1
00:00:40,800 --> 00:00:47,920
Good afternoon everyone. Uh welcome to
our September 9th, 2026 uh board of

2
00:00:46,399 --> 00:00:52,559
Douglas County Commissioners work
session. We are joined here by um our

3
00:00:51,360 --> 00:00:57,520
community partners from H Heartland
Community Health Center. We have um Bob

4
00:00:55,440 --> 00:01:02,640
Transky from staff who might be kicking
us off with a a little bit of an intro.

5
00:01:00,320 --> 00:01:08,159
And just a quick uh reminder for anybody
who might be new to work sessions. Um uh

6
00:01:06,080 --> 00:01:12,799
we do not take public comment or take
any kind of action during work sessions.

7
00:01:10,240 --> 00:01:16,400
It's an opportunity for presentation for
commissioner questions and discussion.

8
00:01:14,799 --> 00:01:19,680
Um we always have a business meeting
that follows which will begin at 5:30

9
00:01:18,159 --> 00:01:23,600
and we always have a general public
comment um period then and you're

10
00:01:21,840 --> 00:01:28,799
welcome to provide any public comments
you might have about today's discussion

11
00:01:25,759 --> 00:01:33,280
at that time or write us later. Um and
with that I will turn it over to Bob.

12
00:01:31,920 --> 00:01:38,720
» Thank you commissioners. Good afternoon
everyone. Um, in 2018, before there was

13
00:01:36,720 --> 00:01:45,040
a mental health sales tax, before there
was a TRC, a mobile response team, care

14
00:01:41,920 --> 00:01:48,960
coordination in the community, um,
behavioral health partners like LMH,

15
00:01:47,200 --> 00:01:54,320
Bert Nash, H Heartland, H Heartland,
Raak, DECA were convening and having

16
00:01:51,680 --> 00:01:58,240
conversations about what the gaps in our
community were with respect to

17
00:01:56,079 --> 00:02:04,159
behavioral health. And even before we
had moved forward on trying to go after

18
00:02:01,040 --> 00:02:08,720
this mental health sales tax as a group,
um, one of the gaps that was identified

19
00:02:06,079 --> 00:02:13,680
was in the area of psychiatry and med
services. And so collaboration between

20
00:02:11,280 --> 00:02:18,879
Bert Nash and Hartland and LMH resulted
in and support from the county resulted

21
00:02:16,720 --> 00:02:23,040
in the creation of a psychiatric
infrastructure workg group that was

22
00:02:20,959 --> 00:02:28,319
tasked with taking a look at what the
needs are across our continuum of care

23
00:02:25,520 --> 00:02:33,840
and community with respect to psychiatry
and med services. That effort led to a

24
00:02:31,599 --> 00:02:38,560
really pretty significant increase in
the number of providers that came to

25
00:02:35,840 --> 00:02:43,840
Douglas County. And over the years, all
of our partners, LMH, Bert Nash, and

26
00:02:41,120 --> 00:02:48,959
Hartland have worked to maintain,
sustain, and expand um the capacity of

27
00:02:46,720 --> 00:02:54,319
our psychiatric infrastructure. That
work group um has members on it. Both

28
00:02:51,760 --> 00:02:58,959
lead executive leadership and providers
from Bert Nash Hartland, from LMH,

29
00:02:56,640 --> 00:03:03,440
Coffin, Logan, and KU have participated
in that work group. The work group was

30
00:03:00,720 --> 00:03:09,200
instrumental in shaping the early drafts
of the medical director position for the

31
00:03:05,599 --> 00:03:14,400
TRC in talking about how we should look
at the costs of psychiatry and med

32
00:03:11,440 --> 00:03:18,959
services across the system of care and
identifying issues that our partners

33
00:03:17,440 --> 00:03:22,239
might want to try to address
collectively and cooperatively. And so

34
00:03:21,040 --> 00:03:26,319
that's kind of been the work of the
psychiatric infrastructure work group

35
00:03:24,159 --> 00:03:30,000
over the last couple of years. There's
been sort of periods where that work as

36
00:03:28,319 --> 00:03:34,159
a work group has been more intense and
less intense. But one thing that hasn't

37
00:03:32,000 --> 00:03:39,599
happened for a while is we have not
given you the opportunity to really hear

38
00:03:36,159 --> 00:03:44,000
from Hartland about how their uh
behavioral health services particularly

39
00:03:41,760 --> 00:03:48,640
with respect to psychiatry and med
services have evolved and are iterating

40
00:03:46,400 --> 00:03:52,799
and continuing to grow in Douglas
County. And so that's why we are really

41
00:03:50,640 --> 00:03:56,799
pleased to have the team from Hartland
here. Um, I'm going to turn this over to

42
00:03:55,120 --> 00:04:00,720
Rachel Hartford, but I want to make sure
that before we start talking that we do

43
00:03:59,040 --> 00:04:05,080
some introductions. And Rachel, I will
let you lead it from here.

44
00:04:05,840 --> 00:04:13,080
» Rachel Hartford. Thank you. Um, I'm the
chief operations officer at the health

45
00:04:10,080 --> 00:04:13,080
center.

46
00:04:17,840 --> 00:04:23,840
» Amy Celiff. I'm the director of quality
at Heartland.

47
00:04:22,240 --> 00:04:28,639
Julie Brandstrom. I'm the CEO at H
Heartland.

48
00:04:26,240 --> 00:04:32,080
» Nicely. I'm the director of psychiatry
and a board-certified adult and child

49
00:04:30,400 --> 00:04:37,919
adolescent psychiatrist. I've been
practicing in the Panda building from

50
00:04:34,400 --> 00:04:43,800
like August um 2023 until now, primarily
seeing patients that are like 26 and

51
00:04:40,800 --> 00:04:43,800
under.

52
00:04:48,720 --> 00:04:54,720
I'll kick us off really quick um for H
Heartland's presentation. Um we just

53
00:04:52,720 --> 00:04:58,800
wanted to kick off by saying thank you
so much um for participating today. We

54
00:04:57,360 --> 00:05:04,560
really appreciate the opportunity to
engage with each of you um to kind of

55
00:05:01,759 --> 00:05:08,800
provide some data on H Heartland's
psychiatry program and also I think some

56
00:05:07,039 --> 00:05:14,240
important narrative that will provide
additional context about how H

57
00:05:11,039 --> 00:05:18,240
Heartland's uh psych services have grown
over the last about eight years or so.

58
00:05:16,560 --> 00:05:22,639
Um I get the privilege of being at the
table today but don't have to have the

59
00:05:20,080 --> 00:05:26,000
pressure of doing the presentation. So,
um, Rachel and Amy, I'm sure, are going

60
00:05:24,320 --> 00:05:30,160
to do an excellent job of walking you
through the data and providing context.

61
00:05:28,240 --> 00:05:33,520
And so, I will hand it over to Rachel.
Great. Thanks. I also want to say thank

62
00:05:31,840 --> 00:05:37,280
you to, um, several of our staff,
community partners that are in the room,

63
00:05:35,120 --> 00:05:41,680
including um, some of our community
health or mental health advocates. Um,

64
00:05:39,759 --> 00:05:45,919
we extended the invitation so that
community partners or our employees or

65
00:05:43,919 --> 00:05:49,039
board members could join us to hear
firsthand and experience the work

66
00:05:47,600 --> 00:05:54,000
session. So, I'm thankful that you guys
took the time to come out. As Bob

67
00:05:51,120 --> 00:05:58,560
mentioned, um, since 2018, uh, H
Heartland Psychiatry model, we've really

68
00:05:55,759 --> 00:06:02,960
evolved in response to the community
needs, um, the workforce availability,

69
00:06:00,880 --> 00:06:08,240
reimbursement structures, and our
funding partnerships. Um, what began as

70
00:06:05,759 --> 00:06:12,479
a response to the growing demand for
communitywide psychiatric services

71
00:06:10,639 --> 00:06:16,000
actually developed into a broader, more
integrated approach to behavioral health

72
00:06:14,080 --> 00:06:20,880
and psychiatry. For us at the community
health center, our priority has been to

73
00:06:18,639 --> 00:06:26,880
improve access, support the continuity
of care, and to try uh to address the

74
00:06:24,479 --> 00:06:32,080
complexity of needs that are experienced
by patients that um see Hartland out as

75
00:06:29,840 --> 00:06:35,360
their primary care provider. Your
investment at the county level has

76
00:06:33,759 --> 00:06:40,240
played an important role from the
beginning and throughout the evolution

77
00:06:37,039 --> 00:06:44,319
of that work. Um, as Bob mentioned,
Douglas County has supported the

78
00:06:41,919 --> 00:06:50,000
infrastructure work and has allowed H
Heartland to expand our ability to

79
00:06:47,120 --> 00:06:55,199
respond to developing community need. Um
these investments have not occurred or

80
00:06:52,720 --> 00:07:01,440
existed in isolation but rather they've
been able to be incorporated into a

81
00:06:57,759 --> 00:07:06,080
larger more continual change of systems
um including providers programs care

82
00:07:03,680 --> 00:07:11,120
coordination internal infrastructure in
our operation and a variety of funding

83
00:07:08,720 --> 00:07:16,240
sources. And so as our model has
developed Hartland has adapted and we've

84
00:07:13,759 --> 00:07:19,599
evolved to change um in response to
that. And so again, very grateful for

85
00:07:18,160 --> 00:07:24,400
the opportunity to share a little bit of
that information. The purpose of our

86
00:07:22,000 --> 00:07:27,599
presentation today um and the narrative
that was sent to you earlier is really

87
00:07:26,000 --> 00:07:32,479
to just try to provide that whole
picture. Um it's been a lot of u

88
00:07:30,319 --> 00:07:35,680
movement over the last decade and so
today we hope to hit some of those

89
00:07:33,840 --> 00:07:41,520
highlights and have a conversation as we
go through the data. Uh more really

90
00:07:38,720 --> 00:07:45,759
importantly, what we want to note is
that the current state of psychiatry at

91
00:07:43,440 --> 00:07:50,720
H Heartland reflects both progress,
achievements, and opportunities to

92
00:07:47,919 --> 00:07:55,520
continue to work forward. Um, our role
as the federally qualified health center

93
00:07:53,440 --> 00:07:59,919
is to serve as a preventative and
ongoing health partner that helps to

