Pamela Hjerpe, Assistant to the Executive Director, Maricopa Health Centers Governing Council

Minutes Maricopa Health Centers Governing Council Finance Committee General Meeting Maricopa Medical Center, Administration Building, Auditorium 1 November 4, 2015 4:00 pm Voting Members Present: Gary Tenney, Committee Chair Liz McCarty, Committee Vice Chair Anita Jordan, Member (telephonically) Melissa Kotrys, Member (Telephonically) Gino Turrubiartes, Member (arrived at 4:07p.m.) Voting Members Not Present: Simon Thomas, Member Others/Guest Presenters: Kathleen Rhodes, Interim Executive Director, Maricopa Health Centers Governing Council Christie Markos, Manager, Budgeting and Financial Reporting Kathleen Benaquista. Chief Financial Officer Mike Zenobi, Vice President Managed Care Operations Michael Mayer, Senior Managed Care Administrator Recorded by: Pamela Hjerpe, Assistant to the Executive Director, Maricopa Health Centers Governing Council Call to Order Chair Tenney called the meeting to order at 4:05 p.m. Roll Call Ms. Hjerpe called roll. Following roll call, Ms. Hjerpe announced that four of the six voting members of the Maricopa Health Centers Governing Council s Finance Committee were present, which represented a quorum. Mr. Turrubiartes arrived shortly 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 Tenney asked if any speaker s slips were turned in or if anyone from the public wished to address the Committee. There were no comments from the public. 1

Discussion, Presentation and Recommendations by the Committee: 1. Approve the Maricopa Health Centers Governing Council s (MHCGC) Finance Committee Meeting Minutes dated October 7, 2015 MOTION: Ms. McCarthy moved to approve the Maricopa Health Centers Governing Council Finance Committee Meeting Minutes dated October 7, 2015. Ms. Kotrys seconded. Motion passed by voice vote. 2. Discuss, Review and Make Recommendations to the Maricopa Health Centers Governing Council to Approve Non-Budgeted Capital Request related to Avondale FHC Imaging Equipment Ms. Rhodes introduced Jackie Hernandez the Director of Radiology Imaging. Ms. Hernandez handed out updated copies of the proposal. The proposal is to take the equipment from Maricopa Medical Center (MMC) and move it to the Avondale Family Health Center (FHC) to replace an x-ray machine. The current x-ray equipment at Avondale is over eighteen years old. The unit does not have a reciprocating bucky for thorax, abdominal and weight bearing views. The imaging is being closely monitored by Radiologists for non-diagnostic quality, and if the image is of poor quality these patients are being redirected to Comprehensive Health Center (CHC) and MMC. Poor quality of images means calling patients back for repeat imaging if the radiologist is unable to interpret, which causes increase dissatisfaction. Potential advantages of replacing this unti is as follows; upright imaging, diagnostic quality images, ability to perform cross table imaging and weight bearing images. With the volumes increasing at the Avondale Clinic in the last three months, we would lose potential patient volume, and potentially high dollar advanced imaging. The equipment that we would move from the hospital is seven years old, with a projected life span up to 20 years. The total cost to move and install is not to exceed $50k. The cost includes moving the equipment from MMC to Avondale by the vendor, the structural estimate for the engineering of the steel fabrication and installation. The newer equipment will require architectural estimations of the flooring, painting, lighting and the general construction. Chair Tenney inquired on how much a new unit would cost. Ms. Hernandez replied $300K. Mr. Turrubiartes asked for clarification, there are two machines, one is going from the hospital to Avondale and the other is salvage. The unit coming from MMC has a ten year life span, so ten years from now we will be thinking about that $300k. The challenge with this is it is a huge cost to move the unit. Ms. Hernandez responded the reason for the cost is the price of de-installing, re-installing and the cost of increasing the height of the ceiling to accommodate the newer equipment which is not the same size as the old equipment. Also keep in mind the vendor has to move the equipment. Mr. Turrubiartes also inquired that the funding for this would be coming out of the first bond money. Ms. Benaquista answered yes that is correct. 2

