Central Health Seton Master and Ancillary Agreements John - - PowerPoint PPT Presentation

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Central Health Seton Master and Ancillary Agreements John - - PowerPoint PPT Presentation

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Central Health Seton Master and Ancillary Agreements John Stephens, Project Manager Central Health David Hilgers, Counsel Brown McCarroll June 5, 2013 Board of Managers Meeting Presentation Overview Evolution of the safety

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Central Health – Seton
 Master and Ancillary Agreements

John Stephens, Project Manager Central Health David Hilgers, Counsel Brown McCarroll June 5, 2013 Board of Managers Meeting

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Presentation Overview

www.CentralHealth.net 2

  • Evolution of the safety net health care delivery

system since 1995

  • Community Care Collaborative
  • Master and ancillary agreements
  • Benefits to the community
  • Looking to the future
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Safety Net Care In Travis County

www.CentralHealth.net 3

  • Safety Net health care delivery is unique in Travis

County compared to other major metropolitan counties in Texas.

  • For the last 18 years, hospital care has been provided

through a contractual arrangement with Seton Healthcare Family

  • Primary care has been provided through a government

entity, either the City of Austin or Central Health (the Travis County Healthcare District).

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Prior to 1995

www.CentralHealth.net 4

City of Austin Hospital Primary Care

The City, not the County, funded most healthcare services in Travis County, resulting in an inequitable and unstable financial model for safety net care.

  • Hospital and primary

care were in separate departments.

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1995 City of Austin Leases the Hospital to Seton

www.CentralHealth.net 5

City of Austin

Primary Care Hospital Seton

Governmental Non-Profit From 1995 until 2004 the City reduced its financial risk as Seton assumed operational responsibility for UMCB, but the delivery of care was fragmented.

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2004 Central Health Created

www.CentralHealth.net 6

City of Austin Primary Care Hospital Seton

Governmental Non- Profit

Travis County Healthcare District MAP

Central Health was created in 2004 and assumed responsibility for indigent health care in Travis County. Central Health also expanded funding for primary care, which remained a City department.

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SLIDE 7

2009 to Present

www.CentralHealth.net 7

Primary Care Network Hospital Seton

Governmental Non-Profit

Travis County Healthcare District MAP

The City transitioned primary care, becoming CommUnityCare, a 501(c)(3). Despite our best efforts, the safety net remains fragmented and unsustainable as demand for care increases.

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New Model

www.CentralHealth.net 8

Governmental Non-Profit

Travis County Healthcare District

CCC

MAP Primary Care Network Hospital Care

Behavioral Health Care

Integrated service delivery improves care coordination and creates a more sustainable safety net system.

Provider Network

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The Community Care Collaborative (CCC)

www.CentralHealth.net 9

  • The CCC is a Public/Private Partnership organized as a 501(c)(3)

between the Seton Healthcare Family and Central Health in which the parties mutually agree to manage the risk for providing safety net healthcare services.

  • The CCC is the main vehicle through which the new Integrated

Delivery System will provide access to health care for vulnerable Travis County residents.

  • The two initial corporate members of the CCC are Central Health

with a 51% membership interest, and Seton with 49% membership interest.

  • Additional members and/or new classes of members may be added

by mutual agreement if the new members make appropriate commitments to the CCC

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Community Care Collaborative

www.CentralHealth.net 10

The CCC will have an initial five-person Operating Board of Directors comprised of three appointees by Central Health Board of Managers and two Seton appointees:

  • Each party shall have the unilateral right to select,

remove, and replace its appointees

  • The parties may mutually agree to change the size

and composition of the CCC Board

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CCC – Reserved Powers

www.CentralHealth.net 11

Significant powers reserved to the Central Health Board and Setonʼs Board under Section 3.8:

  • 1. Admission of new members;
  • 2. Merger, acquisition, consolidation, or

reorganization of the CCC;

  • 3. Approval of annual budgets, fiscal and

purchasing policies;

  • 4. Determination of the covered population; and
  • 5. Approval of the coordination and funding of the

Federally Qualified Health Centers (FQHCs).

