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Travis County Healthcare District Board of Managers Meeting

May 28, 2009

Agenda Item C1 Approve minutes for the following meetings of the Travis County Healthcare District Board of Managers: (a) March

19, 2009 and (b) March 26, 2009. (Back-Up – Minutes)

Unapproved MINUTES OF MEETING – MARCH 19, 2009

TRAVIS COUNTY HEALTHCARE DISTRICT

BOARD OF MANAGERS MEETING On Thursday, March 19, 2009, a regular meeting of the Travis County Healthcare District Board of Managers convened in open session at 11:08 a.m. in the Cesar Chavez Board Conference Room, 1111 East Cesar Chavez, Austin, Texas 78702. A quorum of the Board was present. Secretary Lancaster was present, and Vice-Chairperson Coopwood presided in Chairperson Richie’s absence. The clerk for the meeting was Margo Davis.

CITIZENS’ COMMUNICATION

Clerk’s Notes: None.

REGULAR AGENDA

1. Discuss and take appropriate action regarding a formal evaluation of the

Travis County Healthcare District President and CEO’s performance, including compensation and employment contract.

Clerk’s Notes: Vice-Chairperson announced that the Board convene in executive

session to discuss agenda items 1 and 2 under Section 551.074 of the Texas Government Code, Personnel Matters.

The Board convened in a closed meeting at 11:20 a.m. and re-convened in open

session at 12:37 p.m. No action was taken on Agenda Item 1. 2. Discuss and take appropriate action concerning the evaluation tool for the

District President and CEO’s next formal evaluation. Clerk’s Notes: The Board discussed this item but did not take action on Agenda Item

2. 3. Discuss and take appropriate action regarding an amendment and the

issuance of task orders related to the Contract between Travis County Healthcare District and White Glove Technologies, LLC for Infrastructure and Information Technology Managed Services.

Clerk’s Notes: This item was taken out of order and addressed before the Board

convened in a closed meeting. Donna Scarbrough, District Purchasing Administrator, explained the amendment and

the issuance of task orders related to the contract with White Glove Technologies, LLC. (WGT). In December 2008, the Board authorized one-time expenditures for

3.19.2009 – Meeting Minutes - 1

Unapproved implementation of Information Technology (IT) services for existing health center sites. Since the contract award, there is an amendment to the existing contract to complete two activities, including cleanup of items that migrated from the City of Austin to WGT and IT connectivity for the Rundberg Lane health center site that is scheduled to open April 1, 2009. Pursuant to the City of Austin Interlocal Agreement, some of the CIP funds that will be returned from the City of Austin will fund the IT costs of the Rundberg project.

It is likely that actual quantities will vary slightly from expected quantities once implementation begins and actual quantities are verified. To minimize disruption to the implementation process, District staff is requesting that the Board also authorize the President and CEO to issue task orders to WGT for infrastructure to reflect changes to the estimated quantities or contingencies that are within her signatory authority. Any task orders that are issued will be reported to the Board as part of the CEO’s monthly report.

Manager Patrick moved that the Board ratify two purchase orders entered into with

White Glove Technologies, LLC by the District President and CEO to provide the Rundberg Lane Community Health Center with IT connectivity as presented by staff.

Manager Patrick further moved that the Board approve the proposed amendment to the contract with White Glove Technologies, LLC, as presented by staff and authorize the District President and CEO to negotiate and execute any necessary component contracts on terms similar to those presented or on terms more favorable to the District. Manager Patrick further moved that the Board authorize the District President and CEO to issue task orders for additional quantities, services, or contingencies as needed up to her signature authority limit. Manager Lancaster seconded the motion. The motion was adopted on the following vote:

Chairperson Carl Richie Absent Vice-Chairperson Tom Coopwood For Secretary Rose Lancaster For Treasurer Rosie Mendoza For Manager Bobbie Barker Absent Manager Clarke Heidrick For Manager Donald Patrick For Manager Eduardo Sanchez Absent Manager Frank Rodriguez Absent

There being no further discussion or agenda items, Manager Patrick moved that the meeting adjourn. Manager Heidrick seconded the motion. The motion was adopted on the following vote:

Chairperson Carl Richie Absent Vice-Chairperson Tom Coopwood For


Unapproved


Secretary Rose Lancaster For Treasurer Rosie Mendoza For Manager Bobbie Barker Absent Manager Clarke Heidrick For Manager Donald Patrick For Manager Eduardo Sanchez Absent Manager Frank Rodriguez Absent

The meeting adjourned at 12:37 p.m. ____________________________________ Carl S. Richie Jr., Chairperson Travis County Healthcare District Board of Managers ATTESTED TO BY: ____________________________________ Rose Lancaster, Secretary Travis County Healthcare District Board of Managers

Unapproved MINUTES OF MEETING – MARCH 26, 2009


BOARD OF MANAGERS MEETING On Thursday, March 26, 2009, a regular meeting of the Travis County Healthcare District Board of Managers convened in open session at 5:47 p.m. in the Ned Granger Building Commissioners Courtroom, 314 West 11th Street, Austin, Texas 78702. A quorum of the Board was present. Secretary Lancaster was present, and Vice-Chairperson Coopwood presided in Chairperson Richie’s absence. The clerk for the meeting was Margo Davis.

CITIZENS’ COMMUNICATION

Clerk’s Notes: None.

CONSENT AGENDA

C1. Approve the minutes for the following meetings of the Travis County Healthcare District Board of Managers: (a) December 10, 2008 and (b) January 22, 2009.

C2. Appoint the Travis County Healthcare District Board of Managers as a

committee of the whole to approve the final minutes of the ad hoc Transition Committee, which has completed its purpose and been disbanded, and approve the minutes of the February 24, 2009, ad hoc Transition Committee meeting.

C3. Receive the February 2009 Investment Report and ratify Healthcare District

Investments for February 2009. C4. Approve a proposed Renewal of the Retirement Consulting Services

Agreement between Southwest Retirement Consultants, Southwest Retirement Advisors, LLC, and Travis County Healthcare District.

C5. Approve renewal contracts for orthotic care and custom-made orthotics,

specifically: (a) Renewal of Agreement for Orthotic Care and Custom-Made Orthotics with Hanger Prosthetics & Orthotics, Inc.; (b) Renewal of Agreement for Orthotic Care and Custom-Made Orthotics with Prescott’s Austin Orthotics & Prosthetics; (c) Renewal of Agreement for Orthotic Care and Custom-Made Orthotics with Applied Orthotics, L.L.C.; (d) Renewal of Agreement for Orthotic Care and Custom-Made Orthotics with Orthotic & Prosthetic Technologies, Inc.; and (e) Renewal of Agreement for Orthotic Care and Custom-Made Orthotics with The Orthotic Specialist.


Unapproved C6. Approve the adoption of the 2009 U.S. Poverty Income Guidelines for the

Medical Assistance Program income eligibility determinations. C7. Approve a proposed renewal and amendment to the Professional

Organizational and Operations Assessment Consulting Agreement related to the operations of the Community Health Centers with Phase 2 Consulting.

C8. Approve the District’s unilateral renewal of the Services Agreement for

Development of Human Resources Structures and Systems with Aon Consulting, Inc.

C9. Approve the Renewal and Second Amendment of the Professional Legal

Services Agreement with Fulbright & Jaworski L.L.P. C10. Express support for Senate bill 1063/House Bill 1934 relating to the powers

of certain hospital districts and to the retirement benefits of employees of the districts and related entities and for Senate Bill 957/House Bill 1638 relating to the ability of a county, public hospital, or hospital district to purchase or arrange for the purchase of certain health coverage or benefits for eligible residents.

Clerk’s Notes: Consent Agenda Items C4, C6, C7, and C8 were not considered as part

of the consent agenda on staff’s recommendation. Manager Heidrick moved that the Board approve Consent Agenda items C1, C2, C3, C5,

C9, and C10. Secretary Lancaster seconded the motion. The motion was adopted on the following vote:

Chairperson Carl Richie Absent

Vice-Chairperson Tom Coopwood For Secretary Rose Lancaster For Treasurer Rosie Mendoza Absent Manager Bobbie Barker For Manager Clarke Heidrick For Manager Donald Patrick For Manager Eduardo Sanchez Absent Manager Frank Rodriguez Absent

REGULAR AGENDA C4. Approve a proposed Renewal of the Retirement Consulting Services

Agreement between Southwest Retirement Consultants, Southwest Retirement Advisors, LLC, and Travis County Healthcare District.


Unapproved Clerk’s Notes: Donna Scarbrough, District Purchasing Administrator, explained the

terms for the proposed renewals of retirement consulting services under the District’s contract with Southwest Retirement Consultants and Southwest Retirement Advisors, LLC. These two companies provide comprehensive consulting services to assist the District in adopting a retirement plan and they also analyze the 457 Deferred Compensation Plan and make investment recommendations for that plan. Any funds that the District does not use during a particular contract year will roll forward into the next contract year. There are no significant changes in the scope or tasks associated with this renewal and this is the final renewal term for this agreement. Manager Heidrick moved that the Board approve the Renewal of the Retirement Consulting Services Agreement between Southwest Retirement Consultants, Southwest Retirement Advisors, LLC, and the Travis County Healthcare District and authorize the District President and CEO to sign the renewal on terms similar to those presented or on terms more favorable to the District. Secretary Lancaster seconded the motion. The motion was adopted on the following vote:


Vice-Chairperson Tom Coopwood For Secretary Rose Lancaster For Treasurer Rosie Mendoza Absent Manager Bobbie Barker For Manager Clarke Heidrick For Manager Donald Patrick For Manager Eduardo Sanchez Absent Manager Frank Rodriguez Absent C6. Approve the adoption of the 2009 U.S. Poverty Income Guidelines for the

Medical Assistance Program income eligibility determinations. Clerk’s Notes: Trish Young Brown, District President and CEO, announced that the

poverty guidelines are issued each year in the Federal Register by the U.S. Department of Health and Human Services (HHS).

Claudia Lindenberg, District Patient Services Director, explained the use of the

guidelines to determine eligibility for the Medical Assistance Program (MAP). The guidelines are simplified for administrative purposes to determine financial eligibility for certain federal programs. MAP uses these poverty guidelines to determine eligibility for enrollment in local programs to maintain consistency with federal and state programs, including indigent health care programs. The federal guidelines measure the level of poverty by family/household size and also set the annual income levels for one hundred percent of the federal poverty level.

Manager Barker moved that the Board adopt the 2009 U.S. Poverty Income Guidelines

for the Medical Assistance Program income eligibility determinations in order to be consistent with federal and state guidelines for determining poverty as presented by


Unapproved staff. Manager Patrick seconded the motion. The motion was adopted on the following vote:

Chairperson Carl Richie Absent Vice-Chairperson Tom Coopwood For Secretary Rose Lancaster For Treasurer Rosie Mendoza Absent Manager Bobbie Barker For Manager Clarke Heidrick For Manager Donald Patrick For Manager Eduardo Sanchez Absent Manager Frank Rodriguez Absent C7. Approve a proposed renewal and amendment to the Professional

Organizational and Operations Assessment Consulting Agreement related to the operations of the Community Health Centers with Phase 2 Consulting.

Clerk’s Notes: Ms. Scarbrough explained the proposed renewal and amendment to

the Phase 2 Consulting agreement. In April 2008, Phase 2 Consulting developed an operational business model design to support a proposed 501(c)(3) corporation for the existing Community Health Centers clinic system and provided assistance as needed for implementation of the model. The agreement is for a one-year term with two optional, one-year unilateral renewals. A unilateral renewal means that the District may use its sole discretion to extend the contract for an additional one-year period as opposed to both parties agreeing to renew. The District wishes to retain the ability to access Phase 2 Consulting on an as-needed basis. Therefore, implementation assistance is optional and subject to budget availability and can be accessed with task orders that specify tasks, schedules, deliverables, and agreed-upon costs. Without a renewal, the original agreement will expire April 1, 2009.

Manager Patrick moved that the Board approve the unilateral renewal and amendment

to the Professional Organizational and Operations Assessment Consulting Agreement related to the operations of the Community Health Centers with Phase 2 Consulting as presented by staff and authorize the District President and CEO to implement the unilateral renewal. Secretary Lancaster seconded the motion. The motion was adopted on the following vote:




Unapproved C8. Approve the District’s unilateral renewal of the Services Agreement for

Development of Human Resources Structures and Systems with Aon Consulting, Inc.

Clerk’s Notes: Ms. Scarbrough explained the unilateral renewal for development of

human resources structures and systems with Aon Consulting, Inc. In April 2008, Aon Consulting, Inc. provided technical advice and consulting assistance in the development of human resources, classification, compensation and performance management structures and systems needed to implement the adopted Total Compensation Philosophy and Strategy, which will apply to the District and the 501(c)(3) corporation. The scope of work encompassed the following areas: job analysis and classification, market survey analysis, compensation/pay structure development (including incentive-based programs), performance evaluation systems, and human resource information systems (HRIS). The District wishes to renew this first renewal term for this agreement which is budgeted in fiscal year 2009 for $80,000.

Secretary Lancaster moved that the Board approve the unilateral renewal of the

Services Agreement for Development of Human Resources Structures and Systems with Aon Consulting, Inc. as presented by staff and authorize the President and CEO to implement the unilateral renewal. Manager Patrick seconded the motion. The motion was adopted on the following vote:


Vice-Chairperson Tom Coopwood For Secretary Rose Lancaster For Treasurer Rosie Mendoza Absent Manager Bobbie Barker For Manager Clarke Heidrick For Manager Donald Patrick For Manager Eduardo Sanchez Absent Manager Frank Rodriguez Absent 1. Discuss and take appropriate action regarding a request from Daughters of

Charity Health Services of Austin d/b/a Seton for approximately $350,000 to support funding the expansion of reconstructive and plastic surgery programs on the campus of the University Medical Center Brackenridge that will help enable University Medical Center Brackenridge obtain Level 1 trauma status.

Clerk’s Notes: Vice-Chairperson Coopwood turned the Chairperson’s role over to

Secretary Lancaster for this item. Dr. Coopwood neither participated in the discussion nor voted on this item.

Ms. Young Brown explained that Seton’s request for $350,000 will promote the District’s

role as “community steward” and further the overall viability of the safety net provider system. Seton is requesting that the District support the expansion of the


Unapproved reconstructive and plastic surgery program at University Medical Center Brackenridge (UMCB) to help enable UMCB to obtain Level 1 trauma status. The establishment of a Level 1 trauma facility in Austin would increase access to a wider array of services to all Travis County residents.

The Board expressed their concerns regarding this request as certain members do not

feel the request for capital directly aligns with the District’s Strategic Plan, but stated that once Level 1 trauma status is obtained by Seton, it will improve the type of services that Travis County residents receive and in the process save lives.

