[0:03] All right, good morning, everyone. I call the board of trustees meeting to order and note that

[0:10] a quorum is present. The time is now 8.30 a.m., the live one. While some board members are

[0:17] in the room with us today, others will participate by video conference estimates, full by state law,

[0:21] and the Harris Health video conferencing policy. Holding participants, scheduled to speak, have been

[0:26] provided dial in information for the meeting. All others who wish to do the meeting may access

[0:30] the meeting online through the HRSELF website. Please note, there are ceiling microphones in the

[0:35] boardroom and the audio may pick up background noise. As such, we ask that all individuals limit

[0:40] their side conversations during the meeting so that we can maintain the quality of the audio for

[0:44] the public. Please keep your devices on mute until it is your turn to speak. Please use the chat

[0:49] function to alert the chair. That's me. That you would like to speak. Do not put the content of your

[0:55] comments or questions in the chat. Only alert me that you would like to speak so I can acknowledge you.

[0:59] please do allow me to acknowledge and recognize you before you make comments or ask your questions.

[1:04] With that, we move to agenda item number two, the approval of our previous meeting minutes.

[1:09] Do I have a motion and a second for approval of the May 22nd, 2025, or the meeting minutes?

[1:15] So, move to the second. Thank you, Ms. Verablan. Thank you, Ms. Ferret. Any discussion?

[1:20] All in favor say aye, aye. Any opposed? Hearing none, the motions passes and the minutes are approved.

[1:28] I now, uh, turns you agenda item three, A, RCEO report, and by Dr. Porsa to say a few comments.

[1:35] Thank you, Dr. Puy. Good morning, everyone. I'll keep my comments pretty first and foremost,

[1:39] happy play that were paid by Dr. Puy. Also, I wanted to acknowledge that today is your last day

[1:45] as our board member. So, I wanted to say thank you from the bottom of my part and let you know how

[1:51] much you have meant to me personally. I do have a style. So, thank you for your service,

[1:56] your dedication, your commitment, much much appreciated. We will miss you.

[2:01] To

[2:08] brief comment, our last week we had the Texas Commission on Jail Standards visit

[2:14] at Harris County Jail. This was a suit to not stop the bottom survey of the entire Jail

[2:22] facility, including the Croatia Health Care and I'm proud to say that after one week of our survey,

[2:28] The only two technical assistance, which is what they call their findings,

[2:33] regarding the medical care instead of the Harris County jail,

[2:36] had to do a documentation of dietary referrals and the recreation

[2:41] for the folks who were admitted to our infirmary.

[2:44] Those were the only two findings after one week of serving at the Harris County jail.

[2:48] So I wanted to take this opportunity as I thank you to all of our staff

[2:53] instead of the Harris County jail and the Sheriff's Office for

[2:56] their cooperation, allowing us to do what we need to do to take care of the folks inside

[3:02] the Harris County Jail. And with that, Dr. Parker, I'll turn it back to you. Thank you.

[3:09] So next is the item 3B board member announcements. I do have a brief comment I'd like to make,

[3:16] but I want to see if any of our other board members have announcements that they'd like to make.

[3:23] I just wanted to say that since today is my last board meeting that serving on this board has been the highlight of my career and has meant so much to me but personally and professionally.

[3:37] I hope to serve on the board longer and unfortunately I'm having to leave the state because our Texas legislature decided to pass laws.

[3:47] hospital to LGBT populations that make my continued residence in the state

[3:52] untenable.

[3:56] And I want to, for anybody listening, just ask that we all recognize

[4:02] that vicious laws like that are going to cause brain drain on the state. I was

[4:08] not appointed to this board by commission of Rionis because I'm trans, although I

[4:12] was the first trans person to be appointed me because I'm a lawyer and a doctor, but

[4:16] But I'm being effectively forced off of this board by the realities of our legislature.

[4:21] I would love to continue to be on this board, but I can't because I have to do what's best

[4:26] for me, which is to get out of this state that is becoming increasingly hostile to my community.

[4:34] And so, while diversity didn't get me on the board, my diversity is what's forcing me out

[4:37] thanks to what happened in Austin, and I just want to commend this organization for always

[4:43] been committed to being on the right side of history and doing what's right and I'm going to miss

[4:47] you guys so much.

[4:55] We now move to our public life. I'd like to make a comment. Of course please.

[5:01] So I want to thank you for welcoming me when I came to the board and always being able to answer

[5:09] the question. Answer questions whatever I had them. You made sure that I understood my role

[5:21] here on the board. Your effectiveness in leading us on our governance committee and always being

[5:31] honest and finding for was right. It's important in setting a standard. So we will continue that

[5:39] that standard, even though you won't be with us,

[5:43] but I believe we've made a prayer for life.

[5:49] And so I want to thank you for your service on this floor

[5:53] and hope that at some point in the future,

[5:57] you'll be able to call it used to the home again

[6:01] because you'll always have family here.

[6:03] So thank you for your service and thank you

[6:06] for enriching my life in the patients here at Harris Health through the work that you

[6:14] have advocated for it and have done a little over your term.

[6:17] Thank you so much.

[6:19] All right, so with that, we will move before I get the FBI.

[6:23] We're going to move on to public comment, and I see we haven't speaker scheduled miss Nicarani

[6:30] from nursing point.

[6:34] That's not correct.

[6:40] Good morning.

[6:41] I didn't really get to see all of your faces on my computer screen so I'm

[6:45] fan-girling just a little bit. But my name is Nikita Theroni. I'm here on behalf of

[6:51] Precinct for Commissioner Leslie Breonez. We want to thank you Dr. Pike for your

[6:57] unravering dedication to advancing health equity to representing all of

[7:06] county residents and then advocating for the LGBTQI plus community. Your time here has made

[7:15] us very proud. Often we get to report back to Commissioner and just stand all over you and how

[7:23] you're just rocking it. So we really appreciate you. I have a certificate for you that we can

[7:29] I'll give you once we're done, and I just want to thank you.

[7:33] Thank you so much.

[7:34] Of course.

[7:43] You can get still on uncomfortable with Grace.

[7:47] All right.

[7:48] We're moving now to agenda item five, discussion regarding board governance, best practices,

[7:53] Miss Karma Bass with the Health Care Consulting.

[7:56] I turn out to Miss Bass to say a few words about the sign up.

[8:01] Good morning, everyone, and thank you for the opportunity to be here today.

[8:06] Can you all hear me okay?

[8:11] I'm sorry I can't be there in person with you today, but I appreciate the opportunity

[8:15] to see so many familiar faces again for those of you that don't know me.

[8:21] I had the privilege of facilitating this board's retreat last September and have been working

[8:28] with Harris Health for about a year now.

[8:32] I think I started my work preparing for the retreat a little bit earlier than this time

[8:37] last year. And I work nationally with hospitals and health systems, primarily other health care

[8:44] non-profits as well. My area of expertise is governance as well as strategic planning and

[8:50] leadership development. So I bring with you about 30 years of working with boards of directors

[8:58] similar to yourselves and different across the country. I do have a particular focus in public

[9:05] district hospital boards in those states across the country where they exist, similar to Texas.

[9:11] So, I am not a Texas law expert by any stretch, so I do rely on your in-house counsel Sarah quite

[9:22] a bit for that guidance. But my intention here today with you is to provide you just kind of like

[9:29] a tiny bit of updated governance best practices information and I hope that

[9:37] this information will be helpful to you. We'll keep my comments relatively short and

[9:42] would welcome any questions, comments, engagement that you would care to offer,

[9:47] either as we go along feel free to raise your hand and interrupt me if I don't see a

[9:52] raised hand but also happy to take questions at the end. So I just want to start

[9:58] out and please go to the next slide, Jennifer. I want to start out by thanking you for taking the time

[10:04] to take on this job. I know it is no small feat to be a trustee and certainly not at a public

[10:13] district organization like Harris Health, you operate in a very large context with a lot of visibility

[10:19] given to you. So I want to thank you for doing this in my opinion. Trustees play a vital and often

[10:26] under appreciated role in healthcare today and too often we see trustees kind of not given

[10:33] there do. I'm pleased to say that's not in my experience in working with or observing Harris

[10:38] Health and I'm glad to work with an organization that truly values the contribution of its board

[10:44] members and values the role that governance plays. One of the things I like about this particular

[10:49] quote and this book is old but I think the quote still stands is that it kind of shows the unique

[10:55] position. No one else can have the advantage on the organization that you are able to have

[11:00] as a trustee and so therefore your role kind of bridges that gap between the organization and

[11:08] the community. You are both of the community but you are also of the organization and so I just

[11:14] think that kind of your role providing this crucial perspective is something that provides great

[11:21] stewardship on behalf of the entire community. The next slide that I have is also one I just want

[11:28] to give you as a reminder I know that you are familiar with this you've received training on this

[11:33] but these three core fiduciary duties kind of ground your role as the stewards of the public resources

[11:39] so the way that you fulfill these means showing up being prepared asking good questions,

[11:44] maintaining confidentiality and what's interesting in Texas which I'm not

[11:50] familiar with any other state that has this requirement although there may be

[11:53] them out there but you in order to fulfill your duties as a board member you

[11:58] actually have to be in person so a quorum as you all know very well has to be

[12:03] established in person and without a quorum of course the board can't can't act

[12:09] can't do it's one of its primary functions which is to make decisions so the

[12:14] The next slide I think provides a little bit more granularity because my goal in providing

[12:19] you information is to give you something that you're able to use and maybe apply in your

[12:23] role.

[12:24] And so here are just some examples or some illustrations of how you can feel comfortable

[12:29] that you personally as a trustee and you collectively as a board are fulfilling your duties of care

[12:36] obedience and loyalty.

[12:37] So the duty of care really is about being prepared, about attending the meetings regularly,

[12:44] about having read the materials, about being thoughtful, about decisions that are being

[12:49] brought to you before you make any final decisions, and also doing the regular performance reviews

[12:56] both of yourself in the form of a board self-assessment and the president's CEO evaluation, which

[13:01] will happen, part of which will happen today in executive session.

[13:05] So, I just want to bring these to you as a way of kind of like a lot of times board members are,

[13:10] well, what are these fiduciary duties? How do I know if I'm doing them? These are the kinds of

[13:15] things that you can look for to assure yourself that you are, in fact, carrying out the duties.

[13:21] Of course, these are not the ceiling of what we hope for you to achieve. These are sort of the floor

[13:28] of kind of the entry level of, you know, kind of your ticket to ride and governance is to fulfill

[13:34] these three duties and I'll be talking a little bit more about when you go above and beyond what

[13:39] does that look like. So the next slide talks a little bit about that kind of what do excellent

[13:45] boards do because it's one of those things that having done this work as often as I have and all

[13:51] over the country there are a lot of things that are different from board to board of course but there

[13:56] There are some things that you sort of get a sense of when you work with a board.

[14:00] And one of the things that I noticed in particular is that really excellent boards are just

[14:06] obsessed with this idea of focusing on governance and not management because it is so easy

[14:12] to slide into a focus on kind of doing what management does.

[14:18] And in fact, you have very qualified, very well experienced managers and executives running

[14:26] the organization for you.

[14:28] There is no one else, however, that can do the role that you do, which is governance.

[14:33] And so that is why, for myself, I really encourage boards to be, you know, have that laser focus

[14:39] on is what we're doing governance, or is it management, and why it matters is that no one

[14:45] else can do the role of governance except you and all of the well-qualified people that

[14:49] you have in place are doing the management role.

