a multi-purpose facility. The Board of Managers had further discussion regarding different ways to proceed to respond to the relevant needs of the Dove Springs Community. The board voted in response to the motion made by Manager Rodriguez.

Chairperson Tom Coopwood Against Vice-Chairperson Rosie Mendoza For

Treasurer Frank Rodriguez For Secretary Brenda Coleman-Beattie Absent

Manager Anthony Haley For Manager Clarke Heidrick For Manager Katrina Daniel For Manager Rebecca Lightsey For Manager Lynne Hudson For

5. Receive and discuss information regarding a request for a letter of support from People’s

Community Clinic. Clerks Notes: This item was taken out of order. Ms. Regina Rogoff, CEO of People’s Community Clinic (PCC) and Mr. Phil Dial, Treasurer of the Board at PCC, requested that the Central Health Board provide a letter supporting PCC’s application to receive FQHC Look-Alike status from the Federal Government. Mr. Dial said that PCC would receive an additional $1-$2 million in federal funding if they were granted Look-Alike status and that these


funds would allow PCC to expand their services and capacity for seeing patients. PCC described itself as a private sector compliment to the work of CommUnityCare (CHC) and Central Health. Mr. Dial explained that FQHC status is a route to expansion of service in Travis County Area. PCC applied last fall for full FQHC status. Their 330 Grant application is pending. Since then, they have changed their vision and are asking for support from Central Health for Look-Alike FQHC status. Mr. Dial said that Look-Alike status is a fall back position. PCC has asked Central Health’s board for support as a starting point, and would also seek support from the CommUnityCare Board of Directors. Manager Lightsey asked what PCC saw as its role in the community and how this would change with Look-Alike status. The PCC representatives said they were trying to expand their revenue based on their current client base. Board members also asked about PCC’s interest or willingness to engage in an MOU, or affiliation agreement with CommUnityCare. PCC said it believed their independence adds variety to the community and allows them to fund-raise which also adds value. PCC said it would be sensitive to organizations already established in the service area when it sought expansion locations. The board discussed the impact of shared service areas and the role of PCC in the community. Manager Heidrick spoke noting his respect for the achievement and work of People’s Community Clinic and his understanding of the issue as it stood. The Board spoke of its interest in creating an efficient system of health care delivery. Manager Rodriguez left at 7:15 pm.

CONSENT AGENDA C1. Approve minutes for the following meetings of the Central Health Board of Managers:

a. April 20, 2011 Clerk’s Notes: Vice-Chairperson Mendoza moved to approve item C1 with the changes already communicated to staff.

Chairperson Tom Coopwood For Vice-Chairperson Rosie Mendoza For

Treasurer Frank Rodriguez Absent Secretary Brenda Coleman-Beattie Absent


The board took a ten minute break at 7:20 pm. The board reconvened at 7:30 pm.

REGULAR AGENDA 1. Receive and discuss information related to Central Texas Community Health Centers d/b/a

CommUnityCare and its relationship with Central Health. Clerks Notes: Trish Young Brown, President and CEO, presented the background and history of the relationship between Central Health and CommunityCare, and reviewed at length the relationship created by the shared FQHC status.


2. Receive and discuss an update on CommUnityCare operations for the second quarter of

Fiscal Year 2011. Clerk’s Notes: David Vliet, CEO of CommUnityCare, and Leslee Froehlich, Chief Operating office of CommUnityCare, walked through CommunityCare’s Fiscal Year 2011 2nd Quarter report. They reviewed the status and progress made by the organization in the last quarter and extensively discussed data provided in the written report given to the Board. 3. Discuss and take appropriate action on a grant application with the Texas Department of

State Health Services regarding an HIV testing program. Clerk’s Notes: Leslee Froehlich, Chief Operating Officer for CommUnityCare, asked the board if they had any questions regarding this pilot program. Chairperson Coopwood asked questions determining how the results of the test pilot would be judged. Ms. Leslee Froehlich said with the pilot would be evaluated against baseline numbers to which pilot program data could be compared. Manager Daniel noted that this had been a tested model and that this process has been successfully used in many major cities.

Chairperson Tom Coopwood For Vice-Chairperson Rosie Mendoza For

Treasurer Frank Rodriguez Absent Secretary Brenda Coleman-Beattie Absent


6. Confirm the next regular Board meeting date, time, and location. Citizens Note: Chairperson Coopwood announced that the next regularly-scheduled meeting will be on Wednesday, May 18, 2011, at 5:30 p.m., in the Granger Building, First Floor, Commissioners Courtroom, 314 West 11th Street, Austin, Texas 78701. Chairperson Coopwood announced the meeting was adjourned. The meeting adjourned at 9:21 pm. ____________________________________ Tom Coopwood, M.D. Chairperson Central Health Board of Managers ATTESTED TO BY: ____________________________________ Brenda Coleman-Beattie, Secretary Central Health Board of Managers


May 18th, 2011

AGENDA ITEM C2

Receive the April 2011 Investment Report and ratify Central Health investments for April 2011.


May 18th, 2011

AGENDA ITEM C3

Receive the Central Health Investment Report for the Second Quarter Ending March 31, 2011.


May 18th, 2011

AGENDA ITEM C4 (No Backup)

Approve the appointment of Manager Daniel to serve on the Ad

Hoc Personnel Committee.


May 18th, 2011

AGENDA ITEM C5 (No Backup)

Approve the appointment of Manager Hudson to serve on the Audit & Compliance Committee and the Performance Improvement Subcommittee.


May 18th, 2011

AGENDA ITEM C6 (Backup to be provided separately)

Approve the domestic equity fund replacement as recommended by Southwest Retirement Advisors for the 457 Deferred Compensation Plan.


May 18th, 2011

AGENDA ITEM 1

Receive and discuss a report of the April 2011 financial statements for Central Health.

April 2011 Financial Statements Page 1 of 2 Statement of Revenues, Expenses and Changes in Net Assets Operating Revenues DSH/UPL – received payments for DSH and UPL in April for additional rent of $5.4 million, and $16.1 million for the year. Operating Lease – received the monthly lease payments for Brackenridge and Austin Women’s Hospital. Operating Expenses Healthcare delivery – $5.6 million for the month and $50.9 million for the year are 49.6% of FY2011 annual budget. Received a small refund of $848 from the State Comptroller for 2010 regional UPL IGTs, and made the scheduled $2 million monthly deposit to the UPL bank account. Healthcare expense for the month includes $345k accrued for amounts due to Seton for charity care and home health ($2.4 million fiscal year to date). Salaries & Benefits – $448k for the month and $3 million for the year, in line with recent payrolls and within year to date budget. Other Purchased Goods & Services – $369k for the month and $1.7 million for the year remain well within budget. Non Operating Revenues Tax Revenue – $281k for the month, and $67 million for the year reflect the normal pattern of tax collections, which peaked in December and January. Tobacco Settlement – Received 2011 net revenue of $1.64 million, which is $241k more than the annual budget of $1.4 million. Investment Income – $61k for the month and $448k for the year, in line with prior months, and continuing to lag behind budget.

April 2011 Financial Statements Page 2 of 2 Other revenue – $53k for the month and $248k for the year are drawdowns from Federal ARRA grants for the South and East clinic construction projects. The change in net assets of $857k for the month and $28.8 million for the year are consistent with this time of year, reflecting that our major source of revenue has peaked for the year. Statement of Net Assets (Balance Sheet) Assets Cash balance of $24k is the balance in the operating bank account. The Medicaid/UPL bank account ends the month with a balance of $4.1 million, after a deposit of $2 million for the month. The District had $142 million in investments at the end of the month, but we separate these into current assets of $133 million and noncurrent assets of $9 million restricted for capital acquisition. Ad valorem taxes receivable of $1.4 million reflects the fiscal year’s tax levy, less year-to-date collections of $67.1 million. Other Receivables – major components of this $12.6 million balance are $6 million due from Seton for Dell Children’s DSH/UPL; $47k in property taxes collected in March and remitted in April; $359k in interest receivable; and $6.1 million due from CommUnityCare – short term – there is another $4 million in a long-term receivable from CommUnityCare in the noncurrent asset section. The short-term balance due from CommUnityCare reflects a $235k payment received in April. Liabilities Accounts payable – Major components of this $7.6 million balance are $2.4 million due to Seton for charity care and home health; $3M due to Seton for the urban UPL IGT received on April 29; $228k in invoices received but not yet posted; $214k checks issued and outstanding; and $1.7 million estimated costs incurred but not yet reported by healthcare providers.

