23 - central health home - central health · 9/12/2018 · urgent and convenient care fy18...

Our Vision

Central Texas is a model healthy community.

Our Mission

By caring for those who need it most, Central Health improves the health of our community.

Our Values

Central Health will achieve excellence through: Stewardship - We maintain public trust through fiscal discipline and open and transparent communication.

Innovation - We create solutions to improve healthcare access. Respect - We honor our relationship with those we serve and those with whom we work.

Collaboration - We partner with others to improve the health of our community.

BOARD MEETING

September 12, 2018

CONSENT AGENDA ITEM 1

Receive the August 2018 Investment Report and ratify Central Health Investments for August 2018.

5

Our Vision


Our Mission


Our Values




BOARD MEETING

September 12, 2018

REGULAR AGENDA ITEM 1 Discuss and take appropriate action on an update regarding Sendero Health Plans, Inc., including the effect of federal legislative and regulatory actions.1

20

Our Vision


Our Mission


Our Values




BOARD MEETING

September 12, 2018

REGULAR AGENDA ITEM 2 Discuss and take appropriate action on the 1115 Medicaid Waiver, Delivery System Reform Incentive Payment (DSRIP) projects, the Community Care Collaborative, including health care delivery arrangements, and other interrelated community partnerships.1

21

Our Vision Central Texas is a model healthy community.

Our Mission


Our Values




BOARD MEETING

September 12, 2018

REGULAR AGENDA ITEM 3 Discuss and take appropriate action on the Fiscal Year (FY) 2019 budget for the Community Care Collaborative.

22

Central Health Board of ManagersSeptember 12, 2018

CCC FY19 Budget

23

CCC Strategic Plan FY18-20

• CCC Mission: Optimize the health of our population while using our resources efficiently and effectively• Mission Metric 1: Quality of Life and Longevity• Mission Metric 2: Cost of Care

• CCC Four Strategic Focus Areas:• Build an Integrated Delivery System• Redesign Coverage Programs• Improve Value in Care• Optimize Health of Covered Population

• Supports Central Health Strategic Work Plan

224

Budget Overview

Description FY18 Amended Budget FY18 Year End Estimate FY19 Proposed Budget Increase (Decrease) FY19 Proposed less FY18 YE Est

SOURCESDSRIP Payments $ 58,000,000 $ 58,925,836 $ 59,417,759 $ 491,923 Member Payments* $ 88,245,166 $ 65,129,269 $ 74,000,000 $ 8,870,731 Other $ 100,000 $ 300,000 $ 300,000 $ -

Subtotal Sources $ 146,345,166 $ 124,355,105 $ 133,717,759 $ 9,362,654 Contingency Reserve Carryforward $ 13,760,003 $ 13,760,003 $ 8,331,095

Total, Sources of Funds $ 160,105,169 $ 138,115,108 $ 142,048,854 $ 3,933,746

USESPrimary Care $ 52,396,817 $ 51,056,822 $ 52,046,817 $ 989,995 Urgent & Convenient Care $ 600,000 $ 185,000 $ 250,000 $ 65,000 Specialty Care $ 14,391,711 $ 8,720,977 $ 11,773,000 $ 3,052,023 Specialty Behavioral Health $ 8,933,856 $ 8,683,856 $ 8,933,856 $ 250,000 Post Acute Care $ 2,625,000 $ 2,275,000 $ 1,225,000 $ (1,050,000)Pharmacy $ 6,350,000 $ 4,500,000 $ 5,850,000 $ 1,350,000 Medical Management $ 2,111,102 $ 2,000,000 $ 1,915,141 $ (84,859)Healthcare Delivery Operations $ 12,931,378 $ 10,862,358 $ 12,866,947 $ 2,004,589

Subtotal, Healthcare Delivery $ 100,339,864 $ 88,284,013 $ 94,860,761 $ 6,576,748 Operating Contingency $ 6,534,493 $ - $ 188,093 $ 188,093

Total, Healthcare Delivery $ 106,874,357 $ 88,284,013 $ 95,048,854 $ 6,764,841 DSRIP $ 17,895,812 $ 6,500,000 $ 12,000,000 $ 5,500,000UT Affiliation Agreement $ 35,000,000 $ 35,000,000 $ 35,000,000 $ -

Total, Uses of Funds $ 159,770,169 $ 129,784,013 $ 142,048,854 $ 12,264,841

3

*Final contributions will be subject to provisions of the MSA, which requires the parties to collaborate to adequately fund the CCC, but leaves the amount of funding up to each parties’ discretion. Each member contribution could be more or less than the budget, depending upon a variety of factors.25

Primary Care

FY18 Highlights• Paying for Value: Alternative Visits• Primary Care Metric Set Performance• Care Management Infrastructure Development

FY19 Initiatives• DSRIP 2.0: Clinical Measure Bundles• Dental Service Expansion through LSCC• Healthcare for the Homeless: Pay for Success Project• Pharmacy budget accounts for MAP Basic benefit

426

Primary Care Visits & Rates

5

$0

$50

$100

$150

$200

$250

0

50,000

100,000

150,000

200,000

250,000

2015 2016 2017 2018

Aver

age

Paym

ent P

er V

isit

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its

Visit Volumes and Average Visit Rate (FY15 - FY17; FY18 projected)

CommUnityCare Lone Star Circle of Care

People's Community Clinic El Buen Samaritano

Average Payment Rate Per Visit (SFS & MAP)

27

Primary Care Contracts

6

Provider FY18 Amended Amount FY18 YE Estimate FY19 Proposed NTE

CommUnityCare $ 41,760,000 $ 41,460,000 $ 41,760,000

El Buen Samaritano $ 2,350,000 $ 2,100,000 $ 2,100,000

Lone Star Circle of Care $ 4,564,995 $ 4,100,000 $ 4,364,995

Peoples Community Clinic $ 2,500,000 $ 2,500,000 $ 2,500,000

Volunteer Clinic $ 200,000 $ 175,000 $ 200,000

UT School of Nursing $ 100,000 $ 10,000 $ 25,000

City of Austin EMS $ 696,822 $ 696,822 $ 696,822

Prevention & Wellness (YMCA) $ 225,000 $ 15,000 $ -

Healthcare for the Homeless $ - $ - $ 400,000

28

Urgent and Convenient Care

FY18 Highlights• Expanding Access

• 11 new Urgent Care sites • 10 new Convenient Care sites• New & Existing FQHC walk-in sites

