Maricopa County Special Health Care District Board of Directors Meeting Maricopa Medical Center Auditoriums 1 and 2 September 28, :00 p.m.

Transcription

1 0BMinutes Maricopa County Special Health Care District Board of Directors Meeting Maricopa Medical Center Auditoriums 1 and 2 September 28, :00 p.m. Present: Susan Gerard, Chairman, District 3 Mary A. Harden, R.N., Vice Chairman, District 1 Mark Dewane, Director, District 2 Elbert Bicknell, Director, District 4 Terence McMahon, Director, District 5 Others Present: Steve Purves, MIHS, President & Chief Executive Officer Kris Gaw, MIHS, Chief Operating Officer Kathy Benaquista, MIHS, Chief Financial Officer John Hitt, M.D., MIHS, Chief Medical Officer Sherry Stotler, R.N., M.S.N., MIHS, Chief Nursing Officer Erik Katz, M.D., MIHS, Chief of Staff Louis B. Gorman, MIHS, District Counsel Guest Presenters: Nora Kelly, Kaufman Hall & Associates, Senior Vice President Pete Salisbury, Kaufman Hall & Associates, Assistant Vice President Gene Cavallo, MIHS, Vice President Behavioral Health Services Recorded by: Melanie Talbot, MIHS, Executive Director of Board Operations Cynthia Cornejo, MIHS, Deputy Clerk of the Board Call to Order Chairman Gerard called the meeting to order at 1:01 p.m. Pledge of Allegiance Vice Chairman Harden led the Pledge of Allegiance. Roll Call Ms. Talbot called roll. Following roll call, it was noted that all five voting members of the Maricopa County Special Health Care District Board of Directors were present, which represented a quorum. Call to the Public Chairman Gerard called for public comment. There were no comments from the public. Mission Statement Ms. Talbot read the Mission Statement aloud.

2 General Session, Presentation, Discussion and Action: 1. Approval of Consent Agenda: a. Minutes: i. August 24, 2016 b. Contracts: i. Approve Eight (8) Job Order Contracts for General Construction Services ( through 8) with the purpose of the agreements to provide on-call job order contracting for general constructions services ii. Approve Amendment #9 to the Administrative Services Agreement (C ) between Maricopa County Special Health Care District and University Physicians Healthcare d.b.a. the University of Arizona Health Plans iii. Approve Amendment #10 to the Administrative Services Agreement ( ) between Maricopa Count Special Health Care District and University Physicians Healthcare d.b.a. the University of Arizona Health Plans c. Governance: i. Appoint Cheri Tomlinson to the Home Assist Health Board of Directors d. Medical Staff: i. Approve Maricopa Integrated Health System Medical Staff Appointments, FPPEs, Reappointments, Change of Privileges/Status, Waiver Requests, and Resignations for September 2016 ii. iv. Approve Maricopa Integrated Health System Allied Health Professional Staff Appointments, FPPEs, Reappointments, and Resignations September 2016 Approve Proposed Revisions to the Department of Emergency Medicine Delineation of Privileges e. Proposition 480 Capital: i. INTENTIONALLY LEFT BLANK MOTION: Director McMahon moved to approve the consent agenda. Director Dewane seconded. Motion passed by voice vote. 2. Discussion and Possible Action on the Recommendation on the Final Report for Proposition 480 Implementation Planning Mr. Purves expressed his appreciation for all of the work that lead to the final report, including the work of the experts at Navigant Healthcare (Navigant) and Kaufman Hall & Associates (Kaufman Hall); who was prepared to present the financial analysis and summary. 2

