Meeting. April 5, :00 p.m. Agenda

Maricopa Health Centers Governing Council Meeting April 5, 2017 6:00 p.m. Agenda

Committee Members Gino Turrubiartes, Chair Simon Thomas, Vice Chair Gary Tenney, Treasurer Lloyd Asato, Member Terry Benelli, Member Susan Gerard, Ex-Officio Member Chris Hammond, Member Melissa Kotrys, Member April Jordan-Kramer, Member Liz McCarty, Member Julie Roberts, Member Rose Rubio, Member Eileen Sullivan, Member Ryan Winkle, Member AGENDA Maricopa Health Centers Governing Council Mission Statement Serve the population of Maricopa County with excellent, comprehensive health and wellness in a culturally respectful environment. Welcome We welcome your interest and hope you will often attend Maricopa Health Centers Governing Council Meetings. Democracy cannot endure without an informed and involved electorate. The Maricopa Health Centers Governing Council is the governing body for Maricopa Integrated Health System s Federally Qualified Health Center Look Alike Clinics. Each Council member is a volunteer who represents one of the five Districts in Maricopa County. The Maricopa Health Centers Governing Council sets policy and the Maricopa Health Centers Governing Council s Chief Executive Officer, who is hired by Maricopa Integrated Health Systems and the Maricopa Health Centers Governing Council, directs staff to carry out the policies. Meetings The Governing Council generally holds meetings at 6:00 p.m. on the first Wednesday of the month. Please visit http://www.mihs.org/about-mihs/governing-council or call the Secretary to the Maricopa Health Centers Governing Council at 602-344-1637 to confirm the date of the next regular meeting. The meeting may appear to proceed quickly, with important decisions reached with little discussion. However, the agenda and meeting material is available to the Governing Council prior to the meeting, giving them the opportunity to study every item and to ask questions of Maricopa Integrated Health System staff members. If no additional facts are presented at the meeting, action may be taken without further discussion. How Citizens Can Participate The Governing Council values citizen comments and input. Citizens may appear before the Governing Council express their views. Any member of the public will be given three minutes to address the Council on issues of interest or concern to them. If you wish to address the Council, please complete a Speaker s Slip and deliver it to the Secretary to the Maricopa Health Centers Governing Council. If you have anything that you wish distributed to the Council and included in the official record, please hand it to the Secretary who will distribute the information to the Council Members and to Maricopa Integrated Health System Senior Staff. Speakers will be called in the order in which requests to speak are received. Your name will be called when the Call to Public has been opened or when the Council reaches the agenda item which you wish to speak. As mandated by the Arizona Open Meeting Law, governing bodies may not discuss items not on the agenda, but may direct staff to follow-up with the citizen. Agendas are available within 24 hours of each meeting in the Maricopa Health Centers Governing Council Office, located in the Comprehensive Health Center, 1 st floor, 2525 E. Roosevelt, Phoenix, AZ 85008, Monday through Friday between the hours of 8:00 a.m. and 4:30 p.m. and on the internet at http://www.mihs.org/about-mihs/governing-council.. Accommodations for Individuals with Disabilities, alternative format materials, sign language interpretation, and assistive listening devices are available upon 72 hours advance notice through the Secretary to the Maricopa Health Centers Governing Council at (602) 344-1637. To the extent possible, additional reasonable accommodations will be made available within the time constraints of the request. 3/30/2017 2:13 PM

When Speaking at the Podium Please state your name and the city in which you reside. If you reside in Maricopa County, please state the District you live in. If you have an individual concern involving the Governing Council, you are encouraged to contact the Council Members at 602-344-1637. We will do everything possible to be responsive to your individual requests. Public Rules of Conduct The Governing Council Chair shall keep control of the meeting and require the speakers and audience to refrain from abusive or profane remarks, disruptive outbursts, applause, protests, or other conduct which disrupts or interferes with the orderly conduct of the business of the meeting. Personal attacks on Governing Council Members, staff, or members of the public are not allowed. It is inappropriate to utilize the Call to Public or other agenda item for purposes of making political speeches, including threats of political action. Engaging in such conduct, and failing to cease such conduct upon request of the Governing Council Chair will be grounds for ending a speaker s time at the podium or for removal of any disruptive person from the meeting room, at the direction of the Governing Council Chair. 2

Maricopa Medical Center Administration Building Auditorium 1 and 2 2601 E. Roosevelt St. Phoenix, AZ 85008 Secretary s Office 602-344-1637 Fax 602-344-0937 Wednesday April 5, 2017 6:00 p.m. One or more of the members of the Governing Council may attend telephonically. Governing Council members attending telephonically will be announced at the meeting. Pursuant to A.R.S. 38-431.03(A)(3), or any applicable and relevant state or federal law, the Executive Committee may vote to recess into an Executive Session for the purpose of obtaining legal advice from the Governing Council s attorney or attorneys on any matter listed on the agenda. The Governing Council also may wish to discuss any items listed for Executive Session discussion in General Session, or the Governing Council may wish to take action in General Session on any items listed for discussion in Executive Session. To do so, the Committee will recess Executive Session on any particular item and reconvene General Session to discuss that item or to take action on such item. Call to Order Roll Call Call to the Public This is the time for the public to comment. The Governing Council may not discuss items that are not specifically identified on the agenda. Therefore, pursuant to A.R.S. 38-431.01(H), action taken as a result of public comment will be limited to directing staff to study the matter, responding to any criticism or scheduling a matter for further consideration and decision at a later date. ITEMS MAY BE DISCUSSED IN A DIFFERENT SEQUENCE General Session, Presentation, Discussion and Action: 1. Approval of the Consent agenda 5 min Note: Approval of minutes, committee recommendations, etc. Any matter on the Consent Agenda will be removed from the Consent Agenda and discussed as a regular agenda item upon request of any Council member. a. Approve the Maricopa Health Centers Governing Council Meeting Minutes dated March 1, 2017 b. Approve the Appointment of Eileen Sullivan to the Maricopa Health Centers Governing Council s Compliance & Quality Committee c. Accept the Recommendations from the Compliance & Quality Committee to Approve the Calendar Year 2017 Quality Improvement Plan for the Federally Qualified Health Centers Look Alike Clinics d. Accept the Recommendations from the Finance Committee to Approve Remodeling the Internal Medicine Clinic in the Comprehensive Health Center Utilizing Proposition 480 Funds in an Amount not to Exceed $186,001 End of Consent Agenda 3