94
00:07:58,319 --> 00:08:04,720
address behavioral health needs before
they escalate to a crisis or to be

95
00:08:02,639 --> 00:08:10,080
available to provide continuity of care
following a crisis or if there was a

96
00:08:07,680 --> 00:08:14,960
higher level of intervention needed. Um,
we've said this often in the last year

97
00:08:12,080 --> 00:08:19,280
or so, but Hartland as the FQHC, we're
not a crisis center. um we are not

98
00:08:17,520 --> 00:08:23,280
equipped to provide that emergency
crisis response service like other

99
00:08:21,039 --> 00:08:28,240
partners in our community, but rather we
see our role um within the continuum of

100
00:08:26,000 --> 00:08:32,000
care to provide accessible outpatient
psychiatry or behavioral health services

101
00:08:30,479 --> 00:08:36,719
while aiming to strengthen that
prevention and early intervention,

102
00:08:34,080 --> 00:08:40,560
supporting stabilization or recovery as
embedded in primary care and to ensure

103
00:08:39,200 --> 00:08:45,600
that patients have a trusted health
partner for ongoing care after the

104
00:08:43,120 --> 00:08:49,519
crisis or hospitalization. And I think
this distinction is important as we

105
00:08:47,760 --> 00:08:53,279
define the value and the appropriate
scope of H heartland's u program in our

106
00:08:51,920 --> 00:08:58,240
model of psychiatry at the health
center. Again, our focus is on

107
00:08:55,680 --> 00:09:04,320
prevention, early identification,
treatments, um stabilizing a patient um

108
00:09:01,839 --> 00:09:10,959
in primary care and then con continuing
that care um as patients transition back

109
00:09:07,680 --> 00:09:15,200
into routine life um following a crisis
and wanting to coordinate that care with

110
00:09:12,959 --> 00:09:19,440
community partners. So today we're going
to talk we're going to have some data um

111
00:09:17,360 --> 00:09:24,080
and again I hope that this data is
viewed as a continuum of that investment

112
00:09:22,160 --> 00:09:31,640
and the capacity building rather than
just an isolated um measure or an

113
00:09:27,279 --> 00:09:31,640
isolated moment of success.

114
00:09:35,920 --> 00:09:44,640
So we talk about psychiatry at our
health center and it we view it as um

115
00:09:42,480 --> 00:09:49,440
more than just a specialty clinic or a
subsp specialty service um as an

116
00:09:46,880 --> 00:09:52,959
integrated safety net health center. We
consider that H Heartland serves as a

117
00:09:51,040 --> 00:09:58,080
cornerstone of community health and we
provide that psychiatric care but also

118
00:09:55,839 --> 00:10:03,120
connect patients to a broader network of
primary care behavioral health services

119
00:09:59,920 --> 00:10:07,600
like therapy. Um, we also have embedded
substance use treatments and medication

120
00:10:05,360 --> 00:10:10,720
assistant treatment, pharmacy, we've
talked about over the years care

121
00:10:09,120 --> 00:10:14,800
coordination and other supportive
services that have recently been offered

122
00:10:12,399 --> 00:10:18,560
by community health workers. And so
again, we just want to call our

123
00:10:16,480 --> 00:10:23,519
attention to that psychiatry is best
understood from our our model um as one

124
00:10:21,839 --> 00:10:29,462
component of that integrated system
rather than an isolated service.

125
00:10:26,880 --> 00:10:34,640
Here is a brief snapshot or
[clears throat] a timeline of our

126
00:10:31,120 --> 00:10:39,760
partnership. Um, you may recall that we
received our federally qualified

127
00:10:36,240 --> 00:10:43,200
designation in 2012 and we began
collaborating almost immediately, as Bob

128
00:10:41,839 --> 00:10:48,640
mentioned, with other community health
partners to advance an integrated system

129
00:10:46,079 --> 00:10:52,480
of care. And this timeline shows what we
would identify as some key milestones or

130
00:10:50,880 --> 00:10:56,320
initiatives
and how we have evolved um our

131
00:10:54,480 --> 00:11:03,360
integrated care program at the health
center. Bob mentioned the uh Proposition

132
00:11:00,240 --> 00:11:08,480
One that passed and and even during that
time we were in exploratory

133
00:11:05,839 --> 00:11:12,800
conversations and executed agreements
with our hospital partners and our

134
00:11:10,320 --> 00:11:18,399
community mental health center to try to
attract um providers to our community.

135
00:11:15,680 --> 00:11:22,880
Um we wanted to leverage as the f the
federal dollars that we could. Um we

136
00:11:20,880 --> 00:11:27,360
would share staff again contract staff
back and forth really just trying to

137
00:11:25,040 --> 00:11:32,959
increase access at a rate that um our
community needed. Um following a a

138
00:11:30,000 --> 00:11:40,000
period of organizational changes and uh
challenges around that uh I would say

139
00:11:36,000 --> 00:11:45,680
you know 2021 2022 mark. Hartland, we
really renewed our commitment in 22 and

140
00:11:42,720 --> 00:11:49,279
in 23 to increase psychiatry services.
Um, again, we believe this is

141
00:11:47,440 --> 00:11:54,480
fundamental to the work that we do and
and it advances the mission to welcome

142
00:11:51,440 --> 00:11:59,200
all who need care. And so in 2023,
Hartland uh we welcome Dr. Nick to the

143
00:11:56,880 --> 00:12:04,640
community and that marked for us a very
strategic step forward where we were

144
00:12:01,839 --> 00:12:10,079
developing uh in that program with um
leadership and prioritizing how we could

145
00:12:07,680 --> 00:12:14,639
expand that uh physical or clinical
capacity. Um since then we've increased

146
00:12:12,639 --> 00:12:18,240
our our capital footprint. We've
increased the number of mental health

147
00:12:16,320 --> 00:12:21,680
providers and as you'll see later we've
increased the number of patients that

148
00:12:19,519 --> 00:12:27,519
are being served. So I would say over
the last three years this has really our

149
00:12:24,079 --> 00:12:31,600
renewed focus has allowed us um to offer
greater stability, consistency, growth

150
00:12:30,160 --> 00:12:36,240
within psychiatry and mental health
services at the health center. Um and

151
00:12:33,760 --> 00:12:40,800
the data that Amy is going to present um
demonstrates that progression and and

152
00:12:38,720 --> 00:12:48,560
can provide a measurable view of what
we've been doing. And really the the era

153
00:12:44,399 --> 00:12:54,880
of 2018 uh to 2023 or if you look at
from 2023 to 26 um it's really it's no

154
00:12:52,560 --> 00:12:59,600
longer one of just growth but how we are
building capacity and how we are aiming

155
00:12:57,040 --> 00:13:06,160
to sustain that capacity with the
demand. So again um looking forward to

156
00:13:02,560 --> 00:13:10,959
hearing what Amy has to say.
>> Take it away Amy.

157
00:13:08,720 --> 00:13:14,880
» Amy can you make sure you use the mic?
completely forgot we were muted there.

158
00:13:13,120 --> 00:13:19,519
I'm going to dive in first to talk a
little bit about the unique patients and

159
00:13:16,959 --> 00:13:24,639
the encounters. When it comes to access,
health centers track unique patients and

160
00:13:21,519 --> 00:13:28,320
we track encounters to really look at
how access is happening. They tell two

161
00:13:26,959 --> 00:13:32,720
different stories. They're both
important. And then overlaid with each

162
00:13:30,160 --> 00:13:37,360
other really tells us what our patients
are using for services. Unique patients

163
00:13:35,279 --> 00:13:42,000
is defined as the number of individuals
in a period who received care. Um, in

164
00:13:40,160 --> 00:13:46,000
this case, we're looking at quarter by
quarter. Each bar represents a quarter.

165
00:13:44,240 --> 00:13:49,279
The encounters are the total number of
visits or actual interactions that the

166
00:13:48,000 --> 00:13:52,480
patients had with the health center
provider. So, that might be in-person

167
00:13:50,959 --> 00:13:57,099
visit or it might be a telealth
encounter. Um, those started to happen

168
00:13:54,399 --> 00:14:00,320
once COVID came around.
[clears throat] One patient might have

169
00:13:58,560 --> 00:14:03,839
multiple encounters in a quarter. They
might have multiple encounters in a

170
00:14:01,600 --> 00:14:08,000
year. This really tells us how much care
is being delivered and how frequently

171
00:14:05,760 --> 00:14:12,240
patients are accessing it. If we serve
20,000 patients overall with 80,000

172
00:14:10,240 --> 00:14:16,639
visits, it's an average of four visits
per patient per year. This kind of gives

173
00:14:14,079 --> 00:14:20,399
us an idea of acuity. It's one of the
measures, one of our indicators that we

174
00:14:18,240 --> 00:14:24,720
look at from period to period. We look
at really in relation to each other as

175
00:14:22,480 --> 00:14:30,079
they go up and go down. We want to know
why. Looking at both of these also then

176
00:14:28,160 --> 00:14:34,000
reports out to our leadership to know
whether are we expanding access or are

177
00:14:32,240 --> 00:14:36,959
we just serving the same patients more
frequently. It's also something we

178
00:14:35,519 --> 00:14:41,519
really want to know.
If our unique patients increase, it

179
00:14:39,839 --> 00:14:45,279
generally indicates that a health center
is reaching more people and reducing

180
00:14:43,120 --> 00:14:49,680
barriers to care. However, if our
patients increase, but our encounters

181
00:14:47,199 --> 00:14:53,040
decrease, it might not mean that we're
giving patients enough visits. They

182
00:14:51,600 --> 00:14:57,920
might not be able to get in as
frequently as they needed. If we see

183
00:14:54,959 --> 00:15:02,079
unique patients drop, that also means
that we are not having open access

184
00:14:59,920 --> 00:15:06,480
points. So as these numbers go up and
down by quarter later you'll see there

185
00:15:04,240 --> 00:15:10,240
there is a direct correlation between
our clinical FTEES available.