FY19 Initiatives• Outreach and marketing to optimize use• Digital Urgent Care

729

Urgent & Convenient Care Contracts

8

Provider FY18 Amended Amount FY18 YE Estimate FY19 Proposed BudgetBenchmark Urgent Care $ 50,000 $ 5,000

$ 250,000

NextCare Urgent Care $ 191,000 $ 120,000 Seton Urgent & Convenient Care FastMed/Texan Urgent CareRediClinic $ 359,000 $ 60,000

Good Health Digital Urgent Care

30

Specialty Care

FY18 Highlights• Ophthalmology• Complex Gynecology & MSK IPUs• ENT Network Expansion • Colonoscopy Pilot• Palliative Care

FY19 Initiatives• Gastroenterology IPU• FIT (Fecal Immunochemical Tests)• Rheumatology expansion• E-Consults

931

CRC Screening in CCC Patients

10

• HRSA & CCC goal: 80% colorectal cancer screening rate

• HRSA average, 2016: 39.9%

• CCC average, FY18 YTD: 28.7%

• 600+ screening colonoscopies in FY18

• Intake to procedure completion rate: 70%

• Transitioning to FIT in FY19 with direct reimbursement and performance incentives

32

Specialty Care Contracts 1 of 2

SpecialtyFY18 Amended

BudgetFY18 Year End

EstimateFY19 Proposed

Budget ProvidersSeton Expanded Specialty $ 300,000 $ 150,000 $ 200,000 Seton Healthcare FamilyPalliative Care $ 100,000 $ 10,000 $ 25,000 Austin Geriatric Specialists

Ophthalmology $ 1,725,000 $ 1,482,436 $ 1,700,000

Eye Physicians of AustinBriggs Eye ClinicRetina Consultants of AustinAustin Retina AssociatesBailey Square Surgery CenterSurgicare of South AustinAustin Anesthesia GroupIRIS

Oncology $ 2,359,000 $ 433,728 $ 700,000 Austin Cancer CentersPrimary Care Providers

Complex Gynecology $ 1,500,000 $ 1,100,000 $ 1,500,000

UT Health AustinBailey Square Surgery CenterAustin Anesthesia GroupSeton Healthcare Family

Musculoskeletal $ 2,100,000 $ 1,075,000 $ 1,250,000

UT Health AustinUSPI Northwest Surgery CenterCapitol AnesthesiaSeton Healthcare FamilyTexas Physical Therapy Specialists

Cardiology $ 150,000 $ 40,657 $ 200,000 CommUnityCarePM&R $ 75,000 $ - $ 15,000 Seton Healthcare Family

ENT $ 400,000 $ 318,621 $ 450,000 Austin Regional ClinicUSPI Northwest Surgery CenterCapitol Anesthesia

1133

Specialty Care Contracts 2 of 2

12

SpecialtyFY18 Amended

BudgetFY18 Year End

EstimateFY19 Proposed

Budget ProvidersUrology $ 450,000 $ 250,000 $ 250,000 Seton Healthcare FamilyRheumatology $ 90,000 $ 15,000 $ 200,000 CommUnityCare

Dermatology $ 100,000 $ 10,000 $ 450,000 CommUnityCareSeton Healthcare Family

Gastroenterology $ 800,000 $ 800,000 $ 1,250,000 CommUnityCareAustin GastroenterologySeton Healthcare Family

Pulmonology $ - $ - $ 225,000 CommUnityCareEmergency Service Partners

Endocrinology $ - $ - $ 700,000 CommUnityCare

Orthotics & Prosthetics $ 200,000 $ 111,535 $ 200,000 Applied OrthoticsHanger

Durable Medical Equipment $ 33,000 $ 119,000 $ 168,000

EdgePark Medical SuppliesSeton Health PlanSeton Healthcare FamilyTriCounty Practice Association

Project Access $ 330,000 $ 330,000 $ 330,000 Travis County Medical Society

Ancillary $ 100,000 $ 15,000 $ 175,000

CPACPLUT Health AustinAustin Radiology Associates

Referral Mgmt/ E-Consults $ 950,000 $ 25,000 $ 535,000 To be determined

Specialty Dental $ 629,711 $ 435,000 $ 1,100,000 Affordable DenturesLonestar Oral and Maxilofacial SurgeryCommUnityCare

Single Case Agreements $ - $ - $ 150,000 Seton Health PlanSeton Healthcare FamilyOther providers on an as-needed basis

34

Specialty Behavioral Health

FY18 Highlights• Integral Care Contract• Expanded SUD services with SIMS• Medication Assisted Treatment pilot

FY19 Initiatives• Integral Care contract enhancements• MAT continuation

1335

Integral Care Contract Performance

14

0

1

2

3

4

5

6

7

8

9

0

200

400

600

800

1000

1200

1400

1600

FY13 FY14 FY15 FY16 FY17

CCC-Integral Care Contract Performance, FY13-FY17

Unduplicated Clients Served: Inpatient Services, Extended Observation, Crisis Residential Average Inpatient Service Length of Stay

36

Specialty Behavioral Health Contracts

15

Provider FY18 Amended Amount FY18 YE Estimate FY19 Proposed BudgetIntegral Care $ 8,000,000 $ 8,000,000 $ 8,000,000 SIMS Foundation $ 483,856 $ 483,856 $ 483,856 Medication Assisted Treatment: CommUnityCareIntegral Care

$ 450,000 $ 200,000 $ 450,000

37

Post-Acute Care

FY18 Highlights• Transitions of Care Nurse at DSMC• Expanded SNF network and improved length of stay• Increased hospice services

FY19 Initiatives• Flexible pool of funds to support levels of care• Home health addition• Addition of respite care (for persons experiencing homelessness)