3 2. Discussion and Possible Action on the Recommendation on the Final Report for Proposition 480 Implementation Planning, cont. Ms. Kelly presented the results of the financial analysis and noted the scope of work was built on the specific details and capital costs, which were provided by Navigant. Those details were then layered into the financial plan to assess the operating and financial impact on the organization to develop a full financial view of the impact on the organization over a 10-year period. The purpose of a long-range financial plan was to quantify the impact of existing operations with the current scope of services, to fold in the capital operating and financial impact of new, future strategic and operating initiatives, and to link those together into an integrated set of projected financial statements. The plan would allow the Board and management to link strategic decision making with operating financial performance to provide a comprehensive view. There were two primary building blocks to the long-term financial plan: a current state projection; and the identification of a range of future, incremental projects that may be strategic in nature. She explained the concept of the Corridor of Control, which was the ability to balance two goals; the ability to invest in the organization to be strategically well-aligned, and the fiduciary role to maintain longterm financial strength. There will times when the two objects would be in conflict and the goal was to balance the two forces by appropriately balancing the two. Chairman Gerard said that maintaining the balance was based on assumptions and the willingness to assume more risk. She asked if the uncertainty of the upcoming changes in Washington D.C. influenced the decision making process. Ms. Kelly stated that the long-range financial plan was only as good as the assumptions made. She noted that the financial plan should be reviewed and updated on an annual basis, as more information on the assumptions is available. The financial plan includes information on the sources and uses of funds for the organization, with a cash reserves target for the end of the specified period. That target also includes several factors, including but not limited to the organization risk tolerance. The framing of the long-range financial plan was to apply the District s objectives and to assess the financial viability of the proposed projects. The goal was to assess the affordability of the portfolio of projects. A very thorough due diligence to vet the scope of the portfolio of projects was performed. She noted that to perform that task properly, each project was modeled individually with conservative assumptions on each of the operating performances. Historical data was considered; however, the new sites would be designed with operational efficiency and excellence in mind and would most likely perform more efficiently in the future. She stated that from an affordability perspective, based on historical performance, the District could afford the portfolio. Mr. Salisbury explained the process used to build the models and reviewed the analytics used. The analysis included a total project cost of $829 million for the multiple projects, the capital investment required, timeline of projects, tax levies, all debt service payments, and new debt issuance to occur in the upcoming years related to the projects. The primary metrics focused on throughout the analysis were cash flow, total unrestricted cash, and the number of days cash on hand. The volume growth projections were conservative, included demographic information and utilization data. He noted that all assumptions were reliant on the continued performance improvement initiatives throughout the organization. He reiterated that the analysis was a high-level overview of the financial health of the organization, included assumptions on the construction costs, timing of capital expenditures, and appropriate ramp-up of operations for the various projects. He reviewed the phases toward comprehensive transformation; including the cost reduction and margin improvement, business restructuring, and the clinical transformation. The first phase, categorized as hard, included initiatives already implemented by Maricopa Integrated Health System (MIHS); increased productivity, improvements in revenue cycle, and improving supply chain and purchased services. The second phase, categorized as harder, would be approached with the strategic plan over the next 5-10 years. The tasks would include addressing the service line distribution and creating an ambulatory footprint, as the healthcare industry was progressing service in the ambulatory setting. The final phase, categorized as hardest, was the clinical transformation toward population health management. 3

4 2. Discussion and Possible Action on the Recommendation on the Final Report for Proposition 480 Implementation Planning, cont. Mr. Salisbury stated that MIHS had accomplished many of the necessary tasks in the hard category and had positioned itself to work towards the next phases. The second phase required lot of preparation and buy-in from stakeholders, in terms of service line adjustments and ensuring that medical providers would be available to provide those services. The third phase would begin to transform the way care was delivered within a new configured business and was a change in culture of the organization. Ms. Kelly said the transformation of care considered the future business models and reimbursement methods. The goal was to maintain the Corridor of Control and focus on the timing of particular strategies. Chairman Gerard agreed, especially with the uncertainty of the healthcare industry due to outside influences that regulated funding and reimbursement rates. Mr. Salisbury noted that the key to success was the establishment of a proper infrastructure for the organization that would allow strategic investments in a fiscally responsible manner. He then reviewed the results of the analysis, which was measured by the organization s days cash on hand. The metric considered two measures; the actual amount of unrestricted cash on the balance sheet divided by the estimated expenses of the organization. This metric demonstrates the financial stability of the organization in the future years. The results, after layering all of the components into the analysis, showed the District to be in a comfortable financial situation, with 179 days cash on hand in He noted that the results included variability, based on capital expenditures, and expense inflation without comparable reimbursement inflation. However, the assumptions included were conservative. Director McMahon questioned the starting amount for the days cash on hand, as if differed from reports received by the Board. Mr. Salisbury stated that the current amount displayed included the bond funds; however, going forward, the amounts would not include those amounts. The final result shown would be comparable to the reports currently distributed. By the end of the 10-year period, the bond funds are expected to have been spent down. He referred to the graphic displayed on slide 13, which highlighted the total uses of funds, total sources of funds, and the anticipated annual cash surplus by fiscal year 2026, $21 million. It was determined that the projects were affordable, with a comfortable surplus. Vice Chairman Harden noted that the current ad valorem tax was due to expire in 2024 and questioned if the assumptions were based on the voters approving continuation of that tax. Mr. Salisbury stated that the assumptions included the continuation of the ad valorem tax for the final two years of the planning period, and was approximately $200 million for the two years. Chairman Gerard stated that the analysis, based on conservative assumptions and moderate risk, showed the proposed projects were affordable. Director McMahon requested the basic inflation rate used in making the assumptions. Mr. Salisbury stated that various inflation rates used, based on the service line or expense item; such as salaries and pharmaceutical costs. Those various rates would be provided to the Board. Mr. Purves expressed his appreciation to the work performed by Kaufman Hall with contributions from senior management and the finance department. The results of the analysis demonstrated the affordability of the projects and were predicated on the continued progress on the performance improvement and operations excellence of MIHS. He also commended the employees of MIHS for their willingness to adapt to change and growth within the organization. Without that cooperation, the results would not have been possible. 4