186
00:15:09,150 --> 00:15:14,079
[clears throat]
The distinction is important because

187
00:15:12,480 --> 00:15:17,600
access isn't just about how many
appointments are provided. It's about

188
00:15:15,920 --> 00:15:21,839
how many people are able to enter the
system and receive care and have

189
00:15:19,279 --> 00:15:25,279
continuity of that care. Another way to
say it is that unique patients tell us

190
00:15:23,680 --> 00:15:28,959
how many people we're reaching.
Encounters tell us how much care we are

191
00:15:26,880 --> 00:15:32,720
providing. and tracking both helps us
understand whether we are truly

192
00:15:30,560 --> 00:15:37,920
expanding access, meeting ongoing
patient needs, and using our capacity

193
00:15:34,560 --> 00:15:42,000
effectively. For an FQHC like Hartland,
it's important because the goal is not

194
00:15:39,760 --> 00:15:46,240
simply to increase the volume. It's not
just more visits, more visits. We want

195
00:15:44,160 --> 00:15:49,600
to increase meaningful access to care
for the community while ensuring

196
00:15:48,000 --> 00:15:53,440
patients can receive the appropriate
level and frequency of services they

197
00:15:51,279 --> 00:15:58,000
need to meet their goals, improve their
health outcomes, and prevent acute and

198
00:15:55,199 --> 00:16:03,759
crisis events. Here we are breaking our
access down into the two eras. So as you

199
00:16:01,279 --> 00:16:09,279
see in this era, we're again fluctuating
based on their FTE available.

200
00:16:06,800 --> 00:16:14,639
Next slide, Rachel.
In this next period, we're looking at

201
00:16:11,199 --> 00:16:19,199
2023 to 2026. You can see that since
2018, now in this period, quarterly

202
00:16:17,120 --> 00:16:24,240
psychiatry volume has increased from
approximately 230 unique patients and

203
00:16:22,079 --> 00:16:28,880
fewer than 500 encounters starting all
the way back in that first quarter of

204
00:16:25,759 --> 00:16:33,199
2018 to regularly serving more than,400
unique patients and 2,000 encounters per

205
00:16:31,279 --> 00:16:38,240
quarter. This growth has remained
consistent since 2023 with a renewed

206
00:16:35,680 --> 00:16:42,320
stratey strategy to increase access to
psychiatry indicating an ongoing and

207
00:16:40,959 --> 00:16:47,120
sustainable need for outpatient
psychiatric services rather than a

208
00:16:44,320 --> 00:16:51,519
temporary post-pandemic increase.
>> Currently, our psychiatry providers

209
00:16:48,880 --> 00:16:57,120
average nine patients per day with a
monthly average of a 19% no-show rate

210
00:16:54,160 --> 00:17:01,360
overall. The growth we see is a direct
representation of that strategy to

211
00:16:59,040 --> 00:17:06,000
increase access by preventing expanding
provider FTE as well as strengthening

212
00:17:04,240 --> 00:17:09,600
the integration pathways among our
providers and patient self-referrals

213
00:17:08,160 --> 00:17:14,679
allowing continued growth for new
patients and continuity of care for our

214
00:17:11,280 --> 00:17:14,679
existing patients.

215
00:17:17,919 --> 00:17:23,360
Our new patient demand has also remained
remarkably consistent considering the

216
00:17:22,160 --> 00:17:29,200
changes over the years with
approximately 200 to 250 new patients

217
00:17:26,240 --> 00:17:32,720
per quarter for nearly 3 years. This
sustained referral volume reinforces

218
00:17:31,039 --> 00:17:37,840
that psychiatry is operating in
environment of persistent community need

219
00:17:35,039 --> 00:17:41,919
rather than periodic surges. Regarding
our no-show rates, a no-show, to be more

220
00:17:40,160 --> 00:17:45,360
specific, occurs when a patient is
scheduled for an appointment appointment

221
00:17:43,840 --> 00:17:50,240
but does not come to that appointment
and does not cancel in advance. And that

222
00:17:48,080 --> 00:17:54,640
is particularly important for federally
qualified health centers because an

223
00:17:51,679 --> 00:17:58,559
unused appointment slot is lost access.
It means lower productivity, but it also

224
00:17:57,280 --> 00:18:04,000
means that we have scheduled and
committed resources that a patient is no

225
00:18:01,039 --> 00:18:07,520
longer going to be able to use.
No-how rates are important access and

226
00:18:05,919 --> 00:18:12,000
operational metrics. They measure the
gap between that capacity and then the

227
00:18:09,520 --> 00:18:15,919
actual care delivered. A high no-show
rate can reduce provider productivity,

228
00:18:14,080 --> 00:18:19,840
can increase weight times for patients,
and limit the number of patients who can

229
00:18:17,520 --> 00:18:23,280
access care overall. Understanding the
reasons behind no-shows allows the

230
00:18:21,600 --> 00:18:27,280
health center to address barriers and
improve utilization of available

231
00:18:24,799 --> 00:18:32,559
capacity and ultimately convert more
schedule appointment opportunities into

232
00:18:29,200 --> 00:18:37,039
meaningful visits.
As you can see in 2025, those quarters

233
00:18:35,440 --> 00:18:42,320
and moving forward, the no-show started
to rise. Our pediatric no-show, just for

234
00:18:40,080 --> 00:18:47,840
context, is generally less than one in
10 patients. Adult no-show is generally

235
00:18:45,760 --> 00:18:53,039
higher, and our new patient no-show rate
is even higher, which is closer to 25%

236
00:18:50,160 --> 00:18:56,640
sometimes more. That means one in four
of every new patient in psychiatry care

237
00:18:55,440 --> 00:19:01,280
doesn't show up for that first
appointment.

238
00:18:59,360 --> 00:19:05,039
This is not unique to psychiatry and is
frequently seen across other services.

239
00:19:03,360 --> 00:19:08,480
Heartland's no-show rates are all below
industry standards and generally

240
00:19:06,480 --> 00:19:13,360
observed rates um which are seen among
other FQC's, community mental health

241
00:19:10,720 --> 00:19:19,400
centers and CCBHC's which are around 25
to 45%. Our goal is to always try to be

242
00:19:16,000 --> 00:19:19,400
below 20.

243
00:19:20,480 --> 00:19:27,840
» Payer mix is um the breakdown of the
health center's patients or encounters

244
00:19:24,880 --> 00:19:32,720
by how their care is paid for. So at an
operational level when we look closely

245
00:19:29,679 --> 00:19:36,960
at noshare rates or access uh key
indicators payer mix is one of those key

246
00:19:34,880 --> 00:19:41,200
indicators for us at the health center.
Um we know that payer mix matters

247
00:19:38,799 --> 00:19:46,000
because it's the mix of patients that um
the health center serves that ultimately

248
00:19:42,880 --> 00:19:50,880
has a direct impact on billable revenue
or sustainability and informs our

249
00:19:48,240 --> 00:19:56,559
ability to maintain or increase access.
So an example is if a health center has

250
00:19:54,400 --> 00:20:00,320
a high number of uh patients that may
not have health insurance that is going

251
00:19:58,480 --> 00:20:04,960
to be a high uninsured rate and we know
that that will lead into some

252
00:20:01,919 --> 00:20:10,000
uncompensated care. Um that also we look
at that type of information even based

253
00:20:07,679 --> 00:20:17,840
upon provider panels because that can
also inform how we structure um our

254
00:20:13,360 --> 00:20:22,000
schedules or or how we allow for um
panel management again so that those

255
00:20:19,679 --> 00:20:26,960
payer mix shake out so that those costs
are covered. Um at H Heartland over the

256
00:20:24,160 --> 00:20:30,960
years um I know in this area this
setting our PPS rate has been brought up

257
00:20:29,280 --> 00:20:36,240
as a federally qualified health center.
we get enhanced reimbursement for

258
00:20:33,360 --> 00:20:40,120
Medicaid and Medicare. And our PPS rate
is currently $35962.

259
00:20:40,400 --> 00:20:45,760
Um, and we know, and this is important
because when we again when we look at

260
00:20:43,919 --> 00:20:51,679
panel management or we look at access
points, that payer mix and that

261
00:20:47,919 --> 00:20:57,600
reimburseable uh revenue can impact our
ability to increase access. So, for

262
00:20:54,720 --> 00:21:02,080
example, an adult uh a provider that has
primarily an adult panel may look a

263
00:20:59,840 --> 00:21:07,600
little different than what a provider
with a um primarily pediatric panel

264
00:21:05,200 --> 00:21:13,520
would. You can see our breakdown of
payer mix in the chart. Um I'm sure

265
00:21:10,400 --> 00:21:17,760
we'll talk about that here shortly.
But regarding our psychiatry services,

266
00:21:15,760 --> 00:21:21,600
um, currently and where we're heading,
again, we mentioned this, but it's

267
00:21:19,520 --> 00:21:26,400
really evolved from a program that
hasn't that no longer focuses on

268
00:21:23,760 --> 00:21:32,400
building capacity and expanding access,
but really aiming to stabilize and and

269
00:21:28,960 --> 00:21:38,720
sustain what we've um accomplished. And
so since again 2018, that quarterly

270
00:21:36,159 --> 00:21:45,039
volume has increased. And we throughout
this process, we've learned um what it

271
00:21:42,240 --> 00:21:50,880
what it requires to welcome providers to
our community and to continue to see

272
00:21:47,360 --> 00:21:56,559
them. We know that already in 2026 we've
reached um almost 2,000 unique uh

273
00:21:53,919 --> 00:22:01,440
patients that are seeking uh psychiatric
services at the health center and that

274
00:21:58,080 --> 00:22:06,720
ex that number um exceeds our entire
last year by almost 2 and a.5%. So

275
00:22:04,240 --> 00:22:11,600
steady growth. Um we offer care through
a variety of um inperson and telealth

276
00:22:09,120 --> 00:22:17,200
services. Again, trying to be flexible
in how patients can access their

277
00:22:13,360 --> 00:22:21,360
provider. Um and so we again we know
that it's not just a standalone

278
00:22:19,360 --> 00:22:25,280
specialty service, but really has truly
integrated in the system of care at the

279
00:22:23,280 --> 00:22:29,760
health center and Dr. Nick is an example
of what that looks like when we've

280
00:22:26,640 --> 00:22:34,880
integrated it into um the Panda
Pediatrics location wanting to link arms

281
00:22:33,039 --> 00:22:40,799
between a pediatrician and a site
provider. And so the next phase of um

282
00:22:38,480 --> 00:22:46,480
psychiatric access or improvement for
the health center won't uh be merely

283
00:22:44,240 --> 00:22:52,159
measured and encounters, but the
reliability, the timeliness of care and

