GOVERNANCE/LEADERSHIP INSTITUTE PRESENTERS: KELLY MATHEWS & CAROL LIGHTSEY

GOVERNANCE/LEADERSHIP INSTITUTE PRESENTERS: KELLY MATHEWS & CAROL LIGHTSEY GOOD GOVERNANCE /LEADERSHIP PRACTICES…ENSURING A COMPLIANT BOARD FOR TODAY’S CHALLENGES

AGENDA • GREETINGS AND INTRODUCTIONS OF FACULTY • INFORMATION SHARING AND QUESTIONS??? (QUESTIONS TO BE ANSWERED IN DUE TIME) • HEALTH CARE REFORM –KEY COMPONENTS – PATIENT PROTECTION AND AFFORDABLE CARE ACT (2009)….AND THE HEALTH CARE AND EDUCATION AFFORDABILITY RECONCILIATION ACT OF 2010 • PATHWAYS TO GOOD GOVERNANCE/LEADERSHIP PRACTICES • SUMMARY OF KEY HEALTH CENTER GOVERNANCE PROGRAM REQUIREMENTS • LEADERSHIP AND PLANNING NEEDS • FINANCIAL ISSUES BOARD MEMBERS SHOULD ADDRESS • UNDERSTANDING THE FINANCIAL CONDITION OF YOUR ORGANIZATION AND ENSURING CORPORATE COMPLIANCE • UNDERSTANDING THE IMPORTANCE OF HIT FOR FQHCs • QUESTIONS ……..THIS IS THE DUE TIME!!!!!

OBJECTIVES • TO REINFORCE …..UNDERSTANDING OF THE FIDUCIARY RESPONSIBILITIES OF THE LEADERSHIP (BOARD AND CEO) OF A COMMUNITY HEALTH CENTER; • TO ENSURE APPROPRIATE REVIEW OF UPDATE ON PROGRAM REQUIREMENTS OF A FEDERALLY FUNDED CHC; • TO ENSURE THAT ALL PARTICIPANTS GAIN A BETTER UNDERSTAND OF THE FISCAL ASPECTS OF A NON-PROFIT ORGANIZATION, INCLUDING COMPLIANCE ISSUES.

HEALTH CARE REFORM • HEALTH CARE REFORM- KEY COMPONENTS • Provides coverage for 32 million of the estimated 54 million uninsured Americans by 2019 • Projected Costs 960 billion over 10 years • How is it paid for? ---- Increased taxes; $Billions in new fees on health care industry; Reductions in Medicare Program • Changes in Medicare rates and attacks on fraud and waste.

GRANDFATHERED PLANS • A group health plan that is in existence as of the date of enactment (3/23/2010) is considered grandfathered. • Exempts plans from some reform requirements… Preventive health requirements, discrimination rules, etc……But not 2010/2011 changes regarding lifetime limits, dependent adults to age 26, rescission and pre-existing for children • A plan will lose grandfathered status upon certain plan changes (e.g. carrier change, benefits design change

LIFETIME & ANNUAL LIMITATIONS • A group health plan is prohibited from offering health insurance coverage that imposes a lifetime limit on the dollar value of essential benefits for any participants and beneficiary. • Prior to 2014, restrictions imposed around annual limitations…… After 2014, no annual limitations on essential benefits • Effective for the first plan year that begins on or after September 23, 2010

ADULT AGED CHILDREN • Group health plans must provide coverage for adult dependent children until age 26 unless, for grandfathered plans, the adult child is eligible to enroll in other employer sponsored coverage. • After 2014 – coverage is provided up to age 26, regardless of other coverage. • Tax dependent status extended to age 27

PREVENTIVE CARE • Group health plans must provide standard levels of preventive care and cannot impose cost-sharing….(Does not apply to grandfathered plans) • Type of preventive care includes: Immunizations; Preventive screenings for infants, children and adolescents; Women’s preventive screenings including breast cancer screenings and mammography

OTHER COMPONENTS • Medical Loss Ratio that applies to all insured group health plans.. • Small employer tax credits… • In 2012 ---Further tightening under Medicare and Medicaid. • In 2014 --Implementation of State based Exchanges to facilitate the purchase of qualified health plans in the individuals and small group market… • In 2014 ---Codify the HIPAA wellness program regulations…..Reward for providing wellness programs