5 2. Discussion and Possible Action on the Recommendation on the Final Report for Proposition 480 Implementation Planning, cont. He noted the difficulty in forecasting future, as there were many unknowns in the healthcare industry, including policy decisions determined by federal and state regulators. Given that, the organization was to remain flexible and adapt to the ever-changing healthcare landscape. However, he was confident with the detail included in the analysis and the assumptions made. Chairman Gerard noted that the long-range financial plan was for a 10-year period and questioned how often the plan should be revisited or revised. Ms. Kelly stated that the plan was intended to provide a long-range outlook; however, it was recommended that the plan be reviewed and updated on a semi-annual or annual basis, whichever was most appropriate for the organization to support the strategic and financial decision-making. MOTION: Director Dewane moved to formally acknowledge receipt of the Proposition 480 Implementation Planning Findings and Recommendations and recognize the work of Navigant Healthcare and Kaufman Hall & Associates having written the report. In accepting the findings and recommendations, the Board directed Maricopa Integrated Health System Senior Administration to coordinate implementation and to provide the Board with timely updates as to the progress of the implementation. Director McMahon seconded. Motion passed by voice vote. Chairman Gerard thanked the staff for their time dedicated to the development of the final report. 3. Presentation on Performance Improvement and Quality Management, Approval of Maricopa Integrated Health System s Annual Performance Improvement Plan for Fiscal Year 2017 and Approve Indicators on Which to Measure Quality for Fiscal Year 2017 Dr. Hitt reviewed the MIHS Annual Performance Improvement Plan for Fiscal Year 2017 and stated that the quality targets in healthcare were in constant evolution. The changes in regulatory requirements were reflected in the plan every year, with the goal of enhanced performance. He stated that quality no longer included only the performance in clinical objectives; it also required exercising in a fiscally responsible manner, which was incorporated into the plan. Hospitals were now measured very publically in the performance, and now fiscal responsibility, and the plan reflects those changes and responsibility as well. Chairman Gerard said that many of the indicators on which to measure quality were dictated by federal or state regulatory agencies. Dr. Hitt stated the majority of the quality indicators derived from federal or state regulatory agencies, and were part of the pay for performance aspect. The indicators generally originate with the Center for Medicare and Medicaid Services (CMS), which often sets the pattern for commercial payers. Mr. Purves noted that the plan was a living document and would be presented to the Board with updates, as needed and noted that a modified version of the Plan would be brought back to the board in October. Director McMahon asked if the performance measures listed in Attachment A were defined in a separate document. 5

