Looking Back looking ahead

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Looking Back looking ahead

• Senior Management Presentation to the Board

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HISTORY OF THE FAMILY HEALTH NETWORK EXECUTIVE
DIRECTOR
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Bob(His name really was Bob, but we couldnt
remember his full name in time for this
presentation.So we will go with BOB)

• 19?? 1986

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Its him or me!

• Rumor has it, Dr. Hurley told the Board of
  Directors

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Dr. Hurley is still here.

• BOBwell, he was.

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FIRED!!!
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Tom Herbek

• 1986 1990

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FIRED!!!
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Thom DeLara

• 1991 1998

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But for the purpose of a good laugh and
consistency of this presentation, we would like
to say.

• Officially, Thom was allowed to resign

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FIRED!!!
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Julie Bod?n Schmidt

• 1999-2008

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NOT FIRED! WOOHOO!!!

• Saw the organization through financial hardship,
  going concern, and being an exceptional
  grantee
• Saw the organization through a mass exodus of
  providers due to J-1 Visas leaving Dr. Hurley as
  our sole provider
• Recipient of the Rotarian Pride of Workmanship
  Award 2005
• President of the United Way 2005-2007
• Member of multiple boards
• SVHC, CNYAHEC, United Way, CHCANYS
• Recipient of the Jeffrey T. Latman Award
• Did I mention.NOT FIRED ?

