Tuesday, July 28, :00 p.m. Board Room Texas Diabetes Institute 701 S. Zarzamora San Antonio, Texas 78207

Transcription

1 REGULAR MEETING OF THE BEXAR COUNTY HOSPITAL DISTRICT BOARD OF MANAGERS 6:00 p.m. Board Room Texas Diabetes Institute 701 S. Zarzamora San Antonio, Texas MINUTES BOARD MEMBERS PRESENT: James R. Adams, Chair Ira Smith, Vice Chair Dianna M. Burns, M.D., Secretary Roberto L. Jimenez, M.D., Immediate Past Chair Robert Engberg Robert A. Gilbert James C. Hasslocher OTHERS PRESENT: George B. Hernández, Jr. President/Chief Executive Officer, University Health System Tricia Aleman, Executive Director, Marketing Services/Corporate Communications, University Health System Bryan Alsip, M.D., Executive Vice President/Chief Medical Officer, University Health System Edward Banos, Executive Vice President/Chief Operating Officer, University Health System James Barker, M.D., Vice President/Clinical Services, University Health System Ted Day, Senior Vice President/Strategic Planning & Business Development, University Health System Theresa De La Haya, Senior Vice President, Health Pr9omotion/Clinical Prevention, University Health System Texas Diabetes Institute Sergio Farrell, Senior Vice President, Ambulatory Services, University Health System - Robert B. Green Campus Don Finley, Senior Writer, Corporate Communications, University Health System Roe Garrett, Vice President/Controller, University Health System Greg Gieseman, President/Chief Executive Officer, Community First Health Plans, Inc.; and Vice President, Managed Care, University Health System Francisco Gonzalez-Scarano, M.D, Dean, School of Medicine, The University of Texas Health Science Center at San Antonio Michael Hernandez, Vice President/Chief Legal Officer, University Health System Barbara Holmes, Vice President/Chief Financial Officer, Community First Health Plans, Inc. Reed Hurley, Executive Vice President/Chief Financial Officer, University Health System

2 Page 2 of 13 Sayed Adil Husain, M.D., Professor, W. Randolph Hearst Endowed Chair in Congenital Heart Disease, Cardiothoracic Surgery, UTHSCSA Monika Kapur, M.D. President/Chief Executive Officer, Community Medicine Associates Leni Kirkman, Vice President, Strategic Communications & Patient Relations, University Health System Kathy A. LaCivita, M.D., Medical Director, University Health System -Texas Diabetes Institute/ Ted Lemon, Deputy Chief Information Officer/Information Services, University Health System Kristen A. Plastino, M.D., Associate Professor, Department of Ob/Gyn, UTHSCSA; President, Medical/Dental Staff, University Health System Nancy Ray, Senior Vice President/Chief Nurse Executive, University Health System Richard Rodriguez, Vice President, Assets and Property Management, University Health System Steve Seidner, M.D., Professor, Division of Neonatology, UTHSCSA Roozbeh Taed, M.D, Associate Professor, Clinical/Critical Care, Department of Pediatrics, UTHSCSA Sally Taylor, M.D., Senior Vice President/Chief Behavioral Medicine, University Health System Mark Webb, Executive Vice President/Chief Operating Officer, University Health System Francine Wilson, Senior Vice President, Supply Chain Management, University Health System And other attendees. CALL TO ORDER AND RECORD OF ATTENDANCE: IRA SMITH FOR JIM ADAMS, CHAIR, BOARD OF MANAGERS: Mr. Smith called the meeting to order at 6:00 p.m. INVOCATION AND PLEDGE OF ALLEGENCE: Mr. Smith introduced Chaplain Dan Aguirre of Oasis of Light Church for the invocation, and he led the pledge of allegiance. SPECIAL RECOGNITIONS: The Board of Managers recognized the following staff members: Professional: (Nursing) Professional: (Non-Nursing) Management: Technical: Clerical: Service: Volunteer: Physician: Tonya Burris Health Educator, Title V Primary Health Care - RBGC Sandy Castillo Medical/Dental Staff Coordinator, General Administration - CMA Mario Noli Legarde Director, Clinical Nursing, 5th Floor Sky Tower - Med Acute Lydia Gonzalez Medical Assistant, Southeast Operations Pat Cancino Outpatient Customer Service Rep., TDI - Endocrinology Operations Abdelmoneim Medhat Environmental Associate, Environmental Services - UH Patsy Mitchell Volunteer, Volunteer Services Ayesha Zaheer, MD Staff Physician, Community Medicine Associates - Pavilion EMC