2. Discuss, Review and Make Recommendations to the Maricopa Health Centers Governing Council to Approve Non-Budgeted Capital Request related to Avondale FHC Imaging Equipment (cont.) The Medical Director of Radiology is currently reviewing every film to insure the images meet quality expectation; however some external patients are called back. When a patient is called back many are not going back to Avondale but choose another facility. Chair Tenney wanted to know was a per-forma done, where the equations are. Ms. Jordan agreed with Mr. Turrubiartes that this is a good plan and should pay for itself in three or four months. Ms. Rhodes expanded that the quality of images will be much better; we can plan the move in advance and not have to worry about when the old machine does break down. The concept of one stop shopping other than the CHC is at Avondale. Ms. Hernandez also stated that Avondale is the only FHC that has all three capabilities; mammography, radiography, and ultrasound. Ms. Jordan remarked that the majority of the patients that visit Avondale are from the outlying areas and many travel long distances. Ms. Benaquista stated that it is easy to get the financial numbers you are asking for. Chair Tenney reiterated that this conversation has been had before when we had all those requests for Seventh Ave. He had thought he had made it clear he does not want to see presentation for spending money unless there is some type of pro-forma attached to it. Chair Tenney asked how critical the timeline is. Ms. Rhodes responded the equipment could fail at any time or if the images degrade to the point that it is not safe to use as a diagnostic tool. It is image by image reading by a radiologist and we don t know when but we know it will happen eventually. Ms. Benaquista indicated it is not emergent and feels a delay to the next finance committee meeting would give Ms. Hernandez time to get together with the finance team; the FQHC rate does include the radiology portion. Mr. Turrubiartes stated this is describing a critical path, we could wait a month and in thirty days the machine could fail and then will be outsourcing to somewhere. He also agreed with Chair Tenney that a pro-forma should be presented to the committee and still would like to see the numbers, but in the future The numbers should be presented before a decision can be made. He also feels comfortable with moving forward on this issue. Chair Tenney disagreed with Mr. Turrubiartes and indicated spending $50K and was concerned about not having a clear idea what you are spending it on. 3

2. Discuss, Review and Make Recommendations to the Maricopa Health Centers Governing Council to Approve Non-Budgeted Capital Request related to Avondale FHC Imaging Equipment (Cont.) Mr. Turrubiartes stated that he is relying on what is reported to the Finance Committee and feels the information is accurate. Ms. McCarty interjected that this is not being reported as a financial aspect to the Finance Committee and what is needed to be reviewed and the oversight is gone. Ms. Rhodes responded that the numbers have been provided. She further believes that over a ten year period the investment would be recouped. If it didn t would you eliminate. Chair Tenney replied if we had the numbers we would not be having this conversation. Chair Tenney said it is on the agenda today and sending the numbers at a later date will not help today s discussion and or action. Mr. Turrubiartes would like to make a motion and not defer this agenda item. MOTION: Mr. Turrubiartes moved to make recommendations to the Maricopa Health Centers Governing Council to approve the Non-Budgeted Capital Request related to the Avondale FHC Imagining Equipment. Ms. Jordan seconded. Motion passed by voice vote. 3. Discuss and Review Meritus Report Chair Tenney moved number four to number three on the agenda and requested the Meritus report from Ms. Rhodes and Ms. Benaquista. Ms. Benaquista reported that on October 30, 2015 the Centers for Medicare and Medicaid (CMS) removed Meritus from the Marketplace. The Arizona Department of Insurance filed an Order for Supervision to place Meritus Health Partners and Meritus Mutual Health Partners into supervision. Meritus declined to consent to the Order for Supervision. Ms. Rhodes stated that as of last night Meritus was looking at the option to appeal the order. MIHS has a number of patients that are on the Meritus Plan. The McDowell Clinic has a very high number of Meritus patients and is the only HIV clinic in the county. Pendergast has a high number of patients with 500 visits. Meetings have been happening daily since this announcement and MIHS is looking at other companies to partner with, if Meritus decides not to appeal. Ms. Benaquista replied in the packet is a volumes report that the finance department puts together on a quarterly bases. Meritus increased in enrollment in January of 2015. MIHS worked very closely with Meritus, so the package would be attractive financially. By September there were 2800 visits within the FHC s of Meritus HMO patients. In looking at just the FHCs and the Seventh Ave Walk in Clinic the annualized net-revenue reduction will be about $6M. MIHS is currently having discussions with Tenet 4

