.Minutes Maricopa Health Centers Governing Council Maricopa Medical Center Administration Building, Auditoriums 1 and 2 April 4, 2018 6:00 p.m. Members Present: Liz McCarty, Chair Melissa Kotrys, Vice Chair Gary Tenney, Treasurer Lloyd Asato, Member Terry Benelli, Member Christine Hammond, Member arrived 6:12 p.m. April Jordan-Kramer, Member Eileen Sullivan, Member Ryan Winkle, Member Members Absent: Scott Jacobson, Member Others/ Guest Presenters: Barbara Harding, Chief Executive Officer, Maricopa Health Centers Governing Council Kris Gaw, Chief Operating Officer Rich Mutarelli, Chief Financial Officer Rebecca Birr, Library and Information Service Manager Lenè Hudson, Director, Care Management Melanie Talbot, Chief Governance Officer Ijana Harris, Assistant General Counsel Recorded by: Cynthia Cornejo, Deputy Clerk of the Board Call to Order Chairman McCarty called the meeting to order at 6:00 p.m. Roll Call Ms. Talbot called roll. Following roll call, it was noted that eight of the ten voting members of the Maricopa Health Centers Governing Council were present, which represented a quorum. Ms. Hammond arrived after roll call. Call to the Public Chairman McCarty called for public comment. There were no comments.
General Session, Presentation, Discussion and Action: 1. Approval of Consent Agenda: a. Committee Recommendations: i. Accept Recommendations from the Compliance and Quality Committee Meeting to Approve New Indicators on Which to Measure Quality for the Federally Qualified Health Centers Look-Alike Clinics MOTION: Ms. Benelli moved to approve the consent agenda. Ms. Sullivan seconded. Motion passed by voice vote. 2. Presentation about the Maricopa Integrated Health System Family Learning Centers Ms. Birr noted that Maricopa Integrated Health System (MIHS) currently had four Family Learning Centers (FLCs), which were also referred to as Family Resource Centers. The FLCs were located within the Comprehensive Health Center (CHC), and the Chandler, Maryvale, and South Central Family Health Centers (FHCs). The FLCs were funded by First Things First, with the focus on providing the community with information, resources, referrals to services, and connecting and supporting families. She outlined the timeline in the development and opening of the FLCs, which began in 2004, with research and seeking grants to fund the project. The first FLC opened in 2007 at the CHC. A FLC opened at the South Central FHC in 2009, followed by the Maryvale FHC in 2012 and the Chandler FHC in 2014. She highlighted the key donors and supporters that assisted in the opening of all four locations. She reviewed the current model used in the FLCs, which had evolved over the years, with input from providers and families. The FLCs offer information and referrals, including but not limited to information regarding a diagnosis or nutrition. Families were also connected with various resources, with referrals to social services agencies needed to support their families. There were also various educational workshops offered at the FLCs, including newborn care class, breastfeeding support, Science on Wheels presented by the Arizona Science Center, and music classes. Parent education was offered, focusing on parenting skills for families such as discipline and literacy. There were also educational series offered, with classes presented over 10-weeks, which has been successful. Ms. Benelli asked if those services were offered at each of the four FLCs. Ms. Birr stated that each FLC followed the same model and offered the same services. Ms. Benelli asked, when families were referred to outside social service agencies, if it was based on the location of the clinic, or the family s home address. Ms. Birr stated that were various factors reviewed to determine the most appropriate referral source to best meet the needs of the family, such as the specific need and transportation. Mr. Winkle noted that many families were multi-generational and asked if that was taken into consideration. Ms. Birr stated that multi-generational families utilized a 2-Gen approach, which was an approach that helped identify the needs of the family. Mr. Winkle asked if there was a caseworker available to assist the families. Ms. Birr stated that the FLCs had Family Learning Center Coordinators, which were all bilingual in English and Spanish and certified interpreters, with interpreters for other languages available through the interpreter line, when needed. All Coordinators were social workers with Masters level early childhood development and educational degrees. 2
2. Presentation about the Maricopa Integrated Health System Family Learning Centers, cont. She continued to review the current model used, and the services provided at each of the FLCs. There was a focus on safety, with car seat classes available and free car seats and bike helmets distributed to the community. There was also focus on improving health literacy, through MyChart and other resources. Family stability and economic supports, including utility assistance programs, job assistance, and a legal clinic were available at the CHC FLC. The FLC also provided navigation to assist families that required more case management. There was also Family Social Supports, including activities where families can gather. Each FLC also had a parent advisory group to provide input on the various needs of families in the community. She