General Session, Presentation, Discussion and Action (cont.): 2. Discussion and Possible Action on Holding Special Meeting Monthly to Discuss Proposition 480 Implementation Planning 10 min Maricopa Health Centers Governing Council 3. Discuss, Review and Approve the Maricopa Health Centers Governing Council s Membership Committee Charter; Appoint Members to the Membership Committee 10 min Julie Roberts, Committee Chair, Membership Committee Gino Turrubiartes, Chair, Maricopa Health Centers Governing Council 4. Maricopa Health Centers Governing Council Chief Executive Officer s Report 10 min Operational Dashboard Wyatt Howell, Chief Executive Officer, Maricopa Health Centers Governing Council 5. Maricopa Health Centers Governing Council (MHCGC) Committee Reports 5 min a. Finance Committee Gary Tenney, Committee Chair, Finance Committee, Treasurer b. Compliance & Quality Committee Liz McCarty, Committee Chair, Compliance & Quality Committee 6. Reports to the Maricopa Health Centers Governing Council 20 min a. President and Chief Executive Officer Report Steve Purves, President & Chief Executive Officer, Maricopa Integrated Health System b. District Board Report Susan Gerard, Ex-Officio, Maricopa County Special Health Care District Board of Directors c. Chairman and Member Closing Comments/Announcements Gino Turrubiartes, Chair, Maricopa Health Centers Governing Council d. Review of Council and Staff Assignments Pam Hjerpe, Secretary to the Maricopa Health Centers Governing Council Adjourn 4

Maricopa Health Centers Governing Council Meeting April 5, 2017 Item 1a Consent Agenda Minutes

Maricopa Health Centers Governing Council Meeting Minutes General Session March 1, 2017 Draft Minutes Maricopa Health Centers Governing Council General Meeting Maricopa Medical Center Administration Building, Auditorium 2 March 1, 2017 6:00 p.m. Voting Members Present: Non-Voting Members Present: Others/Guest Presenters: Recorded by: Gino Turrubiartes, Chair Simon Thomas, Vice Chair Gary Tenney, Treasurer Lloyd Asato, Member Terry Benelli, Member (participated telephonically) Christine Hammond, Member (participated telephonically) Melissa Kotrys, Member April Jordan-Kramer, Member (arrived at 6:44 p.m.) Liz McCarty, Member Julie Roberts, Member Rose Rubio, Member (participated telephonically at 6:04 p.m.) Eileen Sullivan, Member Ryan Winkle, Member Susan Gerard, Ex-Officio Member Wyatt Howell, Chief Executive Officer, Maricopa Health Centers Governing Council Kris Gaw, Chief Operations Officer, Steve Purves, President & Chief Executive Officer Melanie Talbot, Executive Director, District Board Pamela Hjerpe, Secretary to the Maricopa Health Centers Governing Council Call to Order Chair Turrubiartes called the meeting to order at 6:00 p.m. Roll Call Ms. Hjerpe called roll. Following roll call, Ms. Hjerpe announced that there were eleven of the thirteen voting members of the Maricopa Health Centers Governing Council present, representing a quorum. Ms. Rubio and Ms. Jordan-Kramer participated after roll call. For the benefit of those participating telephonically, Ms. Hjerpe named the individuals present and those participating telephonically. She asked that participants announce themselves prior to speaking. Call to the Public Chair Turrubiartes asked if any speaker s slips were turned in or if anyone from the public wished to address the Council. There were no comments from the public. 1

Maricopa Health Centers Governing Council Meeting Minutes General Session March 1, 2017 General Session, Presentation, Discussion and Action: 1. Approval of the Consent agenda: a. Approve the Maricopa Health Centers Governing Council Meeting Minutes dated February 1, 2017 b. Approve the Appointment of Lloyd Asato to the Maricopa Health Centers Governing Council s Strategic Planning and Outreach Committee MOTION: Mr. Tenney moved to approve the Maricopa Health Centers Governing Council consent agenda. Ms. Kotrys seconded. Motion passed by voice vote. 2. Discussion and Possible Action on the Performance Evaluation for Wyatt Howell, Maricopa Health Centers Governing Council Chief Executive Officer, for calendar year 2016 Chair Turrubiartes asked the members of the Executive Committee to comment on the performance evaluation conducted at the Executive Committee meeting last month. He complimented Mr. Howell on his first year and all he had accomplished. Mr. Winkle asked if the Governing Council could see a copy of the completed evaluation. Chair Turrubiartes explained that the evaluation was completed at the Executive Committee meeting. Ms. McCarty added that it done in executive session. Ms. Gerard stated that she found it hard to expect Governing Council members to take action on something they were not privy to. Ms. Talbot explained that according to the Maricopa Health Centers Governing Council (MHCGC) bylaws, the Executive Committee conducts the evaluation of the MHCGC s CEO and makes recommendation to the Governing Council based on its review of him/her. The item before the Governing Council is to approve the performance evaluation of Mr. Howell. Based on its review, the Executive Committee concluded that he met performance expectations. Ms. Roberts felt uncomfortable voting on Mr. Howell s performance with him present. Chair Turrubiartes responded that this is common for public boards and councils. Mr. Thomas added that there were several perimeters that were reviewed and assessed. The conclusion was that Mr. Howell met expectations. The Governing Council can accept or reject the Executive Committee s recommendation. Ms. Kotrys added that the Governing Council should follow what is in the bylaws. How the Governing Council handles governance should be discussed in the very near future. MOTION: Mr. Tenney moved to rate the performance of Mr. Howell as the Maricopa Health Centers Governing Council s Chief Executive Officer for calendar year 2016 as meets expectations. Mr. Thomas seconded. Motion passed by voice vote. 2