3. Discuss and Review Meritus Report (cont.) Healthcare; they are currently the lowest plan in the silver market. Continuity of care is very important and MIHS feels that the majority of Meritus patients will choose the Tenet plan, at least on the ambulatory side. Chair Tenney confirmed that from the press releases it does not looked good for Meritus. He also wanted to know who exactly the ownership of Meritus is. Mr. Mayer responded it is a consumer oriented co-op health insurance, and the policy holders are the owners. The grant was awarded from the federal government. The concept was the public manages this product; therefore the public has to be on the board. There is a significant amount of exchanges that are struggling with the ability to make a profit. Mr. Turrubiartes inquired on what is the worst case scenario. Ms. Benaquista responded she stated earlier the net-revenue reduction will be about $6M to the FHC s and Seventh Ave Walk in Clinic. MIHS also receives a case management fee which is $5 per member per month. Hopefully the 8000 to 9000 patients will have a seamless transition to another low cost silver plan that MIHS has been invited to participate in. Mr. Turrubiartes queried which of the health plans is the most likely that the Meritus patients would migrate too. Mr. Zenobi responded that MIHS was already in discussions with the other health plans, Abrazo, Tenet, and Phoenix Health Plan. The other health plan MIHS might entertain discussion with would be Health Choice Arizona, a St. Luke s affiliate and owned by IASIS. Ms. Benaquista concluded that the thought is a lot of the Meritus membership will move to the Tenet Plan as it is the cheapest. The loss to the whole system would be estimated at $15M annually. 4. Discuss and Review the Report on Arizona Health Care Cost Containment Services (AHCCCS), Medicare and Contracted Managed Care Plans including Participation in Medicare Advantage Plans but not limited to SecureHorizon Chair Tenney moved item five to item number four. Mr. Zenobi introduced himself as the Vice President of Managed Care Operations who reports directly to Kathy Benaquista, he introduced Mike Mayer who is the Senior Director Managed Care over the contracting. Mr. Mayer started with a brief summary of what has been happening in contracting. In this presentation the market segment recap for Fiscal Year (FY) 2015, the market segments are with contracted managed care, non-contracted managed care, contracted Arizona Health Care Cost Containment System (AHCCC), contracted Medicare and non-contracted Medicare. The following numbers reflect the transaction results of the contracts, what they do not reflect is the supplemental; this presentation is presenting these contracts as if they were stand alone. With Market segment commercial contracted 5

4. Discuss and Review the Report on Arizona Health Care Cost Containment Services (AHCCCS), Medicare and Contracted Managed Care Plans including Participation in Medicare Advantage Plans but not limited to SecureHorizon (cont.) insurance includes; Blue Cross Blue Shield of Arizona (BCBSAZ), Cigna, United Healthcare and Health Net. With the contracted commercial insurance the rates are negotiated with each payor. Marketplace exchange contracted with MIHS, Meritus (Silver Plan) exclusive to MIHS plus other networks. Health Net (Broad network only) not reported, United (Broad network only) 10,000 statewide, BCBSAZ (Broad network only) not reported (which will be terminating in January 2016) and University of Arizona Heal Plans (all products) 9,453, which is departing the marketplace end of December 2015. MIHS will be looking at replacing these with different partnerships, to provide alternative plans for our patients to stay within the system. Mr. Mayer continued with the top performers being small but largely paid on percentage of charges, with Cigna performing well and producing a positive margin. Health Net is exceptional with 42% margin and United at 41%. Where the challenge is right now is BCBSAZ and MIHS is in contract negotiations with them. The commercial payors MIHS is not contracted with include Aetna. MIHS terminated contract with Aetna in 2012 due to over aggressive denials and number of cases requiring appeal. This was more for business conduct then rates. MIHS has approached Humana regularly over the last 8 years and has not been responsive. MIHS approached Humana in 2014 and the commercial contract is in negotiations, which is being slowed by expected acquisition by Aetna. Humana will not consider MIHS for Medicare. Network Access PPO s which builds networks and markets to the self-insured employers and third party administrators; they do not direct patient care activity. This includes companies like, Multiplan, First Health and Assurant which were declined because these entities do not drive elective volume (discounts