1638

Post-Acute Care Contracts

Provider FY18 Amended Amount FY18 YE EstimateFY19 Proposed Contract NTE

Recuperative Care for Homeless:Front Steps, Regency Integrated Health Services $ 1,000,000 $ 800,000

$ 500,000

Skilled Nursing Facilities:Seton Health Plan, Brookdale Senior Living, Senior Care Centers, Regency Integrated Health Services,Park Bend Health Center $ 900,000 $ 750,000 Respite Care for Homeless:Provider to be determined $ - $ -

Home Health:Provider to be determined $ - $ -

Hospice Austin $ 750,000 $ 750,000 $ 750,000

1739

Health Management Strategy

Health Management

Community Care Collaborative CommUnityCare Ascension Seton

18

Medical Management Department• Transitions of Care• Highly complex patients• Home visits with Case Managers• Population-wide initiatives• Operational Support of Projects

Optimize the health of our covered population

Care Management• Clinic based tiered system• Complex Primary Care clinic

Good Health• Digital Solutions

40

FY 2019 Proposed Budget: Health Care Delivery Operations Detail• Eligibility and Enrollment Department

• United Way 2-1-1 and Network Sciences (Medicaider) contracts• MAP Basic implementation costs

• Quality, Assessment and Performance Department• Teknion (Tableau business intelligence application support) contract• MIA analytics contract (Annual Utilization Study)• Seton Analytics and Clinical Quality Support contract

• Claims Payment & Analysis Department • Covenant Management Systems/Mediview Third Party Administrator (TPA) contract• Seton Health Plan TPA contract• Wakely Actuarial Consulting Contract

• Health Information Technology• CCC share of Enterprise IT expenses• i2i clinical software, professional services for data warehouse

• Medical Management• MCG care guidelines• Carenet Nurse Triage

• Administration/Other• Lease and general operating expenses distributed across departments on a pro rata basis• Three existing positions eliminated; No new positions in FY19

1941

Thank You

www.ccc-ids.org

42

Appendices

• CCC Mission Metrics• Enrollment and Utilization Trends• Clinical Quality Measures• Patient Reported Outcomes

• Service Line Budget Detail

2143

Mission Metric: Quality of Life

2244

Measuring Patient Experience

2345

Shaping the SystemMAP FY13 FY14 FY15 FY16 FY17

Unique Enrollees 41,780 42,136 40,708 41,906 44,414

% Utilizers – Any Provider 71.2% 72.3% 71.4% 71.6% 77.1%

% Utilizers - Seton 40.3% 40.4% 39.6% 37.2% 35.2%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

0

10,000

20,000

30,000

40,000

50,000

FY13 FY14 FY15 FY16 FY17

% U

tilize

rs-p

er-E

nrol

lee

(%)

Uni

que

MAP

Enr

olle

es (#

)

Unique Enrollees % Any Utilization % Seton Utilization

5

Data Source: FY17 CCC Utilization Study

46

Select Clinical Quality Metrics

Diabetic Measures (MAP Patients) Performance, FY16-FY18

Foot Exam Increased 12% since FY16

Nephropathy Screening 4% over NCQA Benchmark

HbA1c Control 5% over NCQA Benchmark

Blood Pressure Control (Diabetic patients) 17% over NCQA Benchmark

25

Population Measures (MAP Patients) Performance, FY17-FY18

BMI Screening & Follow Up Plan 29% over HRSA Benchmark

Cervical Cancer Screening 6% over HRSA Benchmark

Tobacco Screening & Cessation Plan 14% over HRSA Benchmark

Blood Pressure Control (All Patients) 5% over HRSA Benchmark

Depression Screening & Follow Up 8% over HRSA Benchmark

47

BP Control in MAP & SFS Diabetics

2648

DMS IPU PROMs

2749

Primary Care Budget

28


Primary CareCommUnityCare $ 41,760,000 $ 41,460,000 $ 41,760,000 $ 300,000 El Buen Samaritano $ 2,350,000 $ 2,100,000 $ 2,100,000 $ -Lone Star Circle of Care $ 4,564,995 $ 4,100,000 $ 4,364,995 $ 264,995 Peoples Community Clinic $ 2,500,000 $ 2,500,000 $ 2,500,000 $ -Volunteer Clinic $ 200,000 $ 175,000 $ 200,000 $ 25,000 UT School of Nursing $ 100,000 $ 10,000 $ 25,000 $ 15,000 City of Austin EMS $ 696,822 $ 696,822 $ 696,822 $ -Prevention and Wellness Initiatives $ 225,000 $ 15,000 $ - $ (15,000)Healthcare for the Homeless: Pay for Success $ - $ - $ 400,000 $ 400,000

Primary Care Totals $ 52,396,817 $ 51,056,822 $ 52,046,817 $ 989,995

50

Urgent & Convenient Care Budget

29


Urgent & Convenient CareUrgent & Convenient Care (includes Digital) $ 600,000 $ 185,000 $ 250,000 $ 65,000

Urgent & Convenient Care Total $ 600,000 $ 185,000 $ 250,000 $ 65,000

51

Specialty Behavioral Health Budget


Specialty Behavioral HealthInpatient Psych, Extended Obs, Crisis Residential $ 8,000,000 $ 8,000,000 $ 8,000,000 $ -Therapy, Counseling & SUD Services $ 483,856 $ 483,856 $ 483,856 $ -MAT Pilot $ 450,000 $ 200,000 $ 450,000 $ 250,000