Maricopa Health Centers Governing Council Meeting Minutes General Session March 1, 2017 General Session, Presentation, Discussion and Action (cont.): 3. Maricopa Health Centers Governing Council Chief Executive Officer s Report Operational Dashboard Data Mr. Howell recognized and congratulated Ms. Hjerpe for her ten years of service at Maricopa Integrated Health System. Mr. Howell stated the dashboard for the month of January falling within expectations with the exception of Early and Periodic Screening, Diagnostic and Treatments (EPSTD). The consensus of the work group is the consequences of the same day appointments. Parents are not thinking of scheduling a wellness exam for their children. There will be re-engineering the processes at the clinics to have staff reach out to the parents and begin to be more proactive on scheduling a wellness exam for the children that fall in this age group. He continued with giving a report on the providers and the uncovered sessions. Now that there are more providers, he would like to bring back an initiative to have early evening and weekend sessions at the FQHC LA Clinics. 4. Discuss and Review Maricopa Health Centers Governing Council (MHCGC) Committee Reports a. Finance Committee Report Mr. Tenney stated the Finance Committee had favorable news from the quarterly report on dental. The dental clinics are performing better and are close to breaking even. The Committee was impressed with the marketing initiatives to increase volumes in the dental clinics. Initiatives included large billboard signage in the CHC and at the Pendergast FHC. He explained the pater mix was also improving. The number of self-pay patients using dental services went from 58% in FY2014 down to 38% in FY2017. The Committee asked staff to look into how to stimulate more use amongst employees to utilize the dental services at Maricopa Integrated Health System. For this fiscal year, there are over 10,000 for uncovered sessions in the FQHC LA clinics. 5. Reports to the Maricopa Health Centers Governing Council: a. President and Chief Executive Officer Report b. District Board Report c. Chairman and Member s Closing Comments/Announcements d. Review of Council and Staff Assignments Old Business February 1, 2017 o Place an item on the March Governing Council agenda for approval of a Membership Committee Charter. Mr. Purves gave a brief update on the Prop 480 implementation plan. Vanir Construction Management secured the bid to manage the complex project. The Integrated Project Management Office (IPMO) will have their offices set up in the Grants and Research building. Mr. Purves also gave a brief update on behavioral health and the new adolescent inpatient unit that opened in January. He hit a few focus points on the Affordable Care Act (ACA). His team has been highly engaged with the legislation at the state capitol, and working closely with the local hospital association. Mr. Purves update the Council on the Creighton University Arizona Health Education Alliance, which is a partnership between Maricopa Integrated Health System (MIHS), District Medical Group (DMG), Dignity Health St. Joseph s Hospital and Medical Center and the Creighton University School of Medicine. 3

Maricopa Health Centers Governing Council Meeting Minutes General Session March 1, 2017 General Session, Presentation, Discussion and Action (cont.): 5. Reports to the Maricopa Health Centers Governing Council, cont.: Ms. Gerard reported at the last District Board meeting Mr. Howell presented the FQHC LA Clinics semi-annual report. There were discussions on several topics including reducing the abandon call rate, recruiting providers, patient satisfaction scores, and initiative to increase volumes. The Board was very concerned with the providers and the missed sessions report. While MIHS is performing better than budget, there are many things to be done that can be an improvement. There are limited amount of cash reserves to carry MIHS if the ACA does get repelled as opposed to replaced. Ms. Hjerpe stated there were no current follow up or requests for agenda items. Chair Turrubiartes announced the Membership Committee charter would be discussed next month and announced that Julie Roberts has accepted to be the chair of the Membership Committee. Ms. Talbot asked for clarification on the Membership Committee Charter, and if it was to be added to the April Governing Council agenda. Chair Turrubiartes replied no. Ms. Kotrys recalled that there were questions about compliance with the various Committees charters and asked if the responsibility to review governance was going to be added to the Bylaws Committee Charter. Ms. Talbot responded that there was a recommendation to look at creating a charter for a governance type committee; you cannot add governance as part of the Bylaws Committee without changing the bylaws Committee charter. The Bylaws Committee s work is at a standstill until the Cooperative Agreement comes forward. The Cooperative Agreement between the Governing Council and the District Board will affect the bylaws. Adjourn MOTION: Ms. Kotrys moved to adjourn the March 1, 2017 Maricopa Health Centers Governing Council meeting. Mr. Thomas seconded. Motion passed by voice vote. The meeting adjourned at 7:13 p.m. Approved by the Maricopa Health Centers Governing Council on: April 5, 2017. Pamela Hjerpe, Assistant to the Maricopa Health Centers Governing Council 4

Maricopa Health Centers Governing Council Meeting April 5, 2017 Item 1b Consent Agenda Appoint Eileen Sullivan to C&QC (No Handout)