on emergency only) and do not control client payor activity. The overall non-contracted net revenue was $19.8million, percentage of charges 28.8%, and a 5.7 million margin and encounters of 2,823 for FY 2015. United Behavioral Health is a problem; three years ago MIHS cancelled them for market conduct. United Behavioral Health continues to be a problem, with approaching us occasionally, MIHS reviews the contracts and they decline contract change and therefore are not contracted. AHCCCS plans are by far the volume leader for MIHS. MIHS is contracted with all AHCCCS plans including Bridgeway the Arizona Long Term Care System (ALTCS). Revenue of $104,912,664 for FY 2015, the margin adverse with $53M and has been explained. The revenue percent of charges was 14.4% with 244,446 encounters; rates negotiated with each payor but generally tract with AHCCCS rates. This past year MIHS switched to FQHC reimbursements where the actual payors pay us, we use to get a settlement, were we get the cash faster. MIHS also switched to Agency for Healthcare Research and Quality/Diagnosis Related Groups (APR/DRG) which is close to Medicare, but has more categories and includes more pediatrics. MIHS contracts with Mercy Maricopa Integrated Care (MMIC) which is the Regional Behavioral Health Authority (RBHA) for Maricopa County MIHS is co-owner. This produces almost $25M annual revenue above AHCCCS. We are currently in negotiations with Health Choice Integrated who is the MMIC clone for Northern Arizona, which combines both the medical services and behavioral health services. 6

4. Discuss and Review the Report on Arizona Health Care Cost Containment Services (AHCCCS), Medicare and Contracted Managed Care Plans including Participation in Medicare Advantage Plans but not limited to SecureHorizon (cont.) Chair Tenney asked if it was accurate to say MIHS has a better margin on Medicare. Mr. Mayer responded that MIHS has a better margin for Medicare then for AHCCCS. The Medicare rates are higher. Chair Tenney inquired if it was the highest. Mr. Mayer responded that no, commercial insurance is much higher than Medicare. Chair Tenney asked including Meritus. Mr. Mayer responded with taking Meritus out of the equation the margins for commercial would double. Ms. Benaquista explained that there is a discounting off Medicare rates to Meritus rates to be more competitive. With excepting for outpatient Medicare rates at a 100% and inpatient rates at 85% if Meritus would have continued it would have gone to 88%. Mr. Mayer further explained the margins, Tri-care is Military is negative as is TRIWEST. United is a margin of 41%, HEALTHNET is 42%. Cigna is 7.6%, Blue Cross is negative at -8.2%. The Banner PHO is at 59%. Arizona State Hospital is good as is Arizona Foundation for Medical Care is the only network PPO that we offer and is preforming well, and Meritus total is a -28%. Chair Tenney summarized than that it is commercial, than Medicare and then AHCCCS, and Medicaid. Chair Tenney inquired if the entire aged bracket of 65 and older has some sort of coverage based on Medicaid on their income. Mr. Mayer explained there are people that are dueling eligible and those are the Medicare plans that are largely contracted with MIHS. Because of their income level, they age in and Medicare becomes primary and the AHCCCS plan will pay what is left up to what the difference is in the Medicare rate and the AHCCCS rate. Chair Tenney asked if the patients have an incentive to go to a clinic that charges less if on Medicare/Medicaid plan, or is there no incentive for them. Ms. Benaquista responded no there is no incentive because Medicare pays everyone the same. And providers are not allowed to write off the co-insurances or deductibles. Now Medicare recipients don t have to pay for part B which covers the professional and outpatient services, Part A they get, then Part D which is your prescription coverage plan. Chair Tenney asked then does MIHS attract Medicare patients on the location of the clinics and our providers, but noted there is no other incentive. Ms. Kotrys asked if MIHS is working with Health Choice Integrated which is RHBA in the Northern part of the state and what is the strategy, since this is geographically located outside of the MIHS service area. 7