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Strategic plan review

• The Not Fired Executive Directors Report

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STRATEGIC ACTION PLAN REVISED - 2006Progress
Report April 2008
Strategy Action Steps -2006 Progress to Date 4/23/08
1. Improve facilities by relocating the Cortland and Moravia sites. Define needs for each site by 6/1/2006. Develop alternatives for BOD consideration by 10/1/2006. Develop business plan for building and funding by 1/1/ 2007. Present to Finance Committee and Board in the first quarter of 2007. Note All things being equal, Cortland will be the first priority. A HEAL 6 grant will be submitted to the State on May 1 to fund both the Moravia and Cortland sites (leasehold improvements). As a result of the grant, the following has been accomplished Needs have been defined Preliminary clinic schematics have been developed A budget has been developed for both the development and the ongoing operations All will be presented to the respective Board committees and the full Board in April 2008.
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STRATEGIC ACTION PLAN REVISED - 2006Progress
Report April 2008
Strategy Action Steps -2006 Progress to Date 4/23/08
2. Recruit broader representation and increase leadership on the Board. Create a plan for leadership development of new officers by 3/2007. Ensure that new members select a committee on which to participate by 7/1/2007. Two new members were elected in March two will be elected in April. Three of the four are users of services and represent a diversity of backgrounds political science, human resources, business management, and education. Committee choices have been made or are in the process of being selected. Brian Moore will be attending board training in Binghamton in May.
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STRATEGIC ACTION PLAN REVISED - 2006Progress
Report April 2008
Strategy Action Steps -2006 Progress to Date 4/23/08
3. Improve orientation and training of Board members. Implement the board orientation and training plan as outlined in the board calendar (in process). Evaluate the need for additional board training by 10/2006. The board evaluation and education/training needs assessments have been completed and analyzed. The Board President and Executive Director will present a revised calendar and plan for training and education at the June Board meeting.
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STRATEGIC ACTION PLAN REVISED - 2006Progress
Report April 2008
Strategy Action Steps -2006 Progress to Date 4/23/08
4. Investigate the potential for federal funds to support a School Health Program in Moravia. Dependent on funding, implement the dental screening program at Parker and Randall Elementary Schools in Cortland. FHN received funding to expand our School Health Programs dental program to Parker and Randall Elementary Schools. A Change of Scope was approved.
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STRATEGIC ACTION PLAN REVISED - 2006Progress
Report April 2008
Strategy Action Steps -2006 Progress to Date 4/23/08
5. Implement a billing redesign with the long range goal of new technology. Set new goals including the following Decrease technical denials by 10. Develop a methodology and baseline for measuring the accuracy of coding. Develop a plan for improved coding by the end of 2006, including dedicated staff, audits, and training. In process. Losses due to technical denials have been cut by 50 60. Tools to report and analyze coding have been developed for both medical and dental providers. These include comparisons to other FHN providers and other community health center providers. A certified coding expert completed working with two FHN providers who were the greatest outliers. Both report that the assistance was appreciated.
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STRATEGIC ACTION PLAN REVISED - 2006Progress
Report April 2008
Strategy Action Steps -2006 Progress to Date 4/23/08
5. Implement a billing redesign with the long range goal of new technology. Actively seek a new practice management and EHR system. Develop criteria for a new system. Select and evaluate options. Present plan, including funding, to the Finance Committee. In the past quarter, the following have been completed The GE Centricity system is the one now being considered. A contract with Alliance, the network in Chicago which would host the server and manage the implementation and training, is now having legal review. To date, FHN has received a 200,000 legislative grant which was applied to this project, including project management, travel to review different systems, and purchase of most of the needed hardware. Other funding commitments have also been made.
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STRATEGIC ACTION PLAN REVISED - 2006Progress
Report April 2008
Strategy Action Steps -2006 Progress to Date 4/23/08
6. Recruit a family practice physician who will do OB. Reassess current recruitment strategies and seek out more effective approaches. Recruit a FP physician 5/ 2007. Evaluate possible role of midwife in relieving stress on two OB providers by the end of 2006. Kathy Keating was hired and began January 2, working two days a week in Moravia and two days in Marathon. This increased access and relieved the OB stress on the other two providers.
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STRATEGIC ACTION PLAN REVISED - 2006Progress
Report April 2008
Strategy Action Steps -2006 Progress to Date 4/23/08
7.Continue to implement the Health Disparities Care Model. Develop user-friendly manual. Select clinical measures for evaluating success. Fully implement the program in Moravia by the end of 2006. The manual has been developed. The diabetes program in Moravia and DeRuyter has been fully implemented a care manager is on site patients have been identified and registered into the tracking system two diabetes health fairs have been held diabetic education classes have been held. A grant from New York State Health Foundation to fund expansion of the diabetes program to all five clinical sites was approved. We received 251,000 for a two year period!
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STRATEGIC ACTION PLAN REVISED - 2006Progress
Report April 2008
Strategy Action Steps -2006 Progress to Date 4/23/08
8. Strive for a competitive salary and benefit program (based on the agencys financial status) that will attract quality staff. Review current benefits. Compare against other similar agencies. Recommend changes by 12/1/2006. As part of the 2008 operating budget development, all these steps were completed by January 9, 2008 and presented to the board at that time. A 401 K plan was implemented with a 2 employer contribution made in the first quarter of 2008.
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STRATEGIC ACTION PLAN REVISED - 2006Progress
Report April 2008
Strategy Action Steps -2006 Progress to Date 4/23/08
9. Advance critical operational activities. Implement the Corporate Compliance Program (in process). Implement the 340 B Program by 9/30/2006. Implement the Emergency Preparedness Program by 8/2006. All departments have reviewed the critical compliance checklist and have developed policies and procedures as appropriate. Walt Priest made a presentation to the board in early 2008. The 340B Program was implemented in MV, CFP, MR, Marathon SHP, and Dental in 2006. DR began in 2007 (delivery program). CN by early 2008. To date, monthly net revenue has met or exceeded goals. Walt Priest and Jean Shields developed an exemplary Emergency Preparedness Program which was completed in the first quarter of 2008.
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Doug Rahner, MD

• Medical Directors Report

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Performance Improvement Plan

• Peer Review Process
• Alignment of Clinical Indicators with External
  Standards
• Patient satisfaction Surveys now administered by
  CRAN
• Clinical measures aligned with either Federal
  (Healthy People 2010,Office of Performance
  Review) or state (QARR) standards

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Gradual increase in Physicians

• National picture 2007 saw increase in recruiting
  family physicians
• 1 search request for recruiting firms
• Cortland County has a significant need for
  additional OB providers especially for Medicaid
  patients
• Cathy Keating, MD , a family physician who does
  OB began on 1/2/08
• Plan to hire an additional FP with OB in Summer
  2009