[14:53] It's kind of like how your eyes can't simultaneously focus on a near-field of vision and a far-field

[14:59] division.

[15:00] The management is the near field division, and if you're focused there, then you're missing out on the far field division, which is governance. When I say that the board is not a legislative body, what I mean by that is that you collectively have to come together and agree on a direction for the organization. It's not 51% on a vote of some significant importance to me would be a failure on the part of most boards, depending on the or on the organization.

[15:29] and the decision because you represent the senior leadership of this entity and the people

[15:38] kind of like in a family system where the children are always watching the parents to learn how they really should behave.

[15:45] What kind of like in a family system you've got the board and with each other and with its CEO and senior leadership,

[15:53] the rest of the organization is watching you for signals.

[15:56] For signals to tell them, this organization is going in a great direction, this organization

[16:03] is one you should be proud of working with, this organization has a strong culture,

[16:08] we treat each other with respect and engagement.

[16:10] And when they see the senior leadership of the organization kind of, you know, not collectively

[16:18] moving in one direction, not agreeing on the really, really big things, not that you shouldn't

[16:24] voice differing opinions by all means you should and you should get into issues and you

[16:29] shouldn't always agree we don't want group think at the same time at the end of the day

[16:34] you should be able to find a place where you all can represent a unified perspective moving

[16:39] in a single direction that can send the signal not only to the people that work for you

[16:44] and the providers that take care of the patients but the community at large so that's kind

[16:51] of what I would say about what do excellent boards do, another thing that excellent boards

[16:56] do on the next slide is really focus on the facts that meetings are their only currency.

[17:03] So what I mean by this is that as individual board members, you have no individual authority.

[17:09] The only time that the board technically exists is when you're called together in a

[17:13] duly constituted meeting.

[17:15] And so unlike the roles that you might play in your personal or professional lives, where

[17:20] you carry the mantle of that authority, whether you're sitting in a meeting or sitting in front

[17:26] of a computer screen or out meeting with folks in the community, the only time you wear

[17:31] the mantle of the authority of this board is when you are in the meetings like today.

[17:36] And so for that reason, I recommend that these meetings be treated with an even higher

[17:41] level of seriousness of kind of the fact that this is a rare commodity for this organization.

[17:49] And so one way to do that is to make sure, and I believe that you have these things in place,

[17:54] really excellent planning for the meeting, making sure there's plenty of time for dialogue and

[18:00] discussion, making sure there's well-documented summaries through the minutes of what has actually

[18:07] happened, and taking time to make sure that you're touching base with each other and understanding each

[18:13] other's point of view well enough so that you can develop that healthy board culture.

[18:18] And one of the challenges that I believe that you face at Harris' health is that you

[18:24] do have this, the changing of your board members can happen quite frequently and from time

[18:32] to time without any kind of rhythm or rhyme.

[18:35] And so what this does, and I don't mean that as a criticism of the practice, it is written

[18:42] into state law and I greatly respect, you know, kind of the structures that drive that,

[18:46] But the inherent challenge, which is one to be addressed and overcome, is that any time

[18:52] you have a group of people working together, if you take one person out, like unfortunately,

[18:58] losing Dr. Pike after today, or you add one person in, it essentially, we know from social

[19:04] science research, it essentially becomes a whole new group. And so in order to foster that good group

[19:10] culture, particularly when you have a group like yourselves, a team like yourselves at the board

[19:17] level, who does regularly have players kind of switching in and switching out, it's important to

[19:23] focus on this board culture even more than another board might do is my recommendation. The monthly

[19:32] meetings where you have the richer conversations and the timely conversations are really important,

[19:37] I do think that because you oversee such an enormous organization with Harris South

[19:45] and so much complexity that having these monthly meetings is really critical and any time

[19:51] a monthly meeting is missed, it's quite likely that certain work in the organization grinds

[19:56] to a halt.

[19:57] So for instance, credentialing of providers is something that needs to happen on a monthly

[20:03] basis and when the board isn't meeting or doesn't have a quorum to meet, then what happens

[20:09] is there are providers out there who may be ready to come in and treat patients and aren't

[20:14] able to do so because they weren't able to get privileged and credentialed to see patients.

[20:20] And so that is why it's really important that you recognize this meeting as a currency that you

[20:27] possess and a very rare and precious one at that.

[20:31] The next slide gives you just another idea.

[20:34] And this one is one we think I have spent every.

[20:37] Oh, yes, please.

[20:38] Sorry.

[20:39] We need to take it, but just pause for just a second, please.

[20:41] Absolutely.

[20:43] I have to step out and she'll be right back.

[20:45] OK, no worries.

[20:51] Other organizations might do a presumption of quorum

[20:54] and not hear us help.

[20:56] I'm always learning.

[20:58] We don't just establish quorum and then assume

[21:01] that we have at the rest of the meeting.

[21:23] Please continue.

[21:24] Thank you.

[21:25] Wonderful.

[21:25] Thank you so much.

[21:27] Another thing that I see excellent boards do when I work with different organizations

[21:31] around the countries, they're very focused on the fact that this relationship between the

[21:37] board and the CEO is really one of primary importance.

[21:41] It should be at least to the board members and the CEO themselves.

[21:46] What I recognize in doing this work is that I've never seen a

[21:50] Board be successful by undermining the success of its CEO, and vice versa, I've never seen a CEO be successful by undermining the success of the Board.

[22:04] More importantly, the organization itself doesn't succeed.

[22:09] Now, I have often seen boards where the CEO is not the right fit for the organization and not able to deliver on what the organization needs,

[22:18] And it then becomes the board's responsibility to find a new CEO, to replace that CEO.

[22:24] So I'm not suggesting that boards in any stretch should just accept, you know, CEOs

[22:31] that aren't a good fit for their organization.

[22:33] But I would suggest that if you believe that your CEO is a good fit for your organization,

[22:39] you believe that he or she is delivering on what it is that you are looking for for the

[22:46] organization and the community, then it is incumbent on each one of you individually and collectively

[22:52] to do what you can to support each other. And again, it's that idea that your actions and the way

[23:00] that you treat each other is being very closely watched by all of the people that work for you in

[23:05] the community at large. So I think that it's like a family, you know, we have our disagreements

[23:11] and our arguments in private when you give the CEO his evaluation, those things that you

[23:17] would like to see done better, those things that you feel like are not where they need to be.

[23:23] That happens in executive session and going forward with the work that you do with the CEO,

[23:29] having each other's back is a really critical role for outstanding boards to do.

[23:35] The next two slides share a little bit of, it's a little bit tongue-in-cheek and I'll try to explain

[23:40] kind of what I'm saying here, but this idea that CEOs get frustrated by things that

[23:46] boards do and boards get frustrated by things that CEOs do and so here's the slide about

[23:51] what CEOs get frustrated by and this is what I see. A lot of times board members will

[23:57] misunderstand that their role is somehow the role of kind of to police the organization

[24:03] or to catch the organization doing something wrong and what I can share with you is that

[24:08] there are dozens, if not 100, external entities that are watching your organization all the time,

[24:17] all kinds of accreditations, regulatory oversight, laws being attended to compliance issues being

[24:24] managed, and so as a board, you can feel fairly comfortable that so long as you're not seeing any

[24:31] red flags and you're not hearing any reports that sound troubling, you can feel fairly confident

[24:37] that someone else is being the police and making sure the really bad things aren't happening.

[24:44] And your role is to kind of work together.

[24:47] So many of these bullets, as you see, have to do with that sort of cop mentality.

[24:53] The insufficient health care knowledge is a challenge for board members coming from outside.

[24:58] our field, our environment and health care is one that kind of defies logic in many cases

[25:07] and so it does require a regular resource of education and training for the trustees

[25:12] so that you can feel up-to-date and knowledgeable.

[25:16] Another thing that is very important is as you do currently to have at least a couple of folks

[25:22] who have clinical background on the board so that have an understanding of kind of

[25:27] what it's like to care for patients, either if doesn't have to be an MD, more and more

[25:33] often I see nurse practitioners or RNs, other ancillary service providers, but I do think

[25:40] that would be one thing in going forward since today, unfortunately you're losing someone

[25:45] who has that MD to, I know you are not the ones who appoint the board members, but you

[25:57] a couple, not entirely made up of clinicians, but having a board that includes clinicians

[26:03] is an important role, so that you have that grounding in understanding of what it's

[26:07] like to care for patients.

[26:09] The next slide shows what IC boards get frustrated by in their CEO or executive teams, and the

[26:16] fully baked cake is the concept that you hear about something very large for the organization

[26:23] on the first day and you're asked to act on it and you maybe didn't get a whole lot

[26:29] of information in advance and it's a very significant decision and it really wasn't something

[26:34] that just came up overnight but you're hearing about it for the first time and the management

[26:39] says, okay, we need your approval, we need your vote on this.

[26:42] That would be what I would call a fully baked cake and really outstanding executive teams

[26:47] that I work with will give the board multiple bounces on an issue before they ask for an

[26:53] action to be taken. Dr. Pike.

[26:57] You can tell us we could jump into questions.

[26:59] Yes, we did.

[27:00] This is more of a comment.

[27:02] And it's a question by way of a comment to see if that is,

[27:06] if your experience is similar to what my perception is,

[27:11] I see the fully baked cake.

[27:13] And the Board of Trustees, the trustees' duty of care

[27:18] has been closely related because if the trustee is not

[27:23] preparing, or their meeting, and for not reviewing materials, it can feel like the cake is more

[27:28] baked than it actually is. So if you're coming into the meeting without any pre-work done,

[27:34] then what you're being presented feels even more overwhelming than it already is. Is that,

[27:40] would you agree with that sentiment that the frustration of the fully baked cake can be to an extent

[27:46] offset by board members engaging in their duty of care and preparing before it?

[27:51] Yes, absolutely. I appreciate you making that connection because that is a frustration

[27:57] I have heard from executive teams at time is that, you know, they say they want information,

[28:02] we provide the information, we never hear whether that's the right information or not, and

[28:08] then we get criticized for not providing enough information. And so I do think it's important

[28:13] for board members to make sure that they're thoroughly reviewing the materials. And honestly

[28:19] I will tell you board members if you don't understand something that's in your packet and I would

[28:24] be surprised given the complexity of the information if there isn't a right because I don't understand

[28:29] everything in all the packets that I read and I've been doing it for decades. If you don't understand,

[28:35] then ask the question because your executive team I know the women and men that work with you here,

[28:41] they would love to be able to provide you information that is more targeted to what you need to

[28:46] know what you want to know. And so that engagement around the information that's being provided people have spent hours and hours if not days of their working time developing these materials they would love to know how those materials are working for you and it really is incumbent that you take that time in advance to prepare for those meetings because if you don't you are not going to be able to make an informed decision and that is really the basis of the legal obligation.

[29:16] that you have committed to doing.

[29:18] Now, one of the things that I think is really important

[29:20] to note is that, you know, as trustees,

[29:22] you are volunteers and I, again,

[29:25] that's why I commend you for this incredible service.

[29:27] And you're volunteers and that's,

[29:32] however,

[29:34] you cannot afford to be amateurs.

[29:37] This organization that you run is critically important

[29:40] to the well-being and health,

[29:42] not only of the hundreds of thousands of patients

[29:45] that you see every year through your various venues,

[29:47] but also to the community at large.

[29:49] And so it deserves your very best time and attention.

[29:53] And what I would tell you, which I tell boards all the time,

[29:56] if this is not something that, you know,

[29:58] oftentimes people are surprised.

