MEMORANDUM FROM: Patricia A. Young Brown June 13, 2008 RE ... · • SWOT Analysis • Analysis of current strategic plan • Planning document with prioritized staff recommendations

MEMORANDUM

TO: Board of Managers

Patricia A. Young Brown President and CEO

FROM:

DATE: June 13, 2008

RE: Strategic Planning Retreat

This is to remind you of the strategic planning retreat to be held on Wednesday, June 18, 2008, from 1:00 p.m. to 7:00 p.m. in the Board Room of the District offices. Attached to this memorandum are three sets of documents that will help guide our work next Wednesday.

The first set of materials, identified below, are those that we will use throughout the meeting to guide our progress.

Meeting Materials • Posted agenda for retreat • Meeting agenda with specific timeframes identified for each topic • Planning document with prioritized staff recommendations for strategies by focus area

with needed resource, reason for recommended prioritization, and anticipated Return on Investment (ROI) identified for each.

The second set of materials, identified below, are those that we will refer to as needed to assist in our strategic planning discussions. The items are listed below in the order that they were completed

Back-Up Materials • SWOT Analysis • Analysis of current strategic plan • Planning document with prioritized staff recommendations by focus area without

information on needed resources or anticipated ROI • List of current District collaborations

The final set of materials is related to the Board's self-evaluation and will inform the discussion regarding the role and organizational structure of the Board.

Board Materials • Results of Board Self-Evaluation • Proposed revision to Board committee structure

Thank you in advance for your participation in this important effort. The development of a meaningful strategic plan with priorities established for FY09 and beyond along with consensus on the role and organization of the Board will be invaluable in guiding our work in the upcoming fiscal year.

TRAVIS COUNlY HEALTHCARE DISTRICT BOARD OF MANAGERS

STRATEGIC PLANNING SESSION

WEDNESOAY,JUNE1B,2DDB l:DO PM

1111 E. CESAR CHAVEZ. AUSTIN, TEXAS CESAR CHAVEZ BOARD CONFERENCE ROOM

AGENDA

I. Receive. discuss. and take appropriate action on Information related tu the development of the District's strategic plan and budget for fiscal year 2DDB-2DD9 including Items affecting the District's fiscal year 2001-2008 budget and strategic objectives.

2. Rei:eive. discuss. and take appropriate action regarding the District Board of Manager's self evaluation and organization and committee structure for fiscal year 2DDB-2D09.

3. Discuss and take appropriate action regarding the evaluation tool for the District President and CED's performance incentive pay for next formal evaluation period. including a discussion of the purpose of performance incentive pay. and the District President and CED's compensation.' ·

Note I. Section 551.074. Personnel Matters

The Board may consider any item on the agenda in Executive Session if theru are issues that require consideration in Executive Session and the Committee announces that the item will be considered during Executive Session.

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Travis County Health Care District Board of Managers Strategic Planning Retreat

June 18, 2008

Objectives • Review major accomplishments of the past 3 years • Discuss key factors and assumptions to consider in the planning process • Determine short-term priorities for 2008-2009 • Determine priority strategies for the next 3 to 5 years • Identify implications of the priorities for organizational roles, structure and

communication in the coming year ·

Agenda

1:00 Welcome (Carl)

1:05 Session Overview/Participant Expectations Facilitator reviews session objectives, agenda, discussion guidelines and roles. Participants state their goals for the session.

1:20 Where Have We Been? The group sets the context for the day's discussion by briefly reviewing the vision and mission statement. The Board then reflects upon major accomplishments and the factors that made those successes possible. Organizational limitations will also be discussed.

1:50 How Can We Align Our Purpose with the Needs of the Future? Key issues, trends and assumptions for the future will be identified and discussed. The group will clarify implications of the future for the organization's vision and m1ss10n.

2:30 Break

2:45 Where Can We Have the Most Impact? Using the discussion of future trends and organizational purpose as a context, the group discusses and reaches consensus on short- and long-term priorities.

4:00 Break

4:15 Where Can We Have the Most Impact? (Continued)

4:50 Break

5:00 How Can We Work Together to Implement the Plan?

5:50

6:15

6:15-7:00

Participants assess implications of their agreements. Topics include: • Board roles • Committee structure • Budget • Implications for organizational communication and staffing • Processes for completing a more detailed, measurable and operational

strategic plan

Agreements and Next Steps Specific agreements from the retreat are summarized, and assignments and timeframes for follow-up steps are identified.

Evaluation and Close of the Strategic Planning Meeting

Executive Session and Meeting to Discuss Incentive Program for President/CEO

Facilitator Mary Thompson, Corder/Thompson & Associates

Staff Recommendations 6/18/08

1

TCHD Strategy Considerations By Focus Area

Focus Area: Healthcare Services Network (Primary Care, Specialty Care, Mental Health)

Priority Anticipated ROI for Strategy Have To Want To Resource Rationale for FY Designation District/Community

Increase access to urgent care/convenient care centers (PC)

FY09 Current staff New staff (Provider Relations, Business Development)

Additional funds may be required to purchase additional services

Provide increased access to care for patients needing immediate services to reduce use of ER.

• Timely access to continuum of care for patients

• Increased patient satisfaction

Explore options to increase primary and specialty care capacity for target population



Provide increased access to care to manage chronic issues and receive specialized treatment prior to needing emergency or inpatient care


• Better management of patient health

Investigate feasibility of providing specialty care services within new CHC clinics as they are developed

FY09 Current staff New staff (Facilities Manager, Provider Relations)


Provide specialized treatment prior to needing emergency or inpatient care


• Better management of patient health

Work with medical school and community stakeholders to define District role with graduate medical education

FY09 Current staff New staff (Governmental Relations) Additional funds may be needed to purchase services from new school

Need to define District role in relationship to any medical school in Travis County

• Manage community and stakeholder expectations

• Increased access to specialty care services

Work with stakeholders to identify level of need for full continuum of mental health services

FY09 Current staff Continue to move community forward on incremental solutions for mental health services.

• Increased access to care • Better community understanding for

need at all levels of care. Finalize and implement Phase II of mental health plan for community

FY09 Current staff Additional funds will be required to purchase additional services.

