Consultants delivered performance review completed eight months after contract let
Part 5 in a Series
Central Health, aka the Travis County Healthcare District, got its Valentine’s Day present delivered early. The treat was not a perfect confection but did not ruin the celebration either.
Consultants who made an oral presentation to the agency’s board of managers last night overall ranked the agency average or above average in a half-dozen categories, compared with peers in both Texas and in other states, but pointed out numerous areas that need improvement.
The hour-long presentation was made by Tracy Kulik, Germane Solutions vice president for Health Access, and Matt Boll, Germane’s project leader for the assessment.
The report was delivered against the backdrop of a pending lawsuit against Central Health filed October 18, 2017, to challenge the agency’s practice of using part of its property tax revenue for purposes not authorized by the Texas Constitution and state statutes.
“We definitely validated that you are among the most complex health organizations in the country,” Kulik said, noting that only one other organization examined in the assessment did as much partnering with other organizations to provide healthcare services.
She noted that how Central Health determines the return on its investments “may not be as quantitative” as it should be. Which is an understatement that may allude to Central Health’s payments of $35 million a year to the University of Texas at Austin Dell Medical School, in return for which it gets little or no accountability and minimal indigent healthcare services, according to the lawsuit. (Birch et al v. Travis County Healthcare District, dba Central Health, Cause No. D-1-GN-17-005824.)
Concerning where funds flow, “there needs to be more of a mechanism that shows a return on investment,” Kulik said. “There may be merit in having a qualitative return, what you did for social good.”
She said that Central Health had moved at “warp speed” to implement recommendations since the assessment work began last August. “So many of the things we recommended you’ve accomplished or are two-thirds of the way there.”
Benchmarked against others
The assessment included a Benchmarking Analysis that compared Central Health with six other hospital districts in Texas and 10 out-of-state health system providers. The Texas hospital districts are located in Bexar, Dallas, El Paso, Harris, Nueces and Tarrant counties. The out-of-state providers are located in Arizona, California (2), Colorado, Florida (3), Illinois, New York, and South Carolina. (Specific organizations are named on pages 21-22 of the assessment, linked below.)
Kulik said, “You were above average in many areas, so take time to celebrate.”
Boll said he was “floored” when he about how much money Central Health provides to other organizations but that’s “not translated outside,” meaning not adequately known to the general public.
Kulik said that indicates the needs to embrace a “branding strategy” that isn’t now apparent when someone comes to the agency’s website, which offers “too many pieces too fast” but lacks something overall.
Boll recommended exploring opportunities to diversify the agency’s funding with grants and philanthropy.
Kulik added that before doing so the agency should examine its core needs and strategy, and then link that to funding sources. “Go after not just the money but key it to your priorities. You could wind up serving the grant instead of the grant serving you.”
She said that nationally, Central Health was “by far the leanest” but the entities it funds, particularly the Community Care Collaborative, “has an identity crisis.” What is its role? “There needs to be a definition and a decision about what resources go into that and people know what it is.”
The agency’s communication overall compared to others is good and the volume of what you did is incredible, Kulik said, but when it comes to branding “you’re down in the weeds,” and communication needs to be at a higher level.
You have so many partners that having unifying principles would go a long way,” she said.
Not mentioned in the public briefing is that Germane Solutions assessment of Sendero Health Plans, an affiliated nonprofit Medicaid HMO, will be presented to Central Health’s budget committee next week, Kulik told reporters after the briefing. “We just got it finished,” she said.
Board reaction to briefing
Board Secretary Sherri Greenberg complimented Germane on the assessment which she called “really comprehensive.”
“I’m eager to pore over your findings and figure out how to use them.” She noted the board “wanted an independent assessment and a critical eye to compare us to our peers.”
Guadalupe Zamora, a medical doctor and the new board chair, said, “Every entity like Central Health should be reviewed and find out where we an improve and give great access to quality care. Are we perfect? No. We know we have work to do.”