[30:00] By what's involved in being on a board, what's they get on a board? I mean, I've asked questions in conferences of hundreds of people. How many of you, when you got on the board, found that it was what you thought it was, or how many of you found it was not what you thought it was and, you know, two thirds, three quarters of the people in the room will raise their hand. But, oh, it's funny. It raised my hand for me. It's so smart.

[30:29] But so it's not always what you think it is to get on a board, but if you get on a board and you find you just cannot meet the obligations of the board, the higher level of service is to acknowledge that and allow there to be somebody else to be on that board.

[30:43] Now I'm not saying I would encourage any of you to resign because Dr. Porsa tells me that this is the favorite board that he's worked with so far in terms of just how well people show up and engage in all of that.

[30:56] So I he would get mad at me if he thought I was suggesting you leave. However, if you find

[31:02] that the commitment is just not for you, the noble thing to do is to recognize that you're not

[31:08] able to meet the obligations. The next slide just kind of goes on what I see as the buckets of work,

[31:17] as a as a as a board member. So if you are on the board and you're wondering what is my job description

[31:24] and you've got an incredibly well-written standard operating procedures now in your board

[31:30] book and your board policies. So that's one of the legacies that Dr. Pike is leaving behind her

[31:35] is that I believe that she shepherded that and I would encourage you to read that and know it.

[31:40] The other thing that I would encourage you to do is think about these six kind of buckets of work

[31:45] being your primary areas of responsibility for boards and your monthly engagement with these

[31:52] areas, make sure that you're able to do the oversight of the organization effectively.

[32:00] And I'm not going to go into detail on them because I know my time with you this morning

[32:04] is short. The next thing I want to just talk about briefly though is that distinction between

[32:09] governance and management. And how do you know? Jennifer, if you could go to the next slide please.

[32:15] The, so a common challenge is to understand where boardwork ends and management work begins. And

[32:22] And the reason that this is a challenge is because in each organization, in each circumstance,

[32:27] it could be a little bit differently and it could be a little bit different.

[32:31] So depending on where the organization is in its life cycle, depending on what level of

[32:37] crises may be facing the organization, I have seen this line legitimately shift about where

[32:45] the distinction is.

[32:46] What the really great boards that I work with do, though, is they actually think about this

[32:51] and like I mentioned earlier they're always focused on where are we at. There was a board

[32:56] that I worked with in Southern California for many years. They had a person on a man on the board

[33:02] who was a retired medical device salesperson. He was loved governance. He loved

[33:09] he loved the fact that he could be there and make a difference for his community and he's

[33:14] really focused on quality even though he didn't have a clinical background for that.

[33:21] But one thing I will never forget is in the middle of a quality committee one time, they

[33:25] were talking about some very specific aspect of how the organization does certain things

[33:32] and he stopped the meeting because he was the chair and he said, excuse me, I just want

[33:36] to ask the question here, this is a really fascinating conversation, but are we focusing on governance

[33:43] right now or are we focusing on management detail?

[33:45] And I think that's kind of the thing is that what we do in health care I believe is really endlessly fascinating.

[33:52] And so as a board member making sure that your questions and your areas of focus have to do with kind of what your role is as a board.

[34:01] And frankly what I would share, this is my perspective of course, is that idle curiosity just doesn't have a place in the board room.

[34:09] If there is a question you're asking or information you're asking for, it should be related

[34:14] to the board's role, or it probably is not something you should be asking for or focusing

[34:20] on in your governance capacity, of course, you know, love to have you learn more about

[34:26] things in your own time.

[34:28] The next slide just gives you a little bit more granularity on that because that is what

[34:32] I was kind of wanting to do for you today is how do you know?

[34:36] So great boards are always bringing things back to the mission and vision, they're focusing on what is our strategic direction which I know you're in the midst of right now.

[34:47] So looking forward to seeing what you come up with in that regard and they're focusing on the policies and procedures.

[34:54] And so for type A people who have been really outstanding managers and executives in their own right sometimes sitting on a board feels a little bit anticlimactic and people may feel like, well, wait, I'm not quote unquote doing anything.

[35:09] But actually the higher level of governance effectiveness is to focus on that oversight and it's what one board chair that I worked with in Pennsylvania said one time we follow the NIFO rule which is nose in fingers out.

[35:24] So that's kind of the management governance distinction, and I hope that slide is helpful

[35:30] to you.

[35:31] One of the interesting nuances for you at Harris Health is that when we talk about mission

[35:37] and vision, your obligation as a board member is to serve the mission and vision of Harris

[35:43] Health itself, and while Harris Health, of course, exists to serve the community and the public,

[35:49] the duties of loyalty, care and obedience are owed to Harris health, not to the public

[35:55] at large.

[35:56] So, when you think about who do we report to, you are, you are, your selves reporting

[36:02] to yourselves, you are focused on the mission and vision of the organization and the carrying

[36:08] out of the organization's purpose in serving the community, but you are not kind of directly

[36:16] responsible to the community, you're responsible to that mission, and of course, that's my opinion.

[36:23] I know that opinions may vary on that, but that's the perspective I would bring you.

[36:28] The last slide that I have for you this morning is that, you know, just kind of these important

[36:32] notes that I will leave you with. The Board's governance, a collective body, not as individuals or

[36:37] subsets. Speaking with one voice really ensures that clarity and consistency and creates confidence

[36:44] on the part of the employees and the providers that work for you, it creates confidence on the part of the community that you all are unified in the kind of what you see as the highest and best way to provide health care to them.

[36:58] And it builds that trust which is so essential we're learning more and more in all of our areas of work and business that trust is really the underpinning of everything else.

[37:09] So, I will stop there and I think I may have just a few more minutes and I think there's

[37:15] a comment or a question that someone had mentioned in the chat.

[37:20] Thank you so much, Karma, Ms. Robinson, you had a comment?

[37:24] I do.

[37:25] So, one of ones to make sure that the presentation will be put in diligent, make sure we give

[37:32] that.

[37:32] But, second, I wanted to mention at the privilege of attending the Texas Health Care Trust,

[37:41] these governance conference with Dr. Portian, some of the staff.

[37:46] And if any of the board members get an opportunity to go in the future,

[37:52] I think that it would be, it's definitely a conference worth attending.

[37:56] I learned a lot, not only in my role as a board member, but helping me understand some

[38:05] of the challenges and that some of the challenges that we talk about are not unique to Harris

[38:10] help, but our challenges that public health systems are facing across the state until being

[38:17] able to talk to other trustees and it's meeting that I did talk to are where you guys talked about

[38:27] as being several, several years back. And so I think that it was both interesting to get

[38:37] perspectives from around the state, but to also understand some of the legislative challenges

[38:44] is that we all face and how to go about addressing those.

[38:47] So I think it's important from our role in governance

[38:50] if we have an opportunity to participate in conferences

[38:54] like that, that we make an effort to do so

[38:56] because I think that it makes us a more informed and educated

[39:00] board, especially those of us who aren't in health care

[39:04] to help us to better understand that.

[39:07] And I think I didn't have to twist his arm,

[39:11] but one of the things that Dr. Porson,

[39:12] that I spoke about at the conference was a certification

[39:18] that I suggested that we all participate in

[39:21] and then getting as a board.

[39:24] And I think that that will also elevate

[39:26] our role in the governance.

[39:29] So Dr. Porcettino, if you want to speak on that at all.

[39:33] Sure. First of all, thank you for attending the conference.

[39:36] And one of the other things I would like to add

[39:37] to the impact of attending the conference like that,

[39:41] whether they gave me an opportunity to associate with you, you know, out of the board, which was,

[39:48] which was awesome. But yes, so in speaking up with Ms. Robinson and also speaking to Dr.

[39:56] Parnayak, who's the chair of the United States health care trustees, they are actually willing to come

[40:01] to Houston to educate the board in Houston and then provide the kind of a brief

[40:11] competency check examination to get everybody certified as a trustee, which I think is

[40:18] a secret opportunity.

[40:19] And I know with Ms. Robb, I said it just elevates this sport to another level.

[40:24] And I echoed everything they just said.

[40:26] I went to the conference last year and really, really enjoyed it.

[40:33] I'm ashamed to say that I had planned on getting my certified healthcare trustee certification

[40:36] but just did not find time.

[40:38] But getting that certification, I think, would be a great idea for board members.

[40:43] I wanted to echo something that Carmen said with regard to idle curiosity

[40:48] or where you feel like there are gaps in your understanding.

[40:52] I really want to encourage board members use each other as your first resource.

[40:57] You know, Dr. Borses, our only employee, he has a very busy job.

[41:01] He doesn't need us asking him to educate us.

[41:04] And it is inappropriate for us to go around him to ask staff members directly to educate us.

[41:11] That doesn't mean that Dr. Corsa and our team isn't open to and willing to do that because they're wonderful people.

[41:18] But I would encourage you to use each other as your first line of resource.

[41:22] Ms. Robinson, you brought up that when you joined the board, I really love that you were willing to come to me and ask me questions.

[41:28] and I think that phosphorus is a really great dynamic among the board and it's respectful

[41:33] of everyone's time because that way board members are educating each other with our time

[41:37] rather than educating the board becoming a to-do list item for paid staff or for our CEO

[41:45] to add on top of their article plate.

[41:47] So I really hope we can continue that working together and educating each other because

[41:52] we all have, you know, more about housing than I could ever hope to know.

[41:55] So, Ms. Barrett knows more about, you know, healthcare finance, and I know that we all have

[42:02] our own expertise, and I think because of the complexity of healthcare, we can all lean

[42:06] on each other in that way.

[42:09] Any other comments or questions about Ms. Vast's presentation?

[42:16] Thank you for your time.

[42:18] Thank you so much.

[42:20] And we are actually four minutes ahead of schedule.

[42:23] So with that, we've come down to agenda item number six.

[42:29] The board will go into executive section for item six A through G as permitted by law

[42:34] under Texas Occupations Code, sections 151-002, 160-007 and Texas Health and Safety Code,

[42:42] one section 161-032 and Texas Government Code, sections 551-071-551-072-074-085.

[42:53] Board members and presenters scheduled to speak in executive session do not need to log

[42:56] out.

[42:57] IT will move you in and out of the executive session room.

[43:00] The public meeting will resume via live stream from the Harris Health Web site upon our

[43:04] return from executive session.

[43:06] The time is now 9.13 a.m., it will take a brief technology recess in order to transition

[43:11] to our virtual executive session.

[43:19] Let's take it and I note that the form is present.

[43:22] The time is now 10.33 a.m., this brings us to agenda item 8.

[43:28] discussion related to bent-top infrastructure and notice to the city of Houston, Texas,

[43:33] regarding chapter 26 hearing on a proposed taking by him in the domain of approximately 8.9

[43:38] acres out of Kerman Park, the adjacent to bent-top hospital for a project to expand the hospital's

[43:44] facilities. I invite Dr. Porso to say a few words about this, I am. Thank you, Dr. Biden. Good

[43:50] morning again, everyone. I try to be brief while covering the important aspects of

[43:56] conversation. As the board is aware, in November of 2023, the Harris-Kami residents overwhelmingly

[44:04] supported our $2.5 billion bond proposal. Part of that bond proposal was the construction of

[44:12] a new hospital in the LGJ campus, the vast investment in our community health clinics, but also

[44:21] So, summer, the north of $400 million in the expansion of Bentop Hospital in the form

[44:28] of a new inpatient tower added about 100 inpatient beds and procedure periods.