Continue to move community forward on incremental solutions for mental health services.

• Increased access to care • Better community understanding for

need at all levels of care. Contract on a pay-for-performance basis FY09 Current staff

New staff (Purchasing/Contract Manager)

Ensure accountability for District expenditures

• More transparency in use of dollars

Use JAT to establish access targets and reporting of specialty care metrics – encounters, wait times, etc.

FY09 Current staff Ensure accountability for District expenditures

• More transparency in use of dollars

Evaluate findings of UT study on E-merge program and implement recommendations based on priority and feasibility

FY09 Current staff Recommendations may require additional staff and/or dollars to implement

Ensure most efficient and effective use of District dollars for these services

• More effective program – appropriate screening of patients, access to needed care


2

Focus Area: Healthcare Services Network Cont’d. Priority Anticipated ROI for

Strategy Have To Want To Resource Rationale for FY Designation District/Community Work with community providers to enhance capacity for Medicaid/Medicare population within FQHCs to maximize federal funds for community


Maximize availability of federal funds in community

• Leverage federal funding to stretch local dollars

Investigate acquisition/addition of pediatric practices to FQHCs to increase Medicaid participation

FY10 Current staff New staff (Provider Relations & Business Development)

Additional funds and infrastructure may be required for acquisition and operation of additional practice(s)

Will be able to focus on this initiative after CHC system transition is completed and additional infrastructure is in place to implement any identified solutions.

• Leverage federal funding to stretch local dollars

• Expanded access for uninsured through maximized Medicaid funds

Collaborate with community partners, including HMOs, to evaluate opportunities to maximize specialty care resources

FY09 Current staff New staff (Governmental Relations, Business Development)


Community HMOs have expressed interest in pursuing this with us and have approached District to facilitate process

• Additional specialty care resources • Leveraged funding to support these

services

Identify, along with community partners, new funding opportunities to support increased capacity and/or integration of mental health services

FY09 Current staff New staff (Business Development, Governmental Relations)

Continue to move community forward on and supporting incremental solutions for mental health services.

• Leverage funding to stretch local dollars • Increased access to care

Focus Area: Efficiency and Integration of the Service Delivery System


Use shared data available through Medicaider, ICARE, and NexGen to inform program eligibility and care for shared safety net patients

FY09 Current staff Shared data will educate all safety net partners on available programs and allow for better care of shared clients

• Increased community understanding of available services

• Improved coordination of client care Implement NexGen software for specialty care referrals to enhance client access

FY09 Current staff Establish and implement shared standards for referrals for specialty care

• Increased understanding of level of need for specialty care services

Work with safety net providers on “virtual system of care” (shared data, standards for care, clear roles for providers, etc.) for shared clients

FY09 Current District and CHC Decision Support Staff

New staff (Provider Relations)

Create a coordinated system of care through safety net health care delivery system

• Better community and client understanding of available services

Promote concept of standard sliding fee scale for care provided at all safety net clinics

FY09 Current staff Continue work with safety net providers to stress importance of standard sliding fee scale in community and client expectations

• Increased client understanding of financial responsibilities for services

• Level playing field for providers Develop and implement standard sliding fee scale for unfunded at all safety net clinics as part of “no wrong door” approach in access to

FY10 Current staff Can only establish and implement a common sliding fee scale after safety net providers have agreed to this concept

• Increased client understanding of financial responsibilities for services

• Level playing field for providers


3

healthcare for all medically underserved Focus Area: Regional Collaborations and Initiatives


Monitor legislative environment for ability to coordinate regionally and act upon opportunities as they become available.

FY09 Current staff New staff (Governmental Relations)

Legislature in session in FY09 and need to follow any relevant legislation proposed along with any other state or federal efforts. Stay abreast of potential threats to District.

• Greater leveraging of funds • More consistent provision and eligibility

for services

Participate in regional efforts for small-employer health coverage program

FY09 Current staff New staff (Business Development, Provider Relations)

Funds for initial capitalization with commitment from other community partners

Continue to influence final product and monitor effectiveness prior to commitment of additional funds.

• Greater access to affordable health care for small employers and their employees

• Reduction in unfunded within community and better health status for participants.

Support Children’s Optimal Health as charter member to enhance District access to regional planning data

FY09 Current staff Annual membership fee

On-going project to provide enhanced access to real-time (versus historical) data for coordinated community planning efforts

• Better understanding of interrelatedness of various community issues

• Maximize funds through targeted efforts Continue dialogue with Hays County to identify common interests in regional approach to healthcare services and funding

FY09 Current staff New staff (Governmental Relations)

Continue efforts to identify common areas of interest

• Greater leveraging of funds

Focus Area: Patient Coverage Programs


Complete redesign of health coverage program (currently MAP).

FY09 Current staff Complete review of accessibility to current network services

• Improve access to services • Better health outcomes for patients

Increase service contracts to expand provider network.

FY09 Current staff New staff (Provider relations)

Increase access to care through more providers

• Greater patient satisfaction, potential reduction in use of ER

Brand re-designed health coverage program and educate stakeholder son new program, name, services, limitations, etc.

FY09 Current staff Additional funds needed for printing of materials, etc.

Need to rebrand as soon as possible to move away from “MAP” which is confused with the CHC system

• Clear identification of program • Educate community, stakeholders, and

staff on District program Define target population and service provider network for pilot program to monitor total cost of care


Determined to conduct pilot after program redesign has been completed.

• Better pricing and services through competing network of providers

• More comprehensive cost and service data

Deploy new program on revised terms or fully implement within available resources based on results of pilot.


Need data from pilot to be conducted in FY10 to inform whether and to what extent to broaden pilot through redesigned program

• Expanded access for uninsured through maximized use of funds


5

Focus Area: CHC System Transition


Finalize organizational structure (functions) for District and 501(c)3.

FY09 Current District, CHC, and transition staff

New CHC system staff (CFO, Communications, Legal)

Need to complete transition to be operational as non-profit on 3/1/09.