highlighted the various outreach and collaboration activities, including collaboration with First Things First, Chicanos Por la Causa, Parenting Arizona, the Arizona Science Center, and Southwest Human Development. The FLCs also assisted with access to healthcare. Other aspects of the model include school readiness and early literacy. She noted that the aspects of the current model aimed to address the social determinants of health. Many families needed support assistance as they faced struggles and challenges beyond doctor s visits, which impacted their family s health. Mr. Winkle asked how the FLCs reached out to the community. Ms. Birr noted that many families were identified from within the organization, through referrals from providers. The FLCs also networked with many community agencies and other Family Resource Centers, making them aware of the variety of services available at the FLCs. Information was also distributed at local schools and through a monthly e-newsletter with information on the classes available. Ms. Benelli referred to the graphic included on the slide outlining the social determinants of health and requested a future presentation on the topic. She requested information about the direction that healthcare was headed to support the social determinants of health to improve health outcomes. Ms. Birr stated that as the organization planned the new ambulatory sites, there were discussions surrounding the placement of FLCs, with plans to include in the West Valley Primary and Specialty Care Center. Mr. Tenney asked how progress was monitored. Ms. Birr stated that it was complicated to measure overall; however, there were pre-tests and post-tests that were administered in the parent education series. There were also efforts by First Things First to collect and track data through all of the Family Resource Centers to conduct evaluation surveys. Vice Chairman Kotrys asked if there was follow-up conducted when a family was referred to an outside agency. Ms. Birr stated that follow-up was conducted within 30 days to ensure the family received the referred services. If they had not, there was continued follow-up with the family. Vice Chairman Kotrys asked if the provider was made aware of any social determinants identified. Ms. Birr noted that if the patient was referred by an MIHS provider, the outcome of that referral was documented in the Electronic Health Record (EHR) through Epic. Staff was developing a process to document the services provided to families that were not referred by an MIHS provider. 3
3. Presentation on Patient Centered Medical Home Basics Ms. Hudson stated that the National Committee for Quality Assurance (NCQA), an organization that performs the recognition process, defined a Patient Centered Medical Home as a model of care that emphasized care coordination and communication to transform primary care into what patients want it to be. MIHS chose to participate in the accreditation process, to be recognized as a PCMH, and in 2014, had achieved Level 3 recognition by NCQA. There were a variety of functions required to maintain the recognition, such as a focus on caring for the whole patient and reducing the fragmentation of care, which would include coordination with referral management and connecting patients to care. There was also a focus to improve healthcare by centralizing care and having a collaborative approach in patient management, with a care team comprised of physicians, social workers, medical assistants, and care coordinators. The approach increased patient engagement and patients learned to manage and organize their care at a level in which they felt comfortable. She noted that MIHS had achieved Level 3 recognition in 2014, which was the highest level of accreditation, and thirteen FQHC Look-Alike Clinics were accredited. The accreditation was the foundation that supported the goals of improving quality care, as there were many quality metrics involved with the recognition process. There was also focus on patient experience and promoting prevention and disease management while lowering costs. She noted the current accreditation was valid until May 2018, and the reasons to continue the accreditation included validation of the quality of care provided to patients, improved contract negotiations, Health Resources and Services Administration (HRSA) supported PCMH accreditation, and it was the right thing to do for the patients. Ms. Hudson reviewed the recognition process, which included the gathering of a variety of data to demonstrate the standardization of care for every FQHC Look-Alike Clinic. The process consisted of six concepts including team-based care, knowledge and management of patients, patient-centered access and continuity, care management and support, care coordination and care transitions, and performance measurement and quality improvement. There were also 40 core requirements, 25 elective requirements, and up to three virtual reviews. In prior years, the accreditation process took place every three years; however, beginning this year, it would be an annual review. She noted that there were many PCMH opportunities, as some of the health care initiatives and strategies for MIHS were changing, including behavioral health and other specialty certification. Vice Chairman Kotrys noted the increased importance of integrating physical and behavioral health