284
00:22:49,520 --> 00:22:57,200
and those payer structures.
We talk often um over the last few years

285
00:22:54,880 --> 00:23:00,960
too about increasing access and how we
know we're increasing access. One key

286
00:22:59,039 --> 00:23:06,159
measure for us is net provider
availability. Um this this refers to the

287
00:23:04,400 --> 00:23:11,039
amount of care that a health center has
the ability to provide based upon its

288
00:23:08,799 --> 00:23:15,840
available providers clinical hours,
appointment slots, and support

289
00:23:12,799 --> 00:23:20,799
resourcing such as the the staff that
works around that provider. Provider

290
00:23:18,240 --> 00:23:25,600
retention. um that really refers to the
organization's ability to keep providers

291
00:23:23,280 --> 00:23:30,000
over time. We know that transition or
turnover can be disruptive to care. It

292
00:23:27,600 --> 00:23:36,000
can also be costly. And so, we're not
only measuring success by how um how we

293
00:23:33,280 --> 00:23:40,880
can recruit or welcome providers to our
community, but how can we keep them? Um

294
00:23:38,400 --> 00:23:44,159
hiring providers certainly increase
potential capacity, but retaining

295
00:23:42,720 --> 00:23:49,360
providers is what's going to protect
that capacity over time. So, we've been

296
00:23:46,880 --> 00:23:55,760
looking closely at that net provider
availability and it's taken us years to

297
00:23:52,000 --> 00:24:02,799
determine, but we finally have um a
clearer picture that right now Hartland

298
00:23:58,799 --> 00:24:09,440
would Hartland needs six full-time
providers to offer the care based upon

299
00:24:06,159 --> 00:24:17,200
the current patient demand. Um and again
over the years you've seen us have 0.2

300
00:24:12,240 --> 00:24:22,240
two FTE, 3 FTEE, then one FTE, but as
this chart um indicates, we hit a good

301
00:24:20,240 --> 00:24:27,840
stride for three and since then, we've
been able to increase. And when we look

302
00:24:24,320 --> 00:24:33,600
at provider uh or panel management um
provider continuity and the current

303
00:24:30,640 --> 00:24:39,120
patient demand and um weight list, we
know that six providers right now are

304
00:24:36,559 --> 00:24:44,000
actively responding to what is going to
allow us to serve up to about 9,000 uh

305
00:24:41,600 --> 00:24:48,240
visits this year. So it sounds like
significant growth certainly. Um, but

306
00:24:46,480 --> 00:24:51,919
the the goal here is to be able to
retain providers and not have that

307
00:24:49,919 --> 00:24:57,039
turnover because again, it's not just
enough to increase that headcount. Um,

308
00:24:55,760 --> 00:25:02,279
but we don't we don't want to see
providers um move if they don't have to.

309
00:25:02,640 --> 00:25:12,000
» Can I ask a question? I noticed the
previous slide your number of providers

310
00:25:08,880 --> 00:25:17,279
went up and then roughly in the same
period of time your uh commercial

311
00:25:15,440 --> 00:25:24,080
billings
uh went from 20ome to 40 something. Is

312
00:25:22,159 --> 00:25:27,679
that related because you had more
providers or

313
00:25:25,520 --> 00:25:31,520
» Sure. And credentiing and privileging
those providers, how payers are

314
00:25:29,600 --> 00:25:36,000
structured. Um we talk about that
sometimes with those hidden costs of how

315
00:25:34,240 --> 00:25:39,840
um we welcome a provider and if if
they're credentialed with certain

316
00:25:37,120 --> 00:25:43,919
payers. Um we also know that the
welcoming of providers that are

317
00:25:42,320 --> 00:25:49,279
providing pediatric or child and
adolescent uh services that is a payer

318
00:25:47,279 --> 00:25:53,919
there. And so um you're going to see
that where we've increased our child and

319
00:25:51,120 --> 00:25:58,679
adolescent access that inherently has
increased our our billable revenues.

320
00:25:58,880 --> 00:26:07,760
Um full disclosure, this was our list of
uh providers that have been um at our

321
00:26:04,640 --> 00:26:11,840
health center uh since 2022. And and
again, I think you know these are the

322
00:26:09,600 --> 00:26:17,360
licenses of our providers and their FTE.
And why this matters is because um at a

323
00:26:14,720 --> 00:26:21,919
time when we want to again support that
integrated network of care, we're

324
00:26:19,679 --> 00:26:26,880
grateful for the psychiatric nurse
practitioners that offer care alongside

325
00:26:23,840 --> 00:26:32,159
Dr. Nick um in our clinics. And you can
see whenever that provider, you know,

326
00:26:29,760 --> 00:26:39,039
maybe on average a year or two and then
they would um perhaps move on. And

327
00:26:35,760 --> 00:26:43,200
noteworthy, we have uh welcomed pro
providers from outside of our uh

328
00:26:41,120 --> 00:26:48,559
community line, but the providers that
have departed our organization,

329
00:26:46,240 --> 00:26:52,080
some have just left the field of
medicine altogether. Um we're seeing

330
00:26:50,559 --> 00:26:57,360
that when we talk about provider
retention and well-being and and um the

331
00:26:55,360 --> 00:27:01,679
clinical burnout that providers are
experiencing. Um so again these

332
00:26:59,840 --> 00:27:05,520
providers that have departed, they they
have changed their field of practice or

333
00:27:04,000 --> 00:27:09,840
they have taken an administrator role
and they've they've left that clinical

334
00:27:07,200 --> 00:27:16,159
care. And so we started the calendar
year um with six providers and in the

335
00:27:13,360 --> 00:27:21,440
middle of this year we had we decreased
down to four. again, those two providers

336
00:27:18,640 --> 00:27:27,520
um taking a different adventure, but
we're we're thankful to welcome two

337
00:27:24,159 --> 00:27:31,760
additional providers um this fall that
will return us back up to six. And so

338
00:27:30,159 --> 00:27:36,360
I'm going to have Amy talk about what
does this actually mean for capacity.

339
00:27:36,960 --> 00:27:44,000
So at a high level right now with the
trends that we've been following over

340
00:27:41,679 --> 00:27:48,640
the year for the last few years, we're
projecting around 9,800 annual

341
00:27:46,559 --> 00:27:52,799
psychiatry patients to be served by the
end of the calendar year. This really is

342
00:27:51,039 --> 00:27:57,120
just the baseline demand we are
currently experiencing. This is not any

343
00:27:55,120 --> 00:28:00,720
sort of expansion. At the current
productivity and utilization

344
00:27:58,559 --> 00:28:05,039
assumptions, approximately as Rachel
said, six full-time equivalents would be

345
00:28:02,960 --> 00:28:10,720
needed to maintain adequate access to
psychiatry care at H Heartland. Um, this

346
00:28:08,000 --> 00:28:14,880
6 FTE represents that baseline. No
expansion goal yet. If we do want to

347
00:28:13,360 --> 00:28:18,960
increase access beyond our current
demand, we would need to increase staff

348
00:28:16,799 --> 00:28:23,360
above that 6ft FTE. and then
respectively um if we're looking at

349
00:28:21,039 --> 00:28:27,279
pediatrics and adolescence versus adults
potentially those who might specialize.

350
00:28:25,679 --> 00:28:32,080
This provides Hartland with a better
understanding of what our capacity is to

351
00:28:30,080 --> 00:28:36,799
meet the current needs as well as trying
to plan ahead. Um it also has really

352
00:28:34,960 --> 00:28:41,120
helped to inform that framework for
determining additional staffing need.

353
00:28:39,120 --> 00:28:44,120
How big of a case load can a provider
manage?

354
00:28:46,480 --> 00:28:52,799
I won't belabor the integrated services
part or our community health worker. I

355
00:28:51,120 --> 00:28:57,919
know that you all have read a lot of
that narrative over the years, but again

356
00:28:55,279 --> 00:29:01,840
this just is a demonstration of the
number of patients that are accessing

357
00:28:59,760 --> 00:29:06,320
multiple services or programs at the
health center. Again, much of this was

358
00:29:04,080 --> 00:29:11,279
included in that narrative and you you
can see a correlation of increase as we

359
00:29:09,120 --> 00:29:16,480
opened and welcomed um Blue Stem
Wellness as another location for our

360
00:29:13,360 --> 00:29:21,440
health center and continuing to just
increase or uh strengthen our um SUD

361
00:29:19,600 --> 00:29:27,039
programming at the health center with
MAT and our community health workers.

362
00:29:23,760 --> 00:29:33,840
Again, um this is a lot of information,
but it it helps to visualize that

363
00:29:30,320 --> 00:29:38,720
patients um are utilizing multiple
services and again it just champions

364
00:29:35,760 --> 00:29:44,720
that integrated framework or um helps to
validate why it's important to have um

365
00:29:41,279 --> 00:29:48,240
that whole person approach
and then again community health workers.

366
00:29:46,320 --> 00:29:52,159
I know that this group has read and
heard a lot about that, but just a key

367
00:29:50,559 --> 00:29:56,880
advantage of embedding those community
health workers is again just that

368
00:29:54,240 --> 00:30:01,440
ability to offer that comprehensive uh
social needs assessment and and helping

369
00:29:59,520 --> 00:30:04,640
patients overcome barriers to care so
that they can have that adherence to

370
00:30:03,520 --> 00:30:11,279
their treatment.
>> Got a question. [clears throat] Um when

371
00:30:07,200 --> 00:30:14,559
you say psych plus one service, what
does that mean? So that would indic

372
00:30:13,360 --> 00:30:22,320
correct me if I'm wrong, but that would
indicate if um a patient also received

373
00:30:18,000 --> 00:30:26,159
primary care or they saw a therapist or
a dental provider.

374
00:30:23,840 --> 00:30:31,919
» Okay. I was just wondering if somebody
has a dual diagnosis,

375
00:30:28,799 --> 00:30:37,919
if you count that as
maybe they have a SUD with

376
00:30:35,440 --> 00:30:43,200
mental health issues, [gasps and sighs]
is that just considered one service?

377
00:30:41,120 --> 00:30:47,360
That would still just be one service. So
yeah, like if it was, you know, psych

378
00:30:45,840 --> 00:30:51,520
plus three, then maybe they're seeing
dental, primary care, and have a

379
00:30:49,919 --> 00:30:56,799
therapist.
>> Got it.