Manager Heidrick moved that the Board approve a request from the Daughters of

Charity Health Services of Austin d/b/a Seton for funds up to $350,000 to support the future expansion of reconstructive and plastic surgery programs on the campus of the University Medical Center at Brackenridge as presented by staff and authorize the District President and CEO to negotiate and execute final agreements on terms similar to those presented or on terms more favorable to the District. Manager Patrick seconded the motion. The motion was adopted on the following roll-call vote:


Vice-Chairperson Tom Coopwood Abstain Secretary Rose Lancaster For Treasurer Rosie Mendoza Absent Manager Bobbie Barker For Manager Clarke Heidrick For Manager Donald Patrick For Manager Eduardo Sanchez Absent Manager Frank Rodriguez Absent 2. Receive and discuss a report of the January and February 2009 financial

statements for the Travis County Healthcare District. Clerk’s Notes: Carolyn Konecny, District Chief Financial Officer, provided an overview

of the February 2009 financial statements, including a discussion of the Statement of Revenues, Expenses and Changes in Net Assets, and the Balance Sheet. The Change in Net Assets are favorable due to the timing of revenue with most property tax revenue received December through February and expenses spread more evenly throughout the year. No notable items were reported.

3. Received and discuss a presentation regarding analysis of the Integrated

Care Collaboration’s ICare health information exchange utilization data for Central Texas and the related work of the Collaboration.

Clerk’s Notes: Ann Kitchen, Integrated Care Collaboration (ICC) Executive Director,

and Anjum Khurshid, ICC Clinical Research and Evaluation Director, provided an overview of the ICare health information system. The ICare system was created by ICC as a web-based “community health record” that stores patient the demographic and


Unapproved medical visit information of uninsured and/or underserved patients. To compile patient demographics, patients give permission for data to be “shared” or viewable by end-users by signing an authorization form. The data is collected via electronic interfaces from ICC member systems and is used to research community health and determine ways to improve healthcare services. The system is privacy protected and contains information from over 70 locations which includes 16 hospitals, 50 clinics, 1 mental health authority, and 2 physician networks.

4. Discuss and take appropriate action regarding the employment of David Vliet, who will be assigned to serve as Central Texas Community Health Center’s Chief Executive Officer.

Clerk’s Notes: Ms. Young Brown explained the role and basic employment contract

terms of the Chief Executive Officer (CEO) for the Central Texas Community Health Centers. On March 1, 2009, all transitioning City of Austin Community Care Services Department (CCSD) employees became employees of the Travis County Healthcare District, including David Vliet, who has been appointed Chief Executive Officer of the Central Texas Community Health Centers (CTCHC) by the CTCHC Board. The CTCHC Board of Directors approved a basic contract term which includes the following: (1) a one-year term with automatic renewal unless notice of termination is given prior to the contract expiration; (2) an annual salary with an increase in October 2009 assuming satisfactory performance and achievement of goals determined by the CTCHC Board of Directors; (3) reimbursement of reasonable business expenses incurred as per CTCHC reimbursement policy and related budget; (4) termination clause; and (5) severance pay. Mr. Vliet is an employee of the District and has been assigned to serve as the CEO for the CTCHC with the direct responsibility for the supervision and control of the District-assigned employees for the services they provide to the CTCHC. The District wishes to enter into an employment contract with the CTCHC CEO, David Vliet, which outlines the terms of his employment.

Secretary Lancaster moved that the Board delegate the authority to negotiate and

execute an employment agreement with David Vliet, who will be assigned to serve as Central Texas Community Health Center’s Chief Executive Officer, to the District President and CEO. Manager Heidrick seconded the motion. The motion was adopted on the following vote:




Unapproved 5. Discuss and take appropriate action regarding the proposed Professional

Services Agreement between Travis County and the Travis County Healthcare District and the Central Texas Community Health Centers for Interpreting Services.

Clerk’s Notes: Sarah Churchill, Assistant Travis County Attorney, explained the

proposed agreement for interpreting services. Before the Central Texas Community Health Centers (CTCHCs) transitioned to the District, the clinics received deaf interpreting services under the City of Austin’s contract with Travis County. These services are still needed for persons who are deaf or hard of hearing. Travis County will provide these services from March 1, 2009 through September 30, 2009 with automatic annual renewals. The costs for this agreement will be shared between the District and the CTCHCs with each organization paying for the services it uses and the renewal terms will be budgeted and approved by the Board.

Manager Heidrick moved that the Board approve the Professional Services Agreement

between Travis County and the Travis County Healthcare District and the Central Texas Community Health Centers for Interpreting Services as presented by staff and authorize the District President and CEO to negotiate and execute a final agreement on terms similar to those presented or on terms more favorable to the District. Secretary Lancaster seconded the motion. The motion was adopted on the following vote:


Vice-Chairperson Tom Coopwood For Secretary Rose Lancaster For Treasurer Rosie Mendoza Absent Manager Bobbie Barker For Manager Clarke Heidrick For Manager Donald Patrick For Manager Eduardo Sanchez Absent Manager Frank Rodriguez Absent 6. Receive, discuss and take appropriate action where necessary on updates

regarding the March 1, 2009 transfer of the City of Austin Community Care Services Department to the District, including: (a) the leases of community health center facilities from Travis County; (b) the Fifth Amendment to the Interlocal Agreement with Travis County; (c) the proposed Interlocal Agreement for Close-Out and Post-Transition Services with the City of Austin; and (d) the proposed Interlocal Agreement for Emergency Medical Services with the City of Austin.

Clerk’s Notes: John Stephens, District Transition Financial Manager, provided updates

on the transfer of the City of Austin Community Care Services Department (“CCSD”) leases/agreements to the District. There were several clinic spaces that were operated by the City of Austin CCSD but the buildings are owned and leased by Travis County. As part of the transfer from the City of Austin to the District, the District will enter into


Unapproved lease agreements with Travis County for the clinic spaces that will be operated by the Central Texas Community Health Centers (“CTCHCs”). One of the lease agreement terms includes a five year initial lease with a five year renewal period which is subject to change and includes an extension at the time of renewal. Travis County has also clarified payment arrangements for facility repairs in the lease agreement. The District will pay for minor repairs under $10,000; and expenses for major repairs will be shared between the District and Travis County unless the useful life of the repair extends past the lease term. This arrangement is similar to the District’s agreement with the City of Austin.

There have been a couple of changes to the City of Austin Interlocal Agreement. The District will arrange for courier and landscaping services rather than obtaining these services through the City of Austin and purchase two vehicles – a passenger van and a pick-up truck from the City of Austin. The vehicles are used by the CTCHCs for facilities maintenance and transporting of equipment between health centers and will have the same purpose once they are owned by the District.

Ms. Young Brown reported on the ongoing discussions pertaining to the facilities that

are shared with Travis County. The CTCHCs share the patient population with Travis County Health and Human Services. Therefore, the District and Travis County will be in partnership for a long period of time to serve Travis County residents.

Ms. Churchill provided an update on the Interlocal Agreement for Emergency Medical

Services (EMS) with the City of Austin. The proposed agreement is for ground transportation for Medical Assistance Program (MAP) patients. The agreement capitates at $350,000 for the first year beginning March 1, 2009 and is based on historical utilization of EMS. MAP patients will not be charged for the use of EMS. Meanwhile, the District will review utilization data to determine how often EMS is used by MAP patients before the next renewal term of February 28, 2010. The District will also manage utilization to discourage inappropriate use of EMS.

Manager Patrick announced that he is member of the EMS Board. The EMS Board

makes recommendations to the Austin City Council about the delivery of EMS and reviews the performance of the EMS system from the perspective of organizations that participate in the system. Some of the recommendations are regarding the use of assets and resources, and placement of EMS stations to help promote high quality and efficient service throughout Austin and Travis County. The EMS Board does not exercise administrative control over the City of Austin EMS Department and an EMS Board position is voluntary and unpaid which allows Manager Patrick to vote on this item.

Secretary Lancaster moved that the Board approve the Interlocal Fee Agreement for

Emergency Medical Services between the City of Austin and the Travis County Healthcare District as presented by staff and authorize the District President and CEO to negotiate and execute a final agreement on terms similar to those presented or on


Unapproved terms more favorable to the District. Manager Barker seconded the motion. The motion was adopted on the following vote:


Vice-Chairperson Tom Coopwood For Secretary Rose Lancaster For Treasurer Rosie Mendoza Absent Manager Bobbie Barker For Manager Clarke Heidrick For Manager Donald Patrick For Manager Eduardo Sanchez Absent Manager Frank Rodriguez Absent 7. Discuss and take appropriate action regarding a Records Interlocal

Agreement between the City of Austin and the Travis County Healthcare District.

Clerk’s Notes: Stacy Wilson, Assistant Travis County Attorney, explained the terms of

the proposed Records Interlocal Agreement. As CCSD employees transfer to the District, the employees will need access to the records that were created while they were employees of the City of Austin CCSD. The agreement provides for retention, storage, access to, and disposal of the CCSD records and City human resources records. Although the City will continue to own and be the custodian of the records, the District and the CTCHCs will have possession and use of the records. The District is responsible for maintaining the records and complying with applicable records retention requirements and allowing the City access to the records upon request. This agreement became effective March 1, 2009, for an initial one year term and does not contain any financial obligation from the District.

Manager Barker moved that the Board approve the Records Interlocal Agreement

between the City of Austin and the Travis County Healthcare District as presented by staff and authorize the District President and CEO to negotiate and execute a final agreement on terms similar to those presented or on terms more favorable to the District. Manager Patrick seconded the motion. The motion was adopted on the following vote:




Unapproved 8. Discuss and take appropriate action regarding a proposed increase in the

amount of funds allocated for radiation/oncology services provided by Austin Cancer Center and approve the expenditure of expansion funds for this purpose.

Clerk’s Notes: Larry Wallace, District Chief Service Delivery Officer, explained the

request to increase funds for radiation/oncology services that will be provided by Austin Cancer Center. This is the third amendment to the District’s contract with Austin Cancer Center for radiation/oncology services and the increase in the current contract amount will cover increased utilization of services and increase the availability of specialty care services for Medical Assistance Program (MAP) enrollees. The contract amount increase will expand access to an additional 173 MAP enrollees. Since the initial term of this contract, utilization needs and fees have increased and the District is seeking to accommodate the following changes in MAP enrollment: an 18 percent increase in enrollment from February 2008 to February 2009; a 14 percent increase in the number of MAP enrollees utilizing radiation/oncology services since December 2008; and an increase in January 2009 in the Medicaid fee schedule. The request to increase funds to expand radiation/oncology services is related to service expansion and will be withdrawn from the service expansion budget for this purpose.

Manager Patrick moved that the Board approve a third amendment to the Agreement

for Radiation Oncology Services by and between Travis County Healthcare District and Austin Texas Radiation Oncology Group, PA d/b/a Austin Cancer Centers as presented by staff, authorize the expenditure of $301,000 in Fiscal Year 2009 expansion funds for this contract, and further authorize the District President and CEO to negotiate and execute a final agreement on terms similar to those presented or on terms more favorable to the District. Secretary Lancaster seconded the motion. The motion was adopted on the following vote:


Vice-Chairperson Tom Coopwood For Secretary Rose Lancaster For Treasurer Rosie Mendoza Absent Manager Bobbie Barker For Manager Clarke Heidrick For Manager Donald Patrick For Manager Eduardo Sanchez Absent Manager Frank Rodriguez Absent 9. Receive and discuss reports from the Board committees: ad hoc Nominations

Committee, Audit and Compliance Committee, Budget and Finance Committee, and Legislative Committee (including a report from HillCo Partners, the District’s legislative consultant, on current and anticipated legislative and executive branch, including state agency activities).


Unapproved Clerk’s Notes: Ms. Young Brown announced that the ad hoc Nominations Committee

did not have a quorum present at its last meeting and will have a future meeting to nominate Officers and present the results of that meeting to the Board of Managers.

Marsha Jones, Legislative Consultant for the District, gave an update on recent legislative and executive branch activities including the status of the District’s general and local bills. No additional reports were given as no meetings had taken place since the last Board meeting.

10. Receive and discuss the CEO’s report on the following District activities: (a)

procurement activity; (b) communications/outreach statistics for February 2009; (c) the evaluation of the E-merge program; and (d) an update on the status of the Rundberg Lane Community Health Center.

Clerk’s Notes: Ms. Young Brown briefly reported on ongoing staff activities, including

procurement activities, communications/outreach statistics for February, an evaluation of the E-merge program, and an update on the status of the Rundberg Lane Community Health Center.

11. Discuss and take appropriate action regarding a formal evaluation of the

Travis County Healthcare District President and CEO’s performance, including compensation, her employment contract, and District executive employees’ relative pay levels.

Clerk’s Notes: Vice-Chairperson Coopwood announced that the Board convene in

executive session to discuss agenda items 11 and 12 under Section 551.074 of the Texas Government Code, Personnel Matters.

The Board convened in a closed meeting at 7:54 p.m. and re-convened in open session

at 10:12 p.m. Manager Patrick moved that the Board recognize that the performance of Patricia A.

Young Brown over the past twelve months has met or exceeded the Board’s performance expectations and further moved that the Board express its appreciation to Ms. Young Brown for her continued dedication to the District’s mission and vision, her guidance of the District through the transfer of the Community Health Centers operations and employees from the City of Austin, her continued focus on the long-term goals of the District, and her commitment to increasing access to health care for the residents whom the District serves.

Manager Patrick further moved that the Board approve a one-time performance

incentive payment, pursuant to the criteria adopted by this Board last year, of $9,000. Manager Heidrick seconded the motion. The motion was adopted on the following vote:

Chairperson Carl Richie Absent Vice-Chairperson Tom Coopwood Against


Unapproved Secretary Rose Lancaster For Treasurer Rosie Mendoza Absent Manager Bobbie Barker For Manager Clarke Heidrick For Manager Donald Patrick For Manager Eduardo Sanchez Absent Manager Frank Rodriguez Absent

Consistent with the Board’s adopted Total Compensation Philosophy and Strategy, Secretary Lancaster moved that the Board approve the following effective April 1, 2009: (a) the President and CEO’s annual base salary be increased by 3% and (b) her available incentive compensation be set at $10,000 and finally moved that the Board direct legal counsel to prepare an amendment to the President and CEO’s Employment Agreement to reflect the action of the Board. Manager Patrick seconded the motion. The motion was adopted on the following vote:


Vice-Chairperson Tom Coopwood For Secretary Rose Lancaster For Treasurer Rosie Mendoza Absent Manager Bobbie Barker For Manager Clarke Heidrick For Manager Donald Patrick For Manager Eduardo Sanchez Absent Manager Frank Rodriguez Absent 12. Discuss and take appropriate action concerning the evaluation tool for the

District President and CEO’s next formal evaluation. Clerk’s Notes: Manager Barker moved that the Board adopt the same evaluation tool

used previously that includes incentive compensation criteria to evaluate Ms. Young Brown’s performance for the next twelve months with the five areas to include (1) a leadership role in the community as it relates to health; (2) continuation of the progress in the Medical Assistance Program (MAP); (3) establish a system of measurements for the organizations that the District funds; (4) a strengthened and enhanced relationship as a partner with University Medical Center Brackenridge (UMCB); and (5) the continued development of the Braker Lane health center. Secretary Lancaster seconded the motion. The motion was adopted on the following vote:


Vice-Chairperson Tom Coopwood For Secretary Rose Lancaster For Treasurer Rosie Mendoza Absent Manager Bobbie Barker For Manager Clarke Heidrick For Manager Donald Patrick For


Unapproved


Manager Eduardo Sanchez Absent Manager Frank Rodriguez Absent 13. Confirm the next regular Board meeting date, time, and location.