Maricopa Health Centers Governing Council Meeting April 5, 2017 Item 1c Consent Agenda CY 2017 Quality Improvement Plan

Maricopa Integrated Health System Primary Care Ambulatory and Physician Services Quality Improvement Plan

Effective Date 2005, Revised June 2007, Revised July 2008, Revised September 2009, June 2010, Revised June 2011, Revised June 2012, Revised March 2014, Revised October 2015, Revised March 2017 Review and approvals The Maricopa Health Centers Governing Council has reviewed and approved this Quality Improvement Plan, as reviewed and approved by the Policies, Services and Compliance Committee and affirms the Council s commitment to quality improvement to better meet the mission of the Maricopa Integrated Health System. Approved By: Council Chair Signature Date Compliance and Quality Chair Signature Date Medical Director Signature Date Senior Vice President of Ambulatory and Physician Services Signature Date 2

Table of Contents 1. Review and Approvals... 2 2. Introduction... 4 A. Mission... 4 B. Vision... 4 C. Values... 4 3. Purpose... 6 4. Program Scope... 6 5. Program Goals... 7 6. Authority and Responsibility... 9 A. Governing Council... 9 B. Sr. Vice President and Medical Director Involvement in the QI Program... 9 C. Ambulatory Services Medical QI Committee (ASMQIC)... 10 7. Confidentiality... 11 8. Resources... 11 9. Methodology for Improvement... 11 A. The Improvement Model... 12 B. The PDSA cycle... 12 C. The Care Model... 13 10. Measures... 13 11. Schedule of Activities... 13 12. External Accountability... 14 A. HRSA... 14 B. DNV... 14 C. Annual Evaluation... 14 3

Introduction Maricopa Integrated Health System (MIHS) is the health care safety net for the residents of Maricopa County, Arizona. MIHS serves people of many racial and ethnic backgrounds and nationalities who come from diverse cultures and speak many different languages. Many of our patients face major challenges, such as lack of health insurance, complex medical problems, lack of social support, and difficult socioeconomic situations. Caring for such persons demands special knowledge and sensitivity. MIHS is committed to giving cultural appropriate, sensitive medical care and assisting our patients to live healthier lives. Vision: Maricopa Integrated Health System will be nationally recognized for transforming care to improve community health. Mission: The Maricopa Integrated Health System mission is to provide exceptional care, without exception, every patient, every time. Values: Accountability We hold ourselves and each other accountable by accepting personal responsibility for all that we do and stewardship of the resources we deploy on behalf of our community. Compassion We demonstrate sensitivity to our patients and each other by offering emotional, spiritual, cultural and physical support. Excellence We are committed to delivering breakthrough quality and service that exceeds expectations, improves outcomes and provides exceptional patient care. Safety We ensure a safe environment for all and a highly reliable, effective care experience. MIHS includes Maricopa Medical Center, The Arizona Burn Center, two psychiatric facilities and five Whole Health Home Clinics, twelve Federally Qualified community-based family health centers, the McDowell Health Care Center, 7 th Avenue Walk-In Clinic, and the Comprehensive Health Center. Additionally, MIHS is a premier training center for the nation s physicians. To fulfill our vision, mission, and values, we foster an environment that encourages innovation, embraces diversity, respects life, and values human dignity. MIHS s goal is to provide the highest standard of quality health care for our community and all patients who see services. Therefore, every effort will be made to ensure patients receive care that meets community and professional standards while exceeding the patients expectations. 4

Ambulatory services are a key component of the care provided by MIHS. As such, the need for a quality improvement program that is unique to Ambulatory and Physician Services requires integration into the overall quality improvement program of the health system and approval from the Maricopa Health Centers Governing Council. The Ambulatory and Physician Services Quality Improvement Plan (here after referred to as the QI Plan) is not designed to supplant that of MIHS system wide quality plan, but will serve as an interface with the overall quality improvement process. The plan is designed to improve the system processes of the programs within the primary care ambulatory arena at MIHS: the twelve Federally Qualified Family Health Centers (FHC), the McDowell Health Care Center, five Whole Health Home Clinics (WHHC), 7th Avenue Walk-In Clinic, and the primary care services provided at the Comprehensive Health Center (Women s Clinic, Pediatrics, Antenatal Testing Center, Same Day Clinic and Internal Medicine). Summary: The Executive Director of Nursing; Ambulatory and Physician Services co-chairs with the Ambulatory Medical Director the Ambulatory Services Medical Quality Improvement Committee. The information and recommendations are sent to both the Governing Council for the FQHC-LA and to the Performance Improvement Committee where the Executive Director of Nursing; Ambulatory and Physician Services actively serves on. The Senior Vice President, Ambulatory and Physician Services/ Executive Director, Maricopa Health Centers Governing Council serves on the system wide Quality Management Council which reports to the MIHS Board. 5