[44:37] The issue has always been that, at the end, they have studied the event of infrastructure

[44:43] and its location. It has been a question as to where does it make sense for us to invest

[44:52] that $400 million towards a near-term expansion event out of the hospital and ultimately replace it.

[45:00] In the future years, 20, 25 years from now. The issue is this. Ben Top Hospital is very fast

[45:08] approaching this end of his useful life, while we could potentially build on top of the

[45:15] existing mental hospital. That is not a feasible option, a practical option, and a very expensive

[45:23] option. Obviously, building a hospital that is currently serving our patients will cause

[45:31] an issue in the hospital being able to continue to provide those services. Number one, number

[45:37] two, you know, investing $400 million on a rapid-leaf aging and bail the infrastructure,

[45:44] just as not sound like a wise use of taxpayer money.

[45:50] The other issue, if we were not going to be able to build a top of the ventile hospital

[45:55] which we have studied it and the answer is no, we're not able to do that, is there an opportunity

[46:02] to build on the grants of ventile hospitals similar to what we're doing on the LVJ campus,

[46:09] build a new hospital wall to exist and the hospital continues to operate at this starting

[46:15] with the intention tower. And the answer, unfortunately, is no, because of the issue of

[46:22] ventile-based landlocked. What you see on this slide is the, as you might point out here,

[46:31] eastern zoo from the park, the memorial hermit in the light blue, ventile-based college of medicine,

[46:40] and behind Bentow Hospital here,

[46:43] and adjacent to Bentow Hospital,

[46:45] also part of the urban park, land owned by the city of Houston.

[46:51] So really, there is no space on the current footprint

[46:54] of Bentow Hospital where we could potentially begin

[46:58] with the creation of a new inpatient tower.

[47:02] And again, sometime in the future, 2020,

[47:06] 25 years, it's the future once we are able to go back to the residents of Paris and

[47:11] from the bottom of the proposal to replace penthouse hospital.

[47:16] So what I'm bringing into the attention of the board, I'm the public for that matter

[47:21] today, is the idea of Harris Health requesting that Harris County on our behalf condemn the

[47:32] land that is owned by the city of Houston adjacent to ventile hospital this land is part of

[47:41] permanent park hybrid it is not contiguous with the existence of permanent park it is across

[47:46] the street on Cambridge and adjacent to ventile hospital this land represents less than 2% of the

[47:55] entirety of permanent park land. And it is the only reasonable feasible, basically responsible

[48:07] option to start the initial expansion of the hospital in the form of the investment of the

[48:16] The $400 million bond proceeds to create that 100-bit inpatient tower adjacent to Bentow

[48:25] Hospital on the Parkland and will become the first phase again of the future at the

[48:32] eventual replacement of Bentow Hospital.

[48:35] Again, 20, 25 years down the line, but studying with the new hour, which is, I'm not identified

[48:45] here in the dash yellow line. This power could be connected to the existing

[48:50] method hospital through an overpass over the Lamar Fleming street.

[48:56] This is actually very close proximity. What would be the outcome of this

[49:02] action? The existing mental hospital will be able to continue to provide uninterrupted

[49:08] service to our community throughout the entire expansion, studying with this

[49:13] in patient power and eventual replacement of ventile hospital on this parkland adjacent

[49:20] to the ventile hospital.

[49:23] The new ventile expansion tower would add that this is the needed capacity to ventile

[49:28] by adding approximately 100 more patient beds and procedure areas.

[49:33] The future ventile hospital will continue to remain an integral part of the international

[49:41] in a recognized Texas Medical Center, and the future Ben Todd will also have expanded capacity to

[49:47] better serve the level one trauma needs of Harris County. So this really becomes a win, win,

[49:54] win situation for Harris Health, whether it's the up Houston, but the residents of Harris County

[50:01] to look into the future for our ability to continue to provide the services that aren't

[50:07] book to be needed. What are the next steps? The Aristotle Court of Trustees will hold the public hearing beginning at 9 a.m.

[50:17] at our next rigorous schedule board meeting on Thursday July 24th here in this

[50:23] fourth room at 4,800 furnace place. Notice as they're going to the public hearing will appear in the Houston

[50:29] a clinical study tomorrow, Tuesday July 1st, and on a weekly basis on July 8th and again

[50:37] July 15th ahead of the public hearing, all persons interested to speak on this item

[50:44] should call 3 or 6, 4 to 6, 0 to 8, 5, 4, no later than 4 p.m. and Wednesday July 23rd

[50:53] the day before the public hearing, immediately following the public hearing, the Aristotle

[50:58] for the trustees will consider an action to request that Harris County on behalf of

[51:06] Harris Health condemned to discuss parts of land, city of Houston land, for the purposes

[51:12] of Vintal Possible Expansion and eventual replacement. But the part that is my entirety of the presentation

[51:20] I'm happy to take any questions that anyone may have at this point.

[51:27] Any questions from

[51:28] minutes of the board.

[51:32] Okay. Here you can see none. Thank you very much for your presentation.

[51:35] All right.

[51:39] That brings us now to agenda item nine. A general action items related to

[51:44] quality and medical staff. First, we have consideration of approval and credentialing changes

[51:50] for members of Harris Health Medical staff. I invite Dr. Carmen to say a few words.

[51:54] Thank you, Dr. Pike, and good morning again to the board and to the Harris Health community.

[52:00] briefly, I will present our roster changes for the medical staff credentials

[52:06] report for June of 2025. So for this month, we have a total of 13

[52:12] initial appointments, 158 reappointments, 11 change in clinical privileges,

[52:19] and a total of nine resignations. The details of which are enclosed within your packet.

[52:26] I'm happy to answer any questions, but otherwise that's my brief presentation.

[52:29] Thank you again.

[52:33] Thank you, Dr. Sharma.

[52:34] Do I have a motion and second for approval of credentialing changes for members of the

[52:38] Harris Health Medical staff as presented?

[52:40] So move.

[52:41] Thank you.

[52:42] Mr. Point, if you have a motion, thank you.

[52:43] Ms. Vera-Bland for the second on any discussion.

[52:47] All those in favor say aye.

[52:48] Aye.

[52:49] Any opposed?

[52:50] Say nay.

[52:51] The motion passes.

[52:52] Thank you, Dr. Sharma.

[52:54] Next.

[52:54] It's agenda item 9B, general action items related to quality of correctional health and

[53:00] and medical staff, consideration of approval

[53:02] and credentialing changes for members

[53:03] of the hair cell correctional health medical staff.

[53:06] Dr. Egan's, please.

[53:08] The morning, thank you, Dr. Pike,

[53:10] and thank you to the board and the public

[53:13] for this opportunity.

[53:15] The correctional health medical executive committee

[53:17] met on June 9th, and we have one application

[53:21] for initial appointment and four reappointments

[53:23] that we're asking the board to approve at this time.

[53:26] Thank you.

[53:28] Thank you Dr. Egan's. Do I have a motion and second for approval of credentialing changes

[53:33] for members of the Harris Health Correctional Health Medical staff as presented?

[53:37] Thank you, Miss Vera Blant. Thank you, Miss Perrette. Any discussion? All those in favor

[53:42] say aye. Aye. Any opposed? Say nay. The motion passes. This brings us to agenda item 10, strategic

[53:49] discussion 10a, Harris Health Strategic Plant Initiatives. A presentation regarding the

[53:54] Harris Health budget process was included in your packet for review, and I turned to Ms.

[53:59] Nikkeem and Ms. Perez to say a few words about this item.

[54:02] Thank you, Dr. Pike.

[54:03] This was requested as board education for new members who have not been through the budget

[54:10] cycle with us before, as well as a refresher when they just the process part of it and the time

[54:17] lines. The actual board workshop is going to convene very early in the month of August

[54:25] and we will cover very specific financial parameters of the budget going into fiscal 2026 with that.

[54:34] I'd like to turn over to VP of financial planning and analysis.

[54:41] Good morning, so this morning I'm going to go over the various phases of the budget cycle

[54:47] with you and then conclude with some strategies for success.

[54:59] I'm going to go over the various phases of the budget cycle with you all this morning and

[55:04] then concluded with strategies for success.

[55:06] Next slide, please.

[55:09] So we start off the budget process

[55:11] by identifying our financial goals and priorities

[55:14] for the year.

[55:16] Once that has been determined,

[55:19] we begin drafting our budget proposal.

[55:23] Once that initial draft has been developed,

[55:26] we review and consolidate that information

[55:29] and that is the phase of the cycle we're in right now.

[55:31] and we are doing that ahead of our board budget workshop scheduled for August 4th and then the

[55:38] anticipated next phase of the cycle which is the approval by the board and county commissioners.

[55:44] And then once implemented or once approved we're implementing that budget and then there's

[55:50] continuous monitoring that takes place. Next slide please.

[55:56] All right so the first phase of the budget

[55:58] process the identification of financial goals and priorities. So we actually start our budget process

[56:03] off in January of each year. So you can see it's very lengthy and extensive process here,

[56:10] but we start with the development of our budget calendar and in developing that calendar,

[56:15] we are working with our partners, the Harris County OMB, to ensure that we are aligning our deadlines

[56:22] with their timeline and expectations as well.

[56:28] So, we then worked with our executive leadership team

[56:31] again to establish those financial targets

[56:34] and priorities for the coming year.

[56:37] And then with that information we develop our budget guidance.

[56:40] So that would include what is the timeframe we're going to use

[56:43] as the baseline for our budget, what labor, efficiency,

[56:48] or cost-contain reduction expectations we have

[56:51] of, and then applying any inflationary factors or other adjustments to that baseline information.

[56:57] And then also during this phase, we are considering any new strategic initiatives that are submitted.

[57:06] Next slide, please.

[57:09] So once we've got those priorities and that guidance, we begin drafting the budget proposal

[57:14] and that is a collaborative effort with our stakeholders across the system.

[57:19] We began that process by developing volumes, so we would be developing the KVI or key volume

[57:27] indicators for various areas so that could be anything from patient days to emergency

[57:34] room visits, clinic visits, or patient's meal serves, square footage, pounds of laundry

[57:43] just depends on the area we're budgeting for.

[57:46] And so we would take that baseline information and then our stakeholders would adjust that information for any known changes in operations that could be the closure of some operating rooms temporarily for renovation.

[58:06] That could be the loss of some providers and the clinics or maybe the onboarding of some new providers as an example.

[58:17] Today, given our current capacity constraints across the system, we are projecting relatively

[58:23] stable volume for next year's school year.

[58:26] Next slide, please.

[58:29] Once we've got those volume projections developed, we move on to our expense projections.

[58:36] In projecting expenses, we categorize those expenses into two classifications.

[58:42] So, big expenses and variable expenses, so those big expenses are going to be those expenses

[58:48] that were made constant regardless of the volume of activity previously projected.

[58:55] So, think of contract maintenance expense, utilities, repairs, things that are not impacted

[59:01] by that volume.

[59:03] And then variable expenses, just the opposite, we expect that expense to increase or decrease

[59:08] on those volume projections developed in that first step.

[59:14] So that would be things like pharmaceutical expense,

[59:17] medical supplies, food purchases.

[59:22] Next slide, please.

[59:27] So building into specifically the development of FTE targets

[59:31] for those variable areas, we're going to be looking at that projected volume

[59:36] in that step one.

[59:37] Then we're going to be looking to benchmark data where available on worked hours per unit

[59:44] targets where those variable error is and then apply any productivity or labor efficiency

[59:52] goals that were established at part of that guidance.