380
00:30:54,480 --> 00:31:03,679
» And Rachel, I noticed that you were
tracking human trafficking, but there

381
00:30:58,799 --> 00:31:08,000
was nothing indicated on the graph. So
just kind of curious.

382
00:31:06,080 --> 00:31:13,679
» Yeah, take it. Yeah, I can speak more to
that. Um, so that human trafficking is a

383
00:31:10,880 --> 00:31:20,080
new addition to our federal report, our
annual uniform database system. It has

384
00:31:16,799 --> 00:31:24,399
specific criteria and diagnosis codes.
So, we do assess that through our

385
00:31:22,240 --> 00:31:27,520
upstream drivers of health. We do not
necessarily put that on someone's

386
00:31:25,919 --> 00:31:30,799
progress note. We don't want that going
to someone's portal, especially if that

387
00:31:29,039 --> 00:31:34,440
might be sensitive information, but we
do track that information.

388
00:31:35,840 --> 00:31:44,399
» Okay. So
you are tracking it. So potentially you

389
00:31:39,919 --> 00:31:49,799
could have individuals that are uh
coming forward with that information and

390
00:31:46,799 --> 00:31:49,799
if

391
00:31:50,000 --> 00:31:57,360
there is a need you are uh developing
interventions and

392
00:31:54,000 --> 00:32:01,600
» connecting with absolutely coordination.
>> Uh you would not be reporting that out

393
00:31:59,600 --> 00:32:04,880
to other agencies is basically what
you're saying. We are not putting it on

394
00:32:03,120 --> 00:32:08,720
our federal report card primarily
because that's captured in claims

395
00:32:06,640 --> 00:32:12,799
information. We don't want that on an
potentially on a lot of our EOBS, things

396
00:32:10,960 --> 00:32:16,720
that might go to an address and might be
sensitive information. So, right now we

397
00:32:14,640 --> 00:32:21,000
haven't used that as an ICD code.
>> Okay. All right. Thank you.

398
00:32:21,120 --> 00:32:27,600
» Here's a little information about
populations. again um I want to be

399
00:32:25,519 --> 00:32:30,559
considerate of time and allow for uh
questions and conversations but Amy I

400
00:32:29,679 --> 00:32:35,120
don't know if you want to hit some of
the highlights of the population data.

401
00:32:33,519 --> 00:32:42,000
» Yeah I think the biggest thing you can
see is that change in 2023 uh really in

402
00:32:39,440 --> 00:32:46,000
2022 and before that we were primarily
providing adult psychiatric services. It

403
00:32:44,159 --> 00:32:50,480
was with the addition of Dr. Nick that
we really were able to offer services to

404
00:32:48,480 --> 00:32:55,600
pediatric and adolescent populations and
that's where you see that again

405
00:32:52,399 --> 00:33:01,200
increase. Um most of our patients who
are pediatric age have seen Dr. Nick at

406
00:32:58,320 --> 00:33:05,840
least once and
pardon [clears throat] me. Yeah, it was

407
00:33:03,279 --> 00:33:10,399
up through 2022 that it was about 85% of
our patients were adults. Now that we

408
00:33:08,559 --> 00:33:16,080
have added some more pediatric and
adolescent psychiatrists, now nearly two

409
00:33:13,039 --> 00:33:20,480
of every five are under the age of 18.
And interestingly, it's actually one of

410
00:33:18,000 --> 00:33:24,399
every five patients in psychiatry is
between the ages of three and 12. So

411
00:33:22,559 --> 00:33:27,880
it's demonstrating ongoing need of our
school-aged children.

412
00:33:29,120 --> 00:33:34,240
So, we have important work happening
now. We have important work on the

413
00:33:32,399 --> 00:33:39,120
horizon. And again, we're just grateful
for the opportunity to join you for a

414
00:33:36,000 --> 00:33:44,159
work session to demonstrate what has
occurred over the last um 8 to 10 years.

415
00:33:42,480 --> 00:33:47,840
And again, the investment of the county
helped to provide that momentum and

416
00:33:46,240 --> 00:33:52,799
accelerate much of that work that's
happened. And you can, you know, be

417
00:33:50,720 --> 00:33:56,399
assured that H Heartland wants to see
psychiatric mental health services

418
00:33:54,399 --> 00:34:01,039
advance in our community. we know that
there's opportunity to work alongside

419
00:33:58,480 --> 00:34:04,080
community partners and you um to make
that happen. And so again, just really

420
00:34:02,799 --> 00:34:09,280
grateful for the time today and looking
forward to a conversation.

421
00:34:07,600 --> 00:34:12,079
» Thank you everybody, [clears throat]
commissioners, other questions top of

422
00:34:11,200 --> 00:34:17,839
mind.
>> Yeah. Um this probably goes back two or

423
00:34:15,359 --> 00:34:24,720
three years. I'm not sure of my uh
timeline, but I know uh when uh

424
00:34:21,520 --> 00:34:28,159
psychiatry services and mental health
needs were

425
00:34:26,639 --> 00:34:34,000
uh
constricted by the staff. I know my

426
00:34:31,440 --> 00:34:38,639
staff at both places. I know a lot of
people would sign up at H Heartland and

427
00:34:36,000 --> 00:34:43,760
at Bert Nash and then they would take
the first available

428
00:34:40,960 --> 00:34:48,679
appointment. Have you seen that die down
now with your increased staffing?

429
00:34:49,760 --> 00:34:55,679
Well, I mean, we continue to get
referrals from the community and from

430
00:34:54,240 --> 00:35:03,040
all over, whether that's private
practice, um, like Lawrence pediatrics,

431
00:34:59,520 --> 00:35:07,920
um, LMH, emergency room visits, um,
people that aren't able to get in to

432
00:35:04,800 --> 00:35:13,040
other places, um, patients that have had
recent crisis visits, and I mean,

433
00:35:10,960 --> 00:35:18,400
really, it's it's coming from all
directions. Um, so I think as we've

434
00:35:16,079 --> 00:35:23,440
continued to grow and been able to get I
mean we prioritize urgent referrals and

435
00:35:22,160 --> 00:35:28,480
the number of urgent referrals
especially for you know the under 18

436
00:35:25,680 --> 00:35:31,440
population is tremendous. Um you know if
it's if it's your family, if it's your

437
00:35:29,920 --> 00:35:35,200
kid, you know you want them seen as soon
as possible. Um and that's one of the

438
00:35:33,839 --> 00:35:39,680
big goals of being able to hire more
providers is to cut down on the wait

439
00:35:36,720 --> 00:35:42,800
time. Um but yeah, we get referrals from
all over and I'm really proud of that. I

440
00:35:41,359 --> 00:35:46,640
mean, you know, when pediatricians know
they can do an urgent referral and we're

441
00:35:44,960 --> 00:35:49,760
going to prioritize that and get them in
within a couple weeks because we, you

442
00:35:48,320 --> 00:35:54,480
know, read their notes that they sent
over, um, you know, that's really

443
00:35:52,960 --> 00:35:59,760
important to me and that's really
important to our staff. So, even like

444
00:35:56,800 --> 00:36:05,040
going back to the, you know, if somebody
does cancel an intake 24 hours in

445
00:36:02,079 --> 00:36:10,160
advance, like we have urgent intake
lists, we have urgent follow-up lists,

446
00:36:07,520 --> 00:36:13,200
we have regular intake lists, and we
have regular obviously follow-up

447
00:36:11,839 --> 00:36:18,160
patients that are that need to be
scheduled. And so, if somebody gives us

448
00:36:16,400 --> 00:36:23,200
24 hours, like we're going to fill that
slot. Um, if it's a follow-up and

449
00:36:21,839 --> 00:36:26,000
somebody doesn't show up, then we're
going to try to switch it to teleahalth,

450
00:36:24,560 --> 00:36:30,720
even if it's like 10 minutes into the
appointment. Like, we really try to

451
00:36:27,920 --> 00:36:35,040
value obviously getting people seen. And
by doing that, it's going to free up

452
00:36:32,240 --> 00:36:38,079
time to get more urgent referrals in.
So, it always feels good to get, you

453
00:36:36,640 --> 00:36:41,200
know, like a private practice therapist
to refer, you know, an urgent patient

454
00:36:39,920 --> 00:36:45,560
because they know you're going to
prioritize trying to get that person in.

455
00:36:46,800 --> 00:36:53,280
I appreciate you mentioning some of the
greatest need uh because I heard you say

456
00:36:50,720 --> 00:36:58,079
under 18 and then I also heard you say
between the ages of 3 and 12. Uh and so

457
00:36:57,200 --> 00:37:04,320
[gasps]
as we think about that uh I'm kind of

458
00:37:02,079 --> 00:37:10,000
curious about some of the partnerships
that you do have within those uh age

459
00:37:08,400 --> 00:37:14,720
brackets. So that kind of makes me think
of the community health improvement

460
00:37:11,359 --> 00:37:18,320
plan. Uh but then that also makes me
think of some of the partnerships that

461
00:37:16,079 --> 00:37:22,000
maybe we have across the county with our
school districts and how are you

462
00:37:20,640 --> 00:37:24,800
partnering with the school districts?
How are you partnering with some of our

463
00:37:23,599 --> 00:37:30,000
partners within the community health
improvement plan? What do those linkages

464
00:37:27,359 --> 00:37:34,640
look like and how are those referrals
working and those partnerships? And if

465
00:37:33,119 --> 00:37:41,440
those linkages are not built yet,
completely fine. What does it look like

466
00:37:37,280 --> 00:37:45,839
to either build them and
are is there interest if they're not

467
00:37:43,119 --> 00:37:50,480
built to complete them? Because we do
know when we think about property taxes,

468
00:37:48,640 --> 00:37:53,040
right? Some of our largest property
taxes are coming from our school

469
00:37:51,760 --> 00:37:58,400
districts. And so I think there's a
great opportunity there to build those

470
00:37:56,079 --> 00:38:02,720
relationships and to ensure that those
linkages back to our schools and from

471
00:38:00,160 --> 00:38:08,000
the schools to our behavioral health
providers that that is a seamless

472
00:38:04,800 --> 00:38:10,720
continuum of care so that our kiddos are
receiving what they need. And then when

473
00:38:09,680 --> 00:38:14,880
we think about the community health
improvement plan that we have that

474
00:38:13,440 --> 00:38:20,000
linkage back to the community health
improvement plan because we are here to

475
00:38:17,680 --> 00:38:24,640
improve our community.
And I know that was a lot.