4. Discuss and Review the Report on Arizona Health Care Cost Containment Services (AHCCCS), Medicare and Contracted Managed Care Plans including Participation in Medicare Advantage Plans but not limited to SecureHorizon (cont.) Mr. Mayer explained it is the referrals from Yavapai or from Gila County but it is doubtful that MIHS will see anyone from elsewhere in the state, simply because of the distance. Sometimes what MIHS will receive is a on the behavioral side, that happens to be in Maricopa County having an episode and are brought in for Court Ordered Evaluations (COE). MMIC agent thru Maricopa County will pay that COE episode up to 3 to 5 days after which they become court ordered or are released. It facilitates claim processing to be contracted, and since it is integrated for medical is also a way of sending patients to specialty care that would not otherwise receive the care. MIHS contracts all Medicare/AHCCCS dual plans in Maricopa County except Care1st. Revenue of $34,901,018 for FY2015, margins is 1.6, revenue percent of charges 26.8%, encounters of 34,403, rates negotiated with each payor but generally track Medicare. MIHS contracts with Cigna for Medicare except for primary case due to Cigna operating its own clinics. MIHS contracts with Health Net Medicare. Senior Care Action Network (SCAN) is withdrawing from the market at the end of December 2015 and was terminated by MIHS in May of 2015. There are other Medicare payors that have declined to explore contracts with MIHS. MIHS will treat Medicare patients of non-contracted payors, either through the emergency department or specialty referrals. The biggest payor in Medicare in this Market group is Secure Horizons. Secure Horizons enrollment is controlled by four networks, three of them are owned by Banner and their intent is to drive as much volume within their own system. They are not interested in having other entities join in them. Life Print is the other organization; we were 99% completed with discussions about two years ago, when they changed CEO s. The CEO s believes in highly restricted networks. Their Medical/Business model was incompatible. They have clinics and want all their primary care done in their clinics and their hospitalists to manage their admittance and not the attending s and this was clear this is not a model we can do business with, and have since then have been acquired by Untied Healthcare. Chair Tenney asked if Mr. Mayer has spoken with Secure Horizons about primary care. Mr. Mayer explained Secure Horizons is own by United Healthcare and he speaks to United Healthcare every year about getting into their health plans and the answer is no. Ms. Benaquista also responded that this is where they are restricting it to Banner as their primary care. Banner has clinics all over the valley now. Chair Tenney inquired what the top 5 or 6 companies are. Mr. Mayer replied Humana is another big one and MIHS is actually speaking to Humana on the commercial side and asked about Medicare and the answer was no, without any qualifications or explanations, they are not interested. We do have some feedback from Blue Cross who has also excluded us and has recently come into the Medicare advantage market. Unrelated to Medicare, they have this perception that MIHS costs are high, which has proven difficult in convincing them otherwise. MIHS is on par with CMS provided data with Banner Good Sam, St. Joes, Scottsdale Osborn, and Banner Desert. But their comparison is against the more routine hospitals, the outlying hospitals that do not have tertiary services. Banner s drive is to push as much volume into those facilities as they possibly 8

4. Discuss and Review the Report on Arizona Health Care Cost Containment Services (AHCCCS), Medicare and Contracted Managed Care Plans including Participation in Medicare Advantage Plans but not limited to SecureHorizon (cont.) can and then they pick one tertiary facility for anything that the other facilities can t do. In terms of market presence Banner has a much larger footprint, both in terms of the downtown hospital and coverage state wide; including the University in Tucson. What MIHS is discussing is, do we want to partner other networks. The other options is do we become a risk bearing entity and try to manage ourselves, in the same way we did with Meritus as a proxy but with better underwriting of course. And that is the only way to break into Medicare at this point. Ms. Benaquista included we have to clarify that it is Medicare Advantage, Medicare traditional fee for services is an area we could try and focus on to increase our volumes, because they are not restricted to the closed networks like the HMO model for the advantage plans. Banner Corporation is big enough to take the financial risk and is capitated. They are getting a flat rate per member, per month to provide services, and they have the ability to do that. MIHS would have to identify a partner that has deeper pockets and maybe an accountable care organization that they have already created that would partner with us. And that is what is being explored today. This does not prevent us from figuring out where is the traditional Medicare and how to encourage those folks to come and use the clinics. Chair Tenney asked what has been the strategy on those lines. Mr. Mayer explained that there are a few things in terms of market, the resources out there provided by CMS and