• Successful transition of services for community

Complete development and implementation of infrastructure to support District and CHC business, administrative, and operational functions, including the solicitation, purchase and contracting of necessary equipment, information systems and services.





Complete plans with the City for close-out issues and transfer/lease of City assets.





Continue process for transfer of FQHC designation and other federal requirements to TCHD.

FY09 Current staff Contracted legal support Political support



Complete and implement branding for new CHC organization.





Transition CCSD staff 3/1/09 and implement HR policies and systems.






6

Focus Area: District Infrastructure and Resources


Protect Medicaid, DSH, UPL funding streams FY09 Current staff New staff (Governmental Relations)

Maintain sufficient funding to continue current level of services

• Reduce potential loss in access to care due to loss of funding

Sustain tax base FY09 Current staff New staff (Governmental Relations)

Maintain sufficient funding to continue current level of services

• Reduce potential loss in access to care due to loss of funding

Increase Medicaid business FY09 Current staff New staff (Governmental Relations, Business Development)

Maximize availability of federal funds in community

• Leverage funding to stretch local dollars

Explore opportunities for additional funding through grants/philanthropy, development of HMO, and other business/joint ventures

FY09 Current staff New staff (Business Development) Outside legal support, consultants to advise on process

Diversify funding for District • Good stewardship in terms of pursuing other revenue streams besides tax base

• Reduce risk in loss of access to services due to loss of funds in any one area

Identify and implement appropriate level of infrastructure for the District

FY09 Current staff Consultant report Will require new funds for new staff

Ensure “right-sizing” of District • Sustain District through effective management of staff resources

• Ability to plan and work more proactively while not being overstaffed

Manage key relationships with City of Austin, Travis County and other key partners

FY09 Current staff New staff (Governmental Relations Business Development)

Maintain effective working relationships with partners

• Leverage resources

Continue to require and ensure receipt of service performance level data from contracted providers

FY09 Current staff New staff (Purchasing/Contract Management)

On-going prudent business practice • Accountability for expenditure of taxpayer dollars

Conduct annual strategic planning process to incorporate stakeholder input, identify strengths, weaknesses, opportunities, and threats, and prioritize work for next fiscal year in sufficient time to allow plan to inform budget request

FY09 Current staff New staff (all)

Ensure that plan is well thought out to guide budget request and District purchasing decisions each year

• Identify service and resource gaps and ways to address those gaps

• Accountability for expenditure of taxpayer dollars; clarity in District philosophy and prioritized strategies

Prepare appropriate budget request within defined timeframe and including input from District

FY09 Current staff New staff (Accounting Assistant, Chief of Staff)

Required for implementation of effective tax rate

• Accountability for expenditure of taxpayer dollars

Receive approval for proposed budget from District Board of Manager and Travis County Commissioners

FY09 Current staff Need approved budget to purchase services • Accountability for expenditure of taxpayer dollars

Ensure services provided to clients are in compliance with all regulations

FY09 Current staff Ensure compliance with relevant standards and avoid penalties

• Accountability for expenditure of taxpayer dollars

SWOT Analysis for Travis County Healthcare District FY09 Planning

Strengths: What do you do well? Weaknesses: What could you improve? Governance

• Supportive, volunteer board • Strong leadership

Resources • Committed Staff • Good Teamwork • Creative – ability to think outside the box • Funding – ability to raise additional monies • Accountable –

Leverage community resources Pay-for-performance approach to purchasing

• Bringing FQHC status to District • Have established good groundwork for organization

Community Positioning • Work with collaborative partners on common goals • Able to create the organization that we want • “Controlled” community politics – do not have to be as

influenced by community input as City/County • Dedicated focus on health

Governance • Need for Board to further evolve to policy

making body Resources

• Complex relationships that support current organizational structure

• Insufficient infrastructure to plan for and respond to all issues in timely manner – need to increase efficiency to increase productivity

• Lack of strongly defined roles/career ladder for staff and corresponding performance expectations and reward system

• Lack of diversity in district funding • Low tax rate • Thin layer of investment spread over

multiple areas – little focused attention, hard to measure impact

• Facility/space issues • Inheritance of poorly defined contractual

relationships Community Positioning

• Unable to serve all eligible residents • Unable to clearly identify all eligible

residents and report on those served • District’s role still evolving – difficult for

messaging to staff, customers, community • Lack of criteria for community to request

assistance Opportunities: What trends could you take advantage of? Threats: What trends could harm you?

Access to Care • Ability develop most effective purchasing structures

(such as HMO) • Participating in innovative efforts, such as small-

employer product • Senate Bill 10 – potential to increase health coverage

across state • Expanding service availability through purchasing

services and joint ventures • Medical education in Austin – could increase access to

services Business Model

• CCSD Transition to non-profit – change to client service orientation

• Continue to create new County and regional collaborations

• Can pursue private/public partnerships to expand resources

• Build infrastructure to support core values and mission Service Efficiency/Quality

• Streamline services • Standardize costs, eligibility, services among safety net

partners • Increase access to data communitywide • Create stable organizational culture and staffing

Access to Care • Senate Bill 10 – potential to do more harm

than good if reduces local resources • Potential State/Federal health financing

reductions (Ryan White, UPL, DSH, Medicaid, etc.)

• Economy – recession/depression – will increase need (demand) and reduce ability to increase funding

• Aging population and growing uninsured • Increasing costs for care • Lack of service providers – lack of supply

(primary care, nurses), aging workforce Business Model

• Employee resistance to change and carry-over of governmental mind-set

• Turnover of CCSD staff • Medical education in Austin – could be

expensive • Staff burnout

Service Efficiency/Quality • Reviews by regulatory agencies (HRSA,

OPA, DSHS, Joint Commission, • Aging facilities and location of facilities

Initial Evaluation of TCHD Strategic Plan and FY08 Strategic Directions

4/28/08

Strategic Focus Evaluation Recommendations for Future Strategic Focus Overall Strategic Plan

1. The Strategic Plan in its current form requires updating for missing components, including: • Incomplete information regarding the

District’s current state to add context for strategic directions;

• Lack of focus on resources needed to support prioritized services/objectives;

• Lack of inclusion of the transition of the CHCs to the District, a major focus of staff work, and which impacts the safety net health care system for the District and the larger community;

• Lack of specificity regarding performance goals for each strategic direction.

