Central Health – Seton Master and Ancillary Agreements � John Stephens, Project Manager Central Health David Hilgers, Counsel Brown McCarroll June 5, 2013 Board of Managers Meeting
Presentation Overview � • Evolution of the safety net health care delivery system since 1995 � • Community Care Collaborative � • Master and ancillary agreements � • Benefits to the community � • Looking to the future � 2 www.CentralHealth.net �
Safety Net Care In Travis County � • Safety Net health care delivery is unique in Travis County compared to other major metropolitan counties in Texas. � • For the last 18 years, hospital care has been provided through a contractual arrangement with Seton Healthcare Family � • Primary care has been provided through a government entity, either the City of Austin or Central Health (the Travis County Healthcare District). � 3 www.CentralHealth.net �
Prior to 1995 � The City, not the County, funded most healthcare services in Travis County, Hospital resulting in an inequitable and unstable financial City of Austin model for safety net care. � Primary � Care Hospital and primary � care were in separate � departments. � 4 www.CentralHealth.net �
1995 City of Austin Leases the Hospital to Seton � Governmental � Non-Profit � Seton City of Austin Hospital Primary Care From 1995 until 2004 the City reduced its financial risk as Seton assumed operational responsibility for UMCB, but the delivery of care was fragmented. � 5 www.CentralHealth.net �
2004 Central Health Created � Governmental � Non- Profit � Seton Hospital City of Austin Primary Care Central Health was created in 2004 and assumed responsibility for indigent health care in Travis County. MAP Central Health also expanded funding for primary care, which remained a City Travis County Healthcare department. � District 6 www.CentralHealth.net �
2009 to Present � The City transitioned primary care, becoming CommUnityCare, a 501(c)(3). Despite our best Non-Profit � efforts, the safety net remains fragmented and unsustainable as demand for care increases. � Seton Governmental � Hospital MAP Travis County Healthcare District Primary Care Network 7 www.CentralHealth.net �
New Model � Non-Profit � Governmental � Travis County Healthcare District CCC MAP Integrated service Provider Network � delivery improves care Behavioral coordination and creates Health a more sustainable Care Hospital safety net system. � Care Primary Care Network 8 www.CentralHealth.net �
The Community Care Collaborative (CCC) � The CCC is a Public/Private Partnership organized as a 501(c)(3) • between the Seton Healthcare Family and Central Health in which the parties mutually agree to manage the risk for providing safety net healthcare services. � • The CCC is the main vehicle through which the new Integrated Delivery System will provide access to health care for vulnerable Travis County residents. � • The two initial corporate members of the CCC are Central Health with a 51% membership interest, and Seton with 49% membership interest. � • Additional members and/or new classes of members may be added by mutual agreement if the new members make appropriate commitments to the CCC � � 9 www.CentralHealth.net �
Community Care Collaborative � The CCC will have an initial five-person Operating Board of Directors comprised of three appointees by Central Health Board of Managers and two Seton appointees: � � Each party shall have the unilateral right to select, • remove, and replace its appointees � The parties may mutually agree to change the size • and composition of the CCC Board � � � 10 www.CentralHealth.net �
CCC – Reserved Powers � Significant powers reserved to the Central Health Board and Seton ʼ s Board under Section 3.8: � � 1. Admission of new members; � 2. Merger, acquisition, consolidation, or reorganization of the CCC; � 3. Approval of annual budgets, fiscal and purchasing policies; � 4. Determination of the covered population; and � 5. Approval of the coordination and funding of the Federally Qualified Health Centers (FQHCs). � 11 www.CentralHealth.net �
CCC – Material Decisions � The following Material Decisions must be approved by a “super majority” of the CCC Operating Board Representatives (at least two Central Health appointees and both Seton appointees) : � � Composition and selection of the CCC Provider Network 1. and form of the provider contracts; � Benefit plan and care management approach to the 2. Covered Population (including MAP); � Approval of any application or request for any grants or 3. awards, service agreements, or provider contracts; and � Employment of any person or any personal service 4. contract with any person not contemplated in the Master Agreement. � 12 www.CentralHealth.net �
Agreements on Today ʼ s Agenda � Central Health & Seton have completed four of the new five foundational agreements that define the new public- private collaboration for the delivery of health care to vulnerable residents of Travis County. The four completed agreements, available on our Web site, include: � � 1. Master Agreement � 2. Services Agreement � 3. CCC Bylaws � 4. Lease of UMCB � 5. Lease for New Teaching Hospital (this has not been completed) � 13 www.CentralHealth.net �
Master Agreement Overview � The Master Agreement will provide for Central Health and Seton to make joint decisions through the Community Care Collaborative: � � • Management of the MAP population - number of people covered and benefit plan offered � • Management and oversight of the Delivery System Reform Incentive Payments (DSRIP) projects and the expansion of primary and specialty care � • Integration and management of the provider network �� � The initial term shall be 25 years, with automatic successive five year additional terms by mutual agreement. � 14 www.CentralHealth.net �
Benefits to the Community � • Strengthened and stabilized healthcare safety net � • Integrated delivery system � • Medical school � • Teaching hospital � • Expanded primary and specialty care � 15 www.CentralHealth.net �
Working with and listening to the community � We continually collaborate with others, from community members to providers, to guide our work. It ʼ s through these collaborations we learn the needs and expectations of the community, and how best to address them. � � Community meetings, focus groups, and survey research � • Regular citizens communications at board meetings � • Central Health Connection, our community planning & outreach program � • Participation in community events such as health fairs � • Community Health Assessment / Community Health Improvement Plan (CHA/ • CHIP) � Community health research and assessment, such as Healthcare Trends white • paper, Children ʼ s Optimal Health, and LiveStrong cancer white paper � Annual telephone surveys � • Public access to information, data, and records � • 16 www.CentralHealth.net �
Community Feedback via Email � • The original Letter of Intent has been available on our Web site at www.CentralHealth.net since April, 2012. � • In early May, 2013, we created a Master Agreement section on the site. Presentation materials from the May 1, May 15 and May 22 Board of Managers meetings were posted, and a draft of the Master Agreement was made available on May 31. � • On May 15, we began soliciting public commentary on those materials via the site. To date we have received: � 55 comments received through Web site form or sent directly to staff • and board members � 35 comments in support of the Master Agreement � • 8 comments in opposition to the Master Agreement � • 11 comments expressed concerns about the terms of the Master • Agreement without explicitly declaring support or opposition, primarily about Seton ERDs, as they pertain to women's health services � 1 general comment expressing no position � • 64% of all comments were supportive of the Master Agreement � • 17 www.CentralHealth.net �
Looking Ahead � • We all must learn to work in a new system. � • The new integrated model requires more coordination between partners; placing each party a little further into the other party ʼ s world. � • Changes in the healthcare policy and industry fluctuations will continue to be a challenge. � • We will collaborate to allocate scarce resources to fund services and manage risk for our population. � • We will continue to seek input from the community in order to meet their needs and expectations for healthcare services. � 18 www.CentralHealth.net �
Recapitulation � The Board of Managers and staff have worked for more than a year to fulfill the vision in the 1115 waiver and the Letter of Intent “LOI” to: � � Implement the mandate of the voters � • Strengthen the safety net � • Transform the delivery system � • Remain consistent with the LOI and in conformance with • legal and regulatory constraints � Respond to the needs of the community and the • individuals who rely on us for access to health care � 19 www.CentralHealth.net �
Healthy people. � Strong Community. � Thank you � www.CentralHealth.net �
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