SUMMARY • DRAMATIC SHIFTS IN COVERAGE • PAYMENT SHIFTS FROM VOLUME TO VALUE • GROWING INTEREST IN BUNDLED PAYMENT • INCREASING FOCUS ON ACCOUNTABLE CARE • ABILITY TO MANAGE RISK • SKILLS IN COSTING AND PRICING NEW BUNDLES OF SERVICES • PROPENSITY TOWARD VALUE

NEXT-ERA CAREDELIVERY • CULTURE THAT SUPPORTS INNOVATION • STRONG CLINICAL AND FINANCIAL RELATIONSHIPS • CONFOR WITH INCENTIVE STRUCTURES INCORPORATING RISK • CONSUMER FOCUS • PROFICIENCIES IN PRICING AND FINANCIAL MODELING • DATA –DRIVE DECISION MAKING • INVESTMENT IN IT, FROM EHRs TO DATA REPORTING AND ANALYTICS

LEADERSHIP ROLES • CREATING THE MISSION/VISION; • STRATEGIC PLANNING; • DEVELOPING AND MOTIVATING THE TEAM; • EVALUATING THE PROGRAMS; • STEERING THE ORGANIZATION ON A COURSE FOR SUCCESS • UNDERSTANDING AND CARING OUT FIDUCIARY RESPONSIBILITIES…..DUTY OF CARE/LOYALTY/OBEDIENCE

PATHWAYS TO SUCCESS • RAISING DOLLARS AND EXPANDING THE PERCENTAGE OF CONTROLLABLE INCOME • POSITIONING THE ORGANIZATION • ORGANIZING AND MOTIVATING THE BOARD OF DIRECTORS • FORGING ALLIANCES AND PARTNERSHIPS • HIRING, MOTIVATING AND LEADING YOUR STAFF IN AN ETHICAL MANNER • MEETING GUIDELINES AND REQUIREMENTS SET BY FUNDERS

PATHWAYS (CONT.) • ORGANIZE THE BOARD LEADERSHIP SO THEY CAN LEAD; • ASSURE YOUR PROGRAMS AND SERVICES ARE TOP QUALITY; • ASSURE YOUR PROGRAMS AND SERVICES ARE TOP QUALITY; • SOLIDIFY AND EXPAND YOUR CONSTITUENCIES, RELATIONSHIPS WITH DONORS, CLIENTS, MEDIA AND OTHERS; • AVOID CONFLICTS OF INTEREST • ESTABLISH ETHICAL LEADERSHIP (CORE VALUES OF THE ORGANIZATION) • UNDERSTAND THE COMPETITIVE, ENVIRONMENTAL, AND POLITICAL CONTEXT OF YOUR ORGANIZATION; • CONDUCTING A SWOT EVERY YEAR

SUMMARY OF KEY HEALTH CENTER PROGRAM REQUIREMENTS • HEALTH CENTERS ARE NON-PROFIT PRIVATE OR PUBLIC ENTITIES THAT SERVE DESIGNATED MEDICALLY UNDERSERVED POPULATIONS/AREAS OR SPECIAL MEDICALLY UNDERSERVED POPULATIONS COMPRISED OF MIGRANT AND SEASONAL FARMWORKERS, THE HOMELESS OR RESIDENTS OF PUBLIC HOUSING. • KEY HEALTH CENTER PROGRAM REQUIREMENTS ARE IN FOUR CATEGORIES:

KEY HEALTH CENTER PROGRAM REQUIREMENT CATEGORIES • NEED • SERVICES • MANAGEMENT AND FINANCE • GOVERNANCE

GOVERNANCE REQUIREMENT • BOARD AUTHORITY • BOARD COMPOSITION • CONFLICT OF INTEREST POLICY

NEXT UP • UNDERSTANDING THE FINANCIAL CONDITION OF YOUR ORGANIZATION AND WHAT SHOULD BE YOUR FOCUS……

QUESTIONS ANSWEREDTHIS IS THE DUE TIME……

GOVERNANCE/LEADERSHIP INSTITUTE PRESENTERS: KELLY MATHEWS & CAROL LIGHTSEY