Total, Specialty Behavioral Health $ 8,933,856 $ 8,683,856 $ 8,933,856 $ 250,000

3052

Specialty Care Budget

31


Specialty CareCommUnityCare Specialty $ 2,000,000 $ 2,000,000 $ - $ (2,000,000)Seton Healthcare Family Specialty $ 300,000 $ 150,000 $ 200,000 $ 50,000 Palliative Care $ 100,000 $ 10,000 $ 25,000 $ 15,000 Ophthamology $ 1,725,000 $ 1,482,436 $ 1,700,000 $ 217,564 Oncology $ 2,359,000 $ 433,728 $ 700,000 $ 266,272 Complex Gynecology $ 1,500,000 $ 1,100,000 $ 1,500,000 $ 400,000 Musculoskeletal $ 2,100,000 $ 1,075,000 $ 1,250,000 $ 175,000 Cardiology $ 150,000 $ 40,657 $ 200,000 $ 159,343 PM&R $ 75,000 $ - $ 15,000 $ 15,000 ENT $ 400,000 $ 318,621 $ 450,000 $ 131,379 Urology $ 450,000 $ 250,000 $ 250,000 $ -Rheumatology $ 90,000 $ 15,000 $ 200,000 $ 185,000 Dermatology $ 100,000 $ 10,000 $ 450,000 $ 440,000 Gastroenterology $ 800,000 $ 800,000 $ 1,250,000 $ 450,000 Pulmonology $ - $ - $ 225,000 $ 225,000 Endocrinology $ - $ - $ 700,000 $ 700,000 Orthotics & Prosthetics $ 200,000 $ 111,535 $ 200,000 $ 88,465 DME $ 33,000 $ 119,000 $ 168,000 $ 49,000 Project Access $ 330,000 $ 330,000 $ 330,000 $ -Ancillary $ 100,000 $ 15,000 $ 175,000 $ 160,000 Referral Management & E-Consults $ 950,000 $ 25,000 $ 535,000 $ 510,000 Specialty Dental $ 629,711 $ 435,000 $ 1,100,000 $ 665,000 Single Case Agreements $ - $ - $ 150,000 $ 150,000

Total, Specialty Care $ 14,391,711 $ 8,720,977 $ 11,773,000 $ 3,052,023

53

Post-Acute Care Budget


PostAcute Recuperative Care $ 1,000,000 $ 800,000

$ 500,000 $ (300,000)

Skilled Nursing $ 900,000 $ 750,000 $ (750,000)Hospice $ 725,000 $ 725,000 $ 725,000 $ -

Total, PostAcute Care $ 2,625,000 $ 2,275,000 $ 1,225,000 $ (1,050,000)

3254

Description

FY18 Amended Budget** FY18 Year End Estimate FY19 Proposed Budget Increase (Decrease) FY19 Proposed less FY18 YE Est

DSRIP Payments 58,000,000$ 58,925,836$ 59,417,759$ 491,923$ Member Payments* 88,245,166$ 65,129,269$ 74,000,000$ 8,870,731$ Other 100,000$ 300,000$ 300,000$ -$

Subtotal Sources 146,345,166$ 124,355,105$ 133,717,759$ 9,362,654$ Contigency Reserve Carryforward 13,760,003$ 13,760,003$ 8,331,095$

Total Sources 160,105,169$ 138,115,108$ 142,048,854$ 3,933,746$

Primary CareCommUnityCare 41,760,000$ 41,460,000$ 41,760,000$ 300,000$ El Buen Samaritano 2,350,000$ 2,100,000$ 2,100,000$ -$ Lone Star Circle of Care 4,564,995$ 4,100,000$ 4,364,995$ 264,995$ Peoples Community Clinic 2,500,000$ 2,500,000$ 2,500,000$ -$ Volunteer Clinic 200,000$ 175,000$ 200,000$ 25,000$ UT School of Nursing 100,000$ 10,000$ 25,000$ 15,000$ City of Austin EMS 696,822$ 696,822$ 696,822$ -$ Prevention and Wellness Initiatives 225,000$ 15,000$ -$ (15,000)$ Healthcare for the Homeless: Pay for Success -$ -$ 400,000$ 400,000$

Total, Primary Care 52,396,817$ 51,056,822$ 52,046,817$ 989,995$ Urgent & Convenient Care

Urgent & Convenient Care (includes Digital) 600,000$ 185,000$ 250,000$ 65,000$ Total, Urgent & Convenient Care 600,000$ 185,000$ 250,000$ 65,000$

Specialty CareCommUnityCare Specialty 2,000,000$ 2,000,000$ -$ (2,000,000)$ Seton Healthcare Family Specialty 300,000$ 150,000$ 200,000$ 50,000$ Palliative Care 100,000$ 10,000$ 25,000$ 15,000$ Ophthamology 1,725,000$ 1,482,436$ 1,700,000$ 217,564$ Oncology 2,359,000$ 433,728$ 700,000$ 266,272$ Complex Gynecology 1,500,000$ 1,100,000$ 1,500,000$ 400,000$ Musculoskeletal 2,100,000$ 1,075,000$ 1,250,000$ 175,000$ Cardiology 150,000$ 40,657$ 200,000$ 159,343$ PM&R 75,000$ -$ 15,000$ 15,000$ ENT 400,000$ 318,621$ 450,000$ 131,379$ Urology 450,000$ 250,000$ 250,000$ -$ Rheumatology 90,000$ 15,000$ 200,000$ 185,000$ Dermatology 100,000$ 10,000$ 450,000$ 440,000$ Gastroenterology 800,000$ 800,000$ 1,250,000$ 450,000$ Pulmonology -$ -$ 225,000$ 225,000$ Endocrinology -$ -$ 700,000$ 700,000$ Orthotics & Prosthetics 200,000$ 111,535$ 200,000$ 88,465$ DME 33,000$ 119,000$ 168,000$ 49,000$ Project Access 330,000$ 330,000$ 330,000$ -$ Ancillary 100,000$ 15,000$ 175,000$ 160,000$ Referral Management & E-Consults 950,000$ 25,000$ 535,000$ 510,000$ Specialty Dental 629,711$ 435,000$ 1,100,000$ 665,000$ Single Case Agreements 150,000$ 150,000$

Total, Specialty Care 14,391,711$ 8,720,977$ 11,773,000$ 3,052,023$ Specialty Behavioral Health

Inpatient Psych, Extended Obs, Crisis Residential 8,000,000$ 8,000,000$ 8,000,000$ -$ Therapy, Counseling & SUD Services 483,856$ 483,856$ 483,856$ -$ MAT Pilot 450,000$ 200,000$ 450,000$ 250,000$