Clerk’s Notes: Vice-Chairperson Coopwood announced that the next regularly-scheduled Board meeting is scheduled to be held on Thursday, April 9, 2009, at 3:00 p.m., in the Cesar Chavez Building, Board Conference Room, 1111 East Cesar Chavez, Austin, Texas 78702.

There being no further discussion or agenda items, Manager Patrick moved that the meeting adjourn. Secretary Lancaster seconded the motion. The motion was adopted on the following vote:

Chairperson Carl Richie Absent Vice-Chairperson Tom Coopwood For Secretary Rose Lancaster For Treasurer Rosie Mendoza Absent Manager Bobbie Barker For Manager Clarke Heidrick For Manager Donald Patrick For Manager Eduardo Sanchez Absent Manager Frank Rodriguez Absent

The meeting adjourned at 10:22 p.m. ____________________________________ Carl S. Richie Jr., Chairperson Travis County Healthcare District Board of Managers ATTESTED TO BY: ____________________________________ Rose Lancaster, Secretary Travis County Healthcare District Board of Managers


May 28, 2009

Agenda Item C2 Receive the April 2009 Investment Report and ratify

Healthcare District investments for April 2009. (Back-Up – Investment Report)


May 28, 2009

Agenda Item C3 Approve an amendment to the Contract between Travis County Healthcare District and White Glove Technologies, LLC for Infrastructure and Information Technology Managed Services to allow CommUnityCare direct access to the services provided under the contract.

(Back-Up – Memo)

Memo:

To: Travis County Healthcare District Board of Managers

From: Donna Scarbrough, Purchasing Administrator

CC: Patricia A. Young Brown, Stacy Wilson, David Vliet

Date: May 20, 2009

Re: Agenda Item #C3: Approve an amendment to the Contract between Travis County Healthcare District and White Glove Technologies, LLC for Infrastructure and Information Technology Managed Services to allow CommUnityCare to directly access the services provided under the contract.

Background

The District Board of Managers approved a contract award to White Glove Technologies LLC d/b/a Network Logistic Inc. for information technology services competitively procured by the District (RFP 0804-001). The initial contract between NLI and the District was for the implementation of the IT infrastructure and ongoing services support. With the completion of the implementation portion of the contract, CommUnityCare and the District require a mechanism to allow them to flexibly and easily obtain services as IT needs and opportunities emerge. The proposed amendment would modify the existing contract to allow both the District and/or CommUnityCare to obtain IT services on an “as-needed” basis using written task orders. As projects are defined, the task order will be developed and will contain a defined scope of work with agreed-upon tasks, hours, deliverables, and costs using the existing contract labor rates and unit costs. Instead of a fixed not-to-exceed contract amount requiring continual amendment to accommodate evolving needs, the amount of work contracted in any given year will be subject to budget availability with a requirement that budget be verified prior to issuance of a task order. Recommendation

Staff recommends that the Board of Managers approve the proposed amendment to the contract with White Glove Technologies, LLC and authorize the District President and CEO to execute a final contract amendment with terms similar to those presented or on terms more favorable to the District.


May 28, 2009

Agenda Item C4 Approve a proposed Renewal and Fifth Amendment of the External Auditing Contract between Maxwell Locke & Ritter LLP and Travis County Healthcare District.

(Back-Up – Memo & Agreement)

Memo:

To: Travis County Healthcare District Board of Managers

From: Donna Scarbrough, Purchasing Administrator

CC: Patricia A. Young Brown, Stacy Wilson, Carolyn Konecny

Date: May 21, 2009

Re: Agenda Item C4: Approve a proposed Renewal and Fifth Amendment of the External Auditing Contract between Maxwell Locke & Ritter LLP and Travis County Healthcare District

Background Maxwell Locke and Ritter LLP (“ML&R”) was awarded a contract in 2005 to provide external auditing services to the District for four fiscal years. The contract automatically renews unless either party exercises its right to terminate. The last remaining renewal under the original agreement terminates on June 30, 2009. The transition of the Federally Qualified Health Centers from the City of Austin to the District reflects a need for continuity in the annual audit for this year. Therefore, District staff believes that it is prudent to amend the existing contract to add an additional renewal term (through June 30, 2010), with the intent to re-solicit the external auditing services in fiscal year 2010. The remaining terms and conditions, including the proposed fees of $36,750, remain the same. Recommendation Staff recommends that the Board of Managers approve the Renewal and Fifth Amendment and authorize the District President and CEO to sign the Renewal and Fifth Amendment on terms similar to those presented by staff or on terms more favorable to the District.

RENEWAL AND FIFTH AMENDMENT OF THE EXTERNAL AUDITING CONTRACT BETWEEN MAXWELL LOCKE & RITTER LLP AND


This Renewal and Fifth Amendment (“Fifth Amendment”) of the External Auditing Contract (the “Contract”) is entered into by Maxwell Locke & Ritter LLP (“Contractor”) and the Travis County Healthcare District (the “District”) (individually a “Party” and collectively, the “Parties”) effective as of July 1, 2009. WHEREAS, the Parties entered into the Contract for the provision of external auditing services effective March 15, 2005; and WHEREAS, the Parties amended the Contract effective on July 1, 2006; July 1, 2007; July 1, 2008; and September 1, 2008; and WHEREAS, the District’s Board of Managers desire to amend the Contract to extend the available contract terms, particularly in light of the transition of the Federally Qualified Heath Centers from the City of Austin to the District; and WHEREAS, both the District and the Contractor desire to renew the Contract, as amended, for that additional one-year period; and WHEREAS, Section 13 of the Contract permits the parties to amend the Contract in writing; NOW, THEREFORE, for and in consideration of the mutual benefits received by these changes, and other good and adequate consideration as specified herein, the parties agree to the terms and conditions stated in this Fifth Amendment.

AMENDMENT AND RENEWAL 1.0 The parties amend Section 2.2 of the Contract in its entirety to read as follows:

The Contract shall automatically renew on July 1, 2006, for a contract period of one year unless sooner terminated pursuant to the other termination provisions in this Contract, and this Contract shall automatically renew for terms of one (1) year thereafter for a maximum total contract period of five years and three and a half- months unless sooner terminated in accordance with this Contract.

2.0 The parties renew the Contract, as amended, for a period beginning on July 1, 2009, and ending on June 30, 2010.

3.0 The Parties amend Section 11.1 in its entirety to read as follows: 11.1 No expenses are payable under this agreement. In consideration of full performance of Annual Audit Services for District, District shall pay Contractor the following total dollar amount for fees for the audit of the fiscal year ending September 30 of that year. Year Fee

2005 $32,500 2006 $28,250 2007 $29,000 2008 $36,750 2009 $36,750

4.0 The Parties amend Section 12.2 in its entirety to read as follows: 12.2 For field work, within 30 days after completion, and for issuance of reports, within 30 days after completion and acceptance of all reports for the fiscal year, Contractor must invoice District separately for Annual Audit Services at the amount resulting from multiplying the total fees for the applicable year by the percentage applicable to the level of service completed. Fiscal Year � 05 06 07 08 09 Total District Fees � $32,500 $28,500 $29,000 $36,750 $36,750 Level of Service Completed Applicable Percentage Rate Interim Field Work (Attachment A, 5.1.1) 20% End of Final Field Work (Attachment A, 5.1.3) 60% District Acceptance of All Reports due 20% 5.0 Except as amended above, the Contract as modified shall remain in full force and effect, being hereby ratified, approved and affirmed. IN WITNESS WHEREOF, this Fifth Amendment has been executed and delivered on behalf of the Parties by their duly authorized representatives in one or more counterparts, which together shall constitute one agreement. MAXWELL LOCKE & RITTER LLP By:________________________________________ Date: Scott Krcknak, Partner TRAVIS COUNTY HEALTHCARE DISTRICT By: Date:

Name/Title:


May 28, 2009

Agenda Item 1 Receive and discuss an update on CommUnityCare operations for the second quarter of Fiscal Year 2009, including a report on disease management programs and their impact on patient care.

(Back-Up – Presentation)

Travis County Healthcare DistrictTravis County Healthcare DistrictBoard of ManagerBoard of ManagerQuarterly UpdateQuarterly Update

May 28, 2009May 28, 2009

OVERVIEWOVERVIEW

Productivity and Financial MeasuresProductivity and Financial MeasuresService ExpansionsService ExpansionsTransformation UpdateTransformation Update

Operations RedesignOperations RedesignHealth Disparities CollaborativesHealth Disparities Collaboratives

Recruiting AchievementsRecruiting Achievements Provider VacanciesProvider Vacancies

0

2

4

6

8

10

12

14

Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep

FTEs

FY09 FY08 FY07 FY06

Medical Provider VacanciesMedical Provider Vacancies as of May 18, 2009as of May 18, 2009

Family Family PracticePractice

Internal Internal MedicineMedicine PediatricsPediatrics

WomenWomen’’s s HealthHealth TOTALTOTAL

Base Base BudgetBudget

3.03.0 0.50.5 0.00.0 0.00.0 3.53.5

ExpansionsExpansions 2.52.5 0.50.5 0.00.0 0.00.0 3.03.0

Less:Less:IncomingIncoming

2.02.0 1.01.0 0.00.0 0.00.0 3.03.0

Net Net VacanciesVacancies

3.53.5 0.00.0 0.00.0 0.00.0 3.53.5

Medical EncountersMedical Encounters Six Months Ending March 31Six Months Ending March 31

81,749 76,600 76,114 71,567

0

20,000

40,000

60,000

80,000

100,000

120,000

FY2007 FY2008 BUD2009 FY2009

Base Expansion

95,677

76,824

Encounter Per Medical ProviderEncounter Per Medical Provider Six Months Ending March 31Six Months Ending March 31

1871 1822 1773

0

200

400

600

800

1000

1200

1400

1600

1800

2000

FY2008 BUD09 FY2009

Third Next Available AppointmentThird Next Available Appointment as of March 31as of March 31

24 25

20

7 6

12

0

5

10

15

20

25

Long Short

FY07 FY08 FY09CHC Goal: Long = 20 days, Short = 10 days (TDI Standard: 3 months/21days)

(excludes Convenient Care)

Cost Per EncounterCost Per Encounter Six Month ComparisonSix Month Comparison

200

118

220

134

220

133

239

152

215

152

$0

$50

$100

$150

$200

$250

FY07 FY08 BUD09 FY09-COA Mar-09Gross Cost Net Cost

* Excludes impact of PTO and retention accrual of $2 M

*

Fall 2008William Cannon Walk-In Center Opened

January 2009Red River Walk-In Center Opened

April 2009Rundberg Center Opened Adult primary care and pediatric services

May 2009Family Wellness Center OpenedUT School of Nursing

Summer 2009Children’s Wellness CenterUT School of Nursing

RundbergReceptionRooms.

Service ExpansionsService Expansions

William Cannon William Cannon Monthly EncountersMonthly Encounters

0

100

200

300

400

500

600

700

800

OCT NOV DEC JAN FEB MAR APR

ActualTarget

William Cannon HighlightsWilliam Cannon Highlights

All three providers in place as of AprilAll three providers in place as of AprilMarketing to schools, churches and Marketing to schools, churches and community groupscommunity groupsTargeted Saturday marketing strategy Targeted Saturday marketing strategy to expand utilizationto expand utilizationLowered the pediatric service age to Lowered the pediatric service age to six monthssix months

Red River Red River Monthly EncountersMonthly Encounters

0

200

400

600

800

1000

1200

1400

JAN FEB MAR APR

ActualTarget

Red River HighlightsRed River HighlightsVolumes continuing to growVolumes continuing to growWeekday census at 70% or more of total capacity Weekday census at 70% or more of total capacity oneone--third of the time during April third of the time during April Weekend capacity is greatly underutilizedWeekend capacity is greatly underutilizedMarketing information distributed to all sites and Marketing information distributed to all sites and MAP staff, targeting evening and weekend walkMAP staff, targeting evening and weekend walk--in in servicesservicesAfterAfter--hours triage calls referring to Red River when hours triage calls referring to Red River when appropriateappropriateIn June a UMCB hotline will be available for postIn June a UMCB hotline will be available for post--discharge followdischarge follow--up visitsup visits

Rundberg Rundberg Weekly EncountersWeekly Encounters

01020304050607080

4/3/20

094/1

0/200

94/1

7/200

94/2

4/200

95/1

/2009

5/8/20

095/1

5/200

9

ActualTarget

Signage, Web Site, Internal PromotionLarge banner promoted site opening.

Large lighted sign on building. Interior signage within.

Location added to web site.

Providers at NE and Rosewood Zaragosa helping to promote with postcards

MHMR staff distributing Rundberg postcards to clients.

Announced in the “Update” monthly newsletter to staff and board.

Announced in employee “Weekly Briefing”

Promotion of newRundberg location

Direct MailDirect mail postcard sent to 6500 households

Within four-mile radius of office locationHouseholds included someone age 65+Key message: We accept Medicare and Medicaid

Direct mail postcard sent to 1900 CommUnityCare patient households

Within 78753 zip codeWith children in the householdKey message: We accept CHIP and Medicaid for kids

Homeowner associations in the Rundberg area, received letters and/or email announcing the opening of the location.

Coming soon: External print ads to promote Medicare services

Rundberg Promotion - continued

Marketing Visits(Print materials left at all visits)

Schools (In a three zip code area)Visited nine elementary schools and met with school nurses. Visited two middle schools and met with school nurses.

Recreation CenterGus Garcia Recreation Center – Met with recreation program supervisor

Child Care CentersVisited several local child care centers in the Rundberg area

Rundberg Promotion - continued

Hospital Marketing Visits (Print materials left at all visits)

Met with Emergency Services Staff at:St. David’s main, St. David’s NorthSeton NorthwestUMC BrackenridgeDell Children’s HospitalHeart Hospital of Austin

Met with case management directors at:St David’s mainAustin Women’s HospitalDell Children’s HospitalUMC Brackenridge

Met with Director of Perinatal Services at UMC Brackenridge

Met with Director of Pediatric Mobile Van Services at Dell Children’s Hospital

CommUnityCare Promotion

Rundberg Grand Opening Event

“Healthy Kids Day” Community and Media Event

A community event is being planned for Saturday, August 8.Promoted to Medicaid and CHIP families as much as possible.

