[0:40] Good afternoon everyone. Uh welcome to
our September 9th, 2026 uh board of
[0:46] Douglas County Commissioners work
session. We are joined here by um our
[0:51] community partners from H Heartland
Community Health Center. We have um Bob
[0:55] Transky from staff who might be kicking
us off with a a little bit of an intro.
[1:00] And just a quick uh reminder for anybody
who might be new to work sessions. Um uh
[1:06] we do not take public comment or take
any kind of action during work sessions.
[1:10] It's an opportunity for presentation for
commissioner questions and discussion.
[1:14] Um we always have a business meeting
that follows which will begin at 5:30
[1:18] and we always have a general public
comment um period then and you're
[1:21] welcome to provide any public comments
you might have about today's discussion
[1:25] at that time or write us later. Um and
with that I will turn it over to Bob.
[1:31] » Thank you commissioners. Good afternoon
everyone. Um, in 2018, before there was
[1:36] a mental health sales tax, before there
was a TRC, a mobile response team, care
[1:41] coordination in the community, um,
behavioral health partners like LMH,
[1:47] Bert Nash, H Heartland, H Heartland,
Raak, DECA were convening and having
[1:51] conversations about what the gaps in our
community were with respect to
[1:56] behavioral health. And even before we
had moved forward on trying to go after
[2:01] this mental health sales tax as a group,
um, one of the gaps that was identified
[2:06] was in the area of psychiatry and med
services. And so collaboration between
[2:11] Bert Nash and Hartland and LMH resulted
in and support from the county resulted
[2:16] in the creation of a psychiatric
infrastructure workg group that was
[2:20] tasked with taking a look at what the
needs are across our continuum of care
[2:25] and community with respect to psychiatry
and med services. That effort led to a
[2:31] really pretty significant increase in
the number of providers that came to
[2:35] Douglas County. And over the years, all
of our partners, LMH, Bert Nash, and
[2:41] Hartland have worked to maintain,
sustain, and expand um the capacity of
[2:46] our psychiatric infrastructure. That
work group um has members on it. Both
[2:51] lead executive leadership and providers
from Bert Nash Hartland, from LMH,
[2:56] Coffin, Logan, and KU have participated
in that work group. The work group was
[3:00] instrumental in shaping the early drafts
of the medical director position for the
[3:05] TRC in talking about how we should look
at the costs of psychiatry and med
[3:11] services across the system of care and
identifying issues that our partners
[3:17] might want to try to address
collectively and cooperatively. And so
[3:21] that's kind of been the work of the
psychiatric infrastructure work group
[3:24] over the last couple of years. There's
been sort of periods where that work as
[3:28] a work group has been more intense and
less intense. But one thing that hasn't
[3:32] happened for a while is we have not
given you the opportunity to really hear
[3:36] from Hartland about how their uh
behavioral health services particularly
[3:41] with respect to psychiatry and med
services have evolved and are iterating
[3:46] and continuing to grow in Douglas
County. And so that's why we are really
[3:50] pleased to have the team from Hartland
here. Um, I'm going to turn this over to
[3:55] Rachel Hartford, but I want to make sure
that before we start talking that we do
[3:59] some introductions. And Rachel, I will
let you lead it from here.
[4:05] » Rachel Hartford. Thank you. Um, I'm the
chief operations officer at the health
[4:10] center.
[4:17] » Amy Celiff. I'm the director of quality
at Heartland.
[4:22] Julie Brandstrom. I'm the CEO at H
Heartland.
[4:26] » Nicely. I'm the director of psychiatry
and a board-certified adult and child
[4:30] adolescent psychiatrist. I've been
practicing in the Panda building from
[4:34] like August um 2023 until now, primarily
seeing patients that are like 26 and
[4:40] under.
[4:48] I'll kick us off really quick um for H
Heartland's presentation. Um we just
[4:52] wanted to kick off by saying thank you
so much um for participating today. We
[4:57] really appreciate the opportunity to
engage with each of you um to kind of
[5:01] provide some data on H Heartland's
psychiatry program and also I think some
[5:07] important narrative that will provide
additional context about how H
[5:11] Heartland's uh psych services have grown
over the last about eight years or so.
[5:16] Um I get the privilege of being at the
table today but don't have to have the
[5:20] pressure of doing the presentation. So,
um, Rachel and Amy, I'm sure, are going
[5:24] to do an excellent job of walking you
through the data and providing context.
[5:28] And so, I will hand it over to Rachel.
Great. Thanks. I also want to say thank
[5:31] you to, um, several of our staff,
community partners that are in the room,
[5:35] including um, some of our community
health or mental health advocates. Um,
[5:39] we extended the invitation so that
community partners or our employees or
[5:43] board members could join us to hear
firsthand and experience the work
[5:47] session. So, I'm thankful that you guys
took the time to come out. As Bob
[5:51] mentioned, um, since 2018, uh, H
Heartland Psychiatry model, we've really
[5:55] evolved in response to the community
needs, um, the workforce availability,
[6:00] reimbursement structures, and our
funding partnerships. Um, what began as
[6:05] a response to the growing demand for
communitywide psychiatric services
[6:10] actually developed into a broader, more
integrated approach to behavioral health
[6:14] and psychiatry. For us at the community
health center, our priority has been to
[6:18] improve access, support the continuity
of care, and to try uh to address the
[6:24] complexity of needs that are experienced
by patients that um see Hartland out as
[6:29] their primary care provider. Your
investment at the county level has
[6:33] played an important role from the
beginning and throughout the evolution
[6:37] of that work. Um, as Bob mentioned,
Douglas County has supported the
[6:41] infrastructure work and has allowed H
Heartland to expand our ability to
[6:47] respond to developing community need. Um
these investments have not occurred or
[6:52] existed in isolation but rather they've
been able to be incorporated into a
[6:57] larger more continual change of systems
um including providers programs care
[7:03] coordination internal infrastructure in
our operation and a variety of funding
[7:08] sources. And so as our model has
developed Hartland has adapted and we've
[7:13] evolved to change um in response to
that. And so again, very grateful for
[7:18] the opportunity to share a little bit of
that information. The purpose of our
[7:22] presentation today um and the narrative
that was sent to you earlier is really
[7:26] to just try to provide that whole
picture. Um it's been a lot of u
[7:30] movement over the last decade and so
today we hope to hit some of those
[7:33] highlights and have a conversation as we
go through the data. Uh more really
[7:38] importantly, what we want to note is
that the current state of psychiatry at
[7:43] H Heartland reflects both progress,
achievements, and opportunities to
[7:47] continue to work forward. Um, our role
as the federally qualified health center
[7:53] is to serve as a preventative and
ongoing health partner that helps to
[7:58] address behavioral health needs before
they escalate to a crisis or to be
[8:02] available to provide continuity of care
following a crisis or if there was a
[8:07] higher level of intervention needed. Um,
we've said this often in the last year
[8:12] or so, but Hartland as the FQHC, we're
not a crisis center. um we are not
[8:17] equipped to provide that emergency
crisis response service like other
[8:21] partners in our community, but rather we
see our role um within the continuum of
[8:26] care to provide accessible outpatient
psychiatry or behavioral health services
[8:30] while aiming to strengthen that
prevention and early intervention,
[8:34] supporting stabilization or recovery as
embedded in primary care and to ensure
[8:39] that patients have a trusted health
partner for ongoing care after the
[8:43] crisis or hospitalization. And I think
this distinction is important as we
[8:47] define the value and the appropriate
scope of H heartland's u program in our
[8:51] model of psychiatry at the health
center. Again, our focus is on
[8:55] prevention, early identification,
treatments, um stabilizing a patient um
[9:01] in primary care and then con continuing
that care um as patients transition back
[9:07] into routine life um following a crisis
and wanting to coordinate that care with
[9:12] community partners. So today we're going
to talk we're going to have some data um
[9:17] and again I hope that this data is
viewed as a continuum of that investment
[9:22] and the capacity building rather than
just an isolated um measure or an
[9:27] isolated moment of success.