2. The current format of the Strategic Plan does not allow for easy identification of all short-term (fiscal year goals) directions versus those that will be implemented on a more long-term basis.

1. Update Strategic Plan in FY09 to include the following elements: • Add and/or update the District’s Values, organizational

history (including taxing history), budget process, changing community demographics, and any additional information to provide perspective on the District’s current state and strategic directions;

• Separate Strategic Plan into 2 areas – one focused on service delivery and one focused on service resources (including organizational/staffing needs, funding/finance requirements and initiatives, revenue opportunities and growth aspirations, capital requirements;

• Addition of the CHC transition to the Service Delivery section of the strategic plan to reflect the work and goals of this initiative;

• Identification of performance measures for each prioritized short-term direction/goal.

2. List the short-term directions separately from the longer-term direction for easier identification and tracking.

Primary Care

1. Performance-based contracts have been executed with El Buen Samaritano, People’s Community Clinic, and Project Access.

2. Performance expectations are not on target for the federally qualified community health centers. However, with the FQHCs currently under City management, the District cannot directly control staff performance or project implementation.

3. Additional primary care capacity for the medically underserved is still needed within the community.

1. Continue with performance based contracts. Work with community safety net providers to increase capacity for both MAP enrollees and the unfunded to increase the capacity for Medicaid and Medicare payor mix within the FQHCs to optimize federal funds for community.

2. Review the results of the CHC technical operations consultants in implementing operational changes within the FQHCs as they transition to District sponsorship to incorporate more accountability and provide tools to support success.

3. Increase access to urgent care/convenient care centers. 4. Investigate acquisition/addition of pediatric practices to

FQHCs to substantially increase Medicaid participation.


4/28/08

Strategic Focus Evaluation Recommendations for Future Strategic Focus Specialty Care 1. Although staff has been working with Seton

and AMEP for the majority of this fiscal year, no new contracts for increased specialty care access at Brackenridge have been implemented. Limited contracts have been implemented with private providers, and MediView™ has agreed to recruit specialty care providers to expand access.

2. JAT continues to work to establish standards for specialty care access and care.

3. Additional alternatives also need to be investigated.

1. Continue to work to expand specialty care capacity for medically underserved – • Continue to work with Brackenridge Hospital and AMEP

to expand specialty care services. • Finalize MediView™ contract and utilize specialty care

contracts to expand access for specialty care for MAP enrollees.

2. Continue work of JAT to determine access targets and establish reporting of metrics for specialty care referrals, acceptable wait times, etc.

3. Investigate the feasibility as new FQHC clinic(s) are developed to incorporate specialty care services not requiring hospital-based procedures to be offered within the FQHCs.

4. Collaborate with community HMOs, which provide health services coverage for Medicaid and Medicare recipients, to bring additional specialty care providers to our community including evaluating the feasibility of establishing a standalone FQHC for appropriate ambulatory based specialty care services.

Mental Health 1. Expanded IP capacity by funding beds at

Seton Shoal Creek; a total of 10 beds for fiscal year 2008.

2. Through community partners initiated MCOT, expanded PES, expanded integrated behavioral health, initiated expansion of residential services, and supported/coordinated MHMR and other collaborative partners in the application for competitive state crisis services funding.

1. Continue with community partners in developing a long-term plan for the full continuum of needed mental health services.

2. Finalize and implement plan for Phase II of the continuum of care.

3. As a community, foundations, local governments, and providers bring resources together.

4. Implement continuum of care based on community strategies and partnering.


4/28/08

Strategic Focus Evaluation Recommendations for Future Strategic Focus

Integrated Healthcare Service and Information Systems

1. The FQHC System’s Medicaid/Medicare payor mix continues to be less than other systems (i.e., LSCC has a 65% Medicaid/Medicare mix and Seton’s Community Clinics have a 50% Medicaid/Medicare mix).

2. 2.Progress is being made in the implementation of a shared data system (NextGen) within the safety net clinics through the establishment of a separate 501c3 organization and commitment of community resources (CSSS). Additionally, NextGen will be used as the specialty care referral system between the Brack Specialty Clinic and the FQHCs.

1. 1.Focus efforts of FQHC on increasing Medicare and Medicaid clients – District continue/expand contracting with non-FQHC safety net providers to provide primary care for uninsured; Implement consultant recommendations that identify ways for FQHC (through new 501c3 corporation) to become more sustainable

2. Continue collaborating with community partners through support of CSSS (including collaboration with District on IT infrastructure contracting) to move toward a virtual community health record for patients.

Community Steward

1. District continues to prioritize and benefit from community collaborations in a number of areas, including: mental health, regional health care, Code Red report, specialty care, primary care, UPL, etc.

2. Additional revenue streams need to be identified to stretch taxpayer dollars.

1. Continue to assess collaborative partnerships to ensure effectiveness/value for District.

2. Continue with identifying opportunities for new revenue for TCHD, including determining the feasibility of establishing a District-affiliated HMO to serve Medicaid patients initially, and other populations later if financially appropriate.

Regional Collaborations and Initiatives

1. District continues to collaborate on Regional Health Care initiatives – current focus is development of the small employer initiative.

1. Continue to identify collaborative efforts that would benefit District, including: • Support of COH as charter member. • Continue with regional efforts for small-employer

program. • Continue work with ICC to include Hays County as a

member of the ICC. • Discuss with Hays County common interests in a

regional approach to healthcare funding.