Well child exams and immunizations

Bike safety workshops and bike helmet give-aways

Free health education materials – kids topics.

Storytelling corner for kids

Fire safety demonstrations for kids

Championship Heart screenings for HCM

Invited dignitaries and media

Service ExpansionsService Expansions-- continuedcontinued

Affiliation with UT School of NursingAffiliation with UT School of NursingMay 1May 1stst opened Family Wellness as an opened Family Wellness as an affiliated site of CommUnityCareaffiliated site of CommUnityCareAugust date anticipated for ChildrenAugust date anticipated for Children’’s s WellnessWellnessExpands community services by one Expands community services by one Pediatrician and one Nurse PractitionerPediatrician and one Nurse PractitionerLeverages FQHC status to incorporate Leverages FQHC status to incorporate other safety net providersother safety net providers

InfrastructureInfrastructureBaseline completed for March 1, 2009 Baseline completed for March 1, 2009 Transition:Transition:Human ResourcesHuman Resources

Compensation, benefits, payroll, physician Compensation, benefits, payroll, physician agreements, new organization structureagreements, new organization structure

Information TechnologyInformation TechnologyData center, NextGen upgrades, connectivity Data center, NextGen upgrades, connectivity improvements, phone systemimprovements, phone system

FinanceFinanceGeneral Ledger system, chart of accounts, insurance, General Ledger system, chart of accounts, insurance, GPOGPO

OperationsOperationsGOAL: Develop a new service delivery model providing GOAL: Develop a new service delivery model providing comprehensive, high quality medical care that is available comprehensive, high quality medical care that is available at the right time and the right place to meet patientsat the right time and the right place to meet patients’’ needs. This is a three year process that began in FY needs. This is a three year process that began in FY 2008.2008.

Year One (FY 2008) Year One (FY 2008) –– developing a model of care developing a model of care that will serve our communitythat will serve our community

Year Two (FY 2009) Year Two (FY 2009) –– expansion of the patient expansion of the patient care modelcare model

Year Three (FY 2010) Year Three (FY 2010) –– eliminate inefficiencies eliminate inefficiencies from past patient care modelsfrom past patient care models

Operations Operations -- RedesignRedesignYear Two (FY 2009) Year Two (FY 2009) –– expansion of the patient care modelexpansion of the patient care model

Spread Optimizing Comprehensive Clinical Care (OC3) Patient CareSpread Optimizing Comprehensive Clinical Care (OC3) Patient CareModel to all sitesModel to all sites

Two additional teams (Pflugerville and Rosewood Zaragosa) Two additional teams (Pflugerville and Rosewood Zaragosa) participating in TACHC OC3 formal training participating in TACHC OC3 formal training Monthly allMonthly all--sites leadership meetings with formal review of data sites leadership meetings with formal review of data measures and reportmeasures and report--out of previous monthout of previous month’’s accomplishmentss accomplishmentsMonthly meetings with CMO, COO, Lead Provider and Regional Monthly meetings with CMO, COO, Lead Provider and Regional Practice Administrator to review each providerPractice Administrator to review each provider’’s performance measuress performance measures

Panel size, encounters, continuity, thirdPanel size, encounters, continuity, third--next available appointment, ER next available appointment, ER utilization utilization

Continue integration and expansion of clinical collaboratives Continue integration and expansion of clinical collaboratives

Preparation for Joint Commission accreditation surveyPreparation for Joint Commission accreditation survey

Operations Operations -- RedesignRedesign

Five areas of redesign focus:Five areas of redesign focus:Patient ExperiencePatient ExperienceSustainabilitySustainabilityInformationInformationRelationshipsRelationshipsEmpowermentEmpowerment

All redesign objectives fall within one or more of All redesign objectives fall within one or more of these areas, and has measurable outcomes to these areas, and has measurable outcomes to track progress.track progress.

Operations Operations -- RedesignRedesign

Practice Redesign matrix with over 50 objectives Practice Redesign matrix with over 50 objectives covering the five areas of design.covering the five areas of design.Each objective delineated as an organization, site, or Each objective delineated as an organization, site, or provider team responsibility.provider team responsibility.Many objectives are evolutionary with a good, better, Many objectives are evolutionary with a good, better, best practice measure to track progress towards best practice measure to track progress towards moving the entire organization into best practice moving the entire organization into best practice performance.performance.Overarching objectives to be consolidated into Overarching objectives to be consolidated into organizational scorecard.organizational scorecard.Individual objectives to be incorporated into Individual objectives to be incorporated into applicable performance expectations for identified applicable performance expectations for identified staff member.staff member.

Operations Operations –– Redesign Example #1Redesign Example #1

InformationInformation –– Upgrade of NextGen Electronic Upgrade of NextGen Electronic Health Record to Knowledge Based Module Health Record to Knowledge Based Module platformplatform

Measure: System upgrade with provider and staff Measure: System upgrade with provider and staff training completed by July 31, 2009training completed by July 31, 2009Benefits: Benefits:

EHR enhancements (Information)EHR enhancements (Information)Integrated patient charges from EHR to Billing System Integrated patient charges from EHR to Billing System (Sustainability)(Sustainability)Increased clerical staff time redirected to expanded service Increased clerical staff time redirected to expanded service functions (Patient Experience)functions (Patient Experience)Expanded availability of clinical outcomes data for Expanded availability of clinical outcomes data for performance improvement activities (Information)performance improvement activities (Information)


Patient ExperiencePatient Experience –– Home delivery of Home delivery of prescription medicationprescription medication

Measure: Percentage of patients receiving refills via Measure: Percentage of patients receiving refills via home delivery or Walgreens versus Clinic Class D home delivery or Walgreens versus Clinic Class D pharmacypharmacyBenefits: Benefits:

Patient access to prescription refills without a clinic visit Patient access to prescription refills without a clinic visit (Patient Experience)(Patient Experience)Increased access for other patients by eliminating Increased access for other patients by eliminating provider/nurse visits for prescription refills (Sustainability)provider/nurse visits for prescription refills (Sustainability)Registered Nurses performing other licensed duties besides Registered Nurses performing other licensed duties besides prescription dispensing (Empowerment)prescription dispensing (Empowerment)


SustainabilitySustainability –– Financial screening performed Financial screening performed at clinic in conjunction with first appointment.at clinic in conjunction with first appointment.

Measure: Various systems established and PDSA Measure: Various systems established and PDSA completed at four sites (South, Oak Hill, Family completed at four sites (South, Oak Hill, Family Wellness) by August 31, 2009. Wellness) by August 31, 2009. Benefits: Benefits:

Patient access is balanced with available supply of services Patient access is balanced with available supply of services (Sustainability)(Sustainability)Patient appointments are available when needed (Patient Patient appointments are available when needed (Patient Experience)Experience)Staff are able to meet potential new patientStaff are able to meet potential new patient’’s need for s need for services or direct to other providers of care (Empowerment)services or direct to other providers of care (Empowerment)

CultureCultureGOAL:GOAL: Develop a new organization that is patient Develop a new organization that is patient outcome focused, physician engaged, and customer outcome focused, physician engaged, and customer service oriented. This is a three year process that service oriented. This is a three year process that began in FY 2008.began in FY 2008.

Year One (FY 2008) Year One (FY 2008) –– building awareness and building awareness and developing resourcesdeveloping resources

Year Two (FY 2009) Year Two (FY 2009) –– expanding training and expanding training and accountabilityaccountability

Year Three (FY 2010) Year Three (FY 2010) –– providing excellent providing excellent customer service, integrated accountabilitycustomer service, integrated accountability

CultureCulture

Year Two (FY 2009) Year Two (FY 2009) –– expanding training expanding training and accountabilityand accountability

Customer Service training deployed Customer Service training deployed -- roll out to all roll out to all staff began in February, over 70% completestaff began in February, over 70% completePress Ganey customer satisfaction surveys initiated Press Ganey customer satisfaction surveys initiated to benchmark against other practices, measure to benchmark against other practices, measure customer service impact. customer service impact. Management Leadership training to be implemented Management Leadership training to be implemented this fiscal year.this fiscal year.

Health Disparities CollaborativesHealth Disparities Collaboratives

HRSA has set a target of having every Community HRSA has set a target of having every Community Health Center patient with a chronic disease Health Center patient with a chronic disease participating in a relevant disease management participating in a relevant disease management collaborative.collaborative.Disease management is centered on measurement Disease management is centered on measurement of clinical indicators and an integrated team of clinical indicators and an integrated team approach to improve care.approach to improve care.CommUnityCare collaborative participation began in CommUnityCare collaborative participation began in 2003.2003.

Health Disparities CollaborativesHealth Disparities Collaboratives DepressionDepression

Depression Depression –– primary measures are drop in patientprimary measures are drop in patient’’s s depression score, or decline in clinically significant depression score, or decline in clinically significant depressiondepression

Initiated July 2003Initiated July 20032,476 patients enrolled2,476 patients enrolledDavid Powell, East, Montopolis, Northeast, Pflugerville, SouthDavid Powell, East, Montopolis, Northeast, Pflugerville, SouthGoal of 50% of patients experiencing a 5 point drop, Goal of 50% of patients experiencing a 5 point drop, CommUnityCare average is currently 45.1 %CommUnityCare average is currently 45.1 %CommUnityCare average patients with a 50% decline in clinical CommUnityCare average patients with a 50% decline in clinical depression is currently 30.7%, versus a Texas rate of 30.1%depression is currently 30.7%, versus a Texas rate of 30.1%

CommUnityCare received national recognition as one of CommUnityCare received national recognition as one of the top five FQHCs in reducing patient depression the top five FQHCs in reducing patient depression scores in 2006.scores in 2006.

Health Disparities CollaborativesHealth Disparities Collaboratives DiabetesDiabetes

Diabetes Diabetes –– primary measure is average primary measure is average HbA1c scoreHbA1c score

Initiated April 2005Initiated April 20052,026 patients enrolled2,026 patients enrolledMontopolis, Pflugerville, Rosewood Zaragosa, Montopolis, Pflugerville, Rosewood Zaragosa, SouthSouthNational HbA1c rate is 7.65, Texas average is National HbA1c rate is 7.65, Texas average is 7.92. Current CommUnityCare rate is slightly 7.92. Current CommUnityCare rate is slightly higher at 8.0.higher at 8.0.

Health Disparities CollaborativesHealth Disparities Collaboratives Asthma and CardiovascularAsthma and Cardiovascular

Asthma Asthma –– primary measure is symptom free daysprimary measure is symptom free daysInitiated April 2006Initiated April 2006176 patients enrolled176 patients enrolledSouthSouthGoal of 10 days, CommUnityCare average is 7.4 daysGoal of 10 days, CommUnityCare average is 7.4 days

Cardiovascular (as part of OC3) Cardiovascular (as part of OC3) –– primary measure is primary measure is controlled hypertensioncontrolled hypertension

Initiated June 2007Initiated June 20071,019 patients1,019 patientsSouthSouth45% of patients with hypertension have controlled blood 45% of patients with hypertension have controlled blood pressurepressure

Health Disparities CollaborativesHealth Disparities Collaboratives Mental HealthMental Health

Primary Care Mental Health Primary Care Mental Health –– improve care improve care for bipolar patientsfor bipolar patients

Initiated June 2007Initiated June 2007Developed and implemented new screening Developed and implemented new screening tools to identify bipolar patientstools to identify bipolar patientsImplemented new referral process between Implemented new referral process between CommUnityCare and ATCMHMR to improve CommUnityCare and ATCMHMR to improve access to servicesaccess to services


May 28, 2009

Agenda Item 2 Discuss and take appropriate action on a proposed amendment to the Agreement for Primary Care Services by and between the Travis County Healthcare District and Lone Star Circle of Care to provide services to additional individuals, increase the total contract amount, and authorize the expenditure of $227,500 in Fiscal Year 2009 expansion funds to provide the additional services.

(Back-Up – Recommendation Summary)

Travis County Healthcare District Request for Board of Managers Consideration

May 28, 2009 Board of Managers Regular Agenda Item: 2. Discuss and take appropriate action on a proposed amendment to the Agreement for

Primary Care Services by and between the Travis County Healthcare District and Lone Star Circle of Care to provide services to additional individuals, increase the total contract amount, and authorize the expenditure of $227,500 in Fiscal Year 2009 expansion funds to provide the additional services.

Recommended Board Action: Approve a first amendment to the District’s contract with Lone Star Circle of Care for primary care services to increase the contract term amount by $227,500 to expand the service population to include unfunded Travis County residents.

TCHD Strategic Direction: PC02: Implement a systematic approach for better utilization and coordination of primary care services. Resource Impact: The District has $227,500 available in the service expansion budget. Anticipated Result: The requested increase will expand the primary care provider network for unfunded Travis County residents to include the Lone Star Circle of Care Network. Reimbursement for services will be provided at $91.00 per visit which will allow for 2,500 visits for this population during the current contract period.

Background Summary:

Background: The current District contract with Lone Star Circle of Care is in its initial term of February 2, 2009, through February 1, 2010, with four 12-month renewal options. The amount of the initial contract term is $300,000 to serve up to 1,000 Medical Assistance Program (MAP) enrollees.

This request will expand the population to be served from only MAP enrollees to unfunded

Travis County residents within the District’s income guidelines. The funds requested would increase the current contract by $227,500, from an amount not to exceed $300,000 to $527,500, based on the projected utilization needs of the unfunded adult population.

• Current population being served: MAP enrollees • New Eligible population to be served: Unfunded Travis County residents aged 18 or

over who have a household income at or below two hundred percent (200%) of the Federal Poverty Income Guidelines;

• Number of medical visits to be provided with new funds: 2,500 face-to-face meetings between an eligible patient and a physician, physician assistant, or advanced nurse practitioner;

• Services to be provided to eligible population: adult primary care and incidental services such as professional services, ancillary services, pharmacy, medical equipment, and disposable medical supplies routinely provided during a provider’s office visit;

Approval of this request will expand the provider network for the unfunded to include – CommUnityCare, Project Access, People’s Community Clinic, El Buen Samaritano, and Lone Star Circle of Care. LSCC now has clinics in both Williamson and Travis counties.

Board Committee Coordination: COMMITTEE CHAIR COMMENTS DATE

CONSIDERED Budget & Finance Committee

Frank Rodriguez

Not discussed due to lack of time. 5/21/2009

Board of Managers

Tom Coopwood

5/28/2009


May 28, 2009

Agenda Item 3 Discuss and take appropriate action on proposed agreements for the provision of urgent care by and between Texas Urgent Care and NexCare and Travis County Healthcare District and authorize the expenditure of $100,000 in Fiscal Year 2009 expansion funds to fund these agreements.