April 2011 Financial Statements Page 1 of 2 Statement of Revenues, Expenses and Changes in Net Assets Operating Revenues DSH/UPL – received payments for DSH and UPL in April for additional rent of $5.4 million, and $16.1 million for the year. Operating Lease – received the monthly lease payments for Brackenridge and Austin Women’s Hospital. Operating Expenses Healthcare delivery – $5.6 million for the month and $50.9 million for the year are 49.6% of FY2011 annual budget. Received a small refund of $848 from the State Comptroller for 2010 regional UPL IGTs, and made the scheduled $2 million monthly deposit to the UPL bank account. Healthcare expense for the month includes $345k accrued for amounts due to Seton for charity care and home health ($2.4 million fiscal year to date). Salaries & Benefits – $448k for the month and $3 million for the year, in line with recent payrolls and within year to date budget. Other Purchased Goods & Services – $369k for the month and $1.7 million for the year remain well within budget. Non Operating Revenues Tax Revenue – $281k for the month, and $67 million for the year reflect the normal pattern of tax collections, which peaked in December and January. Tobacco Settlement – Received 2011 net revenue of $1.64 million, which is $241k more than the annual budget of $1.4 million. Investment Income – $61k for the month and $448k for the year, in line with prior months, and continuing to lag behind budget.

April 2011 Financial Statements Page 2 of 2 Other revenue – $53k for the month and $248k for the year are drawdowns from Federal ARRA grants for the South and East clinic construction projects. The change in net assets of $857k for the month and $28.8 million for the year are consistent with this time of year, reflecting that our major source of revenue has peaked for the year. Statement of Net Assets (Balance Sheet) Assets Cash balance of $24k is the balance in the operating bank account. The Medicaid/UPL bank account ends the month with a balance of $4.1 million, after a deposit of $2 million for the month. The District had $142 million in investments at the end of the month, but we separate these into current assets of $133 million and noncurrent assets of $9 million restricted for capital acquisition. Ad valorem taxes receivable of $1.4 million reflects the fiscal year’s tax levy, less year-to-date collections of $67.1 million. Other Receivables – major components of this $12.6 million balance are $6 million due from Seton for Dell Children’s DSH/UPL; $47k in property taxes collected in March and remitted in April; $359k in interest receivable; and $6.1 million due from CommUnityCare – short term – there is another $4 million in a long-term receivable from CommUnityCare in the noncurrent asset section. The short-term balance due from CommUnityCare reflects a $235k payment received in April. Liabilities Accounts payable – Major components of this $7.6 million balance are $2.4 million due to Seton for charity care and home health; $3M due to Seton for the urban UPL IGT received on April 29; $228k in invoices received but not yet posted; $214k checks issued and outstanding; and $1.7 million estimated costs incurred but not yet reported by healthcare providers.

Travis County Healthcare DistrictStatement of Revenues, Expenses & Changes in Net Assets

From 4/1/2011 Through 4/30/2011(In Whole Numbers)

MonthActual - This

Year to DateActual - Fiscal

Year to DateBudget - Fiscal

Year TotalBudget - Fiscal

Year to DateActual - Prior

Operating revenues:Additional Rent/Seton 5,398,905 16,105,549 14,590,218 28,389,113 19,042,512 Operating lease revenue 96,283 673,981 673,981 1,155,396 673,981

Total Operating revenues: 5,495,188 16,779,530 15,264,199 29,544,509 19,716,493

Operating expenses:Health care delivery 5,600,598 50,864,370 63,020,889 102,490,901 45,349,814 Salaries and benefits 448,309 3,006,132 3,590,580 6,059,833 2,790,664 Other purchased goods and services 368,604 1,753,621 2,326,148 4,604,021 1,149,937 Depreciation 189,937 1,343,259 1,458,333 2,500,000 1,363,730

Total Operating expenses: 6,607,448 56,967,382 70,395,951 115,654,754 50,654,144

Operating income (loss) (1,112,260) (40,187,853) (55,131,752) (86,110,245) (30,937,651)

Nonoperating revenues (expenses):Ad valorem tax revenue 281,083 67,114,136 65,643,040 66,431,022 65,401,931 Tax assessment and collection expense (66,482) (456,419) (467,822) (801,980) (429,076)Tobacco settlement revenue, net 1,641,354 1,641,354 1,400,000 1,400,000 1,390,461 Investment income 60,845 447,884 1,050,000 1,800,000 665,315 Other revenue 53,066 248,924 0 0 67,795

Total Nonoperating revenues (expenses): 1,969,867 68,995,879 67,625,219 68,829,042 67,096,425

Changes in net assets 857,607 28,808,026 12,493,467 (17,281,203) 36,158,774

Total net assets - end of year 857,607 28,808,026 12,493,467 (17,281,203) 36,158,774

Date: 5/10/11 12:45:22 PM AAA Income Statement Page: 1


May 18th, 2011

AGENDA ITEM 2 (No Backup)

Discuss and take appropriate action on an amendment to the

2011 capital budget to appropriate $10 million for the purchase and renovation of real estate in Southeast Travis County.¹


May 18th, 2011

AGENDA ITEM 3

Discuss and take appropriate action on a Reimbursement Resolution for the financing of the purchase of real estate in

Southeast Travis County.¹

RESOLUTION EXPRESSING INTENT TO FINANCE EXPENDITURES TO BE INCURRED

WHEREAS, the Travis County Healthcare District (the “District”) is a political subdivision of the State of Texas authorized to finance its activities by issuing obligations; and

WHEREAS, the District will make, or has made not more than 60 days prior to the date hereof, payments with respect to the acquisition, construction, reconstruction or renovation of the projects listed below in Section 2 below (the “Financed Project”); and

WHEREAS, the District has concluded that it does not currently desire to issue obligations to finance the costs associated with the Financed Project; and

WHEREAS, the District desires to reimburse itself for the costs associated with the Financed Project from the proceeds of obligations to be issued subsequent to the date hereof; and

WHEREAS, the District reasonably expects to issue obligations to reimburse itself for the costs associated with the Financed Project;

NOW, THEREFORE, be it resolved that:

Section 1. The District reasonably expects to reimburse itself for costs that have been or will be paid subsequent to the date that is 60 days prior to the date hereof and that are to be paid in connection with the acquisition, construction, reconstruction or renovation of the Financed Project from the proceeds of obligations to be issued subsequent to the date hereof.

Section 2. The District reasonably expects that the maximum principal amount of obligations issued to reimburse the District for the costs associated with the Financed Project, which includes certain capital expenditures for a health care facility located within the District (including acquisition of land related thereto) and District administrative facilities, including the acquisition, construction, reconstruction, renovation or equipping of such health care and administrative facilities, will be $10,000,000.

ADOPTED THIS ______ day of May, 2011, by the Board of Directors of the District.

By: ______________________________ Chairman, Board of Directors

US 867360v1


May 18th, 2011

AGENDA ITEM 4

Discuss and take appropriate action on the use of service expansion funds to increase the contract amount with People’s Community Clinic.

Central Health Request for Board of Managers Consideration

May 18, 2011 Agenda Item #4: Discuss and take appropriate action on the use of service expansion funds to increase the contract amount with Peoples Community Clinic. Recommended Board Action: Approve the use of service expansion funds to the increase contract amount from $728,000 to $950,000 to support additional primary care services though September 30, 2011.