3 Page 3 of 13 Team: Biomedical Engineering Team Jesus Lara, Jr., Arnold Torres, Ashley Garza, Hazel Tremor, Isabel Leija, Christine Stofle, Stephanie Stiefer All of this year s quarterly recipients will be special honored guests at the Annual Recognition Awards Ceremony at the Omni Hotel on February 25, Employees of the Quarter receive a plaque, embossed pen and an opportunity to select one of numerous awards valued at $100 on the Employee Recognition website. Mr. Hasslocher addressed the employees on behalf of the Board. He thanked them for doing a great job in serving the patients of University Health System. CITIZENS PARTICIPATION: REPORT FROM THE HEALTH SCIENCE CENTER FRANCISCO GONZALEZ-SCORANO FOR WILLIAM HENRICH, M.D., PRESIDENT: Dr. Gonzalez introduced the physician leaders present. He reported that the new set of Bylaws will soon be considered for approval by the Executive Committee of the Medical/Dental Staff. A t this time the Bylaws are out for a 30-day review by the Medical/Dental Staff. Both he and Mr. Hernandez each wrote a letter to the Medical/Dental Staff supporting and advocating for the amendments and affirming the desire to continue to develop a lasting framework of partnership that is beneficial for both institutions. Preliminary results are positive but response rate has been low. This report was provided for informational purposes. NEW BUSINESS: CONSENT AGENDA IRA SMITH, VICE CHAIR CONSIDERATION AND APPROPRIATE ACTION REGARDING MEDICAL-DENTAL STAFF RECOMMENDATIONS FOR STAFF MEMBERSHIP KRISTEN A. PLASTINO, M.D., PRESIDENT, MEDICAL/DENTAL STAFF CONSIDERATION AND APPROPRIATE ACTION REGARDING 2 ND QUARTER 2015 INVESTMENT REPORT ROE GARRETT/REED HURLEY CONSIDERATION AND APPROPRIATE ACTION REGARDING HEALTH SYSTEM POLICY NO , PREVENTION, ASSESSMENT AND INTERVENTION IN CHILD ABUSE/NEGLECT, EXPLOITATION, FAMILY VIOLENCE, AND ELDER ABUSE NANCY RAY CONSIDERATION AND APPROPRIATE ACTION REGARDING PURCHASING ACTIVITIES (SEE ATTACHMENT A) FELIX ALVAREZ/FRANCINE WILSON The items above were presented for the Board s consideration as consent items. Staff recommended approval of the consent agenda items by the Board of Managers.

4 Page 4 of 13 A MOTION to approve staff s recommendation by Mr. Hasslocher, SECONDED by Mr. Engberg, and PASSED UNANIMOUSLY. CONSIDERATION AND APPROPRIATE ACTION REGARDING SELECTED PURCHASING ITEMS RELATED TO THE CAPITAL IMPROVEMENT PROJECT: UNIVERSITY HOSPITAL CONSIDERATION AND APPROPRIATE ACTION TO CONTRACT WITH SELECTED BEST VALUE PURCHASING COOPERATIVE (TXMAS OR BUYBOARDS) CONTRACTORS FOR RENOVATION CONSTRUCTION SERVICES ON THE GROUND, 8TH, 9TH, 10TH, 11TH, AND 12TH FLOORS OF THE HORIZON TOWER AND 1ST, 9TH, AND 11TH FLOORS OF THE RIO TOWER AT UNIVERSITY HOSPITAL MARK WEBB Currently, pediatric services are located on the 7 th floor Sky Tower, 5 th floor Rio Tower, and 8 th, 9 th, 10 th, and 11 th floors of the Horizon Tower. Due to several operational challenges previously reviewed with the Board, staff has developed a renovation plan that would allow for all of the pediatric inpatient units to be located in the Horizon Tower. This would provide for more centralized pediatric services, locate pediatric services in the same building as the pediatric emergency department, and create a children s tower. Importantly, this project would also help resolve the operational challenges caused by continuing to locate pediatric patients on the 7 th floor of the Sky Tower. The projected initial cost of the project is approximately $8.39M. Staff estimates future work at approximately $3.1M. However, staff needs to complete due diligence before the Board is asked to consider additional work. The intent of this request is to purchase labor and materials to renovate the Ground, 8 th, 9 th, 10 th, 11 th and 12 th floors of the Horizon Tower and 1 st, 9 th, and 11 th floors of the Rio Tower at University Hospital. From the clinical perspective, the renovation of the floors will offer an enhanced and updated look matching the current branding for the health system provided through the Sky Tower project. The specific projects were described as follows: Location Project Description Rio 1 st Adult Infusion Relocation from former Emergency Department to create space for Pedi ED/Observation Unit Horizon Ground Pedi ED/Observation Renovation of space Horizon 12 th Pedi ACU beds Renovation of space Horizon 12 th (17)/ICU beds (8) Pedi Infusion/Clinic/Proced ure Rio 9 th Transplant Admin (temp) Renovation of space to allow move of Pedi Infusion/Clinic from Horizon 10 th floor to create beds on Horizon 10 th floor Minor renovation to make space for other moves