4/28/08

Strategic Focus Evaluation Recommendations for Future Strategic Focus

Patient Programs and Services

MAP 1. Redesign of MAP program incomplete, a

review and recommendation of the following still needs to occur – • Benefits and appropriate use of services; • Eligibility requirements; • Enrollment processes; • Cost sharing; and • Sufficiency of provider network

2. A new brand identity for the MAP program is needed.

1. Continue and/or implement the following activities: • Seek approval for UT study to determine impact of the

increase in the ER co-pay on utilization of these services and use of convenient care services within FQHC once implemented;

• Recommend a pilot of a portion of the redesigned MAP program enrollees who have eligibility up to 100% of poverty to be enrolled in a new network of providers. Set total number of enrollees based on budget. Evaluate systems of care over a two to three year period (pilot vs. public model) utilizing patient satisfaction, costs, health outcomes and utilization of services (ED /1,000, ALOS, bed days per 1,000, etc.);

• Develop eligibility plan to eliminate barriers for patients to access health services, including piloting Point of Service care at the new federally qualified health convenient care center at I-35 and William Cannon

• Evaluate MAP enrollee satisfaction with services, costs, accessing services and health outcomes;

• Expand provider network. 2. Develop new brand and implement roll-out.

CCSD Transition 1. CCSD transition is not addressed in current strategic plan.

1. Finalize organizational structure (functions) for District and 501c3.

2. Complete development and implementation of infrastructure to support District and CHC business, administrative, and operations functions (HR, administrative, IT, facilities, CHC service delivery), including the solicitation, purchase and contracting of necessary equipment, information systems, and services.

3. Complete plans with COA for close out issues and transfer/lease of City assets.

4. Continue process for transfer of FQHC designation and other requirements to TCHD.

5. Complete and implement branding for new CHC organization. 6. Transition CCSD staff March 1, 2009, and implement HR


4/28/08

policies and systems. 7. Continue regular, timely and accurate transition communications with CCSD employees, the District Board of Managers, FQHC Board, the City and other community stakeholders.

District Infrastructure and Resources

1. Infrastructure and resources are not addressed in current strategic plan or direction for the future.

1. Establish sustainable infrastructure/resources to meet current and future business needs of the District.

1

Recommended FY09 Strategic Directions

Definitions

1. Priority Level

• “Have To” – These are service areas which the District has determined to be a core service and/or has previously committed financial, staff or Board resources to the effort. These areas can be programs, contracted services, or a means to maintain or increase resources to support the designated service areas. These areas might have to be provided at a lower level should funding become an issue but would probably not be eliminated. All strategies identified will be undertaken in FY09.

• “Want To” – These are service areas/initiatives that the District has not determined to be a core service but are an opportunity

for the District to provide a “value-added” service or resource for the community in terms of leading, facilitating, or participating in collaborative initiatives that enhance community health planning or reporting, advocate for greater health care access, leverage community resources, etc. Each “Want To” strategy has the proposed fiscal year for the

implementation of the strategy identified.

2. Desired Outcome – The ultimate goal that the District hopes to achieve. 3. Strategy – The major activities the District will undertake in the upcoming fiscal year to try to achieve the Desired Outcome. 4. Strategy Type

• Service – The main focus of the strategy is to increase access to, improve quality of, or further develop the continuum of services.

• Resource – The main focus of the strategy is to leverage funding, develop resources, or achieve financial efficiencies to assist

in purchase of services or improve business operations.

5. District Role • Control – The District has control over the outcome of a strategy if the strategy is being conducted exclusively by District staff

or the performance can be directed and monitored by District staff through a performance-based contract.

• Influence – The District is determined to have influence rather than control over the outcome of a strategy if the District is working with multiple other partner entities, requires governmental action to be able to perform, and/or does not have direct managerial or a direct contract management role over the outcome.

2

I. Focus Area – Health Care Services Network

Priority Strategy Type District Role

Desired

Outcome Have

To

Want To

Strategies Service (S) or

Resource (R)

Control or

Influence

Increase Capacity

FY09

FY09

FY09

FY09

FY09

1. Increase access to urgent care/convenient care centers. 2. Explore options to increase primary and specialty care

capacity for TCHD target population. 3. Investigate feasibility of providing specialty care services

within new CHC clinics as they are developed (SC). 4. Work with stakeholders to identify level of need for full-

continuum of mental health services. (MH) 5. Finalize and implement Phase II of the continuum of

care. (MH)

S

S

S

S

S

C & I

C & I

C I I

Ensure Accountability

FY09

FY09

FY09

1. Contract on a pay-for-performance-basis. 2. Use JAT to establish access targets and reporting of

specialty care metrics – encounters, wait times, etc. 3. Evaluate findings of UT study on E-merge Program and

implement recommendations based on priority and feasibility.

R

S

S

C

C

C

Leverage Funding

FY09

FY10

1. Work with community providers to enhance capacity for Medicaid/Medicare population within FQHCs to maximize federal funds for community (PC).

2. Investigate acquisition/addition of pediatric practices to

FQHCs to increase Medicaid participation (PC).

S & R

S & R

I I

3

FY09

FY09 3. Collaborate with community partners, including HMOs, to evaluate opportunities to maximize specialty care resources.

4. Identify, along with community partners, new funding

opportunities to support increased capacity and/or integration of mental health services.

S

R

I I

Outcome Measures for Health Care Services Network Focus Area:

Success Factor Frequency FY09 Target Rationale for Target

# of Contracted Primary Care Providers

Quarterly

# of Contracted PC Encounters Quarterly

Cost per PC Encounter Quarterly

# of Contracted Specialty Care Providers

Quarterly

# of Contracted SC Encounters Quarterly Cost per SC Encounter Quarterly # of Publicly Funded MH Slots by Service Area

Annually

Total Amount of Stakeholder Investment in MH Continuum of Care

Annually

4

II. Focus Area – Efficiency and Integration of the Service Delivery System


Desired

Outcome

Have

To

Want To

Strategies Service or

Resource

Control or

Influence

Advance data sharing throughout service delivery system

FY09

FY09

1. Use shared data available through Medicaider, ICARE and NextGen to inform eligibility and care for shared safety net patients.

2. Implement NextGen software for specialty care referrals

to enhance client access.

Service

Service

Influence

Influence

Facilitate coordinated system of care throughout service delivery system

FY09

FY09

FY10

1. Work with safety net providers on “virtual system of care” (shared data, standards for care, clear roles for providers, etc.) for shared clients.