476
00:38:22,400 --> 00:38:28,480
» A couple things. So, so like we see a
lot of kids that have high high needs

477
00:38:26,560 --> 00:38:32,880
and they have SEDD waiverss through
Burton Nash or other community mental

478
00:38:30,720 --> 00:38:37,040
health centers and they need, you know,
they they might see us for medication

479
00:38:34,560 --> 00:38:41,119
management and therapy, but they still
depend on the local mental health center

480
00:38:38,880 --> 00:38:46,480
to get, you know, SED waiverss that
would allow, you know, case management,

481
00:38:43,520 --> 00:38:52,160
group therapies, respbit services. So,
we do see a lot of um and obviously that

482
00:38:49,520 --> 00:38:56,560
qualifies them for Medicaid um if they
have an SED waiver. So, we do see a lot

483
00:38:54,640 --> 00:39:03,079
of that population.
Um as far as the to answer the question

484
00:38:59,680 --> 00:39:03,079
about schools,

485
00:39:04,079 --> 00:39:10,880
parents frequently will sign a release
and needs the school might need some

486
00:39:09,359 --> 00:39:18,160
information.
But in the world of child psychiatry,

487
00:39:12,800 --> 00:39:22,400
privacy is very important. And sending,
you know, notes to schools, that's not

488
00:39:20,160 --> 00:39:29,440
something that we commonly do, right?
Parents typically don't want that. Um,

489
00:39:25,760 --> 00:39:32,079
and the communication really,
you were kind of caught in the middle

490
00:39:30,800 --> 00:39:35,839
sometimes with these conversations. So,
the communication has to go through the

491
00:39:33,680 --> 00:39:38,800
parents. Um, sometimes we'll hear
directly from the school and sometimes

492
00:39:37,040 --> 00:39:44,079
that will really, you know, upset the
families. Um, obviously sometimes

493
00:39:41,680 --> 00:39:49,680
they're they're very much for that, but
it's a definitely a um case by case

494
00:39:47,359 --> 00:39:53,040
situation and if we're able to talk to
the, you know, school counselor or

495
00:39:51,119 --> 00:39:56,160
something like that, um, it can be
really, really valuable, but we always

496
00:39:54,880 --> 00:40:00,640
have to go through the proper channels
of getting a release information. And a

497
00:39:58,720 --> 00:40:06,640
lot of times parents really appreciate
that. um if we're if if we talk to the

498
00:40:05,040 --> 00:40:11,839
school and we haven't gone through them
or they haven't told us to do that, I

499
00:40:08,480 --> 00:40:16,640
mean that's just a not a good situation.
And a lot of times they're voicing

500
00:40:14,480 --> 00:40:20,000
frustration. So I spend a lot of time
educating parents on how do you talk to

501
00:40:18,720 --> 00:40:24,240
the schools about a kid that needs an
IEP? How do you educate the parents to

502
00:40:22,240 --> 00:40:28,640
advocate for their kid? How do you deal
with panic attacks? So I do a lot of

503
00:40:26,160 --> 00:40:32,240
education and talking um with the
parents to how know how to address those

504
00:40:30,560 --> 00:40:35,920
things with the school system and I
honestly I mean it would be overwhelming

505
00:40:34,000 --> 00:40:41,200
to contact schools all the time. I mean
I don't have that time. So by educating

506
00:40:39,599 --> 00:40:46,000
the parents to be able to do that it's
it's definitely

507
00:40:43,119 --> 00:40:53,839
the best route.
So am I hearing then that

508
00:40:50,400 --> 00:40:58,160
maybe there's a gap between
the schools and

509
00:40:56,560 --> 00:41:02,800
so there's a gap in the system maybe
between the schools and our behavioral

510
00:41:00,160 --> 00:41:09,040
health, right? To then maybe bridge
between parents.

511
00:41:05,599 --> 00:41:14,960
Maybe there's like a missing piece there
or that education piece.

512
00:41:12,560 --> 00:41:19,599
I wouldn't I wouldn't necessarily say
there's a missing piece. Um like I said,

513
00:41:17,839 --> 00:41:23,200
I think educating parents on how to
address situations with the schools and

514
00:41:21,359 --> 00:41:29,200
if there is more of an extreme situation
or suspension or something like that. Um

515
00:41:27,440 --> 00:41:32,480
you know there's communication when
there needs to be.

516
00:41:30,720 --> 00:41:33,839
» And I would add I'm sorry.
>> Yeah. One last thing.

517
00:41:33,200 --> 00:41:36,400
» No, go for it.
>> Um community health work.

518
00:41:35,119 --> 00:41:40,000
» That's that's where I was going. That's
where I was. That's where my brain is

519
00:41:38,000 --> 00:41:41,920
going that I'm trying to figure out if
maybe

520
00:41:40,319 --> 00:41:46,960
» they're facing if they need to go to an
IEP meeting or they need to, you know,

521
00:41:45,280 --> 00:41:51,359
help with communication and things like
that. Yeah, that's a tremendous benefit

522
00:41:48,720 --> 00:41:55,200
for for our patient population.
>> Yeah, that's exactly what I was going to

523
00:41:52,800 --> 00:41:58,160
say is having them embedded um in
pediatric alongside our care

524
00:41:56,640 --> 00:42:01,839
coordinators. Um they're in and out of
the schools and building that

525
00:41:59,839 --> 00:42:06,160
relationship. And so yeah, a lot of it
is trying to relieve the burden that

526
00:42:03,359 --> 00:42:09,200
families may experience navigating and
being educated on what the options are.

527
00:42:07,680 --> 00:42:13,760
So community health workers is that
linkage for us.

528
00:42:10,960 --> 00:42:16,800
» Thank you.
>> Can you address a little bit more on the

529
00:42:15,280 --> 00:42:21,599
wait times? So we talked about kind of
wait times maybe being a couple weeks

530
00:42:18,319 --> 00:42:25,599
for an acute need. Uh that still seems
like a long time for for a parent with

531
00:42:23,680 --> 00:42:29,839
with a child with acute need especially.
Um what are the different weight times

532
00:42:27,920 --> 00:42:33,839
for different populations? So, a less
acute need, when when would they be seen

533
00:42:31,839 --> 00:42:38,000
for a first visit? Um, and are there
kind of industry standards?

534
00:42:36,480 --> 00:42:43,040
» Oh, I mean, I'm super excited that we're
hiring, you know, two providers um that

535
00:42:41,599 --> 00:42:46,880
are getting ready to start, you know,
this month and next month that are

536
00:42:44,400 --> 00:42:51,920
focused on 26 and under to really cut
down on the weight times. Um, since one

537
00:42:50,079 --> 00:42:56,560
of our child providers went down to two
days a week, I have basically um been

538
00:42:54,640 --> 00:43:00,079
seen on the child side like only urgent
referrals since that time. And so

539
00:42:58,720 --> 00:43:03,760
unfortunately that means that there have
been patients that have been on the wait

540
00:43:01,520 --> 00:43:08,720
list for you know several months. But
I'm really optimistic but that by hiring

541
00:43:05,839 --> 00:43:12,240
these next two providers um it should
address that in the coming months

542
00:43:10,560 --> 00:43:15,520
hopefully even by the end of the year
because that is definitely a high

543
00:43:13,680 --> 00:43:19,200
priority of ours.
>> And that goes back to that net provider

544
00:43:17,359 --> 00:43:24,560
availability. We know if we have six
full-time providers we can stay to where

545
00:43:21,520 --> 00:43:29,119
that access is either at or below that
industry standard. But again, the care

546
00:43:26,720 --> 00:43:33,119
coordinators around the providers, they
they jockey those schedules. And so to

547
00:43:31,200 --> 00:43:37,440
Dr. Nick's point earlier, if there's a
no-show or a late cancellation, they're

548
00:43:35,520 --> 00:43:42,079
working that list to try to get someone
in or to recover that appointment, even

549
00:43:39,520 --> 00:43:45,280
if someone doesn't show up in person and
they can make contact with that patient

550
00:43:43,599 --> 00:43:49,440
in the first 5 to 10 minutes. They'll
flip that and try to um reserve that

551
00:43:47,599 --> 00:43:54,480
access.
And that a couple of weeks for to get an

552
00:43:51,599 --> 00:43:58,200
urgent um first visit in is that pretty
common within the industry?

553
00:43:59,920 --> 00:44:06,079
» Yeah, I mean across the US I mean it's
there's an overwhelming need for

554
00:44:04,319 --> 00:44:10,880
psychiatric services whether it's adult
or child. There's very few areas where

555
00:44:08,800 --> 00:44:14,000
they have you know an overabundance of
child psychiatrist. Where I was trained

556
00:44:12,640 --> 00:44:18,319
actually they did just because it was a
really popular place to live. Um, but

557
00:44:16,800 --> 00:44:21,599
that was part of why I wanted to move
back to Kansas, just knowing that there

558
00:44:20,079 --> 00:44:27,560
weren't a lot of psychi child
psychiatrists and wanting to serve the

559
00:44:23,839 --> 00:44:27,560
community. Kansas

560
00:44:29,839 --> 00:44:36,560
talked about no-shows and how they, you
know, um, kind of disproportionately

561
00:44:33,839 --> 00:44:41,680
impact everybody involved um, for the
the capacity and the access. uh in terms

562
00:44:39,359 --> 00:44:44,880
of like what what tools are there to try
and reduce that because I've you've seen

563
00:44:43,119 --> 00:44:48,160
that the one of the goals is to you
severely reduce the no-shows. It sound

564
00:44:46,640 --> 00:44:52,640
like you're already kind of better than
the industry standard, but what are the

565
00:44:49,520 --> 00:44:57,280
tools that are available for that?
Sure. We have a few things that we've

566
00:44:55,359 --> 00:45:01,760
tried and a few things that I think we
are working on tweaking and perfecting

567
00:44:59,440 --> 00:45:08,079
if we can. Um so we do have a reminder
call system. We have recently opted to

568
00:45:04,960 --> 00:45:12,800
change the language to be pro-social.
So, it is uh a couple days out from your

569
00:45:11,440 --> 00:45:16,319
appointment. You get that phone call
that says, "Hey, if you can't make this

570
00:45:14,720 --> 00:45:19,200
appointment, please give us a call to
reschedule so we can give this

571
00:45:17,680 --> 00:45:23,119
appointment slot to somebody else in
need." Um, we've learned that that is

572
00:45:21,440 --> 00:45:27,680
actually very effective in getting
people to call sooner. We also know that

573
00:45:25,359 --> 00:45:31,760
when we have patients who aren't
confirming those, we're able to give

574
00:45:29,920 --> 00:45:36,480
them a live phone call and try to
confirm on the phone. Um, that's also

575
00:45:34,480 --> 00:45:41,920
one thing that's been helpful to make
sure we all have reminder fatigue with

576
00:45:39,440 --> 00:45:45,839
portal messages, email messages, text
messages, you get an AI phone call and

577
00:45:44,319 --> 00:45:51,359
so sometimes that live phone call can
also make a difference.

