Community Care Collaborative Fiscal Year 2017 Proposed Budget C E N T R A L H E A L T H B O A R D O F M A N A G E R S J U L Y 2 7 , 2 0 1 6 P A T R I C I A Y O U N G B R O W N , C C C B O A R D C H A I R S A R A H C O O K , C C C D I R E C T O R , I N T E G R A T E D D E L I V E R Y S Y S T E M S T R A T E G Y & P L A N N I N G J E F F K N O D E L , C F O D R . M A R K H E R N A N D E Z , C C C C H I E F M E D I C A L O F F I C E R
CCC Mission and Vision Mission • Create an integrated health care delivery system for identified vulnerable populations in Travis County that considers the whole person, engages patients as part of the care team, focuses on prevention and wellness and utilizes outcome data to improve care delivery. Vision • A health care delivery system that is a national model for providing high quality, cost-effective, person- centered care and improving health outcomes. 1
Flow of Funds 2
Key Reserved Powers Twenty Reserved Powers address all major governance and funding decisions of the CCC: • Reserved Powers were developed and approved to ensure that partners/members were involved at an appropriate level with all major governance and funding decisions Any agreement (or amendment of an existing agreement) between the CCC and a • member or an Affiliate of a member (except as permitted or required by the Agreement) Approval of the annual operating and capital budgets, the fiscal and purchasing • policies, and any material deviation from the annual operating or capital budgets or fiscal and purchasing policies Approval of any contract over $100,000 in value or that includes a term of • greater than one year 3
Operational Board Pursuant to Section 3.5 of the Master Agreement, the Central Health Board of Managers appoints three of the five members to the CCC Operating Board of Directors • Governance and Financial decisions were retained by Central Health and Seton Major policy decisions • Major financial decisions • Central Health and Seton are both governed by boards • • Operational duties were delegated to the CCC Board CCC Board was limited to fulfilling operational elements of the decisions made • at the member level Equality in terms of hierarchy of executive employees appointed • Appropriate level of skill and expertise needed to carry out the activities of the • health program (i.e. Integrated Delivery System) including providing day-to- day management Full time executive employees were appointed • 4
Strategic Direction: Alignment Key Central Health Initiatives Transformation Stewardship Partnership Central Health CCC Specialty Care Medicaid 1115 Waiver Brackenridge Campus Improvement Renewal Planning Redevelopment CCC Benefit Plan Collaboration Affordable Care Act Redesign Central Health Equity Subsidy Program CCC Behavioral Health Policy Council CCC Delivery System —Substance Use Reform Incentive Dell Medical School Disorder Services Payment (DSRIP) Continue Women’s Begin to align goals, Delivery Year 6 Health Services strategies and financial Redesign models Value Based Payment Reform 5
FY16 Accomplishments: Delivery System Improvements and Transformation Delivery System Reform Incentive Payment (DSRIP) Projects Expect to serve more than 40,000 patients through DSRIP projects in DY5 • Improvement in all Category 3 population health measures • Thousands of patients receiving services from projects • Infrastructure support, including patient centered medical home (PCMH) recognition • and population health tools Obstetrics (OB) Redesign With CCC convening, Dell Medical School, Seton, CommUnityCare and Central Health • crafted integrated approach to caring for expectant mothers Additional OB-GYN evaluation earlier in pregnancies identifies risk factors • Mothers-to-be receive appropriate level of care in neighborhood clinics or regional hubs • offering additional services Specialty Pilots Cardiology, orthopedics, and colonoscopy referral pilots launched • Neurology and endocrinology launching next • Formal improvement project launched to improve specialty care referrals • Specialty care supported by continuing DSRIP projects • 6
FY16 Accomplishments: Health IT and Quality Support Organized Health Care Arrangement (OHCA) • Links patient data of the CCC’s eight largest safety net providers Patient Portals • Launched CommUnityCare’s patient portal Performance Improvement Assistance • People’s, CommUnityCare and El Buen Samaritano Project Management Professional (PMP) and Performance Improvement (PI) Training • CCC, Seton, FQHC staff attended free programming Medical Management Department • Assisting homeless and disconnected patients 7