5 Page 5 of 13 Location Project Description Rio 11 th Pedi ACU beds (11) Minor renovation to make space for temp other moves Horizon 12 th Pedi Infusion Offices Renovation of space Horizon 10 th Pedi ICU beds (9) Renovation of space Horizon 10 th Pedi Cardiac beds (16) Renovation of space Horizon 9 th Pedi ACU beds Renovation of space (14)/ICU beds (12) *Horizon 8 th Pedi Clinic/Admin Renovation of space Horizon 11 th Pedi PACU/Waiting Renovation of Space Horizon 11 th Operating Room Renovation of space Improvements *future phase project with funding appropriation at a later date These projects will be accomplished in multiple phases; and will include labor and material as required to provide a whole and complete renovation of the floor. Although the detailed schedule is still being developed, a key milestone is to have pediatric activities currently housed on the 7 th floor Sky Tower moved to the Horizon Tower before the end of the year. Any work that may disrupt services will require impact notices to affected departments. Once the designs for the projects are complete, the plans will be bid to a minimum of three TxMAS or BuyBoards (Cooperative) contractors. Bids by the Cooperative contractors will be evaluated by staff to determine the best value to the Health System. Based on the bids received, staff will recommend a contractor to the President/Chief Executive Officer for the renovation projects. The total cost for the renovation work outlined above is not to exceed $8.39M. The fees associated with this item will be funded from operating cash on hand. Mr. Engberg agreed with this approach, it is appropriate to reduce cross action and confusion within Pediatric Services. He asked how the staff plans to finance the necessary $8.4 million, which Mr. Hurley addressed. After re-balancing of the reserves earlier in the year, there are $20 million in the capital reserve account, which is unencumbered. Staff will allocate $8.4 million from that $20 million in the capital reserve account. The additional $3.1 million will be allocated from the same account, if approved by the Board. Mr. Engberg asked Mr. Webb to elaborate on best-value cooperative contracts. Texas Multiple Award Schedule (TxMAS) contracts are those that have been developed from contracts awarded by federal government or any other governmental entity. Texas Buy Board contracts are administered and governed by the Texas Association of School Boards. Cooperative purchasing agreements are an effective tool to help achieve effective best-value solutions for the Health System and its tax payers. With cooperative contracts, multiple organizations have combined their requirements to leverage the benefits of volume purchases which can drive significant savings and price breaks, lower administrative overhead and save significant time and money in contract production. Once the designs for the projects are complete, the plans will be bid to a minimum of three TxMAS or BuyBoards (Cooperative) contractors. Bids by the