Strategic Direction: Develop expanded capacity to assist people in accessing proper healthcare resources. Resource Impact: Central Health has funding available in the current FY 2011 budget. This funding request was included in the budget amendment recently approved by the County. Anticipated Result: This contract amendment is anticipated to increase the availability of primary and preventive care services available to eligible patients.

Summary: Central Health entered into a contract with People’s to support indigent healthcare services. That contract was subsequently assigned to Central Health at the District’s formation. The 2004 contract allowed for up to six, one-year renewals.

Since Central Health began contracting with People’s a number of changes have been made to the contract including: the establishment of a fee-for-service rate, changes to that rate, the expansion of the target population to include MAP enrollees in addition to self-pay clients, and the addition of support for integrated mental health visits. In October 2010 the sixth renewal was approved. Based on current utilization and projected utilization, the annual contract amount of $728,000 needs to be increased by an additional $222,000 to a total of $950,000 to continue to support primary care services through September 30, 2011. Board Committee Coordination: COMMITTEE CHAIR COMMENTS DATE

CONSIDEREDBudget & Finance Frank Rodriguez Not Reviewed – No

Quorum at B&F Comm. 5.12.11

Board of Managers Tom Coopwood, M.D.


May 18th, 2011

AGENDA ITEM 5

Discuss and take appropriate action on the use of service expansion funds to increase the contract amount with CTMF,

Inc. d/b/a Austin Medical Education Program (Blackstock Family Health Center).

Central Health Request for Board of Managers Consideration

May 18, 2011 Agenda Item #5: Discuss and take appropriate action on the use of service expansion funds to increase the contract amount with CTMF, Inc. d/b/a Austin Medical Education Program for Family Medicine Services (including primary and preventive care) for MAP enrollees (“Eligible Patients”) Medical Assistance Program for services provided at the Blackstock Family Health Center. Recommended Board Action: Approve the use of service expansion funds to increase contract amount to from $100,000 to $200,000 to support additional primary care services though September 30, 2011.

Strategic Direction: Develop expanded capacity to assist people in accessing proper healthcare resources. Resource Impact: Central Health has funding available in the current FY 2011 budget. This funding request was included in the budget amendment recently approved by the County.

Anticipated Result: This contract amendment is anticipated to increase the availability of primary and preventive care services available to eligible patients.

Summary: Background: On December 1, 2008, Central Health entered into an agreement with CTMF, Inc. d/b/a Austin Medical Education Program for Family Medicine Services (including primary and preventive care) for MAP enrollees (“Eligible Patients”) in the Medical Assistance Program with services provided at the Blackstock Family Health Center. Previously this agreement was part of the lease arrangement with Seton Healthcare. In December 2009, the First (and last) Renewal and Amendment was approved which did the following: Increased from 240 to 670 Eligible Patients whose assigned primary care provider (“PCP”) is

Blackstock Family Health Center; Increased reimbursement from 108% of the Medicare fee schedule to 115% of the Medicare fee

schedule prevailing on the date of service; and Adjust the annual contract amount from the Initial Cap of $300,000 to $200,000. In December 2010 Central Health entered into a new agreement with CTMF. The new agreement did the following: Due to low utilization from the prior year, decreased the contract Cap to $100,000; and; Increased reimbursement from 115% of the Medicare fee schedule to 133% of the Medicare fee

schedule prevailing on the date of service. In March 2011 the contract was amended. The amendment did the following:

Expanded the scope to include integrated behavioral health services and; Synced up the contract dates to Central Health’s fiscal year.

Based on current utilization and projected utilization, the annual contract amount of $100,000 needs to be increased by an additional $100,000 to a total of $200,000 to continue to support primary care services through September 30, 2011.

Board Committee Coordination: COMMITTEE CHAIR COMMENTS DATE

CONSIDEREDBudget & Finance Frank Rodriguez Not Reviewed – No

Quorum at B&F Comm. 5.12.11

Board of Managers Tom Coopwood, M.D.


May 18th, 2011

AGENDA ITEM 6

Receive and discuss a presentation on Central Health’s preliminary FY 2012 budget.


May 18th, 2011


7. Receive and discuss an update from governmental affairs, including an update on: a. healthcare reform; and b. the state legislative session.


May 18th, 2011


Receive and discuss reports from the Board committees: Audit and Compliance Committee; Budget and Finance Committee; ad hoc Personnel Committee; ad hoc UMCB/Academic Medicine Committee and ad hoc Legislative Committee.


May 18th, 2011

AGENDA ITEM 9

Receive and discuss the CEO’s report on the following Central Health activities: (a) procurement activity; (b) Central Health

Connection; (c) current communications/outreach statistics; (d) the MAP Program, including enrollment and activities; (e) quarterly service update; (f) Annual plan of work; and (g)

Psychiatric Stakeholder’s Meeting.

Central Health Procurement Activity Report

Page 1 of 2

Through its purchasing policy (PUR1-001), the Board of Managers has authorized Central Health President and CEO to execute Central Health contracts with a value of less than $100,000 without requiring board action or approval and to execute certain contracts on its behalf that meet the pre-authorization criteria outlined in policy.

Table 1: Contract actions from April 13, 2011 through May 11, 2011 CONTRACT

ACTION VENDOR NAME DESCRIPTION OF CONTRACT AMOUNT NOTES / COMMENTS

Initial PSA Schneider Halls Design, Inc Professional Architectural Services –

Hancock Center Renovation $28,000 Red River Replacement

3rd Renewal & 2nd Amendment

The Orthotic Specialist Orthotic Care Services – Amend to FY $30,000

3rd Renewal & 2nd Amendment

Applied Orthotics Orthotic Care Services – Amend to FY $30,000

1st Amendment Integrated Care Collaboration

(ICC) Upgrade the ICare Systems $500,000

1st Amendment CTMF, Inc d/b/a AMEP

(Blackstock)

Family Medicine Services – Include Behavioral Health Services and Change Term

Date to Sync with FY No Change

2nd Amendment Rancho Texas 40 & Rancho

Texas 20 Investment Wells Fargo Lease – Extend Term Date until

10/31/11 – HMO $24,216

11th Amendment Walgreens Health Initiative Holdover the contract until August 31, 2011 No Change

Task Order 1 Asterisk Group, Inc Design Services – Waiting Area Signs for

Cesar Chavez $3,000

Task Order 2 Asterisk Group, Inc Design Services – Photo Shoot of Board

Members $1,800

PO 468 Ace Relocation Systems, Inc Move HQ From Wells Fargo to Cesar Chavez $5,000

PO 470 UniFirst Corp. Floor Mat Services for Cesar Chavez – 5

Months (FY11) $59

PO 472 Oce North America, Oce

Imagistics Comanche Copier – Remove Copier Hard

Drive for Destruction $314

PO 474 Apex Cost Consultants, Inc. Cost Estimating Consulting Services East

Austin Clinic $6,097

PO 475 Quest Analytics, LLC Healthcare Network Analysis Software

License - HMO $17,500

PO 484 Skyline Unlimited Temporary Staff – HMO $5,846 PO 332

Change Order 4 Zapalac/Reed Construction

General Construction Change – Cesar Chavez HQ Renovation

($41,835)

PO 370 Change Order 3

Workplace Resources Add Pencil Drawers to Private Office Desks –

Cesar Chavez Renovation $180

Central Health Procurement Activity Report

Page 2 of 2

CONTRACT ACTION

VENDOR NAME DESCRIPTION OF CONTRACT AMOUNT NOTES / COMMENTS


EEA Consulting Engineers Additional Construction Phase Services –

Cesar Chavez Renovation $950 Revise Board Room Lighting


Asterisk Group, Inc. Strategic Plan Graphics – Additional Fee for

Proofs and Concept Production $137

Conflict-of-Interest Statement Information:

Chapter 176 of the Local Government Code requires that local government officers file a conflict-of-interest statement disclosing certain relationships with a vendor within seven (7) days of becoming aware of facts that give rise to the conflict. Central Health has contracted with the following new vendors:

Quest Analytics, LLC

Schneider Halls Design, Inc

Please ensure that you have no conflict-of-interest with this vendor that would require the filing of a conflict-of-interest statement. You do not need to do anything if you have no conflict. Completed conflict-of-interest statements should be filed with the Central Health Purchasing Assistant (Tena Southwell). If you have any questions about whether you have a conflict, please contact Beth Devery. Vendor Debarment and Suspension List: Prior to awarding any contracts, state agencies and qualified local government purchasing entities are reminded to check the list of vendors excluded from doing business at the federal and state level by utilizing the following resources:

Federal Excluded Persons List System (EPLS) at http://www.epls.gov. Office of Texas Comptroller at http://www.window.state.tx.us/procurement/prog/vendor_performance/debarred/

Additionally, in compliance with Executive Order #13224 - "Blocking Property and Prohibiting Transactions with Persons Who Commit, Threaten to Commit or Support Terrorism," state agencies are responsible for ensuring they do not enter into transactions or issue payments to those individuals or organizations identified in the

Office of Foreign Assets Control list of Specially Designated Nationals (SDN) and Blocked Persons. The list may be found at http://www.ustreas.gov/offices/enforcement/ofac/sdn/.

The vendors listed on the Procurement Activity Report are not on the above mentioned Debarment and Suspension Lists.

* HUB Vendor

http://www.epls.gov/

http://www.window.state.tx.us/procurement/prog/vendor_performance/debarred/

http://www.ustreas.gov/offices/enforcement/ofac/sdn/

Board of Managers Update May 5, 2011 Staff is meeting bi-weekly with project lead Health Resources in Action to develop the Central Health Connection white paper and implement the Leader Dialogue. Health Resources in Action is partnering with Freedman Healthcare and Sierra Systems on the initiative. Staff and consultants are engaging stakeholders to develop a list of individuals and organizations that we want to engage in the Leader Dialogue. Initial interviews with stakeholders will begin at the end of May/early June. Stakeholder interviews will help identify issues of interest, individuals/organizations to engage and inform the overall design of the process. A draft outline of the white paper is being finalized and research collection has begun. The following is a high level overview and timeline of this effort.

Activity Proposed Timeframe and

Time Commitment

Stakeholder Interviews 1 hour

May - July

Release White Paper Part 1 Mid - August

Kick-off Event

Present White Paper Findings

Visionary Speaker and discussion

September 9, 2011 7:30 – 9:30 a.m. breakfast meeting

1st Dialogue Session

Draft a shared vision for health and healthcare in Central Texas and define components of a “Model Healthy Community”

September 30, 2011 7:30 – 9:30 a.m. breakfast meeting

2nd Dialogue Session

Finalize vision and components, develop shared outcomes

October 14, 2011 7:30 – 9:30 a.m. breakfast meeting

3rd Dialogue Session

Identify strategies and infrastructure in next 10-20 years to achieve outcomes

October 28, 2011 7:30 – 9:30 a.m. breakfast meeting

Wrap-up Session

Identify community partner roles, associated agreements, and next steps

December 9, 2011 7:30 – 9:30 a.m. breakfast meeting

Release Final White Paper including results of Dialogue

March 2011

1

Board Recognition Two new members, Rebecca Lightsey and Lynne Hudson, were appointed to the Board of Managers, replacing outgoing members Dr. Donald Patrick and Bobbie Barker, respectively.

Ongoing Projects Strategic Plan distribution, Annual Employee Recognition Luncheon, Sendero Health Plans branding & identity, relocation to Cesar Chavez office

Community Relations Pharmacy network change for MAP and Sliding Fee Scale Patients Ed Gomez is creating a communication plan with Central Health MAP and CommUnityCare for an upcoming pharmacy network change for MAP and Sliding Fee Scale patients. The target network change date is July 5, 2011. Greater Kansas City Chamber of Commerce Centurions Leadership Program visit On May 12, Maureen Britton, Executive Director for Childrenʼs Optimal Health presented with Ed Gomez to visitors in the Kansas City Leadership program on data collected and mapped by Childrenʼs Optimal Health and this areaʼs model of healthcare delivery.

Communications/Outreach Report April-May 2011

Presentations/Events

Date Topic/ Venue Presenter ~# attendance 4/28 Univision62 A Su Lado Tele-Marathon to answer community

questions about MAP. More than 300 calls were received. Eligibility Staff ~20

4/26 Our local safety net system/Experience Austin Christie Garbe ~30

4/15 Nuts & Bolts of Local Healthcare Infrastructure/Leadership Austin Essential Class

Trish Young Brown ~60

4/5

Quarterly Regional Healthcare Coverage Coalition meetings at Dell Children auditorium to educate, engage and build awareness of:

other healthcare programs in the region, availability of healthcare coverage;

how to assist families in applying for coverage; keep abreast of federal, state and local changes in eligibility/application processing and coverage;

and further develop outreach opportunities for families to enroll in programs.

Claudia Lindenberg & Stacy Wilson

65

Web Site Statistics Month Visits Unique

Visitors Page

views * Bounce Rate **

Time on Site Top 3 Pages

April 5,333 3,691 15,123 56.98 1:53 1) medical_assistance_program – 23.41% 2) centralhealth.net – 16.76%

3) about us – 7.76% March 6,102 4,182 17,398 57.59 2:04 1) medical_assistance_program – 20.78%

2) centralhealth.net – 17.09% 3) healthcare_services – 7.45%

Earned Media 5/5 Austin American-Statesman Is health program for needy Travis County residents

growing too fast?

4/22 Austin Chronicle The War on Womenʼs Health

2

Greater Kansas City Chamber of Commerce Centurions Leadership Program aims to prepare a cross-section of Kansas Cityʼs emerging leaders for their roles in shaping the future of Kansas City. The program includes active participation in educational programs and exposure to community leaders and issues. It is a two-year commitment and 30-35 new individuals are selected to participate each year. Find out more at www.centurions.org. Univisión A Su Lado Tele- Marathon On Thursday April 28 at Univision studios, fifteen eligibility specialists from Central Health received over 300 calls from the viewing public to navigate callers to health care access and inform them on the Medical Assistance Program (MAP). The event was held between 5:00 and 10:30 PM and was broadcast live between regular programming. Womenʼs Health Inaugural Event On Wednesday April 27, over 65 stakeholders, staff and friends of CommUnityCare gathered to celebrate the partnership with UT Southwestern Austin Residency Program and Seton Family of Hospitals as CommUnityCare assumed the management of Womenʼs High Risk Obstetrics practice. This partnership has expanded and enhanced the services to pregnant women in our service area. Tobacco Cessation Summit The “A Tobacco Free Workplace Makes Cents” summit has been confirmed for June 27, 2011 at the Palmer Events Center from 9:00 AM to 1:30 PM. Free Seminar and Lunch with Richard Carmona, M.D., M.P.H., FACS as keynote speaker. Save the Date.

Government Affairs Legislative Matters – Central Health Local Bills The Senate version of the bill that would permit Central Health to make a contribution to a charitable organization for medical education or training has been voted favorably out of both the House and Senate committees. We are now hoping for final passage. Similarly, the Senate bill that would permit Central Health to lease property without Commissioners Court approval has also been voted favorably out of both the House and Senate committees. We are now hoping for final passage of that bill as well. General Bills The House bill that would add hospital districts to the list of governmental entities that can withhold their audit work papers from disclosure under the Public Information Act has passed the House and will be sent to the Senate for committee referral. The last day on which the House can vote bills from committee is Monday, May 9. We are tracking about 400 bills and have been supporting those bills that increase access to healthcare and those that promote wellness. We have also been monitoring the activities on the State budget to see how those activities could impact Central Health. Other Meetings Stacy Wilson has been attending weekly meetings of Teaching Hospitals of Texas government relations staff, as well as the Texas Hospital Association Hospital Advocacy Group meetings to keep abreast of developments that may affect Central Health and CommUnityCare. She has also been attending the Texas Coalition of Transferring Hospitals meetings on behalf of Central Health. Upcoming Presentations On June 7, 2011, Stacy Wilson will make a presentation to the Regional Healthcare Coverage Collaborative, a group that Claudia Lindenberg and Kit Abney have formed, concerning the Texas legislative session.