[9:35] So we talk about psychiatry at our
health center and it we view it as um
[9:42] more than just a specialty clinic or a
subsp specialty service um as an
[9:46] integrated safety net health center. We
consider that H Heartland serves as a
[9:51] cornerstone of community health and we
provide that psychiatric care but also
[9:55] connect patients to a broader network of
primary care behavioral health services
[9:59] like therapy. Um, we also have embedded
substance use treatments and medication
[10:05] assistant treatment, pharmacy, we've
talked about over the years care
[10:09] coordination and other supportive
services that have recently been offered
[10:12] by community health workers. And so
again, we just want to call our
[10:16] attention to that psychiatry is best
understood from our our model um as one
[10:21] component of that integrated system
rather than an isolated service.
[10:26] Here is a brief snapshot or
[clears throat] a timeline of our
[10:31] partnership. Um, you may recall that we
received our federally qualified
[10:36] designation in 2012 and we began
collaborating almost immediately, as Bob
[10:41] mentioned, with other community health
partners to advance an integrated system
[10:46] of care. And this timeline shows what we
would identify as some key milestones or
[10:50] initiatives
and how we have evolved um our
[10:54] integrated care program at the health
center. Bob mentioned the uh Proposition
[11:00] One that passed and and even during that
time we were in exploratory
[11:05] conversations and executed agreements
with our hospital partners and our
[11:10] community mental health center to try to
attract um providers to our community.
[11:15] Um we wanted to leverage as the f the
federal dollars that we could. Um we
[11:20] would share staff again contract staff
back and forth really just trying to
[11:25] increase access at a rate that um our
community needed. Um following a a
[11:30] period of organizational changes and uh
challenges around that uh I would say
[11:36] you know 2021 2022 mark. Hartland, we
really renewed our commitment in 22 and
[11:42] in 23 to increase psychiatry services.
Um, again, we believe this is
[11:47] fundamental to the work that we do and
and it advances the mission to welcome
[11:51] all who need care. And so in 2023,
Hartland uh we welcome Dr. Nick to the
[11:56] community and that marked for us a very
strategic step forward where we were
[12:01] developing uh in that program with um
leadership and prioritizing how we could
[12:07] expand that uh physical or clinical
capacity. Um since then we've increased
[12:12] our our capital footprint. We've
increased the number of mental health
[12:16] providers and as you'll see later we've
increased the number of patients that
[12:19] are being served. So I would say over
the last three years this has really our
[12:24] renewed focus has allowed us um to offer
greater stability, consistency, growth
[12:30] within psychiatry and mental health
services at the health center. Um and
[12:33] the data that Amy is going to present um
demonstrates that progression and and
[12:38] can provide a measurable view of what
we've been doing. And really the the era
[12:44] of 2018 uh to 2023 or if you look at
from 2023 to 26 um it's really it's no
[12:52] longer one of just growth but how we are
building capacity and how we are aiming
[12:57] to sustain that capacity with the
demand. So again um looking forward to
[13:02] hearing what Amy has to say.
>> Take it away Amy.
[13:08] » Amy can you make sure you use the mic?
completely forgot we were muted there.
[13:13] I'm going to dive in first to talk a
little bit about the unique patients and
[13:16] the encounters. When it comes to access,
health centers track unique patients and
[13:21] we track encounters to really look at
how access is happening. They tell two
[13:26] different stories. They're both
important. And then overlaid with each
[13:30] other really tells us what our patients
are using for services. Unique patients
[13:35] is defined as the number of individuals
in a period who received care. Um, in
[13:40] this case, we're looking at quarter by
quarter. Each bar represents a quarter.
[13:44] The encounters are the total number of
visits or actual interactions that the
[13:48] patients had with the health center
provider. So, that might be in-person
[13:50] visit or it might be a telealth
encounter. Um, those started to happen
[13:54] once COVID came around.
[clears throat] One patient might have
[13:58] multiple encounters in a quarter. They
might have multiple encounters in a
[14:01] year. This really tells us how much care
is being delivered and how frequently
[14:05] patients are accessing it. If we serve
20,000 patients overall with 80,000
[14:10] visits, it's an average of four visits
per patient per year. This kind of gives
[14:14] us an idea of acuity. It's one of the
measures, one of our indicators that we
[14:18] look at from period to period. We look
at really in relation to each other as
[14:22] they go up and go down. We want to know
why. Looking at both of these also then
[14:28] reports out to our leadership to know
whether are we expanding access or are
[14:32] we just serving the same patients more
frequently. It's also something we
[14:35] really want to know.
If our unique patients increase, it
[14:39] generally indicates that a health center
is reaching more people and reducing
[14:43] barriers to care. However, if our
patients increase, but our encounters
[14:47] decrease, it might not mean that we're
giving patients enough visits. They
[14:51] might not be able to get in as
frequently as they needed. If we see
[14:54] unique patients drop, that also means
that we are not having open access
[14:59] points. So as these numbers go up and
down by quarter later you'll see there
[15:04] there is a direct correlation between
our clinical FTEES available.
[15:09] [clears throat]
The distinction is important because
[15:12] access isn't just about how many
appointments are provided. It's about
[15:15] how many people are able to enter the
system and receive care and have
[15:19] continuity of that care. Another way to
say it is that unique patients tell us
[15:23] how many people we're reaching.