2. Promote concept of standard sliding fee scale for care

provided at all safety net clinics 3. Develop and implement standard sliding fee scale for

unfunded at all safety net clinics as part of “no wrong door” approach in access to healthcare for all medically underserved.

Service

Service

Service

Influence

Control

Influence

Leverage Community Resources

FY09

1. Assess collaborative partnerships to ensure effectiveness/value for District.

Service & Resource

Control

Outcome Measures for Efficiency and Integration Focus Area:


# and Value of Collaborative Partnerships

Annually

5

III. Focus Area – Regional Collaborations and Initiatives


Desired

Outcome

Have

To

Want To


Resource

Control or

Influence

Enhanced capacity for services

FY09

FY09

FY09

1. Monitor legislative environment for ability to coordinate regionally and act upon opportunities as they become available.

2. Participate in regional efforts for small-employer health

coverage program. 3. Work with Medical School and community stakeholders

to define District role with graduate medical education

Service & Resource

Service

Service

Control

Influence

Control/ Influence

Leverage Community Resources

FY09

FY09

1. Support Children’s Optimal Health as charter member to enhance District access to regional planning data.

2. Continue dialogue with Hays County to identify common

interests in regional approach to healthcare services and funding.

Service & Resource

Service &

Resource

Control

Influence

Outcome Measures for Regional Collaborations Focus Area:


# and Results of Bills considered that would expand ability to coordinate/serve regionally

Annually

Implementation of Small-Employer Health Program

One-time Yes/No

6

IV. Focus Area – Patient Coverage Programs


Desired

Outcome

Have

To

Want To


Resource

Control or

Influence

Increase access to healthcare for District-eligible clients

FY09

FY09

FY10

FY11

1. Complete redesign of health coverage program (currently MAP).

2. Increase service contracts to expand provider network. 3. Define target population and service provider network for

pilot program to monitor total cost of care. 4. Deploy new program on revised terms or fully implement

within available resources based on results of pilot.

Service

Service

Service

Service

Control

Control/ Influence

Control

Control

Establish and manage community expectations

FY09

1. Brand re-designed health coverage program and educate stakeholders on new program, name, services, limitations, etc.

Service

Control

Outcome Measures for Patient Coverage Programs Focus Area:


For current MAP Program – # of District Program Enrollees Cost/Enrollee Patient Satisfaction

Quarterly Quarterly Annually

Implementation of MAP Pilot Program

One-time Yes/No

7

V. Focus Area – CHC System Transition


Desired

Outcome Have

To

Want To


Resource

Control or

Influence

Transition occurs by March 1, 2009 with all priority systems in place and functional

FY09

FY09

FY09

FY09

FY09

FY09

1. Finalize organizational structure (functions) for District and 501(c)3.

2. Complete development and implementation of

infrastructure to support District and CHC business, administrative, and operational functions, including the solicitation, purchase and contracting of necessary equipment, information systems and services.

3. Complete plans with the City for close-out issues and

transfer/lease of City assets. 4. Continue process for transfer of FQHC designation and

other federal requirements to TCHD. 5. Complete and implement branding for new CHC

organization. 6. Transition CCSD staff 3/1/09 and implement HR policies

and systems.

Resource

Resource

Resource

Resource

Resource

Resource

Control

Control

Influence

Influence

Control

Control

Outcome Measures for CCSD Transition Focus Area:


Transition occurred on time One-time Yes/No

8

VI. Focus Area – District Infrastructure and Resources

Priority Strategy

Type

District Role

Desired

Outcome Have

To

Want To


Resource

Control or

Influence

Protect current District funding

FY09

FY09

1. Protect Medicaid, DSH, UPL funding streams

2. Sustain tax base

Resource

Resource

Influence

Influence Increase/diversify Funding

FY09

FY09

1. Increase Medicaid business 2. Explore opportunities for additional funding through

grants/philanthropy, development of HMO, and other business/joint ventures

Resource

Resource

Influence

Control

Obtain and sustain appropriate infrastructure for District

FY09 1. Identify and implement appropriate level of infrastructure for District

Resource Control

Maintain support of key community stakeholders

FY09 1. Manage key relationships with City of Austin, Travis County, and other key partners.

Resource Control

Maintain fiscal, regulatory and service integrity

FY09

FY09

FY09

1. Continue to require and ensure receipt of service performance level data from contracted providers.

2. Conduct annual strategic planning process to

incorporate stakeholder input, identify strengths, weaknesses, opportunities, and threats, and prioritize work for next fiscal year in sufficient time to allow plan to inform budget request.

3. Prepare appropriate budget request within defined

timeframe and including input from District

Service

Resource

Resource

Control/ Influence

Control

Control

9

FY09

FY09

management and staff to adequately support on-going District services and proposed enhancements for next fiscal year.

4. Receive approval for proposed budget from District

Board of Managers and Travis County Commissioners 5. Ensure services provided to clients are in compliance

with all regulations

Resource

Service

Influence

Control

Outcome Measures for District Infrastructure and Resources Area:


Appropriate ratio of staff Annually % of Administrative Costs to Total Costs

Annually

TCHD Current Collaborative Partnerships

Ranking by Average ScoreTCHD Role Collaboration Function TCHD Support Anticipated ROI

Influencer, Facilitator, Purchaser, Member

Psychiatric Services - Psychiatric Services Stakeholder Group

Services: Create community solutions to MH needs, prioritize needed services, & seek funding.

Staff - facilitation of group & committee

Increased access to mental health services for unfunded clients and greater community acknowledgment of shared role in solution

Services: Smaller group - Resolves operational issues with currently contracted services.

Services: Larger group - Identify needed MH resources, patient processes, and performance levels.


Regional Small Employer Health Coverage Project

Services: Create & manage a small-employer health coverage option for multi-county region.

Financial - $1,500,000 held to help capitalize project

Potentially provide an affordable health coverage option for small employers and their employees to increase access to healthcare

Facilitator, Purchaser, Member Indigent Care Collaboration (ICC)

Services: Identify & implement projects of common interest to regional safety net providers.

$500,000 - annual contract for services

Standardized, coordinated care for safety net population in Central Texasue ce ,

Facilitator, Purchaser, Participant Dental Service Planning

Services: Identify core functions for dental service providers to leverage limited funding.