(Back-Up – Recommendation Summary)

Travis County Healthcare District Request for Board of Managers Consideration

May 28, 2009 Board of Managers Regular Agenda Item: 3. Discuss and take appropriate action on proposed agreements for the provision of urgent

care by and between Texas Urgent Care and Travis County Healthcare District and NexCare and Travis County Healthcare District and authorize the expenditure of $100,000 in Fiscal Year 2009 expansion funds to fund these agreements.

Recommended Board Action: Approve two contracts -- one with Texas Urgent Care and one with NexCare -- for urgent care services for MAP enrollees in an amount not-to-exceed $100,000 for the initial twelve (12) month term of each contract.

TCHD Strategic Direction: PC01: Assure all clinics dedicated to serving underserved populations operate at their full capacity. Explore options to increase primary and specialty care capacity for target population. Resource Impact: The District has $100,000 available in the 2009 expansion budget to support the proposed services. Anticipated Result: This contract for urgent care services is anticipated to support 1,000 visits during the initial 12 month period. The District has negotiated a payment rate of 115% of the prevailing Medicare rate for services provided.

Background Summary:

Background: The District continues to explore options to allow for the timely access of primary care services for its target population. To this end, the District has researched additional opportunities outside of the safety net provider network that would allow for care to be provided outside of the normal business days and hours and in response to urgent care needs as those arrive.

The proposed contracts will provide access to urgent care services for MAP enrollees at any of the five sites managed by the contracted providers. Texas Urgent Care has one urgent care facility at William Cannon and Manchaca in Austin. NexCare has four locations – two in Austin, one in Round Rock, and one in Georgetown. It is hoped that the additional urgent care availability will reduce the inappropriate utilization of emergency room services. To this end, staff will audit services, review claims, and facilitate the transfer of claims data into the Integrated Care Collaboration’s (ICC) I-Care database to ensure other MAP providers are aware of the range of services received by this population. Board Committee Coordination: COMMITTEE CHAIR COMMENTS DATE

CONSIDERED Budget & Finance Committee

Frank Rodriguez

Committee voted to recommend approval to Board with requirement for staff to facilitate transfer of data into the I-Care data repository.

5/21/2009

Board of Managers

Tom Coopwood

5/28/2009


May 28, 2009

Agenda Item 4 Discuss and take appropriate action on information

related to a customer call center for the Medical Assistance Program.

(No Back-Up)


May 28, 2009

Agenda Item 5 Discuss and take appropriate action on proposed

revisions to the District’s purchasing policies. (Back-Up – Memo)

- 1 -

Memo: To: Travis County Healthcare District Board of Managers From: Donna Scarbrough, Manager, Purchasing/Projects CC: Trish Young, Carolyn Konecny, Stacy Wilson Date: May 22, 2009 Re: Agenda Item #5: Discuss and take appropriate action on proposed revisions to

the District’s purchasing policies. Statement of Issue: The District’s current purchasing policy (PUR001) requires Board approval on purchases solely based on contract dollar value; i.e. those items that are above the President and CEO’s signatory authority of $50,000. The policy does not distinguish or make exceptions for Board approval of individual expenditures, whether contract or purchase order, which support items or programs having already received Board approval during the annual budget adoption process or at a Board meeting. At its April 2009 meeting, the Budget and Finance Committee directed staff to bring back three items in May: 1) an update to the previous research related to signature authority for other hospital districts that are comparable to TCHD; 2) updated profiles of contracts by amount; and 3) proposed changes to the purchasing policy. The Budget and Finance Committee discussed this memorandum at its May 21, 2009 meeting and the Committee’s recommendations are reflected in the proposed policy changes. Background: The District Board of Managers approved the District’s purchasing policy in January 2007, at the same time that the purchasing function was transferred from Travis County to the District. The approved policy delegates to the President and CEO signature authority for those contracts and renewals that are at or below $50,000. The basis for this level was that it mirrored the signature authority that the Travis County Commissioners Court had delegated to its Purchasing Agent. Item 1: Updated Signature Authority Table 1 presents the updated signature authority research. Per the Committee’s direction, the staff researched comparative data to determine which hospital district(s) were the most comparable to TCHD. Comparability to TCHD depends on the selected metric. In terms of budget and operations, Nueces County Hospital District is the most comparable to TCHD because it is the only other hospital district that does not directly operate a hospital. However, it does not separately contract for service providers. Clinic operations are also part of the lease. In terms of tax revenue, El Paso County Hospital District is the most comparable to TCHD.

- 2 -

Table 1: Comparison of Contract Signature Authority

Hospital District Authority Notes Travis County $50,000 President and CEO is designated as District purchasing officer.

Authority applies to contracts and renewals (whether competitively procured or exempted)

Harris County $100,000 Harris County Purchasing Agent is designated as purchasing director and has this signatory authority.

El Paso County* $100,000 CEO is authorized to sign contracts for expenditures approved in the annual budget process (no dollar limit); otherwise, authorized up to $100,000.

Bexar County (University Health)

$125,000 $75,000

CEO authority for items that are competitively-procured CEO authority for competitively-exempted items

Dallas County (Parkland)

$200,000 Authority of Vice President of Strategic Sourcing (Dallas County’s equivalent of a purchasing officer).

Nueces* $50,000 All operational contracts (including provider contracts) are covered under hospital lease arrangement with Spohn. CEO’s authority is for administrative contracts (e.g. office supplies)

*Districts that are most comparable to TCHD based on financial or operational metrics. Item 2: Updated Contract Profiles by Amount An analysis of District contracts for fiscal years 2008 and 2009 (year-to-date) shows that 71% of the 124 total contracts are less than $100,000 (Table 2). Several contracts in 2008 and early 2009 are related to transition. Since March 1, 2009, there are more facilities-related contracts, reflecting increased maintenance duties as a result of the ownership of additional buildings and the leases with the City of Austin as well as opening new sites such as CommUnityCare Rundberg.

Table 2: Contract Value Distribution Analysis

Contract Dollar Value

Ranges Number of Contracts

Percent of Total Contracts

Cumulative Percent

$0 – $5,000 37 30% 30% $5,001 – $25,000 23 19% 48% $25,001 – $50,000 19 15% 64% $50,001 – $100,000 9 7% 71% $100,001 – $150,000 5 4% 75% $150,001 – $250,000 6 5% 80%

$250,001 – $1,000,000 15 12% 92% >$1,000,000 10 8% 100%

Total Contracts 124 100% Item 3: Proposed Changes to the Purchasing Policy A summary of the proposed changes includes:

• A “pre-authorization” framework in which the Board authorizes the President and CEO to execute contracts that meet certain criteria regardless of dollar value;

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• Addition of approvals and description of procedural information for emergency purchases;

• Authorization of ministerial contract execution duties by the President and CEO to staff; and

• A proposed change to the President and CEO’s contract signature authority from $50,000 to $100,000.

Proposed Policy Language Changes (President & CEO Authority): The District Board of Managers delegates the following authority to its CEO in the purchasing and execution of contracts on behalf of the District:

• Identification and application of the appropriate procurement method as outlined by policy;

• Approval and administration of exemption orders based on the following categories:

o Exemptions for sole source as prescribed by statute;

o Situations where a single provider(s) are geographically available or have been designated for use by another governmental entity;

o Exemptions from the competitive procurement requirements for professional services or specialized consulting services; and

o Exemptions for emergency situations affecting public health or District operations.

• Authorization to execute contracts, including renewals and amendments, (regardless of amount) that meet any of the following “pre-authorization” criteria so long as the contract is reported to the Board of Managers at a subsequent regular monthly meeting:

o Reflects the budgeted funds that have been previously approved by the Board of Managers for the contracted item or service during the annual budget adoption process;

o Reflects the use of budgeted service expansion funds that have been previously approved by the Board of Managers during the annual budget adoption process so long as the budget remains within the category and limit of expenditures of the expansion funds;

o Contract is required to implement initiatives and/or projects that have been previously approved as an agenda item by the Board of Managers; or

o Contract is of an emergency nature, affecting public health or inhibiting District operations.

• Authorization to execute contract renewals and amendments regardless of the amount if the amendment and renewal for a technical correction and the amendment and renewal is reported to the Board of Managers at a regular monthly meeting.

• Authorization to award contracts and/or contract amendments and modifications that have not been “pre-authorized” up to $100,000;

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• Authorization to reject bids/proposals that do not meet District needs and to re-solicit procurements as needed.

Notwithstanding the authority granted herein, the President and CEO, in his or her discretion, may choose to take any procurement action to the District Board of Managers for approval. Proposed Policy Language Changes (Procedural Information): In complying with this policy, the following is expected from employees based on their designated roles and responsibilities:

• The District will use Requisitions also known as Purchase Requests as the mechanism for identifying non-routine, non-contract, singular purchases that will be solicited informally.

• District staff that is the most knowledgeable about the good or service needed is primarily responsible for specification development. Staff will complete a Purchase Request to document the needed item or service and submit it for approval by the appropriate supervisory senior staff and for review by the Chief Financial Officer (CFO)/designee to confirm available budget as outlined in the purchasing procedure. The Purchasing Administrator provides technical expertise and works with District staff to ensure the specification will provide what the District needs and that it is not too narrowly focused to effectively minimize competition.

• For emergency purchases, District staff will notify the Purchasing Administrator of the emergency and work with the Purchasing Administrator to promptly identify and purchase the needed item or service to handle the emergency using the most appropriate procurement method. The Purchasing Administrator will submit the appropriate procurement documentation for approval by the District President and CEO or designee.

• District executive staff and the Purchasing Administrator will perform ministerial duties to process and sign Purchase Orders and contracts as authorized by the District President and CEO and outlined in the purchasing procedure.

• The Chief Financial Officer is authorized to approve and sign Purchase Requests, Purchasing Card purchases, Purchase Orders and/or contracts up to $$25,000, subject to available budget. The Purchasing Administrator is authorized to sign approved Purchase Orders up to $25,000 that have been electronically approved by Chief Financial Officer, the President and CEO or Chief Service Delivery Officer (Associate Administrator).

• The District will use multiple methods to make vendors aware of District procurement opportunities. Examples of methods that may be used include: direct notices sent to vendors based on Internet research; advertisement in local newspapers, including those that focus on HUB communities; use of the District website; use of the District’s e-bidding system (BidSync); and posting the requirements on the State’s procurement website.


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Proposed Policy Changes (Purchasing Thresholds and Methods): The amount and type of purchase will influence the purchasing method chosen by the District. In general, the District will use the following purchase dollar thresholds as guidelines for determining which procurement method to use:

• Less than $5,000: District staff will develop requirements, research potential vendors, and obtain appropriate approvals (supervisory and financial) in accordance with the purchasing procedures. Staff will note whether the vendor will accept the procurement card. Staff will work with the Purchasing Administrator to obtain a quote from a single vendor (preferably a HUB if practical) that results in a Purchase Order issued by the Chief Financial Officer or Purchasing Administrator or a Procurement Card purchase as allowed by policy.

• Between $5,000 and $24,999: District staff will develop requirements, research potential vendors, and obtain appropriate approvals (supervisory and financial) in accordance with the purchasing procedures. The Chief Financial Officer/designee will verify funds are available before the procurement process begins. The Purchasing Administrator will informally solicit bids/quotes from potential vendors. Attempts will be made to solicit at least three vendors and to include HUBs whenever practical. Pools of pre-qualified vendors may also be used. The Chief Financial Officer or Purchasing Administrator will issue a Purchase Order or contract as authorized by policy.

• $25,000 or More. For purchases of $25,000 or more (excluding professional services that specify a different process), the District Purchasing Administrator will use a competitive method such as sealed bid or proposal or reverse auction. Professional services will be solicited when practical as determined by the President and CEO in consultation with the Purchasing Administrator. The resulting contract for award will be executed by a Board member or the President and CEO as authorized by the District Board of Managers. The District may choose to exempt or limit competition in certain situations such as: procurements of personal or professional services, procurements when the good or service is sole source or is only available from a limited number of vendors, or in unique situations where expediency is needed because it affects public health or is detrimental to District operations.

• Emergency Purchases: The following purchases are considered exempted from the

competitive procurement process:

o an item or service that must be purchased in a case of public calamity if it is necessary to make the purchase promptly to relieve the necessity of the citizens or to preserve the property of the District;

o an item or service necessary to preserve or protect the public health or safety of the residents of the District; or

o an item or service necessary because of unforeseen damage to District property (including leased facilities).


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1

Travis County Healthcare District

Policy Name: General Purchasing Policy Policy Number: PUR 001

Approval Date:

President/CEO: Patricia A. Young-Brown

Original Signed:

Attachments:

Effective Date: Last Revision Date:

Policy: It is the policy of the Travis County Healthcare District (TCHD or District) that its procurement processes for goods and services result in the best value for the District while providing an open and fair process for qualified vendors.

Intent and Scope: As a public institution, TCHD is held to a high degree of public scrutiny and accountability for its business practices. District funds should be used responsibly and in a manner consistent with TCHD’s mission, applicable laws, and ethical practices, as well as in a manner that obtains the best value for the District for each purchase. This policy establishes and communicates a standard District-wide approach to procurement activities and applies to all District employees and funds. Detailed procedures for applying this policy and applicable forms are found in the District’s purchasing manual. Exception to or deviation from this policy may be allowed in the best interest of the District and its provision of services for the under-insured and un-insured residents of Travis County, provided the intent set out in this policy is observed. Such deviations must be approved by the District President and CEO (CEO).

Guiding Principles: The District identifies the following procurement principles that are essential to its success: • Quality customer service based on flexibility, competitiveness, and innovation. The

District’s health service delivery environment requires quick responses and adaptability to changing needs.

2

• Integrity and commitment to the highest ethical standards of the purchasing profession when dealing with internal and external customers. The District is committed to a fair, non-discriminatory purchasing process with open access to procurement opportunities and information.

• Obtaining goods and services that provide the greatest value to the District based on

factors other than price. The District expects quality, innovation, and superior service and delivery from vendors and business partners that will result in the best overall value to the District over the life of the contract.

• Effective partnerships among the District, its purchasing staff, and the business

community based on a mutual understanding of the District’s business needs. This understanding is the foundation for planning, implementing, and managing the best contracts.

• Innovation and creativity in developing and providing successful procurement

solutions to meet the District’s business needs. • Equal opportunity in contract awards to all businesses, including Historically

Underutilized Businesses (HUBs). The District’s Board of Managers seeks to ensure that a good faith effort is made to assist certified HUB vendors and contractors in its award of contracts and subcontracts.