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Focus on Diabetes

• Diabetes Collaborative begun in Spring 2006 at
  Moravia
• Expanded to DeRuyter - Spring 2007
• Plan expansion to Marathon and Cincinnatus
• Fall, 2007, FHN awarded 250,000 Setting the
  Standard grant for diabetes care by New York
  State Health Foundation
• Currently recruiting for an additional care
  manager and a nutritionist
• Take the Plunge weight loss contest
• Words of encouragement from NYSDOH
• Plan Present at CDC diabetes conference May 2009
• Plan Attain NCQA Diabetes Recognition

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Electronic Health Record

• 2007 finished initial presentations by 7 vendors
• September, 2007 Site visits to CHCs using two
  top products (eClinical Works, Centricity)
• November, 2007 Super Demo Day.
• The winner Centricity
• Finding a network
• January/February, 2008 Visits with Alliance
• Reviewing Contract -Going on now
• The Future
• Implement practice management
• Do pre-implementation for EHR
• Implement
• Return on Investment?
• Quality
• Money

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Lynn Bond

• Director of Finance Report

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Shes tall, shes slender, and she loves to stay
late and work all night

• Lynns Highlight of 2007

• Say hello to Lynns
• newest assistant, BRIDGET
• Okay, so her real name is
• Bridge-It
• And its not a she, its a computer program
  that crunches numbers
• But still.A Finance Directors
• dream come true!

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Annual Expenses
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Future Challenges REVENUE

• 340B
• Medicaid offsite payments
• Decrease in state payments to SHP

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Walt Priest

• Director of Operations

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It is under greatest adversity that there exists
the greatest potential for doing good, both for
oneself and others.
Dalai
LamaWhat the Heck?!!! Walt Priest

• 2007 OPERATIONAL
• EFFORTS AND CHALLENGES

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Dentist Recruitment Difficulties

• Dental covering expenses, but.
• Dental bonus system put in place
• Dentists are
• unique
• BUT, we currently
• have 4 candidates
• and are in the
• process of
• scheduling
• interviews

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Limited Data Management and Reporting Capability

• What happened? Lets research! Wait we cant
  unless we spend a lot of time and a lot of
  person power.
• TBS, its a start
• Flow and cycle time, in minutes (or sadly in
  hours)
• Bridge-It where have you been all of Lynns life?

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Limited Discretionary Spending for Project
Development

• Thank the Good Lord and Barbara Lifton
• HEAL NY Were in!, YAHOO!...
• no wait, were not
• Thank you NYS
• Health Foundation
• 340B one-site,
• one pharmacy,
• no sliding seen

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Space and process challenges in Cortland and
Moravia

• Limitation of growth
• No room at the Inn
• for people or records
• Have you heard about the studies on Rats?

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Grant Preparation Timeline Challenges,
Recruitment Problems and Payment Delays 2007/2008

• Relax, the 330 Grant is due in August
• Just kidding its due in April
• Wrong again, its due in May
• Innovative Childcare
• Just find the darn provider
• Mental Health, 330 Grant and HEAL 6
• (squeeze everything else in)
• Fidelis will help, Total Care
  
• will help, no weaseling
  out
• allowed

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Insurance contracts and reimbursements all over
the place

• 93 cents isnt bad is it?
• Who do we bill?
• Multi-Plan buys PHCS, PHCS
• contracts with Cigna, Cigna goes to
• MVP (but just in this county and just for some
  products).
• Going on strike from Workers Comp
• Quality incentives and the rule of
  interpretation.

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The Sites Must Go On!

• Groton Get up to speed, retain the staff, deal
  with the internal dynamics, recruit for the
  dentist, fix the no-shows, cancelations and
  re-schedules.
• Marathon Hire the New Manager, fire the new
  manager.. put in the cameras, take out the
  cameras..transfer the providers, repopulate the
  providers. interview the staff, stabilize the
  staff.keep it going, keep it going.
• DeRuyter- 340B and the new site delivery program,
  rebuilding from a misstep, ants, snakes, and
  toilets.