MAP Enrollment

17,73818,311 18,387 18,551

18,887 19,05919,592 19,783 19,935

20,72021,034

21,957 21,991

8,000

10,000

12,000

14,000

16,000

18,000

20,000

22,000

24,000

May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11

Enrollment as of the 1st of Every Month

5/13/2011 1

FY2011 (10/1/10-3/31/11) Healthcare Service Expenditures

Provider Payment Rate Contracted Populations

Annual Budget Contract Start Date

Expenditures & Accruals

% of Budget

Primary Care

Blackstock Family Health Center (M)

133% Medicaid Fee Schedule MAP $100,000 12/1/2010 $80,970 81%

CommUnityCare (M)

Monthly Payment MAP, SFS, Medicaid, Medicare

$35,396,931 10/1/2010 $16,023,082 50%

(MH) $509,423

(D) $1,233,475

El Buen Samaritano (M)

$133 per encounter SFS $1,020,000 1/1/2010 $405,916 40%

LoneStar Circle of Care (M, BH)

$181.60 (Medicaid PPS) for MAP, $133 for SFS

MAP, SFS $3,029,995 6/1/2010 $1,319,953 44%

NextCare (Urgent Care) (M)

133% of Medicare fee Schedule MAP $100,000 6/15/2010 $60,484 60%

Paul Bass Internal Medicine Clinic (M, BH)

133% Medicare Fee Schedule MAP $709,647 8/1/2010 $250,731 35%

People’s Community Clinic (M, BH)

$133 per encounter, 133% Medicare fee schedule for MAP

SFS, MAP $728,000 10/1/2010 $441,895 61%

Project Access (M) Quarterly payment SFS $330,000 10/1/2010 $165,000 50%

Samaritan Health (M, D)

$133 per medical encounter; $91 per dental encounter

SFS $100,000 5/1/2010 $4,693 5%

SIMS Foundation (BH)

Fee-for-service SFS $265,000 1/1/2010 $120,340 45%

Volunteer HealthCare (M)

$133 per encounter SFS $100,000 3/1/2010 $35,863 36%

Note 1: M = primary medical care, D = primary dental care, BH = primary behavioral health care

5/13/2011 2

. FY2011 (10/1/10-3/31/11) Healthcare Service Expenditures Cont’d.

Provider Payment Rate Contracted

Populations Annual Budget Contract

Start Date Expenditures &

Accruals % of

Budget

Specialty Care

Austin Cancer Centers 133% Medicare Fee Schedule MAP $334,000 10/1/2010 $71,523 21%

Dental Specialty Care (Oral Surgery, Dentures, Pediatric Dentistry)

Fee-for-service MAP $773,711 10/1/2010 $120,625 16%

Eye Disease: Dr. Briggs Eye Screening: Multiple Providers


Multiple Specialties: Paul Bass Clinic


Women’s Health Services: Multiple Providers

Fee-for-service MAP $450,000 3/1/2010 $170,465 38%

Orthotics and Prosthetics: Multiple Providers

Medicare fee schedule MAP $27,000 4/7/2010 $8,193 30%

Medical Services Spot Purchased as Needed MAP $110,000 N/A $0 0%

Hospital Services

General Medical Hospital: Seton Healthcare Network

Monthly Payment Charity Care, home health,

equipment for MAP

$4,140,697 10/1/2010 $2,070,348 50%

General Medical Hospital: Seton/TCHD Medicaid

Quarterly contribution UPL Participation

$24,000,000 10/1/2010 $12,762,020 53%

5/13/2011 3

FY2011 (10/1/10-3/31/11) Healthcare Service Expenditures Cont’d.

Provider Payment Rate Contracted Populations

Annual Budget Contract Start Date

Expenditures & Accruals

% of Budget

Hospital Services Cont’d.

Mental Health Services: Seton Shoal Creek, Austin Lakes Hospital

$813.51 per day SFS $6,225,319 7/1/2010 $3,832,714 62%

Women’s Health Services: Austin Women’s Hospital

Monthly Payment Charity, SFS $3,900,000 10/1/2010 $1,950,000 50%

Pharmacy Services

UMCB Pharmacy 340b pricing for drugs MAP $171,670 7/15/2010 $34,946 20%

Walgreen’s $4.50/claims fee/$13.50 for 340B drug/$1.75 dispensing fee plus discount for non-340b drug

MAP, SFS $3,343,108 11/27/2009 $2,087,182 62%

Emergency Transportation

City of Austin EMS Quarterly Payment MAP $350,000 3/1/2009 $175,000 50%

All Contracted Service Providers

All N/A All $86,284,355 N/A $44,094,950 51%

5/13/2011 4

FY2011 (10/1/10-3/31/11) Healthcare Service Utilization

Primary Care Medical

14,490

10,991

12,426

12,928

12,297

13,728

15,184

13,832

14,83814,623

13,841

15,252

16,025

14,007

14,814

15,764

14,908

16,887

15,981

14,899

14,393

13,162

14,896

14,188

14,911

14,14214,311

15,856

13,977

15,888

8,000

10,000

12,000

14,000

16,000

18,000

Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep

Primary Care Medical Visits -- CommUnityCare(All Payor Sources)

FY09

FY10

FY11

Total FY09 YTD Q2 Visits 76,860 Total FY10 YTD Q2 Visits 92,405 (20%) Total FY11 YTD Q2 Visits 89,085 (4% )

5/13/2011 5


Primary Care Medical

1,335

1,0281,123

1,4581,613

1,807 1,8441,694

1,806 1,858

1,671

2,1222,201

1,892

2,0692,169 2,229

2,6662,561

2,434

2,7862,707 2,737

2,835

3,167 3,1913,065

3,541

3,260

3,912

0 0 0 0 0 0

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500


Primary Care Medical Visits -- Community Providers

FY09

FY10

FY11

FY09 = People's, Project Access, El Buen, Paul Bass, LSCC (four months), NextCare (2 months)FY10 = People's, Project Access, El Buen, Paul Bass, LSCC, NextCare, Blackstock, Volunteer Health Clinic, Samaritan Health Ministries (1 month)

FY11 = People's, Project Access, El Buen, Paul Bass, LSCC, NextCare, Blackstock, Volunteer Health Clinic, Samaritan Health Ministries

Total FY09 YTD Q2 Visits 8,364 Total FY10 YTD Q2 Visits 13,226 (58%) Total FY11 YTD Q2 Visits 20,136 (52%)

5/13/2011 6


Primary Care Dental

2,496

1,808

2,0512,103

2,074

2,502

2,631

2,176

2,506

2,272

2,3632,398

2,606

2,273

2,339

2,550

2,483

2,7162,638

2,441 2,436

2,145

2,232

1,997

2,0562,124

2,189

2,687

2,194

2,711

1,000

1,200

1,400

1,600

1,800

2,000

2,200

2,400

2,600

2,800

3,000


FY09

FY10

FY11

Dental VisitsFY09 -- CommUnityCare Only (all payor sources)

FY10 -- CommUnityCare (all payor sources) and Samaritan Health Ministries (1 month)FY 11 - CommUnityCare (all payor sources)