Encounters tell us how much care we are
[15:26] providing. and tracking both helps us
understand whether we are truly
[15:30] expanding access, meeting ongoing
patient needs, and using our capacity
[15:34] effectively. For an FQHC like Hartland,
it's important because the goal is not
[15:39] simply to increase the volume. It's not
just more visits, more visits. We want
[15:44] to increase meaningful access to care
for the community while ensuring
[15:48] patients can receive the appropriate
level and frequency of services they
[15:51] need to meet their goals, improve their
health outcomes, and prevent acute and
[15:55] crisis events. Here we are breaking our
access down into the two eras. So as you
[16:01] see in this era, we're again fluctuating
based on their FTE available.
[16:06] Next slide, Rachel.
In this next period, we're looking at
[16:11] 2023 to 2026. You can see that since
2018, now in this period, quarterly
[16:17] psychiatry volume has increased from
approximately 230 unique patients and
[16:22] fewer than 500 encounters starting all
the way back in that first quarter of
[16:25] 2018 to regularly serving more than,400
unique patients and 2,000 encounters per
[16:31] quarter. This growth has remained
consistent since 2023 with a renewed
[16:35] stratey strategy to increase access to
psychiatry indicating an ongoing and
[16:40] sustainable need for outpatient
psychiatric services rather than a
[16:44] temporary post-pandemic increase.
>> Currently, our psychiatry providers
[16:48] average nine patients per day with a
monthly average of a 19% no-show rate
[16:54] overall. The growth we see is a direct
representation of that strategy to
[16:59] increase access by preventing expanding
provider FTE as well as strengthening
[17:04] the integration pathways among our
providers and patient self-referrals
[17:08] allowing continued growth for new
patients and continuity of care for our
[17:11] existing patients.
[17:17] Our new patient demand has also remained
remarkably consistent considering the
[17:22] changes over the years with
approximately 200 to 250 new patients
[17:26] per quarter for nearly 3 years. This
sustained referral volume reinforces
[17:31] that psychiatry is operating in
environment of persistent community need
[17:35] rather than periodic surges. Regarding
our no-show rates, a no-show, to be more
[17:40] specific, occurs when a patient is
scheduled for an appointment appointment
[17:43] but does not come to that appointment
and does not cancel in advance. And that
[17:48] is particularly important for federally
qualified health centers because an
[17:51] unused appointment slot is lost access.
It means lower productivity, but it also
[17:57] means that we have scheduled and
committed resources that a patient is no
[18:01] longer going to be able to use.
No-how rates are important access and
[18:05] operational metrics. They measure the
gap between that capacity and then the
[18:09] actual care delivered. A high no-show
rate can reduce provider productivity,
[18:14] can increase weight times for patients,
and limit the number of patients who can
[18:17] access care overall. Understanding the
reasons behind no-shows allows the
[18:21] health center to address barriers and
improve utilization of available
[18:24] capacity and ultimately convert more
schedule appointment opportunities into
[18:29] meaningful visits.
As you can see in 2025, those quarters
[18:35] and moving forward, the no-show started
to rise. Our pediatric no-show, just for
[18:40] context, is generally less than one in
10 patients. Adult no-show is generally
[18:45] higher, and our new patient no-show rate
is even higher, which is closer to 25%
[18:50] sometimes more. That means one in four
of every new patient in psychiatry care
[18:55] doesn't show up for that first
appointment.
[18:59] This is not unique to psychiatry and is
frequently seen across other services.
[19:03] Heartland's no-show rates are all below
industry standards and generally
[19:06] observed rates um which are seen among
other FQC's, community mental health
[19:10] centers and CCBHC's which are around 25
to 45%. Our goal is to always try to be
[19:16] below 20.
[19:20] » Payer mix is um the breakdown of the
health center's patients or encounters
[19:24] by how their care is paid for. So at an
operational level when we look closely
[19:29] at noshare rates or access uh key
indicators payer mix is one of those key
[19:34] indicators for us at the health center.
Um we know that payer mix matters
[19:38] because it's the mix of patients that um
the health center serves that ultimately
[19:42] has a direct impact on billable revenue
or sustainability and informs our
[19:48] ability to maintain or increase access.
So an example is if a health center has
[19:54] a high number of uh patients that may
not have health insurance that is going
[19:58] to be a high uninsured rate and we know
that that will lead into some
[20:01] uncompensated care. Um that also we look
at that type of information even based
[20:07] upon provider panels because that can
also inform how we structure um our
[20:13] schedules or or how we allow for um
panel management again so that those
[20:19] payer mix shake out so that those costs
are covered. Um at H Heartland over the
[20:24] years um I know in this area this
setting our PPS rate has been brought up
[20:29] as a federally qualified health center.
we get enhanced reimbursement for
[20:33] Medicaid and Medicare. And our PPS rate
is currently $35962.
[20:40] Um, and we know, and this is important
because when we again when we look at
[20:43] panel management or we look at access
points, that payer mix and that
[20:47] reimburseable uh revenue can impact our
ability to increase access. So, for
[20:54] example, an adult uh a provider that has
primarily an adult panel may look a
[20:59] little different than what a provider
with a um primarily pediatric panel
[21:05] would. You can see our breakdown of
payer mix in the chart. Um I'm sure
[21:10] we'll talk about that here shortly.
But regarding our psychiatry services,
[21:15] um, currently and where we're heading,
again, we mentioned this, but it's
[21:19] really evolved from a program that
hasn't that no longer focuses on
[21:23] building capacity and expanding access,
but really aiming to stabilize and and
[21:28] sustain what we've um accomplished. And
so since again 2018, that quarterly
[21:36] volume has increased. And we throughout
this process, we've learned um what it
[21:42] what it requires to welcome providers to
our community and to continue to see
[21:47] them. We know that already in 2026 we've
reached um almost 2,000 unique uh
[21:53] patients that are seeking uh psychiatric
services at the health center and that
[21:58] ex that number um exceeds our entire
last year by almost 2 and a.5%. So
[22:04] steady growth. Um we offer care through
a variety of um inperson and telealth
[22:09] services. Again, trying to be flexible
in how patients can access their
[22:13] provider. Um and so we again we know
that it's not just a standalone
[22:19] specialty service, but really has truly
integrated in the system of care at the
[22:23] health center and Dr. Nick is an example
of what that looks like when we've
[22:26] integrated it into um the Panda
Pediatrics location wanting to link arms
[22:33] between a pediatrician and a site
provider. And so the next phase of um
[22:38] psychiatric access or improvement for
the health center won't uh be merely
[22:44] measured and encounters, but the
reliability, the timeliness of care and
[22:49] and those payer structures.
