Retreat Follow Up 12-5-05

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Central Piedmont Access II

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CENTRAL PIEDMONT ACCESS II

Board Retreat Work Group Session December 5, 2005

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OverviewAgendaBoard Retreat Minutes ApprovalBoard Retreat Action ItemsMeasurement - Network PerformanceStrategic PlanBudget Template

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Primary GoalReach Consensus Board Retreat Action ItemsComponents of Strategic Plan

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Retreat Action ItemsTransition of OrganizationBoard Membership/ Education Steering, Medical Management CommitteesBudget Template

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Current OrganizationExecutive Board

(1 Representatives from each Community Steering Committee)

WilkesSteering Committee

PCPs, HD

StokesSteering Committee

PCPs, HD DavieSteering Committee

PCPs, Davie Memorial, HD

YadkinSteering

CommitteePCPs, HD

SurryMedical

Management CommitteePCPs, HDDSS, HD

ForsythSteering

CommitteePCPs, HD, WFUBMC

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Network ExampleExecutive Board

(4 Representatives / Steering Committee)

County 1/County 2Medical Management

(PCPs)

County 3/ County 5Medical Management

(PCPs)


(PCPs)

County 1/County 2Steering Committee

PCPs, Hospitals, DSSs,& HDs

County 3/County 4/County 5Steering Committee

PCPs, Hospitals, DSSs, and HDs

County 6/County 7Steering CommitteePCPs, Hospitals,

DSSs, & HD

Representatives:1 MD; SC

1 MD; MCC1 DSS1 Open

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The BoardFunction

1 Representative/ Steering

Committee

Composition

Governance

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Board MembersFunction

Responsibilities

GUIDE TO LEGAL RESPONSIBILITIES

OF A NONPROFIT CORPORATION BOARD MEMBER

WOMBLE CARLYLE SANDRIDGE & RICE, PLLC

Winston-Salem Prepared by Ranlet S. Bell One West Fourth Street Winston-Salem, NC 27101 Telephone (336) 721-3675 Facsimile (336) 733-8332 Email [email protected]

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Board MembersComposition

OfficersChairmanPresident Vice-

President

1 Representative from each Community Steering Committee

3 Representatives from 2 Network Hospitals

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SecretaryTreasurer

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Steering/MM CommitteesFunctionResponsibilitiesCompositionOfficersOther Sub-Committees

Network ExampleExecutive Board

(4 Representatives /Steering Committee)


(PCPs)

County 3/ County 5Medical Management

(PCPs)


(PCPs)


PCPs, Hospitals, DSSs,& HDs

County 3/County 4/County 5Steering Committee

PCPs, Hospitals, DSSs, and HDs


PCPs, Hospitals, DSSs, & HD

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Measurement Network Performance

020406080

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1st Qtr 2nd Qtr 3rd Qtr 4th Qtr

Network X Network Y Network Z

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Network ComparisonNon-Emergent ED PMPM Cost of Pediatric Practice Patients

$-

$2.00

$4.00

$6.00

$8.00

$10.00

$12.00

4thQ 20031stQ 20042ndQ 20043rdQ 20044thQ 20041stQ 20052ndQ 2005

1.5 SD=$7.32

2 SD = $8.24

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Other ComparisonsTotal Cost PCP Visit CostNon-Emergent ED RatesInpatient CostInpatient Admission RatesPharmacy Cost

PPI & NS AntihistaminesSpecialist Visit CostOutpatient Mental Health Visit CostAsthma ED & IP RatesDiabetic Eye Exams, Lipid Tests

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Measurement Practice Performance

020406080

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1st Qtr 2nd Qtr 3rd Qtr 4th Qtr

Provider A Provider B Provider C

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Practice Profile

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PAL Scorecard

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Single PCP Report

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Tier 2Tier 1OTC

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A B C D E F G H I J K L M

Central Piedmont Access II UpdatePractice A March 2004 ED Utilization Rate Goal: utilization of non-emergent Emergency Department (ED) care.

Congratulations… ED Rates are less than for all other practices.

Diabetic Eye Examinations

Goal: the percentage of diabetics receiving eye exams to 100%.

Using support or office staff to ask patients with diabetes if they have had their annual eye exam may improve your screening rate.

Prescription Tiers Utilized Goal: utilization of OTC and Tier 1 drugs and utilization of Tier 2 and 3 drugs.

Congratulations… OTC and Tier 1 prescription utilization is higher than for all other practices.

For more information on how to improve quality and financial outcomes for the Medicaid population and your practice, contact your Central Piedmont Access II Case Manager at 713-5141.

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*Percent of diabetics receiving an eye exam in the previous 12 months.

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Strategic Plan

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Strategic PlanGoalProvide Focus, DirectionSet Framework for Measurable Outcomes

Community Care of NC ChargeDevelop coordinated systems of care in concert with community

providers Improve the access and quality of health careContain costs and improve outcomes

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Strategic PlanComponentsMission, VisionStrengths, Weaknesses, Opportunities,

ThreatsGoal Development

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MissionWho We Are Example: To

improve the health and well-being of all patients through effective case management intervention.

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VisionWho We Want To Become Example: To create

a systematic framework of community providers who are dedicated to the mission.