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CCC – Material Decisions

www.CentralHealth.net 12

The following Material Decisions must be approved by a “super majority” of the CCC Operating Board Representatives (at least two Central Health appointees and both Seton appointees):

  • 1.

Composition and selection of the CCC Provider Network and form of the provider contracts;

2.

Benefit plan and care management approach to the Covered Population (including MAP);

3.

Approval of any application or request for any grants or awards, service agreements, or provider contracts; and

4.

Employment of any person or any personal service contract with any person not contemplated in the Master Agreement.

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Agreements on Todayʼs Agenda

Central Health & Seton have completed four of the new five foundational agreements that define the new public- private collaboration for the delivery of health care to vulnerable residents of Travis County. The four completed agreements, available on our Web site, include:

  • 1.

Master Agreement 2. Services Agreement 3. CCC Bylaws 4. Lease of UMCB

  • 5. Lease for New Teaching Hospital (this has not been completed)

www.CentralHealth.net 13

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Master Agreement Overview

www.CentralHealth.net 14

The Master Agreement will provide for Central Health and Seton to make joint decisions through the Community Care Collaborative:

  • Management of the MAP population - number of people covered

and benefit plan offered

  • Management and oversight of the Delivery System Reform

Incentive Payments (DSRIP) projects and the expansion of primary and specialty care

  • Integration and management of the provider network
  • The initial term shall be 25 years, with automatic successive five

year additional terms by mutual agreement.

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Benefits to the Community

www.CentralHealth.net 15

  • Strengthened and stabilized healthcare

safety net

  • Integrated delivery system
  • Medical school
  • Teaching hospital
  • Expanded primary and specialty care
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Working with and listening to the community

We continually collaborate with others, from community members to providers, to guide our work. Itʼs through these collaborations we learn the needs and expectations of the community, and how best to address them.

  • Community meetings, focus groups, and survey research
  • Regular citizens communications at board meetings
  • Central Health Connection, our community planning & outreach program
  • Participation in community events such as health fairs
  • Community Health Assessment / Community Health Improvement Plan (CHA/

CHIP)

  • Community health research and assessment, such as Healthcare Trends white

paper, Childrenʼs Optimal Health, and LiveStrong cancer white paper

  • Annual telephone surveys
  • Public access to information, data, and records

16 www.CentralHealth.net

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Community Feedback via Email

  • The original Letter of Intent has been available on our Web site at

www.CentralHealth.net since April, 2012.

  • In early May, 2013, we created a Master Agreement section on

the site. Presentation materials from the May 1, May 15 and May 22 Board of Managers meetings were posted, and a draft of the Master Agreement was made available on May 31.

  • On May 15, we began soliciting public commentary on those

materials via the site. To date we have received:

  • 55 comments received through Web site form or sent directly to staff

and board members

  • 35 comments in support of the Master Agreement
  • 8 comments in opposition to the Master Agreement
  • 11 comments expressed concerns about the terms of the Master

Agreement without explicitly declaring support or opposition, primarily about Seton ERDs, as they pertain to women's health services

  • 1 general comment expressing no position
  • 64% of all comments were supportive of the Master Agreement

www.CentralHealth.net 17

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Looking Ahead

www.CentralHealth.net 18

  • We all must learn to work in a new system.
  • The new integrated model requires more coordination

between partners; placing each party a little further into the other partyʼs world.

  • Changes in the healthcare policy and industry

fluctuations will continue to be a challenge.

  • We will collaborate to allocate scarce resources to fund

services and manage risk for our population.

  • We will continue to seek input from the community in
  • rder to meet their needs and expectations for

healthcare services.

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Recapitulation

www.CentralHealth.net 19

The Board of Managers and staff have worked for more than a year to fulfill the vision in the 1115 waiver and the Letter of Intent “LOI” to:

  • Implement the mandate of the voters
  • Strengthen the safety net
  • Transform the delivery system
  • Remain consistent with the LOI and in conformance with

legal and regulatory constraints

  • Respond to the needs of the community and the

individuals who rely on us for access to health care

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SLIDE 20

www.CentralHealth.net

Thank you

Healthy people. Strong Community.