6 Page 6 of 13 Cooperative contractors will be evaluated by staff to determine the best value to the health system. Board members asked the staff to ensure that local and small businesses are given the opportunity to be considered for work by the larger contractors who are part of the cooperative. In the staff s attempts to expedite these projects, the Board does not wish to omit local and small businesses. Mr. Smith asked Ms. Wilson and Mr. Webb to continue their efforts to keep local business within the community involved. Mr. Webb noted that the majority of the work on these projects will be performed by subcontractors. Further, he and Ms. Wilson recently met with the Fair Contracting Coalition where 15 different entities were represented, in a concerted effort to reach small business in the community. Ms. Wilson will be providing them with a listing of all of upcoming Health System projects. Mr. Gilbert asked about insurance requirements for smaller business. With the Capital Improvement Program, the Health System was able to waive such requirements. The staff plans to continue that practice with smaller projects because sometimes insurance is an obstacle for smaller businesses. Staff recommends Board of Managers approval to execute an agreement in an amount not to exceed $8,390,000 for construction services with best value TxMAS or BuyBoards contractors for work on the Ground, 8 th, 9 th, 10 th, 11 th, and 12 th Floors of the Horizon Tower and 1 st, 9 th, and 11 th floors of the Rio Tower at University Hospital. A MOTION to approve staff s recommendation by Mr. Engberg, SECONDED by Mr. Hasslocher, and PASSED UNANIMOUSLY. CONSIDERATION AND APPROPRIATE ACTION REGARDING SELECTED PURCHASING ITEMS: CONSIDERATION AND APPROPRIATE ACTION REGARDING A SUBCONTRACT WITH THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT SAN ANTONIO FOR PROFESSIONAL RADIOLOGY SERVICES TO SUPPORT THE HEALTH SYSTEM S BREAST HEALTH PROGRAM THERESA DE LA HAYA/PAMELA OTTO, M.D., CHAIR, DEPARTMENT OF RADIOLOGY, UTHSC-SA Screening mammograms are provided by UHS at three entry points, the Robert B. Green campus, the mobile mammography - Healthy U Express, and the Cancer Therapy and Research Center (CTRC) while diagnostic services are provided at two locations RBG and CTRC. UHS provides the technical component of the mammography screening while UT Medicine provides the professional component (image read). The funding to contract professional services come from multiple breast screening and diagnostic grant sources which include the Breast and Cervical Cancer Services (BCCS) grant, the Susan G. Komen Foundation, the Expanded Primary Health Care grant, the Alamo Breast Cancer Foundation, the Cancer Prevention Institute of Texas (CPRIT) and CommuniCare s grant program funding. UHS utilizes these grant funds to subcontract the radiology professional component with UT Medicine/UTHSCSA. The goal of the grant program is to provide the uninsured and underinsured potential lifesaving screening and diagnostic services. The grant funding removes the

7 Page 7 of 13 financial barrier to care and provides funding for a patient navigation service to assist women with transportation and scheduling appointments. Approximately 2,250 clients will be provided services through the grant programs and if cancer is detected the program offers early detection options for remission. At UHS clinic sites, women are financially screened to identify eligibility for these programs. They are then enrolled into the appropriate program and an assigned patient navigator will assist with scheduling their screening and/or diagnostic appointments. The navigator assesses the client s status and will navigate the client to the appropriate access point which could initially be a well-woman office visit, or a clinical breast exam visit or a direct appointment for a screening and/or diagnostic follow-up. The navigator follows the patient from the initial appointment through resolution. Women may also be referred to these grant programs from other locations such as the Emergency Department, the Cancer Therapy and Research Center (CTRC) or from a community agency/organization. Staff recommends Board of Managers approval of a subcontract in the amount of $190,000 to secure professional radiology services from UT Medicine/UTHSCSA to support the Health System s Breast Health Program. A MOTION to approve staff s recommendation by Dr. Burns, SECONDED by Mr. Gilbert, and PASSED UNANIMOUSLY. CONSIDERATION AND APPROPRIATE ACTION REGARDING A CONTRACT WITH PEDIATRIX MEDICAL SERVICES, INC., FOR PEDIATRIC SURGICAL SERVICES ALLEN STRICKLAND While UTHSCSA provides professional services across numerous specialty areas, there is a need for pediatric surgical support to assist in the diagnosis and treatment of pediatric surgery patients at University Hospital. Therefore, contracting with a third party to cover urgent, elective and outpatient and pediatric surgical cases is critical to the overall success of the pediatric program. Currently, UT does not have the specialized providers to support pediatric surgical services. This agreement with Pediatrix Medical Services, Inc. (Pediatrix) will ensure that the Health System maintains access to high-quality pediatric surgical coverage. All physicians providing services pursuant to this agreement are credentialed through UTHSCSA. UT Pediatrics is supportive of this agreement which compliments the current UT Pediatric practice at University Health System. Pediatrix is a multi-specialty group practice that has an excellent reputation in providing specialized pediatric surgical services in the community. Staff recommends Board of Managers approval of a contract with Pediatrix Medical Services, Inc. for specialized pediatric surgical services in the amount of $300,000 for a 12 month period beginning July 1, A MOTION to approve staff s recommendation by Mr. Hasslocher, SECONDED by Mr. Gilbert, and PASSED UNANIMOUSLY.