[59:56] and then for fixed area

[1:00:00] Those FTEs are going to be based on our courier budgeted FTEs. We would only make changes to those based on approved strategic initiatives. So that could be any new strategic initiatives approved in that first phase. Or it could be any that were approved for this year, but maybe aren't fully reflected in that budget number. And so we're adjusting for that. All other incremental requests for FTEs happen.

[1:00:29] Then outside of our annual budget process, we have a very robust approval process where

[1:00:35] the approval of FTEs, where we have a chief staffing officer over each of our pavilions

[1:00:41] that works with leaders to review their request and then those requests go to the labor management

[1:00:50] oversight committee or LMOC for approval throughout the year as those requests come up.

[1:00:56] And then once those FTE targets are developed, the finance is projecting, what is the cost

[1:01:02] of that labor using current average allureate information at the job code level?

[1:01:08] We're adjusting that for anticipated or known market increases, merit adjustments, and then

[1:01:14] applying benefits.

[1:01:18] For non-labor expenses, again, for variable expenses, such as medical supply,

[1:01:26] As far as pharmaceuticals, we're looking at that projected volume and taking that time's

[1:01:32] that cost per category so that pharmaceutical expense times the projected volume and then

[1:01:38] applying inflationary increases and we work with our supply chain departmental leaders on

[1:01:44] those inflationary increases.

[1:01:46] We look to premier or GPO and other benchmark on an industry information to guide us on what

[1:01:52] those inflationary increases are.

[1:01:54] And then for our fixed areas, our fixed expenses, rather, we're taking into account what is

[1:02:03] our historical spend. So for example, repairs kind of looking at on average what do we spend on

[1:02:09] repairs for things such as contract maintenance, looking at what are the current contract rates

[1:02:14] and what are the contract terms to protect that expense. Next slide.

[1:02:22] All right, so now we've talked

[1:02:23] about our expense projections. Let's move on to our revenue projections. We start with our

[1:02:30] that patient revenue and that is going to be driven by those volume projections in the first step

[1:02:35] and then collection reimbursement rates as received from our revenue cycle team. We're not expecting

[1:02:41] again any significant changes in volume or those collection reimbursement rates for next year

[1:02:47] and so that's going to save that to be relatively stable in FY 2026.

[1:02:53] So Medicaid supplemental payments, so these comprise about a third of our revenue.

[1:03:00] When we come to you in early August, those are going to be based on our current year projections.

[1:03:06] We will update those as we have more current information available from the stage that that

[1:03:11] doesn't typically happen until the August September timeframe.

[1:03:14] So we may not have that at the time of the initial budget workshop.

[1:03:20] And then other revenue, that would include things like brands, donations, machine revenue,

[1:03:31] you know, all of those other sources of revenue.

[1:03:34] So, you know, we're going to look to the historical actions and then we'll adjust for

[1:03:38] known changes.

[1:03:38] So if we know that you know the amount of funding we're receiving for a particular grant is changing we will make that change and adjust accordingly.

[1:03:49] And then lastly net and alarm tax revenue.

[1:03:53] So again at the time we come to you in August that projection is going to be based on our car your budget and will apply some conservative inflationary adjustments to that.

[1:04:04] Those numbers will not be updated until we receive projections from the county, which

[1:04:10] won't occur until early to mid-August, and we'll talk about that a little more in the

[1:04:15] next slide.

[1:04:21] So, diving into that net-advolarm tax revenue a little more, in early to mid-August we will

[1:04:28] receive two projections from the county.

[1:04:32] that would be the no-new revenue rate and the voter approved rate, so that no-new

[1:04:37] revenue rate is going to be the tax rate that generates flat revenue as

[1:04:42] compared to the current year for the same properties. And then that voter

[1:04:47] approved rate would represent the maximum that we are allowed by-law without

[1:04:52] having to go back to the voters for approval. So think of it as the floor in the

[1:04:58] So the commissioners can approve either of those rights or they can approve anything in between.

[1:05:07] And so we will not have that.

[1:05:09] We won't know what that adopted tax rate is until that public hearing is held by the commissioners court and the tax rate is voted on, which is currently scheduled for September 18th.

[1:05:22] So we will talk about how that impacts the timeline and what we bring forward to you guys

[1:05:26] in just a minute.

[1:05:28] Next slide, please.

[1:05:30] So this far, everything we've talked about is how we develop our operating budget.

[1:05:34] So for our capital budget, we're working with our facilities team on what our equipment replacement

[1:05:43] needs are, what projects are upcoming, but we're just talking about routine capital.

[1:05:49] We come to you with and our capital budget projections does not include any of the projects related to the strategic facilities plan or the $2.5 billion bond issuance.

[1:06:01] One major change we are making in FY 2026 is that we're shifting from a commitment based methodology to cash.

[1:06:09] And what I mean by that is, you know, currently when a project is approved, the cost of that project is committed to.

[1:06:19] And then that would be a part of the budget that we would present to you in any given year.

[1:06:24] We're shifting to cash basis, which says, okay, let's look at that project.

[1:06:29] Let's look at when we plan to start that project, the timing, the one we're going to need, those funds.

[1:06:35] and then budget for that cash in the appropriate year.

[1:06:40] And so, as a result of that shift,

[1:06:42] we are expecting a decrease in the capital budget

[1:06:45] compared to prior fiscal years.

[1:06:48] Next slide, please.

[1:06:52] So, again, once all of those inputs are developed

[1:06:55] and a draft budget is complete,

[1:06:58] we're holding formal budget hearings with our stakeholders.

[1:07:02] This is where executive leadership

[1:07:04] Leadership provides input and feedback regarding their request, the stakeholders go back and

[1:07:13] they then revise their request accordingly and admits it or a trip.

[1:07:18] There may be, you know, multiple meetings held, you know, to revise that budget until we

[1:07:24] get to a place where, you know, executive leadership and finance signs off on those requests.

[1:07:29] Once it's been signed off on, and again, finances were doing it, making sure it appears

[1:07:36] to that budget guidance initially established that all of the feedback received from the

[1:07:42] executive leadership team has been incorporated, and then we're consolidating all of that

[1:07:47] information to present to you all.

[1:07:51] Next slide.

[1:07:55] And so, Phase 4, we would come to the board and the county commissioners for their approval

[1:08:01] and so I've outlined here some important dates and next steps for you all to be aware of

[1:08:07] starting with the board budget workshop. As I mentioned, we just scheduled for August 4th.

[1:08:13] Again, we don't expect to receive those tax revenue projections from the county until

[1:08:17] the first couple of weeks in August, so at the time we have to submit that data to the board

[1:08:22] office for y'all, we will not likely have that information.

[1:08:27] We'll receive that in the first couple of weeks in August ahead of our first budget presentation to the Commissioner's Court, which is scheduled for August 14th.

[1:08:37] And then we'll come back to you all on August 28th. We will have those no new revenue and voter approved revenue projections and we will ask you all to approve a not to exceed budget.

[1:08:51] Why is it not to exceed because the county commissioners have not voted on what our adopted tax rate will be yet?

[1:09:00] And so, again, that won't happen until tentatively September 18th, after which if there are any reconciling items, if something is approved outside of that not to exceed budget that we asked you all to approve that we'll bring that back as a reconciling item for your awareness.

[1:09:20] Yes.

[1:09:21] Real quickly.

[1:09:22] So we have a question from Ms. Robinson, but before we turn to that, I want to make sure

[1:09:27] I understand correctly with regard to Medicaid supplemental payments and Medicaid reimbursement

[1:09:32] rates.

[1:09:34] Does the state, this is HHSC, did they have a specific deadline by which they have to give

[1:09:42] us that information?

[1:09:43] You know, the state has their own schedule.

[1:09:45] So what the state does is simply provide us the intergovernmental transfer date and the distribution of the final payment date. So just to give you an example why this is pushing into the budget cycle and creates additional uncertainty.

[1:10:02] Our largest payment is uncomplensated care payment.

[1:10:07] It is according to the state schedule, the distribution of that payment, the schedule,

[1:10:13] I believe, for September 29, which is the end of our fiscal year, and the IGT call,

[1:10:19] which tells us exactly what that amount is going to be until which time we don't know is

[1:10:26] going to be the middle of August.

[1:10:28] So if some of you remember last year, we have to go to this body and the Commissioner's

[1:10:36] Court with one number, predicating it on potential updates, and then we have to change and adjust

[1:10:44] that number down and come back to this body and the Commissioner's Court with new information.

[1:10:50] So, we have been working with the state to let them know that this creates a challenge

[1:10:59] with this board for the administration to present our annual budget.

[1:11:06] They seem to be understanding, however, they are still going to stick with their schedule.

[1:11:12] So, we will do the absolute best that we can to provide this board the information

[1:11:19] that we have available to us, but I cannot guarantee that this is going to be

[1:11:25] something that is, you know, sent still and we can take forward.

[1:11:30] So, and I admittedly asked a question, I knew the answer to you, but it was because I wanted

[1:11:37] the board members to appreciate the amount of both work that our finance team does as well as

[1:11:43] the uncertainty that we have going in. So I won't be here for this upcoming budget cycle,

[1:11:48] But for more members who have not had the privilege of going to that process yet, it's

[1:11:54] going to feel a little chaotic.

[1:11:56] And that is a, that is a, unfortunately, a known issue because of how the various schedules

[1:12:03] line up.

[1:12:04] So our team doesn't get even what, we don't know what our main reimbursement is going

[1:12:09] to look like until less than six weeks before we're supposed to have voted on and published

[1:12:14] budget for the next fiscal year and in that six weeks we have to they have to

[1:12:20] calculate make projections bring it to us. We tend to really vote on the

[1:12:24] projection. We take that to Commissioner's Court and Commissioner Court

[1:12:26] deliberates on it and they might ask us to send it back and have us look at it

[1:12:30] again and all of that is happening without us even knowing what our tax rate is

[1:12:33] going to look like because Commissioner's Court oftentimes holds on voting on

[1:12:37] that tax rate until they've seen a proposed budget and so it's all going to feel

[1:12:41] very compressed. And historically, there was, I know some board members have had a perception

[1:12:49] that it was like there was a transparency or there wasn't good communication happening.

[1:12:54] And I want to reassure everyone having gone through this process twice now at least,

[1:12:57] that our team is incredibly transparent. It's just, we literally are sitting here,

[1:13:01] biting our nails, waiting for the state health services groups to tell us how much money they're

[1:13:07] going to give us. And then we also have to wait on commissioners court to tell us what are

[1:13:11] tax rate is going to be. And without those two key pieces of information, I mean, that's

[1:13:16] our revenue.

[1:13:17] Yes, that's two thirds of our revenue management, so thank you for that comment.

[1:13:21] So just be patient, trust the process. It's going to feel chaotic and rushed, but trust

[1:13:28] the process. And with that, I miss Robinson, you had a question.

[1:13:33] I wanted to ask, on the slide, when you talked about the capital budget and you talked about

[1:13:39] commitment versus cash basis to help me understand that a little bit more so the commitment is

[1:13:46] that we believe that we can get it done for this amount and then the cash is this is what we

[1:13:52] actually have on hand or no the the commitment based budgeting process. I'm sorry.

[1:14:02] The commitment based budgeting process we've used historically has been based on

[1:14:07] If we commit to a project and the estimated cost for that project is $5 million, then we

[1:14:15] would include that $5 million within our capital budget projection that we present to you all.