Total, Specialty Behavioral Health 8,933,856$ 8,683,856$ 8,933,856$ 250,000$ PostAcute

Recuperative Care 1,000,000$ 800,000$ (300,000)$ Skilled Nursing 900,000$ 750,000$ (750,000)$ Hospice 725,000$ 725,000$ 725,000$ -$ New Initiatives: Respite Care, Home Health -$

Total, PostAcute Care 2,625,000$ 2,275,000$ 1,225,000$ (1,050,000)$ Pharmacy

6,350,000$ 4,500,000$ 5,850,000$ 1,350,000$ Total, Pharmacy 6,350,000$ 4,500,000$ 5,850,000$ 1,350,000$

Medical Management2,111,102$ 2,000,000$ 1,915,141$ (84,859)$

Total, Medical Management 2,111,102$ 2,000,000$ 1,915,141$ (84,859)$ Healthcare Delivery Operations

Service Delivery Operations 1,516,171$ Claims Payment & Analysis 2,425,492$ Strategy, Communications, Population Health 381,583$ Project Management Office 1,463,784$ 1,229,579$ 918,619$ (310,960)$ Quality, Assessment & Performance 1,995,199$ 1,675,967$ 1,567,385$ (108,582)$ Adminstration Department 1,260,753$ 1,059,033$ 1,206,793$ 147,760$ Joint Technology 3,236,029$ 2,718,264$ 3,230,900$ 512,636$ Eligibility & Enrollment 1,478,005$ 1,241,524$ 1,620,005$ 378,481$

Subtotal, Healthcare Delivery Operations 12,931,378$ 10,862,358$ 12,866,947$ 2,004,589$

Subtotal 100,339,864$ 88,284,013$ 94,860,761$ 6,576,748$

Operating Contingency 6,509,493$ -$ 188,093$ 188,093$ Total, Healthcare Delivery Operations 106,849,357$ 88,284,013$ 95,048,854$ 6,764,841$

DSRIP 17,895,812$ 6,500,000$ 12,000,000$ 5,500,000$

Total, DSRIP 17,895,812$ 6,500,000$ 12,000,000$ UT Affiliation Agreement

35,000,000$ 35,000,000$ 35,000,000$ Total, UT Affiliation Agreement 35,000,000$ 35,000,000$ 35,000,000$

Total, Uses of Funds 159,745,169$ 129,784,013$ 142,048,854$ 12,264,841$

*Final contributions will be subject to provisions of the MSA, which requires the parties to collaborate to adequately fund the CCC, but leaves the amount of funding up to each parties’ discretion. Each member contribution could be more or less than the budget, depending upon a variety of factors.** Amended budget items are noted in bold

1,385,255$

500,000$

Community Care Collaborative PROPOSED Budget FY19

2,937,991$

SOURCES

3,497,608$

USES

55


Our Mission


Our Values




BOARD MEETING

September 12, 2018

REGULAR AGENDA ITEM 4

Discuss and take appropriate action on Central Health’s proposed Fiscal Year (FY) 2019 budget.

56

1111 E. Cesar Chavez St. Austin, Texas 78702 Phone: 512 978-8155

Fax: 512 978-8156 www.centralheath.net

MEMORANDUM To: Central Health Board of Managers CC: Mike Geeslin, President and CEO From: Jeff Knodel, VP of Finance Date: September 7, 2018 Re: INFORMATIONAL ITEM – Changes to the FY 2019 Proposed Budget Staff has made changes to the FY 2019 Proposed Budget based on updates to the FY 2018 Current Year Estimate (CYE). Synopsis In developing the Central Health FY 2019 budget, the prior year estimate is periodically updated to provide a beginning balance for the FY 2019 budget. The latest version contained in the Board of Managers’ packet for the meeting of September 12th contains current year estimate revisions based upon the best available information to date. Major revisions include a decrease in Intergovernmental Transfers (as a result of timing differences) and lower than anticipated costs associated with the Brackenridge Campus. The revisions can be seen in the budget presentation slide “Central Health – FY 2019 Proposed Budget (in millions) 6% over effective”. For FY 2019, additional discussion may result in revisions to the budget and may include Sendero, CCC Member Payment or Intergovernmental Transfers to be discussed on Wednesday. Action Requested This item is informational; no Board action is required at this time.

57

Public Hearing on Central HealthFiscal Year 2019 Proposed Budget and Property Tax Rate

Central Health Board of ManagersSep. 12, 2018Jeff Knodel, CFO

58

FY 2019 Proposed Budget Support of the Strategic Work Plan

Objective 1: Develop and execute health care delivery strategy based on people and place

Objective 2: Implement patient focused and coordinated health care system

Objective 3: Implement sustainable financial model for health care delivery and system strategies through 2024

259

FY 2019 Proposed Tax Rate

3

FY18 FY19(Proposed)

Average Taxable Homestead Value

$305,719 $326,895

Tax Rate 10.7385¢ 10.5221¢

Tax Bill $328.30 $343.97

Annual Taxpayer Impact: $15.67 (+4.8%)

Annual Tax Rate Change: (-2%)

Homestead Exemption

Over 65 Homestead Exemption

Disability Homestead Exemption

20% (A)$5,000 Minimum $85,500 (B) $85,500 (B)

(A) Maximum allowable by state law(B) Increased from $80,000

*10.5221¢

*10.4495¢*0.0726¢

60

Central Health FY 2019 - Proposed Budget(in millions)

4

DESCRIPTION FY 2018 FY 2018 FY 2019 FY 2019

APPROVED BUDGET

YEAR END ESTIMATE

Budget Presented on 9/5/18

PROPOSED BUDGET

SourcesProperty Taxes $181.8 $181.8 $196.9 $196.9

Lease Revenue 10.3 10.3 18.0 18.0

Other Revenue 2.2 5.4 2.4 2.4Increased Interest Revenue by $0.3M

Subtotal Revenue 194.3 197.5 217.3 217.3 Contingency Reserve 43.5 51.6 28.8 41.1 Updated CYE