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SWOT AnalysisStrengthsWeaknesses

Internal

ExternalOpportunitiesThreats

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Strengths

ExamplesOrganized BoardOrganized Steering

Committee51 Enrolled Providers

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WeaknessesExamplesCommunity AwarenessDirector Position Vacancy

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Other ItemsStrategies to Address WeaknessesSignificant Barriers to Address Weaknesses

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OpportunitiesExamplesPartner With Community AgenciesDevelop Education ForumsExamine Successful Initiatives In Other

Networks

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ThreatsExamplesLack Of Community

InvolvementLack Of Provider

Buy-In/Support

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Other ItemsGeneral Perception of CPAIIin CommunityGreatest Need of PCPsGreatest Need of Patients

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Goal DevelopmentPurpose Provide Measurable

Outcomes Provide Framework

for Accountability Motivate and Guide

Daily Operations

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CCNC Lessons Learned1. Top down approach is not effective in N.C.2. Community ownership3. Can’t do it alone - must partner4. Incentives must be aligned5. Must develop systems that change behavior6. Have to be able to measure change7. Change takes time and reinforcement

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Goal DevelopmentExample: Create a Scoreboard for a Comparison of Network OutcomesMethods:– Determine Variables (Slide 15)– Identify Frequency of Reporting

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Goal DevelopmentExample: Promote CPAII Education, Awareness in the Patient CommunityMethod:– Explore Alternative Communication

Methods, i.e. Audio and Video

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Goal DevelopmentOther Possibilities…Acquire NFP status by June 30, 2006Evaluate needs of Hispanic enrollees;

Identify ways to address Evaluate current intake process;

Identify opportunities for improvement

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Goal DevelopmentOther Possibilities…Organize a public relations committee;

Address communication needsEstablish metrics to measure cost

savings/ program effectiveness

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Budget Template

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Budget TemplateDRAFT

ACCESS II FORSYTH COUNTY BUDGET JULY 1, 2005 – JUNE 30, 2006

Operating Revenue: Davie Case Management Fees $36,000 (1,200 enrollees) Forsyth Case Management Fees $849,000 (28,300 enrollees) Stokes Case Management Fees $56,730 (1,891 enrollees) Surry Case Management Fees $180,000 (6,538 enrollees) Wilkes Case Management Fees $115,350 (3,845 enrollees) Yadkin Case Management Fees $43,080 (1,436 enrollees) Total $1,280,160

Non-Operating Revenue, In-Kind Support, Other: Interest $3,000 Forsyth County $4,225 – In-Kind The North Carolina Baptist Hospitals, Inc. $6,265 – In-Kind Wake Forest University Health Sciences $2,240 – In-Kind Total $15,730

Forsyth Reserve Funding $65,000 (School Outreach) $128,000 (Hispanic Patient Outreach Strategy)

$12,000 (Sub-Regional Clinical Director Support) $72,950 (Quality Improvement Specialists) $7,500 (OTC Outreach; Includes Polypharmacy funds)

Total $277,950

Davie Reserve Funding $1,200 Yadkin Reserve Funding $4,000 Stokes Reserve Funding $14,350 Total $19,550 TOTAL REVENUE AND IN-KIND SUPPORT $1,600,890 Expenses Personnel (Salary and Fringe) $1,254,343 Davie $68,634 ($50,894 Salary/$17,740 Fringe)

Forsyth $805,200 ($632,000 Salary/$173,200 Fringe) Stokes $62,500 ($46,375 Salary/$16,125 Fringe) Surry $169,609 ($135,000 Salary/$34,609 Fringe) Wilkes $104,550 ($76,845 Salary/$27,705 Fringe) Yadkin $43,850 ($32,490 Salary/$11,360 Fringe)

Meeting and Travel Expense $46,796 Davie $3,167 Forsyth $27,267 Stokes $1,695 Surry $8,667 Wilkes $4,700 Yadkin $1,300

Disease and Utilization Management/Patient and Provider Education/Printing/Supplies $97,197 Davie $2,967 Forsyth $56,070 Stokes $3,000 Surry $9,407 Wilkes $25,618 Yadkin $135

Office Supplies, Telephone, Miscellaneous $45,629 Davie $2,977

Forsyth $26,500

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Budget Template

HIGHLAND BLUE WINSLOW TOTALSRevenue

Case Management Fees 420,000$ 118,860$ 136,500$ 675,360$ School Nurse Program 97,504 - - 97,504 CAP-C Grant 72,000 - - 72,000

Total Revenue 589,504 118,860 136,500 844,864

ExpensesStaff 264,811 59,191 56,900 380,902 Fringes 66,203 14,798 14,225 95,226 Managed Care Rep 22,099 - - 22,099 Medical Director Fees 20,000 14,400 14,400 48,800 Accounting Services 15,000 5,000 5,000 25,000 IT / Administration 7,200 - - 7,200 Occupancy 26,457 3,223 4,200 33,880 Supplies/Printing 6,000 2,000 2,500 10,500 Case Manager System 5,400 1,200 1,200 7,800 Copier 2,100 - - 2,100 Staff Education 4,500 500 4,500 9,500 School Nurse Program 97,135 - - 97,135 Disease Management 36,500 - - 36,500 Board Meetings 3,000 1,200 2,400 6,600 Travel 3,000 1,800 3,000 7,800 Audit Fees 3,500 - - 3,500 Minor Equipment - - 4,000 4,000 Other Expenses 6,599 15,548 24,175 46,322

Total Expenses 589,504 118,860 136,500 844,864

Net Income -$ -$ -$ -$

July 1, 2005 - June 30, 2006

PROPOSED BUDGETSJuly 1, 2005 - June 30, 2006

HIGHLAND, BLUE, WINSLOW COUNTIES

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TimelineFirst Planning Retreat September 2005Follow Up Work Group December 2005Initial Draft Strategic Plan January 2006Next Meeting ???

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Thank you

Retreat Follow Up 12-5-05

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Transcript of Retreat Follow Up 12-5-05