other sources like the Hospital Compare, this puts out information on patient satisfaction, clinic outcomes, and cost. MIHS historically has not done a lot of marketing; there was the support for the bond issue. And a few things here and there, some PR on the Burn, but when you consider what Honor Health is doing right now with their branding effort, what Dignity Health did when they changed their name. Banner does not really need to do a lot of advertising, Mr. Purves is aware. Mike Robertson s initiative is to tell our story, we have a good story to tell but we have not historically been good at is telling the story. Convincing people that we are not just the County Hospital, we are not just payor or provider of the last resort, but be somebody who is on the top of the list for consideration. If you change that image people will start knocking on the door. But this needs to be done cautiously as we do not have deep pockets and cannot afford to guess wrong initially. We have to step incrementally and take on more and more of our population. Mr. Mayer continued his report on the list of Non-contracted Medicare Plans and reported that the Medicare Complete AARP is actually underwritten by United Healthcare privately by AARP. We had Medicare with them but were cancelled. Not a huge loss. These volumes do not necessarily reflect their size in the market. These are the cases we get from the Emergency Department or from an authorized referral for specialty care. Humana is big in the market, BCBS Advantage is a new comer, SCAN is relative active for non-contracted but leaving the marketplace. Secure Horizons is big but we are not seeing much, one inpatient day only. Valued based purchasing or pay for performance, we are seeing a few things on the AHCCCS side, with Medical home and hitting certain gaps, benchmarks for follow up visits. The growth in rates in the future will be adjusted on hitting certain criteria. This will be heavily relied on data and to be able to present our findings, that is to say creating a consolidated template of the health plan quality incentive programs 9

4. Discuss and Review the Report on Arizona Health Care Cost Containment Services (AHCCCS), Medicare and Contracted Managed Care Plans including Participation in Medicare Advantage Plans but not limited to SecureHorizon (cont.) across all plans and quality measures. This does not solve our problem this year but it seems to be the way the market is heading. Chair Tenney thanked the speakers and stated that he has asked for this kind of information for a long time and this was very informative. The bottom line is, it is profitable. 5. Discuss and Review the Quarterly Federally Qualified Health Centers Look Alike Clinics (FQHC LA) Referrals Report and Down Stream Revenue Report Chair Tenney announced we are now on Item 5 which was item 3, and is pleased that the report is very extensive. Ms. Rhodes explained that internal referrals are when the FHC or the primary care providers (PCPs) within the CHC refer internally to the CHC specialist. External referrals these are when the PCPs send the patient to a provider or a specialist that is outside of MIHS. There are a variety of reasons for referrals outside of the system; one reason is that MIHS does not have the particular service, so an external referral is made. The services that MIHS does not provide for are included in the external referral numbers the report for external referrals. In addition geography plays a big part in this as it is very difficult to get someone from El Mirage to come downtown Phoenix to see a specialist that they could see within four miles of their home. The third reason is that many patients have already established a relationship with a specialist outside of MIHS and they want to continue that relationship. For general information we do not do home health, hospice, hyperbaric treatment, home infusions, neurological rehab, very limited pain management, pediatric cancer of any type, sleep studies, heart surgery, transplant service, knee replacements, adult genetics, eating disorders, substance abuse and very limited wound care. The staff attempt to direct the patient to have the referral at MIHS if we provide that service. As an example; if your PCP says it is time for your colonoscopy, the patient may choose not to have it done and those are counted in these referral numbers as well. Chair Tenney asked Ms. Markos about the Chandler numbers internal referrals which are only 40%. Are they going external because of distance. Ms. Benaquista stated that Ms. Markos can answer the mechanics of the report, not the whys of the report and asked that Ms. Rhodes respond. Ms. Rhodes answered that in looking at the referrals there are a lot of outstanding referrals for services that we do not provide. Particularly at Chandler, Avondale, El Mirage and Mesa there is a geographic barrier. Mesa has a very high self-pay and those patients are more likely to come all the way down to MIHS campus because the cost is a lot less than going to a private specialist in their community. Ms. Markos indicated she did not see any major spikes. 10