Total Sources 237.8 249.1 246.1 258.4

UsesHealthcare Delivery (IGT, Healthcare services and Initiatives)

181.3 146.5 179.9 179.9 Reduced IGT by $9.5MReduced Service Expansion by $0.5M

Healthcare Operations, Health Promotions*, and Downtown Campus*

15.2 12.8 22.9 22.9 Reduced Downtown Campus by $2 M

*Prior year was in initiatives

Contingency Reserve (appropriated) 23.7 - 7.1 19.4 Updated CYEOther Reserves and transfers 5.4 37.4 23.8 23.8Debt Service 1.4 1.4 1.4 1.4

Total Healthcare Delivery 227.0 198.1 235.1 247.4Administration 9.1 8.3 9.3 9.3

Tax Collection 1.7 1.6 1.7 1.7Total Uses 237.8 208.0 246.1 258.4

Reserves (estimated ending balance)Contingency Reserve Total 41.1

Allocated 10.9Unallocated 30.2

Emergency Reserve 31.3 32.3

61

Attachment A – FY 2018 Approved Budget and FY 2019 Proposed Budget Sources and Uses Summary

5

DESCRIPTION FY 2018 APPROVED BUDGET

FY 2019 PROPOSED BUDGET

TAX RATE 0.107385 0.105221

SOURCESProperty Taxes 181,839,054 196,861,527 Lease Revenue 10,303,467 18,067,937 Interest 400,000 400,000 Tobacco Litigation Settlement 1,800,000 2,000,000 Subtotal Revenue 194,342,521 217,329,464 Contingency Reserve 43,482,960 41,039,184

Total Sources 237,825,481 258,368,648

USESHealthcare Delivery 227,029,205 247,343,600 Administration 9,143,516 9,321,838 Tax Collection 1,652,760 1,703,210

Total Uses 237,825,481 258,368,648

RESERVES (ending balance)CapitalHMO Risk-based Capital ReserveContingency ReserveEmergency Reserve 31,313,546 32,313,546

Total Reserves 31,313,546 32,313,546

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Attachment B – FY 2018 Approved Budget and FY 2019 Proposed Budget Sources and Uses Summary

6

DESCRIPTION FY 2018 APPROVED BUDGET FY 2019 PROPOSED BUDGET

HEALTH CARE DELIVERY

Intergovernmental transfers:IGT - Private UC 24,000,000 24,000,000 IGT - Public UC 25,000,000 24,500,000 IGT - Disproportionate Share 35,000,000 35,000,000 IGT - CCC DSRIP 29,300,000 27,500,000 IGT - Seton DSRIP 29,000,000 27,500,000 IGT - St. David's DSRIP 620,000 630,000

Total Intergovernmental Transfers 142,920,000 139,130,000 Healthcare Services

Member Payment to CCC 29,245,166 34,000,000 Charity Care - Seton 4,251,733 -Primary Care - Planned Parenthood 731,800 790,344 Womens Health Services 1,000,000 1,080,000 Integrated Care Collaboration (ICC) 666,657 719,990 Mobile Health Clinics - 768,500 Healthcare Services Expansion 2,000,000 2,000,000

Total Healthcare Services 37,895,356 39,358,834

Healthcare Initiatives:UMCB Campus Redevelopment 4,360,644 -ACA education and enrollment -Health Promotion -

New Initiatives - Cancer, Womens Health, Healthcare Workforce Development 500,000 1,400,000

Total Healthcare Initiatives 4,860,644 1,400,000Total Healthcare Services & Initiatives 42,756,000 40,758,834 Healthcare Operations

Salary and Benefits 3,773,584 3,689,436 ACA Education and Enrollment 2,700,000 2,916,000 Legal 26,200 46,200 Consulting 289,000 459,590 Other professional services 401,085 365,000 Marketing & Community Relations 307,326 414,868 Community Engagement - 350,000 Leases, security & maintenance 739,876 599,320 UT land lease for teaching hospital 903,467 912,502 Phones, computer equipment & utilities 932,021 1,091,890 Printing, copying, postage & signage 198,694 133,750 Travel, training and professional development 47,044 40,285 Health Promotions 358,713 315,455 Downtown Campus Operations and Redevelopment - 11,125,542 Other operating expenses 234,892 407,480

Total Healthcare Operations 10,911,902 22,867,318

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Attachment B – FY 2018 Approved Budget and FY 2019 Proposed Budget Sources and Uses Summary

DESCRIPTION FY 2018 APPROVED BUDGET FY 2019 PROPOSED BUDGET

Reserves, appropriated uses & transfers:Transfer to capital reserve - 2,840,000 Transfer to emergency reserve 1,417,922 1,000,000 Sendero risk-based capital 4,000,000 20,000,000 Contingency reserve appropriation 23,650,587 19,374,631

Total Reserves, appropriated uses & transfers 29,068,508 43,214,631 Debt service:

Debt service - principal retirement 1,000,000 1,030,000 Debt service - interest 372,795 342,818

Total Debt Service 1,372,795 1,372,818 Total Healthcare Delivery 227,029,205 247,343,600

ADMINISTRATION

Personnel ExpensesSalary and Benefits 4,413,183 4,690,997 Legal 926,200 1,198,320 Consulting 1,208,800 1,026,500 Investment Services (Travis County) 105,000 110,000 Benefits & Payroll administrative services 249,920 165,150 Other professional services 483,200 495,000 Marketing & Community Relations 192,400 194,800 Leases, security & maintenance 273,348 308,096 Insurance & Risk Management 157,500 150,030 Phones, computer equipment & utilities 204,930 147,000 Printing, copying, postage & signage 136,560 117,820 Travel, training and professional development 259,625 176,495 Other operating expenses 532,850 541,630

Total Administration 9,143,516 9,321,838

TAX COLLECTIONAppraisal District Svcs 970,200 1,018,710 Tax Collection Expense 682,560 684,500