We talk often um over the last few years
[22:54] too about increasing access and how we
know we're increasing access. One key
[22:59] measure for us is net provider
availability. Um this this refers to the
[23:04] amount of care that a health center has
the ability to provide based upon its
[23:08] available providers clinical hours,
appointment slots, and support
[23:12] resourcing such as the the staff that
works around that provider. Provider
[23:18] retention. um that really refers to the
organization's ability to keep providers
[23:23] over time. We know that transition or
turnover can be disruptive to care. It
[23:27] can also be costly. And so, we're not
only measuring success by how um how we
[23:33] can recruit or welcome providers to our
community, but how can we keep them? Um
[23:38] hiring providers certainly increase
potential capacity, but retaining
[23:42] providers is what's going to protect
that capacity over time. So, we've been
[23:46] looking closely at that net provider
availability and it's taken us years to
[23:52] determine, but we finally have um a
clearer picture that right now Hartland
[23:58] would Hartland needs six full-time
providers to offer the care based upon
[24:06] the current patient demand. Um and again
over the years you've seen us have 0.2
[24:12] two FTE, 3 FTEE, then one FTE, but as
this chart um indicates, we hit a good
[24:20] stride for three and since then, we've
been able to increase. And when we look
[24:24] at provider uh or panel management um
provider continuity and the current
[24:30] patient demand and um weight list, we
know that six providers right now are
[24:36] actively responding to what is going to
allow us to serve up to about 9,000 uh
[24:41] visits this year. So it sounds like
significant growth certainly. Um, but
[24:46] the the goal here is to be able to
retain providers and not have that
[24:49] turnover because again, it's not just
enough to increase that headcount. Um,
[24:55] but we don't we don't want to see
providers um move if they don't have to.
[25:02] » Can I ask a question? I noticed the
previous slide your number of providers
[25:08] went up and then roughly in the same
period of time your uh commercial
[25:15] billings
uh went from 20ome to 40 something. Is
[25:22] that related because you had more
providers or
[25:25] » Sure. And credentiing and privileging
those providers, how payers are
[25:29] structured. Um we talk about that
sometimes with those hidden costs of how
[25:34] um we welcome a provider and if if
they're credentialed with certain
[25:37] payers. Um we also know that the
welcoming of providers that are
[25:42] providing pediatric or child and
adolescent uh services that is a payer
[25:47] there. And so um you're going to see
that where we've increased our child and
[25:51] adolescent access that inherently has
increased our our billable revenues.
[25:58] Um full disclosure, this was our list of
uh providers that have been um at our
[26:04] health center uh since 2022. And and
again, I think you know these are the
[26:09] licenses of our providers and their FTE.
And why this matters is because um at a
[26:14] time when we want to again support that
integrated network of care, we're
[26:19] grateful for the psychiatric nurse
practitioners that offer care alongside
[26:23] Dr. Nick um in our clinics. And you can
see whenever that provider, you know,
[26:29] maybe on average a year or two and then
they would um perhaps move on. And
[26:35] noteworthy, we have uh welcomed pro
providers from outside of our uh
[26:41] community line, but the providers that
have departed our organization,
[26:46] some have just left the field of
medicine altogether. Um we're seeing
[26:50] that when we talk about provider
retention and well-being and and um the
[26:55] clinical burnout that providers are
experiencing. Um so again these
[26:59] providers that have departed, they they
have changed their field of practice or
[27:04] they have taken an administrator role
and they've they've left that clinical
[27:07] care. And so we started the calendar
year um with six providers and in the
[27:13] middle of this year we had we decreased
down to four. again, those two providers
[27:18] um taking a different adventure, but
we're we're thankful to welcome two
[27:24] additional providers um this fall that
will return us back up to six. And so
[27:30] I'm going to have Amy talk about what
does this actually mean for capacity.
[27:36] So at a high level right now with the
trends that we've been following over
[27:41] the year for the last few years, we're
projecting around 9,800 annual
[27:46] psychiatry patients to be served by the
end of the calendar year. This really is
[27:51] just the baseline demand we are
currently experiencing. This is not any
[27:55] sort of expansion. At the current
productivity and utilization
[27:58] assumptions, approximately as Rachel
said, six full-time equivalents would be
[28:02] needed to maintain adequate access to
psychiatry care at H Heartland. Um, this
[28:08] 6 FTE represents that baseline. No
expansion goal yet. If we do want to
[28:13] increase access beyond our current
demand, we would need to increase staff
[28:16] above that 6ft FTE. and then
respectively um if we're looking at
[28:21] pediatrics and adolescence versus adults
potentially those who might specialize.
[28:25] This provides Hartland with a better
understanding of what our capacity is to
[28:30] meet the current needs as well as trying
to plan ahead. Um it also has really
[28:34] helped to inform that framework for
determining additional staffing need.
[28:39] How big of a case load can a provider
manage?
[28:46] I won't belabor the integrated services
part or our community health worker. I
[28:51] know that you all have read a lot of
that narrative over the years, but again
[28:55] this just is a demonstration of the
number of patients that are accessing
[28:59] multiple services or programs at the
health center. Again, much of this was
[29:04] included in that narrative and you you
can see a correlation of increase as we
[29:09] opened and welcomed um Blue Stem
Wellness as another location for our
[29:13] health center and continuing to just
increase or uh strengthen our um SUD
[29:19] programming at the health center with
MAT and our community health workers.
[29:23] Again, um this is a lot of information,
but it it helps to visualize that
[29:30] patients um are utilizing multiple
services and again it just champions
[29:35] that integrated framework or um helps to
validate why it's important to have um
[29:41] that whole person approach
and then again community health workers.
[29:46] I know that this group has read and
heard a lot about that, but just a key
[29:50] advantage of embedding those community
health workers is again just that
[29:54] ability to offer that comprehensive uh
social needs assessment and and helping
[29:59] patients overcome barriers to care so
that they can have that adherence to
[30:03] their treatment.
>> Got a question. [clears throat] Um when
[30:07] you say psych plus one service, what
does that mean? So that would indic
[30:13] correct me if I'm wrong, but that would
indicate if um a patient also received
[30:18] primary care or they saw a therapist or
a dental provider.
[30:23] » Okay. I was just wondering if somebody
has a dual diagnosis,
[30:28] if you count that as
maybe they have a SUD with
[30:35] mental health issues, [gasps and sighs]
is that just considered one service?
[30:41] That would still just be one service. So
yeah, like if it was, you know, psych
[30:45] plus three, then maybe they're seeing
dental, primary care, and have a
[30:49] therapist.