Purpose The Ambulatory and Physician Services Quality Improvement program has as its focus the ongoing assessment and improvement of clinical care and health services delivery. Some of the benefits derived from the implementation and maintenance of a Quality Improvement program include: The momentum for the system to work towards continuous quality improvement (CQI) as a means to conduct business; A framework by which to monitor and strengthen health services delivery process of the organization; The ability to measure and improve clinical outcomes on specific patient populations; The integration of performance measurement in clinicians and health care staff performance reviews; An emphasis on team work and a multi-departmental approach to quality improvement; and A systems approach to health care delivery and data integration. The purpose of the QI program is to promote an ongoing effort by Ambulatory and Physician Services and the Council to monitor and evaluate the quality, cost, safety, and appropriateness of ambulatory health care. Ambulatory and Physician Services and the Council are committed to pursuing opportunities to improve health care delivery by taking ongoing action on identified quality and cost issues, and monitoring and evaluating problems-solving interventions. The pursuit of these efforts is designed to result in the provision of professionally acceptable care through timely access to care, facilitation of best practices, appropriate resource utilization, and improved community health services. Program Scope Ambulatory and Physician Services comprises all Federally Qualified Health Centers Look- Alike (FQHC-LA) designated clinics including twelve Family Health Centers (FHCs), five Whole Health Home Clinics, the McDowell Health Care Center, the Seventh Ave Walk-In Clinic and the primary care services at the Comprehensive Health Center (CHC). The twelve Family Health Centers (FHCs) include primary care for persons of all ages, obstetrics/gynecology, and pediatrics. The providers come from such disciplines as Family and Community Medicine, Internal Medicine, Complementary Alternative Medicine, Obstetrics/Gynecology, and Pediatrics. McDowell Health Care Center provides primary, dental and specialty care (infectious disease and psychiatry) for HIV infected persons. The Comprehensive Health Center (CHC) includes primary care services encompassing obstetrics/gynecology, pediatrics, internal medicine and a same day walk-in clinic. The range of available ambulatory services spans the continuum for preventive care to diagnosis and treatment of acute and chronic medical conditions. The 7 th Ave Walk-In clinic is designed to offer a broad range of services to ambulatory patients of all ages, including pediatric through geriatric patients. The Walk-in Clinic provides additional after hour services and weekend hours to all MIHS ambulatory patients. The five Whole Health 6

Home Clinics, co-located in community agencies, provide primary care services for adults (ages 18 years and up) who are receiving behavioral health care needs at the behavioral health site. Ancillary services offered include routine and emergency dental services for eligible children and adults, laboratory services, pharmacy services, radiology, mammography, OB ultrasound, echogram, and psychiatry. The continuum of care also includes services such as nutrition, diabetes, education, patient education, care management, community resources, and others that, while non-medical in nature, contribute to the overall health and well-being of the individual, family, and community. MIHS has 13 primary care clinics that have been granted the highest level of recognition by the National Committee for Quality Assurance (NCQA) as a Patient Centered Medical Home. A Patient Centered Medical Home (PCMH) is an approach to providing health care that puts the patient at the center of the provider-led PCMH team. In a PCMH, each patient is encouraged to be an active participant in the decisions concerning their health and wellness. The PCMH team of health care professionals work together with the patient to ensure that all the healthcare needs are coordinated. The scope and content of the QI program is designed to continuously monitor, evaluate and improve clinical care and health services delivery provided to our patients. Specifically, the QI program includes, but is not limited to: Monitoring and evaluation of: o o o o o o Primary care delivery Preventive health services Management of chronic disease Acute care provided in clinic Specialty services Dental, OB/GYN, Pediatrics The continuity of care for our patients. Development, implementation and monitoring of evidence-based practice guidelines Regulatory and accreditation compliance Development and implementation of health and disease management programs Medical record review/documentation audits Patient and staff satisfaction surveys, and Monitoring, evaluation and resolution of patient complaints and grievances in coordination with the Risk Management Department. Program Goals To disseminate the principles and spirit of continuous quality improvement throughout Ambulatory and Physician Services and provide a means for integrating quality improvement responsibilities of all professional, managerial, technical, and support personnel, and demonstrate that our procedures, methods and systems are efficient and effective. 7

To establish guidelines, protocols and procedural operations with the objective of producing a positive impact on health services delivery and patient care 8

Authority and Responsibility Governing Council The Governing council is ultimately accountable for the management and improvement of the quality of clinical care and services provided. The council authorizes the Senior Vice President of Ambulatory and Physician Services to allocate sufficient staff and other resources to adhere to the stated QI program description and work plan. The Council meets monthly and receives a report at a minimum of quarterly. Senior Vice President of Ambulatory and Physician Services and Medical Director Involvement in the QI Program The Senior Vice President delegated the authority and responsibility for all quality improvement processes and activities to the Medical Director who chairs the Ambulatory Services Medical Quality Improvement Committee (ASMQIC) and is supported by the QI Analyst. The Senior Vice President and Medical Director are the driving force behind the ASMQIC; they are accountable to the Council for all aspects of the quality improvement program to meet regulatory compliance and support the improvement needs of Ambulatory and Physician Services. At each Council meeting they, or designee, provide a report on specific QI projects and measures. Annually they submit the QI program evaluation from the previous year to the Council for analysis and to provide direction for the QI program in the new year. This evaluation is presented in the first quarter of each new fiscal year. ASMQIC The Medical Director has delegated the day-to-day responsibilities of the QI program to the QI Analyst, who works closely with the Medical Director and Executive Director of Nursing. The QI Analyst in conjunction with the Medical Director will act in a facilitative and consultative manner to assist the ASMQIC in the implementation of policies, plans and projects aimed at improving performance, achieving/maintaining compliance and accreditation, or external (HRSA) Performance Review. Membership in ASMQIC is multidisciplinary and represents the different facilities operated and services provided by Ambulatory and Physician Services. ASMQIC is composed of the following members: (Refer to attachment C for a list of current members and a diagram of the reporting structure). Medical Director of Ambulatory and Physician Services Senior Vice President of Ambulatory and Physician Services Medical Directors for each primary care delivery site Directors for Ambulatory and Physician Services Executive Director of Nursing for Ambulatory and Physician Services Managers from the primary care clinics QI Analyst Membership from the Governing Council 9