[1:14:21] Cash basis says, okay, this project is estimated to cost $5 million, but we're not going to

[1:14:29] start it until about half of the year, it has a couple of phases, really, you know, by

[1:14:34] time it's fully implemented it will be next fiscal year and so we only anticipate needing

[1:14:41] you know cash up to two and a half million dollars for the given fiscal year.

[1:14:47] It's really the timing, Ms. Robinson, that's the point.

[1:14:51] You're spending cash it's literally a little bit down the road from when you are putting in the

[1:14:57] purchase order in the system, so.

[1:15:00] Well, the timing was, it may be a different, different period. Okay. All right. Thank you very much. Any other questions for our presenters? Just a question. On the tax rate, you turn on your microphone please. On the tax rate, has there been consistency throughout the fiscal budget year, the year? No.

[1:15:28] Um, um, could you clarify consistency, which I mean, well, if they gave us a percentage

[1:15:35] from the last fiscal year to this fiscal, I mean, you know, from previous years, as

[1:15:41] the percentage has been the same.

[1:15:43] No.

[1:15:44] So in terms of the, I mean, how far is there's approving a particular rate, um, and stands each year

[1:15:52] stands on its own. So there is not a commitment or consistency to be expected. There are floors

[1:16:00] of the ceiling that we will know in advance but then where it lands depends on priorities of

[1:16:08] the county and how the commissioners decide to abortion and allocate. So we're the last five years

[1:16:17] We've had two non-net revenue tax rates last year was the first time in 10 plus years

[1:16:27] that we actually had a border improvement, but those two non-net revenue tax rates that

[1:16:35] we faced over the last five years has actually brought our overall tax rate so low that it

[1:16:43] would take several years of order of proof rate

[1:16:47] to just get us back to work we were at 2019.

[1:16:53] The rate and amount of aggregate tax receipt

[1:16:56] are sometimes going in different directions.

[1:17:00] So while the rate is low,

[1:17:02] the amount of aggregate revenue received from tax support

[1:17:06] is higher because the properties in Harris County

[1:17:10] have been growing for the time at a very good clip.

[1:17:14] And it wasn't much.

[1:17:14] And so, without being said, your rate may be lower,

[1:17:18] but the amount of tax support that you're getting is higher.

[1:17:21] So, that's kind of the truth of that station equation.

[1:17:25] Thank you.

[1:17:27] All right.

[1:17:28] Great discussion, everyone.

[1:17:31] So, with that, we now move to our agenda item 10B committee reports.

[1:17:38] We only have one committee report for the June 13th, 2025 governance committee,

[1:17:43] where I chaired that meeting, the governance committee met on June 13th, 2025, and we discussed

[1:17:52] board self-governance as well as board member meeting attendance and how it interacts with

[1:17:57] how board members communicate with it, one another, how it can optimize that using

[1:18:01] modern technology without running a file of the Texas of a meeting deck,

[1:18:05] and also looking at possible revisions to our standard operating procedures.

[1:18:11] And that includes my report for the Governance Committee.

[1:18:14] Any comments or questions about that?

[1:18:17] Okay.

[1:18:18] Next is new items for Board Consideration, the agenda item 11A, discussion and appropriate

[1:18:24] action calling an interim officer election for the current term 2025 resulting from the

[1:18:29] vacancy in the office of the Board Vice Chair and any other resulting vacancies required by

[1:18:33] Article 5 Section 3 of the Harris Health Board of Trustees by-laws.

[1:18:37] So because I'm unfortunately leaving or Article 5 of Section 2 of our bylaws, we must conduct an interim election to fill the vacancy of the Office of the Vice Chair, as a result of my recent resignation.

[1:18:51] The newly elected interim Board Vice Chair would only serve for the remainder of this calendar year until end of 2025.

[1:18:59] five. Prior to this meeting we received one nomination for consideration which is our

[1:19:04] current board secretary, Ms. Carol Perez. Now we will take nominations from the floor for

[1:19:11] the interim position of board vice chair. Are there any members who would like to nominate

[1:19:17] someone from the floor or nominate themselves to be office of interim board vice chair for the

[1:19:22] remainder of the calendar year of 2025?

[1:19:28] I have to ask you two more times. Are there any members

[1:19:33] We would like to nominate someone from the floor or nominate themselves to the office of Interim Board Vice Chair for the remainder of the calendar year of 2025.

[1:19:44] And once more, are there any members who would like to nominate someone or themselves from the floor to the office of Interim Board Vice Chair for the remainder of calendar year of 2025?

[1:19:57] This time, the nominations for the office of Interim Board Vice Chair for the remainder of the calendar year of 2025 are now closed.

[1:20:04] Our final slate of candidates for this office are Miss Perret.

[1:20:07] but if you would like to make any brief remarks, you may do so.

[1:20:13] I'll be happy to do it until the end of December.

[1:20:16] Thank you.

[1:20:18] Now that the candidates for interim board bus here have all spoken,

[1:20:21] we will now conduct the election.

[1:20:23] There's only one name to read after which I will issue a roll call

[1:20:27] or you will vote in favor by saying aye or nay so that we can record in the minutes

[1:20:31] and I will read off nominees names in the order of nations.

[1:20:35] So those in favor of electing Ms. Caret to the Office of Interim Board Vice Chair, please indicate.

[1:20:42] So by saying aye or nay, I'll start, I'm just going to go in the order I have.

[1:20:47] Dr. Pike, aye.

[1:20:52] Is Dr. Caret Costas on the call with us?

[1:20:55] That would be excellent.

[1:20:57] Okay.

[1:20:57] So Mark, here's an absentee.

[1:21:00] Absentee.

[1:21:00] Ms. Davis, are you on the call?

[1:21:08] Ms. Caret.

[1:21:13] Mr. Robinson,

[1:21:16] Mr. Puerreland, Mr.

[1:21:20] Puerreland, Mr. Sun, I, thank you, sir, I have Ms. Lacheladjian.

[1:21:30] I'll vote she's off.

[1:21:31] No, I'm caught.

[1:21:32] Okay.

[1:21:33] So 1, 2, 3, 4, 5, 6, they're being 6 eyes and 3 absents and 0 names, the motion passes.

[1:21:42] Congratulations, you have my jump.

[1:21:51] So, with that, we have a new officer position that is not vacant because Board Secretary

[1:21:59] Carol Paret has been duly elected as the interim board vice chair.

[1:22:02] We must now fill the new vacancy for the Office of Interim Board Secretary.

[1:22:07] So again, this is for the Office of Secretary until the end of the calendar year 2025.

[1:22:13] Are there any members who would like to nominate themselves or someone else from the floor to the Office of Interim Board Secretary?

[1:22:23] I'd like this up and nominate.

[1:22:24] Okay, let me give you a blend that is nominated.

[1:22:34] Anyone else would like to nominate themselves or someone else from board to serve as the Interim Board Secretary until the end of calendar year 2025?

[1:22:44] Once more, any members who would like to nominate themselves or someone else to the Office of Interim Board Secretary Board 2025.

[1:22:55] Here are the last three times.

[1:22:58] So nominations are now closed. Our final state of candidates for the Office of Interim Board Secretary is Ms. Yarra Blanned.

[1:23:06] Ms. Yarra Blanned, if you'd like to make any remarks, you may do so at this time.

[1:23:08] Just like to say that I'd be honored to serve the board in this capacity.

[1:23:12] Thank you.

[1:23:14] Thank you.

[1:23:15] Now that our candidate has spoken, we will not conduct the election after I read your name.

[1:23:20] I'm going to do the same thing where I go through a roll call of everyone.

[1:23:23] So all those in favor of electing Ms. Libby Vera Blanche, the Office of Interim Board Secretary.

[1:23:28] Please indicate so by saying aye or nay.

[1:23:30] Dr. Pike.

[1:23:31] Aye.

[1:23:32] Dr. Caracostis is absent.

[1:23:34] Ms. Davis is absent.

[1:23:35] Ms. Carrette, Ms. Robinson, Ms. Vera-Bland,

[1:23:44] Mr. Quentin,

[1:23:47] Mr. Sun,

[1:23:51] I think you needed

[1:23:51] sir.

[1:23:52] Thank you.

[1:23:54] Ms. Lutton-Baudillon is absent.

[1:23:56] There being six eyes, zero nays, and three absences, and congratulations to our new

[1:24:02] interim board secretary.

[1:24:09] Elections go so significantly when the following one candidate.

[1:24:14] All right.

[1:24:14] that concludes the agenda item 11A. We are now on a agenda item 11B, consideration of approval

[1:24:21] of resolution setting the rate of mandatory payment that has turned possible different local

[1:24:25] provider participation fund and notice of public hearing. I turn now to Ms. Nikita to say a few words

[1:24:31] about this item. Thank you, Dr. Karpai. This is an annual item that would come to the board.

[1:24:37] Just a quick refresher for new members and members who have heard this one year ago, local

[1:24:46] provider participation fund or LPPF is a financing structure enacted by the Texas legislature.

[1:24:55] They have existed in Texas since 2013.

[1:24:59] Harris County was approved in 2019, so this is year number six for us.

[1:25:06] And we as local government entity are administering the assessing of the taxes on the hospitals that are participating in the fund so that the state and we deposit it in the state account so that the state and uses the funds to access the federal share for the two large programs.

[1:25:34] One being the uncompensated care and second one is an umbrella program. It's called Comprehensive Hospital Increase Remorsement Program.

[1:25:45] We are asking for a mandatory payment not to exceed 6% of the net patient revenue on the hospitals that are participating in the funds.

[1:25:56] and we will be assessing that throughout the year as the IGT calls our send fund

[1:26:03] the safe and that process takes place. So asking for your approval at this time.

[1:26:11] Thank you Miss Nikita. Any questions?

[1:26:15] With that do I have a motion and a second

[1:26:17] to the approval of a resolution setting the rate of mandatory payment for the

[1:26:20] Harris County Hospital District's local provider participation fund as

[1:26:23] presented.

[1:26:28] This is Robinson, thank you for the motion, and Ms. Brett pick the second. Any discussion?

[1:26:35] All those in favor say aye. Aye. Any opposed? Motion passes. We're now on agenda item 11,

[1:26:42] Steve. Consideration of approval staffing plans and payment for the contract and services specified in

[1:26:48] the Harris Health Operating and Support Agreement with Fairer College of Medicine for the contract

[1:26:52] to your ending June 30th, 2026, Mr. Keaton, and Mr. Smith.

[1:26:58] Yes, thank you again. This is a funding request for the contact year.

[1:27:03] It's just been stated starting tomorrow for a full year ahead for faculty and resident

[1:27:11] physicians for Baylor College of Medicine, now to exceed $292 million.

[1:27:17] dollars. Thank you. Do I have a motion in a second for the approval of staffing times and payment

[1:27:23] for the contracted services specified in the Harris Health Operating and support agreement

[1:27:27] with Baylor College of Medicine, the contract year ended to June 30th, 2026 as presented.

[1:27:35] Thank you, Ms. Perret. Thank you, Ms. Vera-Bland. Any discussion?

[1:27:41] Those in favor say aye.

[1:27:42] Aye.

[1:27:43] Any opposed?

[1:27:45] The motion passes.

[1:27:46] Agenda item 11-D.

[1:27:49] Consideration of approval of statute of fines and payment for the contract and services specified in the Harrisville operating and support agreement with the University of Texas Health Science Center at Houston or UT Health for the contract year ended June 30th, 2026.

[1:28:02] Mr. Keke.

[1:28:04] Thank you.