Standards: The District shall comply with the following standards in its purchasing processes.

Health & Safety Code § 281.049 (Purchasing/Accounting Methods and Procedures) Government Code § 497.024 (Purchase of items from the Institutional Division of the Texas Department of Corrections) Government Code Chapter 791 (Interlocal Cooperation Act) Government Code Chapter 2157 (Catalog Purchase Procedures through the Texas Building and Procurement Commission) Government Code Chapter 2251 (Prompt Payment Act) Government Code Chapter 2252 (Contracts with Government Entities – Reciprocal penalties for out-of state governments that impose penalties on Texas bidders) Government Code Chapter 2253 (Public Work Performance and Payment Bonds) Government Code Chapter 2254 (Professional Services Procurement Act) Government Code Chapter 2258 (Prevailing Wage Rates) Human Resources Code Chapter 122 (Purchasing from People with Disabilities) Local Government Code Chapter 171 (Conflict of Interest Reporting) Local Government Code Chapter 176 (Disclosure of Relationships with Local Government Officers) Local Government Code Chapter 271 (Purchasing and Contracting Authority of Municipalities, Counties and Certain Other Local Governments)- Chapters A-I, Z 28 Tex. Admin. Code § 110.110 (Workers’ Compensation-required language for Construction Contracts) Health & Safety Code § 361.426 (Recycled Product Preferences)

3

Code of Ethics District employees are expected to be impartial to ensure fair and competitive access to governmental procurement by responsible vendors. District employees shall act to foster public confidence in the integrity of the District and its procurement process. District employees shall avoid any activity (either business or professional) and avoid incurring any obligation that would cause a conflict with, compromise, or give the perception of compromising the integrity of the District. Examples of the types of activities to be avoided include: accepting gratuities (gifts, cash, meals, loans) of any kind valued at more than $50 per year from current or potential vendors; using confidential proprietary information for actual or anticipated personal gain; or disclosing a vendor’s confidential proprietary information inappropriately to other vendors during the procurement process.

Definitions: Competitive Bidding: A process that allows available vendors to compete with each other to provide goods or services to the District. The responses to a competitive bid are sealed until publicly opened by the District.

Competitive Proposal: A process that allows available vendors to compete with each other to provide goods and services to the District but permits flexibility and negotiation in soliciting the best value for the District. To the extent permitted by law, the responses to a competitive proposal are sealed until a contract has been awarded.

Historically Underutilized Business (HUB): A business with at least 51 percent ownership by one or more persons who have been historically underutilized (economically disadvantaged) because of their identification as being African American, Hispanic American, Asian-Pacific American, Native American, or women who actively participate in the business’s control, operation, and management and that has been certified by a governmental program.

Item: Any good or service that is to be purchased for use by TCHD.

Purchasing Administrator(s): An individual(s) designated by the CEO with the responsibility for purchasing and overseeing the procurement process of the District.

Purchase Order: Document expressing the contractual terms and conditions related to a particular procurement prepared by the District.

Requisition: A request from an authorized District employee to place an order for specific materials, supplies, equipment, or services needed to conduct normal District business operations.

Specification: A detailed description of the good or service to be procured by the District, including its use.

4

Restricted Purchasing Strategies District employees shall refrain from using purchasing strategies designed to avoid formal competitive bidding, such as component purchases (purchasing in pieces rather than purchasing as a whole), separate purchases (purchasing goods in a series of separate purchases that normally would have been combined), and sequential purchases (purchases made over a period of time that would normally have been made as one purchase).

Purchasing Thresholds and Methods The amount and type of purchase will influence the purchasing method chosen by the District. In general, the District will use the following purchase dollar thresholds as guidelines for determining which procurement method to use: • Less than $5,000: District staff will develop requirements, research potential

vendors, and obtain appropriate approvals (supervisory and financial) in accordance with the purchasing procedures. Staff will note whether the vendor will accept the procurement card. Staff will work with the Purchasing Administrator to obtain a quote from a single vendor (preferably a HUB if practical) that results in a Purchase Order issued by the Chief Financial Officer or Purchasing Administrator or a Procurement Card purchase as allowed by policy.

• Between $5,000 and $24,999: District staff will develop requirements, research potential vendors, and obtain appropriate approvals (supervisory and financial) in accordance with the purchasing procedures. The Chief Financial Officer/designee will verify funds are available before the procurement process begins. The Purchasing Administrator will informally solicit bids/quotes from potential vendors. Attempts will be made to solicit at least three vendors and to include HUBs whenever practical. Pools of pre-qualified vendors may also be used. The Chief Financial Officer or Purchasing Administrator will issue a Purchase Order or contract as authorized by policy.

• $25,000 or More. For purchases of $25,000 or more (excluding professional services that specify a different process), the District Purchasing Administrator will use a competitive method such as sealed bid or proposal or reverse auction. Professional services will be solicited when practical as determined by the President and CEO in consultation with the Purchasing Administrator. The resulting contract for award will be executed by a Board member or the President and CEO as authorized by the District Board of Managers. The District may choose to exempt or limit competition in certain situations such as: procurements of personal or professional services, procurements when the good or service is sole source or is only available from a limited number of vendors, or in unique situations where expediency is needed because it affects public health or is detrimental to District operations.

• Emergency Purchases: The following purchases are considered exempted from the competitive procurement process: • an item or service that must be purchased in a case of public calamity if it is

necessary to make the purchase promptly to relieve the necessity of the citizens or to preserve the property of the District;

5

• an item or service necessary to preserve or protect the public health or safety of the residents of the District; or

• an item or service necessary because of unforeseen damage to District property (including leased facilities).

The District will also extensively use cooperative purchasing through established local, state, and national purchasing cooperatives and will also “piggyback” on existing contracts with other governmental entities when these methods provide savings in staff time and costs and are determined by the Purchasing Administrator to provide the best value to the District. The District Board of Managers delegates the following authority to its CEO in the purchasing and execution of contracts on behalf of the District:

• Identification and application of the appropriate procurement method as outlined by policy;

• Approval and administration of exemption orders based on the following categories: • Exemptions for sole source as prescribed by statute; • Situations where a single provider(s) are geographically available or have

been designated for use by another governmental entity; • Exemptions from the competitive procurement requirements for professional

services or specialized consulting services; and • Exemptions for emergency situations affecting public health or District

operations.

• Authorization to execute contracts, including renewals and amendments, (regardless of amount) that meet any of the following “pre-authorization” criteria so long as the contract is reported to the Board of Managers at a subsequent regular monthly meeting: • Reflects the budgeted funds that have been previously approved by the Board

of Managers for the contracted item or service during the annual budget adoption process;

• Reflects the use of budgeted service expansion funds that have been previously approved by the Board of Managers during the annual budget adoption process so long as the budget remains within the category and limit of expenditures of the expansion funds;

• Contract is required to implement initiatives and/or projects that have been previously approved as an agenda item by the Board of Managers; or

• Contract is of an emergency nature, affecting public health or inhibiting District operations.

• Authorization to execute contract renewals and amendments regardless of the amount if the amendment and renewal for a technical correction and the amendment and renewal is reported to the Board of Managers at a regular monthly meeting.

6

• Authorization to award contracts and/or contract amendments and modifications that have not been “pre-authorized” up to $100,000;

• Authorization to reject bids/proposals that do not meet District needs and to re-solicit procurements as needed.

Notwithstanding the authority granted herein, the President and CEO, in his or her discretion, may choose to take any procurement action to the District Board of Managers for approval.

Procedural Information In complying with this policy, the following is expected from employees based on their designated roles and responsibilities:

• The District will use Requisitions also known as Purchase Requests as the mechanism for identifying non-routine, non-contract, singular purchases that will be solicited informally.

• District staff that is the most knowledgeable about the good or service needed is primarily responsible for specification development. Staff will complete a Purchase Request to document the needed item or service and submit it for approval by the appropriate supervisory senior staff and for review by the Chief Financial Officer (CFO)/designee to confirm available budget as outlined in the purchasing procedure. The Purchasing Administrator provides technical expertise and works with District staff to ensure the specification will provide what the District needs and that it is not too narrowly focused to effectively minimize competition.

• For emergency purchases, District staff will notify the Purchasing Administrator of the emergency and work with the Purchasing Administrator to promptly identify and purchase the needed item or service to handle the emergency using the most appropriate procurement method. The Purchasing Administrator will submit the appropriate procurement documentation for approval by the District President and CEO or designee.

• District executive staff and the Purchasing Administrator will perform ministerial duties to process and sign Purchase Orders and contracts as authorized by the District President and CEO and outlined in the purchasing procedure.

• The Chief Financial Officer is authorized to approve and sign Purchase Requests, Purchasing Card purchases, Purchase Orders and/or contracts up to $$25,000, subject to available budget. The Purchasing Administrator is authorized to sign approved Purchase Orders up to $25,000 that have been electronically approved by Chief Financial Officer, the President and CEO or Chief Service Delivery Officer (Associate Administrator).

• The District will use multiple methods to make vendors aware of District procurement opportunities. Examples of methods that may be used include: direct notices sent to vendors based on Internet research; advertisement in local newspapers, including those that focus on HUB communities; use of the District website; use of the District’s e-bidding system (BidSync); and posting the requirements on the State’s procurement website.


May 28, 2009

Agenda Item 6 Receive and discuss a report of the April 2009 financial statements for the Travis County Healthcare District.

(Back-Up – Financial Statements)


May 28, 2009

Agenda Item 7 Receive and discuss information related to development

of the District’s fiscal year 2009-2010 budget and strategic objectives, including a discussion of the

District’s tax rate for that fiscal year. (No Back-Up)


May 28, 2009

Agenda Item 8 Receive and discuss reports from the Board committees: Audit and Compliance Committee, Budget and Finance Committee, and Legislative Committee (including a report from HillCo Partners, the District’s legislative consultant, on current and anticipated legislative and executive branch, including state agency activities).

(Back-Up – Minutes)

Unapproved

TRAVIS COUNTY HEALTHCARE DISTRICT BOARD OF MANAGERS

BUDGET AND FINANCE COMMITTEE

MINUTES OF THE MEETING –THURSDAY, APRIL 16, 2009 On Thursday, April 16, 2009, the Budget and Finance Committee of the Travis County Healthcare District Board of Managers convened in open session at 11:39 a.m. in the Cesar Chavez Board Conference Room, 1111 E. Cesar Chavez, Austin, Texas 78702. A quorum of the committee was present. The clerk for the meeting was Margo Davis.

1. Approve the minutes from the Budget and Finance Committee meeting on February 19, 2009.

Clerk’s Notes: A motion was made by Manager Coopwood and seconded by Manager

Rodriguez to approve the minutes as presented. The motion was adopted on the following vote:

Chair Rosie Mendoza For Manager Bobbie Barker Absent Manager Tom Coopwood For Manager Frank Rodriguez For

2. Approve a proposed amendment to the previously-approved minutes of the January

15, 2009, Budget and Finance Committee meeting. Clerk’s Notes: A motion was made by Manager Rodriguez and seconded by Manager Coopwood to approve the proposed amendment to the previously-approved minutes of the January 15, 2009, Budget and Finance Committee meeting as presented. The motion was adopted on the following vote:

Chair Rosie Mendoza For Manager Bobbie Barker Absent Manager Tom Coopwood For Manager Frank Rodriguez For

3. Discuss and take appropriate action on items affecting the District’s fiscal year 2008-2009 budget and strategic objectives.

4. Discuss and take appropriate action on items affecting the District’s fiscal year

2009-2010 budget and strategic objectives. 5. Discuss and take appropriate action on proposed revisions to the District’s

purchasing policies. 6. Discuss and take appropriate action on proposed agreements for the provision of

urgent care by and between Texas Urgent Care and RediClinics and Travis County Healthcare District and authorize the expenditure of Fiscal Year 2009 expansion funds for these services.

Page 1 of 2

Unapproved

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Clerk’s Notes: Manager Barker entered the meeting during this agenda item. 7. Discuss and take appropriate action regarding a proposed amendment to the

Agreement for Ophthalmologic Services between Travis County Healthcare District and Richard A. Briggs, M.D., P.A. to increase funding for eye disease services.

8. Discuss and take appropriate action on a proposed amendment to the Primary Care

Services Agreement by and between the Travis County Healthcare District and El Buen Samaritano Episcopal Mission and authorize the expenditure of Fiscal Year 2009 expansion funds for these services. Clerk’s Notes: The committee meeting adjourned at 1:35 p.m. on a motion made by Manager Coopwood and seconded by Manager Rodriguez which was adopted on the following vote: Chair Rosie Mendoza For Manager Bobbie Barker For Manager Tom Coopwood For Manager Frank Rodriguez For


May 28, 2009

Agenda Item 9 Receive and discuss the CEO’s report on the following District activities: (a) procurement activity; (b) communications/outreach statistics for April 2009; (c) a status report on CommUnityCare-North Central; (d) E-Merge evaluation monthly update; (e) the MAP Program, including May enrollment and activities; (f) District’s Fiscal Year 2009 second quarter activities in support of the District’s strategic plan; and (g) Psychiatric Stakeholders meetings.

(Back-Up – Reports)

Travis County Healthcare District Board of Managers

Procurement Activity Report

Through its purchasing policy (PUR001), the Board of Managers has authorized the District President and CEO to execute District contracts with a value of less than $50,000 without requiring board action or approval. In addition, the Board of Managers also authorizes the President and CEO to execute certain contracts on its behalf where the terms are as or more favorable than those presented to the Board at a regularly-scheduled meeting. The following list identifies the contracts that were executed by the District President and CEO from April 15, 2009 through May 20, 2009. A contract summary page outlining specific terms, conditions, and award information (as applicable) is provided for each contract directly executed by the President and CEO as authorized by PUR001. Contracts approved by Board of Managers with authorization for the District President and CEO to execute:

Renewal of agreement with Aon Consulting for human resource consulting services on an as needed basis.

Renewal of agreement for orthotics with Applied Orthotics.

Leases with the City of Austin for the following CommUnityCare sites: AK Black, Rosewood-Zaragosa, South Austin, ARCH, Montopolis (Grounds), RBJ 5th Floor.

Amendment with Dr. Richard Briggs for Ophthalmologic Services.

Amendment of contract for infrastructure and IT managed services with White Glove Technologies d/b/a Network Logistic, Inc. (NLI) and issuance of a task order ($28,754) for outstanding items.

Amendment of contract with Texas Institute for the Blind and Handicapped (TIBH) for custodial services at Rundberg site.

Interlocal agreement with City of Austin for EMS Services.

Interlocal agreement with City of Austin for close out and post transition services.

Amendment of contract with Radiation Oncology Group (d/b/a Austin Cancer Centers) for radiation oncology services.

Renewal and second amendment with Fulbright & Jaworski for professional legal services (transfer of Medicaid and Medicare numbers).