>> Got it.
[30:54] » And Rachel, I noticed that you were
tracking human trafficking, but there
[30:58] was nothing indicated on the graph. So
just kind of curious.
[31:06] » Yeah, take it. Yeah, I can speak more to
that. Um, so that human trafficking is a
[31:10] new addition to our federal report, our
annual uniform database system. It has
[31:16] specific criteria and diagnosis codes.
So, we do assess that through our
[31:22] upstream drivers of health. We do not
necessarily put that on someone's
[31:25] progress note. We don't want that going
to someone's portal, especially if that
[31:29] might be sensitive information, but we
do track that information.
[31:35] » Okay. So
you are tracking it. So potentially you
[31:39] could have individuals that are uh
coming forward with that information and
[31:46] if
[31:50] there is a need you are uh developing
interventions and
[31:54] » connecting with absolutely coordination.
>> Uh you would not be reporting that out
[31:59] to other agencies is basically what
you're saying. We are not putting it on
[32:03] our federal report card primarily
because that's captured in claims
[32:06] information. We don't want that on an
potentially on a lot of our EOBS, things
[32:10] that might go to an address and might be
sensitive information. So, right now we
[32:14] haven't used that as an ICD code.
>> Okay. All right. Thank you.
[32:21] » Here's a little information about
populations. again um I want to be
[32:25] considerate of time and allow for uh
questions and conversations but Amy I
[32:29] don't know if you want to hit some of
the highlights of the population data.
[32:33] » Yeah I think the biggest thing you can
see is that change in 2023 uh really in
[32:39] 2022 and before that we were primarily
providing adult psychiatric services. It
[32:44] was with the addition of Dr. Nick that
we really were able to offer services to
[32:48] pediatric and adolescent populations and
that's where you see that again
[32:52] increase. Um most of our patients who
are pediatric age have seen Dr. Nick at
[32:58] least once and
pardon [clears throat] me. Yeah, it was
[33:03] up through 2022 that it was about 85% of
our patients were adults. Now that we
[33:08] have added some more pediatric and
adolescent psychiatrists, now nearly two
[33:13] of every five are under the age of 18.
And interestingly, it's actually one of
[33:18] every five patients in psychiatry is
between the ages of three and 12. So
[33:22] it's demonstrating ongoing need of our
school-aged children.
[33:29] So, we have important work happening
now. We have important work on the
[33:32] horizon. And again, we're just grateful
for the opportunity to join you for a
[33:36] work session to demonstrate what has
occurred over the last um 8 to 10 years.
[33:42] And again, the investment of the county
helped to provide that momentum and
[33:46] accelerate much of that work that's
happened. And you can, you know, be
[33:50] assured that H Heartland wants to see
psychiatric mental health services
[33:54] advance in our community. we know that
there's opportunity to work alongside
[33:58] community partners and you um to make
that happen. And so again, just really
[34:02] grateful for the time today and looking
forward to a conversation.
[34:07] » Thank you everybody, [clears throat]
commissioners, other questions top of
[34:11] mind.
>> Yeah. Um this probably goes back two or
[34:15] three years. I'm not sure of my uh
timeline, but I know uh when uh
[34:21] psychiatry services and mental health
needs were
[34:26] uh
constricted by the staff. I know my
[34:31] staff at both places. I know a lot of
people would sign up at H Heartland and
[34:36] at Bert Nash and then they would take
the first available
[34:40] appointment. Have you seen that die down
now with your increased staffing?
[34:49] Well, I mean, we continue to get
referrals from the community and from
[34:54] all over, whether that's private
practice, um, like Lawrence pediatrics,
[34:59] um, LMH, emergency room visits, um,
people that aren't able to get in to
[35:04] other places, um, patients that have had
recent crisis visits, and I mean,
[35:10] really, it's it's coming from all
directions. Um, so I think as we've
[35:16] continued to grow and been able to get I
mean we prioritize urgent referrals and
[35:22] the number of urgent referrals
especially for you know the under 18
[35:25] population is tremendous. Um you know if
it's if it's your family, if it's your
[35:29] kid, you know you want them seen as soon
as possible. Um and that's one of the
[35:33] big goals of being able to hire more
providers is to cut down on the wait
[35:36] time. Um but yeah, we get referrals from
all over and I'm really proud of that. I
[35:41] mean, you know, when pediatricians know
they can do an urgent referral and we're
[35:44] going to prioritize that and get them in
within a couple weeks because we, you
[35:48] know, read their notes that they sent
over, um, you know, that's really
[35:52] important to me and that's really
important to our staff. So, even like
[35:56] going back to the, you know, if somebody
does cancel an intake 24 hours in
[36:02] advance, like we have urgent intake
lists, we have urgent follow-up lists,
[36:07] we have regular intake lists, and we
have regular obviously follow-up
[36:11] patients that are that need to be
scheduled. And so, if somebody gives us
[36:16] 24 hours, like we're going to fill that
slot. Um, if it's a follow-up and
[36:21] somebody doesn't show up, then we're
going to try to switch it to teleahalth,
[36:24] even if it's like 10 minutes into the
appointment. Like, we really try to
[36:27] value obviously getting people seen. And
by doing that, it's going to free up
[36:32] time to get more urgent referrals in.
So, it always feels good to get, you
[36:36] know, like a private practice therapist
to refer, you know, an urgent patient
[36:39] because they know you're going to
prioritize trying to get that person in.
[36:46] I appreciate you mentioning some of the
greatest need uh because I heard you say
[36:50] under 18 and then I also heard you say
between the ages of 3 and 12. Uh and so
[36:57] [gasps]
as we think about that uh I'm kind of
[37:02] curious about some of the partnerships
that you do have within those uh age
[37:08] brackets. So that kind of makes me think
of the community health improvement
[37:11] plan. Uh but then that also makes me
think of some of the partnerships that
[37:16] maybe we have across the county with our
school districts and how are you
[37:20] partnering with the school districts?
How are you partnering with some of our
[37:23] partners within the community health
improvement plan? What do those linkages
[37:27] look like and how are those referrals
working and those partnerships? And if
[37:33] those linkages are not built yet,
completely fine. What does it look like
[37:37] to either build them and
are is there interest if they're not
[37:43] built to complete them? Because we do
know when we think about property taxes,
[37:48] right? Some of our largest property
taxes are coming from our school
[37:51] districts. And so I think there's a
great opportunity there to build those
[37:56] relationships and to ensure that those
linkages back to our schools and from
[38:00] the schools to our behavioral health
providers that that is a seamless
[38:04] continuum of care so that our kiddos are
receiving what they need. And then when
[38:09] we think about the community health
improvement plan that we have that
[38:13] linkage back to the community health
improvement plan because we are here to
[38:17] improve our community.