ASMQIC is an interdisciplinary committee directed by the Council to have oversight for primary care ambulatory quality improvement. The committee is a fact-finding and educational body, with responsibility and ultimate accountability to the Council. ASMQIC conducts itself as a forum for the discussion on matters of clinic policy and practice, particularly for those issues pertaining to the quality and efficiency of patient care, customer satisfaction (patients, employees, physicians, and others), and primary care ambulatory services operations. It shall also have the following specific duties: Provide leadership in establishing a quality improvement process that includes effective systems to review, evaluate, and monitor the quality of patient care and customer service in the clinics. It shall continuously assess and evaluate the results and effectiveness of the QI Plan and take action as warranted by its findings. Annually review and recommend a primary care ambulatory service plan to the Council for approval. Oversee quality improvement teams or work groups. In keeping with regulatory and contractual requirements, assure that each committee or team selects the appropriate performance assessment and quality improvement indicators/criteria, which meet recognized standards; these are approved and accepted by the Council. Ensure that quality reviews are completed using monitors and studies for high/low volume, high risk, high cost, problem-prone, and acute and chronic conditions. The demographic and epidemiological characteristics of primary care ambulatory services patients will be used in the selection of important aspects of care for routine monitoring, evaluation, and special studies done by the committee and/or quality action teams/work groups Provide a forum for interdisciplinary and interdepartmental communication and problem solving as part of the total quality process Ensure there is a process for the receipt and timely management of patient/provider/staff complaints, and tending of information for quality care and services. Help foster the development of practice guidelines that are based on scientific evidence, with quality indicators to monitor provider performance, and methods to communicate guidelines as well as individual and group performance to providers. Receive and provide reports to the Council. Share information as appropriate with other committees/groups. Assist in the periodic review of all existing policies, practices, and procedures relative to primary outpatient care, and recommend any appropriate or necessary changes. Reports and minutes of ASMQIC activities, conclusions, actions, recommendations, and evaluation will be kept by the Ambulatory QI Analyst and reported to the Council. Meet monthly but no less than nine times a year. 10

Confidentiality Records and information generated in the performance of the medical staff and other allied professional staff and the QI program activities are confidential and protected as privileged information under ARS 36-445, ARS 36-2403, The Health Care Quality Improvement Act of 1986 or the Patient Safety and Quality Improvement Act of 2005/ Health care providers duly appointed and acting within the scope and functions of the program are protected under Arizona law from liability and damages. All Copies of minutes, reports, worksheets and other data will be maintained in a manner assuring strict confidentiality. A written confidentiality policy detailing procedure for maintenance and release of data and other QI information will be utilized to assure compliance with the confidentiality policy. Resources All staff of Ambulatory and Physician services participates in the monitoring and promotion of the QI program. All Federally Qualified Family Health Center managers and managers of the primary care clinics in the CHC are responsible for the direction and oversight of the improvement process/projects in the respective health services delivery area. The organization has dedicated these resources to the QI program: QI Analyst 1FTE Medical Director 0.2 FTE Executive Director of Nursing 1.0 FTE Additional resources include technical assistance from HRSA and the Arizona Association of Community Health Centers on compliance, regulatory, safety, quality and risk management, and performance improvement. Methodology for Improvement The methodology for all improvement activities is the Improvement Model. Clinical improvements use both the Improvement Model and the Care Model. The Improvement Model guides ASMQIC and QI teams through tests of change and identification of improvement based on data. The Care Model for Ambulatory and Physician Services is the NCQA Patient-Centered Medical Home. Staff is trained on how to use the Improvement Model, PDSA cycles and the Care Model. Each team will address the three fundamental questions as they work toward improvement, utilizing the PDSA cycle. 11

The Improvement Model: PDSA What are we trying to accomplish? Model for Improvement What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? The team will complete a written statement of AIM (goal of project) with input from ASMQIC & senior leadership. The AIM will explain in broad terms what is to be accomplished and why. How will we know that a change is an improvement? The key measures will answer this question. Guidelines for development of key measures are: Act Plan Multiple measures are required more than one but less than six Include both process and outcome measures Each measure will address the AIM Study Do Measures will be based on national indicators, like HEDIS Goals for each measure will be set according to national or regional benchmarks. What changes can we make that will result in improvement? Based on the data and information gained from testing the change, the team will identify the best improvement(s) to make to accomplish the AIM of the project. The PDSA cycle is the primary means for turning the ideas from the third fundamental question into action and for connecting action to learning. Each PDSA cycle will be developed using the PDSA worksheet. 12

The Care Model: Patient-Centered Medical Home MIHS Patient Centered Medical Home Coordinated Care across health care settings Family and Caregivers Patient is an Quality And Safety Active Member of The Care Team Enhanced Access to Care Team based Care The Care Model incorporates the four essential elements of the patient-centered medical home: the practice organization, health information technology, the patient experience and quality measures. The team based approach to the delivery of health care has been shown to allow improved access to care, increased satisfaction with care and better health outcomes. 13

Measures Clinical and service indicators of quality are established and monitored on a regular basis in order to assess performance in the management of clinical care and services. Indicators are designed to reflect the demographic characteristics, prevalence of disease and/or utilization of services of the patient population. All indicators will be trended for change over time and be included in ASMQIC reports to the Council. External Accountability HRSA As a Federally Qualified Health Center Look-alike, Ambulatory and Physician Services is regulated by the Health Resources and Services Administration performance evaluation. DNV Net Norske Veritas (DNV) is the accreditation agency chosen by MIHS. DNV s standards are called NIAHO (National Integrated accreditation for Healthcare Organizations). The NIAHO standards integrate requirements based on the CMS Conditions of Participation (CoPs) with the internationally recognized ISO9001 Standard. Annual Evaluation The activities of the Quality Improvement Program will be reviewed, evaluated and revised annually. The results of the quality indicators and other focused reviews will be evaluated to identify strengths and barriers and to assess the organization s effectiveness in improving quality of care and service to its population. The QI Program evaluation will be completed and reported to the council in the first quarter of the new fiscal year. 14