care in Arizona and asked if it was possible to obtain distinction in the accreditation by NCQA by meeting certain criteria in behavioral health. Ms. Hudson stated that there were special distinctions for some specialties, such as, maternal and pediatrics, with behavioral health being relatively new. Mr. Tenney recommended an additional item to list on the opportunities; patient education on self-care and how their diet affected their overall health. Ms. Hudson stated there was currently a component to address that and would require the organization to demonstrate the development of self-centered patient care plans and working with patients to create goals and plans to accomplish them, factoring in the social determinants. Ms. Benelli asked how the PCMH differed from Whole Health Homes, which were being closed. Ms. Harding stated that the PCMH were services embedded in the FHCs, where the Whole Health Homes were established to provide medical care to a behavioral health population. Ms. Benelli asked if the PCMH targeted a certain population or if the focus on every patient. Vice Chairman Kotrys stated that PCMH was a concept that applied to the entire healthcare environment, and all patients were treated with a patient-centric approach. 4
3. Presentation on Patient Centered Medical Home Basics, cont. Mr. Asato requested an explanation of the Level 3 designation. Ms. Hudson explained that NCQA had established three levels of recognition, with Level 3 being the highest recognized level. The designation was based on points received through a reporting system. However, NCQA would no longer have levels of recognition, it was moving to a pass or fail system. MOTION: Chairman McCarty moved to recess general session and convene in executive session at 6:29 p.m. Ms. Hammond seconded. Motion passed by voice vote. General Session, Presentation, Discussion and Action: Chairman McCarty reconvened general session at 7:00 p.m. 4. Maricopa Health Centers Governing Council s Chief Executive Officer s Report Ms. Harding noted volumes at the FQHC Look-Alike clinics were discussed at length at the Finance Committee, which showed a slight regression from the previous month. There was discussion on how to approach targeted expectations for the fiscal year 2019 budget. She provided an update on the 100-day workout, which focused on access to care and had generated multiple projects totaling near $16 million in estimated cost savings, with over $4 million savings being implemented, and $4 million in validated savings. She thanked Mr. Asato for attending a Check-in meeting. Mr. Asato stated that he was impressed how the work was progressing and encouraged other Governing Council members to participate. Ms. Harding reviewed quality initiatives and announced the addition of Ms. Crystal Garcia and Ms. Teresa Wightkin, who would assist in the establishment of a solid foundation with data management to analyze the impact of change on the population. She noted that MIHS had also joined efforts with Health Center Controlled Network (HCCN) to receive consultation services to improve management of the diabetic patient population. There were also initiatives to move forward with Fecal Occult Blood Testing (FOBT) for early screening of colorectal cancer. She announced that the Seventh Avenue FHC received the Arizona Partnership for Immunization Award for best immunization coverage levels statewide for toddlers and teens. There were also individual winners, with nurses from the Maryvale FHC. Ms. Harding provided an update on the various initiatives and ventures, including the Targeted Investment Program (TIP), which focused on adults transitioning from the criminal justice system and was moving forward toward implementation at the Mesa FHC, Seventh Avenue FHC, and Avondale FHC. The First Episode Center began services at the Avondale FHC in March. While at the Mesa FHC, she met with the Dean of St. Benedictine University and provided a tour and an overview of services provided. The Mobile Food Pantry continued to take place the third Saturday of each month and she encouraged all Governing Council members to participate. She expressed her appreciation for the Governing Council members that attended the employee barbeque at the beginning of April. She stated that HRSA had performed an audit on the 340B Drug Program at Maricopa Medical Center (MMC), with the results expected in eight to ten weeks, however, the surveyors were complimentary of the MMC team. The HRSA on-site review was scheduled for August 21-23, 2018 and staff was preparing, with plans on scheduling a retreat and conducting a simulated on-site review with consultants. 5
