GOVERNANCE/LEADERSHIP INSTITUTE PRESENTERS: KELLY MATHEWS

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GOVERNANCE/LEADERSHIP INSTITUTE PRESENTERS
KELLY MATHEWS CAROL LIGHTSEY

• GOOD GOVERNANCE /LEADERSHIP PRACTICESENSURING A
  COMPLIANT BOARD FOR TODAYS CHALLENGES

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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!!!!!

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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.

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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.

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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, etcBut 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

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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

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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

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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 Womens preventive screenings
  including breast cancer screenings and mammography

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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

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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

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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

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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

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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

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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

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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

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KEY HEALTH CENTER PROGRAM REQUIREMENT CATEGORIES

• NEED
• SERVICES
• MANAGEMENT AND FINANCE
• GOVERNANCE

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GOVERNANCE REQUIREMENT

• BOARD AUTHORITY
• BOARD COMPOSITION
• CONFLICT OF INTEREST POLICY

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NEXT UP

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

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QUESTIONS ANSWEREDTHIS IS THE DUE TIME