Maricopa Health Centers Governing Council Meeting April 5, 2017 Item 1d Consent Agenda Remodeling the Internal Medicine Clinic in the CHC

Maricopa Integrated Health System Internal Medicine / Same Day Clinic 5 Year Pro Forma January 10, 2016 Year 0 Year 1 Year 2 Year 3 Year 4 Year 5 5 Yr Total Capital Outlay Renovation/Addition of 2 exam rooms $ 160,224 Furnishings (2 exam rooms/3 work stations) $ 25,777 Total Capital Outlay $ 186,001 Net Revenue - 2 Exam Rooms - 480 additional sessions Total Net Revenue $ 458,816 $ 458,816 $ 472,581 $ 472,581 $ 486,758 $ 2,349,551 Program Expenses Staffing $ - $ - $ - $ - $ - $ - Direct Expenses 265,845 273,821 282,035 290,496 299,211 $ 1,411,409 Total Operating Expenses $ 265,845 $ 273,821 $ 282,035 $ 290,496 $ 299,211 $ 1,411,409 Contribution Margin $ 192,971 $ 184,995 $ 190,545 $ 182,084 $ 187,547 $ 938,142 Recap: 5 Year Contribution Margin $ 938,142 Cash Outflow for Capital Acquisition $ (186,001) Net 5 Year Cash Flow $ 752,141 Program Statistics Year 1 Year 2 Year 3 Year 4 Year 5 Patient visits 2,720 2,720 2,801 2,801 2,885 Page 1

P&L CHC INTERNAL MED / SAME DAY CLINIC EXPANSION Addition of 2 new exam rooms and 3 new workstations Int Med P&L Visits Est Net Rev Rev/Visit Expenses MSF Total Exp Exp / Visit CM/visit FY16 10,546 1,807,171 171.36 1,150,696 258,518 1,409,214 133.63 37.74 109.11 24.51 SDC P&L Visits Est Net Rev Rev/Visit Expenses MSF Total Exp Exp / Visit CM/visit FY16 3,662 589,682 161.03 238,079 501,816 739,895 202.05 (41.02) 65.01 137.03 Combined Visits Est Net Rev Rev/Visit Expenses MSF Total Exp Exp / Visit CM/visit FY16 14,208 $ 2,396,853 $ 168.70 $ 1,388,775 $ 760,334 $ 2,149,109 $ 151.26 $ 17.44 97.75 53.51 Visits / session Rev / visit Net Rev/Session Exp/Session Prov Exp/Session Total Exp/Session CM/SESSION Combined/session 5.67 $ 168.70 $ 955.87 $ 553.84 $ 303.22 $ 857.07 $ 98.80 Annual - 480 sessions $ 458,816 265,845 $ 192,971 ASSUMPTIONS: No additional clinic staffing or MD's 6 new residents Worked weeks per year 48 Annual sessions 480 other expense/session 97.75 additional visits per year 2,720 Same payor mix Same volume / session Direct expense from the P&L includes clinic salary/benefits which will not be increased This number is used instead to reflect the costs of the 5 new residents and misc supplies

Per FQHC Reports Int Med / SDC Sessions 15-Dec 16-Jan 16-Feb 16-Mar 16-Apr 16-May 16-Jun 16-Jul 16-Aug 16-Sep 16-Oct 16-Nov TOTAL Int Med 136.75 115.50 139.00 141.00 138.50 137.00 140.00 114.00 152.00 118.00 107.00 161.00 1,599.75 SDC 79.50 68.00 68.00 84.00 76.00 69.00 83.00 66.00 77.00 77.00 32.00 46.00 825.50 216.25 183.50 207.00 225.00 214.50 206.00 223.00 180.00 229.00 195.00 139.00 207.00 2,425.25 Patients Int Med 789.00 758.00 824.00 896.00 864.00 910.00 898.00 667.00 938.00 778.00 656.00 923.00 9,901.00 SDC 348.00 343.00 342.00 401.00 312.00 308.00 375.00 349.00 309.00 320.00 177.00 220.00 3,804.00 1,137.00 1,101.00 1,166.00 1,297.00 1,176.00 1,218.00 1,273.00 1,016.00 1,247.00 1,098.00 833.00 1,143.00 13,705.00 Combined 5.26 6.00 5.63 5.76 5.48 5.91 5.71 5.64 5.45 5.63 5.99 5.52 5.67 Avg Visits per Session 476103 476106 Page 3

Furnishings Quote from Dale Owens Exam Rooms (per Exam Room) Exam Table $1,400.00 Exam Light $280.05 Medical Supply Tray $78.47 Integrated Diagnostic System $795.55 Kleenspec Dispenser $234.18 Doctor Stool $200.00 Guest Chair (2) $500.00 Total $3,488.25 Work Stations (per each work station) Desk Area $1,750.00 Chair $450.00 Computer $1,500.00 Phone $1,000.00 Total $4,700.00 Wiring? Renovation document is a pdf file. Page 4

Maricopa Health Centers Governing Council Meeting April 5, 2017 Item 2 Holding Special Meeting Monthly for Prop 480 (No handout)

Maricopa Health Centers Governing Council Meeting April 5, 2017 Item 3 Membership Committee Charter; Appoint Members

