Health Care for Vulnerable Travis County Residents: A Public-Private Partnership Presentation #3 May 22, 2013 �
Remarks by Central Health Board of Managers Chairperson Rosie Mendoza �
Agenda � 1. Opening Remarks � 2. Presenter: Greg Hartman � 3. Presenter: Dr. Andy Agwunobi � 4. Presenters: John Stephens and David Hilgers � 5. Presenter: Trish Young Brown � 6. Public Comment � 7. Board Discussion � 8. Closing Remarks � 3
Remarks By Greg Hartman, President and CEO Seton Medical Center Austin; University Medical Center Brackenridge; and Network Communications, Advocacy and Marketing Seton Healthcare Family �
Remarks from Dr. Andy Agwunobi, Director Berkeley Research Group, LLC �
Health Care for Vulnerable Travis County Residents: A Public-Private Partnership Presentation #3 A Review of Lease & Services Agreement and an impact analysis of the Master Agreement May 22, 2013 � John Stephens, Project Manager �
The Master Agreement � The Master Agreement (MA) accomplishes three main community objectives: � � 1. Implements the Mandate of Voters � 2. Strengthens the Safety Net � 3. Transforms the Delivery System � � 7
Discussion Outline � The following presentation examines four areas: � � 1. Risk analysis, based on community concerns and how the MA mitigates those risks � 2. Benefits to the community � 3. Discussion of Lease Agreement � 4. Discussion of Services Agreement � � 8
Community Risk Analysis � The Master Agreement aligns incentives with our shared � mission and mitigates risk. The following issues are posed � as frequently asked questions from community members, � public officials, and health care professionals: � � 1. Will we lose the safety net hospital? � • If the hospital is a building, we will still own UMCB � • If it ʼ s an institution, we have strengthened our hold � • If Seton defaults or breaches, we can buy Teaching Hospital, equipment, licenses � � � 9
Community Risk Analysis � 2. Will we lose access to women ʼ s healthcare services? � • Access to women's health services has been maintained since the beginning of the lease for UMCB � • Our goal is not only to maintain these services, but to expand them - as we have done through our network of providers � • Central Health has the unilateral right under the Master Agreement to approve, fund, and deliver any women ʼ s health care services allowable by law � 10
Community Risk Analysis � 3. Does Seton have a financial advantage in the Master Agreement? � • Seton agrees to provide the same level of care it currently provides for the same value of compensation � • Seton is contributing $250 million of its own funds to improve hospital care � 11
Community Risk Analysis � 4. Will Seton have a financial advantage in the future? � • Under the Master Agreement, Seton cannot impose additional payment from Central Health unilaterally � • If a funding deadlock arises, then we have an agreed upon dispute resolution process � • If it ʼ s still not resolved, Seton (or Central Health) has the option to terminate � • If Seton terminates, they must provide services for at least 5 years at the same cost � • If Seton does not provide those services, then Central Health has option to buy the Teaching Hospital � Both parties have a substantial interest � � in making this agreement work. � 12
Community Risk Analysis � What are some of the risks inherent to the healthcare industry? � • Under-performance of projects funded by the 1115 Waiver � • Regulatory or other external changes � � And how will we deal with them? � • We will need to be vigilant in responding to the changing healthcare environment, policies and other external and internal factors. � 13
Community Benefits � The voters are getting what they voted for – the November 6, 2012 ballot language included a broad range of services: � “ Approving the ad valorem tax rate of $0.129 per $100 valuation in Central Health, also known as the Travis County Healthcare District, for the 2013 tax year, a rate that exceeds the district's rollback tax rate. The proposed ad valorem tax rate exceeds the ad valorem tax rate most recently adopted by the district by $0.05 per $100 valuation; funds will be used for improved healthcare in Travis County, including support for a new medical school consistent with the mission of Central Health, a site for a new teaching hospital, trauma services, specialty medicine such as cancer care, community-wide health clinics, training for physicians, nurses and other healthcare professionals, primary care, behavioral and mental healthcare, prevention and wellness programs, and/or to obtain federal matching funds for healthcare services.” � 14
Community Benefits � What The Community Gets From This Agreement � 1. New Medical School � Economic benefits � • Construction jobs � • 2. New Teaching Hospital that will serve as the safety net hospital � Economic benefits � • Construction jobs � • 3. Transformed Delivery System that is improved in every measurable way � 4. Increased Transparency � 5. More open meetings and opportunity for public input � 6. A more secure and sustainable safety net system � � 15 �
Community Benefits � What The Community Gets From This Agreement � 7. Better access to care for our most vulnerable populations including: � expanded hours for primary and specialty care � • More workers on the job � • More kids in school � • 8. More healthcare providers � 9. Shorter wait times in the ER at public and private facilities � 10. Better behavioral and mental health services � 11. 26 DSRIP projects, including women ʼ s health, behavioral health, primary and specialty care, information technology � 12. Greater certainty on continuity of hospital care � 13. Option to purchase the Teaching Hospital if Seton defaults or breaches � 16
Omnibus Healthcare Services Agreement Between Central Health and Seton Family of Hospitals David Hilgers, Legal Counsel �
Purpose of Services Agreement � • Establishes the current level of services provided by Seton to MAP and charity care patients (“Current Services”) � • Establishes value currently received by Seton for the provision of Current Services (“Current Funding”) � • Important because the Master Agreement requires Seton to maintain the Current Services at the Current Funding Level throughout the term of the Master Agreement and for five years thereafter � • Establishes a process for the parties to agree to change the Current Services or the Current Funding � 18
Major Provisions � 1. Attaches a list of current services being provided by Seton to MAP and Charity Care patients. � 2. Establishes a value of $56,300,000 as the value presently received by Seton for these services. This value is provided through local and Federal funds received by Seton through the Disproportionate Share (DSH) and uncompensated care program. � 3. This current level or value cannot be changed without the approval of both parties. � 19
Major Provisions � 4. Provides an audit mechanism to allow CH to determine if Seton is meeting the following requirements established by the Agreement: � • Access to care requirements � • The Level of Services requirements � • Clinical Quality and Patient Satisfaction requirements � 20
Major Provisions � 5. Provides a process by which the parties will review the level of services and value. Any changes must be approved by both parties and documented in writing. � 21
Changes � • Either party can propose changes to the Agreement � • No changes to the following without agreement of the CCC and the execution of a definitive agreement: � • Eligibility for MAP or Charity Care patients � • Amount of co-payments � • Value of services � • Changes in level or availability of services � • Number of MAP patients � • Changes that adversely affect Seton or Seton providers � 22
Changes in Location of Services � • Seton may change the sites at which these services will be provided � • Central Health must be notified prior to any such changes � 23
Term and Termination � • Term is 25 years � • The termination provisions are not finalized, but will track the termination provisions of the Master Agreement and will provide for the continued delivery of services during the Post-termination period. � 24
Lease Agreement Between Central Health and Seton Family of Hospitals � David Hilgers, Legal Counsel �
Role of this Lease in the Master Agreement � • This Lease will govern the continued leasing by Seton of UMCB. � • It will remain in place until the new Teaching Hospital is completed and a lease is signed between Seton and Central Health for the Teaching Hospital. � • This Lease sets forth the obligations of the parties while Seton is leasing UMCB. � • We tried to retain as much of the existing Lease as made sense given the creation of the Master and Services Agreements. � • The Lease needs to assure Central Health that Seton will continue to lease the Hospital during the Post-Termination Period agreed to in the Master Agreement. � 26
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