Staff - coordination of planning effort

Greater leveraging of funding for dental services; focus individual resources on areas of expertise

Influencer, Facilitator, Member

Centex Systems Support Services (CSSS)

Data: Implement NextGen medical record system throughout safety net clinics.

Staff - Legal support to establish non-profit

Increased access to shared patient data to enhance patient care and better understand needs and health status of target population

Influencer, Facilitator, Participant

Regional Eligibility Determination Initiative

Services: Create a coordinated, multi-county effort to determine client eligibility for multiple programs

In the initial stages -- may consist of staff and/or financial support

Greater community understanding about eligibility for healthcare programs for unfunded and how to access; more consistency in cost-sharing for community unfunded

Influencer, Purchaser, Member Joint Action Team (JAT)

Services: Identify & implement solutions to service delivery issues for clients of TCHD & Seton.

Staff participation on on-goining projects Improved service delivery for shared clients.

Influencer, Purchaser, Member Children's Optimal Health (COH)

Data: Share & geographically map service data to inform community planning.

Financial $35,000/year for 3 years for data services

Gain access to more comprehensive service-related data to better inform District planning efforts

Influencer, Purchaser, Participant HIV Services Planning

Services: Identify HIV needs/gaps & best practices for supporting services for HIV/AIDS clients

Staff and program support - Lead on HIV screening project. Possible future facilitation role.

Gain better understanding of HIV-related healthcare needs for the community assist in identification of disease at earliest possible stage

Purchaser, Participant, Recipient E-Merge Evaluation Collaborative

Research: Evaluate the participants, effectiveness, & impact of E-merge program. Financial - $155,000

Gain better understanding of E-merge participants and successfulness of program to date and how program could be enhanced

Purchaser, Member Community Action NetworkServices: Identifies and informs community on a range of health and social service indicators

ppthrough member fees, minimal staff participation on committees

Gain access to community partners and data distributed through monthly reports

MemberPsychiatric Services - Mayor's Mental Health Taskforce

Services: Monitor & report on progress made in implementing Task Force recommendations.

Staff - monthly meeting participation

Monitor on-going non-stakeholder mental health efforts within the community and ensure District's participation as appropriate

Increased access to mental health services for unfunded clients and greater community acknowledgment of shared role in solution

Psychiatric Services - Crisis Implementation Services Committee (CIC) Staff - facilitation of committee


TCHD Current Collaborative Partnerships

Ranking by Average ScoreParticipant United Way Health Coverage ProjectServices: Recommend selection of United Way-funded healthcare grants & health planning.

Staff - monthly meeting participation

Gain better understanding of other healthcare services for the underserved being supported within the community

Board of Managers Self Assessment

Compiled responses

February 26, 2008

Responses -- Responses -- Board Self Assessment Feb 2008

1) In your opinion, do we have the right committees to perform our duties as a Board? If not, do you have suggestions for revisions to the committees to ensure that those duties are being performed?

A. For the most part – yes. B. I think we have the right type of committees to handle the district’s business. I

commend our Board officers for giving careful thought in selecting committees using a good balance of our board members’ backgrounds, expertise, and interest.

C. The committees are very useful to help us understand in more depth what will be

presented to Board and to give feedback. D. We have the right committees to perform the Board’s duties. E. I believe the committees are covering the right topics. F. Present committees seem to be performing adequately. Perhaps, it’s time to explore at

an annual planning retreat. G. I think our committee structure has been well thought out and modified whenever

appropriate.

~is county HEALTHCA ~ ~ DISTo/


Compiled responses

February 26, 2008


2) Are the committees functioning effectively? Do you have suggestions for improvement?

A. Yes – for the most part. B. I think the committees are functioning effectively. I appreciate that the staff tries to

accommodate everyone’s schedules in scheduling meetings. C. Attendance seems spotty. Not sure how to improve us, everyone is busy. Don’t seem

to hear much from Strategic Planning. D. The committees are functioning effectively. E. I wonder if we are spending too much time in meetings on the past or “lag” indicators. I

believe we need to spend more time on strategic planning and “lead” indicators. F. Re: Primary Care/Specialty Care/Mental Health – we need more long term

responsibilities in these three areas: (1) What are our plans to bridge our committee with FQHC 501(c)(3) Board?; (2) Where are goals initiated for decreasing uninsured?; and (3) How do stakeholders for mental health goals tie in to the TCHD Board?

I am anxious to hear about specialty care activities which have been assigned recently to this committee.

G. It seems as if the committees are fulfilling the purpose designed – dealing with issues

at a higher level of detail and reporting back to the board.



Compiled responses

February 26, 2008


3) Are financial and other reports to the Board clear and understandable? Do you have suggestions for improvement of those reports?

A. 1) Very good generally. 2) I would like to see more information and analysis with

respect to what we are paying and what we are getting from Seton and City of Austin. B. I think financial and other reports to the board are clear and understandable. The staff

are using a good executive summary type format that provides all the information needed for decision-making.

C. I have problems with the financials but [it] is just me. I’d just like to know if we are on

budget and there are no problems. D. I’m satisfied with the financial reports that we receive. E. I would like to spend a little more time reviewing progress compared to the strategic

plan. F. Mostly clear and understandable. As someone on fringe of finance, I appreciate

explanations when there are changes or unusual circumstances. G. As someone who does not deal with finances on a daily basis, it has been more of a

challenge to me, but I find now that I can keep up with the flow of ideas during Carolyn’s report.



Compiled responses

February 26, 2008


4) Do you believe you receive sufficient information to make informed decisions about the District’s mission, its strategies, its policies and funding decisions?

A. I do not think we are being as impactful or as strategic as we can be because we spend

so much time on the compulsory details. B. The staff provides sufficient information to make informed decisions. In addition to self-

education and through the committee structure we also are privy to most information that will affect the District.

C. Yes thanks to being on committees. D. Yes. E. Yes. F. Yes. G. As a committee chairman, I notice that I am not communicated with on a regular basis

between board and committee meetings.