Agreement with Seton for the expansion of reconstructive and plastic surgery programs.

Contracts (<$50,000) executed by District President and CEO as authorized by PUR001:

Purchase order for laptop with En Pointe Technologies Sales, Inc. ($1,687).

Purchase order for inspection of structures at 1210 W. Braker Lane to Baer Engineering and Environmental Consulting, Inc., a HUB ($2,860).

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Travis County Healthcare District Board of Managers

Procurement Activity Report

Page 2 of 2

Conflict-of-Interest Statement Information: Chapter 176 of the Local Government Code requires that local government officers file a conflict-of-interest statement disclosing certain relationships with a vendor within seven (7) days of becoming aware of facts that give rise to the conflict. The District has contracted with the following new vendors:

En Pointe Technologies Sales, Inc.

Baer Engineering and Environmental Consulting, Inc.

Please ensure that you have no conflict-of-interest with this vendor that would require the filing of a conflict-of-interest statement. You do not need to do anything if you have no conflict. Completed conflict-of-interest statements should be filed with the District Administrative Supervisor (Kay Williams) using the form found in your Board packet. If you have any questions about whether you have a conflict, please contact Stacy Wilson.

Date Presenters ~# in attendance

4/28/09Christie &

Larry 200+

4/29/09Trish & Christie 15

5/5/09 Trish & Leslee NA

5/12/09 NA NA

5/19/09 Elaine & Beth 15

5/20/09 Trish

Month Visits Unique VisitorsPage

views *Bounce Rate **

Time on Site Top 3 Pages

April, 2009 1,477 885 5,768 46.24% 2:27 1) traviscountyhd.org - 26.21%

2) /healthcare_services.htm - 8.56%

3) /about_us.html - 6.93%

March, 2009 1,747 1,277 6,639 40.70% 2:44 1) /healthcare_services.htm - 21.16%

2) /about_district - 9.79%

3) /people_profile - 8.98%

Date Author/Reporter

5/15/09 Mary Ann Roser

4/24/09 Matt Fleener

4/24/09

4/24/09

Patients struggle to paymedical bills

Venue/Topic

Communications/Outreach ReportApril-May 2009

Presentations/Events

Drive the Change communitywide product launch

Special Projects

ATCMHMR Budget Community Forum

Hispanic Quality of Life Community Health Forum

North Shore Lake Travis Rotary Club

Web site launched, completion of FY08 Annual Report, Messaging session with TateAustinHahn, internal communications development, employee recognition

**Bounce Rate is the percentage of single-page visits (i.e. visits in which the person left your site from the entrance page).

Earned Media

Media Outlet Title/Content

Travis County Commissioners Court

CAN - local impact of stimulus funding

Web Site Statistics

*Pageviews is the total number of pages viewed on your site and is a general measure of how much your site is used.

Healthcare District Board Selects Officers

Austin American StatesmanHealth district board torn: Raise taxes? Tap reserves? Do both?

*Numbers are incomplete as new Web site was not launched until mid-April.

Media ReleasesTravis County Commissioners Court appoints Brenda Coleman-Beattie to the Healthcare District Board of

Managers

KXAN

Timeline Development Work Plan Land Prep Communications

Dec. 5

TCHD made all study reports available via the dedicated NC HC Web site, including Feasibility Study Report, Phase I Environmental Site Assessment, Traffic Impact Analysis, Land Title Survey and a Topographic and Tree Survey.

Dec. 10TCHD Board of Managers held a special meeting to discuss the study reports with interested residents of the area.

Dec. 18 Board votes to purchase land. Board votes to purchase land.A press release was issued and notice placed on both the dedicated NC HC Project and TCHD Web sites.

January

A Purchase Order was issued by TCHD and a bid subsequently awarded for securing and boarding up all structures on the property.

FebruaryWork began to secure and board up all structures on the property.

A postcard was physically mailed to all residents within three miles of the site during the second week of February, advising of the upcoming work and to be aware of other future projects.

March

April

An environmental survey to determine if any hazardous materials are present within the structures prior to demolition was begun on April 20.

Notification was sent on April 16 to everyone who had registered to receive news via the NC HC Web site.

May

Results of environmental survey accepted. Request for Qualifications for project management firm released on May 8.

Initial meeting with neighborhood leadership to discuss community outreach and involvement held on May 6. Next meeting planned for mid-June.

Contract for structure demolition to be awarded.

Environmental abatement project completed. Demolition completed. Notification will be sent as details become available.

Contract for brush clearing to be awarded. Demolition completed.Project planning and neighborhood input work plans developed once project management firm is hired.

Contract for project management firm to be awarded. Structure demolition to be completed.

Brush clearing of the entire property.

Updated May 20

North Central Health Center Project Report

Future Projects to be Completed

Translating Behavioral Health Interventions into the Primary Care Setting: Evaluation of an Integrated Behavioral Health Program for Underserved Patients

Project Status Report May 1, 2009

This report provides a status update for the project as of May 1, 2009. Study 1: Characterizing the E-Merge Program Study 2: Adequacy of Mental Health Screening Study 3: Evaluating the Impact of the E-Merge Program Studies 1, 2, and 3 are combined for this update because they share a common data source. A conference call to was held on April 20, 2009 with Elaine Carroll (TCHD), Andres Guariguata (Integrated Behavioral Health Services), David Pease (CommUnity Care), Brandon Suehs (UT), and Ken Lawson (UT) participating. The purpose of the call was to discuss the extraction of data from the Austin/Travis County NextGen computerized medical records system. At the time of the call, eligibility data had been matched to approximately 182,000 of the 185,000 relevant encounters in the database. To expedite the process, CommUnity Care will do the initial data extraction based on encounters and demographics, and UT will test for continuous eligibility. We expect to receive the data in the near future. As noted in the previous update, the extent of data cleaning needed will not be known until UT receives and evaluates the data. Once we have received the initial NextGen data extraction, it will be necessary to link to the ICC data. We have had discussions with ICC personnel about this process, and we will begin working on this process immediately upon receiving the data. Data analyses will begin after data cleaning and linking are completed. Study 4: Survey of E-Merge Participants and Primary Care Staff Perceptions about the Program Study 4a: Patient Survey

Patient recruitment began on Friday, March 13, 2009 at the Northeast Clinic. As of April 29, 2009, we had 20 study participants. With the addition of another graduate research assistant, we are looking to expand our recruitment to 3 clinics and have 3 recruitment

1

days a week by the end of May which should allow us to achieve our goal of 150-160 subjects as proposed. Study 4b: Clinician Survey The invitation to participate in the survey was sent by e-mail to clinicians on March 16, 2009. A follow-up e-mail reminder was sent on April 8, 2009. A total of 23 clinicians have completed the survey as of April 30, 2009. We plan to follow-up once more to improve the response rate. Data analyses will begin after data collection has been completed. Timeline At this time, we expect to complete the patient survey and the clinician survey by August 31, 2009. The timeline for completion of Studies 1, 2, and 3 will depend on receipt of the data; a delay in completion is likely for those studies. A revised study timeline is attached. Respectfully submitted on behalf of the project team, Ken Lawson, Ph.D. Associate Professor College of Pharmacy The University of Texas at Austin

2

3

Updated Timeline (as of May 1, 2009)

STUDY Estimated Completion

Studies 1-3

Preparation and submission to the DRC and IRB

Completed

IRB approval (expedited review) Completed Development of a data analysis plan

Preliminary plan completed (will be finalized after evaluating the data)

Data Cleaning July 15, 2009* Data Analysis August 31, 2009* Final report preparation October 15, 2009*

Study 4a

Patient survey development including translation into Spanish

Completed

Preparation and submission to the DRC and IRB (Full board review)

Completed

IRB approval (Full Board review) Completed Implementation and data collection June 30, 2009 Data coding, entry and analysis July 31, 2009 Final report preparation August 31, 2009

Study 4b

Clinician Survey Development Completed Preparation and submission to the DRC and IRB

Completed

IRB approval (expedited review) Completed Online survey development Completed Survey implementation March 16, 2009 Data Analysis June 30, 2009 Final report preparation August 15, 2009 * Estimates are subject to receipt of data by May 15, 2009 and extent of data cleaning needed.

MAP Enrollment FY08 and FY09

10,580

10,317

8,872

8,493

8,887

9,215

9,721

10,06510,240

10,34910,573

11,007

11,892

9,492

8,907

8,592 8,541 8,499

8,898

12,759

8,066

8,566

9,066

9,566

10,066

10,566

11,066

11,566

12,066

12,566

13,066

Oct-07

Nov-07

Dec-07

Jan-08

Feb-08

Mar-08

Apr-08

May-08

Jun-08

Jul-08 Aug-08

Sep-08

Oct-08

Nov-08

Dec-08

Jan-09

Feb-09

Mar-09

Apr-09

May-09

Enrolllment as of the 1st of Every Month

TCHD Strategic Quarterly Report -- FY09 Year-to-Date (YTD)

Strategic Focus Area: Healthcare Services Network

Primary Care FY09 YTD Service Levels and Trends Service Type/Provider FY08 Visits

(10/07-3/08) FY09 Visits

(10/08-3/09

% Change Total Primary Care Medical 81,018 84,048 +4%

CommUnityCare 76,600 76,860 -- El Buen Samaritano 323 3,083 +854%

People’s Community Clinic 3,789 3,768 -1% Project Access 306 337 +10%

Total Primary Care Dental (CommUnityCare)

12,732 13,034 +2%

FY09 YTD Network Expansions • The CommUnityCare network added the William Cannon facility and the Red River

Clinic. The District Board approved the purchase of property for a new North Central Community Health Center within the CommUnityCare network. (Q1)

• The contracts with El Buen, People’s, and Project Access were renewed at increased rates to allow for additional primary care service in the community. (Q1)

• The Board approved the renovation of a health care facility on Rundberg for a new CommUnityCare clinic. (Q2)

Specialty Care

FY09 YTD Service Levels and Trends Service Type/Provider FY08 Visits

(10/07 – 3/08) FY09 Visits

(10/07 – 3/09)

% Change Total Specialty Care Medical 23,258 21,775 -6%

Project Access 375 354 -6% *Specialty Clinic at UMCB 22,883 21,421 -6%

*Reflects total specialty clinic visits for self-pay, charity care, and MAP clients.

FY09 YTD Network Expansions • Specialty Care access was increased for MAP enrollees at the Paul Bass Clinic. (Q1)

Mental Health Care

FY09 YTD Service Levels and Trends Service Type/Provider FY08

Services (10/07-3/08)

FY09 Services (10/08-3/09)

% Change

Total Primary Behavioral Health Care Visits (CommUnityCare E-Merge)

6,073 5,419 -11%

*Total Inpatient Psych Admissions 590 822 +39% Austin State Hospital (ASH) 395 413 +5%

Community-Based Psych Hospital Admissions 195 409 +110% Austin Lakes Hospital 0 191 +100%

Seton Shoal Creek 195 218 +12% *ASH funding is provided by the state. Funding for the community-based beds provided by ATCMHMR, state crisis funds, and District.

5/19/2009 1


5/19/2009 2

FY09 YTD Network Expansions • The Austin Lakes Hospital began receiving inpatient mental health admissions. (Q1) • Crisis Respite services, supported with new state crisis funds, were initiated in

December. The inpatient portion of the program began in January. (Q1 and Q2) • The new District contract with Austin Lakes Hospital and Seton Shoal Creek allows for

purchase of intensive outpatient services in addition to inpatient beds. The first District-supported client enrolled in intensive outpatient services in March 2009. (Q2)

Annual Individual and Service Trends – Note that for current year YTD numbers will be

reported and added to until the annual number is complete for FY09. Quarterly trends are reported above.

Individuals Served by Primary Care Service Type

41,076

65,52761,580

6,96711,83312,628

4,5072,232

4,2350

10,000

20,000

30,000

40,000

50,000

60,000

70,000

FY07 FY08 FY09 YTD

Primary Care Medical(CommUnityCare, ElBuen, People's,Project Access)Primary Care Dental(CommUnityCare)

Primary CareBehavioral Health(CommUnityCare)

*Individuals are unduplicated by provider and service type but potentially duplicated across providers and service types.

Primary Care Visits by Type

85,517

164,872

194,767

11,49426,411 23,593

5,38910,376 11,4090

30,000

60,000

90,000

120,000

150,000

180,000

FY07

FY08

FY09

Q2

Primary CareMedical(CommUnityCare, El Buen,People's,ProjectAccess)Primary CareDental(CommUnityCare)

Primary CareBehavioralHealth(CommUnityCare)


Strategic Focus Area: Healthcare Services Network

Healthcare Expenditures

Provider Annual Budget

Amended Budget

YTD (thru 3/09)

% of Amended Budget

Expended

TCHD-Contracted

Services

TCHD-Contracted Populations

CommUnityCare $30,474,514 $30,474,514 $15,208,073 50% Primary Care Medical, Dental, Behavioral Health

MAP, Self-Pay

El Buen Samaritano

$163,728 $453,728 $114,671 25% Primary Care Medical

Self-Pay

People’s Community Clinic

$700,000 $700,000 $298,957

43% Primary Care Medical

Self-Pay,

Project Access $330,000 $330,000 $165,000 50% Primary Care Medical, Specialty Care

Self-Pay

Paul Bass Clinic $429,000 $429,000 $58,584 14% Primary (Continuity) Care

MAP

Seton Healthcare Network

$4,067,304 $4,067,304 $2,033,652 50% Hospital-Based Services

N/A -- All

Seton/TCHD Medicaid

$27,518,607 $27,518,607 $13,759,308 50% Hospital-Based Services

N/A -- All

UTMB $3,900,000 $3,900,000 $1,938,524 50% Hospital-Based Women’s Health Services

MAP, Self-Pay

Walgreen’s $1,224,866 $1,224,866 $577,205 47% Prescriptions MAP, Self-Pay

Seton Shoal Creek/Austin Lakes Hospital

$5,224,701 $5,224,701 $1,650,248 32% Inpatient and Intensive Outpatient Mental Health

Self-Pay

Report reflects recorded expenditures through 3/31/09.

5/19/2009 3


Strategic Focus Area: Patient Coverage Programs

FY09 YTD Average Enrollment Levels and Trends Average Monthly Enrollment FY08

(10/07-3/08)

FY09 (10/08-3/09)

% ChangeMAP Full Benefit 9,460 10,326 +9%

FY09 YTD Network Expansions • Expanded MAP primary care provider network to include Paul Bass (Continuity Care)

Clinic, Lone Star Circle of Care, and People’s Community Clinic (Q1) • Received Board approval to expand specialty care to be provided to MAP enrollees at

the Paul Bass Clinic (Q1) • Developed solicitation to seek urgent care availability for MAP clients (Q2)

FY09 YTD Service Utilization

FY09 Q1 MAP Visits by Encounter Type

14,919

11,505

16,588

508

5,463

2,4714,353

02,0004,0006,0008,000

10,00012,00014,00016,00018,000

CommUnity

Care Med

ical

CommUnity

Care Denta

l

CommUnity

Care Beh

avior

al Healt

h

Brack E

mergen

cy D

ept

Brack I

npati

ent

Brack O

utpati

ent

Brack S

pecia

lty C

linic

Visits

NOTE: Specialty care visits are also included in the outpatient numbers.