Maricopa Healthcare Centers Governing Council Membership Committee Charter Purpose The purpose of the Membership Committee (Committee) of the Maricopa Healthcare Centers Governing Council (Council) is to recruit, screen, and recommend candidates to serve on the Council of the Federally Qualified Health Center Look-Alike (FQHC-LA) designated sites and to assure that the Council is meeting the Health Resources & Services Administration (HRSA) Program Requirements concerning representation on the Council. Membership The Committee shall consist of a Chair, a Vice Chair, and no more than three (3) additional Council members. A voting member of the Council will serve as the Committee Chair. The Committee Chair will recommend and the Committee will appoint a Vice Chair. The Chief Executive Officer of the Council is an ex-officio, non-voting member of the Committee. In addition, the Committee will appoint one (1) MIHS Family Health Center Clinic Manager to sit on the Committee as a non-voting member. In accordance with the Council Bylaws, voting members are appointed by the Council. Voting members shall serve for a two (2) year term with a maximum of two terms. Responsibilities 1. Develop the criteria for qualifications of potential applicants for membership on the Council. Potential applicants should represent the individuals being served by the FQHC LA designated sites in terms of demographic factors such as race, ethnicity, and sex. 2. Actively recruit and screen new applicants. This includes seeking community assistance (which may include local civic, religious and community organizations) in identifying persons interested and qualified for the positon. 3. Seek and identify potential applicants. These new applicants are to be representative of the community and allow the ratio of User Members and Non-user Members to be maintained. Non-users should be selected for their expertise in community affairs, local government, finance and banking, legal affairs, trade unions, and other commercial and industrial concerns, or social service agencies within the community. 1

Maricopa Healthcare Centers Governing Council Membership Committee 4. Conduct appropriate inquiries into the qualifications of interested candidates for the Council. 5. Promote retention of existing Council members. 6. Maintain an awareness of the needs of the Council when recruiting prospective candidates. 7. Periodically review the Committee Charter and make recommendations for suggested revisions to the Council. Meetings Meetings will be held monthly or as needed. Additional meetings can be scheduled at the discretion of the Committee Chair. Meeting Procedures 1. The Committee Chair will facilitate all meetings. The Committee Vice Chair will facilitate meetings in the Chair s absence. 2. Meetings will be attended by Committee members in person or, when circumstances dictate, telephonically. A quorum shall consist of a majority of the voting Committee members, which is necessary for the Committee to meet and to take action. 3. Minutes shall be recorded and maintained for each Committee meeting in compliance with Arizona Open Meeting Laws and shall contain all actions taken by the Committee. Minutes recorded or maintained for Executive Session discussions, however, will be kept confidential pursuant to A.R.S. 38-431.03. 4. The Committee will report its actions to the Council at the next regularly scheduled Council meeting.

Maricopa Health Centers Governing Council Meeting April 5, 2017 Item 4a MHCGC CEO s Report Operational Dashboard

AMBULATORY AND PHYSICIAN SERVICES ~ FQHC CLINICS QUALITY DASHBOARD FY 2017: All Clinics Combined Target Threshold Action Trigger Equal or greater than goal < 10% negative variance > 10% negative variance SERVICE Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun YTD No Show Rate Target= < 25% Connect Experience Survey "Would Recommend Providers Clinic" Target= 88.9% n= count of Returned Connect Surveys CGCAHPS Patient Satisfaction NRC (Quarterly) Target= 76.8% County Owned Average FQHC 21.7% 21.5% 22.8% 22.4% 21.5% 20.5% 19.5% 18.7% 21.1% FQHC 82.2% 82.3% 84.5% 83.9% 84.7% 84.6% 84.3% 85.7% 84.1% FQHC 2074 2991 2468 2445 2057 1797 2199 2441 18472 FQHC Quarterly Quarterly 81.0% Quarterly Quarterly 84.7% Quarterly Quarterly Quarterly Quarterly 82.3% n= count of Returned CGCAHPS Surveys FQHC Quarterly Quarterly 273 Quarterly Quarterly 262 Quarterly Quarterly Quarterly Quarterly 535 Mychart Activation Target > 50% FQHC 56% 63% 58% 59% 55% 60% 61% 60% 59% % of Abandoned Calls Target: 7.5% QUALITY Average HbA1c for Diabetic Patients Target: 8.0% % CHF Patients on ACEI/ARB Target: 92% % HTN Patients with BP < 140/90 Target: HEDIS 66% EPSDT Volumes for 3-6 Year Olds Target: 15% increase from FY2016>417 EPSDT Volumes for 13-18 Year Olds Target: 10% increase from FY2016 > 400 FQHC 5.6% 6.1% 5.7% 8.7% 7.4% 5.2% 5.0% 7.68% 6.4% FHC/IM 7.70% 7.59% 7.55% 7.57% 7.57% 7.9% 7.78% 8.04% 7.7% FHC/IM 92.1% 94.1% 95.5% 93.6% 94.2% 97.2% 100.0% 100.0% 95.8% FHC/IM 65.0% 66.1% 65.6% 61.8% 63.4% 66.0% 65.9% 67.1% 65.1% Peds 392 457 356 276 274 279 337 311 335 Peds 503 627 342 383 275 169 242 270 351 ` Percent of MIHS voluntary turnover Target < 12% FQHC 2.70% 3.10% 5.4% 1.1% 0.1% 4.30% 0.4% 0.8% 2.24% Count of Provider turnover by FTE= FQHC 2.00 2.00 1.00 1.80 0.60 2.00 0.00 0.00 9.40 n= count of Providers FQHC 2 2 1 3 1 2 0 0 11