And I know that was a lot.
[38:22] » A couple things. So, so like we see a
lot of kids that have high high needs
[38:26] and they have SEDD waiverss through
Burton Nash or other community mental
[38:30] health centers and they need, you know,
they they might see us for medication
[38:34] management and therapy, but they still
depend on the local mental health center
[38:38] to get, you know, SED waiverss that
would allow, you know, case management,
[38:43] group therapies, respbit services. So,
we do see a lot of um and obviously that
[38:49] qualifies them for Medicaid um if they
have an SED waiver. So, we do see a lot
[38:54] of that population.
Um as far as the to answer the question
[38:59] about schools,
[39:04] parents frequently will sign a release
and needs the school might need some
[39:09] information.
But in the world of child psychiatry,
[39:12] privacy is very important. And sending,
you know, notes to schools, that's not
[39:20] something that we commonly do, right?
Parents typically don't want that. Um,
[39:25] and the communication really,
you were kind of caught in the middle
[39:30] sometimes with these conversations. So,
the communication has to go through the
[39:33] parents. Um, sometimes we'll hear
directly from the school and sometimes
[39:37] that will really, you know, upset the
families. Um, obviously sometimes
[39:41] they're they're very much for that, but
it's a definitely a um case by case
[39:47] situation and if we're able to talk to
the, you know, school counselor or
[39:51] something like that, um, it can be
really, really valuable, but we always
[39:54] have to go through the proper channels
of getting a release information. And a
[39:58] lot of times parents really appreciate
that. um if we're if if we talk to the
[40:05] school and we haven't gone through them
or they haven't told us to do that, I
[40:08] mean that's just a not a good situation.
And a lot of times they're voicing
[40:14] frustration. So I spend a lot of time
educating parents on how do you talk to
[40:18] the schools about a kid that needs an
IEP? How do you educate the parents to
[40:22] advocate for their kid? How do you deal
with panic attacks? So I do a lot of
[40:26] education and talking um with the
parents to how know how to address those
[40:30] things with the school system and I
honestly I mean it would be overwhelming
[40:34] to contact schools all the time. I mean
I don't have that time. So by educating
[40:39] the parents to be able to do that it's
it's definitely
[40:43] the best route.
So am I hearing then that
[40:50] maybe there's a gap between
the schools and
[40:56] so there's a gap in the system maybe
between the schools and our behavioral
[41:00] health, right? To then maybe bridge
between parents.
[41:05] Maybe there's like a missing piece there
or that education piece.
[41:12] I wouldn't I wouldn't necessarily say
there's a missing piece. Um like I said,
[41:17] I think educating parents on how to
address situations with the schools and
[41:21] if there is more of an extreme situation
or suspension or something like that. Um
[41:27] you know there's communication when
there needs to be.
[41:30] » And I would add I'm sorry.
>> Yeah. One last thing.
[41:33] » No, go for it.
>> Um community health work.
[41:35] » That's that's where I was going. That's
where I was. That's where my brain is
[41:38] going that I'm trying to figure out if
maybe
[41:40] » they're facing if they need to go to an
IEP meeting or they need to, you know,
[41:45] help with communication and things like
that. Yeah, that's a tremendous benefit
[41:48] for for our patient population.
>> Yeah, that's exactly what I was going to
[41:52] say is having them embedded um in
pediatric alongside our care
[41:56] coordinators. Um they're in and out of
the schools and building that
[41:59] relationship. And so yeah, a lot of it
is trying to relieve the burden that
[42:03] families may experience navigating and
being educated on what the options are.
[42:07] So community health workers is that
linkage for us.
[42:10] » Thank you.
>> Can you address a little bit more on the
[42:15] wait times? So we talked about kind of
wait times maybe being a couple weeks
[42:18] for an acute need. Uh that still seems
like a long time for for a parent with
[42:23] with a child with acute need especially.
Um what are the different weight times
[42:27] for different populations? So, a less
acute need, when when would they be seen
[42:31] for a first visit? Um, and are there
kind of industry standards?
[42:36] » Oh, I mean, I'm super excited that we're
hiring, you know, two providers um that
[42:41] are getting ready to start, you know,
this month and next month that are
[42:44] focused on 26 and under to really cut
down on the weight times. Um, since one
[42:50] of our child providers went down to two
days a week, I have basically um been
[42:54] seen on the child side like only urgent
referrals since that time. And so
[42:58] unfortunately that means that there have
been patients that have been on the wait
[43:01] list for you know several months. But
I'm really optimistic but that by hiring
[43:05] these next two providers um it should
address that in the coming months
[43:10] hopefully even by the end of the year
because that is definitely a high
[43:13] priority of ours.
>> And that goes back to that net provider
[43:17] availability. We know if we have six
full-time providers we can stay to where
[43:21] that access is either at or below that
industry standard. But again, the care
[43:26] coordinators around the providers, they
they jockey those schedules. And so to
[43:31] Dr. Nick's point earlier, if there's a
no-show or a late cancellation, they're
[43:35] working that list to try to get someone
in or to recover that appointment, even
[43:39] if someone doesn't show up in person and
they can make contact with that patient
[43:43] in the first 5 to 10 minutes. They'll
flip that and try to um reserve that
[43:47] access.
And that a couple of weeks for to get an
[43:51] urgent um first visit in is that pretty
common within the industry?
[43:59] » Yeah, I mean across the US I mean it's
there's an overwhelming need for
[44:04] psychiatric services whether it's adult
or child. There's very few areas where
[44:08] they have you know an overabundance of
child psychiatrist. Where I was trained
[44:12] actually they did just because it was a
really popular place to live. Um, but
[44:16] that was part of why I wanted to move
back to Kansas, just knowing that there
[44:20] weren't a lot of psychi child
psychiatrists and wanting to serve the
[44:23] community. Kansas
[44:29] talked about no-shows and how they, you
know, um, kind of disproportionately
[44:33] impact everybody involved um, for the
the capacity and the access. uh in terms
[44:39] of like what what tools are there to try
and reduce that because I've you've seen
[44:43] that the one of the goals is to you
severely reduce the no-shows. It sound
[44:46] like you're already kind of better than
the industry standard, but what are the
[44:49] tools that are available for that?
Sure. We have a few things that we've
[44:55] tried and a few things that I think we
are working on tweaking and perfecting
[44:59] if we can. Um so we do have a reminder
call system. We have recently opted to
[45:04] change the language to be pro-social.