4. Maricopa Health Centers Governing Council s Chief Executive Officer s Report, cont. Ms. Harding stated that she had reached her six-month milestone and welcomed feedback from the Governing Council members. Vice Chairman Kotrys referred to quality components included in the Quality Dashboard and requested clarification on the updates. Ms. Harding stated that the approved Quality Dashboard contained more defined metrics, with metrics provided for individual FQHC Look-Alike Clinics, as opposed to the combined results that were presented in the previous dashboard. Vice Chairman Kotrys referred to the arrows on the dashboard and asked if the metrics would also be color coded, to indicate which metrics were within the established benchmark. Ms. Harding stated the arrows indicated the desired direction of the metric. However, staff may adjust the dashboard to incorporate colors to highlight the results. Ms. Talbot noted that dashboard would be reviewed by the Compliance and Quality Committee and reported to the Governing Council during the Committee reports. Vice Chairman Kotrys requested an educational presentation on the meaning of the quality metrics, as well as the purpose for monitoring each metric, such as the impact on the patient. 5. Maricopa Health Centers Governing Council Committee Reports a. Bylaws Review Committee b. Compliance and Quality Committee c. Executive Committee i. Membership Recruitment ii. Current Members/User Status iii. Attendance d. Finance Committee e. Strategic Planning and Outreach Committee Chairman McCarty stated that the Bylaws Review Committee met on March 14, 2018. The Committee compared the Maricopa Health Centers Governing Council Bylaws to the Co-Applicant Operational Agreement and the HRSA Compliance Manual. The Committee would meet again on April 11, 2018 to continue to review the Maricopa Health Centers Governing Council Bylaws. Ms. Sullivan noted the next Compliance and Quality Committee was scheduled for April 9, 2018 and would begin to meet on a monthly basis to prepare for the upcoming HRSA onsite visit. The Committee planned to review new quality indicators to consider. Chairman McCarty announced that the Executive Committee had established a recruitment and application process, with edits to the interview questions. She noted the need to focus on recruitment of users of the FQHC Look-Alike Clinics and there was information about the Governing Council on Facebook to engage interest from the public. Ms. Benelli referred to the recruitment flyer and noted the photo did not represent the patient demographics which may deter individuals from participating. 6
5. Maricopa Health Centers Governing Council Committee Reports, cont. Ms. Hammond recommended the Spanish recruitment flyer include the requirement for the applicants to speak English, since all material and presentations were prepared in English. Ms. Benelli noted that having an interpreter at the meetings would address that obstacle. Ms. Harding stated that staff was working through solutions while developing the Patient and Family Advisory Council, as a language barrier may be a challenge. She did not recommend excluding individuals due to language, as there were solutions, such as the utilization of interpreter services. Vice Chairman Kotrys recommended a new photo for the flyer and updating the information on Facebook. Ms. Sullivan requested clarification on the information provided on current Governing Council members and the user status. Ms. Talbot outlined the information in the report, noting the number of current Governing Council members was 10, with 50% consumers (users). The remaining information was obtained from the information provided by Governing Council members; race, ethnicity, and area of expertise. Ms. Sullivan recommended the recruitment of a social worker. Vice Chairman Kotrys stated the higher priority was the recruitment of consumers that were representative of the community served, as the Governing Council was out of compliance with that requirement. Ms. Benelli suggested utilizing the FLCs to recruit consumers (users). Mr. Tenney noted the improved volumes in the dental clinics, including the number for employees utilizing MIHS s dental services. However, the FQHC Look-Alike Clinics did not meet the budgeted targets for the month. The Finance Committee reviewed the proposed volumes for the fiscal year 2019 budget, which projected a 2% increase in volumes. The upcoming budget also included capital projects utilizing Care Reimagined funds exceeding $1 million. The Committee would continue to work to finalize the fiscal year budget. Ms. Jordan-Kramer stated that the Strategic Planning and Outreach would meet in April 2018, with a focus on a developing a strategy to encourage more employees to utilize MIHS s dental services. 6. Maricopa Integrated Health System s President and Chief Executive Officer s Report Ms. Gaw provided the MIHS CEO report. She reviewed the progress with Care Reimagined, including the purchase of the Maryvale Hospital and the aggressive timeline to remodel and open the emergency department in approximately one year, the planning of the Roosevelt campus, and the finalization of the ambulatory network. She noted the Creighton Alliance was also progressing on schedule, and MIHS was currently in the budgeting process for fiscal year 2019. 7. Maricopa County Special Health Care District Board of Directors Report This item was not discussed. 8. Chairman and Council Member Closing Comments/Announcements Chairman McCarty noted that MIHS was in a state of change, with many exciting initiatives and strategies to improve health care for the community. 7
9. Review Staff Assignments Ms. Talbot reviewed the request for future presentations including a presentation on social determinants of health and an overview of quality metric meanings and purpose of monitoring them. Adjourn MOTION: Vice Chairman Kotrys moved to adjourn the April 4, 2018 Maricopa Health Centers Governing Council meeting. Ms. Benelli seconded. Motion passed by voice vote. Meeting adjourned at 7:35 p.m. Melanie Talbot, Chief Governance Officer 8