While the work of making necessary changes will be complex, Zamora said, “The end game is simple, to provide the best possible care for Travis County and be the most transparent stewards of our funds.”
Board Member Cynthia Valadez asked who was interviewed for the assessment. Kulik said not everyone’s name was listed but about 45 people in all, including partners directly funded, affiliated or contracted.
Valadez replied saying “People who get money from us are providers—not stakeholders.” She noted that some people rarely get asked about issues or concerns with Central Health services. “I’m more concerned about the validity of what I’m hearing rather than what people we pay think. I want an opportunity for the public to come in.”
Greenberg asked if client surveys were part of the assessment.
Kulik said a focus group was used and consultants reviewed more than a thousand surveys completed by patients. She said in the context of the contract, those were stakeholders.
Greenberg said “robust input is needed from the public, all stakeholders, and the residents we serve,” which will be accomplished through a public workshop in March.
Not mentioned in the briefing
Here’s just a quick sampling of issues embedded in the assessment itself and in the management response to it.
The assessment points out physician shortages, particularly in specialty care, a problem that Central Health is addressing to add additional specialty care capacity. “It also affirms the decision to invest in a medical school in Austin by having faculty, residents, and students working with our population and affiliated with the Central Health brand,” the response states.
The composition of the board of Community Care Collaborative needs to be changed with consideration of how best to expand among partners to advance clinical services and share in the risk of care.
There is confusion related to intergovernmental fund transfers, which relate to how Central Health must provide local funding to qualify for federal matching funds, a process subject to state and federal regulations. Staff is exploring various models and working with hospitals to enforce reporting requirements that measure impact on the agency’s population.
More needs to be done to build awareness and engage the community through social media, but do so in a way that does not disrupt provider relationships with patients.
The assessment comes with a disclaimer: The findings, recommendations and opinions expressed in the assessment deal only with “operational effectiveness” of Central health and do not address any legal, regulatory or other issues.
The assessment was prepared under a $315,000 contract issued June 6, 2017, and signed by Central Health president and CEO Mike Geeslin, who started his new job to head the agency May 15, 2017. The Germane Solutions effort also included work by Whitecap Health Advisors and BB Imaging and Health Care Consulting.
Geeslin wrote the agency’s response, which states, “Overall, Central Health’s management team concurs with Germane Solution’s assessment of the organization. Where applicable, we note additional considerations.”
“Central Health executives and the Board of Managers will need to discuss, along with the community and partners how best to refine its strategic plan and develop implementation strategies that support the plan,” Geeslin wrote.
The assessment was to be shared later today with partners, key stakeholders, Travis County Commissioners Court, and other key elected officials.
Sometime in March the agency will host a public workshop to discuss, prioritize, and develop a proposed implementation plan.(The location and date will be announced later.)
Going forward, on March 28 the Board of Managers will discuss public comments, proposed plans and begin forming its final recommendations.
On April 25 staff will begin developing the fiscal impacts of proposed plans to implement the recommendations for the FY 2019 budget and five-year forecast.
The Central Health assessment was to be posted at www.CentralHealth.net later today for public access. (The copy linked below is labeled a draft and may be changed to correct spelling.) Anyone who has a questions about the assessment can email them to [email protected].
“The public can pose questions and we will respond to those over a three-week period,” Kulik said.
Related Bulldog coverage:
Lawsuit Challenges Central Health Spending: Plaintiffs argue it is not legal to give $35 million a year to the UT Austin Dell Medical Center, Part 4 in a Series, October 18, 2017
Critic: Proposed Financial Policies “’Pointless’: Commissioners Court will vote tomorrow on Central Health financial policies for FY 18, Part 3 in a Series, October 9, 2017
Central Health Financial Policies Hotly Debated: $185 million given to Dell Medical School and Seton, with little to show for indigent healthcare, and $55 million more is on the way for FY 2018, Part 2 in a Series, September 29, 2017
Central Health Feedback Meetings Ill-Attended: Two public forums to gather opinions about the agency drew just nine speakers, Part 1 in a Series, August 27, 2017
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