[1:28:04] then the administration requests another funding request for UT Health, faculty and residents

[1:28:13] and members for the year beginning tomorrow. July 1, 2025, June 20, 2026, and they're about

[1:28:24] not to exceed $209 million. Thank you, Mr. Keaton. Do I have a motion and a second to the approval

[1:28:31] of staffing plans and payment for the contracted service is specified in the

[1:28:35] Harris Health Operating and support agreement with UT Health for the contract

[1:28:39] year ended June 30th, 2026 as presented. Thank you Ms. Libby Bearblin. Thank you

[1:28:47] Ms. Robinson. All those in favor say aye. Aye. Any opposed? Say nay. The motion

[1:28:53] passes. We're now on agenda I am 11. E is an echo in presentation of the Harris

[1:28:59] County Hospital District 401k and pension plan independent audit towards reports and overview for

[1:29:04] fiscal year end of December 31st, 2024. Mr. Ryan Singleton from Fortis, a presentation was

[1:29:10] included in your packet for review and I'm going to invite now Mr. Singleton to say a few words about

[1:29:15] this item. Thank you all board for giving us the opportunity to present. I believe also you should

[1:29:22] have copies of the financial statements that were provided related to each plan. As part of our

[1:29:28] require communications to this board to go to the next slide. Our responsibilities are outlined in

[1:29:34] the scope of engagement between the two parties relate to the drafting of the financial statements

[1:29:39] and related notes and based on the work that's been performed and presented, we are prepared to

[1:29:47] issue unmodified opinions on both of those reports. The accounting policies and practices that were

[1:29:55] You're noted during our procedure.

[1:30:00] Assistant with Accounting and Industry Standards. During our audit procedures and working with Jay Camp, there were no difficulties encounter between our team and his team. There were no disagreements with management. There were no contentious accounting issues. There were also no identified material weaknesses are significant deficiencies internal controls. There will be a sport of our required communication letters. You will receive an audit communication letter at the issuance

[1:30:29] of the audit, as well as a management representation

[1:30:33] letter that we provided.

[1:30:37] As part of our audit procedures on the next slide,

[1:30:41] we go through one more slide, please.

[1:30:45] We go through certain areas that we identify as potentially

[1:30:48] risked areas where we focus our procedures on.

[1:30:51] The first one is inherent in every audit

[1:30:53] as management over audit controls.

[1:30:55] Based on the work related forbickeries,

[1:30:57] journal entry testing, no matters were affordable.

[1:31:01] Related party disclosures, there were no issues to be reportable now.

[1:31:05] Any related party disclosures are properly disclosed in the financial statements.

[1:31:10] Nothing significant unusual in those matters.

[1:31:13] The fair value of estimates.

[1:31:15] We perform a sample sent out to a third party valuation specialist, which provides those fair values back to us.

[1:31:22] All of their fair values came back within reasonable expectations of what the fair values of the investments for both plans were recorded at.

[1:31:30] So no matters or issues there.

[1:31:32] We also, when the pension, we get the actual report,

[1:31:35] go through the input, its management assumptions,

[1:31:39] perform reasonable tests on those.

[1:31:41] No items were noted and knows a significant differences there.

[1:31:46] And that wraps up our required communications related

[1:31:49] to the audit of the two benefit points.

[1:31:53] Thank you very much, Mr. Singleton.

[1:31:56] And Sarah, just to be clear, this presentation covers both

[1:31:59] of the motions I need to make next, correct?

[1:32:01] This presentation covered both the 401k and the district pension.

[1:32:06] That is for credit.

[1:32:08] Thank you.

[1:32:09] So members, we're going to do two motions based on the presentation.

[1:32:12] That was just provided.

[1:32:14] Mr. Webman, sorry.

[1:32:19] Ryan, were there any unfundent liabilities within the report?

[1:32:26] No, sir. Nothing was noted on those.

[1:32:28] The appropriate funding that was calculated was done in with regards to the pension.

[1:32:33] Okay, thank you.

[1:32:36] Thank you, Mr. Puente. Sorry, I got an agreement and didn't see your question on the chat.

[1:32:42] So again, we have two motions. One for the 401K and one for the pension plan. So first, we'll do the 401K motion.

[1:32:48] We have a motion and a second for the acceptance of the Harris County Hospital District's 401K plan. Independent auditors report and financial statements for the years ended December 31, 2024 and 2023 as presented.

[1:33:02] Thank you, Mr. Puente. All those in favor say aye. Any opposed? Say nay. Motion passes.

[1:33:12] Do I have

[1:33:13] a motion and a second for the acceptance of the Harris County Hospital District pension plan,

[1:33:17] independent auditorous report and financial statements for the years and in December 31, 2024 and 2023

[1:33:22] as presented? Thank you, Mr. Puente. Thank you, Mr. Robinson. Those in favor say aye. Any opposed? Say

[1:33:30] Yay!

[1:33:31] The motion passes.

[1:33:32] Thank you very much.

[1:33:33] You're single, anyway.

[1:33:34] Yes.

[1:33:35] Thank you all.

[1:33:35] Have a great day.

[1:33:36] You as well.

[1:33:38] All right, we are now moving to our consent agenda items which is agenda item raw mandu-ural

[1:33:43] 12 or consent purchasing recommendations.

[1:33:48] We have consideration of approval of purchasing recommendations items.

[1:33:51] Alpha 1 through Alpha 13 of the purchasing metrics.

[1:33:55] These purchasing recommendations were included in your packet for review.

[1:33:59] I turn to Mr. Kenneson, Mr. Adger, to say a few comments about these items.

[1:34:07] Thank you, Dr. Pai, Jack Adger, for purchasing.

[1:34:10] There are no changes or additions that we ask that the board approve as presented.

[1:34:17] Thank you very much. Any questions or comments from the board members?

[1:34:22] Hearing none, do I have a motion in a second for the approval of purchasing recommendations?

[1:34:27] items alpha one through alpha 13 at the purchasing matrix. So thank you Mr. Whitley. Seconded. Thank you Miss Vera blend any discussion?

[1:34:36] Those in favor say aye. Hi, let's say those opposed say nay.

[1:34:44] Let's just do a quick.

[1:34:46] Some little echo lolly is going on

[1:34:50] Those in favor of the motion as presented say aye. I any opposed

[1:34:58] That's it. We now move to consent agenda items B is in boy through D is in delta, and

[1:35:06] the board members let me know if you'd like to pull any items for discussion.

[1:35:13] Hearing no

[1:35:14] items pulled for discussion, drive a motion and second for the approval of consent agenda items

[1:35:19] B and C, please note that agenda item D does not require any action and is for an update

[1:35:25] only. So thank you, Ms. Vera-Bland. Thank you, Mr. Pointe. Any discussion? Hearing none,

[1:35:33] all those in favor say aye. Aye. And all of those say nay. The motion passes. Okay. This brings us

[1:35:42] now to agenda item 13. Item is related to the health care for the homeless program. agenda item 13,

[1:35:50] output review and acceptance of the following reports for the health care for the homeless program

[1:35:53] As required by the United States Department of Health and Human Services, which provides

[1:35:57] funding to the Harris County Hospital District to provide health services to persons experiencing

[1:36:03] homelessness under Section 330H of the Public Health Service Act, Dr. Jennifer Small and

[1:36:09] Mr. Tracy Bergen.

[1:36:11] Good morning, everyone.

[1:36:13] Okay.

[1:36:14] Next slide, please.

[1:36:17] Today's June War presentation will cover our patient from the Children Report, our Consumer

[1:36:23] Advisory Report.

[1:36:23] A revision to your ACHP bylaws, a pollite from our 2024 annual report.

[1:36:30] I'm sorry, Mr. Dillon, but I think I forgot to say something before you start it.

[1:36:34] Yes, ma'am.

[1:36:35] So our health care for the homeless program team is going to present all items together

[1:36:40] in one presentation. Afterward, we will take it along each of their items separately as required

[1:36:46] by law. But before they do their combined presentation, I need to read the remaining agenda items

[1:36:51] approval before that presentation, so we're going to be covering approval of the Health

[1:36:58] Care for the Homeless Program Consumer Advisory Council report, the Health Care for the

[1:37:02] Homeless Program revised by-laws, the Health Care for the Homeless Program 2024 annual

[1:37:07] progress support, and the Health Care for the Homeless Program quality management report.

[1:37:12] And we'll have to do a separate motion for each of those, but this one presentation will

[1:37:16] cover all of them before we vote.

[1:37:18] Thank you, please continue.

[1:37:19] We will also cover our quality management report, which will be covered by our medical

[1:37:23] doctor, Dr. Rich today.

[1:37:26] Next slide, please.

[1:37:29] Okay.

[1:37:29] Year-to-date, we have served on a duplicated patient year-to-date as in May.

[1:37:35] We have served 3889 on duplicated patients and completed 13,000 visits.

[1:37:42] And that has put in us slightly ahead of schedule for our targeted goals, so we're happy about

[1:37:47] that.

[1:37:47] Next slide, please.

[1:37:49] For the month of May, we've served a total of 1399 on duplicated patients, 874, which

[1:37:56] were seeking family practice services, and completed 2,000, 1,2700 completed visits.

[1:38:04] Next slide, please.

[1:38:06] For the Consumer Advisory Council report, these activities were covered from May of 25,

[1:38:11] February of 2025 to April of 2025 and the items that we discussed this month were for assessment

[1:38:19] of our operational hours. We're looking at our hours at Harmony House trying to decide if we

[1:38:24] need to provide services, even clinic for the individuals there that are working. We also looked at

[1:38:31] updates to the Open Door renovation project, participation in our community health events,

[1:38:37] and also the outcomes that our UDS report, which we'll be presenting to the board later in the year.

[1:38:45] Next slide, please.

[1:38:48] Okay, we've recently made some revisions to our bond laws.

[1:38:52] The first one is that we changed the hair cell system to re-hair cell.

[1:38:58] And the second one, due to recent updates under the new federal administration,

[1:39:03] First, I have provided us with revised guidelines, and it's into concerning terminology.

[1:39:09] So what we change was gender to sex, but I do want to say this, that this is only a

[1:39:17] language update, and it does not impact our values or our commitment to equitable care.

[1:39:23] Next slide, please.

[1:39:25] Here are highlights from our annual report, and I know it won't pass, but I need that for

[1:39:30] It's a comfort quality, so I'm going quick.

[1:39:32] Thank you, Dr. Pry.

[1:39:34] A few more on your report.

[1:39:36] We're just going to show you a few highlights

[1:39:37] from that report.

[1:39:39] So our top five diagnosis is obesity, depression,

[1:39:43] tobacco use disorder, hypertension, and diabetes.

[1:39:48] Somebody of the mental health and substance use trends

[1:39:50] involved, again, depression, anxiety, PTSD.

[1:39:54] We actually have a lot of PTSD.

[1:39:56] And we're trying to tailor our services to that.

[1:39:58] and also other substance-related disorders.

[1:40:01] We're going to be working on some additional treatment

[1:40:04] to implement later in the years,

[1:40:07] so we'll bring that to the board as we work through them.

[1:40:10] Next slide, please.

[1:40:14] In 2024, we served 6,684 and duplicated patients.

[1:40:19] This was 89% of our targeted goal,

[1:40:22] and we completed 27,000 completed visits,

[1:40:26] which was 121% of our goal.

[1:40:28] So we did really well and complete a business to the point where, first of all, you guys are doing a great job.

[1:40:33] So they boosted that number to 30,000 businesses this year, like yes.

[1:40:38] And that's why I said that.