5/13/2011 7


Primary Care Behavioral Health

1,171

818

920969

917893

992

893

1,109

1,224

971

1,082

1,247 1,2191,272

1,772 1,763

1,956

1,822

1,7071,780

2,310

2,490

2,137

1,8311,868

1,651

1,994

1,754

2,058

400

900

1,400

1,900

2,400

2,900


Behavioral Health VisitsFY09 -- CommUnityCare Only (all payor sources)

FY10 and FY11 -- CommUnityCare (all payor sources), LoneStar (MAP and unfunded), People's (MAP and unfunded), SIMS (unfunded), and Paul Bass (MAP)

FY09

FY10

FY11


5/13/2011 8


Crisis Behavioral Health Services

82

53

6875

64 64

84

105109

135

114104

122 124 125 127127

145

132138

157

139

172

151

160

125

151

105

127

157

0

20

40

60

80

100

120

140

160

180

200


Inpatient Psychiatric Hospital AdmissionsSeton Shoal Creek and Austin Lakes Hospital

(Central Health, State, and ATCIC Funds)

FY09

FY10

FY11

Total FY09 YTD Q2 Admissions 406 Total FY10 YTD Q2 Admissions 770 (90%) Total FY11 YTD Q2 Admissions 825 (7%)

5/13/2011 9

FY2011 (10/1/10-3/31/11) -- Customer Service/Eligibility Services

Call Center Statistics

Oct-10 Nov-10 Dec-10 1st Qtr Jan-11 Feb-11 Mar-11 2nd Qtr

Number of Calls Offered 7929 7584 8180 23693 10203 7218 8801 26222

Number of Calls Handled 6602 6513 7298 20413 8306 6560 7928 22794

Percentage % of Offered Calls Handled 83.3% 85.9% 89.2% 86.2% 81.4% 90.9% 90.1% 86.9%

Average Call Handle Time (minutes:seconds) 4:09 4:52 4:46 4:35 5:30 4:38 4:01 4:43

Average Answer Wait Time (minutes:seconds) 1:41 1:47 1:30 1:39 1:52 :56 1:20 1:36

Number of Days Calls Answered 21 20 21 62 21 20 23 64

Calls Offered counts all incoming calls even during hours when the call center is not open (evenings and weekends). Calls Handled counts all calls answered.

MAP Eligibility Actions Taken

In Person Mail-In Virtual Total

# % # % # %

Oct-10 6,548 88.3% 712 9.6% 154 2.1% 7,414

Nov-10 6,404 86.5% 899 12.1% 102 1.4% 7,405

Dec-10 5,545 86.5% 743 11.6% 120 1.9% 6,408

Q1 Totals 18,497 87.1% 2,354 11.1% 376 1.8% 21,227

Jan-11 6,295 86.0% 904 12.4% 117 1.6% 7,316

Feb-11 5,438 83.2% 940 14.4% 159 2.4% 6,537

Mar-11 6,342 82.9% 1,166 15.2% 145 1.9% 7,653

Q2 Totals 18,075 84.0% 3,010 14.0% 421 2.0% 21,506

5/13/2011 10

Medical Assistance Program Overview

9,721 10,065 10,240 10,349 10,573 11,007

11,892

12,75913,371

13,900 14,011 14,32214,64315,441

15,668 16,041

17,05717,534 17,777 17,639

18,202 18,258 18,569 18,82319,15319,551 19,809 19,841

20,65221,177

0

2,500

5,000

7,500

10,000

12,500

15,000

17,500

20,000

22,500

25,000


Full Benefit MAP Enrollment by Fiscal Year

FY09

FY10

FY11

Average Monthly Enrollment:

FY09 YTD Q2 = 10,326 FY10 YTD Q2 = 16,064 (56%) FY11 YTD Q2 = 20,031 (25%)

Includes CBRACKFQ and CPENDSSI with full benefits. Excludes Other with only dental and/or pharmacy benefits.

5/13/2011 11

Medical Assistance Program Overview

MAP Enrollee Utilization of Primary Care Medical Services (past 12 months – 4/10-3/11)

Provider Unduplicated Enrollment

# of MAP Visits

*Average # of Visits per

Enrollee

# of Unduplicated Individuals In Care

**Average # of Visits per Enrollee

In Care Blackstock 604 1,459 2.4 488 3.0 CommUnityCare 30,176 35,324 1.2 12,951 2.7

Lone Star Circle of Care 3,319 6,919 2.1 2,532 2.7

Paul Bass Internal Medicine 2,714 5,060 1.9 1,965 2.6

People’s Community Clinic 504 1,148 2.3 388 3.0

Total Unduplicated 37,317 49,910 1.3 18,324 2.7

MAP Enrollee Utilization of Primary Care Dental Services (past 12 months – 4/10-3/11)


# of MAP Visits


Enrollee



In Care CommUnityCare 36,084 19,200 0.5 4,843 4.0

MAP Enrollee Utilization of Primary Care Mental Health Services (past 12 months – 4/10-3/11)


# of MAP Visits


Enrollee



In Care

CommUnityCare 30,176 5,871 0.2 1,802 3.3 Lone Star Circle of Care 3,319 1,227 0.4 354 3.5

Paul Bass 2,714 58 0.0 59 1.0

People’s Community Clinic 504 128 0.3 52 2.5 Total Unduplicated 36,713 7,284 0.2 2,267 3.2

* Average # of Visits per Enrollee is calculated by dividing the number of MAP visits by the number of MAP enrollees. This provides an indication of the level of access to care, although it should be noted that, as in all health plans, individuals are enrolled in MAP regardless of whether they need care.

** Average # of Visits per Individual in Care is calculated by dividing the number of MAP visits by the number of individuals accessing services. This provides an indication of frequency of utilization of services by individuals accessing care.

*** MAP Visits reflect only those for which a claim was submitted to MAP and does not include other services not paid for by MAP coverage.

5/13/2011 12

MAP Utilization – Seton Services (past 12 months – 4/10-3/11)

1,1691,332 1,291 1,443 1,417 1,455 1,410 1,350 1,347

1,411 1,1571,448

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

22,000

Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11

# o

f E

R V

isit

s

MA

P E

nro

llm

ent

Date/Time/Period

# of Emergency Room VisitsApril 2010 - March 2011

MAP Enrollment

# of ER Visits (Seton Mediview Claims)

5/13/2011 13

MAP Utilization – Seton Services (past 12 months – 4/10-3/11)

182 170 195

206 217 189

176 174 183

214

165

193

-

100

200

300

400

500

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

22,000

Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11

# In

pat

ien

t Ad

mis

sion

s

MA

P E

nro

llmen

t

Date/Time/Period

# Inpatient AdmissionsApril 2010 - March 2011

MAP Enrollment

# of IP Admissions (Seton Mediview Claims)

5/13/2011 14

MAP Medical Director’s Report

Primary Care: Utilization of primary care at MAP/unfunded contracted providers continues to grow. Expansion of contract amounts is being considered. Specialty Care: Services through Paul Bass specialty care continue to be maximized with the limitations of space and physician staff there. Access data for each clinic is reviewed monthly with staff from the clinic. Even with the implementation of increased clinic time, wait time for clinic access continues to increase in some of the specialties. Further expansion of specialty care is pending network development with Sendero Health Plan. Mental Health: The contract with ATCIC (Austin/Travis County Integral Care) for inpatient and intensive outpatient services at Austin Lakes and Seton Shoal Creek continues to exceed utilization projections. We anticipate they will be requesting additional funds to maintain services this fiscal year. Performance Improvement (PI): The staff PI committee meets monthly to evaluate and decide on action plans to correct data gathered through complaint line, facility reviews, clinical outcomes and eligibility activities. Onsite and medical records reviews were completed for East Austin, David Powell, Del Valle, Planned Parenthood, Whole Woman’s Health, El Buen, LSCC AW Grimes, SIMS, Samaritan, and Blackstock. Review of clinical outcome data measures continues on a quarterly basis with providers who have been contracted with Central Health more than 12 months. Results from the clinical outcome reviews for FY11 1st quarter were presented by Medical Director to Lead Providers at CommUnityCare, QI Director/Family Medicine Chief at LSCC, Family Medicine Faculty at Blackstock, Medical Director at PCC and to Internal Medicine Faculty at Paul Bass in January and early February. Medical Management: The Medical Management staff and the Medical Director continue to have regular meetings with the UMCB case managers and social workers to improve coordination of discharge planning for MAP patients. Since discharge planning is most difficult in the Homeless population, we have included nursing and case management staff from CHC ARCH. Central Health staff has convened a workgroup with community partners to discuss EMS and ER utilization. Patient with high utilization of services in a variety of healthcare areas are discussed and a community care plan is developed to improve care. This process is undergoing refinement now that it is 6 months in existence. The group is working with the ICC to see if there can be a community database the group can use for its work. Negotiations are ongoing to replace the pharmacy benefits management system (PBM). Implementation date continues to be pending. Repeated extensions of the WHI contract due to the delay are impacting pharmacy costs for this fiscal year.