FY16 Year-End Estimate DESCRIPTION FY16 BUDGET FY16 Estimate SOURCES DSRIP Revenue 55,665,911 62,689,485 Member Payment - Seton 46,100,000 33,100,000 Member Payment - Central Health 26,245,166 26,245,166 Contingency Reserve 23,614,250 29,783,176 Other 15,000 30,413 Total Sources 151,640,327 151,848,240 USES Health Care Delivery 92,782,800 73,249,499 Emergency Reserve - - DSRIP Project Cost 23,857,527 21,297,362 UT Affiliation Agreement 35,000,000 35,000,000 Total Uses 151,640,327 129,546,861 Sources over Uses - 22,301,379 Contingency Reserve - 22,301,379 Emergency Reserve 5,000,000 5,000,000 Total Reserves 5,000,000 27,301,379 8
FY16 Year-End Estimate: Health Care Delivery FY 16 Health Care Delivery Approved Budget Estimate Primary Care 52,771,147 46,287,085 Specialty Care 1,622,985 1,321,498 Vision 550,915 553,802 Dental Care 596,711 565,792 Orthotics 41,000 82,725 Mental Health 8,429,022 8,471,856 Pharmacy 4,500,000 4,567,134 Client Referral Services 856,309 840,310 Claims Administration 1,000,000 1,133,176 HCD Operating Cost 1,276,435 915,421 Service Expansion Funds 500,000 500,000 Health Information Technology 5,550,000 3,496,986 Integrated Care Collaborative 160,000 0 Administration 1,238,451 1,238,451 IDS Plan Initiatives 12,024,549 3,275,263 Operations Contingency 1,665,276 0 Total Health Care Delivery 92,782,800 73,249,499 9
FY16 Year-End Estimate: Primary Care Health Care Delivery FY 16 Approved Budget Estimate Primary Care CommUnityCare 42,101,395 38,018,506 People’s Community Clinic 1,798,000 1,532,716 Volunteer Healthcare Clinic 100,000 100,000 NextCare Urgent Care 191,000 192,212 Front Steps/Recuperative Care Beds 400,000 500,438 Paul Bass Clinic 709,647 182,704 El Buen Samaritano 2,350,000 2,016,561 Lone Star Circle of Care 4,364,995 2,814,361 Other Urgent Care - 200,000 Other Medical 59,288 32,765 City of Austin EMS 696,822 696,822 Total Primary Care 52,771,147 46,287,085 10
FY17 Operational Priorities • Value based payment • Primary care transformation • Benefit plan redesign • Specialty care improvements • Delivery System Reform Incentive Payment (DSRIP) operations and program renewal • Data warehouse • Social determinants of health, homeless services, health management planning 11
FY17 Budget Highlights • Expansion of primary care continuum • Medical Access Program (MAP) Benefit Plan Redesign • More medically appropriate benefit design • Coverage expansion • Focus on Specialty Care • Expanded access and demand management • Improved referral management • Substance use disorder services • DSRIP Year 6 • Data Warehouse Development • Additional resources • Insurance • Information technology • Project management • Compliance 12
FY17 Proposed Budget: Sources and Uses FY16 APPROVED FY17 PROPOSED DESCRIPTION BUDGET BUDGET SOURCES DSRIP Revenue 55,665,911 62,432,400 Member Payment - Seton 46,100,000 41,500,000 Member Payment - Central Health 26,245,166 26,245,166 Contingency Reserve 23,614,250 22,301,379 Other 15,000 40,400 Total Sources 151,640,327 152,519,345 USES Health are Delivery 92,782,800 94,031,111 DSRIP Project Cost 23,857,527 23,488,234 UT Affiliation Agreement 35,000,000 35,000,000 Total Uses 151,640,327 152,519,345 Sources over Uses - - Contingency Reserve - - Emergency Reserve 5,000,000 5,000,000 Total Reserves 5,000,000 5,000,000 13
FY17 Value Based Payment (VBP) Incremental steps under consideration include: • Continuation of DSRIP VBP contract structure • Establishing baseline quality measures • Implementation of performance dashboards • Shift payment model to promote expansion and variation of reimbursable services (RNs, PharmDs) • Addition of payment for care management and encounters with non-providers • Creation of quality incentive pools for improved outcomes and achievement of quality measures • Pilot projects to better understand impact of changes 14
FY17 Primary Care Transformation Convenient Primary Urgent Emergency Care Care Care Care More Expensive Less Expensive • Utilize care Review network • • Expand urgent Partner with • management capacity care network additional Start transition • • Launch convenient, to value based education effort walk-in care payments 15
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