• Cincinnatus- Busy, busy, busy. Waltwe need to
  talk to you.
• School Health Program-Cut 20,000 of the base
  grant, get involved in a scandal in DeRuyter,
  putting the nose on the grindstone, and becoming
  part of the BIG TEAM.
• Moravia and Cortland Get us the heck out of
  here! (and all the stuff that goes with it).

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Policies, Procedures, and Protocols

• Making progress
• (better, but not good enough)
• Emergency Preparedness
• Corporate Compliance
• OSHA
• All Article 28 PPPs
• Credentialing
• Etcetera, etcetera, etcetera
• One More Little Surprise!
• Waste not, want not.

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INTERMISSION

• (just kidding)

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"Aim high, aim for something that will make a
difference.."
The EffectivE Executive"I
think we can, I think we can, I think we
can"Walt Priest

• 2007 OPERATIONS
• Looking Ahead

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The 340B Solution

• The Alternative Methods Demonstration Project
• Site Deliveries
• Sliding Fees
• Win-Win

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HPSA/MUA the Suggestions Continue

• What it means
• What they think
• What impact it might have

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The PMS/EHR Connection

• (The 6 Ps)
• The Potential
• The Process
• The Pain
• The Partners
• The Price
• The Payoff

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The Operational Necessity

• The Site and Programmatic Imperatives
• The Building Projects
• Teams, Committees, Trainings,
• Meetings and Maintaining Momentum
• Being as gentle as doves and as wise
• as serpents! The challenge of
• working not just smarter, but
• better.
•  

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Laurie Sperger

• Director of Personnel

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Employee Picnic

• In 2007 the agency celebrated its 35th
  anniversary, and the employees celebrated at a
  company picnic at Little York Park. 

• It was a huge success and was attended by 95 of
  our employees and lots of family members.
•  
• We even had a Sr. Management member that came
  incognito as a thug.

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Holiday Party

• The staff also celebrated at our annual holiday
  party. Again it was one of the biggest turnouts
  ever.
• We had several celebrity singers who should try
  out for the next American Idol contest.

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And then there are our next Dancing with the
Stars contenders.
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Showcases, health fairs, etc

• NEW DISPLAY WALL
• (everyone say ooohh)
• Moravia Health Fair
• Diabetes focus
• Cazenovia College
• 90 Blood Glucose Screenings
• Business Showcase
• Blood Glucose Blood Pressure Screenings
• Childrens Health Fair
• (part of MICAH, Cover the Uninsured)

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We were able to give employees both cost of
living raises and finally start our 401K!!!!!
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Challenges

• In 2007 we lost 3 very good Nurse Practitioners
  to other practices due to salaries.
• In 2008 we will need to be addressing this salary
  issue.
• I have started an in depth survey and will be
  bringing recommendations to the Personnel and
  Finance Committees.

• Midlevel providers have been proving to be very
  hard to recruit at this time.
• We currently have two openings and I have not
  received any applications from the ads that I
  have placed.
• And just this past year we had received a child
  care grant to place a midlevel provider in the 4
  local child care settings and had to give the
  grant back due to the inability to hire an
  applicant.

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New Addition

• Dr. Catherine Keating started in January 2008,
  and she has been very well received in both
  Marathon and Moravia.

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Recruitment

• We have started
• recruitment for a
• 6th Family practice
• physician who will do OB.
• Its not what you know, its not
  who you
• knowits where you go!
• Dr. Keating, Dr. Hurley, and Dr. Whites OB
  portion of their care is continuing to grow and
  overwhelm them.
• Currently, for certain months we have no new OB
  patient openings.

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And on a final note

• I will be very sorry to see Julie leave. She is
  the third and I might add BEST Executive Director
  I have worked with (of course seeing that the
  other two were fired) Im not sure there is a
  comparison. She brought both knowledge and a
  sense of fairness to this organization that was
  desperately needed. She has been a teacher, a
  mother (when certain employees leave dirty dishes
  in the sink) and most of all an inspiration to
  several employees to pull together and make this
  organization what is it today. I wish her the
  best of luck and I hope she knows how much she
  will be missed.

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Farewell from the Board

• Nancy Rongo Presentation

Oh Yeah, and BOB after talking with a few
staff members to track it downhis real name is
Robert (Bob) CLARK!