So, it is uh a couple days out from your
[45:11] appointment. You get that phone call
that says, "Hey, if you can't make this
[45:14] appointment, please give us a call to
reschedule so we can give this
[45:17] appointment slot to somebody else in
need." Um, we've learned that that is
[45:21] actually very effective in getting
people to call sooner. We also know that
[45:25] when we have patients who aren't
confirming those, we're able to give
[45:29] them a live phone call and try to
confirm on the phone. Um, that's also
[45:34] one thing that's been helpful to make
sure we all have reminder fatigue with
[45:39] portal messages, email messages, text
messages, you get an AI phone call and
[45:44] so sometimes that live phone call can
also make a difference.
[45:49] » And then I would add the recovery of the
slots. Um, again flipping the
[45:53] appointment. You know, perhaps the
family's running a little late and they
[45:56] can't make it in person, but we flip
that. Um and we don't um we try really
[46:01] hard not to block a provider's schedule.
Um that's the other thing is um really
[46:05] preserving that clinic facing time and
again of care coordinators suggest
[46:10] alongside providers to reshape that
schedule to allow you know we look at
[46:15] what's the maybe the trends in the
no-show like what what time of day is
[46:20] most likely to be no-showed well then we
that can help us inform how we structure
[46:25] that schedule. Dr. where you can say
something.
[46:29] » It's some um help again from the
community health workers. If somebody's
[46:32] consistently not been able to make their
appointments, getting them involved to
[46:35] try to problem solve, you know, what's
the issue? Is it transportation? Is it a
[46:38] certain time of day or something like
that that can help them make sure their
[46:41] next appointment's successful?
I have another That's right. Um we
[46:47] looked at your payer mix and how that's
been changing over time. Um and and a
[46:50] larger percentage of the payer mix was
Medicare, Medicaid. Um, is that because
[46:54] of do you suppose a changing demographic
being served or is that because of the
[46:59] ability to kind of get people signed up
for Medicare and Medicaid as they need
[47:02] as they require it?
>> I had a same question and just want to
[47:06] tack on similarly
um has there been support with enrolling
[47:11] more patients onto commercial and
marketplace insurance if they're not
[47:15] because both those numbers seem to have
gone up. So curious if you can point to
[47:19] any strategies around that.
>> I'll say something kick it your way. Um
[47:21] I think we I think Mr. Dorsy uh
mentioned this but yes the the welcoming
[47:27] of child and adolescent providers have
impacted our payer mix because uh the
[47:33] number of children that have Medicaid or
covered insurance. So that's one key
[47:38] indicator that we know that by
increasing child and adolescent
[47:41] psychiatry access or capacity that
inherently has impact our payer
[47:46] structure.
We also have several of our CHWs who are
[47:50] certified to navigate that marketplace
too. So we are proactively running
[47:55] reports looking at patients who might
have expiring Medicare, Medicaid,
[47:59] looking at patients who might be
eligible for marketplace and trying to
[48:02] reach out and getting them enrolled
>> or if there's a gap in coverage. Um our
[48:07] pediatric teams work alongside those
community health workers to try to scrub
[48:11] those list to make that contact with
families.
[48:19] Other questions, commissioners?
[48:23] And one quick one. Um, and and Rachel,
you mentioned it and I didn't quite
[48:26] catch it. You told me you said how many
uh patients per day typically your
[48:30] providers are at.
>> Um, about nine.
[48:36] I mean, if you want to really know Dr.
Nick's schedule, I'll tell you.
[48:39] [laughter]
>> See up to I mean, you can see 15
[48:41] follow-ups in a day.
>> Yeah. Um, and that's one thing I really
[48:45] appreciate appreciate about H Heartland.
Um, the support from the administration,
[48:49] but also just I mean, we have to have
time with our patients and having time
[48:52] for that initial visit is really
important. Um, so I really value that. I
[48:57] mean, we're not doing 15-minute med
checks. That's not our mission or goal.
[49:02] » Yeah. And that that number is the
average across the department. And so,
[49:05] if you were to look at Dr. Nick's
schedule, he can typically see 10 to 11.
[49:10] again not just met checks but um hour or
so appointments
[49:20] » and you did mention the PPS rate earlier
as well.
[49:22] » I did. Yeah.
>> Okay. Uh go ahead.
[49:24] » Um
>> yes and it's a narrative. Our PPS is
[49:28] 359.
>> Uh we will this is something that Sarah
[49:33] and I were talking about earlier, but
we'll probably potentially be seeing
[49:36] changes coming in 2027.
Uh are you all tracking to maybe some of
[49:41] the changes that we might see in the
future?
[49:44] » Yes. Yes.
>> Okay. Uh yeah, we are um actively
[49:50] monitoring what the [clears throat]
impacts would be to our state and at a
[49:54] local level as well.
>> Okay. And so as you're monitoring some
[49:57] of those potential changes coming down,
uh what are some of your thoughts?
[50:03] » Oh, dear Julie.
>> Yeah.
[50:08] Um well, we're concerned um clearly um
and that's also why I think um ensuring
[50:15] that we have adequate support with
community health workers that are
[50:19] working on that um intake and enrollment
for our patients is really important. Uh
[50:24] and we will continue to add staff there
um because we know that it will be
[50:28] needed. Um but we are concerned and
currently working on trying to project
[50:33] what the fiscal impact impact will be um
with you know knowing that there will be
[50:38] likely a reduction in the number of
patients that we will be seeing with
[50:41] Medicaid.
>> Yeah. So in pra in practical terms the
[50:46] community health workers are we're
trying to increase um the number of our
[50:50] IE team members that can help navigate
some of those changes. We're doing some
[50:55] worst case scenario planning um you know
running those worst case budget but also
[51:00] um trying to take advantage of some of
our technical assistant trainings
[51:05] through our national and state
association. Obviously we're not going
[51:07] to be the only ones impacted by this.
And so when you run those scenarios and
[51:12] you run those different plays, what does
your infrastructure need in the
[51:15] organization and trying to maximize what
we can um and leverage where we can, but
[51:21] also being very realistic in what's a
boundary line for us in terms of what
[51:26] could be lost or what could be gained.
And um for our community health center,
[51:31] I think an example of that is how we're
engaging um valuebased strategies into
[51:36] the workplace and into the clinic. And
you know, we don't just talk about our
[51:40] quality care, but putting that into
action and seeing payers um respond to
[51:46] that in positive ways is very helpful.
We see that as an opportunity as an
[51:50] FQHC, but nonetheless, it is worrisome
and I know that it keeps many of us up
[51:55] at night, but at the end of the day,
we're trying to take the the best step
[51:59] forward knowing what we know today.