8 Page 8 of 13 CONSIDERATION AND APPROPRIATE ACTION REGARDING OPERATIONS AND FINANCIAL REPORT FOR JUNE 2015 ROE GARRETT/REED HURLEY/EDWARD BANOS In June clinical activity (as measured based on discharges adjusted for outpatient activity) was up 7.5% for the month compared to budget. Community First Health Plan (CFHP) fully-insured membership was down 1.6% due to lower membership in STAR Medicaid and CHIP. The bottom line gain excluding debt service was $4.9 million, $2.8 million better than budget and was due to higher patient revenue and lower operating expense. Debt Service Revenue was $3.7 million which is equal to the budgeted portion of the Debt Service payment of $3.7 million. Mr. Hurley reviewed notable increases and/or decreases from the Consolidated Balance Sheet in detail with the Board. Regarding third party liabilities that increased by $2.8 million due to the settlement of Medicare Cost Reports for years 2006, 2010, and 2011, 2006 is the oldest cost report under review. Staff can request any prior years report be reopened if an error is discovered. The Health System has reserves set up to cover any reporting costs that might arise from prior years, to minimize the impact to the current year s bottom line. How does the staff plan to handle health insurance costs that are over by $2.9 million, due primarily to increased pharmacy expenses? Staff is working to figure out how to target some of the high dollar employees and/or dependents to make the 340b program more attractive to them. To obtain 340b pricing, the patient must be seen by a UTHSCSA or CMA physician. The Health System also has a 90-day prescription mail order program that waives the copayment requirement for the patient and reduces pharmacy labor hours. This report was provided for informational purposes. A MOTION to approve staff s recommendation by Mr. Gilbert, SECONDED by Mr. Engberg, and PASSED UNANIMOUSLY. PRESENTATIONS AND EDUCATION: UPDATE ON THE SOUTH TEXAS PEDIATRIC CONGENITAL HEART CENTER ACTIVITIES SHANNON FRIESENHAHN/MICHELLE RYERSON/MARK WEBB Mr. Webb welcomed Dr. Michelle Ryerson, Dr. Adil Husain, and Dr. Roozbeh Taeed and yielded the floor to Dr. Husain. Dr. Husain introduced Dr. Taeed as the medical director of the pediatric critical care unit and an excellent example of a physician partner and leader; he has been instrumental in getting the congenital heart program started. Dr. Husain also introduced Ms. Shannon Friesenhahn; she was a nurse at CHRISTUS Santa Rosa for 15 years as the director of neonatal transport, prior to joining the Pediatrics Team at UHS about 18 months ago. He credited Ms. Friesenhahn for being at the center of every detail of this program in terms of inpatient services, its successes, failures, joys, and sorrows. He s very proud of what she has accomplished and he yielded