6 3. Presentation on Performance Improvement and Quality Management, Approval of Maricopa Integrated Health System s Annual Performance Improvement Plan for Fiscal Year 2017 and Approve Indicators on Which to Measure Quality for Fiscal Year 2017, cont. Dr. Hitt reassured that the performance measures were well-defined, including exclusion and inclusion criteria. The definitions were vetted on a national level and began with evidence-based practices, and outlined how to measure the standards. He stated that one challenge facing public hospitals, the performance measures rarely were risk adjusted for social determinants of health. There were national efforts to address the issue. That information was available for those interested in reviewing. MOTION: Director McMahon moved to approve the Maricopa Integrated Health System s Annual Performance Improvement Plan for Fiscal Year Director Dewane seconded. Motion passed by voice vote. MOTION: Director McMahon moved to approve the Indicators on Which to Measure Quality for Fiscal Year Vice Chairman Harden seconded. Motion passed by voice vote. 4. Consideration, Discussion, and Possible Action on the President & Chief Executive Officer s Performance Goals for Fiscal Year 2017 Mr. Purves stated the performance goals for fiscal year 2017 included the major objectives of the medical center and were developed to keep the focus on the various aspects of the organization. The goals were designed to keep management and him accountable. Director McMahon commented that each of the minimum standards established for fiscal year 2017 was an improvement over the previous year results. MOTION: Vice Chairman Harden moved to approve the Chief Executive Officer s performance goals for fiscal year 2017 with the following changes to goal 3.b.; the minimum will be greater than 85, the midpoint will be greater than 90, and the maximum will be greater than 95, and the correction to the dates in the heading to reflect the current 2017 fiscal year. Director Dewane seconded. Motion passed by voice vote. 5. Reports to the Board of Directors; Possible Action: a. Monthly Proposition 480 Capital Purchases Update b. August 2016 Maricopa Integrated Health System Key Indicator Dashboards; Financial Report c. Quarterly Update on the Mercy Maricopa Integrated Care Initiatives d. Semi-Annual Report from the Maricopa Health Centers Governing Council e. Monthly Media Report Ms. Benaquista referred to 5.a., the Proposition 480 Capital Purchases Update report, and noted an error on page 29 of 32. The amount listed was the annual administration fee; not a capital expense. The error would be corrected on the next report. 6

7 5. Reports to the Board of Directors; Possible Action, cont.: Vice Chairman Harden referred to 5.b., the August 2016 MIHS Key Indicator Dashboards, and requested the inclusion of a monthly quality dashboard, which would include but not be limited to medication errors and falls. Ms. Stotler noted that many of the items appear in different reports throughout the year; however, Vice Chairman Harden was invited to work with the quality team to develop a list of Board-level quality measures to track and report on a monthly basis. Director McMahon reiterated a previous request for a quality index metric, one measure that would determine the overall quality at the organization in an understandable manner. Dr. Hitt noted that there was the ability to create a quality index; however, it would be complicated and not easily understood. The staff would coordinate with Vice Chairman Harden to develop a Board-level quality dashboard to report on a monthly basis. Director McMahon referred to the operational dashboard of the same report, and noted his concerned with the ambulatory volume. He asked if there was a plan in place to address the issue. Ms. Gaw stated that a Clinic Taskforce had been formed and its focus was on volume and reviewing the processes surrounding access to care. It was a multidisciplinary team, with representation from the each clinic, as each clinic had its own set of challenges. Chairman Gerard referred to item 5.c., the Quarterly Update on Mercy Maricopa Integrated Care (MMIC) Initiatives, and invited Mr. Cavallo to elaborate on the various programs. Mr. Cavallo stated that there were three new programs in behavioral health: the Assertive Community Treatment (ACT) team, Family Support & Education, and First Episode Intervention. The ACT program was operating at Desert Vista and was ramping up the enrollment. This program had strict criteria for participation and was very prescription on how the care was delivered. The Family Support & Education was operating out of the South Central Family Health Center, and provided family support and education to family members and significant others of individuals with serious mental illness. The First Episode Intervention was scheduled to begin operation within the coming months, and would be operating out of the Pendergast Community Center. Director McMahon asked if there were key performance indicators in place, to determine the success of the program. Mr. Cavallo noted that the ACT program was regulated with fidelity measures at the federal level, established by the Substance Abuse Mental Health Services Administration (SAMHSA). With regard to the other programs, there were not established indicators from external sources. However, the Regional Behavioral Health Authority (RBHA) will outline the measures of success. Those metrics for the First Episode Intervention program may include the number of hospitalizations, number of arrests, and stable housing, over an established timeframe. Chairman Gerard stated that the quality measures for behavioral health varied from the quality measures for acute care, and were much more difficult to measure. Mr. Purves said that each program had goals, which were in the organizational goals; however, as the programs progress, specific goals would be developed would be reported to the Board. Chairman Gerard referred to the ACT program and requested that the Board receive indicators that related to the number of incarcerations/arrests and permanent housing for the individual enrolled in the program. She asked when the First Episode Intervention program was scheduled to being seeing patients. 7

