The Future of Healthcare from a Public Health System Perspective. George V. Masi President and Chief Executive Officer

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1 The Future of Healthcare from a Public Health System Perspective George V. Masi President and Chief Executive Officer

2 Mission: We improve our community s health by delivering high-quality healthcare to Harris County residents and by training the next generation of health professionals. Vision: We will create a healthier community and be recognized as one of America s best community-owned healthcare systems. Statutory Requirement for Hospital Districts: A hospital district shall provide health care assistance to each eligible resident in its service area who meets the basic income and resources requirements (to the extent the district is financially able to do so).

3 18 Community Health Centers 3 Hospitals 6 Same Day Clinics 5 School-based Clinics 5 Specialty Clinics 9 Homeless shelter clinics Ben Taub Hospital 492 beds Level I Trauma Center Lyndon B. Johnson Hospital 235 beds Level III Trauma Center Quentin Mease Hospital 49 beds Rehabilitation, skilled nursing, physical and occupational therapy Ambulatory Care Services Smith Clinic Outpatient Center Medical Staff Faculty and residents from Baylor College of Medicine and UT Health 844 faculty/provider 626 resident FTEs

4 System is a component unit of but legally separate from Harris County Created in 1965 to provide patient care to the indigent population of Harris County Residents, not eligible for Medicaid, with income less than 150% of the federal poverty level Board of Managers approves threshold for indigent designation; 200% prior to March 2016 By reducing criteria, estimated reimbursement / cost savings of $21 million for fiscal 2017 Harris County Commissioners Court appoints members to the System s governing board Comprised of 9 appointed members who reside in the County Board selects a chairman, sets policy, appoints a CEO and submits an annual budget to the Commissioners Court for approval CEO and employed staff responsible for day-to-day operations of Harris Health System Commissioners Court approves the System s tax rate

5 County uninsured 1.1 million out of total 4.5 million population Most uninsured Texas adults are low income workers 70 percent are in a working family 40% are below 200 percent of the poverty level 20% of uninsured are undocumented immigrants, outside reach of the ACA Harris Health is the foundation of the healthcare safety net for the County Provides 47% of the cost of care for the uninsured reported by participating hospitals, and 18% of the Medicaid payment shortfall in the Harris County area* Unique patients in most recent fiscal year: 322,988; Over 62% of the services provided were charity or unfunded *Based on FFY 2013 Uncompensated Care data from THHSC

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7 Population Growth Median Household Income ( ) Millions (Est.) Source: U.S Census Bureau Unemployment Rate 9.00% 8.00% 7.00% 6.00% 5.00% 4.00% 3.00% Source: U.S. Bureau of Labor Statistics; not seasonally adjusted; through May 2016 $55,000 $50,000 $45,000 $40, Harris County National Source: U.S Census Bureau

8 Property appraised annually by the Harris County Appraisal District By each September 1, the Commissioners Court, acting for the District, adopts a tax rate for the current year Tax rate has been flat at cents for the past three years, a decline from cents in 2013 and cents in 2012 Taxable Assessed Valuation has increased from $268.4bn in 2012 to $379.6bn in 2016 County s economy has remained stable, despite lower oil prices, as a result of the size and diversity of industry and employment Economic growth has slowed; expectation that tax base will increase 5% in current year (compared to 11%+ last year)

9 Total Revenues ($mm) $1,400 $1,200 $1,000 $800 $600 $49 $53 $224 $272 $309 $295 $34 $44 $50 $60 $74 $90 $236 $181 $256 $362 $366 $349 $400 $200 $512 $508 $516 $574 $635 $0 FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 Ad Valorem Taxes Net Patient Revenue DSH / UPL / UC 1115 Waiver DSRIP Revenue (Net) Other Revenue

10 Patient Volume 250, , , ,000 50,000 0 Inpatient Days 200, , , , ,038 FY12 FY13 FY14 FY15 FY16 1,000, , , , ,000 0 Primary Care Clinic Visits 748, , , , ,651 FY12 FY13 FY14 FY15 FY16 Specialty Clinic Visits Adjusted Patient Days 400, , , , , , , , , , , , , , , , , ,000 0 FY12 FY13 FY14 FY15 FY16 0 FY12 FY13 FY14 FY15 FY16

11 Payor Mix Comparison (1) 4% 4% 10% 20% 62% Charity & Self-pay Medicaid & CHIP Medicare Private Insurance Other (1) Based on charges

12 Total Margin ($mm) Total Margin - All Revenues less Expenses $10 $5 $7 $0 $1 -$5 -$10 -$15 -$17 -$20 -$22 -$25 -$30 -$35 -$31 FY 2012 FY 2013 FY 2014 FY 2015 FY 2016

13 Days Cash on Hand - FY End FY 2012 FY 2013 FY 2014 FY 2015 FY 2016

14 No Texas Solution for Medicaid coverage for Texas adults below 133% of the poverty level Stable Medicaid Supplemental Payments DSH and UC through 2017; declining thereafter Renewal terms of the Texas Medicaid 1115 Waiver after December 2017 Insurance Exchange enrollment expected to increase from higher tax penalties and change in eligibility criteria; other options to facilitate enrollment being evaluated