Major FY09 YTD Program Enhancements • 1,303 individuals have been certified in FY09 utilizing the mail-in renewal applications • Implemented scanning of eligibility-related documents • Initiated pilot testing of virtual eligibility certification process • Reviewed current eligibility guidelines/rules to identify possible changes that would

maintain program integrity while simplifying process for clients and staff such as reviewing feasibility of moving to 12 month coverage for all MAP enrollees (up from usual 6 months)

• Implemented point-of-service eligibility for sliding-fee-scale determinations at William Cannon site

• Executed consulting services agreement for re-branding of program

5/19/2009 4


Strategic Focus Area: Efficiency and Integration of the Service Delivery System

Major FY09 YTD Strategic Activities

• Working with safety net providers on standardizing required documentation for self-pay clients to facilitate access to services for this population. The efforts to expand the implementation and use of the NextGen system in all safety net clinics will facilitate the sharing of eligibility and healthcare information to also facilitate care. Presented project charter to the ICC in December.

• Working with St. Davids Community Health Foundation on the coordination of dental services in Travis County.

• Staff presented an overview of the community planning process to date including the airing of the Critical Conditions documentary and a regional community panel discussion. Next steps identified included creating and sustaining an action-oriented community conversation on what health care is currently available, what health care is still needed, and what actions are needed to achieve better access to health care for the community.

• The Board approved the District’s purchasing of NextGen software licenses, related programming and installation for the NextGen system at Seton specialty clinics to improve the exchange of clinical referral information of CommUnityCare clients requiring specialty services.

Strategic Focus Area: Regional Collaborations and Initiatives

Major FY09 YTD Strategic Activities

• Finalized legislative agenda and initiated efforts for current legislative session. • Signed contracts and data sharing agreements with Children’s Optimal Health program to

obtain maps reflecting all current safety net health care providers and specified demographics of Travis County population by small area to assist in planning of future services.

• Continued dialogue with Hays County to identify common interests. • The Board approved up to $339,450 to support the first year of a scaled-back small

employer health coverage program for qualifying Travis County employers with less than 50 employees. It is projected that 900 individuals will enroll in year 1. The Board also approved the District President and CEO to move forward with the development of the necessary organizational structure for the small employer health coverage program.

• The Board approved the award of $350,000 to the Seton Family of Hospitals to expand reconstructive and plastic surgery programs at University Medical Center at Brackenridge to help UMCB obtain Level 1 trauma status.

Strategic Focus Area: Infrastructure and Resources

Status of Tax Collections • Current year tax collections as a percent of the total tax is 99% through Q2 which is the

same percentage as the prior year second quarter. CommUnityCare Visit Payor Mix • Medicaid as a percent of payor mix for the clinics is 22.7% through Q2 of FY09. This is

about even with the Medicaid percentage of 22.6% through Q2 of FY08.

5/19/2009 5


5/19/2009 6

Strategic Focus Area: Infrastructure and Resources Cont’d.

Trends in Source of District Funding • Trends in the source of District funding is provided below.

Travis County Healthcare DistrictActual Revenue $ % $ % $ % $ % $ %Property Tax Revenue 46,299,165 60% 49,533,162 53% 54,461,216 60% 58,502,840 62% 63,005,817 79%DSH/UPL (Seton Lease) 28,029,577 36% 36,670,256 40% 28,434,895 31% 28,168,429 30% 15,167,637 19%Operating Lease Revenue 1,155,396 1% 1,155,396 1% 1,155,396 1% 1,155,396 1% 577,698 1%Investment Income 690,752 1% 2,803,272 3% 4,087,153 5% 3,733,173 4% 1,139,302 1%Tobacco Settlement 1,165,771 2% 2,489,720 3% 2,280,598 3% 2,993,571 3% - 0%Other/Miscellaneous -- 0% 820 0% 315 0% 6,250 0% 125 0%

77,340,661 100% 92,652,626 100% 90,419,573 100% 94,559,659 100% 79,890,579 100%

2009 YTD (thru 3/31/09)2005 2006 2007 2008

Psychiatric Services Stakeholder Meeting April 13, 2009

4:00 p.m. Cesar Chavez Building (1111 East Cesar Chavez)

MEETING NOTES

Attendees: Sherry Fleming – Travis County Health and Human Services and Veterans Services Betty Dunkerley – Former Mayor Pro Tem, City of Austin Larry Schooler – Aide to Council Member Lee Leffingwell David Evans – ATCMHMR Dr. Jim VanNorman – ATCMHMR Dawn Handley -- ATCMHMR Toni Inglis – ATCMHMR Board Diana Resnik – Seton Family of Hospitals Alan Isaacson – Seton Shoal Creek Hospital Dr. Chris Ziebell – University Medical Center at Brackenridge Mark Clayton – St. David’s Healthcare Steve Berkowitz – St. David’s Healthcare Bobbie Barker -- St. David’s Community Foundation Maria Talamo – Austin Lakes Hospital David Halpern – Mental Health America Diana Kern – Consumer Representative Dr. Tom Coopwood – Travis County Healthcare District Board Manager Brenda Coleman-Beatty – Travis County Healthcare District Board Manager Appointee? Patricia A. Young Brown –Travis County Healthcare District Elaine Carroll – Travis County Healthcare District Beth Peck – Travis County Healthcare District Kim McPherson – Health Management Associates Agenda/Notes: 1. Update on Stakeholder Funding Commitments

Trish Young reported that the District has a current commitment of approximately $5.2M for inpatient mental health services (as well as intensive outpatient services as deemed appropriate) for District-eligible patients. She stated that while the District is just beginning its budget process she anticipates that this amount will remain stable for FY10. She also indicated that the District anticipates continued funding of the E-merge program at the FY09 level but has not yet received a budget proposal from CommUnityCare. She reported that the District is currently in discussion with People’s Community Clinic to purchase integrated mental health services there as well. Bobbie Barker reported that a recent evaluation of the integrated mental health services being provided at People’s Community Clinic and LoneStar Circle of Care showed very positive outcomes for participating individuals. She stated that St. David’s Community

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Foundation will continue to support these programs and is considering supporting these services at other community clinics. The Foundation is also reviewing a proposal for the funding of crisis respite beds. ATCMHMR currently supports inpatient mental health services at $519,000 annually. David Evans reported that they are requesting this same amount for FY10. Sheri Fleming noted that while she does not feel that there will be any reductions to the MCOT financial support from the County she did note that all county departments have been asked to propose a five percent reduction. Larry Schooler reported that funding increases to social services contracts are being phased in beginning this year. Basic needs contracts are targeted for FY10 which he thought included mental health contracts as well. While it appears that there will be funding at the continued level for FY10, there were a number of concerns expressed about whether the current funding level is sufficient and/or whether it is being managed appropriately. Hospital staff noted longer wait times to place mental health clients in psychiatric beds while psychiatric hospital staff noted fluctuating enrollment. It was determined that the next CIC meeting should focus on the management of the dollars available for inpatient services to determine if there are other ways to allot the dollars, what risks the other methods might impose, and whether entities would be willing to assume the associated risks.

2. Update on Legislative Session David Evans reviewed a matrix on the status of appropriations requests for various services. The matrix reflects the dollars requested by service type, the dollars allocated to Article II (most likely to be funded) by both the house and senate as well as the dollars allocated to Article XI (only funded if funds available) in both houses. No final decisions on funding have been made. David also noted that Travis County will be part of an approved 1915(c) Medicaid waiver project. The program, called Youth Empowerment Services (YES) allows more flexibility in the funding of intensive community-based services and supports for children with serious emotional disturbances and their families. ATCMHMR will be providing administrative management for the program.

3. Update on State Crisis Expenditures and Potential Appropriations

Dawn Handley began by discussing the results of a recent accreditation review of ATCMHMR’s hotline. The hotline was reviewed in a number of areas and received a total score of 126 out of 130. In terms of the state crisis dollars, Dawn noted that ATCMHMR is anticipating the receipt of the FY09 amounts for the next biennium as well. With the crisis respite facility opening in January, ATCMHMR estimates that it will be unable to spend approximately $400,000 towards crisis respite services in FY09. They have submitted a plan to the

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state to request that they be allowed to use these dollars towards one-time facility improvements. They are awaiting feedback from the state on this request.

4. Update on Inpatient Service Capacity Analysis

Dr. Jim VanNorman noted that in early 2008 an inpatient bed analysis had been conducted based solely on capacity and utilization data from the state hospital. This analysis indicated a total community need for 99.2 civil beds with an unmet need, at the time of the analysis, of 67 beds. This methodology was reviewed and updated in early 2009 to account for changes made locally in the use of funds, patient diversions to emergency departments, and the utilization patterns of both state hospital beds and community beds. The revised analysis indicates an estimated community unmet need for inpatient psychiatric beds of 7.3. See the attached document for the full analysis.

5. Update on Study of Psychiatric Care in Brackenridge ED

Dr. Ziebell reported that the collection of baseline data for the study with Advocacy, Inc. has been completed.

6. CIC Activities Update

Beth Peck presented a 6 month review of FY09 statistics against the FY08 average. She noted that diversions to EDs are down 66% in FY09 from the FY08 monthly average. She also noted that the average monthly admissions to Seton Shoal Creek and Austin Lakes are up 64% from the FY08 monthly average. She noted that HMA will be assisting in a review of the data being collected to propose streamlining the measures to make them more impactful and to more clearly indicate the state of the service continuum. Diana noted that Seton will be presenting some success stories at the next ICC meeting as a result of their High Alert reviews and may be able to bring those to the stakeholders group as well.

7. The next meeting of the stakeholder group will be Monday, May 11th in the Travis

County Healthcare District Board Room at 4:00 p.m.

Psychiatric Services Stakeholder Meeting May 11, 2009

4:00 p.m. Cesar Chavez Building (1111 East Cesar Chavez)

MEETING NOTES

Attendees: Sherry Fleming – Travis County Health and Human Services and Veterans Services Guy Herman – Travis County Judge Bert Lumbreras –City of Austin Larry Schooler – Aide to Council Member Lee Leffingwell David Evans – ATCMHMR Dr. Jim VanNorman – ATCMHMR Dawn Handley -- ATCMHMR Toni Inglis – ATCMHMR Board Diana Resnik – Seton Family of Hospitals Alan Isaacson – Seton Shoal Creek Hospital Dr. Chris Ziebell – University Medical Center at Brackenridge Becky Pastner -- St. David’s Community Foundation Maria Talamo – Austin Lakes Hospital Dr. Tom Coopwood – Travis County Healthcare District Board Manager Brenda Coleman-Beattie – Travis County Healthcare District Board Manager Patricia A. Young Brown –Travis County Healthcare District Elaine Carroll – Travis County Healthcare District Beth Peck – Travis County Healthcare District Kim McPherson – Health Management Associates Agenda/Notes: 1. New Member Discussion

Trish Young reminded everyone that the group had approved the inviting of Dr. Edward Sherwood, Director of Central Texas Veteran’s Administration, and Dr. Octavio Martinez, Director of the Hogg Foundation to attend the Psychiatric Stakeholders Services (PSSM) meetings. The invitation has been extended but neither were able to attend the May meeting. This raised a discussion regarding the membership of the PSSM. It was determined that meetings should be limited to members and other invitees, as needed, to ensure that the group remains at a manageable size. It was noted that more participation is available through the Crisis Implementations Services Committee (CIC) group. It was noted that Judge Hohengarten has been asked to participate on the CIC as available.

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2. Update on State Crisis Expenditures and Potential Appropriations Dawn Handley noted that the request to the state to approve ATCMHMR’s plan to expend FY09 crisis respite dollars that cannot be used for services has moved to the next level of consideration within the state. She felt that it was looking favorable for ATCMHMR to receive approval on their plan.

3. Update on Legislative Session

David Evans provided an update on some of the bills of interest for this legislative session. He noted that ATCMHMR will be providing testimony on SB796 which would fund expanded access to substance abuse services through other budget savings. He also called attention to HB1233 which would increase access to psychoactive medication and mental health services to jailed individuals. David noted that ATCMHMR should be funded at their current level for the next budget cycle. Trish Young reported that a number of hospital districts have been working on SB7 which would allow for funding of pilot projects for integrated health care services. She has had language added to allow for the funding of the mobile health care team for which ATCMHMR had submitted a funding request through the state for new crisis dollars. Judge Herman stated that there is a bill to allow emergency detention requests to be filed before 4:00 p.m. instead of the current noon deadline. He feels that this bill will pass. Another bill has been filed to allow probate judges to determine whether an individual is “manifestly dangerous” instead of requiring a psychiatrist to make this determination. If this passes, there is concern that this ability might be over-utilized and the Vernon facility would fill up quickly which would cause a ripple effect on the other state hospitals and, ultimately, community facilities.

4. Update on Study of Psychiatric Care in Brackenridge ED

Dr. Ziebell reported that the Advocacy, Inc., study is on-going and that Brackenridge is regularly submitting the required data. He will be meeting with the consultants soon to receive an update on their findings.

5. Update on Allocation of District Funding for Inpatient Services

It was determined that there is plenty of District funding available through the end of the fiscal year, so as of April 22nd, ATCHMHR was instructed to push all eligible individuals to beds. The only barriers will be physical capacity of needed beds at the hospitals. Trish Young noted that there is approximately $5M available for these services from the District this year. She is proposing that the Board of Managers approve the same level of funding for FY10. As the small CIC provider group is reviewing delivery and utilization of services, opportunities for improvement are being identified. One item targeted for discussion it the use of bed types within psychiatric hospitals.

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6. Other Updates

Dawn Handley noted that the crisis respite facility is not fully filled yet due to some remodeling issues that are being completed. Dr. VanNorman noted that the City Council is to consider the needed renovations to the 15th Street facility on Thursday, May 14th. This facility will provide 12 beds for Competency Restoration and 16 beds for Project Recovery. It was noted that the St. David’s Community Foundation is considering the purchase of additional crisis respite beds. Possible agenda items discussed for upcoming meetings were local funding for mental health services (July meeting) and High Alert program findings.

7. The next meeting of the stakeholder group will be Monday, June 8th in the Travis

County Healthcare District Board Room at 4:00 p.m.


May 28, 2009

Agenda Item 10 Confirm the next regular Board meeting date, time, and

location. (No Back-Up)

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