Compiled responses

February 26, 2008


5) Do you have suggestions regarding types of board training that would be welcome or are needed?

A. No suggestions. B. I think board training and development would be useful. Some examples include:

customer perception/satisfaction; market/community awareness; access measures; and, clinical outcomes. I also think that the Board members and Executive Staff should participate in several of the Health related associations (TAPNH, TACHC, THA, and others).

C. Anything would probably be welcomed but not sure any is needed. D. Training is always good but I believe we have a very well trained and sophisticated

board. E. What does “green lights” offer? F. I believe we are to receive annual conflict of interest. Perhaps, an attorney can highlight

some gray areas from other experiences. G. We have had a lot of training over the years and I never turn any down, if I can help it,

but I would attend to the degree that I can “if” such sessions were to be deemed needed.



Compiled responses

February 26, 2008


6) Do you have other feedback would you like to provide to the other Board members concerning the Board’s functioning or suggestions to improve the functioning of the Board?

A. I think we should spend some time envisioning what success in our mission looks like

in terms of facilities, people and capability and how much that will cost and how we will accomplish that success. We are playing too much “small ball” as a Board.

B. In the May 2002 edition of Trustee, Robert E. Wilson states: “The current climate

creates an imperative for each not-for-profit health care board to reflect upon its rightful roles and duties, its current performance, and its preparedness in meeting the governance challenges of today and tomorrow.” He goes on to recommend that health care boards should undertake 5 activities immediately; the first is to conduct a critical self-assessment with an eye toward strengthening governance effectiveness. The other four activities include: enhance the content of your meetings with outside auditors; set a strong expectation of management for thoroughness, relevance, timeliness, and transparency of financial and operating performance information provided regularly to board; commit to a regimen of intensive and in-depth board education; and do not hesitate to act when a current pattern of low or negative operating margins or other early warning indicators suggest financial viability may be at risk.

C. It seems that the board functions well and I have no suggestions on how to improve. D. We have a good board that works well together. E. I value the multi-disciplinary board member view points. Actively engaged board

members help us do a better job. F. No. G. I am generally happy with the functioning of the board.


Travis County Healthcare District

Request for Board of Managers Consideration

June 18, 2008

Board of Managers Strategic Planning Retreat Agenda Item:

• Discuss and take appropriate action regarding a proposed revision to the Board

committee structure to become effective in FY09. Resource Impact: N/A. TCHD Proposed Board Committee Structure: Create one monthly board working session to replace the separate standing committee meetings related to service delivery and planning. Recommended Board Action: Discuss and take appropriate action to revise the current Board of Managers committee structure. Decision Statement: What is the best way to provide information to the Board of Managers that will allow for the most comprehensive discussion of issues prior to the monthly Board of Managers voting session? Background Summary:

Background: Currently, members of the Board of Managers serve on one or more committees focused on a specific issue related to District operations and/or service delivery. The table below reflects the current committee structure and Board of Managers participation.

Monthly Monthly Monthly Monthly As Needed As Needed As Needed As Needed As Needed As Needed

Board ManagersBudget &

Finance Hospital

Primary

Care/Specialty

care/Mental

Health

Strategic

Planning

Ad Hoc

Compensation

Design

Ad Hoc

Transition

Audit &

Compliance

Brackenridge

Lease Team Legislative Personnel

Bobbie Barker x x x xCarl Richie x x x x x xClarke Heidrick x x x x x xDonald Patrick x xEduardo Sanchez x x x xFrank Rodriguez x x x x x xRose Lancaster x xRosie Mendoza x x xTom Coopwood 1 x x x x

Chair Chair Chair Chair Chair Chair Chair Chair Chair Chair

Rosie Donald Rose Frank Eduardo Bobbie Clarke n/a Bobbie TomChair of the

Committee

Frequency

x

x

x

In this structure, items are considered under the most relevant committee with items

impacting the budget also considered under the Budget and Finance committee. However, since not all members of the Board of Managers attend any one committee, this results in only part of the Board being fully informed on certain issues that come before the full Board for consideration and action. Also, with the small number of Board participants on each committee, the inability of any Board participant to attend a committee meeting can result in the loss of a quorum and deny the committee the opportunity to take action on committee items.

Request: Approve a revised Board committee structure which would eliminate some of

the standing committee meetings and replace them with a second full-Board session during the month. One full-Board session would be scheduled as a working session and the Board of Managers meeting scheduled for the 4th Thursday of the month would continue as the voting

Chair of the

Committee

Frequency

session. Under this proposal, the following committees would be collapsed into the working session:

• Hospital • Primary Care/Specialty Care/Mental Health • Strategic Planning • Personnel

The following committees would be retained and would meet on a regular or periodic basis as determined by need:

• Budget and Finance (monthly) • Audit & Compliance (periodic) • Legislative (periodic)

The following committees would be retained and would meet on an as-needed basis:

• Transition • Brackenridge Lease Team

This proposal would mean that most members of the Board of Managers would have two meetings per month – the working session and the Board Meeting. Members of the Board of Managers on the Budget and Finance Committee would have a third meeting each month. Other members would have additional committee meetings on a periodic or as needed basis.

Monthly Monthly As Needed Periodic As Needed Periodic

Board ManagersBudget &

Finance Board Work

Session

Ad Hoc

Transition

Audit &

Compliance

Brackenridge

Lease Team Legislative

Total

Bobbie Barker Carl Richie Clarke Heidrick Donald Patrick Open Frank Rodriguez Rose Lancaster Rosie Mendoza Tom Coopwood

Chair Chair Chair Chair Chair Chair

Anticipated Result: The anticipated benefits of the proposed committee restructuring,

include: • Fewer meetings for Board Managers to attend and staff to prepare for,

communicate about, and support; • Better dissemination of pertinent information on service delivery, planning, and

operational issues to all Board Managers; and • More robust discussion of policy-related issues by full Board to enhance Board

decisions at the voting session.

Documents

MEMORANDUM FROM: Patricia A. Young Brown June 13, 2008 RE ... · • SWOT Analysis • Analysis of current strategic plan • Planning document with prioritized staff recommendations