[1:40:41] Okay, a breakdown of our patients showed that we have 65% of our patients are male and 35% of them are female.

[1:40:49] And they range in an age group of 25 to 64 years age.

[1:40:52] So that told us that we need to continue to give dedicated care to our adult population

[1:40:59] while we're still continuing to focus on women's care and our older adults.

[1:41:04] We do need to kind of cater to our men's care.

[1:41:06] And that included behavioral health services, preventive care services, chronic disease management as well.

[1:41:13] Next slide please.

[1:41:15] I find it's an overview for 2024, we received over $4.9 million in grant funding.

[1:41:24] And of that funding, we utilize 71%.

[1:41:26] We are lucky that we are allowed to use that funding as carryover.

[1:41:32] And we're trying to do so in the limit amount of funding that Herzl has to contribute to this program by utilizing my grant funds.

[1:41:40] Next slide.

[1:41:41] And this is why we do what we do. This slide speaks to this young lady who was residing in the shelter at Starr Hope Cornerstone.

[1:41:51] And she received services from our mobile dental unit. And that team started to reserve her as an advocate and became her support system throughout her journey.

[1:42:02] And then she decided she was going to join the army.

[1:42:05] Our team, the dental team, not only wrote letters until phone calls while she was in basic

[1:42:11] training, they actually attended her graduation when she graduated from the basic training.

[1:42:16] And I have to say that, just like the hairstyle mantra, my team truly lives this, and so I'm

[1:42:22] very proud of them for staying with her throughout her journey.

[1:42:27] Next slide, please.

[1:42:31] I'm trying to know if the doctor reached for a positive management process.

[1:42:36] Good morning, everyone.

[1:42:38] All

[1:42:45] right. First slide, please.

[1:42:49] All right. So we have our first slide here,

[1:42:51] which lists our quality goals that we have set for this quarter.

[1:42:56] We're going to be talking about data from the first quarter of 2025.

[1:43:00] Next slide, please.

[1:43:03] So in the interest of time, we are highlighting five of the metrics that did not meet our established quality standards.

[1:43:10] Childhood immunizations, diabetes, management, and early entry into prenatal care did not

[1:43:16] reach the UDS benchmark measure, whereas management of intravascular disease and depression

[1:43:23] screening failed to surpass our programs more aggressive internal goals.

[1:43:29] I'd like to focus on those goals that are not currently meeting the UDS benchmark and provide

[1:43:35] a more high level for those that are not surpassing

[1:43:38] our own internal goals.

[1:43:40] There are six patients in the pediatric vaccine standard

[1:43:44] to them that the standard,

[1:43:46] while the remaining four had either missing or refused vaccines.

[1:43:50] Again, primarily is ROTA and influenza vaccines

[1:43:54] which have to be given doing infancy.

[1:43:56] And once that time period is passed,

[1:43:58] we're not able to go back and give them those vaccines.

[1:44:02] But all of the children of parents

[1:44:04] to agreeable to vaccinations are enrolled in participating in a catch-up vaccine plan.

[1:44:12] diabetes control continues to be challenged because patients had A1C levels, they were

[1:44:17] greater than 9, or did not have A1C measurement completed during the first quarter.

[1:44:23] We're addressing transportation and scheduling issues to support those patients who did not

[1:44:29] have an A1C check, and we're promoting aggressive diabetes management for those with elevated levels

[1:44:36] for the primary focus to address this measure. Those aggressive measures include early insulin

[1:44:42] therapy, dual therapy, referral to our nutritionists, and inclusion of our clinical case nurse and

[1:44:48] our health educator to help our patients. One of the challenges we face is that a lot of our patients

[1:44:55] is live in facilities where they do not have control of their diets.

[1:45:00] Selection, however, when you don't have much to eat, you have to eat what's given. And so we are working with our patients in understanding to try to help them make the best possible decisions in those circumstances. The early entry into prenatal care metric measures the number of patients who present for prenatal care in the first trimester. The 10 patients is quarter to met the metric, but the majority of patients presented in the second trimester.

[1:45:29] semester. The drill down reveal that it was a lack of pregnancy awareness before the end of the first

[1:45:36] trimester and a lack of understanding or the acceptance of need for early prenatal care.

[1:45:43] We provide education for the need of early prenatal care when we do our annual family planning

[1:45:51] tool and at well woman visits. So we're focusing on trying to educate patients that prenatal care

[1:45:57] is necessary and is effective.

[1:46:02] And then highlighting those measures that did not meet the secondary goal.

[1:46:07] We are working with the epic IT team to assure appropriate identification of patients from

[1:46:12] whom anti-platelets are appropriate for the intravascular disease metric.

[1:46:18] And then for the depression screening and follow-up, there was a change in the metric this year

[1:46:24] from HRSA previously, we were, it was considered positive if the patient scored above 10 and then we

[1:46:31] would have to put in a follow up plan. However, it changed from 10 to 5. And so there was a bit of a

[1:46:37] lag between when it dropped down to 5 and then we caught on to it. I submitted an SBAR to consider

[1:46:45] changing it back to 10. But in the meantime, we are addressing those patients who scored above a 5.

[1:46:53] And that's what we have for our presentation.

[1:46:56] I thank you all for your smiles and your nods of encouragement.

[1:47:00] And it's just awesome.

[1:47:02] Thank you.

[1:47:03] Quick question of curiosity.

[1:47:05] How many FTEs of providers do you guys have on your team?

[1:47:12] I'm trying to figure out how many encounters your team is having to see per day

[1:47:16] to hit 27,306 in a year.

[1:47:20] So there's, there's not, there's not at this, so that's why you're putting on the, you're

[1:47:30] putting us on the, we'll call us to the road, but there's nine FTE and the goal is that

[1:47:37] each provider should see an average of 204 patients a month, a month, yes, so if we round

[1:47:44] it out to 10. That means each, I mean you're exceeding that by a lot. If we

[1:47:52] rounded to 10 providers, which is one more person, then you actually have 30,000

[1:47:56] would be 3,000 patients in a year, and that's what HRSA is asking for. That's what

[1:48:01] they're asking for. And we just, we actually just completed our last vacancy.

[1:48:14] We're

[1:48:14] here. Thank you. I just want to applaud the work you guys are doing because it hit 27,000 encounters

[1:48:22] with a team of nine plus minus one that's really incredible and you guys should be very, very proud.

[1:48:31] Yes, ma'am. Thank you so much. Thank you.

[1:48:38] Okay. Board members, we're not going to do that flurry of

[1:48:42] motions that I was telling you about earlier. So first, do I have a motion and second,

[1:48:47] for acceptance of the Health Care at the Homeless Program June 2025 operational update.

[1:48:52] Thank you, Ms. Vera-Bland.

[1:48:54] Second.

[1:48:54] Thank you, Mr. Quentin.

[1:48:55] Any discussion?

[1:48:56] All in favor, say aye.

[1:48:58] Aye.

[1:48:59] Any opposed, say aye.

[1:49:01] Motion passes.

[1:49:03] Do I have a motion and second for the approval of the Health Care at the Homeless Program

[1:49:06] Consumer Advisory Council report?

[1:49:09] I have a motion.

[1:49:10] Thank you, Ms. Vera-Bland, for the second.

[1:49:14] Any discussion?

[1:49:17] All those in favor say aye.

[1:49:19] Any opposed say nay.

[1:49:23] I'm sorry.

[1:49:23] Was that an aye, Mr. Sun?

[1:49:26] Aye.

[1:49:28] Thank you.

[1:49:29] All right.

[1:49:31] The motion passes there with no nays.

[1:49:35] Next, do I have a motion in a second for approval of the health care for the homeless program revised by loss?

[1:49:43] Thank you, Ms. Robinson.

[1:49:44] Thank you, Ms. Friend.

[1:49:45] All those in favor say aye.

[1:49:48] Aye.

[1:49:48] The vote say nay.

[1:49:51] No, ma'am.

[1:49:52] Thank you.

[1:49:52] The motion passes.

[1:49:54] They have a motion and a second to the approval of the health care for the homeless program.

[1:49:59] 2024 annual promise work.

[1:50:03] So a lot more than you could say.

[1:50:07] Thank you, Mr. Vierrobland.

[1:50:09] Thank you, Mr. Pundit, for the second.

[1:50:10] Those in favor say aye.

[1:50:11] Aye.

[1:50:12] Any opposed say nay.

[1:50:15] and last one, the revolution in a second-day approval of the health care for the homeless

[1:50:19] program, Quality Management Report.

[1:50:23] Thank you, Mr. Wednesday.

[1:50:24] Thank you, Ms. Perret.

[1:50:26] Any discussion?

[1:50:28] Hearing none, those in favor say aye.

[1:50:30] Aye.

[1:50:31] Any opposed say aye.

[1:50:33] Motion passes.

[1:50:35] Thank you very much.

[1:50:38] Lift that.

[1:50:40] This brings us to Board of Gender Item, or TEAM.

[1:50:44] I have a request on my room and the board will go now into executive session for items 14

[1:50:54] H through Cain as permitted under law pursuant to Texas Health and Safety Code, section 161.032

[1:51:02] and Texas Government Code, sections 551.071, 072, 074 and 085.

[1:51:11] Board members and presenters scheduled to speak in executive session do not need to log

[1:51:14] off.

[1:51:14] IT will move you in and out of executive session room.

[1:51:17] Public meeting will resume via live stream from the hairstyle website upon our return from

[1:51:20] executive session.

[1:51:22] The time is now 11.42 a.m., we will take a brief technology recess in order to transition

[1:51:27] to our virtual session.

[1:51:29] Recording stopped.

[1:51:38] We have returned from our executive session where no action was taken and I know that a

[1:51:42] is present. The time is now 114 pm. The board will now take action on item 14J and 14K

[1:51:53] of the executive session agenda item 14J settlement with Texas Health and Human Services Commission.

[1:52:00] Do you have a motion and a second approval of the settlement with the state of Texas Health

[1:52:04] and Human Services Commission, Office of the Inspector General, related to reimbursement of Medicaid

[1:52:08] It came as in the amount of $2,516,662 of $27 cents for

[1:52:15] soon to the terms discussed in our executive session.

[1:52:20] Thank you, Mr. Sun for the second.

[1:52:23] This is in favor say aye.

[1:52:25] Any of those say nay.

[1:52:27] The motion passes.

[1:52:30] And next agenda item 14k regarding CEO evaluation.

[1:52:35] Do I have a motion and second for the approval of the review of the chief executive officer evaluation and compensation recommendations as presented in our executive session?

[1:52:47] Thank you, Mr. Buendin. Thank you, Mr. Robinson. Any discussion?

[1:52:54] Those in favor say aye.

[1:52:55] I, all those say nay, of any abstention, Mr. Son noted as abstaining, the motion passes.

[1:53:08] With that, we have completed our posted agenda.

[1:53:11] If there is no, I'm going to invite this one more action.

[1:53:30] Do I have a motion and a second approval of the CEO goals for the period of July 25

[1:53:44] to June of 2026, as presented in our executive session?

[1:53:48] Thank you, Mr. Nierbland, thank you, Ms. Robinson, all in favour say aye.

[1:53:55] Any of you both say aye.

[1:53:58] All right.

[1:53:59] Everyone voted aye.

[1:54:00] The motion passes.

[1:54:01] Now, we have completed our posted event that if there is no objection, the meeting is

[1:54:08] now adjourned that the time is 1.17 pm.

Jun 30, 2025 Board Meetings - Harris Health System

Agenda

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