9 Page 9 of 13 the floor to her for a graphics presentation. In early 2013, the UTHSCSA School of Medicine s child health programs transitioned from the Children s Hospital of San Antonio into University Health System. Leaders and staff from Health System, the Departments of Pediatrics and Cardiothoracic Surgery, and the School of Medicine worked diligently to meet the needs of the Division of Pediatric Cardiothoracic Surgery and the Pediatric Congenital Heart Program. A strong commitment of resources was made by the Health System to a long term strategy for the growth of pediatric congenital heart services. The South Texas Pediatric Congenital Heart Center was established within University Health System, and the center s first pediatric cardiac surgery was performed in November With a steadfast commitment from the Health System, physician and staff leadership built a new team that continues to strive towards excellence through innovation and collaboration. Building on past successes, the Pediatric Congenital Heart Center set course to become a leader in outcomes and in establishing a family-centered approach to neonatal and pediatric cardiac care. Ms. Friesenhahn provided an in-depth program overview and described the organizational structure, staffing progress, quality initiatives, accomplishments, vision for the future, renovation projects, improved referral pattern, and cardiology support. She touched upon quality initiatives and shared several success stories and accomplishments related to pediatrics and the staff. At the conclusion of her presentation, she introduced of Ms. Josie Molina, executive director of hospital based pediatric clinics, and two pediatric charge nurses. She thanked Dr. Ryerson for her support and answered questions from the Board members. This report was provided for informational purpose only. COMMUNITY FIRST HEALTH PLANS, INC., OPERATIONS REPORT GREG GIESEMAN Mr. Gieseman provided a graphics presentation during which he reviewed Medicaid Market Share data for the Bexar County Service area for the period July 2014 through July 2015 for CFHP, Superior, Aetna, and Amerigroup, with CFHP at percent at the end of July, Medicaid Membership for the Bexar County Service Area, same time period compared against same health plans indicates a membership of 105,952 for CFHP. CHIP Market Share Data same service area, same time period and health plans, indicates CFHP at percent at the end of July CHIP membership for the Bexar County Service Area, same time period health plans, indicates CFHP has a membership of 17,014 at the end of July, Also reviewed were Healthcare Effectiveness Data and Information Set Quality Measures (HEDIS) for 2014 for STAR and CHIP Medicaid services. Pre-natal and post-partum care (PPC) post-partum rate for CFHP is 58.8 percentile (the percentage of deliveries that had a post-partum visit on or between 21 and 56 days after delivery) and puts CFHP in the 25 th to 49 th Quality Compass 2014 Emergency Department utilization are at 733 visits/1,000 members per month. All other measures were within appropriate ranges. Mr.

10 Page 10 of 13 Gieseman reviewed comparative data on 2014 Quality Measure by Consumer Assessment of Healthcare Providers (CAHPS) Medicaid General Population Children, Children with Complex Conditions (CCC), Medicaid Adult, and Commercial Adult. CFHP s financial performance YTD through June 2015 (Consolidated) indicates an actual net income of $3,062,844 compared to a budgeted $1,309,061, a favorable variance of $1,753,782. Year to date through June 2015 vs. Prior Year through June 2014 indicates net income of $3,062,844 for 2015 compared to $6,238,751 for 2014, an unfavorable variance of $(3,175,907), or 50.9 percent. Financial revenue drivers (compared to budget) were premiums that fell below budget by $8.9M. Unfavorable variance due to 36,111 fewer member months $6.8 M, and lower premium yield of $2.1 M. There were fewer higher premium category members (pregnant mom & newborn) as a percentage of total Medicaid members. Also, a shortfall of HIE premium to budget of $58 per member per month due to average age of members being younger than budgeted. Compared to the prior year, premiums were favorable by $8.7M due to higher member months at $15.2 million. Unfavorable variance was due to premium reductions in the Medicaid program by $6.5 million. Also reviewed were Medicaid Premium and Medical Expense PMPM (without pharmacy) for the period 2011 through YTD 2015; and CHIP Premium and Medical Expense PMPM (without pharmacy) for the same time period. Initiatives for 2015 in Care Management include: Implemented new speech therapy management authorization program Expanded ER case management program through HASA Increase in generic prescription utilization Negotiated new participation agreement with Baptist Health System for all CFHP at risk products effective 4/2015 Renegotiated financial terms of Southwest General Hospital contract effective 5/15/2015. Revising contractual language Initiatives for 2015 in Infrastructure include: Completing internal and partner testing for ICD Conversion in October. (Began Provider and staff training programs). Established monitoring oversight as required under NAIP (financial impact to CFHP) Improve STAR/CHIP risk group analysis and interventions Implemented new subrogation vendor Implemented improved Fraud, Waste and Abuse audit and recoupment program IT modernization plan/recommendation. (Using HTMS as a lead consultant, completed review of CFHP s current operational, organizational and technical capabilities ) Mr. Gieseman also reported on the following concerns: Adequacy of 9/2015 STAR and CHIP premium rates o Impact of hospital SDA increases