578
00:45:49,040 --> 00:45:54,800
» And then I would add the recovery of the
slots. Um, again flipping the

579
00:45:53,440 --> 00:45:57,760
appointment. You know, perhaps the
family's running a little late and they

580
00:45:56,240 --> 00:46:03,680
can't make it in person, but we flip
that. Um and we don't um we try really

581
00:46:01,359 --> 00:46:08,480
hard not to block a provider's schedule.
Um that's the other thing is um really

582
00:46:05,839 --> 00:46:13,760
preserving that clinic facing time and
again of care coordinators suggest

583
00:46:10,960 --> 00:46:17,760
alongside providers to reshape that
schedule to allow you know we look at

584
00:46:15,599 --> 00:46:24,000
what's the maybe the trends in the
no-show like what what time of day is

585
00:46:20,720 --> 00:46:28,240
most likely to be no-showed well then we
that can help us inform how we structure

586
00:46:25,839 --> 00:46:30,880
that schedule. Dr. where you can say
something.

587
00:46:29,040 --> 00:46:33,839
» It's some um help again from the
community health workers. If somebody's

588
00:46:32,400 --> 00:46:36,720
consistently not been able to make their
appointments, getting them involved to

589
00:46:35,200 --> 00:46:39,760
try to problem solve, you know, what's
the issue? Is it transportation? Is it a

590
00:46:38,480 --> 00:46:44,800
certain time of day or something like
that that can help them make sure their

591
00:46:41,520 --> 00:46:48,720
next appointment's successful?
I have another That's right. Um we

592
00:46:47,280 --> 00:46:52,640
looked at your payer mix and how that's
been changing over time. Um and and a

593
00:46:50,960 --> 00:46:57,280
larger percentage of the payer mix was
Medicare, Medicaid. Um, is that because

594
00:46:54,960 --> 00:47:01,040
of do you suppose a changing demographic
being served or is that because of the

595
00:46:59,200 --> 00:47:04,800
ability to kind of get people signed up
for Medicare and Medicaid as they need

596
00:47:02,640 --> 00:47:09,200
as they require it?
>> I had a same question and just want to

597
00:47:06,800 --> 00:47:13,839
tack on similarly
um has there been support with enrolling

598
00:47:11,839 --> 00:47:17,119
more patients onto commercial and
marketplace insurance if they're not

599
00:47:15,440 --> 00:47:20,160
because both those numbers seem to have
gone up. So curious if you can point to

600
00:47:19,280 --> 00:47:24,319
any strategies around that.
>> I'll say something kick it your way. Um

601
00:47:21,680 --> 00:47:30,160
I think we I think Mr. Dorsy uh
mentioned this but yes the the welcoming

602
00:47:27,280 --> 00:47:36,319
of child and adolescent providers have
impacted our payer mix because uh the

603
00:47:33,200 --> 00:47:40,000
number of children that have Medicaid or
covered insurance. So that's one key

604
00:47:38,480 --> 00:47:44,400
indicator that we know that by
increasing child and adolescent

605
00:47:41,599 --> 00:47:47,839
psychiatry access or capacity that
inherently has impact our payer

606
00:47:46,079 --> 00:47:52,720
structure.
We also have several of our CHWs who are

607
00:47:50,800 --> 00:47:56,880
certified to navigate that marketplace
too. So we are proactively running

608
00:47:55,200 --> 00:48:00,960
reports looking at patients who might
have expiring Medicare, Medicaid,

609
00:47:59,680 --> 00:48:04,960
looking at patients who might be
eligible for marketplace and trying to

610
00:48:02,960 --> 00:48:09,599
reach out and getting them enrolled
>> or if there's a gap in coverage. Um our

611
00:48:07,440 --> 00:48:12,880
pediatric teams work alongside those
community health workers to try to scrub

612
00:48:11,119 --> 00:48:15,880
those list to make that contact with
families.

613
00:48:19,040 --> 00:48:22,839
Other questions, commissioners?

614
00:48:23,520 --> 00:48:28,640
And one quick one. Um, and and Rachel,
you mentioned it and I didn't quite

615
00:48:26,640 --> 00:48:31,839
catch it. You told me you said how many
uh patients per day typically your

616
00:48:30,559 --> 00:48:35,319
providers are at.
>> Um, about nine.

617
00:48:36,400 --> 00:48:39,440
I mean, if you want to really know Dr.
Nick's schedule, I'll tell you.

618
00:48:39,368 --> 00:48:42,640
[laughter]
>> See up to I mean, you can see 15

619
00:48:41,359 --> 00:48:46,720
follow-ups in a day.
>> Yeah. Um, and that's one thing I really

620
00:48:45,040 --> 00:48:50,800
appreciate appreciate about H Heartland.
Um, the support from the administration,

621
00:48:49,119 --> 00:48:54,000
but also just I mean, we have to have
time with our patients and having time

622
00:48:52,480 --> 00:48:58,480
for that initial visit is really
important. Um, so I really value that. I

623
00:48:57,040 --> 00:49:04,079
mean, we're not doing 15-minute med
checks. That's not our mission or goal.

624
00:49:02,000 --> 00:49:07,680
» Yeah. And that that number is the
average across the department. And so,

625
00:49:05,760 --> 00:49:14,800
if you were to look at Dr. Nick's
schedule, he can typically see 10 to 11.

626
00:49:10,960 --> 00:49:18,760
again not just met checks but um hour or
so appointments

627
00:49:20,240 --> 00:49:23,680
» and you did mention the PPS rate earlier
as well.

628
00:49:22,880 --> 00:49:25,920
» I did. Yeah.
>> Okay. Uh go ahead.

629
00:49:24,960 --> 00:49:30,640
» Um
>> yes and it's a narrative. Our PPS is

630
00:49:28,720 --> 00:49:34,480
359.
>> Uh we will this is something that Sarah

631
00:49:33,200 --> 00:49:39,760
and I were talking about earlier, but
we'll probably potentially be seeing

632
00:49:36,079 --> 00:49:43,359
changes coming in 2027.
Uh are you all tracking to maybe some of

633
00:49:41,920 --> 00:49:46,079
the changes that we might see in the
future?

634
00:49:44,079 --> 00:49:52,319
» Yes. Yes.
>> Okay. Uh yeah, we are um actively

635
00:49:50,720 --> 00:49:55,440
monitoring what the [clears throat]
impacts would be to our state and at a

636
00:49:54,400 --> 00:50:00,400
local level as well.
>> Okay. And so as you're monitoring some

637
00:49:57,760 --> 00:50:05,119
of those potential changes coming down,
uh what are some of your thoughts?

638
00:50:03,760 --> 00:50:08,119
» Oh, dear Julie.
>> Yeah.

639
00:50:08,240 --> 00:50:17,760
Um well, we're concerned um clearly um
and that's also why I think um ensuring

640
00:50:15,680 --> 00:50:21,920
that we have adequate support with
community health workers that are

641
00:50:19,200 --> 00:50:26,960
working on that um intake and enrollment
for our patients is really important. Uh

642
00:50:24,800 --> 00:50:31,280
and we will continue to add staff there
um because we know that it will be

643
00:50:28,079 --> 00:50:36,640
needed. Um but we are concerned and
currently working on trying to project

644
00:50:33,359 --> 00:50:40,480
what the fiscal impact impact will be um
with you know knowing that there will be

645
00:50:38,640 --> 00:50:42,880
likely a reduction in the number of
patients that we will be seeing with

646
00:50:41,839 --> 00:50:47,760
Medicaid.
>> Yeah. So in pra in practical terms the

647
00:50:46,000 --> 00:50:53,680
community health workers are we're
trying to increase um the number of our

648
00:50:50,640 --> 00:50:57,680
IE team members that can help navigate
some of those changes. We're doing some

649
00:50:55,119 --> 00:51:03,440
worst case scenario planning um you know
running those worst case budget but also

650
00:51:00,880 --> 00:51:06,319
um trying to take advantage of some of
our technical assistant trainings

651
00:51:05,040 --> 00:51:10,079
through our national and state
association. Obviously we're not going

652
00:51:07,839 --> 00:51:13,760
to be the only ones impacted by this.
And so when you run those scenarios and

653
00:51:12,079 --> 00:51:17,839
you run those different plays, what does
your infrastructure need in the

654
00:51:15,280 --> 00:51:24,720
organization and trying to maximize what
we can um and leverage where we can, but

655
00:51:21,440 --> 00:51:28,559
also being very realistic in what's a
boundary line for us in terms of what

656
00:51:26,720 --> 00:51:33,760
could be lost or what could be gained.
And um for our community health center,

657
00:51:31,760 --> 00:51:38,800
I think an example of that is how we're
engaging um valuebased strategies into

658
00:51:36,640 --> 00:51:42,640
the workplace and into the clinic. And
you know, we don't just talk about our

659
00:51:40,800 --> 00:51:48,400
quality care, but putting that into
action and seeing payers um respond to

660
00:51:46,240 --> 00:51:53,359
that in positive ways is very helpful.
We see that as an opportunity as an

661
00:51:50,240 --> 00:51:57,119
FQHC, but nonetheless, it is worrisome
and I know that it keeps many of us up

662
00:51:55,440 --> 00:52:04,040
at night, but at the end of the day,
we're trying to take the the best step

663
00:51:59,359 --> 00:52:04,040
forward knowing what we know today.