Total Tax Collection 1,652,760 1,703,210

TOTAL USES 237,825,481 258,368,648

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FY 2019 Budget Detail

8

DESCRIPTIONFY 2018

APPROVED BUDGET

FY 2019 PROPOSED

BUDGET

USES

Primary CarePlanned Parenthood 731,800 790,344

Women's HealthPrimary Care - Planned Parenthood 200,000 250,000

ACA Education and EnrollmentSendero Premium Assistance 2,085,000 2,085,000 Foundation Communities (enrollment services) 400,000 400,000 Outreach for Premium Assistance Enrollment 200,000 Media/Marketing Campaign 150,000 150,000 Enrollment Tools 20,680 36,680 United Way 24,320 24,320 Printing 20,000 20,000

Total ACA Education and Enrollment 2,700,000 2,916,000

Health Care Initiatives: Community Outreach, Strategic Work Plan

Integral Care School Based Care Program 420,000

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FY 2019 Projects – Operating/Capital

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Project Description Estimated Project Cost Funding Source

Operating Budget

Downtown Campus Redevelopment Tower DemolitionOther DemolitionHazard Remediation

Total Operating Budget 6,400,000 Operating

Capital Budget

Downtown Campus Redevelopment CEC Alt Utilities 2,040,000 Lease

Red River Realignment 8,052,000 Debt

Eastern Travis County ETC Service Expansion 1,500,000 CapitalETC Service Expansion TBD DebtSEHWC Walk-in Clinic 737,000 GrantSEHWC Walk-in Clinic 43,000 Capital

Facilities and Information Technology Bldgs and IT 1,000,000 Capital

Total Capital Budget 13,372,000 Plus Debt Financing TBD

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Next Steps (preliminary dates)

April 25 Central Health Board of Managers Meeting May 16 Central Health Budget and Finance Committee (5-year forecast) May 23 Central Health Board of Managers (5-year forecast) June 13 Central Health Budget and Finance Committee (FY 2019 Central Health proposed

budget and property tax rate) June 27 Central Health Board of Managers (FY 2019 CCC proposed budget) July 25 Central Health Board of Managers (FY2019 Central Health proposed budget and tax

rate) Aug 8 Central Health Budget and Finance Committee (FY2019 Central Health proposed

budget and tax rate and CCC Fiscal Year 2019 proposed budget) Aug 14 Travis County Commissioners Court (Fiscal Year 2019 Central Health proposed budget

and tax rate) Aug 15 Central Health Board of Managers (Fiscal Year 2019 Central Health proposed budget

and tax rate – vote on the maximum tax rate) Aug 29 First public hearing Sept 5 Second public hearing• Sept. 12 Central Health Board of Managers (Fiscal Year 2019 budget and tax rate adopted)• Sept. 18 Travis County Commissioners Court (Fiscal Year 2019 Central Health adopted

budget and tax rate approved)

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Resources

For detailed information regarding Central Health’s proposed FY 2019 budget and tax rate, visit:

http://www.centralhealth.net/finance/

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(512) 978-8000www.centralhealth.net@centralhealthtx

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Appendix

• Downtown Campus• Eastern Travis County Service Expansion

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FY 2019 Propose Budget:Central Health Downtown Campus

14

Description FY 2019 Proposed Budget

Building operations and management $2,918,192

Campus infrastructure and development 8,207,350

Total $11,125,542

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Eastern Travis County Service Expansion

15

SourceFY 2019

PROPOSED BUDGET

DESCRIPTION

Capital Budget 1,500,000 Modular Buildings/Mobile Clinic Vehicle

New Initiatives 230,000 Project Management and Analysis

Mobile Health Clinics 768,000 Operating Cost

Service Expansion 1,000,000 TBD

Total 3,498,000

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TRAVIS COUNTY HEALTHCARE DISTRICT D/B/A CENTRAL HEALTH BOARD OF MANAGERS

RESOLUTION ADOPTING THE FISCAL YEAR 2019 BUDGET

The Travis County Healthcare District d/b/a Central Health Board of Managers (the “Board”) hereby adopts the Central Health Fiscal Year 2019 Budget, which (i) consists of the Central Health Fiscal Year 2019 Budget Sources and Uses Summary (attached as Attachment A) and the Central Health Fiscal Year 2019 Budget Uses Detail (attached as Attachment B), both of which are incorporated herein by reference as if set out in full, and (ii) expresses the following budget priorities:

• To support Strategic Work Plan Strategy 1.1, entitled Service Locations and Care Delivery, an estimated $3.498 million in priority projects in Eastern Travis County, including but not limited to, the necessary capital acquisitions and operations for services offered in the Austin’s Colony/Hornsby Bend area, Colony Park communities, and the areas surrounding the Elroy and Creedmoor communities, as detailed in Central Health’s management recommendation and approved by the Board at its September 5, 2018 meeting. The funding for these projects consists of $1.5 million in capital funds, $230,000 in operating funds, $1.0 million from service expansion, and $768,000 allocated for mobile health clinics.

• To support Strategic Work Plan Strategy 3.4, entitled Optimal Use of Brackenridge Campus, a/k/a the Central Health Downtown Campus, redevelopment through abatement, demolition, infrastructure investment, and road realignment, estimated at $16,942,000 from operating funds and debt financing.

• To support Strategic Work Plan Strategies 2.2 and 2.3, entitled Patient Outcomes and Experiences and Women’s Reproductive Health, respectively, women’s health initiatives intended to address disparate postpartum outcomes and maternal care access issues, in amounts dependent on available funding and viable service plans.

• To support Strategic Work Plan Strategy 2.5, entitled Central Health’s Role in Brain Health and Cancer Strategies Refinement, and the interim funding request by Integral Care, mental health services for children attending schools within the Austin Independent School District, estimated at $420,000 from new initiatives funding.

• To support Strategic Work Plan Strategy 1.3, entitled Communications, an estimated $350,000 from operating funds for community outreach and engagement efforts designed to inform and educate Travis County residents and Medical Access Plan enrollees, as well as, to enable better utilization by residents and enrollees of available health care programs.