5. Discuss and Review the Quarterly Federally Qualified Health Centers Look Alike Clinics (FQHC LA) Referrals Report and Down Stream Revenue Report (cont.) Chair Tenney asked if the total balance in the last column is the balance of what you expect to get paid. Ms. Markos responded that it is the remaining balance on the account. Chair Tenney requested to add to the report the numbers of what we might likely get paid, to keep it consistent with previous reports. Ms. Benaquista stated she can try to find an old report, but the methodology had changed. We use to adjust the accounts down, to expect at the time of billing. MIHS does not do that now, but adjusting the accounts at the time of payment and would be reported at gross revenue. Ms. Markos expanded we could include the Horizon Performance Manager (HPM) expected. Chair Tenney requested this be included in the next quarterly report to keep it consistent. 6. Discuss and Review the MHCGC s Financial Reports: a) Visits Summary b) Governing Council Expenditures and Budget c) FQHC LA Financials and Payer Mix d) Uncovered Sessions Report e) Capital Equipment f) Pendergast Clinic Report in age groups Chair Tenney requested a short version of these reports as we are running out of time. Ms. Rhodes reported the month to date is within budget, the net revenue is better than budgeted. There are no real surprises in this report. In the payor mix report there is nothing notable as well as the missed sessions, with 409 missed sessions being low. Everyone is back in school and vacations are over. District Medical Group (DMG) has a use it or loses it policy for their PTO as it relates to their providers with time off. We do see an increase in the number of providers wanting to take time off in December. The clinics are open the day after Thanksgiving in all the FHC s; although it will be a smaller staff and providers. Ms. Rhodes then concurred with Chair Tenney that yes, the Capital equipment report was voted on and approved by this committee. She also stated if the strategic plan is going to change then some of the allocation of the capital may change. 11

6. Discuss and Review the MHCGC s Financial Reports (cont.) Chair Tenney wanted to know where the Finance Committee stands on this since they approved a $2.5M on the old list, and wanted to know how this is going to be brought back to the Finance Committee. Ms. Rhodes supplied that there is not a list identifying what the $3M bond money will cover, because of it being a 30 month plan. We have identified some top items, the ones we would like to bring to the next meeting so we can start purchasing. We knew it was going to be an ongoing process. Chair Tenney asked to look at a list in the December meeting and he will have a discussion with Ms. Rhodes if the Finance Committee needs to be involved beforehand. Some of these items have been preapproved and the Finance Committee has seen the proformas when we did the million two fifty in 2014. Ms. Rhodes indicated she will research the previous proformas and pull the minutes. Ms. Benaquista also stated you can request a contingency fund for future unplanned needs. Chair Tenney said the report on Pendergast age group is very disappointing. When Finance Committee was asked to set up this dental clinic, we are not seeing the age group that was proposed to us. There was a consent form circulating; the consent form was for the Pendergast parents. Chair Tenney said the last time he saw the consent was going to Legal. Chair Tenney expressed concern that the ball was dropped related to the consent and the need to be competitive. Ms. McCarthy recalled that was not in Finance Committee, but was discussed at another meeting. Chair Tenney asked that Ms. Rhodes meet with Louis Gorman in the Legal Department on this. 7. Announcements and Closing Comments: Chair Tenney wanted to remind the committee members that the December s meeting is on December first at 11:30 in the ACR and can be joined by phone if needed. Chair Tenney is also going to defer the discussion on the charter until after the holidays. Ms. Kotrys indicated that she will be at an out of town conference on December first and may not participate. Ms. Hjerpe affirmed the following follow up items: Add to the agenda as a quarterly item the Downstream Revenue Report and include the expected payment: Christie Markos-Pam Hjerpe Add to the December agenda the Capital for Proformas: Kate Rhodes Check with Legal on where the consent form and report to committee-kate Rhodes Defer Charter Review to after the first of the year. 12