664
00:52:06,720 --> 00:52:12,480
Well, community partners from H
Heartland, we appreciate the

665
00:52:09,520 --> 00:52:16,480
presentation. Uh, I think my my final
question, and I I would welcome you all

666
00:52:14,160 --> 00:52:22,000
chiming in on this um as well, but um
really it goes back to Bob just to sort

667
00:52:18,720 --> 00:52:27,839
of um put this conversation and all of
this specific data and context about uh

668
00:52:25,760 --> 00:52:32,640
how things have evolved at H Heartland
in the the sort of greater context of

669
00:52:30,640 --> 00:52:37,200
the psychiatric psychiatry
infrastructure work group. Um, so if you

670
00:52:35,359 --> 00:52:41,599
could just give us a little bit of
whatever context you think is helpful in

671
00:52:39,040 --> 00:52:47,680
terms of where this uh conversation
exists now and sort of what we uh what

672
00:52:44,960 --> 00:52:55,280
we might see coming forward in terms of
um any recommendations or or

673
00:52:51,280 --> 00:52:59,280
considerations for for changes.
>> I think one of the changes is in the

674
00:52:57,440 --> 00:53:03,760
convening structure of that group. So
for a long time Dr. Dodson and I were

675
00:53:01,920 --> 00:53:09,200
the co-conveners of the psychiatric
infrastructure group. Um we are

676
00:53:06,559 --> 00:53:12,559
fortunate to have a retired psychiatrist
with quite a bit of expertise in the

677
00:53:11,040 --> 00:53:17,440
community who is also a member of the
crisis system advisory group. Dr. Coup

678
00:53:15,680 --> 00:53:22,400
is here and I think you've had a chance
to meet him. So Dr. Coup is going to uh

679
00:53:20,480 --> 00:53:27,280
co-f facilitate that group now with Dr.
Nick. So will be some change there. uh

680
00:53:25,440 --> 00:53:32,880
and I think really bringing that group
back together to look at the landscape

681
00:53:30,400 --> 00:53:36,880
that has shifted and changed and to ask
you know what are the priorities that we

682
00:53:34,800 --> 00:53:42,240
should be looking at collectively and
collaboratively um to meet the community

683
00:53:39,359 --> 00:53:48,000
needs as those change as payer structure
changes the system is constantly fluid

684
00:53:45,280 --> 00:53:52,480
and the fluidity the pace of the
fluidity and change happens kind of

685
00:53:50,240 --> 00:53:56,160
quickly so I think that's one piece and
you know I I I just think that some of

686
00:53:54,240 --> 00:54:00,960
the progress that's been made on
addressing no-shows and cancellation

687
00:53:58,079 --> 00:54:04,480
rates. I think we could point to all
kinds of examples where Bert Nash and

688
00:54:02,720 --> 00:54:08,800
Hartland have collaborated together to
be looking at these things and to

689
00:54:06,880 --> 00:54:12,960
experiment with how their scheduling
practices are are implemented. Um, I

690
00:54:10,880 --> 00:54:17,359
think we can learn from each other and
we can learn with each other. Um, and

691
00:54:15,760 --> 00:54:21,920
and and that's really the purpose of a
work group like that. I know that Rachel

692
00:54:19,520 --> 00:54:26,240
and Ryan Storch from Bert Nash um
collaborated on that focus area of the

693
00:54:24,319 --> 00:54:30,880
the behavioral health plank of the chip
on improving access to care. So, not

694
00:54:28,720 --> 00:54:35,680
just looking at visits and volumes, but
also looking at quality of care, patient

695
00:54:32,960 --> 00:54:39,599
satisfaction, willingness of of patients
to stay engaged with a particular

696
00:54:37,280 --> 00:54:43,839
provider or a particular agency, I think
are some of the thoughtful discussions

697
00:54:42,000 --> 00:54:48,640
that we could we could have coming
forward and we look forward to that

698
00:54:45,760 --> 00:54:53,359
time.
Thanks, Bob. That's helpful. Julie,

699
00:54:50,960 --> 00:54:57,040
Rachel, Amy, Dr. Nick, do you have
anything to add?

700
00:54:54,960 --> 00:55:01,119
» Um, again, we just want to thank you for
your um active participation in the

701
00:54:59,440 --> 00:55:06,319
conversation today. It's really um
important to us and uh we're hopeful

702
00:55:03,520 --> 00:55:11,200
that the um data that's been presented
has uh been informative and also

703
00:55:08,800 --> 00:55:15,760
demonstrates I think uh the impact and
the value that Hartland brings um around

704
00:55:13,599 --> 00:55:21,200
access to psychiatry especially with
continuity of care and um just the

705
00:55:19,119 --> 00:55:25,680
ability to provide preventive care as
well. And um so we would welcome uh the

706
00:55:23,839 --> 00:55:31,520
county's continued partnership and
support um when especially when we have

707
00:55:28,880 --> 00:55:38,079
conversations around uh parity of the
investment um between uh funded agencies

708
00:55:34,880 --> 00:55:42,079
that provide uh care to people in our
community that need access. So again we

709
00:55:40,400 --> 00:55:47,040
just appreciate the time. Can
>> I just say one thing that I thought that

710
00:55:43,839 --> 00:55:51,760
I didn't add? Um I think we both I think
both Bert Nash and Hartland have

711
00:55:48,480 --> 00:55:56,079
experienced this challenge which is you
know you want to bring a new provider

712
00:55:54,240 --> 00:56:00,160
but you don't know when that opportunity
is going to present itself and in the

713
00:55:58,480 --> 00:56:03,920
budget cycle and the way that the budget
cycle operates um there have been a

714
00:56:02,400 --> 00:56:08,240
number of opportunities where we have
had to scramble and so I think having

715
00:56:06,559 --> 00:56:12,880
some conversations about how to be
prepared to receive an opportunity and

716
00:56:10,400 --> 00:56:17,119
to be ready to act on it when one agency
or another um has something that they

717
00:56:15,760 --> 00:56:20,799
would like to move forward on and they
might not be able to in the absence of

718
00:56:19,200 --> 00:56:24,880
funding. I think that's a conversation
that we might want to look at because

719
00:56:22,960 --> 00:56:29,079
we've seen that happen on several
occasions at both agencies.

720
00:56:29,280 --> 00:56:34,559
» Great. Thank you. That's really helpful
context for me and uh I wonder if any

721
00:56:33,520 --> 00:56:36,880
other questions for commissioners. Go
ahead.

722
00:56:34,880 --> 00:56:43,200
» Yeah. And so I'm just asking uh cuz I
think Bob you are uh make or making that

723
00:56:40,799 --> 00:56:47,520
comment in regards to like out of budget
cycle correct having these conversations

724
00:56:45,680 --> 00:56:54,880
out of budget cycle between now and
potentially uh 2027 budget cycle is

725
00:56:51,520 --> 00:56:59,680
maybe what what you're saying. So if an
opportunity or a need, a gap arises,

726
00:56:57,440 --> 00:57:04,480
you're desiring for these conversations
to happen, uh iterating around what that

727
00:57:02,559 --> 00:57:08,559
need might be or potential project out
of budget cycle.

728
00:57:06,400 --> 00:57:12,240
» This was easy when both agencies were
saying we would like to add one

729
00:57:09,680 --> 00:57:16,960
psychiatrist and one APRN to our panel
of providers. And now it's more fluid

730
00:57:15,359 --> 00:57:22,319
and the challenges come and go as
there's turnover. So being prepared to

731
00:57:19,359 --> 00:57:28,799
have to be able to act if we're ready to
act. um and to have conversations that

732
00:57:24,640 --> 00:57:31,839
maybe are not annual conversations.
I don't know, you know, there's no way

733
00:57:30,079 --> 00:57:37,760
to predict what the need is, but we have
seen this on several of occasions and

734
00:57:34,240 --> 00:57:43,680
because we have acted um I think
responsibly responsively um we've been

735
00:57:41,359 --> 00:57:47,920
able to have the the benefit of some
really talented providers. I mean the

736
00:57:46,079 --> 00:57:52,720
talent that's in this community is
significantly higher and the result is

737
00:57:50,559 --> 00:57:57,839
that more people are being seen by the
provider that best meets their needs.

738
00:57:56,240 --> 00:58:01,599
» Thank you. I just appreciate you raising
the need uh and mentioning that so that

739
00:57:59,680 --> 00:58:05,520
we can be proactive and having these
conversations and bringing partners

740
00:58:03,200 --> 00:58:09,799
together to address that need and
starting to have the conversation with

741
00:58:06,799 --> 00:58:09,799
you.

742
00:58:11,920 --> 00:58:17,599
» All right. If there are no further com
uh questions from commissioners, um I

743
00:58:16,000 --> 00:58:22,000
will bring us to a close and thank you
again for your time and for all the uh

744
00:58:19,280 --> 00:58:29,520
work and effort put into giving us this
data. It is um it's nice to see

745
00:58:26,319 --> 00:58:34,960
accumulation of many decision points and
many uh it iterative changes and and

746
00:58:33,119 --> 00:58:39,760
growth capacity. It's it's nice to be
able to see it all in one place um for

747
00:58:37,920 --> 00:58:44,000
your [clears throat] organization and to
uh see that as a holistic story I think

748
00:58:41,680 --> 00:58:47,440
was really um helpful to me. I think
it'll be helpful for us as a commission

749
00:58:45,839 --> 00:58:53,680
moving forward with these conversations
and I really do look forward to sort of

750
00:58:49,200 --> 00:58:58,559
the reconvening um and um contemporary
assessment from that workg group about

751
00:58:55,920 --> 00:59:04,319
what the total landscape looks like and
what some strategies moving forward um

752
00:59:01,520 --> 00:59:08,960
can be based on lessons learned so far.
But um thank you for your commitment to

753
00:59:06,319 --> 00:59:13,200
continuing to uh increase capacity and
hold capacity and and work on all of

754
00:59:11,200 --> 00:59:17,680
those metrics that help make access to
care um possible in our community and at

755
00:59:16,240 --> 00:59:22,960
a higher standard than many other
communities enjoy. So appreciate your

756
00:59:20,000 --> 00:59:28,440
work. And with that, we are um recessed
until our 5:30 business meeting. Thanks

757
00:59:25,440 --> 00:59:28,440
y'all.