FY2011 Annual Plan of Work – Quarter Report 2 (January - March 2011)

T:\MEETINGS - Board and Committees\Board Meetings\FY2011 - Board Meetings\5.18.11 - Board Meeting\Item 9- CEOs report\(6) Annual plan 2011 Q2 Report.docx Page 1 of 6

Goal A – Access: Increase access to healthcare for residents of Travis County

Strategy Activity Related Tasks/Projects Assigned To FY11 Q2 Progress

A.1.a.i. Expand call center activities Larry Wallace Central Health Call Center continues to screen and appoint individuals for Medicaid, CHIP, and CHIP Perinatal application assistance.

A.1.a.ii. Implement application assistance Larry Wallace Training has been completed for all of CH eligibility staff to perform application assistance for Medicaid, CHIP, and CHIP Perinatal to include Central Health staff and insure-a-kid staff located at the insure-a-kid main office. The results of this training will allow for all staff to perform integrated eligibility for MAP and state programs. This promotes the open door philosophy.

A.1.a.iii Develop provider capacity database Larry Wallace The programming required for this database to reside in the Medicaider database has occurred. Testing of the programming is underway. El Buen, LSCC, and Peoples information has been loaded in the database. If the testing is successful the other safety net healthcare providers will be contacted.

A.1.a.iv Expand virtual MAP eligibility certifications

Larry Wallace Programming of Medicaider is underway in order to successfully expand the virtual eligibility process to the broader community.

A1. Develop expanded capacity to assist people in accessing proper healthcare resources

A.1.a. Develop and implement service navigation/healthcare linkage capabilities

A.1.a.v Working with ICC partners on eligibility document sharing through Medicaider

Larry Wallace ICC partners continued to hold regular meetings to work on the development of a system of document sharing through Medicaider.

A.2.a.i Review results of Third Party Administrator solicitation for potential new PC and SC networks

Larry Wallace

A decision was made to put this project on hold pending implementation of the HMO.

A.2.a.ii Working with Seton to expand specialty care

Larry Wallace Central Health and Seton Operations staff meet monthly to discuss access and specialty care services for MAP patients. However, expansion of specialty care services is on hold pending HMO implementation

A.2.a. Continue to pursue additional service contractors and/or expand contracts with current providers

A.2.a.iii CommUnityCare working with ATCIC on “Reverse E-merge” program

Larry Wallace The program was established and will begin in February 2011 and a physician has been hired.

A.2.b.i Support new dental clinics – Ben White and RBJ

Larry Wallace

Ben White CommUnityCare and LSCC dental office opened 12/22/2010.

A2. Increase healthcare service capacity

A.2.b. Expand access to dental services

A.2.b.ii Implement pilot program with Capital Area Dental Foundation for MAP enrollees

Larry Wallace The first service was rendered February 10, 2011, during the first five weeks of operation CADF rendered 101 visits.




A.2.b.iii Work with regional dental purchasers /providers on dental strategic plan

Larry Wallace St. David’s Foundation is hosting an all day planning meeting with the Regional Dental Committee on May 18th. Central Health representatives include Dr. Glenn, Robin Hudgins and Diane Hosmer.

A.2.c. Expand access to mental health services

A.2.c.i Review possibility for supporting additional outpatient services through AMEP

Larry Wallace A decision was made to put this project on hold pending implementation of the HMO

A.3.a. Use data on size and location of need for additional services to create new access opportunities

A.3.a.i Use data from TPA consultant, Dr. Cerny, Central Health Connection, etc. to inform service planning

Larry Wallace

The Joint Data Analysis Team made recommendations to the Joint Exec Team and the Board of Managers that identified priority areas for developing services: northeast replacement, southeast, West Central and Jonestown.

A.3.b.i. Determine feasibility for formation of HMO

John Stephens

Board approved formation of HMO, pursuit of licensure from TDI, and responding to the State RFP (now due on May 23). A consultant team has been working diligently on these tasks and is on track to meet all deadlines.

A.3.b.ii Establish a business development unit within Central Health

John Stephens An inventory of projects has been developed and interviews are underway with potential staff members.

A3. Explore innovative approaches to enhance healthcare access A.3.b. Explore opportunities for

additional resources (HMO, FQHC affiliations, resource development)

A.3.b.iii Determine feasibility for establishing a non-profit foundation

Christie Garbe A Greenlights report completed for CommUnityCare was reviewed and the results will be presented to the CommUnityCare Board. This report also informs our discussion regarding the formation of a foundation. Discussion continues regarding the best approach and timing related to this project.



Goal B -- Technology: Maximize the use of technology community-wide to inform healthcare decisions and delivery


B.1.a. Educate legislative representatives on the capabilities and utilization of the community Health Information Exchange (HIE)

B.1.a.i Receive completed presentation from LoneStar on current HIE capabilities and present to legislative representatives

Christie Garbe Pete Perialis of LoneStar presented a report to the Board of Managers on the current state of HIE capabilities.

B.1. Increase community capacity for healthcare information exchange (HIE)

B.1.c. Seek and leverage local and non-local funds to support the development of HIE capabilities for the community

B.1.c.i Continue to identify either local or non-local funds to support system development

John Stephens Central Health has pledged $500,000 for 2011 and $500,000 for 2012 to fund the development of a replacement for the ICare system. Central Health and ICC have also identified other sources and potential sources of funding. Funding commitments include: Lone Star Circle of Care/HCCN ($1,042,976), Seton ($1,000,000), and St. David’s Foundation ($650,000). Other potential sources include the Michael and Susan Dell Foundation and a THSA Local HIE grant program.

B.2.a. Support efforts to further develop and maintain a community Heath Information Exchange (HIE)

Trish Young

The proposal for a new technology platform to enhance the capabilities of the current ICare Health Information Exchange was approved by the ICC Board in January. Project implementation has begun.

B.2. Maintain a leadership role toward further development of community HIE capabilities

B.2.b. Pilot use of data to impact healthcare outcomes and/or cost

B.2.b.i Continue to develop pilot projects based on HIE data to impact healthcare outcomes and/or cost

Trish Young Q1. Staff participate in the Integrated Care Collaboration Data Analytics committee which analyzes data gleaned from the ICare Health Information Exchange (HIE) to observe trends in utilization. This information is then utilized to develop action plans for service delivery changes that can improve the health of patients and positively impact the appropriate use of the healthcare system. Specific areas of focus currently include diabetes, asthma and the frequent utilization of the emergency room by individuals with chronic conditions. Q2. Evaluations of the areas of focus noted above have been completed. The ICC Analytics committee is being reorganized in member composition. This will enable the committee to better develop strategies to use the data to form action plans.