8 5. Reports to the Board of Directors; Possible Action, cont.: Mr. Cavallo stated that the program was licensed and he was working on the final amendment with MMIC, which was anticipated within the month. He had secured the appropriate staff for the program and was working on the final details, such as outreach to the community. There will also be education provided to primary health care providers, schools, family groups, and emergency rooms, to identify individuals that would benefit from the programs available. Director Dewane questioned if the care rendered in the behavioral health arena was more palliative, as opposed to making an individual well. Chairman Gerard stated that the care and outcomes were more subjective, which made it more challenging to quantify success and outcomes. There had always been a paternalistic approach with behavioral health, to keep people safe and protected. However, the care was moving toward making individuals independent and able to care for themselves. There was a change in the culture in behavioral health care. Mr. Cavallo concurred and stated that the assessment of the patient would include input from family members, and employers or schools, which was more of a population health management approach. The normal trajectory of those affected by mental health disorders can have drastic effects on the individual and their family. However, the goal of the First Episode Intervention program was to intervene early to prevent that progression. The benefits to the individual, their families, and the community as a whole, were limitless. Dr. Hitt mentioned that the support of the community could affect any disease or disorder. He noted the progress made surrounding HIV/AIDS, including the community creating an advocacy on a national basis for new drug discovery and social support groups, which resulted in positive results for the patients living with the disease. With behavioral health, there was a stigma, not a focus of attention for mental health disorders. Those social determinants can greatly affect the outcomes for behavioral health patients. Director Dewane stated that there needed to be a mechanism in place to demonstrate outcomes; to ensure that the programs had a positive impact on the community, as it was utilizing taxpayer dollars. Chairman Gerard referred to 5.d., the Semi-Annual Report from the Maricopa Health Centers Governing Council (Governing Council), and noted the improvement on the percentage of abandoned calls; which were trending in the correct direction. Vice Chairman Harden referred to the dashboard included in the report and requested clarification on the number of surveys return, in particular, the return rate. Ms. Stotler stated that the return rate in the ambulatory environment was approximately 30%, with established goal of 40%. Chairman Gerard suggested the return rate be included in the report. Director McMahon noted that the cost per visit was performing better than budget and commended the team for their efforts. There were no comments or questions on 5.e., Monthly Media Report. 8

9 6. Concluding Items a. Old Business: November 12, 2015 Annual Board of Directors Compliance Training HIPAA Risk/IT Research Assessment will be completed by February 2016; Results will be reported to Board of Directors August 24, 2016 Reports to the Board Key Indicator Dashboards and Financial Statements: As plans are developed to address the ambulatory volume, the Board will be updated. MIHS Compliance Department Reports Annual System-Wide Compliance Education Results: The Board will receive an update on the progress by the end of the calendar year. Mercy Maricopa Integrated Care (MMIC) Fiscal Year 2016: Board will receive a document that outlines the various behavioral health initiatives, including how the program was performing, when the program was scheduled to begin, if it had not already, and the likely impact on MIHS. Concluding Items The vacancy on the Home Assist Health Board of Directors will be filled. b. Board Member Requests for Future Agenda Items or Reports c. Comments i. Chairman and Member Closing Comment ii. President & Chief Executive Officer Summary of Current Events Ms. Talbot reviewed old business and reiterated the outstanding items. Mr. Purves recognized Mr. Cavallo, and all involved, for all of the time and effort spend on the new behavioral health programs at MIHS. The programs were a new focus and were designed to meet the need for behavioral health care in the community. He also stated that as the RBHA, MMIC had a vast responsibility to fulfill, and the new programs would assist in making progress with those initiatives. Mr. Purves referred to the work completed with the Proposition 480 implementation and planning and noted the importance of the planning process. There was an opportunity, not to just build buildings, but to redefine the safety net system of care and set the standard on a national level. He expressed his gratitude to the senior management team, and thanked all involved for their contributions, including stakeholders, advisors, and consultants. He acknowledged the Board for the diligence provided, holding staff accountable, and demonstrating stewardship throughout the process. Director Dewane announced the upcoming Maricopa Health Foundation s 13 th Annual CopaBall on Saturday, October 22, The fundraising event supports the foundation s efforts to provide direct support to the MIHS patients and programs. There was still time to purchase the tickets or make a donation. 9

10 Adjourn MOTION: Director Dewane moved to adjourn the September 28, 2016 Special Health Care District Board of Directors Formal Meeting. Vice Chairman Harden seconded. Motion passed by voice vote. Meeting adjourned at 3:06 p.m. Susan Gerard, Chairman Special Health Care District Board of Directors 10