Pursuant to Chapter 281 of the Texas Health & Safety Code, the Central Health Fiscal Year 2019 Budget Sources and Uses Summary and any amendments thereto must be approved by the Travis County Commissioners Court before the budget becomes effective. Moreover, any expenditures incurred or paid pursuant to this Central Health Fiscal Year 2019 Budget shall be controlled by the Travis County Healthcare District Financial Policies (attached hereto as Attachment C), and any policies adopted by the Board related to Reserves and Investments (the current policies are attached hereto as Attachment D). The acquisitions and services funded by Central Health will, to the greatest extent possible, be predicated on the submission of service or business plans that prove viability, sustainability for the intended term, and value to the Central Health Mission. ADOPTED at an open meeting of the Central Health Board of Managers held on the 12th day of September 2018. TRAVIS COUNTY HEALTHCARE DISTRICT BOARD OF MANAGERS ______________________________________ Guadalupe Zamora Board Chairperson

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Our Mission


Our Values




BOARD MEETING

September 12, 2018

REGULAR AGENDA ITEM 5 Discuss and take appropriate action regarding Central Health’s proposed 2019 tax rate.

a. Total Maintenance and Operations Tax Rate; b. Total Debt Service Tax Rate; and

Total Ad Valorem Tax Rate.

74

FY 2019 Proposed Tax Rate (6% over Effective Rate)

1

FY18 FY19(Proposed)

Average Taxable Homestead Value

$305,719 $326,895

Tax Rate 10.7385¢ 10.5221¢

Tax Bill $328.30 $343.97

Annual Taxpayer Impact: $15.67 (+4.8%)

Annual Tax Rate Change: (-2%)

Homestead Exemption

Over 65 Homestead Exemption

Disability Homestead Exemption

20% (A)$5,000 Minimum $85,500 (B) $85,500 (B)

(A) Maximum allowable by state law(B) Increased from $80,000

*10.5221¢

*10.4495¢*0.0726¢

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TRAVIS COUNTY HEALTHCARE DISTRICT D/B/A CENTRAL HEALTH BOARD OF MANAGERS

ORDER ADOPTING THE AD VALOREM TAX RATE FOR YEAR 2018

STATE OF TEXAS § § COUNTY OF TRAVIS § It is necessary to levy for the current 2018 Travis County Healthcare District d/b/a Central Health tax year ad valorem taxes on each $100 valuation of all taxable property within the boundaries of the Travis County Healthcare District d/b/a Central Health as follows: MAINTENANCE AND OPERATIONS : $0.104495 Total Maintenance and Operations Tax DEBT SERVICE: $0.00726 Total Debt Service Tax I. On motion by: , and seconded by: , The following was adopted by the Travis County Healthcare District d/b/a Central Health Board of Managers on September 12, 2018 It is moved that the property tax rate be increased by the adoption of a tax rate of $0.104495 for maintenance and operations, which is effectively a negative two percent (-2.0%) increase in the tax rate. Voting in favor of the motion: ___________________________________ ___________________________________ Guadalupe Zamora, Chairperson Sherri Greenberg, Vice-Chairperson ___________________________________ ___________________________________ Charles Bell, Treasurer Abigail Aiken, Secretary ___________________________________ ___________________________________ Katrina Daniel, Manager Shannon Jones, Manager ___________________________________ ___________________________________ Maram Museitif, Manager Julie Oliver, Manager ___________________________________ Cynthia Valadez, Manager

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2

II. On motion by: , and Seconded by: , The following was adopted by the Travis County Healthcare District d/b/a Central Health Board of Managers on September 12, 2018: It is moved that the property tax rate be increased by the adoption of a tax rate of $0.00726 for each $100 valuation of all taxable property for debt service and to provide sinking funds and to pay interest on the outstanding debt issuances which include certificates of obligation. Voting in favor of the motion: ___________________________________ ___________________________________ Guadalupe Zamora, Chairperson Sherri Greenberg, Vice-Chairperson ___________________________________ ___________________________________ Charles Bell, Treasurer Abigail Aiken, Secretary ___________________________________ ___________________________________ Katrina Daniel, Manager Shannon Jones, Manager ___________________________________ ___________________________________ Maram Museitif, Manager Julie Oliver, Manager ___________________________________ Cynthia Valadez, Manager

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3

III. On motion by: , and Seconded by: , The following was adopted by the Travis County Healthcare District d/b/a Central Health Board of Managers on September 12, 2018: Having approved the two components of the Travis County Healthcare District d/b/a Central Health tax rate for the current year, property taxes are increased by the adoption of a total Travis County Healthcare District d/b/a Central Health ad valorem tax of $0.105221 for each $100 valuation of all taxable property. THIS TAX RATE WILL RAISE MORE TAXES FOR MAINTENANCE AND OPERATIONS THAN LAST YEAR'S TAX RATE. THE TAX RATE WILL EFFECTIVELY BE RAISED BY -2.0 PERCENT AND WILL RAISE TAXES FOR MAINTENANCE AND OPERATIONS ON A $100,000 HOME BY APPROXIMATELY $6.11 (SIX DOLLARS AND ELEVEN CENTS). Voting in favor of the motion: ___________________________________ ___________________________________ Guadalupe Zamora, Chairperson Sherri Greenberg, Vice-Chairperson ___________________________________ ___________________________________ Charles Bell, Treasurer Abigail Aiken, Secretary ___________________________________ ___________________________________ Katrina Daniel, Manager Shannon Jones, Manager ___________________________________ ___________________________________ Maram Museitif, Manager Julie Oliver, Manager ___________________________________ Cynthia Valadez, Manager

Dated this the 12th day of September 2018.

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Our Mission


Our Values




BOARD MEETING

September 12, 2018


Discuss and take appropriate action on a ground lease agreement to be entered into between Central Health and Travis County Emergency Services District 11.1

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Our Mission


Our Values




BOARD MEETING

September 12, 2018


Discuss and take appropriate action on Central Health owned property, including the Downtown Campus and adjacent properties.1

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Our Mission


Our Values




BOARD MEETING

September 12, 2018


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

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23 - central health home - central health · 9/12/2018 · urgent and convenient care fy18...

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