Goal C – Quality: Strategically invest in practices designed to improve healthcare outcomes

Goal Strategy Activity Assigned To FY11 Q1 Progress

C.1.a. Develop and implement a disease management program

C.1.a.i Review TPA responses and determine if this can be conducted via a new vendor or done in-house

Larry Wallace

This project is on hold pending implementation of the HMO. C.1. Improve management of program enrollees

C.1.b.Strengthen relationships with contracted health services providers

C.1.b.i Continue regularly scheduled meetings with various contractors to assist in coordination of care, reporting, etc. for service population

Larry Wallace Routine provider meetings are being held with all contacted provider to discuss concerns.

C.2.a. Increase capacity for performance improvement activities

C.2.a.i Review TPA responses and determine if this can be conducted via a new vendor or done in-house

Larry Wallace

This project is on hold pending implementation of the HMO. C.2. Direct efforts to improve service effectiveness and client satisfaction

C.2.b. Increase satisfaction survey activities

C.2.b.i Complete contract with new vendor to allow for more focused surveys to a broader population of clients

Larry Wallace

MAP enrollee satisfaction survey was conducted and completed February 2011. The final outcome of the survey will be received during the third quarter. During the third quarter another MAP enrollee survey will be conducted to determine enrollee satisfaction with Specialty Care Services provided by Brackenridge. Central Health Customer Service Line is conducting surveys on all individuals that contact them for information about services.



Goal D – Leadership: Assume a leadership role in convening and planning for the healthcare needs of our community


D.1.Collaborate with other leaders to shape the expansion of academic medicine, including Graduate Medical Education (GME)

D.1.a.Further define role of Central Health in academic medicine, including (GME)’

D.1.a.i Initiate series of planned committee meetings to discuss this issue

Trish Young UT Southwestern, Seton and CommUnityCare leadership have begun programmatic planning for GME at the new North Central Community Health Center. Specific opportunities for specialty services to be provided at NCCHC in conjunction with the GME program have been identified and are in process of being evaluated.

D.2.a.Identify and understand opportunities of health reform at federal and state level

D.2.a.i Continue to review/monitor state and national opportunities

Christie Garbe

Staff monitored various sources of information. Regular reports were given to the Board of Managers and to Executive Staff.

D.2.b.Respond appropriately to opportunities and implement program requirements

D.2.b.i Explore potential for obtaining outside resource to facilitate this process

Larry Wallace

Staff partnered with insure-a-kid to develop the Regional Healthcare Coverage Collaborative. The first meeting was November 30, 2010 and the second one is scheduled for April 5, 2011. The Collaborative targets community partners who provide healthcare coverage for the uninsured. One area of focus of the group is to create a community strategy addressing changes as it relates to healthcare reform.

D.2. Maximize the community benefits of health reform.

D.2.c.Develop capacity to become a

reliable local source of information on health reform

D.2.c.i Create multiple methods for public to access information – website updates, educational sessions, podcasts, presentations, etc.

Christie Garbe Stacy Wilson spoke on federal health reform as follows: o St. David's Foundation Healthy People Annual Grant

Partner meeting in January 2011; o League of Women Voters in February 2011; o Texas Association of Homes and Services for the Aging in

February 2011. D.3.a.Initiate community leadership

dialogue on a long-range plan for healthcare infrastructure in Central Texas

D.3.a.i Retain outside resource to develop and implement this effort

Trish Young

In March a consulting team lead by Health Resources in Action was selected to develop a white paper and conduct the planned community leader dialogue.

D.3.b.i Complete efforts with Dr. Cerny to identify and prioritize areas of need

Christie Garbe

Prioritized areas of need were presented to the Board of Managers in February. Further analysis and drill down work continues.

D.3. Collaborate with the community to improve the healthcare delivery system D.3.b. Position Central Health to

become a resource for community-level healthcare data for Central Texas

D.3.b.ii Develop white paper describing healthcare landscape in Central Texas

Christie Garbe In March, a consulting team lead by Health Resources in Action was selected to develop the white paper. Initial component of the document anticipated in August.




D.3.b.iii Create multiple venues for sharing data collected – website, data summit, etc.

Christie Garbe Planning staff have begun meeting with the City, County and CAN to work more collaboratively. Data summit planning discussions have begun.

D.3.c.i Continue collaborative planning efforts – ICC, CAN

Christie Garbe Invited ICC staff to the CommUnityCare/Central Health Data Analysis team meeting to discuss the development of community wide analysis of unmet need.

D.3.c. Work with other Central Texas communities to promote regional integration

D.3.c.ii Identify additional opportunities to promote regional integration

Christie Garbe Austin Area Research Organization agreed to co-convene and partner on the Central Health Connection leader dialogue and white paper project.

Psychiatric Services Stakeholder Meeting April 18. 2011

4:00 p.m. St. David’s Foundation (811 Barton Springs Road, Suite 600)

Meeting Notes

Attendees Trish Young Brown – Central Health Dawn Handley – ATCIC Jim Van Norman – ATCIC Bert Lumbrerts – City of Austin Ashton Cumberbatch, Jr. – Seton Family Hospital Stacy Wilson – Central Health/Community Care Tim Coopwood – Central Health Board Becky Pastner – St. David’s Foundation Chris Ziebell – UMC Brackenridge Nancy Hohengarten – Court 5 Steve Bendowitz Alan Issacson – Seton Shoal Creek Kim McPherson – St. David’s Foundation David Evans – ATCIC Diana Resnik – Seton Liz Johnson – Seton Lisa Glenn – Central Health Betty Dunkerly Agenda/Notes 1. Welcome and Introductions Trish Young Brown opened the meeting and attendees introduced themselves. Debbie Berndt announced that she will provide support to the committee for HMA in place of Kim McPherson. Kim has assumed a position with the St. David’s Foundation and will continue to participate in the committee in that role. 2. Legislative Update David Evans provided an update on the status of the state budget proposals and hearings. He noted that the city, county and Central Health had coordinated on a response on mental health-related issues for the local legislative delegation. The Senate Finance budget is better for mental health than the House budget but the Senate has yet to find the funds to restore funding at the committee’s recommended level. There is interest in seeking legislative permission to move up to 20% of appropriated funds around for more flexible use. In Travis County, up to 3300 persons would lose services in current budget scenarios.

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Stacy Wilson commented on efforts to cover telehealth services through Medicaid and expanding the scope of practice for Advanced Nurse Practitioners. There is interest in privatizing two state hospitals if cost savings could be achieved. An effort to expand the NorthSTAR model statewide is pending in committee. The committee discussed the need to quantify and communicate the impact of cuts. Kim noted that the state could choose to pursue a federal medical home grant that would allow enhanced federal Medicaid match. Stacy offered to draft a rider directing HHSC to pursue the grant. It is widely believed that a budget will not be passed out during the regular session but that a special session will be called on July 11. 3. CIC Subcommittee meeting report The CIC plans a May meeting on interagency data sharing on frequent users of multiple service systems. Members noted that the EMS community care plan and the peer review process are underway and show great promise. The CIC wants to discuss the potential value of a forensic ACT team and will bring further information to the Stakeholder Committee. The group felt it was important to develop briefing materials on these activities for use with target audiences. 4. Dashboard Review A question was raised as to whether a new indicator could be added to measure ASH wait times for those with civil vs. forensic commitments. Another commenter suggested that costs be linked for important interventions (e.g., housing) to measure cost benefit. The group felt that the dashboard indicators should be revisited after the impact of budget cuts is apparent. They also want to assure that stakeholder input is solicited on who is chosen for the City’s permanent housing initiative. 5. Next Steps and Announcements The committee felt that planning for a response to the reduction of services to 3300 people should begin immediately. ATCIC received a federal SAMHSA grant for “reverse integration” (i.e., bringing primary healthcare services to persons with serious mental illness in the CMHC setting). Universal may build a new for-profit psychiatric hospital in Austin. The next meeting will be held on May 16, 2011 from 4:00-6:00 p.m. at the Central Health offices at 1111 East Cesar Chavez.

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May 18th, 2011


Confirm the next regular Board meeting date, time, and location.

board of managers meeting - central health...5.4.2011 – board minutes - 1 minutes of meeting –...

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