11 Page 11 of 13 o Impact of Medicaid speech therapy rate decreases HHSC determination of P4Q performance on HEDIS and potential preventative metrics Utilization experience of new marketplace members o Final decision 10/2015 o Enrollment period 11/2015; effective 1/2016 If awarded, investment in STAR Kids development prior to HHSC disclosure of premium rates Effectiveness of efforts to better manage speech therapy and ER utilization Risk adjustment for STAR/CHIP and marketplace products Decreasing STAR market size o CFHP share of STAR pregnant women This report was provided for informational purposes only. Mr. Engberg asked Mr. Gieseman to forecast whether CFHP will see a profit next year. The state will provide more information in the near future, but staff is predicting a two percent profit on Medicaid. Regarding the decrease in number of Medicaid eligible patients, no one seems to know the reason for the 2.5 percent drop between January and July, however, it is a statewide issue. AMBULATORY MATTERS: ANNUAL COMMUNITY MEDICINE ASSOCIATES (CMA) REPORT - MONIKA KAPUR, M.D. CMA has grown from fifteen physicians in the 1990s to greater than 150 provider FTEs as of the conclusion of Through the years, the organization has evolved into a robust and progressive primary care group with some specialty groups represented. Dr. Kapur described CMA s contributions to UHS as follows: Uncompensated Care (UC) - Net Revenue DSRIP and NAIP - Net Revenue (participating in all 26 DSRIP projects) Downstream Revenue (CTs, MRIs, Pharmacy, Lab, PT/OT, etc.) Keeping patients out of the ER/Hospital - cost comparison (ExpressMed CPV vs. ER and Hospital Admission CPV) Referrals to UT Specialists Annually Managed Care Incentive Dollars Meaningful Use Incentive Dollars Grant Deposits Referrals to University Hospital Lower Cost of Care Regarding patient mix, since 2008 CMA has realized an approximate 45 percent increase in funded patients, with a year-end rate of for Patient activity at the end of 2014 totaled 423,840 with physician

12 Page 12 of 13 FTEs and mid-level FTEs (physician assistants and nurse practitioners. Included in these FTEs are leased services of providers from UT Medicine (neonatology, psychiatry, Ob/Gyn, and pediatrics). Dr. Kapur noted that CMA has retained many patients who transitioned to coverage under the health care exchange. She reviewed service line activity for Primary Care, ExpressMed, Pediatrics, Endocrinology, Psychiatry, and Women s Health with a cost per visit ranging from $ in 2012 to $ in During 2014, CMA generated more than 105,000 specialty referrals and continues to collaborate with UT Medicine to identify opportunities for preventing these referrals outside of the system. The top 10 Referral Specialties are: Ophthalmology, Gastroenterology, Podiatry, Psychiatry, Ob/Gyn, Orthopaedics, Otolaryngology, Cardiology, Pain Management, and Neurology. Looking forward, CMA will focus its efforts on the following initiatives. Expansion of urgent care services Development and fulfillment of NAIP initiatives Service line expansion to include geriatrics NCQA Patient-Centered Medical Home recognition for other CMA clinics Determining and managing appropriate panel sizes Population health management This report was provided for informational purposes only. No action by the Board of Managers was required. INFORMATION ONLY ITEMS: REPORT REGARDING MEDICAL-DENTAL STAFF COMMITTEES AND DEPARTMENTS KRISTEN A. PLASTINO, M.D., PRESIDENT, MEDICAL/DENTAL STAFF UPDATE ON CAPITAL IMPROVEMENT PROGRAM ACTIVITIES MARK WEBB REPORT ON RECENT RECOGNITIONS AND UPCOMING EVENTS LENI KIRKMAN QUARTERLY REPORT ON HOSPITAL INPATIENT METRICS BRYAN ALSIP, M.D. Mr. Adams directed the Board s attention to the four (4) written reports above. He urged his colleagues to contact staff with specific comments, questions, or suggestions. These reports were provided for informational purposes only. No action by the Board of Managers was required.

13 Page 13 of 13 ADJOURNMENT: There being no further business, the public meeting adjourned at 8:05 p.m. James R. Adams Chairman, Board of Managers Dianna M. Burns, M.D. Secretary, Board of Managers Sandra D. Garcia, Recording Secretary