[52:06] Well, community partners from H
Heartland, we appreciate the
[52:09] presentation. Uh, I think my my final
question, and I I would welcome you all
[52:14] chiming in on this um as well, but um
really it goes back to Bob just to sort
[52:18] of um put this conversation and all of
this specific data and context about uh
[52:25] how things have evolved at H Heartland
in the the sort of greater context of
[52:30] the psychiatric psychiatry
infrastructure work group. Um, so if you
[52:35] could just give us a little bit of
whatever context you think is helpful in
[52:39] terms of where this uh conversation
exists now and sort of what we uh what
[52:44] we might see coming forward in terms of
um any recommendations or or
[52:51] considerations for for changes.
>> I think one of the changes is in the
[52:57] convening structure of that group. So
for a long time Dr. Dodson and I were
[53:01] the co-conveners of the psychiatric
infrastructure group. Um we are
[53:06] fortunate to have a retired psychiatrist
with quite a bit of expertise in the
[53:11] community who is also a member of the
crisis system advisory group. Dr. Coup
[53:15] is here and I think you've had a chance
to meet him. So Dr. Coup is going to uh
[53:20] co-f facilitate that group now with Dr.
Nick. So will be some change there. uh
[53:25] and I think really bringing that group
back together to look at the landscape
[53:30] that has shifted and changed and to ask
you know what are the priorities that we
[53:34] should be looking at collectively and
collaboratively um to meet the community
[53:39] needs as those change as payer structure
changes the system is constantly fluid
[53:45] and the fluidity the pace of the
fluidity and change happens kind of
[53:50] quickly so I think that's one piece and
you know I I I just think that some of
[53:54] the progress that's been made on
addressing no-shows and cancellation
[53:58] rates. I think we could point to all
kinds of examples where Bert Nash and
[54:02] Hartland have collaborated together to
be looking at these things and to
[54:06] experiment with how their scheduling
practices are are implemented. Um, I
[54:10] think we can learn from each other and
we can learn with each other. Um, and
[54:15] and and that's really the purpose of a
work group like that. I know that Rachel
[54:19] and Ryan Storch from Bert Nash um
collaborated on that focus area of the
[54:24] the behavioral health plank of the chip
on improving access to care. So, not
[54:28] just looking at visits and volumes, but
also looking at quality of care, patient
[54:32] satisfaction, willingness of of patients
to stay engaged with a particular
[54:37] provider or a particular agency, I think
are some of the thoughtful discussions
[54:42] that we could we could have coming
forward and we look forward to that
[54:45] time.
Thanks, Bob. That's helpful. Julie,
[54:50] Rachel, Amy, Dr. Nick, do you have
anything to add?
[54:54] » Um, again, we just want to thank you for
your um active participation in the
[54:59] conversation today. It's really um
important to us and uh we're hopeful
[55:03] that the um data that's been presented
has uh been informative and also
[55:08] demonstrates I think uh the impact and
the value that Hartland brings um around
[55:13] access to psychiatry especially with
continuity of care and um just the
[55:19] ability to provide preventive care as
well. And um so we would welcome uh the
[55:23] county's continued partnership and
support um when especially when we have
[55:28] conversations around uh parity of the
investment um between uh funded agencies
[55:34] that provide uh care to people in our
community that need access. So again we
[55:40] just appreciate the time. Can
>> I just say one thing that I thought that
[55:43] I didn't add? Um I think we both I think
both Bert Nash and Hartland have
[55:48] experienced this challenge which is you
know you want to bring a new provider
[55:54] but you don't know when that opportunity
is going to present itself and in the
[55:58] budget cycle and the way that the budget
cycle operates um there have been a
[56:02] number of opportunities where we have
had to scramble and so I think having
[56:06] some conversations about how to be
prepared to receive an opportunity and
[56:10] to be ready to act on it when one agency
or another um has something that they
[56:15] would like to move forward on and they
might not be able to in the absence of
[56:19] funding. I think that's a conversation
that we might want to look at because
[56:22] we've seen that happen on several
occasions at both agencies.
[56:29] » Great. Thank you. That's really helpful
context for me and uh I wonder if any
[56:33] other questions for commissioners. Go
ahead.
[56:34] » Yeah. And so I'm just asking uh cuz I
think Bob you are uh make or making that
[56:40] comment in regards to like out of budget
cycle correct having these conversations
[56:45] out of budget cycle between now and
potentially uh 2027 budget cycle is
[56:51] maybe what what you're saying. So if an
opportunity or a need, a gap arises,
[56:57] you're desiring for these conversations
to happen, uh iterating around what that
[57:02] need might be or potential project out
of budget cycle.
[57:06] » This was easy when both agencies were
saying we would like to add one
[57:09] psychiatrist and one APRN to our panel
of providers. And now it's more fluid
[57:15] and the challenges come and go as
there's turnover. So being prepared to
[57:19] have to be able to act if we're ready to
act. um and to have conversations that
[57:24] maybe are not annual conversations.
I don't know, you know, there's no way
[57:30] to predict what the need is, but we have
seen this on several of occasions and
[57:34] because we have acted um I think
responsibly responsively um we've been
[57:41] able to have the the benefit of some
really talented providers. I mean the
[57:46] talent that's in this community is
significantly higher and the result is
[57:50] that more people are being seen by the
provider that best meets their needs.
[57:56] » Thank you. I just appreciate you raising
the need uh and mentioning that so that
[57:59] we can be proactive and having these
conversations and bringing partners
[58:03] together to address that need and
starting to have the conversation with
[58:06] you.
[58:11] » All right. If there are no further com
uh questions from commissioners, um I
[58:16] will bring us to a close and thank you
again for your time and for all the uh
[58:19] work and effort put into giving us this
data. It is um it's nice to see
[58:26] accumulation of many decision points and
many uh it iterative changes and and
[58:33] growth capacity. It's it's nice to be
able to see it all in one place um for
[58:37] your [clears throat] organization and to
uh see that as a holistic story I think
[58:41] was really um helpful to me. I think
it'll be helpful for us as a commission
[58:45] moving forward with these conversations
and I really do look forward to sort of
[58:49] the reconvening um and um contemporary
assessment from that workg group about
[58:55] what the total landscape looks like and
what some strategies moving forward um
[59:01] can be based on lessons learned so far.
But um thank you for your commitment to
[59:06] continuing to uh increase capacity and
hold capacity and and work on all of
[59:11] those metrics that help make access to
care um possible in our community and at
[59:16] a higher standard than many other
communities enjoy. So appreciate your
[59:20] work. And with that, we are um recessed
until our 5:30 business meeting. Thanks
[59:25] y'all.